Libyan International Journal of Oncology

Established Methods for Diagnosis of Breast Cancer in Tripoli, Libya

Mohamed Abuagela, Nadra Elalem — Sun, 31 Dec 2023 00:00:00 +0000

Background and aim. Globally, breast cancer is one of the most frequent cancers among women. Methods for screening and diagnosis allow healthcare professionals to detect it early and provide personalized treatments that improve the outcomes and survival. It has been showed that various im-aging techniques such as mammography, magnetic resonance imaging (MRI), positron-emission to-mography (PET), Computed tomography (CT), and single-photon emission computed tomography (SPECT) could be used for diagnosis and monitoring patients with breast cancer in various stages. Methods. Seventy cases were diagnosed with breast cancer and were attending Breast Clinic at Tripoli University Hospital, Tripoli, Libya. The study revealed the most common tools used in Tripoli to di-agnose breast cancer, stage of cancer and risk factors. Results. Most patients were within the age group ranged between 46 to 60 years (40%) and most cases with martial state married (77.1%). The first detection was at stage 2 in 37.1%. The most common risk factor was family history of breast cancer by 42.9% and unknown causes was 28.6%. Physical examination is the primary method for early breast cancer detection (92.9%), followed by ultrasound (60%) and mammogram (58.6%) while biopsy is the fourth tool by 35.7% and the fifth tool was MRI by 42.9%. Conclusion. The physical examination is the best diagnostic tool for early detection of breast cancer; however, have to also focus on other techniques with more sensitivity and specificity.

Rare Case of Malignant Transformation of Pulmonary Hamartoma

Theeb Osama Sulaiman, Mushtaq Ahmed, Aasir Suliman, Abdullah Arshad — Sat, 30 Dec 2023 00:00:00 +0000

We reported a rare case of malignant transformation in a pulmonary hamartoma observed in a 48-year-old female. The hamartoma was incidentally identified with the presence of fat attenuation component. Subsequent imaging during follow-up revealed a significant loss of fat content accompanied by an increase in solid components within the nodule. The patient remained asymptomatic for respir-atory or systemic issues. An interventional radiology-guided CT biopsy was performed, and histo-pathological analysis confirmed the presence of a lipid-rich adenocarcinoma. This case underscores the importance of vigilant monitoring and consideration of malignant transformation in pulmonary hamartomas.

Updates on the Diagnosis and Management of Tumor Lysis Syndrome

Fahmi Yousef Khan, Musaab Fahmi Yousef — Sat, 30 Dec 2023 00:00:00 +0000

Tumor lysis syndrome (TLS) represents a serious oncological emergency characterized by hyperu-ricemia, hyperkalemia, hyperphosphatemia, and hypocalcemia, carrying the potential for life-threatening complications such as arrhythmias, renal failure, and seizures. The diagnostic process relies on serum markers, though limitations in radiological and electrocardiographic assessments necessitate further research. Effective management involves aggressive hydration, electrolyte balance restoration, and hypouricemic agents like allopurinol and rasburicase. Strategies for managing hy-perkalemia and hyperphosphatemia include sodium polystyrene sulfonate, glucose and insulin therapy, diuretics, and phosphate binders. In cases of recurrent hypocalcemia, calcium gluconate infusion is recommended, and hemodialysis should be considered for patients with severe metabolic disturbances or acute renal failure. This review discusses the key aspects of TLS, with an emphasis on risk assessment, laboratory-based diagnosis, and management strategies. The diagnostic process is based on serum markers, although limitations in radiological and electrocardiographic studies require further inves-tigation.

Malignant Pleural Effusion Pathophysiology, Causes, Epidemiology, and Therapies: Updates Review

Sat, 30 Dec 2023 00:00:00 +0000

Background. Pleural effusion (PE) is frequently seen in ordinary medical practice, often resulting from various underlying pathological conditions. Lung cancer is the primary etiology of malignant PE, with breast cancer ranking second in prevalence. PE is mostly attributed to many prevalent etiologies, in-cluding congestive heart failure, parapneumonia, paramalignant, empyema, and pulmonary embolism. Pleural fluid aspiration facilitates the distinction between various forms of PEs. In addition to addressing the primary pathology, malignant PE management encompasses a spectrum of interventions, including antibiotics, pleurodesis, video-assisted thoracoscopy, early thoracic surgeon consultation, thoraco-scopy, and the insertion of a long-term indwelling pleural catheter. Methods. The evaluation presented below is predicated upon relevant literature published between Jan 2020 and Sept 2023, obtained by a meticulous PubMed, Google, and Google Scholar search for updates about malignant PEs. We used different keywords and expressions concerning malignant PE. We aim to review the pathophysiology, epidemiology, and therapy updates of malignant PEs. The appropriate management of malignant PE requires a thorough exclusion of other differential diagnoses. The available therapy choices have been expanded significantly. These therapeutic choices are affected by the underlying pathology. Despite the great changes in malignant PE treatment, the anticipated future diagnostic tests for the causation of the effusion, enhanced pleurodesis agents, advancements in interventional procedures, and the genetic makeup of the afflicted individuals are expected to expand, dynamically altering the diagnostic and therapeutic choices.

Comparative Analysis of Clinicopathological Profiles and Survival Outcomes of Early-Onset Versus Late-Onset Colorectal Cancer Patients

Sat, 30 Dec 2023 00:00:00 +0000

Aims. To study the clinicopathological characteristics and survival of patients with early onset colorectal carcinoma (CRC) (i.e., patients with age of < 50 years at time of diagnosis) versus late onset CRC (i.e., patients with age of ≥ 50 years at time of diagnosis) patients. Methods. A total of 182 patients with early-onset CRC and 284 patients with late-onset CRC diagnosed during 2008–2017 were included. The demographic and clinicopathological characteristics of patients with early-onset CRC were compared with those of patients with late-onset CRC. Kaplan-Meier survival analysis and Cox regression analysis was performed to determine the patient's prognosis. Results. The early onset and late onset CRC groups represented of 39.1% and 60.9%, respectively. The late onset group were diagnosed with a higher proportion of positive Rh antigen, comorbidities and obesity (61.4%, 70.6 % and 71.2% respectively). The early onset group was diagnosed with a higher proportion of signet ring cell carcinoma (61.9%, P = 0.018) and distant metastasis (62.0%, p > 0.0001). Moreover, low expression of CEA (CEA < 5ng/ml) was more common in late onset group than early onset (73.1% vs. 26.9%; p < 0.0001). Rectal bleeding and the rectum tumor site were more common among the early onset patients (63.5 % and 60.2 respectively). However, there was no significant difference between the two groups regarding gender distribution, address, family history and histological grade. During a median of 46 months of follow-up, 44.0% of patients had died from CRC. Shorter survival rates were observed in the early onset group CRC (p < 0.0001). The late onset CRC were associated with a low recurrence rate (p < 0.0001). Based on the multivariate analysis, clinical stage and age at diagnosis are independent risk factors for both overall survival and disease-free survival. Conclusion. The clinical stage and age at diagnosis are an independent prognostic factor for patient's outcome. The early onset group of CRC patients is more advanced at the time of diagnosis, and they should be evaluated promptly and carefully.

Diagnosis Delay and Predicated Factors in Libyan Women with Breast Cancer

Sat, 30 Dec 2023 00:00:00 +0000

Aims. To investigate the diagnosis-related delay time and its predicating factors as well as impacts of this delay on stages of disease. Methods. A total of 400 women, aged 19 to 80 years with breast cancer diagnosed during 2020-2021 were interviewed about the period from the first discovering of symptoms to final histology diagnosis of breast cancer. This timed (diagnosis related time) was divided into three arms: 1) less than 3 months, 2) 3-6 months, and 3) more than 6 months. If diagnosis related time took longer than three months, considered delayed. Patient related time was the calculated time from the date of the discovering of symptoms to the date of the first medical advice. If this time took longer than two months, considered delayed. Systemic related time, the calculated time from the date of first medical advice to the date of final histology diagnosis. Systemic related time considered delayed if took longer than 1 month, Retrospective preclinical and clinical data were collected on a form (questionnaire) during an interview with each patient and from patient's records. Results. The median of diagnosis related time was 6 months, 25 months as the maximum. 40.5% of patients were diagnosed within a period less than 3 months after symptoms and 10.3% of patients from 3 to 6 month, while 49.2% of patients within a period longer than 6 months. A several factors predicted patient-related delay time: Symptoms were not considered serious enough in 18% of patients. Alternative therapy was applied in 17.7% of the patients, while fear and shame prevented the visit to the doctor in 7.7% and 4.3% of patients, respectively. Patient-related delay time was also associated with old age (p<0.0001), with rural residence (p<0.0001), with illiteracy (p<0.0001), with comorbidity (p<0.0001), with women who had used oral contraceptive pills longer than 5 years (p<0.0001), with unawareness of breast cancer (p<0.0001), with women who did not report monthly self-examination (p<0.0001), with initial breast symptom(s) that did not include a lump (p<0.0001), and with past history of benign fibrocystic disease (p=0.049). Failure of medical practitioners to act on presenting findings with inappropriate reassurance that the lump was benign was an important reason for prolongation the systemic related time. At the time of diagnosis, the stage distribution was as follows: 13% stage I, 27.5% stage II, 47.2% stage III and 12.3% stage IV. Diagnosis-related delay time was associated to larger tumour size (p <0.0001), to positive lymph nodes (p< 0.0001), and to a higher rate of advanced stages (p<0.0001). Conclusion. The present study shows a significant relationship between late diagnosis and advanced stage of breast cancer. In Libya, late diagnosis of breast cancer is still a large serious health problem. It was related to a complex interaction between patient and systemic predicating factors, which resulting in a high risk of advanced stage of breast cancer with lower survival rate. Therefore, public awareness programs and training of general practitioners are highly recommended to reduce breast cancer mortality by promoting early detection.

Correlations of Sociodemographic and Clinicopathological Features with Survival Outcome of Colorectal Cancer: A Retrospective Study from A Libyan Cohort

Sat, 30 Dec 2023 00:00:00 +0000

Aims. To study the correlations of sociodemographic and clinicopathological variables of patients with colorectal cancer (CRC) and the association of these variables with patients' outcome. Methods. A retrospective analysis of 466 patients with CRC were diagnosed and treated at the National Cancer Institute (NCI), Misurata, Libya during the 2008-2017 period. Data for sociodemographic, clinicopathological, biological variables, presentation, treatment, and survival related data were collected from the patients' records. Results. The mean age of patient was 53.2 years (range 22-90 years) and most of patients (60.9%) were aged > 50 years. For gender distribution, CRC was nearly the same frequent among males and females (50.2% and 48.9%, respectively). Intestinal obstruction was the most frequent presentation (41.6%) followed by bleeding per rectum (34.1%). Colon cancer was more common than those located in the rectum, (60.1% vs. 39.9%), %), left sided tumours (35.4%) was more frequent than right colon (24.7%). Most tumours were adenocarcinoma (82.0%) and most of patients had moderate differentiated tumours (60.5%). In term to the AJCC staging system, the distribution of stages was as follows: 4.9% stage I, 25.4% stage II, 40.3% stage III, and 29.4% stage IV. Liver was the most common metastatic site (70.5%). In the overall population (median follow-up 46 months), patients with <50 years of age, with an advanced stage and with a high-grade tumour had shorter survival times than those with ≥50 of age, early stage and low-grade tumour (p <0.0001, p <0.0001 and p <0.0001, respectively). Disease-free survival (DFS) was better in patients with old age (p <0.0001), early stage (p <0.0001) and low-grade tumour (p <0.0001). In a Cox multivariate analysis, clinical stage (p<0.0001) and age at diagnosis (p =0.017) were independent predictors of overall survival, and clinical stage (p <0.0001) and age at diagnosis (p =0.019) also proved to be independent predictors of DFS. Conclusion. The present Libyan cohort of CRC shows that the mean age at diagnosis was 52.3 years with equal gender distribution. Colon cancer was more frequent than rectum cancer. Most patients had tumours that were adenocarcinoma, moderate grade and most presented with stage III. Liver was the commonest metastatic site. Clinical stage was powerful independent predicators of patients' outcome and DFS.

Radiotherapy Effect on Immediate Two-Stage Post Mastectomy Breast Reconstruction

Munir Abdulmoula — Sat, 30 Dec 2023 00:00:00 +0000

Background and aims. In the field of breast reconstruction, the two-stage tissue expander/implant technique is commonly used. However, radiation therapy, which is often employed in implant-based reconstruction, has well-documented negative effects such as increased risk of implant exposure, infection, capsular contracture, and other surgical complications. This study aimed to compare the outcomes of patients who underwent radiation therapy prior to implant exchange with a control group of non-irradiated patients, focusing on complications, capsular contracture, revision surgery, and the use of autologous salvage. Methods. This study included 30 patients who underwent immediate two-stage tissue expander/implant reconstruction. They were divided into two groups: irradiated group of 11 patients and control group of 19 patients. Numerous factors such as complications, capsular contracture, revision surgery, and autologous salvage rates were examined and compared between the two groups. We standardize other factors such as patient age, chronic illness for both groups. Results. The irradiated group showed 4.2 times higher of major complications compared to the control group (p = 0.001). The rate of grade III and IV capsular contracture was significantly higher in the irradiated group (21.7%) compared to the control group (10%; p < 0.008). Conclusions. This study concludes that irradiation of the tissue expander after mastectomy is associated with a higher risk of complications. After reviewing another studies, the capsular contracture rate in these patients -which considered the most major complication- with this approach is still acceptable compared to other implant-based radiotherapy approaches. Based on these findings, immediate tissue expander/implant reconstruction can be considered a viable surgical option for patients undergoing post mastectomy radiation therapy.