Polychlorinated biphenyls in bile of patients with biliary tract cancer

Cholangiocarcinoma Among Children and Adolescents: A Review of the Literature and Surveillance, Epidemiology, and End Results Program Database Analysis

OBJECTIVE

Cholangiocarcinoma (CCA) is a biliary malignancy found primarily in adults. The incidence of CCA in children is unknown. The aim of this study was to describe characteristics of CCA in children and adolescents.

METHODS

Using the Surveillance, Epidemiology, and End Results Program (SEER 18) database, we identified incident cases of CCA diagnosed at <20 years of age during the period of 1973 to 2013. Additionally, we reviewed published case reports describing pediatric patients with CCA. We calculated descriptive statistics for CCA cases identified in SEER and in case reports. Kaplan-Meier analysis was performed to determine median and 3-year overall survival (OS) rates.

RESULTS

We identified 15 children and adolescents diagnosed as having CCA from SEER 18 with an incidence rate of 0.0036 per 100,000. Two-thirds of cases were male, and the majority were white (n = 10). The median age at diagnosis was 17 years (range: 11-19 years). Nine tumors were intrahepatic, 3 extrahepatic, and 3 unspecified. One-third had distal metastases at diagnosis. Eight patients underwent surgical resection including liver transplant in two. Six patients were alive at the time of follow-up. Patients without surgical treatment did not survive. Three-year OS was 50%. Twenty-two children with CCA were found in the literature with a median age at diagnosis of 15 years (range: 3-18 years). Half were male, and 90% had an underlying gastrointestinal comorbidity. Three-year OS was 35.3%.

CONCLUSIONS

CCA in children and adolescents is rare with poor survival. A high proportion of cases had a history of biliary disease. Surgical resection is necessary for cure.

Cholangiocarcinoma

Biliary tract cancer accounts for <1% of all cancers and affects chiefly an elderly population, with predominance in men. We distinguish cholangiocarcinoma (intrahepatic, hilar and distal) and gallbladder cancer, with different pathogenesis and prognosis. The treatment is based on surgery (whenever possible), radiotherapy in selected cases, and chemotherapy. The standard cytotoxic treatment for advanced/metastatic disease is represented by the combination of gemcitabine and cisplatin, whereas fluoropyrimidines are generally administered in second line setting. At the present time, no biologic drug demonstrated a clear efficacy in this cancer, although the molecular characterisation could provide a promising basis for experimental treatments. A good supportive care and an early palliative care are warranted in most patients and should be delivered as a part of a global approach.

[Diagnostics and treatment of cholangiocellular carcinoma]

Cholangiocellular carcinoma (CCA) is the second most frequent primary liver carcinoma and is an aggressive tumor, which is mostly diagnosed in advanced stages. The overall survival is poor. Histpathological analysis of tumor biopsies or cytological analysis of biliary brushings can be used to confirm the diagnosis. A differentiation is made between distal, perihilar and intrahepatic CCA. The anatomical position determines the diagnostic and therapeutic strategy. Before diagnostic or therapeutic measures are undertaken it is essential to resolve biliary obstruction via endoscopic stenting or percutaneous biliary drainage. Depending on the tumor stage curative treatment options comprise radical surgical resection with hepaticojejunostomy or in selected cases liver transplantation. For intrahepatic or distal CCA liver transplantation is not indicated. In the palliative setting systemic chemotherapy with gemcitabine and cisplatin leads to a significant improvement in survival time.

Diabetes mellitus and the risk of cholangiocarcinoma: an updated meta-analysis

INTRODUCTION

A number of studies have shown that diabetes mellitus is implicated in susceptibility to several cancers. However, the relationship between diabetes and cholangiocarcinoma remain unclear.

AIM

To quantitatively assess the relationship between diabetes and incidence of cholangiocarcinoma in cohort and case-control studies.

MATERIAL AND METHODS

A literature search was performed for entries from 1996 to 2014 using the PubMed and EMBASE databases. Studies were included if they reported odds ratios (OR) and corresponding 95% CI of cholangiocarcinoma with respect to diabetes mellitus.

RESULTS

Twenty studies met the inclusion criteria, which included fifteen case-control studies and five cohort studies from Asia (n = 11), the United States (n = 5), and Europe (n = 4). Compared with individuals without diabetes, the pooled OR of cholangiocarcinoma was 1.74 (95% CI: 1.62-1.87, p = 0.568 for heterogeneity) for patients with diabetes, ICC (summary RR, 1.93; 95% CI: 1.65-2.25; p = 0.037 for heterogeneity), and ECC (summary RR, 1.66; 95% CI: 1.39-1.98; p = 0.001 for heterogeneity). The funnel plot revealed no evidence for publication bias concerning diabetes and the risk of CC (including ICC and ECC).

CONCLUSIONS

The findings from this meta-analysis suggest that diabetes may increase the risk of cholangiocarcinoma. This relationship needs to be confirmed by further follow-up studies.

Objective assessment of an ionic footbath (IonCleanse): testing its ability to remove potentially toxic elements from the body

Ionic footbaths are often used in holistic health centres and spas to aid in detoxification; however, claims that these machines eliminate toxins from the body have not been rigorously evaluated. In this proof-of-principle study, we sought to measure the release of potentially toxic elements from ionic footbaths into distilled and tap water with and without feet. Water samples were collected and analyzed following 30-minute ionic footbath sessions without feet using both distilled (n = 1) and tap water (n = 6) and following four ionic footbaths using tap water (once/week for 4 weeks) in six healthy participants. Urine collection samples were analyzed at four points during the study. Hair samples were analyzed for element concentrations at baseline and study conclusion. Contrary to claims made for the machine, there does not appear to be any specific induction of toxic element release through the feet when running the machine according to specifications.

Hormonal exposures and the risk of uveal melanoma

OBJECTIVES

Several studies suggest that hormonal mechanisms may be associated with the development of uveal melanoma. Therefore, the association between the risk of uveal melanoma and exposure to hormonal exposures was investigated in a case-control study from nine European countries.

METHODS

Incident cases of uveal melanoma were frequency-matched to population and hospital controls by country, age, and sex. Female subjects were asked about their reproductive history, use of menopausal hormone replacement therapy and oral contraceptives. Among men, occupational handling of oils while working with transformers or capacitors which contain polychlorinated biphenyls (PCB) was solicited. Unconditional logistic regression analyses were calculated, adjusting for several potential confounders. Analyses were stratified by sex.

RESULTS

Two hundred and ninety-three cases (165 men, 128 women) and 3,198 control subjects (2,121 men, 1,077 women) were interviewed. Among women, no associations were observed with hormonal status variables, intake of hormonal therapy or intake of oral contraceptives. Men showed an increased risk with occupational exposure to transformer/capacitor oils (OR = 2.74; Bonferroni-corrected 99.3% CI 1.07-7.02). However, these results were based on few exposed subjects only.

CONCLUSION

The results of this study do not support the hypothesis of a hormonal influence in the carcinogenesis of uveal melanoma. Our finding of a potentially increased risk with PCB-containing oils requires further research.