The Cancer Treatment Center

Globally, in 2018, 4.8 million new patients have a diagnosis of gastrointestinal (GI) cancers, while 3.4 million people died of such disorders. GI malignancies are tightly relevant to 26% of the world-wide cancer incidence and occupies 35% of all cancer-associated deaths. In this article, we principally investigated molecular and cellular mechanisms of tumorigenesis in five major GI cancers occurring at esophagus, stomach, liver, pancreas, and colorectal region that illustrate high morbidity in Eastern and Western countries. Moreover, through this investigation, we not only emphasize importance of the tumor microenvironment in development and treatment of malignant tumors but also identify significance of M2PK, miRNAs, ctDNAs, circRNAs, and CTCs in early detection of GI cancers, as well as systematically evaluate contribution of personalized precision medicine including cellular immunotherapy, new antigen and vaccine therapy, and oncolytic virotherapy in treatment of GI cancers.

Arterio-portal fistula (APF) is a rare vascular abnormality, characterized by communication between artery and portal vein. We describe a 69-year-old male patient with APF, who developed acute clinical symptoms 10 months after hepatectomy. The APF was accompanied by massive ascites and thrombosis in the superior mesenteric vein. The condition was successfully treated using anticoagulant, diuretics, and interventional coil embolization of the fistulas. This case indicates that APF is an important postoperative complication after hepatectomy, and that intrahepatic APFs could manifest acutely with ascites and superior mesenteric vein thrombosis.

「緩和ケア」という用語を患者に使い難いという医療者の声を聞くことがある．用語を使うのが遅れると患者や家族が緩和ケアを知る機会が遅れる可能性がある．われわれは「緩和ケア」という用語を用いた医療者から患者・家族への説明について調査した．2010年2月，広島大学病院の医師387名・病棟看護師518名に，質問紙調査を行った．回答率は医師70.3％，看護師54.8％で，そのうち77.2％の医師，56.0％の看護師が「緩和ケア」という用語を使用すると回答した．過半数の医師が診断時か症状出現時にはじめて用語を使用していた．看護師では医師が緩和ケアについて説明してから用語を使うとした者が約3割で，臨床経験年数が少ないほどその割合は多かった．医師は早い時期にはじめて用語を使う者が多く，看護師は早い時期に使う者も多いが医師より先に用語を用いにくい者も少なからずいることがわかった．

がん診療に携わる医師に対する緩和ケア研修会が，効果的であることを示す報告は多くない．受講者の知識や満足感に加え緩和ケアの実践に近い評価項目を用いた検討を行うため，広島県で1年間に行われた緩和ケア研修会（PEACEを利用）の受講者323名を対象とした調査を行った．研修会で扱う内容を踏まえ，緩和ケアの専門家ではなくても自分から実践しようとする姿勢に変化があるかを問う形式の質問票を作成した．26項目につき，「ほとんど自分で行う」から「ほとんど緩和ケアの専門家にまかせる」まで5段階のLikartスケールを用い，受講前後の変化について解析した．結果，有効回答を得た206名では，せん妄および気持ちのつらさに対する薬剤の調整をのぞき，ほとんどの項目について有意に緩和ケアの実践を自ら行う方向に傾向が移っていた．緩和ケア研修会は受講者の緩和ケア実践の姿勢についても良い変化を生じる可能性が示唆された．

乳癌に対する乳房温存術において，術後乳房の整容性を保つために内視鏡補助下乳房温存術と遊離真皮脂肪片移植による同時性乳房再建を施行した2例を経験したので報告する．症例1は35歳の女性で，右乳房のC領域に2cm大の腫瘤と腋窩リンパ節腫大を認めた．腋窩リンパ節郭清を施行した後，腋窩創より内視鏡を挿入し大胸筋前面を剥離した．乳輪切開を加え皮弁を作成し乳房部分切除を行った．右下腹部より遊離真皮脂肪片を採取し欠損部へ補填した．術後は化学放射線療法を行った．症例2は52歳の女性で，左乳房のC領域に1.8cm大の腫瘤を認めた．センチネルリンパ節生検を行い，症例1と同様の手術を施行し，術後は放射線治療とホルモン療法を行った．2例ともに良好な整容性が得られ，本術式は乳癌に対する乳房温存術後の整容性を向上させる新たな試みであると考えられた．

We report the case of a 60-year-old male patient who was diagnosed with metastasis from primary lung cancer to the breast. The patient presented with a mass in the right breast. Mammography, ultrasound, and magnetic-resonance imaging each suggested primary breast cancer. A core-needle biopsy of the right breast mass indicated poorly differentiated adenocarcinoma. A basic chest X-ray showed a shadow in the left upper lung. Thoraco-abdominal computed tomography revealed a mass with a diameter of 90 mm in the left superior region, the shape of which was indicative of primary lung cancer. A lung biopsy confirmed poorly differentiated adenocarcinoma. We diagnosed primary lung cancer with metastases to the bone, brain and right breast (cT2N3M1, stage IV) by imaging and histopathology. He was administered carboplatin (area under the curve 6 mg / ml) and paclitaxel (200 mg / m(2)) tri-weekly, and underwent gamma-knife treatment for the brain metastasis. The treatments reduced the primary tumor and the metastases. However, after completion of the fifth treatment cycle, he developed disseminated intravascular coagulation from septic shock, and died on the eleventh day after completing the fifth cycle of treatment. Although metastasis to the mammary gland is uncommon, especially among males, metastasis to the mammary gland should be considered when a mammary mass does not exhibit the typical characteristics of breast cancer. A correct diagnosis of metastasis to the mammary gland from lung cancer makes it possible to select the most appropriate treatment method.