Attitude of Japanese doctors in their practice of truth-telling to patients with non-curable terminal cancer was extensively investigated to evaluate the difference between doctors from various types of medical institutions. A semi-structured interview using a questionnaire consisting of 18 items covering the doctors' attitudes towards truth-telling and their styles of informing patients about cancer diagnosis and prognosis was performed. Nominal responses to the questions were compared among 10 physicians from 1 cancer center, 71 from 7 university hospitals, 62 from 5 city hospitals, and 50 private general practitioners. The physicians from university hospitals, general city hospitals and/or general practitioners have significant tendencies that they were reluctant to tell negative information to patients both in terms of their inner perceptions as well as in their real clinical practice compared with those at cancer center from various viewpoints: seven perceptive questions (p < 0.05) and five practice questions (p < 0.05). This study shows that physicians in university hospitals, general city hospitals or private practitioners tell the truth in a less qualitatively and quantitatively explicit manner than those at the cancer center when caring patients with terminal-stage cancer in Japan.
Background Calcitriol is a steroid hormone, inhibits the proliferation and promotes the differentiation of human prostate cancer cells. Calcitriol markedly inhibits the invasiveness of human prostate cancer cells in vitro. These properties support the use of calcitriol as differentiation therapy in prostate cancer. Chemopreventive role of calcitriol on prostate cancer remains unknown. Prostatic intraepithelial neoplasia (PIN) is the most common precancerous state and represents the major target for chemoprevention of prostate cancer. Methods Prostate cancer was induced in Wistar rats using MNU+T (N-Methyl nitroso urea + Testosterone). Calcitriol (0.5 μg/kg body weight) was administered weekly thrice as i.p. injection simultaneously to MNU+T treated rats. The control group received vehicle alone. After 16 weeks of experimental period ventral and dorsolateral lobes were removed for histopathological evaluation and serum prostatic acid phosphatase (PAcP) was determined. Results MNU+T treated rats showed hyperplasia, dysplasia and PIN (70%, 60% and 30%) changes in dorsolateral prostate and ventral prostate 60% 50% 30%, respectively. Where as MNU+T along with calcitriol treated rats, the incidence of hyperplasia, dysplasia and PIN in the ventral was 10% each and in dorsolateral it was 20%, 10% and 10%, respectively. Hyperplasia, dysplasia and PIN were less common in these rats. Serum PAcP significantly increases in MNU+T treated rats, whereas decreased in the calcitriol treated rats. The results of this study suggests that calcitriol may have chemopreventive activity in rat prostate carcinogenesis. Interpretation During the treatment with calcitriol on MNU+T induced prostate carcinogenesis, calcitriol might be capable of inhibiting the initiation of prostate cancer. Hence, calcitriol may have useful for the prevention of prostate cancer.
Background Prophylactic oophorectomy is effective for risk-reduction for both breast and ovarian cancer in patients with hereditary breast/ovarian cancer syndromes. Oophorectomy in a woman with breast cancer might also be done as a diagnostic or therapeutic procedure for ovarian pathology discovered during pre-operative work-up. We carried out a study of breast cancer patients who underwent the combined procedure of bilateral laparoscopic oophorectomy and breast surgery to determine the short-term outcome. Methods From November 2000 until April 2004, 14 breast cancer patients had breast surgery and bilateral laparoscopic oophorectomy in the same operating room session. The files of these women were analyzed retrospectively. Results The mean age of the 14 women was 50.7 years (range 39-61). Six women had known BRCA1 or BRCA2 mutations, 3 women had suspected ovarian pathology, 2 had a family history of ovarian cancer and 3 others had a family history suggestive of hereditary breast cancer syndrome but no known mutation. There were no ovarian malignancies on histological examination of the resected ovaries. The mean operating time was 160 minutes (SD ± 60, range 40-240), the mean hospital stay was 2.7 days (SD ± 1.9, range 1-7), and the time from date of surgery to date of 1st chemotherapy was 25.4 days (SD ± 6.7, range 22-37) or 3.6 weeks (SD ± 0.95). There were no post-operative complications. Conclusions Combining laparoscopic oophorectomy with oncologic breast surgery is a reasonable treatment option that extends operating time and does not increase the complication rate. Time to discharge seems to be determined only by the breast component of the surgery. The time to start of chemotherapy did not extend beyond 6 weeks in our series. This approach should be considered for any breast cancer patient undergoing breast surgery who might require oophorectomy as well.
Between 1987 and 2005 we performed serological HLA typing in 4,094 Japanese people to evaluate the frequencies of HLA antigens among cancer patients, non-cancer patients and normal subjects. Among these cancer patients compared with non-cancer and normal patients, there were significantly lower frequencies for HLA-24, -A33, -B35, -B44, -DR8, and -DR9, but there was only one significantly lower frequency for HLA-DR8, even after the Bonferroni correction. In cases of gastric cancer, there was a significantly lower frequency for HLA-A33 and -B44 than among non-cancer subjects, even after the Bonferroni correction. In cases of esophageal cancer, significantly lower frequencies for HLA-A33, -B44, -DR6, -DR8, and -DQ4 were found. In cases of hepatoma, the frequency of HLA-DQ3 was significantly lower. In lung cancer, HLA-DR8 and DQ4, and in breast cancer, HLA-Cw3, -DR8, and -DR9 were also significantly lower after the Bonferroni correction. The data demonstrated here shows that there may be an association between different cancers and different antigens. The frequencies of HLA-A33, -B44, -Cw3, -DR6, -DR8, -DR9 and -DQ4 antigens were lower in total; therefore, these antigens may act as defensive factors of carcinogenesis.