To identify and examine evaluation methods and metrics used for specialist cancer nursing. A scoping review of published and grey literature on evaluation approaches for specialist cancer nursing roles and models of care. Comprehensive searches were conducted across CINAHL, Cochrane Library, Medline, PsycINFO and Google Scholar for English-language published and grey literature published between January 2014 and November 2025. Two reviewers independently screened and extracted data. Findings were synthesised narratively and mapped to the Strong Model of Advanced Practice Nursing and Quintuple Aim. Of 3360 records screened, 23 sources met the inclusion criteria: 14 published articles, and 9 grey literature sources (conference abstracts, theses, textbooks). Most sources originated from the USA (n = 12, 52%) or high-income countries (n = 22, 96%), and focused on nurse navigator roles (n = 9, 39%). Five themes emerged in the sources: (1) purpose of evaluation; (2) development of methods and metrics; (3) selection and implementation; (4) data collection approaches; and (5) challenges and considerations. Evaluation was primarily used to demonstrate value and drive quality improvement through pragmatic methods. Metrics varied widely and were concentrated in the Strong Model domains of Direct Comprehensive Care and Support of Systems, with fewer addressing Education, Research and Professional Leadership. Key challenges to evaluation included role variability and lack of standardised tools. Despite the lack of standardised evaluation practices for specialist cancer nursing, the five themes synthesised in this review can guide evaluation of specialist cancer nursing roles and models of care in real-world settings. Opportunity exists for international collaboration to develop a comprehensive, context-sensitive set of metrics, relevant in diverse healthcare settings, that capture both excellence in service delivery and nursing scholarship. What problem did the review address? ○ Specialist cancer nurses perform a diverse range of interventions and roles that are complex in nature, leading to challenges in their accurate evaluation. ○ Effective and efficient approaches to evaluation of specialist cancer nursing roles are crucial to demonstrate their value. ○ A significant body of literature has demonstrated the efficacy of specialist cancer nursing roles and models of care in a research framework; however, evaluation is needed to better understand the impact of translating this evidence into real-world settings. What were the main findings? ○ A scoping review exploring evaluation methods and metrics of specialist cancer nursing revealed five key themes: (1) purpose of evaluation; (2) development of evaluation methods and metrics; (3) selection and implementation of evaluation methods and metrics; (4) methods of data collection; and (5) challenges and considerations. ○ Evaluation of specialist cancer nursing is important, however variation in nurses' roles and responsibilities and lack of standardised measurement tools were key challenges. ○ Evaluation metrics varied widely and were specific to specialist cancer nursing roles; predominantly reported under the domains of Direct Comprehensive Care and Support of Systems, with fewer reported under Education, Research and Professional Leadership. Where and on whom will the research have an impact? ○ Nursing and health service leaders can use the identified themes and subthemes as a framework to guide evaluation of specialist cancer nursing. The predominance of English-language and high-income country evidence limits the global applicability of these findings. ○ Gaps in knowledge can drive the future work of cancer nursing organisations to collaboratively develop a comprehensive list of evaluation metrics that can be contextualised for specific roles across diverse health care settings. ○ Specialist cancer nurses in all roles and models of care should have metrics for Research, Leadership and Professional Leadership to support the scholarship of nursing. ○ Consistent national role definitions, shared competency frameworks and standardised outcome measures should be embedded in policy and commissioning to enable systematic evaluation, appropriate resourcing, and integration into workforce and service planning of specialist cancer nurses. Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews PRISMA-ScR checklist. Employees of a cancer patient advocacy group were involved in the design of the study, interpretation of the data and the preparation of the manuscript. No patients were involved in the conduct of this scoping review.
The International Children's Palliative Care Network (ICPCN) held its 4th international conference in Manila, Philippines (12th-15th November 2025), in partnership with The Ruth Foundation. The conference, 'Milestones & Horizons,' marked ICPCN's 20th anniversary and convened 419 delegates from 49 countries across all World Health Organisation regions to celebrate the progress of children's palliative care (CPC), while identifying priorities for equitable access for the 21 million children with life-threatening and life-limiting conditions. Hosted in the Philippines, it showcased local developments, including the National Children's Hospital Pediatric Palliative Care Unit and community models, catalysing CPC's formal recognition as a specialty by the Philippine Pediatric Society. The conference featured 155 accepted abstracts (63 oral, 26 rapid-fire and 46 posters), 10 keynotes, 5 plenary panels, 7 'Meet the Expert' sessions and 9 workshops on leadership, research, advocacy, spiritual care, touch therapy and equity. Sessions highlighted milestones in system building, service integration, interdisciplinary collaboration and family-informed research, alongside horizons in digital innovation, humanitarian reach and children's voices. Several sessions highlighted significant CPC 'Milestones', focusing on health system strengthening, service integration and diverse multidisciplinary research. Around the theme of 'Horizons', key conference sessions explored future directions such as digital innovation, care in humanitarian settings, interprofessional leadership and amplifying children's voices through co-design and creative therapies. Conference evaluations emphasised the high value of the in-person event with the opportunity for increasing personal motivation, peer support and new collaborations. The 2025 ICPCN conference demonstrated CPC's maturation through interdisciplinary collaboration while catalysing local progress in the Philippines. Critically, the conference demonstrated the irreplaceable value of in-person convening for relationship-building across diverse organisations, creating momentum toward shared goals of universal access and health system integration. Evaluations confirmed this collaborative energy as uniquely motivating, fostering cross-border partnerships and actionable commitments amid constrained resources, climate challenges and humanitarian needs.
Ovarian metastasis from breast cancer has been reported in a substantial number of cases; however, reports that specifically document ovarian metastasis in the setting of hereditary breast and ovarian cancer syndrome remain limited. We describe a woman in her forties with hereditary breast and ovarian cancer syndrome caused by a germline BRCA1 mutation (c.117_118del) and a history of left-sided triple-negative breast cancer, invasive ductal carcinoma, clinical stage T1cN1M0, treated with mastectomy, adjuvant dose-dense epirubicin/cyclophosphamide and paclitaxel, followed by one year of maintenance therapy with olaparib. Two months after completion of olaparib, surveillance imaging identified bilateral ovarian masses with marked fluorodeoxyglucose uptake, peritoneal dissemination, and para-aortic lymph node enlargement, with elevated cancer antigen-125. Diagnostic laparoscopy with bilateral salpingo-oophorectomy revealed yellow serous ascites and multiple peritoneal nodules. Both ovarian tumors showed adenocarcinoma composed of small nests and cords. Sections prepared using the Sectioning and Extensively Examining the Fimbrial End protocol showed no serous tubal intraepithelial carcinoma. Immunohistochemical staining revealed CK7 and GATA3 expression, but no CK20, PAX8, WT-1, AR, ER, PgR, or HER2 expression. These results support a diagnosis of ovarian metastasis from the patient's prior triple-negative breast cancer. Cytologic examination of ascitic fluid was negative for malignant cells. This case highlights that, in patients with hereditary breast and ovarian cancer syndrome and a history of breast cancer who present with ovarian tumors, both primary ovarian cancer and metastatic breast cancer should be considered. Diagnostic laparoscopy with pathologic and immunohistochemical evaluation provides a definitive diagnosis, helps avoid unnecessary cytoreductive ovarian cancer surgery, and supports timely initiation of breast cancer-directed systemic therapy. The online version contains supplementary material available at 10.1007/s13691-026-00869-z.
Implementation of remote robotic-assisted surgery (rRAS) has the potential to significantly improve access to high-quality surgical care for patients worldwide. Advances in robotic systems and telecommunications now enable highly reliable, low latency, and cybersecure connectivity. These technological developments, together with the broader adoption of telemedicine, have driven an increasing interest in the implementation of rRAS. The Clinical Robotic Surgery Association (CRSA) convened a conference to develop international clinical recommendations for rRAS using the Danish Model of Consensus. The society identified five key issue categories and invited a panel of experts to address specific questions for each. Panel members and a jury of 10 unbiased, non-expert in rRAS professionals participated in a day-long conference on November 19, 2025 (Los Angeles, USA). During the conference, participants presented, discussed, and reached consensus on specific guidelines relevant to each category. Immediately after the conference, the jury reviewed and approved the recommended guidelines. Multiple recommendations were approved for each of the following categories: Operating Models, Roles and Responsibilities (2 recommendations), Clinical Pathway (2 recommendations), Emergency Management (8 recommendations), Technical Considerations (5 recommendations), and Medico-legal and Ethical Considerations (4 recommendations). There was consensus that with recent advances in telecommunication and robotic technologies, rRAS can be offered safely and effectively if the identified safeguards are realized. Adoption of rRAS is expected to continue advancing rapidly.
Endoscopic submucosal dissection (ESD) enables en bloc resection of early gastrointestinal cancers and provides specimens suitable for precise pathological risk assessment. However, reporting remains variable for key parameters that determine curative resection and the need for additional treatment, including submucosal invasion depth and breadth, margin status, lymphovascular invasion, tumour budding, differentiation and use of ancillary stains. To develop practical international standards for pathology assessment and reporting of invasive carcinoma in ESD specimens. An international panel of 42 experts, including 28 gastrointestinal pathologists and 14 therapeutic endoscopists from 15 countries, participated in a modified Delphi consensus process. Statements addressed measurement of invasion, margin assessment, staining, specimen handling, prognostic histological features and clinically relevant reporting. 56 recommendations reached consensus across seven domains. The panel recommends using Sm1-Sm3 subclassification only when the muscularis propria is present; otherwise, submucosal invasion depth should be reported in micrometres, rounded to the nearest 100 µm. Submucosal invasion breadth should be reported in millimetres as an adjunct metric for future validation. Margin positivity should be defined as direct tumour contact with the inked surface, supported by standardised pinning, inking, complete embedding and parallel sectioning. H&E remains the baseline stain, with selective immunohistochemistry or elastic stains for equivocal lymphovascular invasion, distorted architecture or difficult margin interpretation. Tumour budding should be reported according to International Tumour Budding Consensus Conference criteria, and differentiation, histological subtype, lymphovascular invasion, perineural invasion and margin status should be integrated into composite risk assessment. These consensus standards provide immediately implementable, synoptic-ready pathology reporting criteria after ESD. By standardising measurement landmarks, margin terminology, ancillary stain use and reporting of adverse histological features, they aim to reduce interinstitutional variability, improve multidisciplinary decision-making and support future validation of risk models in early gastrointestinal cancer.
Bahrain reports the highest age-standardized cancer incidence among Gulf Cooperation Council (GCC) countries, but its oncology research output has not been comprehensively mapped. We profiled four decades of Bahrain-linked cancer publications to describe growth, contributors, collaboration, impact, and gaps. We searched Scopus and PubMed from inception to December 2024 using cancer-related terms combined with "Bahrain". We included articles, reviews, editorials, letters, conference papers, and book chapters. After deduplication, screening, and manual supplementation, 502 publications were analyzed by year, document type, journal quartile, SCImago Journal Rank (SJR), Bahraini authorship and first-author affiliation, geographic scope, study design, citations, and cancer site grouped using the ICD-O (3rd edition). The first indexed paper appeared in 1981. Output was low until 2010, then increased sharply; 77.7% of publications appeared from 2011 to 2024, peaking at 66 papers in 2024. Articles accounted for 69.3% of the outputs, and reviews accounted for 21.7%, with greater diversity after 2010. The Bahrain Medical Bulletin was the most common outlet (20.2%). Salmaniya Medical Complex led in first-author output, followed by Arabian Gulf University and King Hamad University Hospital. Bahraini first authorship was observed in 66.7% of papers, and most studies were conducted exclusively in Bahrain (65.3%), although the proportion of global collaborations increased to 17.0% from 2021 to 2024. Descriptive designs predominated (57%, including 25.5% case reports), whereas analytic studies were uncommon (4.3%). Breast cancer was the most studied site-specific cancer (23.3%), followed by digestive organ cancers (11.4%); 27.1% of the papers addressed "unspecified" cancer. Respiratory and intrathoracic cancers remain persistently underrepresented despite a high mortality burden. Journal quality improved after 2010, reflected by increasing Q1/Q2 representation and higher SJR distributions. The citation peaks from 2014 to 2018 were driven by highly cited multinational collaborative publications. Bahrain's oncology research output has increased more than 30-fold over four decades, with expanding institutional participation and increasing international collaboration. Persistent reliance on descriptive designs and gaps in high-burden cancers-especially lung cancer-highlights priorities for capacity building, targeted funding, and a nationally aligned oncology research agenda for policy action.
Cancer cells increase their uptake and use of glucose to facilitate processes such as proliferation and metastasis development. It may therefore be speculated that the availability of glucose in the blood may influence cancer progression and impact clinical outcomes. This study exploratively investigated if blood glucose levels (HbA1c) were associated with overall survival, in an unselected population representing a real-world group of patients diagnosed with cancer. Between 2012 and 2017 a total of 296 patients diagnosed with lung (n = 99), colon (n = 98) and ovarian (n = 99) cancer were included. The patients were included from three clinical cohorts (the LUCAS cohort study (lung cancer), the REBECCA cohort study (colon cancer) and the Pelvic Mass/GOVEC study (ovarian cancer)) based on a few inclusion and exclusion criteria. HbA1c was measured using a blood sample taken during the course of treatment. Survival analysis was performed using the Kaplan-Meier method and multivariate Cox regression. We observed that lower levels of blood glucose (HbA1c) were significantly associated with improved overall survival across the three different cancer types. In combined univariate analysis including all 296 patients, an HbA1c value < 40 mmol/mol (5.8%) was associated with a 5-year survival of 55.1%, whereas an HbA1c value ≥ 40 mmol/mol (5.8%) was associated with a 5-year survival of 27.0% (P-value < 0.0001). Furthermore, an HbA1c value within the interval (-inf, 30] mmol/mol ((-inf, 4.9%]) was associated with a 5-year survival of 66.7%, with increasing HbA1c intervals gradually correlating with decreased survival (P-value < 0.0001). Multivariate analysis maintained an HbA1c value < 40 mmol/mol (5.8%) as an independent factor with an estimated hazard ratio of 0.64 (95% CI 0.45, 0.91 P-value = 0.013). These results raise the question whether HbA1c could serve as an important prognostic factor across multiple types of cancer, and whether therapeutically controlling the blood glucose level might potentially be beneficial. However, further studies are needed before definitive conclusions can be made.
We present a case of occult apocrine breast cancer in a man presenting with back pain and multiple bone and large liver metastases. The primary tumour was not identified, and the patient was initially considered to have cancer of unknown primary origin. During referral to our hospital, 2 months had passed since the initial consultation, and the prognosis was considered poor. Empirical treatment with carboplatin and paclitaxel was then administered. Histological examination of the liver metastases revealed large cells with eosinophilic cytoplasm, morphologically suggestive of apocrine breast cancer, but no tumour was found in the breast. The diagnosis of occult apocrine breast cancer was confirmed by concurrent immunohistochemical examination of the biopsy tissue sample, revealing androgen receptor positivity, oestrogen receptor negativity, gross cystic disease fluid protein 15 positivity, human epidermal growth factor receptor 2 overexpression, and gene amplification. Carboplatin and paclitaxel treatment resulted in the near-complete remission of liver metastases and reduction of bone metastases. The reduction has still been maintained at 16 months since the symptom onset. Molecular targeted therapy, including trastuzumab, is expected to further extend survival. Male occult apocrine breast cancer is extremely rare, with only one other case reported in the literature. We report the diagnosis and treatment response of this extremely rare case.
Cervical cancer remains the leading cause of cancer-related death among Ethiopian women, second only to breast cancer. Previous qualitative studies have simply listed the barriers and facilitators without showing how the identified barriers interact across different levels to result in low screening coverage despite national efforts. Guided by the socio-ecological model (SEM), we aimed to explore barriers and facilitators influencing cervical cancer screening uptake in Ethiopia focusing on the dynamic interplay between women, their social networks, the health system, the community, and the policy at large. A descriptive qualitative study design was employed among women, male partners, community and religious leaders, service providers, and health officials. The study was guided by the previously published SEM. Focused group discussions (FGDs), in-depth interviews (IDIs), and key informant interviews (KIIs) were conducted, and the audio recordings were transcribed, translated, and analyzed using Braun and Clarke's reflexive thematic analysis, supported by ATLAS.ti version nine software. The entire research team was involved in several rounds of discussion and consensus-building to refine themes and sub-themes. The study was conducted in four zones of the South Ethiopia Region in June 2025. A total of 104 participants were included: 56 women in seven FGDs, 34 in KIIs, and 14 in IDIs. Barriers and facilitators did not act in isolation but interacted dynamically across SEM levels. At the individual level, fear of procedure and symptom-based screening were reinforced by interpersonal barriers, particularly fear of divorce following a positive diagnosis. Institutionally, service integration facilitates, but supply failures and transport costs erode trust. Community-level religious leaders endorse screening, yet prayer-based beliefs override this. Policy-level partnerships enable programs, but weak funding and broken equipment undermine delivery. Policy achievements do not translate into reliable frontline services. According to the findings of this study, the complex interaction of barriers and facilitators across all levels of the SEM underscores the importance of multi-level implementation strategies to achieving treatment follow-up uptake. Mrs Berta Kamprad Cancer research FBKS-2022-24-(432).
One of the most significant clinical challenges in breast cancer is late recurrence, especially in estrogen receptor-positive disease. The biochemical causes of long-term dormancy are still not fully understood, and conventional surveillance frequently lacks sufficient sensitivity to reliably predict relapse. The objectives of this review are to: (1) investigate the molecular connections among immunosenescence, chronic inflammation, and tumor dormancy; (2) critically assess new therapeutic and diagnostic strategies; and (3) pinpoint methodological and translational gaps for further investigation. By combining geroscience and oncologic biology, this narrative review critically summarizes contemporary research on immunological senescence, tumor dormancy, and chronic inflammation published between 2015 and 2025. For preclinical, translational, and clinical research, databases such as PubMed and Scopus were examined, with a focus on mechanistic insights, liquid biopsy technologies, and experimental therapy approaches. Using combinations of phrases like "breast cancer recurrence," "tumor dormancy," "immunosenescence," "inflammaging," "liquid biopsy," and "senolytics," a focused literature search was carried out across PubMed and Scopus for research published between January 2015 and September 2025. Original English-language studies, reviews, and meta-analyses that addressed the molecular, translational, or clinical aspects of immunological aging and dormancy met the inclusion criteria. When preclinical research was pertinent to human pathology, it was included. Non-peer-reviewed commentary, conference abstracts without complete data, and research unrelated to breast cancer were the exclusion criteria. Although causality has not been established, there is evidence that immunosenescence and inflammation may create suitable habitats for dormant micrometastases. While liquid biopsy platforms for detecting minimal residual disease (MRD) provide earlier relapse signals, they have questionable clinical usefulness, analytical limitations, and confounding issues related to clonal haematopoiesis. Senolytics, epigenetic modulators, and "awaken-and-kill" immunotherapies are examples of experimental approaches that show promise but also have unidentified hazards, such as off-target toxicity and unintentional acceleration of metastases. Crucially, the majority of mechanistic insights derive from studies in young murine models, which restricts their applicability to aging human populations. Equity issues remain poorly understood, particularly in environments with limited resources. Rethinking late recurrence as a chronic inflammation and aging ailment offers a unifying theory, but it must be interpreted carefully. Translation necessitates rigorous MRD-linked trial designs, prospective validation in diverse and elderly cohorts, and a methodical assessment of both safety and efficacy. Adopting these strategies too soon could backfire if limitations and confounders are not critically evaluated.
Comprehensive genomic profiling can identify actionable mutations and guide therapy selection in metastatic breast cancer. Tumor mutation burden (TMB) may predict response to immune checkpoint inhibitor (ICI) therapy, but its clinical utility in estrogen receptor (ER)-positive, human epidermal growth factor receptor 2 (HER2)-negative metastatic breast cancer remains unclear. In this case report, we describe a 63-year-old woman with ER-positive, HER2-negative metastatic breast cancer who had exhausted standard treatment options. Comprehensive genomic profiling of the pancreatic metastatic tissue revealed a TMB of 33 mutations per megabase (mut/Mb), consistent with TMB-high status. Based on this result, pembrolizumab therapy was initiated in October 2022. Subsequent imaging demonstrated a complete response, with disappearance of FDG uptake in the pancreatic, renal, and lung metastases on positron emission tomography/computed tomography (PET/CT). Tumor marker levels also normalized, and this response has been maintained as of January 2026. This case highlights the potential utility of TMB-high status as a predictive biomarker for ICI therapy in ER-positive, HER2-negative metastatic breast cancer. Although this subtype is typically considered less immunogenic, TMB-high may identify patients who could benefit from immune checkpoint blockade. Comprehensive genomic profiling should be considered when standard treatments are limited.
The primary objective of comprehensive genomic profiling (CGP) is to identify actionable genomic alterations. We report a case in which CGP performed by liquid biopsy (LB) led to the diagnosis of multiple primary cancers. A 66-year-old man was diagnosed with unresectable esophagogastric junction cancer and received systemic chemotherapy. Initially, all distant metastases disappeared; however, a new liver tumor-first suspected to be a metastasis-appeared and gradually enlarged, while the other lesions remained controlled. CGP by LB, performed after initiation of fifth-line chemotherapy, detected genomic alterations suggestive of hepatocellular carcinoma (HCC). Subsequent liver biopsy confirmed the liver tumor, initially thought to be a metastasis, as a second primary HCC. This case suggests that CGP by LB may provide an opportunity to detect multiple primary cancers. When genomic alterations that are inconsistent with the clinical diagnosis are identified, the possibility of multiple primary cancers should be considered.
The POLE-ultramutated subtype of endometrial cancer is associated with a favorable prognosis and is most frequently presents at an early stage. Even in advanced disease, which is uncommon, available data suggest favorable outcomes and a potentially limited incremental benefit of immunotherapy. We report a case of chemotherapy-resistant, POLE-mutated advanced endometrial cancer that showed a remarkable and durable response to immunotherapy. A 54-year-old woman was diagnosed with stage IVB endometrial cancer (endometrioid carcinoma, grade 3). Despite first-line therapy consisting of paclitaxel plus carboplatin and cytoreductive surgery, the disease progressed. Subsequent doxorubicin plus cisplatin chemotherapy also failed to achieve an objective response. Comprehensive genomic profiling revealed a pathogenic POLE mutation (p.V411L) with a markedly elevated tumor mutational burden of 174 mutations/Mb, while the tumor was microsatellite stable. Pembrolizumab was initiated, resulting in substantial regression of peritoneal metastases and multiple lymph node metastases. Although treatment was interrupted because of immune-related adverse events, disease has remained controlled for more than 2 years after discontinuation. This clinical course suggests that timely comprehensive genomic profiling may provide clinically actionable molecular information to guide treatment modification, even in advanced POLE-mutated endometrial cancer showing chemotherapy resistance. It also highlights that immunotherapy may play an important role in achieving durable disease control in this molecularly defined subset.
Tumor budding (TB) is a pathological hallmark of malignant invasion at the invasive front of colorectal cancer (CRC) and provides a morphologic window into early dissemination. In the International Tumor Budding Consensus Conference (ITBCC) framework, buds are single tumor cells or clusters of up to four cells, graded by hotspot counting to support standardized evaluation. Evidence from histopathology, single-cell profiling, spatially resolved analyses, and functional models links TB to invasion-competent tumor states. TB often tracks partial epithelial-mesenchymal transition, with weakened cell-cell adhesion, E-cadherin loss, altered β-catenin localization, and activation of integrin signaling, cytoskeletal remodeling, and extracellular matrix (ECM) degradation while retaining epithelial features. Spatial/trajectory analyses suggest that budding-rich regions concentrate plastic, stem-like programs biased toward migration and stress tolerance and lie close to intravasation. The TB niche also shows immune and metabolic specialization, with constrained dendritic-cell maturation and antigen presentation, reduced or dysfunctional CD8+ T-cell and NK-cell activity, and enrichment of tumor-associated macrophages and other suppressive myeloid programs. Hypoxia-driven glycolysis, lactate-associated acidification, adenosine signaling, and myeloid lipid-metabolic reprogramming can further stabilize invasive phenotypes and raise the threshold for immune control. Digital pathology and AI-enabled whole-slide analysis can improve scoring consistency and add spatial readouts linking TB patterns to immune contexture and stromal organization. Collectively, TB marks an interface between invasive tumor biology and the local microenvironment with direct relevance for risk stratification and therapeutic tailoring in CRC.
To determine if a pragmatic, conservative approach to managing < 3 cm anterior mediastinal lesions in lung cancer screening (LCS) is safe. 55- to 77-year-old current or former smokers underwent low-dose computed tomography (LDCT) screening. Anterior mediastinal lesions < 3 cm at baseline were managed conservatively with annual LDCT follow-up for up to 2 years. Lesions ≥ 3 cm at baseline, growing during follow-up (based on visual assessment), or demonstrating concerning radiological characteristics were referred for further assessment. Outcomes for all anterior mediastinal lesions were assessed using follow-up LDCT images, electronic health records and the national cancer registry. Descriptive frequencies were calculated for all reported outcomes. The baseline prevalence of anterior mediastinal lesions was 0.7% (n = 91/12,961). Among 54 participants with < 3 cm lesions who underwent annual LDCT follow-up, 74.1% (n = 40/54) completed 2 years of surveillance, while 26.9% (n = 14/54) required further assessment due to interval growth. Four participants with growing lesions were diagnosed with thymoma following surgery, and one required adjuvant radiotherapy for an R1 resection margin. Among all participants with anterior mediastinal lesions, 16 underwent surgical resection, resulting in eight thymoma diagnoses. The benign resection rate was 50%. No thymic or anterior mediastinal malignancies have subsequently been diagnosed among participants with < 3 cm lesions who completed surveillance within the study over a median follow-up of 1997.5 days. Screen-detected anterior mediastinal lesions < 3 cm at baseline without concerning radiological characteristics can be managed conservatively with annual LDCT follow-up. Referral for further assessment only in the event of interval growth does not appear to compromise clinical outcomes. Question No standardised approach for managing anterior mediastinal lesions identified incidentally through lung cancer screening currently exists. We aimed to determine if utilising a 3 cm baseline diameter referral threshold for screen-detected anterior mediastinal lesions is safe. Findings 74% of < 3 cm anterior mediastinal lesions remained stable over two annual screening rounds and did not require a secondary care referral. Four (out of 14) individuals with growing lesions during follow-up were diagnosed with thymoma, and one required adjuvant radiotherapy for an incomplete resection. Clinical relevance Utilising a 3 cm baseline referral threshold is safe and may improve the efficiency of large-scale, population-based LCS by reducing referrals to secondary care.
Fertility-sparing treatment is a viable treatment option for selected patients with endometrial or ovarian cancer. However, its use in synchronous endometrial and ovarian cancer (SEOC) remains rare, and standardized treatment strategies have yet to be established. We report the case of a 26-year-old woman diagnosed with SEOC, characterized as grade 1, stage IA endometrioid carcinoma of both the endometrium and ovary. Genetic analysis ruled out hereditary cancer syndromes, including Lynch syndrome. The patient was treated with medroxyprogesterone acetate for 26 weeks, after which histological evaluation confirmed complete remission. She subsequently achieved two spontaneous pregnancies, both resulting in uncomplicated vaginal deliveries. To our knowledge, this is the fifth reported case of childbirth following fertility-sparing treatment for SEOC and the first involving two successful deliveries.
To compare the perioperative outcomes of a novel laparoscopic-like 3-arm + 2-port and traditional 4-arm + 1-port models in robot-assisted distal gastrectomy with Billroth II reconstruction in patients with resectable, non-metastatic gastric cancer. This randomized controlled trial included patients with resectable, non-metastatic gastric cancer who underwent robot-assisted distal gastrectomy with Billroth II reconstruction with Braun anastomosis and D2 lymphadenectomy. Patients were randomly allocated into two groups based on trocar port placement: traditional 4 + 1 and novel laparoscopic-like 3 + 2 models, using a computer-generated stratified blocked randomization sequence. Outcome measures included operative times, intraoperative blood loss, lymph node yield, postoperative outcomes, and operating room costs. A total of 195 patients were included: 98 in the 3 + 2 group and 97 in the 4 + 1 group. The total operative time was significantly shorter in the 3 + 2 group than in the 4 + 1 group (207.14 ± 22.214 vs. 221.38 ± 26.689 min, p < 0.001). Subsequently, significant reductions in the regional and non-operative times, including omentectomy, stations 4sb, 6, 5/12, 11p/8a/7/9, and 1/3 lymph node dissection, robotic arm docking and switching, and target organ exposure times were also demonstrated in the 3 + 2 group. Significantly more lymph nodes were harvested from station 4sb in the 3 + 2 group (5.26 ± 1.431 vs. 4.70 ± 1.393, p = 0.007). Operating room costs were also significantly lower in the 3 + 2 group (CNY 15,140.56 ± 2,712.21 vs. CNY 18,650.03 ± 1,497.41, p < 0.001). This novel 3 + 2 laparoscopic-like model represents a technically viable and economically advantageous alternative to robot-assisted distal gastrectomy for patients with gastric cancer.
Esophagorespiratory fistula is associated with a poor prognosis in patients with esophageal cancer, which may cause lung abscess and respiratory deterioration. Here, we report our experience when facing challenges in managing a case of advanced esophageal cancer with esophagorespiratory fistula complicated by a large lung abscess. A woman in her 60s visited a nearby clinic complaining of fever and cough. She was initially diagnosed with lung abscess and treated with oral antibiotics. However, because of a poor clinical response, she was referred to our hospital for further examination and treatment. Computed tomography (CT) revealed an esophageal tumor with multiple mediastinal lymphadenopathies and mediastinal emphysema. She was suspected of having esophageal cancer, and upper gastrointestinal endoscopy and esophagography revealed a circumferential Type 3 tumor lesion extending 28-38 cm from the incisors, with fistula formation in the lung abscess. We inserted a double-elemental diet tube for drainage and enteral feeding, followed by CT-guided drainage of the lung abscess and placement of an esophageal stent. The inflammatory marker levels improved, and she was able to resume oral intake and was discharged. Subsequently, chemoimmunotherapy with 5-fluorouracil, cisplatin, and pembrolizumab was initiated. However, before starting the second chemotherapy course, the elevation of inflammatory markers was remarkable, and CT revealed reoccurrence of fistulas. The fistula was likely caused by shrinkage of the primary lesion. Despite intensive treatment, the patient's general condition deteriorated because of airway obstruction caused by progressive lymphadenopathy, and she died 4 months after the initial presentation.
Curative-intent resection of colorectal cancer (CRC) liver metastasis (CRLM), combined with perioperative chemotherapy, is the standard of treatment for selected patients. However, accurately predicting which patients will benefit from this strategy remains challenging. Circulating tumour DNA (ctDNA) has emerged as a promising non-invasive biomarker for detecting minimal residual disease and predicting prognosis. This study aims to evaluate the prognostic value of ctDNA in patients with CRC undergoing surgery for CRLM. CRC patients undergoing LIver curative-intent MEtastasis Surgery is a prospective multicentre, observational cohort study designed to enrol 232 patients with upfront or potentially resectable CRLM. All patients will receive standard-of-care treatment. Serial blood samples will be collected at multiple time points: before chemotherapy (baseline, if applicable), before surgery, after surgery and during follow-up. The primary objective is to assess the association between preoperative ctDNA status and disease-free survival. Secondary objectives include evaluating ctDNA dynamics over time, exploring associations with clinical and pathological features and identifying prognostic factors for recurrence and survival. ctDNA will be analysed using targeted next-generation sequencing and digital droplet PCR. Outcomes will be assessed using Kaplan-Meier survival analysis, Cox proportional hazards models and multivariable regression modelling. This protocol was approved by the Comités de Protection des Personnes Ouest-I Ethics Committee (N°2022-A02593-40) on 31 January 2023. Study findings will be disseminated through peer-reviewed publications and relevant national and international conference presentations. This study was registered in ClinicalTrials.gov (NCT05627681).
Cross-country disparities in access to guideline-recommended early breast cancer care persist across Europe. PORTRAIT is a clinician-reported, cross-sectional access study mapping availability and state reimbursement of key services across the early breast cancer pathway. A 49-item survey covering diagnostics, pathology and genomics, systemic therapy, surgery, radiotherapy, and supportive care was emailed from June to September 2024 to multidisciplinary teams at one expert breast centre in 42 European countries. Respondents provided a consensus perspective on service availability and reimbursement. Descriptive proportions with full, partial, or no access were calculated. Thirty-nine countries responded (93%). Core diagnostics were widely available, but gaps persisted: MRI-guided biopsy was absent in 29% of countries and vacuum-assisted biopsy was fully reimbursed in 66%. Genomic assays were unavailable in 14% and not fully reimbursed in 35%. Public funding gaps were reported for PARP inhibitors (33%) and CDK4/6 inhibitors (26%). Immediate implant-based reconstruction and biological meshes lacked reimbursement in 21% and 33%, respectively. Despite broad availability of hypofractionated radiotherapy, 38% of countries still used per-fraction reimbursement. Psycho-oncology was limited in 35%, fertility preservation in 46%, and patient-reported outcome measures absent in 43%. Basic services are nearly universal, but gaps persist in advanced imaging, molecular testing, targeted therapies, radiotherapy reimbursement, reconstructive/oncoplastic surgery, and survivorship care. PORTRAIT identifies practical targets for policy audit, reimbursement alignment, and resource stewardship. Findings reflect clinician perspectives from expert centres, potentially representing best specialist care rather than average national care, and are not population-representative estimates or direct measures of patient outcomes.