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PubMed1988

The toluidine blue test: an aid in the diagnosis and treatment of early squamous cell carcinomas of mucous membranes.

Early diagnosis of squamous cell carcinoma on mucosal surfaces can be lifesaving, and examination of mucosal sites should be included in the general dermatologic examination. Difficulty in distinguishing the erythematous lesions appropriate for biopsy and treatment can be partially overcome with the use of a supravital stain well known to oral surgeons. This paper recommends the addition of this test to the dermatologist's armamentarium. Five patients with mucosal in situ squamous cell carcinoma were treated. Three had squamous cell carcinoma of the glans penis, one of the vulva, and one of the oral mucosa. In all patients the toluidine blue test was helpful in the diagnosis of subclinical malignant epithelium, in the delineation of the lesion borders as a guide for surgery, and, postoperatively, in the detection of early disease recurrence. The toluidine blue test, which is a simple procedure accessible to all dermatologists, can help achieve early diagnosis and effective treatment of mucosal squamous cell carcinoma.

Acetates↗
PubMed1971

Cancer in Chiang Mai, North Thailand. A relative frequency study.

The relative frequency of histologically diagnosed cancer at the Chiang Mai Medical School in North Thailand in 1964-67 inclusive is examined.Most of the 1877 cancers seen are in Thais (males, 927; females, 908), the remainder arising in Chinese (males, 21; females, 12), Hill People (males, 6; females, 1) and others (females, 2). The cancers in Thais are presented by site, sex and 10-year age-group together with the relative frequency (crude and corrected for age).In Thais, the outstanding finding is the extraordinarily high frequency of cancer of the hypopharyngeal-laryngeal region in both sexes (males, 18.4 per cent; females, 3.4 per cent). This may be associated with the smoking of a local variety of the cigar called "keeyo" This cigar, smoked in the usual manner, contains approximately equal quantities of home-grown, sun-dried, Thai tobacco and the chopped bark of the "koi" tree (Streblus asper). In women, who also smoke "keeyo", the frequency of hypopharyngeal-laryngeal cancer is unusually high by occidental standards. There is no sex difference in the frequency of bronchial cancer (4 per cent).In males cancer of the penis, in second rank (6.6 per cent) is much more frequent than cancer of the prostate and testis combined. Stomach and skin cancers (ICD 191) are in third place (each 5.7 per cent).In females the most frequent cancers are cervix uteri (19.8 per cent), breast (8.8 per cent) and skin (ICD 191) (6.1 per cent). Cancers of the lip and skin of the head and neck are more frequent in females than in males. Choriocarcinoma is common (1.9 per cent) and there is a large number of vulvar cancers in young women (2.6 per cent).The geography, economy and medical facilities of Chiang Mai Province are described. It is considered that, although there is likely to be considerable under-reporting of internal cancers, the high frequency of hypopharyngeallaryngeal cancer is not due to selective bias.

Adolescent↗
PubMed1971

The cancer pattern in Africans at Baragwanath Hospital, Johannesburg.

Material on African cancer cases admitted to Baragwanath Hospital, Johannesburg, over the years 1948-64 has been analysed, and it has been possible to obtain a useful incidence rate, a ratio study and a tribal analysis for purposes of comparison. The incidence rate, when compared to an earlier Johannesburg survey, showed a rise in oesophageal cancers for males and females. Both lung and prostate cancers showed rising rates in the men, while the female breast and cervix cancer rates remained relatively constant. Liver cancers had decreased in both sexes.

Adolescent↗
PubMed1980

Mortality of wives of men dying with cancer of the penis.

711 women were identified who in 1939 were married to men who died with cancer of the penis in England and Wales during the period 1964 to 1973. The records of women were traced through the National Health Service Central Register and, by January 1975, 378 (53%) were found to have died. Expected numbers of deaths from all causes, all cancers and from some specific cancers were calculated assuming the women to have the same mortality rates as the general population of England and Wales. The total number of deaths (378) was close to the number expected (366-8) but there was a slight excess of deaths from cancer (89 against 76.5 expected). Of the individual sites examined only cancer of the cervix showed a statistically significant excess (11 deaths against 3.9 expected, P = 0.002). This finding is similar to those reported in two other studies of the wives of men with cancer of the penis. On the basis of these studies it is suggested that some cases of cancer of the cervix and cancer of the penis may have a common aetiology. Other epidemiological characteristics of the two diseases do not show a marked similarity.

Adult↗
PubMed1999

Primary mucosal and glans penis melanomas: the Sydney Melanoma Unit experience.

BACKGROUND: Melanomas that arise on mucosal surfaces and the glans penis are rare. METHODS: A retrospective study of the Sydney Melanoma Unit experience with 69 patients treated since 1956 for these types of melanomas was undertaken to determine primary lesion site, sex, age at diagnosis, symptoms, clinical stage at first presentation. histopathology, treatment and outcome. RESULTS: Primary lesion sites were: nasal cavity (n = 9), oral cavity (n = 16), vulva/vagina (n = 25), anus/rectum (n = 13) and glans penis (n = 6). At diagnosis, 55 patients had local disease only, eight had regional lymph node metastases and six had widespread disease. Local recurrence as the first sign of relapse developed in 15 of the 55 stage I patients (three-stage system). Prognosis for the entire group was poor, only 10% being disease free 3 years after diagnosis and overall 3- and 5-year actuarial survival being 40% and 23%. respectively. The only statistically significant factor influencing survival was stage of disease at diagnosis (P = 0.002). CONCLUSIONS: Possible reasons for poor survival include: (i) non-specific symptoms resulting in late presentation; (ii) locally advanced disease not being recognized by a clinician as a rare form of melanoma, resulting in a delay in treatment; (iii) anatomical constraints precluding surgery with generous margins and consequently resulting in a high incidence of local recurrence. Also, rich vascularity and multiple lymphatic drainage pathways may mean a predisposition to early dissemination. Prompt diagnosis and referral to a specialist unit for treatment and follow up are essential. Adequate surgery remains the cornerstone of treatment for these types of melanoma until more effective systemic therapies become available.

Anus Neoplasms↗
PubMed2002

Analgesia for pelvic brachytherapy.

Pelvic brachytherapy presents the anaesthetist with numerous challenges. Patients vary from highly distressed young adults, to the elderly with coincidental disease severe enough to preclude surgery. The painful radioactive implants remain in place for a number of days. Treatment in isolated rooms reduces radiation exposure to staff, but makes close postoperative monitoring difficult, so the analgesic technique should involve minimum risk to the patient. Although there is very little published evidence of specific analgesic techniques in this area, knowledge of these problems allows the anaesthetist to select appropriate systemic analgesics and regional blocks to provide safe and effective pain relief.

Analgesia↗