Day 2 :
Memorial Sloan Kettering Cancer Center, USA
Denise Johnson Miller was accepted in a six year Bachelor of Science/MD program after graduating high school in Chicago Illinois. She has completed her MD at Washingon University Medical School, St. Louis Mo. She has completed her General Surgery Residency at University of Illinois in Chicago. She has completed two fellowships, the first in Tumor Immunology at University of Texas, Southwestern in Dallas, TX during her surgical residency. She has completed her Surgical Oncology Fellowship at City of Hope Medical Center in Duarte, CA. She was recruited to VA in Palo Alto and she has served as a Chief of General Surgery and Acting Chief of Surgery, she was then promoted to Assistant than Associate Professor of Surgery at Stanford University Medical School where she served as a Advising Dean and Director of Melanoma Surgery. She is currently a Medical Director of Breast Surgical Oncology for the MSK Hackensack Meridian Health System in New Jersey and Clinical Associate Professor of Surgery Rutgers Medical Center and Clinical Professor of Surgery Seton Hall University.
The keynote address will provide evidence based information to guide clinicians in evaluation and treatment of high risk for genetic breast and gynecologic cancers. A review of BRCA gene function, incidence of genetic mutations related to BRCA and other high risk genes will be provided. The use of next gene sequencing and multi-gene panels and discussion of new genes that are high, moderate and low penetrance pathologic mutations that impact risk of developing breast/gynecologic cancers will be noted. Clinical management of carriers, of pathogenic gene variants will be reviewed with incidence of primary and secondary cancers. Impact of high risk for breast/gynecologic cancers pathologic genetic mutations on patient’s wellbeing, economics of surveillance vs. prophylactic surgery or chemo prevention will be addressed.
Baylor College of Medicine, USA
Homer S Black received a BSc fromTexas A & M University, a MEd from Sam Houston State University, a M.S.Admin. (business/health science management) from the University of Houston and a PhD from LSU in Plant Biochemistry in 1964. He joined the Faculty at Baylor College of Medicine and the Houston Veterans Affairs Hospital as a Physiologist in 1968. His research interests have centered around UVR-induced skin cancer and antioxidant and dietary lipid modulation of this most common of cancers. He became Professor Emeritus in 2003.
The evidence for omega-3 fatty acid (FA) involvement in cancer has generally been equivocal. However, considerable circumstantial evidence has accrued from both experimental animal and human clinical studies that support a role for omega-3 FA in the prevention of non-melanoma skin cancer (NMSC). Direct evidence from animal studies has shown that omega-3 FA inhibit ultraviolet radiation (UVR) induced carcinogenic expression. In contrast, increasing levels of dietary omega-6 FA exacerbate NMSC. Both omega-3 and omega-6 FA are essential and exhibit only minor structural differences. Nevertheless, these differences lead to differential metabolites, as these FA are metabolized through the lipoxygenase (LOX) and cyclooxygenase (COX) pathways. These metabolites are influential in inflammatory and immune responses involved in carcinogenesis. Clinical studies have shown that omega-3 FA ingestion protects against UVR-induced genotoxicity, raises the UVR-mediated erythema threshold, reduces the level of pro-inflammatory and immunosuppressive prostaglandin E2 (PGE2) in UVR-irradiated human skin and appears to protect human skin from UVR-induced immune suppression. Thus, there is considerable evidence, albeit circumstantial, that omega-3 FA supplementation might be beneficial in reducing the occurrence of NMSC, especially in those individuals who are at highest risk.
- Gynecologic Oncology | Breast Cancer | Preventive Oncology
Aurora Health Care, Milwaukee, USA
Aaron H Chevinsky is the Director of Surgical Oncology at Aurora Health Care in Wisconsin. He has lectured nationally and internationally and has published on many aspects of cancer care. He attended medical school and completed his surgical residency in New York, and completed a surgical oncology fellowship at Ohio State. He has been named to the Top Docs list and has won awards for the development of multidisciplinary cancer care programs. He also appeared on TV and radio to raise awareness and promote cancer screening he remains committed to providing the best cancer care to the patients he treats.
Nanoknife Irreversible Electroporation is a locally based treatment for unresectable cancers, particularly those close to major vascular structures. Using DC electrical current, small pores are created in the cellular membrane allowing extracellular fluid to enter and rupture the cell. This is accomplished without damage to the underlying vessels and ducts in the vicinity. In contradistinction to heat based ablative therapies such as radiofrequency and microwave ablation, there is no heat-sink effect which increases the rate of recurrence near major vascular structure. This procedure has been primarily used for locally advanced tumors of the pancreas involving the superior mesenteric artery and/or vein or the celiac artery, and tumors of the liver near the major hepatic veins, inferior vena cava or portal veins. It has also been successfully used in tumors of the head and neck, lung, retroperitoneum, kidney and prostate. Martin et al (1) documented a doubling in survival in patients with locally unresectable pancreatic cancers from under 12 months (historical controls) to 24.9 months. This procedure can be done both as an open surgical procedure and percutaneously by interventional radiology. Nanoknife therapy provides a safe alternative therapy for patients with previously unresectable disease in the liver and pancreas. With a short follow up, we have demonstrated effective local control. Longer follow up and larger series are needed.
Aurora Health Care system has become the first site in Wisconsin to offer this new technology. The procedural details, indications, patient selection and precautions will be presented along with case studies of patients undergoing this procedure.
Federal University, Nigeria
Joseph O Nwankwo obtained his DPhil from Oxford University and Post-doctoral/Research fellowships at University of Southern California and University of Iowa. He was also an Associate Scientist at the University of Wisconsin, Madison Department of Surgery and the Cancer Centre. He was the pioneer Director of the Centre for Molecular Biosciences and Biotechnology, Michael Okpara University of Agriculture, Umudike, Nigeria and currently, the Head of Department of Medical Biochemistry at the Federal University, Ndufu-Alike, Ikwo, Nigeria. He has published more than 25 papers in reputed journals.
Many indigenous west African plants have been employed as local remedies for various human ailments in the traditional medicine of the region and as nutritional sources for countless generations. Isolation and characterization of the chemical structures for phytochemicals from useful indigenous plants have however been undertaken only for a minimal fraction largely, because the modern techniques of chromatography and mass spectroscopy have been exploited by African scientists relatively, recently. The significance of the latter development has been to greatly enhance an understanding of the molecular mechanisms of action for these isolated compounds as pharmacological agents. In particular, such knowledge has been applied in the present discussion to identify indigenous west African phytochemicals with potential anticancer activities based on their structure-activity relationships to known active compounds – an outcome totally unanticipated by the organic chemists who merely isolated and characterized these phytochemicals. The compounds are grouped as potential “Cancer Chemopreventive” and “Cancer Chemotherapeutic” agents and cover most of the known phytochemical classes of alkaloids, flavonoids, lignans, quinones, terpenoids and ‘miscellaneous’, the latter class comprising compounds considered chemically inappropriate for the previous classes. Such identified compounds still await relevant biological activity tests before confirmation of suggested anticancer potentials.
Institute of Post Graduate Medical Education & Research, India
Debarshi Jana is presently pursuing Young Scientist (DST, New Delhi) at Department of G & O, Institute of Post Graduate Medical Education & Research and Seth Sukhlal Karnani Memorial Hospital, under Calcutta University, Kolkata, India and has completed his PhD in October 2014. He has published more than 14 papers in reputed journals. He has presented more than 26 papers in oral/poster presentations in various conferences.
Female genital and gonadal cancer is first becoming commonest malignancy in female in urban population in India. Till now, most of the treatments are guided by the tumor parameters and many occasions the results of treatment have been unpredictable. This work aims to study various molecular factors and will try to link them with the tumor factors. This study has evaluated prognostic significance of miR-34a in female genital and gonadal cancer and correlated them with NF-κB and p53 expression in cancer patients. In this hospital based study, female genital and gonadal cancer patients attend at OPD in our institute of Eastern India. miR-34a, NF-κB and p53 protein expression was measured from cancer tissue sample by both Western Blot and RT-PCR techniques. Statistical significant risk of NF-κB and p53 positive tumor was found in advance stage. It was concluded that miR-34a is an independent prognostic and predictive marker of Indian female genital and gonadal cancer. Thus, the study can result in a pioneering work in establishing new risk stratification system which will be of importance in selecting appropriate adjuvant therapy following surgery. No such host-tumor integrating study has come out from this subcontinent and therefore is of importance in establishing female genital and gonadal cancer guideline for general Indian population.
Dr. B R Ambedkar Hospital Medical College Raipur, India
Ashutosh Gupta has done his MCh in Surgical Oncology from Gujarat Cancer Research Institute, Ahmadabad, completed in the year 2007. He is Associate Professor and Head of surgical oncology Regional Cancer Center Dr. B R Ambedkar Hospital Medical College Raipur, India. He has expertise and special interest in minimal invasive oncosurgery. He has more than 12 publications in various national and international reputed journals.
Aim: To study retrospectively the outcome, feasibility, morbidity and safety of total radical hysterectomy and lymphadenectomy at our institution.
Materials & Method: A total of 20 patients of carcinoma cervix and endometrium according to International Federation of Gynecology and Obstetrics (FIGO) stage were studied. Various patients parameters i.e. age, weight, BMI and stage of the disease were noted. Intra-operatively mean operative time and mean blood loss were recorded. Post-operative parameters noted in the present study included lymph node yield, surgical margin and hospital stay. Patients were followed up for a period of 6 months.
Results: Mean age of the patients was 54.2 years (range 45–67 years). Sixteen (16) patients had carcinoma cervix (12 patients had stage IB1 and 4 patients had stage IA2) and four patients were diagnosed to have endometrial carcinoma. Mean operative time recorded was 166 minutes (range 120-210 minutes) and average blood loss calculated was 212 ml (range 150–320 ml). These patients neither required intra operative blood transfusion nor had any intra operative complications. Surgical margins of the specimen were clear for all patients and average lymph node yield was 15.35 per patient. Mean hospital stay was 3 days. All the patients were followed up for a period of 6 months and all of them were locally controlled till last follow up.
Conclusion: Total laparoscopic radical hysterectomy and lymphadenectomy can be performed safely with shorter hospital stay and no morbidity and patients can be started on the post-operative adjuvant therapy early.
Ghurki Trust Teaching Hospital, Pakistan
Shaila Anwar working in the Department of Obstetrics and Gynecology of Ghurki Trust Teaching Hospital, Pakistan. She has published many papers in reputed journals
Objectives: To find out pelvic and paraaortic lymph node enlargement with clinical stage of carcinoma of cervix; and also to see the histopathological correlation with lymph node enlargement.
Duration: June 2004 to May 2016.
Place of Study: Department of Obstetrics & Gynecology, Department of Radiotherapy and Department of Radiology Ghurki Trust Teaching Hospital and Mayo Hospital, Lahore.
Method: 115 patients were clinically staged and evaluated by CT. Treatment record of radiotherapy was available.
Results: Paraaortic and pelvic lymph node involvement was seen to be increasing with advancing stage of carcinoma of cervix. Highest lymphatic involvement was seen with SCK type of histopathology.
Conclusion: With SCK tumor and advanced stage of disease, radiation fields may need to be modified to include lymph nodes in para aortic region. More studies need to be conducted in this area.
Lahore Medical & Dental College, Pakistan
Nabeela Shami working in the Department of Obstetrics and Gynecology of Lahore Medical & Dental College, Pakistan. She has published many papers in reputed journals.
Background: Secondary cytoreductive surgery should be considered in all patients with recurrent epithelial ovarian cancer as optimal secondary cytoreduction has been associated with improved survival, irrespective of duration of disease free interval (DFI). A good performance status, initial optimal cytoreduction and absence of ascities are suggestive of increased odds of optimal secondary cytoreduction. Extent of disease is also a major determinant as patients with smaller disease burden are more likely to achieve optimal cytoreduction. Consequently, delay in secondary cytoreduction may reduce the number of patients who can undergo optimal cytoreduction. As yet, there is no consensus in literature regarding the optimum timing of secondary cytoreduction in patients with recurrent disease. The present series aims to document the success rate of optimal secondary cytoreduction in patients based on their DFI.
Methods: Patients who had undergone primary cytoreductive surgery, had received chemotherapy and showed a complete response, but subsequently presented with disease recurrence, were included. Evidence of measurable disease on imaging study was required. Abdomen was opened with a vertical incision, ascitic fluid/washings were removed, maximal cytoreduction was performed with a goal to reduce the tumor to <1 cm diameter. All patients were given gemcitabine 1250 mg/m2 on day 1 and 8 and cisplatin 70 mg/m2 on day 1 only. Cycles were repeated every three weeks. RECIST was used for response evaluation.
Result: One hundred and eight patients were enrolled from December 1998 to December 2013. Median age was 52 years (range 40-68). Seventy two patients had previously received cyclophosphamide and cisplatin while 36 had received paclitaxel and carboplatin. The disease free interval was less than 6 months in 32 patients, more than 6 months in 50 patients and more than 12 months in 26 patients. Optimal cytoreduction was achieved in 42 (38.8%) patient only and included 15, 20 and 7 patients with DFI of <6 months, >6 months and >12 months, respectively. Gut injury was seen in 8 (7.4%) and bladder perforation in 8 (7.4%). Among 42 patients with optimal cytoreduction, 20 had a CR while 22 showed a PR with chemotherapy whereas in patients with sub-optimal surgery CR was seen in 14 patients, PR in 20 and less than PR in 32 patients.
Conclusion: Secondary cytoreduction and postoperative second line chemotherapy with gemcitabine and cisplatin is a reasonable treatment option for patients with recurrent epithelial ovarian cancer. Early cytoreduction seems to confer a favorable surgical outcome. The present data suggests that early detection and surgical intervention of recurrent disease may result in increased response rates. Further studies are needed to validate our findings in larger patient cohorts.
Bahir Dar University, Ethiopia
Birtukan Derso is BSC mid wife working in felegehiwot Referral hospital as a midwife for the last 5 year and currently doing her second degree in public health in Bahir Dar university .She has been a sole participant in many research activities undertaken in the region , especially in maternal and child health
Background: Intracranial tuberculoma in new born is a rare occurrence. We report a 7-month-old male infant presenting to our tertiary care referral center with complaints of global developmental delay and right hemiparesis for 3 months. Radiologic imaging was suggestive of large left frontoinsular space–occupying lesion with initial differential of primitive neuroectodermal tumor or desmoplastic infantile ganglioma. Considering the clinicoradiologic findings and no history suggestive of immunodeficiency or contact with tuberculosis, surgical decompression was done. Final histopathology revealed multiple epithelioid granulomas suggestive of tubercular etiology or intracranial Langerhans cell histiocytosis. He was started on antitubercular therapy after ruling out Langerhans cell histiocytosis using CD1a and Langerin immunohistochemistry staining. Interpretation of tuberculous etiology in infants can be challenging for clinicians, radiologists, and pathologists. A high index of suspicion is necessary to diagnose such lesions, predominantly in endemic regions.
Case Presentation: A 2500 gm neonate is born from a para-ii mother at a gestational age of 35weeks. The mother had only two antenatal follow up. In the last two months before delivery she had productive cough, shortness of breath, easy fatigability. Obstetric ultrasound showed normal pregnancy. Labor started in a week. She delivered 2800gm male with APGAR of 5 and 6in the 1st and 5th minutes. With widened anterior fontanel, increased tones of lower extremity of the right side and progressively fails to suck. With investigation the problem is found to be tuberculoma. The diagnosis, treatment and outcome of the case will be discussed in the presentation
Emirates College of Technology, Abu Dhabi, UAE
Sajid Iqbal have completed his predoctoral program in Biomedical Sciences from department of human genetics, KU Leuven University, Belgium. Currently working as Institution Research Manager with Emirates College of Technology, Abu Dhabi, U.A.E, Few of his publications are in international journals already.
Brest cancer (BC) is the second most widespread and the utmost common cancer among females population in the world. It has foremost influence on women health. Deaths from BC account for 1.6% of female deaths every year. The aim of this study was to determine the prevalence of BC, also to determine and quantify the associated risk factors for BC among Pakistani females. We carried out an observational case-control study for the present research. The study includes 105 BC patients and a group of 105 controls (healthy women). Univariate and multivariate logistic regression analysis along with Pearson’s Chi-square was applied to determine and quantify the association between risk factor and BC risk. In multivariate models, Environmental area and exposure to X-Ray radiations were found to be significantly associated with BC risk (p = 0.012, 0.03). Female with a positive family history of BC/ were at higher risk for developing BC. An early age at menarche was a strong risk factor for developing BC. Age less than 12 years increased the risk 2.551 times and an older age at menarche was associated with a significant reduction in the risk of BC. Menopausal status and age at last pregnancy were also risk factor of BC. We may conclude that the breast cancer is highly prevalent in the local population and its risk increases with X-ray radiation exposure, living area and habits, family history, early age of monarch and menopausal status.