Search Results (14,503)

Background/Objectives: A cancer diagnosis forces a rapid, often unwelcome reorganization of a patient’s sense of self, routines, and future plans, and patients vary considerably in how far they progress toward accepting that new reality. Personality is a candidate explanation for this variability, and although the Five-Factor Model has been linked to cancer-related distress and coping in several large cohorts, its relationship to illness acceptance specifically, alongside disease duration, treatment self-assessment, and perceived social support, has not been jointly examined in a single, diagnostically broad oncology sample. Methods: We surveyed 114 outpatients with a confirmed malignant tumor diagnosis, combining a study-specific questionnaire with the NEO-Five-Factor Inventory (NEO-FFI) and the Acceptance of Illness Scale (AIS). Because several study variables were non-normally distributed and the study-specific measures were ordinal, associations were examined using Spearman’s correlation, the Kruskal–Wallis H test, and the Mann–Whitney U test. Results: Illness acceptance was moderate on average (mean [M] = 26.55, standard deviation [SD] = 7.34); 22 patients (19.30%) were classified as having low acceptance, 76 (66.67%) as average acceptance, and 16 (14.04%) as high acceptance. All five personality domains correlated with acceptance, led by a strong negative association with neuroticism (ρ = −0.632, p < 0.001) and moderate positive associations with extraversion, agreeableness, conscientiousness, and openness to experience (all p < 0.001). Longer disease duration and a more favorable self-rated treatment outcome were both associated with higher acceptance, and patients who felt supported by close relatives scored higher than those who found support difficult to gauge. Conclusions: Personality traits, particularly neuroticism, were associated with illness acceptance. Brief psychosocial assessment may help identify patients reporting greater difficulties in psychological adjustment to cancer. Full article

Breast cancer-related lymphedema (BCRL) is a chronic disease that stems from damage to the lymphatic system due to breast cancer treatment leading to interstitial fluid buildup in the affected extremity. Patients with axillary lymph node dissection in combination with radiation therapy are at the highest risk of developing lymphedema. The mainstay non-surgical treatment involves participation in complete decongestive therapy with certified lymphedema therapists, daily compression garment usage, at-home pump treatments, and diligent skin care. Surgical treatments options can help alleviate symptoms associated with the disease by improving lymphatic drainage and removing fibrofatty tissue. Immediate lymphatic reconstruction (ILR) involves reconstructing cut lymphatics prophylactically at the time of axillary dissection with lymphovenous bypass (LVB) to decrease the risk of developing lymphedema. Delayed reconstruction addresses clinically diagnosed lymphedema and is divided into physiologic and debulking surgical techniques. Physiologic surgeries include lymphovenous bypass and vascularized lymph node transplantation (VLNT) aimed to treat fluid buildup. Debulking surgeries include lymphatic sparing liposuction or direct excision of fibrofatty tissues in the affected extremity to treat excess fibrofatty tissue secondary to lymphedema. This review discusses the pathophysiology of BCRL, diagnosis and staging of the disease, as well as provides an algorithmic overview on delayed lymphatic reconstruction options for BCRL. Full article

Background/Objectives: Management of locally advanced cervical cancer (LACC) and other gynecological malignancies aims to achieve locoregional control while avoiding morbid surgical salvage. This exploratory, hypothesis-generating study described the treatment pathways of three protocol groups and examined whether clinical, sociodemographic, and treatment-deviation variables are associated with any oncological surgery. Methods: Sixty-nine adult patients with gynecological or urogenital cancers (89.9% cervical carcinoma) treated with platinum-based chemotherapy at a Romanian tertiary center between April 2024 and April 2025 were stratified into INTERLACE-type dose-dense induction chemotherapy followed by chemoradiotherapy (Group A, n = 27), classic three-weekly neoadjuvant chemotherapy followed by chemoradiotherapy (Group B, n = 7), and no induction chemotherapy (Group C, n = 35). Associations with any oncological surgery (upfront, completion, or salvage) were explored by multivariable logistic regression with bootstrap internal validation, Firth penalized regression, and restricted sensitivity analyses. Results: Twenty-five patients (36.2%) underwent surgery (14 upfront, 8 completion, 3 salvage), and none of them were from Group A, whose median follow-up was only 8.6 months and whose allocation was confounded by diagnosis and stage. The model showed an apparent area under the curve of 0.717 (optimism-corrected 0.672), accuracy of 73.9% against a no-information rate of 63.8% (p = 0.049), sensitivity of 0.480, and specificity of 0.886. Urban provenience (OR 0.343, 95% CI 0.113–1.039, p = 0.059), Delta Target Dose (OR 1.109 per Gy, p = 0.076), and number of chemotherapy cycles (OR 1.298 per cycle, p = 0.076) showed non-significant trends whose direction was unchanged in all sensitivity analyses. Conclusions: The absence of surgery after induction chemotherapy is hypothesis-generating rather than confirmatory, and the exploratory model is not a clinical prediction tool. Geographic provenience and planning-to-delivery treatment deviation are candidate variables for prospective evaluation in a homogeneous LACC population with standardized radiotherapy parameters and mature oncological endpoints. Full article

Background/Objectives: Healthcare resources are unevenly distributed across Miyazaki Prefecture, Japan. We examined regional differences in the clinical presentation of renal cell carcinoma (RCC) recorded in the Miyazaki Urological Cancer Database (MUCD), together with area-level healthcare resource indicators. Methods: We performed a retrospective descriptive observational analysis of prospectively collected data from the multicenter MUCD registry. After deduplication and rechecking eligibility, 540 patients with a documented diagnosis date within the study period (1 April 2019–31 March 2024) were included (Central/Southern, n = 333; Western, n = 116; Northern, n = 91). The three main clinical outcomes were adjusted for age and sex, with clustering by registering facility taken into account. Results: Presentation with predefined local symptoms occurred in 18.6%, 19.0%, and 34.1% of patients in the Central/Southern, Western, and Northern areas, respectively. Compared with Central/Southern, the adjusted odds ratio for predefined local symptoms in the Northern area was 2.30 (95% CI, 1.39–3.81). Median tumor size was 3.8, 4.4, and 5.0 cm, respectively; the adjusted mean difference for Northern versus Central/Southern was 1.24 cm (95% CI, 0.65–1.82). Clinical M1 disease was recorded in 10.2%, 12.1%, and 19.8%, respectively; the global test accounting for facility clustering yielded p = 0.076, and the Holm-adjusted p value for Northern versus Central/Southern was 0.082. Urologist density in 2024 was 8.7, 8.0, and 5.3 per 100,000 population, respectively. Conclusions: Regional differences were observed in the clinical presentation of MUCD-recorded RCC and in area-level healthcare resource availability. These findings are descriptive and hypothesis-generating and do not show that differences in resource availability caused the observed clinical patterns. Full article

The conventional workup for suspected early-stage lung cancer requires multiple visits, anesthetics, and procedures. Single anesthetic event lung cancer surgery integrates shape-sensing robotic bronchoscopy, cone-beam CT, rapid on-site cytologic evaluation (ROSE), endobronchial ultrasound staging, lesion localization, and minimally invasive resection into one operative encounter. In this narrative review, we describe the technical components of this pathway, summarize the supporting literature, and offer expert, institution-based troubleshooting guidance for common intraoperative dilemmas. Reported diagnostic yields for shape-sensing robotic bronchoscopy range from 80 to 96%, with approximately 90% concordance between ROSE and final pathology. Published single-institution series report reductions in time from detection to resection of 15–51 days, cost savings of approximately $3000–$10,000, and perioperative outcomes (length of stay 1.8–3.6 days; complication rates comparable to traditional pathways) similar to staged care. The supporting evidence is retrospective and derived from small, single-institution, high-volume referral cohorts; no prospective comparative trials or long-term survival data yet exist. Single anesthetic event lung cancer surgery is therefore best regarded as an emerging, resource-intensive care pathway for carefully selected patients at experienced centers rather than an established standard of care, pending prospective, multicenter validation. Full article

Cutaneous T-cell lymphoma (CTCL) is a chronic, generally incurable group of non-Hodgkin lymphomas associated with substantial symptom burden, yet receipt of palliative-intent treatment in this population remains uncharacterized. We conducted a cross-sectional retrospective study of 13,215 patients with CTCL using the National Cancer Database (2004–2023) to evaluate receipt of palliative-intent treatment by sociodemographic and disease characteristics using χ² tests, Wilcoxon rank sum tests, Fisher’s exact tests, and multivariable logistic regression. Only 355 patients (2.7%) received palliative-intent treatment. In multivariable analysis, the strongest factors associated with palliative-intent treatment receipt were regional stage (OR, 3.19; 95% CI, 2.43–4.17) and distant stage (OR, 2.49; 95% CI, 1.86–3.31). Treatment at academic facilities was associated with significantly lower odds of NCDB-defined palliative care receipt (OR, 0.59; 95% CI, 0.47–0.76). Medicare insurance, primary cutaneous CD30+ histology, higher comorbidity burden, head and neck primary site, and more recent diagnosis were also independently associated with receipt of palliative-intent treatment. Sex, race, income, and distance to the facility were not significant. Palliative-intent treatment receipt is markedly low in CTCL despite guideline recommendations supporting early integration. Systematic screening for palliative care needs is warranted, particularly for patients with advanced-stage disease or high symptom burden. Full article

Background: Class imbalance remains a major limitation in artificial intelligence based oral cancer diagnosis, particularly in small clinical image datasets where malignant lesions are underrepresented. Methods: Using a dataset of 3000 mobile-acquired oral cavity images categorized into four diagnostic classes (healthy, benign, oral potentially malignant disorders, and oral cancer), we systematically evaluated the impact of imbalance mitigation strategies on diagnostic performance. Three backbone architectures, EfficientNet, Vision Transformer, and Swin Transformer, were trained under four conditions: raw imbalanced training, random under-sampling, random over-sampling, and medical-safe data augmentation. Performance was evaluated using stratified five-fold cross-validation, and all reported metrics correspond to the mean performance across the validation folds. Results: In multiclass evaluation, augmentation yielded the strongest overall performance, with EfficientNet achieving the highest macro-${\mathrm{F}}_1$ score (0.669 ± 0.024) and area under curve (0.881 ± 0.015). Under clinically oriented binary malignant-risk evaluation (high-risk vs. low-risk lesions), sensitivity reached 0.817 ± 0.030 with EfficientNet, while data augmentation maintained competitive malignant-risk detection across the evaluated architectures. In contrast, random undersampling consistently yielded lower descriptive performance across architectures. Conclusions: These findings indicate that augmentation-based imbalance mitigation is associated with improved multiclass and oral cancer specific performance while maintaining competitive overall discrimination. The results provide practical guidance for developing clinically robust artificial intelligence systems for early oral cancer detection in imbalanced real-world datasets. Full article

Background: Despite the observed association between death anxiety and experiential avoidance, their joint short-term trajectories in patients with newly diagnosed cancer remain unclear. This study aimed to identify joint trajectories of death anxiety and experiential avoidance during early cancer care. Methods: This secondary longitudinal analysis included 266 adults with newly diagnosed cancer recruited at Hunan Cancer Hospital, China, between April and September 2022. Death anxiety and experiential avoidance were assessed using the 15-item Templer Death Anxiety Scale (DAS) and the seven-item Acceptance and Action Questionnaire-II (AAQ-II), respectively, at hospital admission, discharge, and one month after discharge. This interval represented the acute adaptation phase after diagnosis and treatment initiation. Outcome-specific trajectory models informed a fully crossed dual-trajectory model. Results: Participants (mean age, 48.33 ± 11.18 years; 53.8% male) followed three jointly re-estimated declining DAS trajectories (low, 37.3%; moderate, 26.5%; high, 36.3%) and two declining AAQ-II trajectories (low, 70.6%; high, 29.4%). In the dual-trajectory model (entropy = 0.849), the probability of high-AAQ-II increased across low, moderate, and high-DAS trajectories (8.5%, 18.7%, and 58.6%), and 72.3% of the high-AAQ-II trajectory followed the high-DAS trajectory. A high-DAS/low-AAQ-II combination accounted for 15.0%, indicating incomplete correspondence. Conclusions: During early care after cancer diagnosis, high-AAQ-II membership was concentrated in higher DAS trajectories, whereas high-DAS could also accompany low-AAQ-II. Full article

Mucins are a class of highly glycosylated macromolecules that constitute a cornerstone of the gastrointestinal mucosal barrier and play multiple essential roles in maintaining tissue homeostasis. During the progression from normal gastric mucosa through precancerous lesions to gastric cancer and metastasis, the expression profiles, glycosylation patterns, and spatial distribution of mucins undergo systematic and programmatic alterations, a process referred to as “mucin reprogramming.” Recent studies have revealed that this reprogramming is by no means a passive bystander phenomenon accompanying tumorigenesis; rather, it is a central biological event that actively drives malignant transformation, shapes an immunosuppressive microenvironment, and influences therapeutic response. This article aims to systematically delineate the dynamic landscape of mucin expression changes during gastric cancer progression, to provide an in-depth analysis of the underlying molecular mechanisms, and to focus on its clinical value and translational potential in the early diagnosis, molecular classification, prognostic assessment, and targeted therapy of gastric cancer. In addition, this review also discusses recent applications of artificial intelligence in the precise identification of mucin phenotypic features. By integrating the latest research advances, this review seeks to provide new perspectives and a theoretical basis for a deeper understanding of the mechanisms of mucin reprogramming during gastric cancer progression and for the development of novel diagnostic and therapeutic strategies. Full article

¹⁸F-fluorodeoxyglucose (FDG) positron emission tomography (PET)/computed tomography (CT) is widely used for oncologic staging, restaging, and response assessment. Its CT component frequently reveals pulmonary lesions that are not the principal target of the examination. In patients with known malignancy, such lesions may have a higher pre-test probability of malignancy than incidental pulmonary lesions detected in the general population and cannot be reliably characterized by CT morphology or FDG uptake alone. Small lesion size, partial-volume effects, respiratory motion, and low tumor cellularity may render metastases metabolically occult, whereas infectious and inflammatory processes may show intense FDG uptake and mimic malignancy. This review presents a case-based, lesion-by-lesion approach integrating thin-section CT morphology, concordance or discordance between FDG uptake and CT findings, interval evolution, and oncologic and clinical context. Illustrative cases demonstrate PET-occult pulmonary metastases, inflammatory mimics, coexisting infection and metastasis, synchronous or metachronous primary lung cancer, and subsolid nodules representing either atypical metastases or primary lung adenocarcinoma. Subsolid or cavitary morphology, waxing-and-waning interval changes, and low FDG uptake should not prompt premature benign labeling. Systematic evaluation of the CT component, followed by lesion-based integration of imaging and clinical data, is essential for characterizing these lesions and may help reduce both false-positive and false-negative interpretations. Full article

Introduction: Black men experience persistent disparities across the prostate cancer continuum, including inequities in access to survivorship support. This study examined the perceived value, acceptability, and experiences of accessing a multicomponent digital survivorship program among Black men with prostate cancer. Methods: This exploratory mixed-methods study was embedded within the ongoing international Phase 4 implementation trial of the Prostate Cancer Patient Empowerment Program (PC-PEP), a six-month digital intervention integrating exercise, pelvic floor muscle training, nutrition, stress management, psychosocial support, and peer connection. Fourteen self-identified Black participants contributed six-month program evaluation and qualitative data collected through open-ended responses and conference-based focus group discussions. Nine participants (64%) had undergone surgery with or without radiation and/or hormone therapy, four (29%) had received radiation with or without hormone therapy, and one (7%) was on active surveillance or had received no treatment. Quantitative data were summarized descriptively, and qualitative data were analyzed using inductive thematic analysis. Results: PC-PEP was highly valued, with median ratings of 10 (IQR 8–10) for likelihood of recommending the program and 9 (IQR 8–10) for overall usefulness. Among participants with available item-level data, 11/13 (85%) reported lifestyle improvement and 12/13 (92%) endorsed offering PC-PEP as standard care. Qualitative findings identified the value of holistic survivorship support, peer connection, normalization of vulnerability, and support for physical and psychological self-management. Participants also described limited awareness of PC-PEP at diagnosis and reliance on individual clinicians or incidental opportunities to learn about the program. Participants emphasized the need for earlier referral, greater representation, and culturally relevant community outreach. Conclusions: Black men who accessed PC-PEP reported high perceived value and identified benefits across multiple dimensions of survivorship. Their experiences, however, highlighted an important distinction between program availability and meaningful access: participants’ experiences suggest that availability alone may not ensure timely connection to survivorship support. Earlier referral, culturally responsive outreach, and integration of survivorship support into routine prostate cancer care may help close this gap. Full article

Colorectal cancer (CRC) remains one of the leading causes of cancer-related mortality worldwide, largely due to delayed diagnosis. Current screening approaches are limited by invasiveness, cost, and low patient adherence, underscoring the urgent need for non-invasive biomarkers that could complement the existing strategies. Cancer-associated metabolic reprogramming, together with alterations in host–microbiota interactions, is reflected in the urinary volatilome, offering a potential source of candidate biomarkers. In this exploratory, case–control pilot study, urinary volatile organic metabolites (VOMs) were profiled in patients with colorectal cancer (CRC, n = 19) and healthy controls (HCs, n = 17) using headspace solid-phase microextraction coupled with gas chromatography–mass spectrometry (HS-SPME/GC–MS). Univariate and multivariate statistical modelling was applied to characterize disease-associated metabolic patterns. Sixty-seven urinary VOMs were identified, with terpenoids, ketones, phenolic compounds and norisoprenoids representing the predominant chemical classes. Following participant-level analysis and correction for multiple comparisons, 18 VOMs remained statistically significant between the two groups, consistent with metabolic perturbations previously associated with colorectal carcinogenesis, including gut microbial dysbiosis, oxidative stress, lipid peroxidation, chronic inflammation and altered energy metabolism. Orthogonal partial least squares-discriminant analysis (OPLS-DA), validated with participant-level cross-validation and 1000 permutations, revealed a separation between CRC and HC groups, supporting the existence of a disease-associated urinary volatilomic profile. Notably, one participant initially classified as an HC was subsequently diagnosed with metastatic CRC. This participant clustered with the CRC group in an unsupervised analysis performed using the original group label, without knowledge of the later diagnosis, raising the hypothesis, to be confirmed in a prospective cohort, that urinary volatilomic alterations may be detectable before clinical diagnosis. Our findings indicate that urinary volatilomic profiling captures metabolic changes associated with CRC and represents a promising, hypothesis-generating starting point for non-invasive biomarker discovery. Full article

Background and Aims: Hepatocellular carcinoma (HCC) is frequently diagnosed at an advanced stage, and serum alpha-fetoprotein (AFP), the most widely used biomarker for HCC surveillance, exhibits substantial interpatient variability. However, longitudinal AFP patterns preceding HCC diagnosis and their clinical correlates remain incompletely characterized. We aimed to characterize pre-diagnostic AFP trajectories and identify clinical features associated with rising versus non-rising AFP patterns. Methods: We analyzed 529 patients with newly diagnosed HCC at Songklanagarind Hospital, each with at least three serum AFP measurements obtained within five years before diagnosis. Log-transformed AFP values were modeled using latent class mixed models with natural cubic splines and linear fixed and random effects. The optimal model was selected based on Bayesian Information Criterion (BIC), entropy, and clinical interpretability. Multinomial logistic regression and Cox proportional hazards models were used to evaluate associations between AFP trajectory class, baseline characteristics, and overall survival. Results: A two-class natural spline model (df = 3) provided the optimal fit (BIC = 9003). The non-rising trajectory (n = 440; 83.2%) showed stable AFP levels throughout follow-up, whereas the rising trajectory (n = 89; 16.8%) demonstrated exponential increase beginning 18–24 months before diagnosis. Compared to the non-rising group, patients in the rising group were significantly more likely to present with tumors >2 cm (78% vs. 62%; p = 0.009). The rising trajectory was associated with shorter overall survival in univariable analysis (hazard ratio [HR] 1.33, 95% confidence interval [CI] 1.02–1.73; p = 0.033), but not after adjustment for clinical and tumor characteristics, including Barcelona Clinic Liver Cancer stage (adjusted HR 1.01, 95% CI 0.77–1.33; p = 0.920). Conclusions: Two distinct AFP trajectories precede HCC diagnosis. Most patients did not demonstrate a substantial rise in AFP, underscoring the need for complementary surveillance biomarkers. Prospective validation in independent cohorts is required before AFP trajectory-based approaches can be incorporated into HCC surveillance practice. These findings are exploratory and hypothesis-generating rather than a validated clinical prediction tool. Full article

Background: Secondary acute promyelocytic leukemia (sAPL) is a very rare subtype of acute myeloid leukemia that develops following exposure to chemotherapy, radiotherapy, or immunosuppressive agents. The treatment results and survival outcomes of sAPL patients are still not precisely defined. Methods: A search of the Polish Adult Leukemia Group (PALG) database identified 29 cases of sAPL (median age 57 years; 62.1% female) among 437 APL patients (6.7%) diagnosed between 2006 and 2024. Each sAPL case was matched to a de novo APL patient by sex, age, year of diagnosis, and treatment protocol (LPA (Leucemia Promielocítica Aguda) 2005, LPA 2012, or LPA 2017). Results: All sAPL cases occurred following chemo- and/or radiotherapy, most commonly for breast cancer. The sAPL cases demonstrated higher CD15 expression than the de novo APL cases (median 27.6% vs. 7%, p = 0.04). The two groups exhibited comparable complete remission rates (82.8% sAPL vs. 75.9% de novo; p = 0.75) and early mortality rates (17.2% vs. 20.7%, p = 1.0). However, relapse-free survival was significantly shorter in sAPL (median 94.7 months vs. not reached; HR 7.23, 95% CI 1.63–32.02, p = 0.030), whereas overall survival did not differ significantly between groups. Multivariate analysis identified Eastern Cooperative Oncology Group performance status ≥3 and CD15 expression > 20% as independent predictors of inferior survival. Conclusions: These findings suggest that sAPL shares many clinical features with de novo APL but carries a higher risk of relapse, highlighting the need for further prospective studies and the potential implementation of tailored therapeutic strategies. Full article

Triple-negative breast cancer (TNBC) is an aggressive and clinically heterogeneous breast cancer subtype characterized by the absence of estrogen receptor, progesterone receptor, and HER2 overexpression, limited targeted treatment options, early relapse, and frequent development of therapy resistance. Although TNBC often shows initial sensitivity to chemotherapy, durable responses are commonly undermined by the emergence of adaptive resistant cell states rather than solely by fixed genetic mutations. This review synthesizes the role of epigenetic plasticity as a central mechanism that enables TNBC cells to dynamically reprogram transcriptional identity, survive therapeutic stress, and transition between epithelial, mesenchymal, stem-like, immune-evasive, and drug-tolerant persister phenotypes. Key epigenetic mechanisms include aberrant DNA methylation, histone acetylation and methylation, BET/BRD4-dependent transcriptional regulation, EZH2-mediated repression, SWI/SNF-dependent chromatin remodeling, non-coding RNA networks, and three-dimensional genome reorganization. These processes regulate tumor suppressor silencing, DNA-damage repair, epithelial–mesenchymal plasticity, cancer stem-cell maintenance, metabolic adaptation, immune-checkpoint regulation, and minimal residual disease. The review also highlights the translational relevance of epigenetic biomarkers, including DNA methylation signatures, circulating epigenetic markers, chromatin-accessibility profiles, and single-cell epigenomic approaches for diagnosis, prognosis, therapy prediction, and monitoring resistance evolution. Finally, therapeutic strategies targeting epigenetic plasticity are discussed, including DNMT, HDAC, BET, EZH2, KDM, and LSD1 inhibitors, with emphasis on rational combination approaches involving chemotherapy, PARP inhibitors, immunotherapy, and metabolic targeting. Overall, epigenetic plasticity represents both a major driver of TNBC resistance and a therapeutically exploitable vulnerability, provided those future strategies account for tumor heterogeneity, adaptive cell-state transitions, biomarker-guided patient selection, and combination-based treatment design. Full article