Environmental and occupational cancers             No Of Abstract is : 9  
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New insights on non-B non-C hepatocellular carcinoma in mid Delta Region, Egypt   
  Abou El Azm AR1, Yousef M, Mansour N, Awad A, El Dardiry S, Abdel Aziz I.   
  Department of Tropical Medicine and Infectious Diseases, Faculty of Medicine, Tanta University, Tanta, Egypt    
PURPOSE: The rate of hepatocellular carcinoma (HCC) is increasing worldwide, including in Egypt. Hepatitis B (HBV) and C (HCV) viruses are major risks. Non-B non-C HCC was reported in some countries. We investigated non-B non-C HCC-independent risk factors and associated profiles in viral hepatitis endemic region. METHODS: In a consecutive series, 281 patients were diagnosed with HCC and received for management, atTanta University Hospitals, within the past 3 years. Demographic variables and environmental exposures were recorded by direct application of a modified questionnaire. Sera were tested for HCV (antibodies by ELISA and RNA by RT-PCR) and HBV (HBs Ag by ELISA and HBV DNA). Antinuclear antibody, serum copper, and iron were assessed in non-viral HCC. Liver biopsy was performed for HCC diagnosis and grading and liver tissue in all patients by histopathological and immunohistochemical methods to assess HBV and/or HCV etiology. RESULTS: Non-B non-C HCC patients were 13.87% of the total and were associated with multiple risks, predominantly pesticides (100%, p < 0.001) and super phosphate and ammonium sulfate fertilizers (94.87%, p < 0.001) with significant exposure in industry, farming, and residence. Their tumors were mainly solitary, smaller sizes, and of lower alpha-fetoprotein titers. The study showed insignificant increase in prevalence of non-B non-C HCC and had special characters. Multivariate analysis showed significance of pesticides and smoking as independent risks for non-B non-C HCC. CONCLUSIONS: Pesticides and smoking heavy exposure can be considered as primary risks for non-B non-C HCC. Phosphate and ammonium sulfate fertilizers were associations. The study will increase awareness for better prevention and management.      

Do We Are All Susceptible To Cancer Equally   
  Prof of clinical oncology ,ain shams university    
Do We Are All Susceptible To Cancer Equally environmental factors such as smoking,diet, and pollutants play a role in most human cancer. However, new molecular evidence indicates that specific groups it was discovered that there are both genetic and acquired susceptibility in the population to cancer so certain individuals are more gentically prone to cancer of certain environmental carcinogen,,,,so some regularities and proper protection maneuvers are required for a specified groups ,,for a better cancer protection we well review the various causes of individual variation in susceptibility to environmental carcinogens. Most cancer results from the interaction of genetics and the environment . That is, genetic factors by themselves are thought to explain only about 5% of all cancer . The remainder can be attributed to external, “environmental” factors that act in conjunction with both genetic and acquired susceptibility. exposure to environmental carcinogens—tobacco smoke, dietary constituents, pollutants (in the workplace, air, water, and food supply), drugs, radiation, and infectious agents—is theoretically preventable. The two parallel approaches in prevention are, strategies to help individuals modify hazardous lifestyles or use chemoprevention, and , reduction of involuntary exposure to carcinogens, usually through regulation. Both approaches have been stymied by our inability to explicitly address risks to sensitive subsets of the population. we must find a way to pick those who are more prone genetically to the hazardous carcinogenic effect of commen pollutants      

Assessment of genotoxic potential of hydrogen cyanamide using micronucleus assay   
  Ahmad A. El-Ebiary1,*, Arwa A. Abuelfadl1, and Naglaa I. Sarhan2   
  1Department of Forensic Medicine and Clinical Toxicology, 2Department of Histology, Faculty of Medicine, Tanta University, Tanta, Egypt    
Limited reports are available about the effects of exposure to hydrogen cyanamide. It did not stimulate unscheduled DNA synthesis and its genotoxic potential was considered equivocal in vitro. Hence, the current study was carried out using micronucleus (MN) assay to evaluate the in vivo mutagenic potential of hydrogen cyanamide to complement the earlier in vitro mutagenic research work. Thirty rats were randomly assigned into 3 equal groups. Group I rats served as a control. Animals of group II received hydrogen cyanamide in a dose of 10 mg/kg body weight/day, whereas those of group III were given hydrogen cyanamide in a dose of 20 mg/kg body weight/day. All animals were treated by oral gavage, once daily, for 3 months. At the end of the treatment period, 1000 polychromatic erythrocyte (PCE) and 1000 normochromatic erythrocyte (NCE) cells were screened per slide for the presence of micronuclei. The incidence of micronucleated PCE and NCE in both low dose and high dose hydrogen cyanamide-treated groups did not differ from that observed in the control group. The PCE/NCE ratio showed a comparable pattern in all the studied groups. This study found no association between hydrogen cyanamide exposure and genotoxicity in the doses used and under the conditions of this assay.      

Dietary Management of cancer patients   
  Dr. Doaa Fenon   
  Assistant professor of clinical nutrition, Alexandria University    
Dietary management of cancer patients is typically seen during the patients active treatment phase – weight loss, anorexia, cachexia, nausea, vomiting. Long term survival- No advice for patients in terms of diet and lifestyle similar to cardiac rehab or dietary management of diabetes. Dietary management lowers disease mortality. Weight maintenance may lower disease mortality. Moderate exercise may lower disease mortality. The American Institute for Cancer Research “Food, Nutrition, Physical Activity and the Prevention of Cancer: a Global Perspective” The result of an analysis of over 7000 research studies on the link between diet, lifestyle and cancer, and for the first time cancer survivors. www.aicr.org à à “comprehensive global report” à 10 Recommendations, last one specific to survivors. Nutrition Therapy in the cancer patient The primary goal of nutrition therapy is: • Prevention of malnutrition • Prevention of metaboliulteration • Overcome the side effect of the treatment. Side effects from treatment • Nausea • Vomiting • Indigestion/Heartbum • Bloating/Feelings of Fullness • Gas/Flatulence/Cramping • Diarrhea/Constipation • Fluid Retention and Edema      

Retrospective Clinicoepidemiological Study on Lymphoma with Insight to Immunotherapy   
  Marwa Ismail Khalaf Abdelgawad   
  Lecturer of Clinical Oncology, Faculty of Medicine, Assiut University    
Introduction: In Egypt, NHL is the second most common cancer in adults and lymphoma is the most common cancer in children. Therapy for non-Hodgkin's lymphoma has progressed significantly over the past decades . Methods: Retrospective analysis of 113 cases, 36 of them were HL while 77 cases were NHL, in Clinical Oncology Department, Assuit University Hospital in period from (2007-2011) in order to evaluate demographic characteristics and evaluation of the treatment outcome on local control, response to treatment, disease free survival and overall survival. Results: HL treatment is ABVD regimen (97.1%) while (2.9%) were treated with Stanford V as a first line treatment . Non Hodgkin patients were treated with CHOP regimen (91.9%) and small number were treated with CVP (8.1%) as a first line treatment with number of cycles ranging from 2-8 cycles . Total response of Hodgkin lymphoma to first line treatment was 41.2 % and of Non Hodgkin was 56.5% . Recurrence observed in 5.9% in Hodgkin lymphoma and 14.5% in Non Hodgkin lymphoma cases. Median survival was 48 months in Hodgkin lymphoma , 36 months in Non Hodgkin lymphoma and 5- year overall survival 73.52% for Hodgkin lymphoma and 69.35% for Non Hodgkin lymphoma cases. Conclusions:. stage of the disease and complete response to first line treatment are most important prognostic factors. Some monoclonal antibodies trigger the immune system to attack and kill cancer cells,others simply attach themselves to cancer cells, making them easier for the cells of the immune system to find them.      

Spatial Autocorrelation and environmental risk factors of Cancer Incidence Ratios in Middle Delta Counties in Egypt   
  Dr. Dina Abdelhady   
  Faculty of Commerce, Tanta University, Egypt    
In Egypt, breast cancer is estimated to be the most common cancer among females accounting for 37.7% of their total . 44.9% of female cancers in Egypt, Gharbiah. Breast cancer is the most frequent cancer among Egyptian females, The reasons for elevated breast cancer rates remain unknown despite several epidemiological studies that investigated possible environmental risk factors. However, the epidemiology and geographic distribution of breast cancer in Egypt and possible links to environmental carcinogens is relatively less documented . Since the causes of breast cancer are only partially understood, one way to identify environmental factors that might play a role in the etiology of breast cancer is to study the spatial pattern of the disease . Searching for disease clusters in space and time can suggest links to geographical, environmental, or occupational risks, providing a foundation for in-depth epidemiological investigations, including investigating for environmental contaminants and carcinogens at or near where the clusters are located. The combination of statistical modeling and mapping is a powerful tool for visualizing disease risk in a spatial-temporal analysis. Advances in geographic information systems (GIS) enable spatial analytic techniques in public health studies previously not feasible. This study seeks to generate hypotheses regarding environmental causes of breast cancer in Egypt. We examined the spatial patterns of breast cancer to determine whether cancer cases are spatially clustered at the county-level and whether the clustering persisted overtime      

Cancer and Environment   
  Prof. Mohamed Elshanshory   
  Prfofessor of Hematooncology, Pediatrics Department, Faculty of Medicine Tanta University, Egypt    
Human cancer is the consequence of interaction among many factors. Cancer is a complex disease, and a large number of cellular genes have to be implicated in the development of malignancy. It is widely accepted that 80-90% of human cancer may be irrefutable to environmental factors. Acquired genetic abnormalities in multiple genes, perhaps as a result of exposure to environmental factors which can initiate cancer. The hypothesis that chemicals can cause cancer emerges in 18th century, some environmental factors are linked to certain organ affection. Children have many years of life remaining for carcinogenic agent to become manifest and that exposure during childhood may not result in cancer until adulthood. Once modifiable risk factors are known, primary preventive program may be feasible. Pediatric health workers and policy makers must cooperate to detect, restrict, and prevent carcinogenic agents in the environment from reaching to our children and her mothers. Such program whatever the cost will be economic regarding the price of anti- cancer chemotherapy, and the cost that our children pay from their health.      

Aflatoxin as an environmental risk factor attributable to liver cancer in Nile delta   
  Mohamed Sharaf-Eldin 1, Raafat Salah 1, Hanan Hamed Soliman 1, Said Hammad Abdou 2, Sherief abd-elsalam1, Walaa Elkhalawany1   
  1Tropical Medicine & Infectious Diseases, 2Professor of Clinical pathology Tanta University Faculty of Medicine, Tanta, Egypt    
Background and Aim: The burden of hepatocellular carcinoma (HCC) has been increasing in Egypt. This has been attributed to several biological factors (e.g. hepatitis C virus infection) and may be environmental factors (e.g. aflatoxin). The aim of this study was to identify the role of aflatoxin as an environmental risk factor attributable to liver cancer in Nile delta. Methods: This cross sectional study was carried out in tropical medicine department in Tanta university hospital on 40 patients with HCC, 20 cirrhotic patients. Fifteen individuals who were neither HCC patients nor cirrhotic patients, were invited to share in the study, as a control group. All patients and control were evaluated for age, sex, residence, occupation, viral markers, liver functions and serum level of aflatoxinB1. Results: The mean age of our patients was 58.575 ± 9.583 years versus 50.00 ± 8.724 for cirrhotics and 27.8+12.061 for controls. Aflatoxin level in serum was significantly higher in HCC patients when compared to cirrhotics and to controls. HCC was much higher in males than females with male to female ratio 4.7:1. Concerning smoking, 45% of HCC patients were smokers versus 30% only of cirrhotics and 26.67% of controls. DM was diagnosed in 42.5% of HCC cases versus 15% of cirrhotics and 20% of controls. Anti HCV-Ab was present in 95% of HCC cases versus 90% of cirrhotics and 13% of controls. Conclusions: Aflatoxin B1 may play an important role as an environmental risk factor attributable to the occurrence of HCC in the Nile delta area.      

  Prof. Dr. Mona Helmy Shehata   
  Tropical Medicine. Tanta University, Egypt    
Hepatocellular carcinoma (HCC) is the fifth most common cancer in the world and the third most common cause of cancer deaths. HCC, accounting for 90% of primary liver cancer and is a global clinical issue. For improvement in the prognosis of HCC, curative therapy following early detection is important. To this end, it is critical to identify high risk groups for HCC and perform appropriate surveillance in the clinical practice of chronic liver disease In Egypt, HCC is reported in about 4.7% of chronic liver disease * (CLD). El-Zayadi et al in 2005 reported an almost twofold increase in HCC among Egyptian patients with CLD between 1993 and 2003. Since then, HCC was reported as the second cause of cancer incidence- and mortality in men. Therefore, HCC represents an important public health problem in Egypt with increasing incidence uptill now. This currently increased HCC incidence may be the result of a shift in the relative importance of HBV and HCV as primary risk factors. Egypt has the highest prevalence of HCV in the world. Further risk factors were then emerged with great importance. The major risk factors for HCC will be discussed.      


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