Abstract Normal cells must become cancer-enabling before anything else occurs, ac cording to latest literature. The goal in this mini-review is to demonstrate special tetraploidy in the enabling process. This we have shown from genomic damage, DDR (DNA Damage Response) activity with skip of mitosis leading to diploid G2 cells at the G1 border in need of chromatin repair for continued cell cycling to the special tetraploid division system. In several studies specific methylation transferase genes were activated in normal human cells in tissue fields, containing different cell growth stages of the cancerous process. His tology studies, in addition to molecular chemistry for identification of onco genic mutational change, were a welcome change (see below). In a study on melanoma origin, DDR also showed arrested diploid cells regaining cycling from methylation transferase activity with causation of 2n melanocytes transforming to 4n melanoblasts, giving rise to epigenetic tumorigenesis enabled First Cells. Such First Cells were from Barrett’s esophagus shown to have inherited the unique division system from 4n diplochromosomal cells, first described in mouse ascites cancer cells (below). We discovered that the large nucleus prior to chromosomal division turned 90˚ relative to the cy toskeleton axis, and divided genome reductive to diploid, First Cells, in a perpendicular orientation to the surrounding normal cells they had origi nated from. This unique division system was herein shown to occur at me tastasis stage, implying activity throughout the cancerous evolution. Another study showed 4-chromatid tetraploidy in development to B-cell lymphoma, and that such cancer cells also proliferated with participation of this unusual division system. Such participation has long been known from Bloom’s inhe rited syndrome with repair chiasmas between the four chromatids, also an in vitro observation by us. Our cytogenetic approach also revealed that they be lieved mitotic division in cancer cells is wrong because such cell divisions were found to be from an adaptation between amitosis and mitosis, called amitotic-mitosis. Amitosis means division without centrosomes, which has long been known from oral cancer cells, in that MOTCs (microtubule orga nizing center) were lacking centrioles. This observation calls for re-introduction of karyotype and cell division studies in cancer cell proliferation. It has high probability of contributing novel approaches to cancer control from screen ing of drugs against the amitotic-mitotic division apparatus.

Abstract Introduction: The decision to stop anti-cancer treatment is fraught with many challenges for the oncologist, the patient, and their caregivers. This re view examines the special considerations surrounding the decision to cease chemotherapy in terminally ill cancer patient. Methods: A comprehensive li terature search was conducted to find relevant publications on chemotherapy cessation. A total of 2700 records were retrieved and 141 were identified as eligible for inclusion in this review. Results: Palliative chemotherapy does not achieve the goal of tumor-related symptom reduction for patients who have experienced progressive disease with more than two prior lines of chemothe rapy. ECOG performance status is a crucial predictor of response to therapy and chemotherapy-related complications. Challenges to stopping chemothe rapy at the end of life are multifactorial and are both patient and physi cian-driven. Racial, ethnic, and income-based disparities are seen in the tim ing and quality of end-of-life conversations offered by physicians to their pa tients. Conclusions: The decision to cease chemotherapy is one that should be approached with careful consideration and accurate information. Clear communication, compassion and empathy are important components to the therapeutic relationship. Early involvement of palliative care and clear con versations about prognosis and the expected utility of further chemotherapy is essential to conduct the best possible care for cancer patients at the end of life.

Abstract Gamma radiation exposure and physical inactivity occur in medical radio therapy patients and astronauts resulting in substantial deterioration of their health. At the molecular level, the radiation triggers elevated markers for DNA double-strand breaks and tumorigenicity. Cell stasis is a potential phe nomenon associated with low physical activity in recovering cancer patients and astronauts. This preliminary study assessed parameters of stasis and gam ma radiation on human adipose stem cells (ADSCs) that have important re generative functions for the body. A prototype pharmaceutical formulation (PF) was tested to prevent and reverse the effects of radiation and stasis. ADSCs were subjected to short-term (1 - 5 days) and longer-term (8 - 25 days) stasis and radiation with a combined total exposure of alpha, beta and gamma radi ation measured at 455 microSv/hr on the Geiger counter. Cell health markers were grouped for characteristics of cellular health (annexin, H2A.X, NO, ROS) and tumorigenicity potential (P13, Ki67, MAPK) that were measured with flow cytometry. Results showed PF to improve cell health in days 1 - 5 compared to stasis (p = 0.01) and radiation (p = 0.02), and PF reduced tumo rigenicity compared with stasis (p = 0.018) and radiation (p = 0.03). For longer exposure (8 - 25 days) PF improved cellular health compared with sta sis (p = 0.038) and showed a non-significant trend for decreasing radiation effects (p = 0.07). There was decreased tumorigenicity compared with stasis (p = 0.003) and radiation (p = 0.005). This preliminary evaluation of the PF showed it to have 88% (66/75) positive assay results (p < 0.00001 Chi-square) indicating three promising beneficial effects: 1) prevent cell/DNA damage, 2) reduce cancer risk, and 3) recover damaged and precancerous stem cells. The PF could have important applications for medical radiotherapy patients, as tronauts and future space mining personnel. PF reduced carcinogenesis and DNA damage of stem cells by approximately 50% from radiation that was the microSievert equivalent of 4 months on board the international Space Station.

Abstract Objective: The objective is to explore the effects of different surgical methods retroperitoneal laparoscopic radical nephrectomy (RLRN) and open radical nephrectomy (ORN) on the number of circulating tumor cells (CTC) in the pe ripheral blood of patients with renal cancer. Methods: The clinical data of 63 patients in the Department of Urology, Affiliated Hospital of Chengde Medi cal College who underwent radical surgery for renal cancer were divided into CTC positive group (18 cases of open surgery and 16 cases of minimally inva sive surgery) and CTC negative group (14 cases of open surgery), 15 cases of minimally invasive surgery), overall group (32 cases of open surgery, 31 cases of minimally invasive surgery). Observe the changes in the number of CTC 1 week before operation and 1 week after operation. Results: In the positive group, whether it was open surgery or minimally invasive surgery, the post operative CTC level of patients was significantly reduced (P < 0.05). In the negative group, the CTC changed significantly after minimally invasive sur gery (P < 0.01), and the CTC level changed indistinctly after open surgery (P > 0.05). In the overall group, both open and minimally invasive surgery CTC decreased significantly, and the difference was statistically significant (P < 0.05). Conclusion: The two different surgical methods can reduce the level of CTC, but compared with ORN, RLRN can significantly increase the num ber of postoperative CTC. Patients in the CTC-negative group may be less suitable for minimally invasive surgery. CTC levels have certain potential in the selection and guidance of treatment modes for patients with renal cell carcinoma (RCC).

Abstract Introduction: Male breast cancer is rare; representing 1% of breast cancers and less than 1% of all male neoplasia worldwide. We here analyzed the clinical, histological, therapeutic and prognostic characteristics of male breast cancer in Bamako, Mali. Patients and methods: A retrospective descriptive study was conducted on 14 male patients with breast cancer who visited two university hospitals in Bamako (Hospital Gabriel TOURE and Hospital du Point G) in Mali, from January 2005 to December 2018. Results: Male breast cancer represented 0.63% of all breast cancers and 0.23% of all male cancers. The following was observed: the mean age of 53 years (range: 23 - 82); a family history of cancer in 2; breast pain in 9; the average time to consultation of 8 years (6 -24); gynecomastia found in 1; the tumor palpable in all 14 (size of 5 cm [3 -10]); ulceration in 5. The most common histological type was non-specific infiltrating carcinoma with 92.8%. SBR II grade was found in 78.5% of cases. Of 8 patients with immunohistochemistry, hormone receptor positive was in 13 and Her2 positive was in 5. Metastases were found in 4, 2 pulmonary and 2 hepatic. Treatment: Neoadjuvant chemotherapy in 21.4%; radical surgery in 13 cases; surgery + radiotherapy in 2; surgery + hormonal therapy in 4. After an average follow-up of 36 months, 1 patient developed a lung metastasis and another patient had a lymph node recurrence. Conclusion: Male breast cancer was detected at relatively later stages. Physicians must be aware of this condition.

Abstract Background: Surgery is the treatment for early-stage cervical cancer. Radio chemotherapy is used in the treatment of locally advanced stages. But the choice of treatment can be difficult. Objective: The objective of this work was to evaluate the therapeutic aspects of cervical cancer in the early stages IA to IIA in the oncology department of A Ledantec Hospital in Dakar. Patients and methods: This was a descriptive retrospective study, from January 2015 to December 2020, in the oncology department of A Ledantec Hospital, including all the patients who had been treated for early-stage invasive cervical cancer. Results: We included 28 patients. The average age was 49.54 years old. There were 11 patients (39.3%) with a stage ≤ IB1. Surgery was the first in 14 patients (50%). The initial approach was a midline supra and subumbilical laparotomy. The surgery was R0 in 65.22%. Postoperative complications were found in 4 patients including 1 case of operative wound suppuration, 1 case of dysuria, 1 case of postoperative eventration and 1 case of rectovaginal fistula. Concomitant Radio chemotherapy was neoadjuvant in 7 cases (25%), adjuvant in 14 cases (50%). The chemotherapy was neoadjuvant in 09 cases (56.25%) and adjuvant in 7 cases (43.75%) with minor toxicities. We had recorded 2 deaths. Conclusion: The treatment of the early stages of invasive cervical cancer is based on surgery. Neoadjuvant treatments may be useful in particular situations.

Abstract Cancer patients develop cachexia due to systemic inflammation, negative protein and energy balance. Esperer Onco Nutrition (EON) has come up with innovative nutritional supplements (EON Therapy) that help patients take the rigours of cancer therapy thereby improving prognosis and Quality of Life (QoL). This Post-marketing surveillance study was undertaken on 38 volunteers to assess the impact of EON therapy on cachexia and QoL of patients undergoing curative treatment. Body weight and biochemical parameters of the volunteers were recorded at each visit. Volunteers were assessed using ECOG Scale and Malnutrition Screening Tool (MST) to assess impact of nutritional supplements on QoL. Weight loss was observed in most of the patients for first two visits but the patients gained weight over subsequent visits and average weight at end of the study was higher than initial weight. At the end of study 22 of 38 volunteers gained weight and 7 volunteers maintained initial weight. The biochemical parameters either showed improvement or remained same. The QoL analysis indicated a marked improvement in physical wellness and nutritional status and no adverse effects were reported. In conclusion, the study underlines importance of research based on nutritional supplements for cancer patients for better disease management and prognosis.

Abstract Objective: To investigate the short-term efficacy of laparoscopic radical resection of right-sided colon cancer with two different surgeon positions and trocar placements. Methods: The data of 78 patients who underwent laparoscopic radical resection of right-sided colon cancer between January 2018 and August 2019 were retrospectively analysed. The surgical method was selected by the patients. The patients were divided into two groups according to the surgeons’ positioning habits and trocar placements. The group with the lead surgeon standing between the patient’s legs had 35 patients, and the group with the lead surgeon standing at the left side of the patient had 43 patients. The operation time, intraoperative blood loss, postoperative anal gas evacuation time, postoperative urinary catheter indwelling time, postoperative hospital stay, C-reactive protein (CRP) level on the first day after surgery, and postoperative pathological data and complications were compared between the two groups. Results: All patients underwent the laparoscopic radical resection of right-sided colon cancer, none converting to laparotomy. No significant difference (P > 0.05) in intraoperative blood loss (57.6 ± 21.3 ml vs 60.2 ± 35.3 ml), postoperative anal gas evacuation time (3.5 ± 1.1 d vs 3.8 ± 1.3 d), postoperative urinary catheter indwelling time (2.6 ± 1.3 d vs 2.4 ± 1.2 d), postoperative hospital stay (7.1 ± 1.8 d vs 7.5 ± 2.1 d), or CRP level on the first day after surgery (54.7 ± 9.6 mg/L vs 53.9 ± 8.2 mg/L) was detected between the two groups. The operation time was shorter in the group with the lead surgeon standing between the patient’s legs (185.2 ± 25.6 min vs 196.2 ±19.7 min) (P < 0.05). The two groups did not differ significantly in the tumour length (4.2 ± 1.3 cm vs 3.9 ± 1.5 cm), number of dissected lymph nodes (27.5 ± 11.6 vs 25.1 ± 15.4), pathological type, or postoperative pathological tumour-node-metastasis stage (P > 0.05). No patients died or had anastomotic fistula during their postoperative hospital stay, and the incidence of postoperative complications did not differ between the two groups (22.9% (8/35) vs 23.3% (10/42); P > 0.05). Conclusion: Under the principle of radical resection, the surgeon should adopt the most suitable standing position and trocar placement according to the specific situation. If the surgeon stands between the patient’s legs, this might shorten the operation time and promote a smoother surgery.

Abstract In vitro 3D cancer spheroids (tumoroids) exhibit a drug resistance profile similar to that found in solid tumors. 3D spheroid culture methods recreate more physiologically relevant microenvironments for cells. Therefore, these models are more appropriate for cancer drug screening. We have recently developed a protocol for MCF-7 cell spheroid culture, and used this method to test the effects of different types of drugs on this estrogen-dependent breast cancer cell spheroid. Our results demonstrated that MCF-7 cells can grow spheroid in medium using a low attachment plate. We managed to grow one spheroid in each well, and the spheroid can grow over a month, the size of the spheroid can grow over a hundred times in volume. Our targeted drug experimental results suggest that estrogen sulfotransferase, steroid sulfatase, and G protein-coupled estrogen receptor may play critical roles in MCF-7 cell spheroid growth, while estrogen receptors α and β may not play an essential role in MCF-7 spheroid growth. Organoids are the miniatures of in vivo tissues and reiterate the in vivo microenvironment of a specific organ, best fit for the in vitro studies of diseases and drug development. Tumoroid, developed from cancer cell lines or patients’ tumor tissue, is the best in vitro model of in vivo tumors. 3D spheroid technology will be the best future method for drug development of cancers and other diseases. Our reported method can be developed clinically to develop personalized drugs when the patient’s tumor tissues are used to develop a spheroid culture for drug screening.

Abstract Background and Aim: Primary testicular lymphoma (PTL) is a rare form of extranodal non-Hodgkin’s lymphoma. It represents for 1% - 2% of non-Hodgkin’s lymphoma, and mostly affects the elderly. We describe an interesting case of PTL managed by a combined multimodal approach with a review of the literature. Case Presentation: Patient aged 56 years, consulted for an increase in the volume of the right testicle without associated pain, all evolving in the context of a slight decline in general condition. Clinical examination revealed a large painless mass in the right scrotal bursa. A scrotal ultrasound showed a right intra-testicular mass. The patient had undergone inguinal orchiectomy. Pathological analysis showed diffuse large B-cell lymphoma of the testis. Whole-body 18-fluorodeoxyglucose positron emission tomography (18-FDGPET-CT) showed no suspicious hypermetabolism. Lumbar puncture did not reveal malignant cells in the cerebrospinal fluid (CSF). The patient then received 6 cycles of chemotherapy according to the R-CHOP protocol (Rituximab, Cyclophosphamide, Doxorubicin, Vincristine, and Prednisone) and 2 cycles of intrathecal methotrexate. After chemotherapy, scrotal radiotherapy at a dose of 30 Gy was delivered. The evolution was marked by the death of the patient six months after the end of the scrotal radiotherapy following a diffuse lymph node relapse with a profound alteration of the general state. Conclusion: The treatment depends imperatively on the stage of the disease. The therapeutic approach is multimodal and combined based on orchiectomy, systemic and intrathecal treatment and scrotal radiotherapy. PTL is an aggressive malignant with a poor prognosis. Randomized trials are needed to define a better therapeutic strategy.

Abstract Background: The coronavirus disease 2019 (COVID-19) pandemic has led to the imposition of a strict nationwide lockdown, which has affected all aspects of healthcare, including the delivery of standard care to cancer patients. Objective: The aim of this study was to report the impact of the COVID-19 pandemic on patient attendance at a radiotherapy department during the lockdown period. Methods: This is a retrospective analysis of all patients planned for radiotherapy at the National Institute of Oncology in Rabat. Patient compliance to radiotherapy during the lockdown period was measured and compared with that during the same period in 2019. Data regarding age, sex, tumor site and treatment-related factors were analyzed and compared with those during the same period in 2019. Results: We included a total of 650 patients, 348 patients in Group A (control period) and 302 in Group B (lockdown period). Patients were aged between 30 and 70 years in about 85%,with a female predominance in both groups. The most common sites of occurrence of cancer were breast, female reproductive organs and the head and neck. A 13.2% reduction in the number of treated patients and a 16.9% reduction in the number of sessions was observed. There was a significant decrease in the proportion of breast cancers treated (P = 0.03). The proportion of patients receiving palliative radiotherapy increased significantly (P = 0.03), with a significant increase in the use of single-fraction palliative radiation therapy (P = 0.006). There was a significant difference in the compliance to radiotherapy during the lockdown period (92.3% versus 86.4%, P = 0.01); delays and interruptions were due to travel restrictions (58.5%) and fear of contamination (29.2%). No patient was tested positive for COVID-19 during radiotherapy during the study period. Conclusion: We observed a decrease in the number of treated patients during the lockdown despite our efforts to maintain the treatment routine. A significant decrease in radiotherapy compliance was noted during the lockdown. The proportion of irradiated breast cancers decreased significantly during the lockdown while patients treated with palliative intent increased significantly, with increased use of single fraction palliative radiotherapy.

Abstract Background and Objective: Bladder cancer frequently occurs between the ages of 50 years and 70 years and rarely occurs before the age of 40 years. It accounts for 1% - 4% of all cases of cancer. This study focuses on the clinical, etiological, histological, therapeutic, and evolutive profiles of patients with bladder cancer aged less than 45 years. Materials and Methods: This retrospective study was carried out over seven years (from January 2014 to December 2020) on 15 patients below 45 years of age who were being treated for bladder cancer. The diagnosis was made in all patients via cystoscopy and abdominal computerized tomography, while the nature, grade, and degree of infiltration were determined via endoscopic resection and pathology. Results: The mean age of the 15 patients in this study was 34.4 ± 5.19 years. In 86.6% of cases, the patients had macroscopic hematuria as the main presenting complaint. Twelve patients (80%) had bladder tumors that did not infiltrate the muscle. These patients were followed up clinically. In 86.6% of cases, there was a single tumor with a mean diameter of 2.53 cm. In four patients (26.6%), mitomycin was started early. The overall rates of tumor recurrence and progression were 26.6% and 20%, respectively. Conclusion: Bladder cancer also occurs in young people, with similar clinical and epidemiological profiles as exists in elderly patients. The prognosis of bladder cancer in young people depends on the treatment method chosen by the physician.

Abstract Primary breast lymphomas are rare. They are defined by the involvement of one or both breasts. This is the first site affected or mainly affected with the exception of ipsilateral axillary involvement. Due to the absence of specific clinical and radiological signs, the diagnosis is confirmed by histology. The most frequent entity remains diffuse large B-cell lymphomas. The place of surgery remains exclusive in establishing the initial diagnosis. Anthracycline based chemotherapy with or without Rituximab remains the gold standard in the therapeutic arsenal. We present the case of a 42-year-old woman with no surgical history; nulliparous; followed in nephrology for chronic renal failure, received as an outpatient for a nodule in the left breast in a context of dyspnea. This is a nodule discovered incidentally during a routine examination. Clinical examination of the left breast found nipple retraction without ulceration; a mass 7 cm in diameter located in the left upper outer quadrant. Breast ultrasound and mammography suggest a suspected lesion of malignancy. After a percutaneous micro biopsy; the histological study confirms the diagnosis of a large B-cell lymphoma of the left breast. A TAP CT scan is performed as part of the extension assessment. Chemotherapy based on R-CHOP with local radiotherapy is decided in CPR.