Modeling efficacy of bevacizumab treatment for metastatic colon cancer.

Purpose: Bevacizumab, an FDA-approved adjuvant treatment for metastatic colon cancer, has extended survival for many patients. However, factors predicting response to treatment remain undefined.

Patients And Methods: Relevant clinical and environmental data were abstracted from medical records of 149 evaluable patients treated with bevacizumab for metastatic colon cancer at a multi-specialty clinic.

Breast and prostate cancer survivors in a diabetic cohort: results from the Living with Diabetes Study.

Objective: Diabetes is more common in cancer survivors than in the general population. The objective of the present study was to determine cancer frequency in a cohort of patients with diabetes and to examine demographic, clinical, and quality of life differences between cancer survivors and their cancer-free peers to inform better individualized care.

Methods: Self-reported survey data from 3,466 registrants with type 2 diabetes from Australia's National Diabetes Services Scheme (NDSS) were analyzed to compare relevant variables between cancer survivors and cancer-free patients.

Prostate cancer risk in pre-diabetic men: a matched cohort study.

Background: Diagnosis and duration of type 2 diabetes mellitus (DM) appear to be associated with decreased prostate cancer risk. Limitations of previous studies include methods of subject selection and accurate definition of DM diagnosis. We examined the temporal relationship between DM and prostate cancer risk exploring the period of greatest risk starting from the prediabetic to the post-diabetic period using clinical and administrative data to accurately define the date of DM diagnosis.

Adequate lymph node recovery improves survival in colorectal cancer patients.

Introduction: Current recommendations suggest recovery of 12 lymph nodes during surgical resection for colorectal cancer (CRC) for proper staging and prognostication. Adequate lymph node recovery has been associated with improved patient survival, with results inconsistent.

Methods: We examined factors for association with adequate lymph node recovery and used findings to adjust survival analyses to clarify whether adequate lymph node examination is associated with CRC survival or associated with a subset of characteristics that biases lymph node recovery.

Breast cancer incidence before and after diagnosis of type 2 diabetes mellitus in women: increased risk in the prediabetes phase.

The physiological changes associated with type 2 diabetes mellitus begin before disease onset, yet few have examined the incidence of cancer both before and after diabetes onset. We examined the temporal relationship between diabetes and breast cancer risk. Breast cancer risk was assessed in a retrospective cohort study using patient data from the Marshfield Clinic electronic medical record including 5423 women who developed diabetes between 1 January 1995 and 31 December 2009 (reference date) and 26 346 nondiabetic women matched by age, smoking history, residence, and reference date.

Long-term cardiac and vascular disease outcomes following adjuvant tamoxifen therapy: current understanding of impact on physiology and overall survival.

The relative impact of tamoxifen therapy in women with breast cancer on overall survival, especially as it pertains to cardiac and cardiovascular outcomes, remains under debate in the literature. This review focuses specifically on outcomes of studies that examined large clinical trials with longest duration in patient follow-up relative to these parameters in which compliance with therapy could be documented. Over time, evidence supports potential cardioprotective effects and capacity of adjuvant therapy to improve lipid profiles in women treated with tamoxifen.

Digital ischemia as a paraneoplastic consequence of squamous cell lung carcinoma.

We report the case of a 40-year-old man who presented with digital ischemia and squamous cell lung carcinoma. Based on review of the literature, to our knowledge this case represents the youngest patient with lung carcinoma associated with digital ischemia and the only one with this type of tumor. The patient's digital ischemia symptoms improved rapidly with systemic chemotherapy; however, he did eventually lose the distal portion of 1 finger to dry gangrene and mummification.

Hereditary diffuse gastric cancer: a family diagnosis and treatment.

Hereditary diffuse gastric cancer (HDGC) is a rare cancer representing approximately 2% of all gastric cancers. It is caused by CDHI gene mutations, inherited in an autosomal dominant fashion, that affect the function of E-cadherin. Approximately 38% of HDGC families have a CDHI gene mutation.

Diabetes and cancer I: risk, survival, and implications for screening.

Type 2 diabetes mellitus (DM) and cancer are common diseases that are frequently diagnosed in the same individual. An association between the two conditions has long been postulated. Here, we review the epidemiological evidence for increased risk of cancer, decreased cancer survival, and decreased rates of cancer screening in diabetic patients.

Diabetes and cancer II: role of diabetes medications and influence of shared risk factors.

An association between type 2 diabetes mellitus (DM) and cancer has long been postulated, but the biological mechanism responsible for this association has not been defined. In part one of this review, we discussed the epidemiological evidence for increased risk of cancer, decreased cancer survival, and decreased rates of cancer screening in diabetic patients. Here we review the risk factors shared by cancer and DM and how DM medications play a role in altering cancer risk.

High-sensitivity C-reactive protein (hs-CRP) as a biomarker for trastuzumab-induced cardiotoxicity in HER2-positive early-stage breast cancer: a pilot study.

Monitoring of left ventricular ejection fraction (LVEF) is the current standard for detection of trastuzumab-induced cardiotoxicity; however, time-to-diagnosis and cost of assessment are suboptimal in women with early-stage breast cancer. We assessed the utility of B-type natriuretic peptide (BNP), high-sensitivity C-reactive protein (hs-CRP), and cardiac troponin I (cTnI) as serum biomarkers for early detection of trastuzumab-induced cardiotoxicity. Fifty-four women with human epidermal growth factor receptor 2 (HER2)-positive early-stage breast cancer were prospectively enrolled, and the relationship between elevated serum BNP, hs-CRP, and cTnI levels and clinically significant decreases in LVEF was examined.

Clustering of venous thrombosis events at the start of tamoxifen therapy in breast cancer: a population-based experience.

Introduction: The epidemiology of tamoxifen and venous thromboembolism (VTE) is not well understood, and most data on tamoxifen toxicity are from adjuvant clinical trials. This study examined the relationship between the duration of tamoxifen use in female patients with breast cancer and the risk of VTE in a large population-based setting.

Materials And Methods: Retrospective electronic data extraction on tamoxifen utilization was undertaken among a cohort of 3572 women with breast cancer seen at Marshfield Clinic between January 1, 1994 and June 31, 2009.

The possible role of hemochromatosis in testicular cancer.

Hemochromatosis is a genetic disorder of iron metabolism that results in elevated iron absorption in the intestines, which leads to progressive iron accumulation in a variety of organs. Studies have shown that excessive iron deposits in the liver due to hereditary hemochromatosis leads to cirrhosis, which can put an individual at increased risk for developing hepatocellular carcinoma. Testicular atrophy, sometimes caused by excessive iron deposition in the testes, is a risk factor for testicular cancer.

Anthracosis and large mediastinal mass in a patient with healed pulmonary tuberculosis.

A Mexican woman, aged 71 years, with life-long exposure to soot from a wood cook stove in a closed environment, who was treated for tuberculosis 4-years prior, presented with prominent mediastinal lymphadenopathy with anthracosis. Mediastinal lymphadenopathy is a common presentation of diverse granulomatous, malignant and infectious conditions like tuberculosis. Anthracotic pigment is found in different conditions such as tuberculosis or domestically acquired particulate lung disease.

Prostate carcinoma metastatic to the stomach: report of two cases and review of the literature.

We report two cases of prostate carcinoma metastatic to the stomach. In the first case, the patient had indolent disease before presenting with gastric metastasis. The patient responded to treatment with resolution of gastrointestinal bleeding and other symptoms.

Wound drainage after metal-on-metal hip arthroplasty secondary to presumed delayed hypersensitivity reaction.

An emerging concern with metal-on-metal total hip arthroplasty is metal-induced hypersensitivity. Currently, this is a diagnosis of exclusion in patients with groin pain after metal-on-metal total hip arthroplasty. We describe a patient presenting nearly a year after arthroplasty with incisional drainage.

Breast cancer subtypes based on ER/PR and Her2 expression: comparison of clinicopathologic features and survival.

Objective: To compare the clinicopathologic features and survival in the four breast cancer subtypes defined by immunohistochemistry (IHC) expression of estrogen receptor (ER) or progesterone receptor (PR) and human epidermal growth factor receptor 2 (Her2): ER/PR+, Her2+; ER/PR+, Her2-; ER/PR-, Her2+; and ER/PR-, Her2-.

Methods: A 7-year retrospective study of 1134 invasive breast cancer subjects. Clinical and pathologic features and survival of the four subtypes were compared.

Lifting lips: 28 years of experience using the direct excision approach to rejuvenating the aging mouth.

The mouth ages along with the face, but it is frequently ignored when performing facial rejuvenation. The authors have addressed the mouth area with direct surgical options and excisions since 1980. In using the direct approach, the tradeoff for an improved appearance at a conversational distance is a scar that is barely visible from inches away.

Silent thyroiditis, isolated corticotropin deficiency, and alopecia universalis in a patient with ulcerative colitis and elevated levels of plasma factor VIII: an unusual case of autoimmune polyglandular syndrome type 3.

Objective: To describe an unusual case of autoimmune polyglandular syndrome (APS) type 3 and provide a brief review of the literature.

Methods: We present the clinical course and laboratory data of a patient with silent thyroiditis, isolated corticotropin (adrenocorticotropic hormone or ACTH) deficiency, alopecia universalis, and ulcerative colitis with an associated hypercoagulable state. The related literature is also reviewed briefly.

Simplifying the TNM system for clinical use in differentiated thyroid cancer.

Purpose: The TNM stratification has been found useful at stratifying patients with differentiated thyroid carcinoma (DTC) into prognostic risk groups. However, it is cumbersome to implement clinically given the large number of bins within this system and the complicated system of arriving at stage information.

Patients And Methods: We decided to quantify each variable in this system to arrive at a simplified quantitative alternative to the TNM system (QTNM) and compare this with the conventional system.

Estrogen receptor genotype is associated with risk of venous thromboembolism during tamoxifen therapy.

Thromboembolism is a serious complication of tamoxifen therapy in women with breast cancer. Banked DNA from tamoxifen-treated individuals with breast cancer from the Marshfield Clinic Personalized Medicine Research Project, a population-based DNA repository, was tested for association between incidence of tamoxifen-associated thromboembolic events (TTE) and single nucleotide polymorphisms encoding the estrogen receptors 1,2 (ESR1, ESR2) or drug metabolism enzymes cytochrome P450 2D6 (CYP2D6) and aromatase (CYP19). TTE were experienced by 16/220 subjects with risk association noted for XbaI (rs9340799) genotype and ESR1 Xbal/PvuII diplotype (rs9340799 and rs2234693) (hazard ratio 3.