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Purpose: Cancer is an increasingly important health problem, and is second only to cardiovascular disease as cause of death. Cancer diagnosis causes significant changes in patients and their families, and social relationships are affected. For this reason, we examined the lives of patients subsequent to their diagnosis and sought to determine any changes in their lifestyles., Methods: Between March 16th and September 30th, 2011, a questionnaire consisting of 20 questions was distributed via a face-to-face interview to 150 patients at the Marmara University Hospital Oncology Unit. Each patient was queried during the administration of his/her chemotherapy. Six of the questions were independent choices, and 14 were dependent (multiple choice). A Local Ethics Committee approval was obtained., Results: Of the 150 patients, 70 (46%) were male and 80 female, and their median age was 55 years (range: 22-82). Following their diagnosis, 71% of males and 50% of females reported that they were complying with guidelines for a healthy lifestyle, and 19% of the patients said that they were eating healthier food. At the time they filled in the questionnaire, 61% said that they were hopeful; however, close to 10% said that they felt hopeless. Approximately 53% of the participants said that following their diagnosis they had a more sympathetic view of the underserved and underprivileged., Conclusions: It was surprising that an unexpectedly high percentage of the respondents reported that they did not make any changes in their lifestyles after their diagnosis of cancer, including eating healthier food. It appears Turkish cancer patients are coping with cancer in different means and ways than we expected of them.

Purpose: hepatocellular cancer (HCC) is a common malignancy with a high mortality rate. Existence of excisional repair cross complementation1 (ERCC1) is implicated in resistance to cisplatin treatment. Expression of ERCC1 in HCC is not known. In this study we aimed to find out whether a subset of HCC patients can be identified to benefit from cisplatin., Methods: sixty-one patients with HCC who had enough tissue to do immunohistochemistry were identified in 3 institutions. Immunohistochemical staining was performed manually using the standard streptavidin-biotin-peroxidase method. Monoclonal anti-ERCC 1 (D-10) antibody from Santa Cruz Biotechnology (Santa Cruz, CA) was used., Results: only one out of 61 patients (1.6%) had ERCC1 expression., Conclusion: although around 10% of HCC patients respond to cisplatin, this is unlikely to be due to ERCC1 negativity. Pathways other than ERCC1 should be searched to find ways to help these patients' treatment strategies.

Purpose: we investigated the anxiety and depression rates in breast cancer patients (BCPs) and compared their rates with a group of unemployed women attending courses at a local government agency to increase their chances for employment., Methods: a total 129 BCPs were included [60 were treated and followed up in Marmara University Hospital (PHG), 69 were from a private oncology clinic (POG)] and 101 healthy people (control group; CG) came from a course for the unemployed. All participants completed the Turkish-language version of the Hospital Anxiety and Depression Scale., Results: The mean ages of the BCPs and CG were 52.7 ± 13.1 and 38.9 ± 11.9 years, respectively (p=0.001). Compared to the CG, the percentage of housewives was significantly higher in the BCP group (p=0.04). These 2 factors (age and profession) were not independent factors predicting anxiety or depression (p>0.05). The rates of anxiety and depression were 27.9 and 35.7% for BCP, 28.7 and 34.7% for CG, 33.3 and 51.7% for PHG, and 23.2 and 21.7% for POG, respectively. The difference of the rates of depression between the POG and the PHG was significant (p=0.0001)., Conclusion: the anxiety and depression rates were not higher in BCPs than in the CG who had a risk factor (such as unemployment) for psychosocial ill health. Being treated and/ or followed up in a private office was related to lower depression rates.

Purpose: Although there are many myths about cancer in Turkey, there is no study evaluating Turkish public's knowledge about cancer. The goals of our research were to: 1) measure the extent of knowledge of cancer among the Turkish public; 2) determine the differences in extent of cancer-related knowledge between participants who have relatives with cancer and those who do not; and 3) determine the sources of knowledge possessed., Methods: Data were obtained from a total of 415 participants (244 female, 171 male), all of them sitting at the Marmara University Faculty of Medicine Hospital (MUFMH) outpatient clinic waiting area for non-cancer-related reasons. Each participant completed a 3-part questionnaire. Appropriate statistical tests were used for comparison., Results: The mean age was 41 years. Of 415 participants, 65.3% stated that they had one or more cancer patient in their immediate family; 70.1% of the participants had a high-school education or greater. The questionnaire showed that, depending on the question, anywhere from 1.7% to 88.5% of the general public possesses some false information; furthermore, the difference in accuracy between relatives of cancer patients and non-relatives was marginal. Only 3 specific questions, related to the following ideas, rendered answers that were statistically significantly different between these 2 groups: breast cancer is only seen in females (p <0.005), cell phones cause cancer (p <0.001), and cancer is always very painful (p <0.001)., Conclusion: The proportion of false knowledge about cancer was unacceptably high in our cohort. Broader efforts should be made to inform the Turkish public about cancer.

Coexistence of renal cell carcinoma (RCC) and multiple myeloma (MM) is an extremely rare condition. Appearance of synchronous RCC and MM was not reported independently so far. In this brief communication, we report 2 cases of synchronous RCC and MM, discuss common risk factors or pathogenetic mechanisms seen in either RCC or MM, point out the importance of IL-6 in this coexistence and provide some descriptive properties of all reported synchronous RCC and MM cases.

Kikuchi-Fujimoto disease (KFD), a rare clinicopathological entity, is a benign and self-limiting disease. It was first described in 1972 by Kikuchi and Fujimoto in Japan independently. KFD is prevalent in Asia, although it may be seen in wide geographical areas, including Turkey. It mainly affects young women. Cervical lymphadenopathy is the most prominent sign and should be differentiated from lymphoproliferative, autoimmune, and infectious diseases. We report on a 30-year-old female patient who was referred to our medical oncology unit for chemotherapy and/or radiotherapy with diagnosis of Hodgkin's lymphoma. Ultimately her diagnosis was corrected as KFD after second opinion of the pathology specimens. We herein provide a brief review about KFD and the importance of second opinion of the pathology specimens.

Purpose: To assess the side effects of cisplatin-based concurrent chemoradiotherapy (CRT) for locally advanced nasopharyngeal carcinoma (NPC)., Patients and Methods: From 2001 through 2007, 34 (27 males; 7 females) patients received a median of 70 Gy curative radiotherapy (RT) with conventional fractionation. Twenty-one (62%) patients received induction chemotherapy (CT): 8 of them received 2 courses of cisplatin (75 mg/m(2), day 1) and 5-fluorouracil (5-FU) (750 mg/m(2), days 1-5) every 3 weeks and 13 patients received 3 courses of cisplatin (75 mg/m(2), day 1) and docetaxel (75 mg/m(2), day 1) every 3 weeks. Concomitant cisplatin was administered either 40 mg/m(2) weekly (n=8) or 75-80 mg/m(2) every 3 weeks (n=26) during RT. Median Karnofsky performance status (KPS) prior to RT was 80 (range 70-90). Patient, disease and treatment-related factors were analysed in relation to termination of concurrent CT., Results: Concurrent CT was administered to 13 (38.2%) patients without cisplatin termination, whereas 10 (29.4%) patients received 2 cycles of the 3-weekly schedule. Grade 3 oral mucositis (47.1%), grade 2-3 weight loss (44.2%) and grade 2 fatigue (44.1%) were the most frequently dose-limiting side effects during concurrent therapy. The rate of receiving cisplatin cycles as planned was 85% for patients with KPS >80, whilst it was 15% only for patients with KPS < or = 80 (p=0.006). None of the patients suffering of grade 2 fatigue could complete all cycles compared to 68% of patients with < grade 2 fatigue who completed all cycles (p <0.001). The severity of mucositis was significantly related to initial haemoglobin level (p=0.02) and weight loss during RT (p=0.04). Median follow-up was 20 months (range 5-65). Three-year locoregional relapse free (LRRFS), disease free (DFS) and overall survival (OS) rates were 79.3%, 68.8% and 79.2%, respectively., Conclusion: Concurrent administration of CT during RT reveals better outcome but requires careful consideration for toxicity. Initial performance status prior to CRT might be a predictor for unplanned CT stopping due to side effects.

Purpose: To determine the impact of body mass index (BMI) on cancer in a hospital-based Turkish population., Patients and Methods: The study group consisted of 2015 (1172 females: 423 pre- and 749 postmenopausal; and 843 males) patients with histologically proven cancer who applied to Marmara University Medical School, Medical Oncology Clinic. The control group included 305 healthy caregivers (192 females: 110 pre- and 82 postmenopausal; and 113 males)., Results: Mean BMI of the patients with breast, ovarian and cervical carcinoma was significantly higher than that of the healthy female controls (p<0.001, 0.003, <0.001, respectively). Postmenopausal breast cancer patients had significantly higher BMI than postmenopausal female controls (odds ratio [OR] 1.3; 95% confidence interval [CI], 1.06-1.6; p=0.012), while this was not seen in premenopausal patients. When compared with controls obese postmenopausal female patients had 3.26-fold (95% CI 1.54-6.90) increased risk for breast cancer (p=0.002). Mean BMI of lung, stomach, esophagus, pancreas and head and neck carcinoma patients was significantly lower than that of the healthy controls. Female patients with lung and colorectal carcinoma had higher BMI than female controls., Conclusion: Elevated BMI might be a risk factor for breast cancer in postmenopausal women. Case-control studies may not show the actual association between BMI and cancers that present with pre-diagnosis weight loss and advanced stage.

Viruses are known to be associated with human malignancies, e.g., Epstein-Barr virus, human papillomavirus (HPV) and human T-cell leukemia virus type I. We conducted a prospective study to define the role of HPV in breast cancer. The malignant and normal breast tissue samples of 50 consecutive breast cancer patients were obtained postoperatively. DNA extracted from all tissues was amplified with the polymerase chain reaction using HPV primers. HPV 11, 16, 18, 33 subtypes were searched in HPV-DNA positive samples. Thirty-seven samples (74%) of tumoral breast tissue expressed HPV-DNA, 16 normal breast tissue samples (32%) were positive as well. There was a significant difference in HPV-DNA positivity between normal and tumoral breast tissue samples. HPV 18 was detected in 20 of the HPV-DNA positive tumoral tissue (54.4%) and in 9 of the HPV-DNA positive normal tissue (56.3%). HPV-33 also was detected in 35 (94.6 %) of the HPV-DNA positive tumoral tissue and in 14 (87.5 %) of the HPV-DNA positive normal tissue samples. HPV DNA was significantly associated with breast tumor tissue compared to normal breast tissue. Additional studies looking at HPV and HPV subtypes are needed to clarify the etiological role of the HPV in breast cancer.

Purpose: The aim of this survey was to assess the status of colorectal cancer (CRC) care in the Balkans by contacting cancer care specialists in the Balkan Union of Oncology (BUON) member states., Materials and Methods: The authors searched the 2004 membership directories of the ASCO and ESMO and identified members from the Balkan countries. They then sent them a 3-page questionnaire via e-mail or fax., Results: Fifty-two responses from 8 countries were received and analysed. The response rate varied from 25% (Turkey) to 3% (Bulgaria). No Bosnian (n=13), Croatian (n=16) and Albanian (n=1) participated. The results showed that, despite variations on the state of development among Balkan countries, there were some striking similarities and also some similar difficulties that CRC specialists are facing in their individual countries., Conclusion: Combined and coordinated efforts at solving some of these common problems may help CRC patients receive better and higher quality care.

The purpose of this study was to define the measurement properties and clinical validity of the European Organisation for Research and Treatment of Cancer (EORTC) questionnaire module to assess health-related quality of life (HRQL) in gastric cancer. The EORTC gastric cancer module, QLQ-STO 22, was administered with the QLQ-C30, core questionnaire, to 219 patients undergoing treatment with curative or palliative intent before and after treatment. Reliability and validity of the module was tested and patients' debriefing comments analysed. Compliance rates were high, questionnaires well accepted and less than 4% of items had missing data. Multi-trait scaling analyses and face validity refined the module to five scales and four single items. Scales distinguished between clinically distinct groups of patients and demonstrated treatment-induced changes over time. Test-retest scores demonstrated good reliability. The EORTC QLQ-STO 22 demonstrates psychometric and clinical validity that supports its use to supplement the EORTC QLQ-C30 to assess quality of life in patients with gastric cancer undergoing surgery, surgery and chemoradiotherapy, palliative chemotherapy, palliative surgery and best supportive care.

Adjuvant chemoradiotherapy is the standard treatment in resected stage II/III rectosigmoid carcinoma. We report a retrospective analysis of 33 patients who received adjuvant chemoradiotherapy. Patients received 5-fluorouracil (375mg/m2/day x 5days) and calcium leucovorin (20mg/m2/day x 5days), q4weeks, two courses before and two courses after radiotherapy. The 5-fluorouracil dose was reduced to 225mg/m2/day given continuously as protracted short-term infusion on the first and last 3 days during radiotherapy. Radiotherapy was started at 7th week and 45-50.4 Gy was given to pelvic region. Median age was 63 years. Median follow-up was 38 months starting from the operation date. Four-year local and distant control rates were 78% and 69%, respectively. Four-year disease-free survival and overall survival were 60% and 62%, respectively. Protracted short-term infusion of 5-fluorouracil during pelvic irradiation is a safe treatment modality. Further studies are needed to improve the local control of high-risk rectal and sigmoid carcinomas.

Purpose: The purpose of this study was to register the different cancer cases diagnosed in our hospital with an aim to define the most common and treatable cancer types and help define accurate targets for the allocation of the already limited resources of the Ministry of Health., Materials and Methods: We surveyed 12 months of the hospital's pathology records to determine the prevalence of various cancer types., Results: Out of 9720 biopsy and cytology samples, 662 were cancer cases. Breast and gastric cancers were higher and colorectal cancers were lower than the series reported from the United States. Of the pulmonary malignancies, lung cancer in general was not particularly higher in proportion to other cases, something interesting for a country with smoking rates exceeding 60% of the adult population. Squamous cell lung cancer was more common compared to the rates reported in the western world statistics., Conclusion: Although biases may exist, as certain cancers are more amenable to surgical intervention and physician groups may have special interest toward a particular cancer, distribution of cancer cases in Turkey is probably similar to the western world.

Duct cell adenocarcinomas may produce neuroendocrine markers such as pancreatic polypeptide, gastrin and gastrin releasing hormones. A 53 year old patient, with a history of insulin dependent diabetes, was found to have a pancreatic mass which was later pathologically demonstrated to be a duct cell adenocarcinoma. The tumor produced elevated circulating neuroendocrine markers specifically gastrin and pancreatic polypeptides. An 111In Octreotide imaging showed definite uptake of Octreotide by the tumor. The patient was subsequently treated with Somatostatin analog which resulted in the reduction of some of the circulating endocrine markers. The patient had essentially six months of asymptomatic clinical remission but then she relapsed. Octreotide scanning could be useful for selected patients with pathologic diagnosis of duct cell adenocarcinoma, because some tumors may have neuroendocrine features and can be imaged, and might even respond to Somatostatin analog therapy.

Imipenem is an antibiotic used with cilastatin in the bone marrow transplant (BMT) setting. Cyclosporin A (CsA) is an immunosuppressive agent. Seizures can be seen with both imipenem/cilastatin and CsA. Our hypothesis for study was that CNS toxicity and seizures are increased by the concomitant administration of CsA and imipenem/cilastatin. Between December of 1989 and 1996, all of the 166 stem cell BMTs performed at Mount Sinai Hospital in New York were evaluated for this study. Three groups were studied: 77 patients received CsA alone (Group 1); 89 patients received imipenem/cilastatin, and of these, 45 received concomitant CsA (Group 2); and 44 patients who underwent autologous BMT received imipenem/cilastatin only (Group 3). We observed a total of 5 seizure episodes. There were no statistical differences in frequency between the groups. Adverse effects may be difficult to relate to a particular drug, especially for patients on multidrug regimens but the use of imipenem/cilastatin and CsA did not cause a significant rise in the frequency of seizures when compared to CsA alone.