Although gastric cancer is the most common cancer and the second leading cause of cancer deaths in Korea, the prognosis for advanced gastric cancer remains poor, and there is no established standard front-line chemotherapy for advanced stage. However, many clinical trials have been developed to improve the response rate and survival in patients with advanced gastric cancer. Novel oral fluoropyrimidines, capecitabine and S-1, are substituting inconvenient 5-FU continuous infusions. These oral fluoropyrimidines combined with docetaxel (1-hour infusion) lead to improve anticancer efficacy and convenience. Capecitabine and docetaxel combination regimens showed response rates 39~60% with median survival 9.5~12 months, and major adverse reactions were hand-foot syndrome and neutropenia. Also, S-1 and docetaxel combination regimens showed response rates 46~56% with median survival 14~14.9 months, and major adverse reaction was neutropenia. The combination of docetaxel and novel oral fluoropyrimidine is highly active and well tolerated in patients with advanced gastric cancer. Large randomized clinical trials are warranted to confirm the efficacy of those regimens. Also, we are looking forward to having the results from studies of new chemotherapeutic agents and modalities.
Capecitabine ; Drug Therapy ; Drug Therapy, Combination* ; Fluorouracil ; Hand-Foot Syndrome ; Humans ; Korea ; Neutropenia ; Prognosis ; Stomach Neoplasms*

Gastric cancer remains the second most common malignancy worldwide. Surgical resection with D2 lymph node dissection is the standard of care in localized gastric cancer. However about 40% of patients in East Asia and 70% of patients in Western countries experience recurrence after curative surgical resection of localized gastric cancer. Once recurrence occurs, the prognosis of patients is usually dismal, especially in case of distant metastases. Although many clinical trials of adjuvant treatment were conducted to reduce recurrence of gastric cancer after surgical resection, it was controversial until early 2000s whether adjuvant treatment could improve recurrence-free survival or overall survival in gastric cancer. In early 2000s, adjuvant chemoradiation became the standard of care in the US based on the results of SWOG 9008/INT 0116 trial, where only minor portion of patients underwent D2 lymph node dissection. However, adjuvant chemoradiation was considered not applicable to patients with gastric cancer in East Asia where D2 lymph node dissection is the standard surgical method. Recently, large scale phase III studies including ACTS-GC and CLASSIC trial were conducted in the East Asia. Based on those studies, adjuvant chemotherapy is currently accepted as standard treatment in gastric cancer in the East Asia.
Chemotherapy, Adjuvant ; Far East ; Humans ; Lymph Node Excision ; Neoplasm Metastasis ; Prognosis ; Recurrence ; Standard of Care ; Stomach Neoplasms

Involvement of the lower urinary tract by advanced non-Hodgkin's lymphoma (NHL) has been reported in up to 13% of cases, but primary NHL of the urinary bladder is very rare. A 35-year-old man was admitted to our hospital with a chief complaint of gross hematuria with left flank pain on April 12, 2001. Cystoscopy revealed an edematous broad-based mass on the left lateral wall of the bladder, and transurethral biopsy showed NHL, diffuse large B-cell type. Abdomino-pelvic CT scan demonstrated left-side hydronephrosis and hydroureter with left proximal ureter infiltration and thickening of the left lateral wall of the bladder with perivesical fat infiltration without lymph node enlargement. Full-scale staging work-up revealed the bone marrow as the solely involved site. The lesions of the bladder and left urinary tract were nearly completely regressed after two cycles of systemic cyclophosphamide, doxorubicin, vincristine and predinisone (CHOP) chemotherapy with simultaneous restoration of urinary function.
Adult ; Antineoplastic Combined Chemotherapy Protocols/*administration & dosage ; Biopsy, Needle ; Bone Marrow/*pathology ; Bone Neoplasms/pathology/*secondary ; Cyclophosphamide/*administration & dosage ; Cystoscopy ; Doxorubicin/*administration & dosage ; Follow-Up Studies ; Humans ; Immunohistochemistry ; Lymphoma, Non-Hodgkin/drug therapy/*pathology ; Male ; Neoplasm Staging ; Prednisone/*administration & dosage ; Tomography, X-Ray Computed ; Treatment Outcome ; Urinary Bladder Neoplasms/drug therapy/*pathology ; Urodynamics ; Vincristine/*administration & dosage

Primary effusion lymphoma (PEL) is a recently described subtype of malignant lymphoma which develops in association with human herpesvirus-8 (HHV-8) in human immunodeficiency virus (HIV)-infected patients. PEL presents predominantly as lymphomatous effusion in the body cavities without a definite mass or lymphadenopathy. The malignant cell has large-cell morphology with null immunophenotype and B-cell genotype. We describe an unusual case of HIV negative HHV-8 negative PEL patient. A 48-year-old man presented with symptoms of right lower chest pain and fatigue for 3 months. Chest radiography and CT scan showed right pleural effusion and pleural thickening and no evidence of lymphadenopathy. Examination of the pleural fluid revealed lympho-dominant exudate and the results of all cultures were negative. A malignant lymphoma of diffuse large B-cell type was confirmed by pleural biopsy. The results of serologic studies for HIV and PCR of HHV- 8 using pleura fluid and tissue were all negative.
B-Lymphocytes ; Biopsy ; Chest Pain ; Exudates and Transudates ; Fatigue ; Genotype ; Herpesvirus 8, Human ; HIV ; Humans ; Lymphatic Diseases ; Lymphoma* ; Lymphoma, Primary Effusion ; Middle Aged ; Pleura ; Pleural Effusion* ; Polymerase Chain Reaction ; Radiography ; Thorax ; Tomography, X-Ray Computed

Prolymphocytic leukemia (PLL) is a member of chronic lymphoproliferative disorders with relatively distinct clinical, morphologic, immunologic and prognostic features. The diagnosis of PLL is determined by more than 55% of prolymphocytes in the peripheral blood. It is characterized by leukocytosis, massive splenomegaly with little or no lymphadenopathy, and male prevalence. In immunophenotyping, the majority (80%) of the cases express B cell markers and the rest (20%), T cell type. We experienced a case of B-PLL. The patient was a 65 year-old man who presented with marked leukocytosis (110.5x109/L) and 78% of characteristic prolymphocytes in the peripheral blood. The bone marrow aspirate showed 13.6% of prolymphocytes and coarse granular positivity of prolymphocytes in PAS stain. The immunophenotyping of the leukemic prolymphocytes revealed the positivity of surface immunoglobulin (IgM, lambda type), HLA- DR and CD19. The monoclonal gammopathy (IgM, lambda type) was also detectable in the patient's serum.
Aged ; Bone Marrow ; Diagnosis ; Humans ; Immunoglobulins ; Immunophenotyping ; Leukemia* ; Leukemia, Prolymphocytic ; Leukocytosis ; Lymphatic Diseases ; Lymphoproliferative Disorders ; Male ; Paraproteinemias ; Prevalence ; Splenomegaly

BACKGROUND: This study examined moderating effects of optimism and family support on the depression of family caregivers of cancer patients aged 55 and over by adopting stress process model. METHODS: 359 family caregivers who accompanied with cancer patients to out-patient clinics were recruited and completed questionnaire at three university hospitals located in Seoul and Gyeonggi province. Exploratory factor analysis was applied to test validity of the construction of the scale. Hierarchical multiple regression analysis was used to determine moderating effects of optimism and family support on depression after making mean centering of each variable. RESULTS: Results showed that spouse caregivers have more depression than do adult children as the nursing period gets longer. Education and income status were significant variables affecting depression of family caregivers. Optimism and family support for family caregivers have moderating effects on the association between stressors (emotional functioning of cancer patients and role overload of family caregivers) and depression of family caregivers. CONCLUSIONS: The findings suggest that more attentions are needed to the depression of spouse caregivers. Interventions are strongly recommended for health professionals to provide cancer patients and their family caregivers with "holding environments" caring for emotions and facilitating adjustment.
Adult Children ; Attention ; Caregivers* ; Depression* ; Education ; Gyeonggi-do ; Health Occupations ; Hospitals, University ; Humans ; Nursing ; Optimism* ; Outpatients ; Seoul

BACKGROUND: This research is an exploratory study that is based on previous studies focusing on relationship between the doctors and the elderly cancer patients; moreover, the research focuses on the doctors' negative attitudes and discriminative behaviors towards the elderly cancer patients so that we may be able to suggest the ways to decrease the ageism. METHODS: Qualitative method and quantitative method were applied sequently. In this research, we practiced in-depth interviews with 8 doctors and then the surveys with 274 doctors. The in-depth interview questions were categorized depending on meaningful testimonies and the survey data were analyzed in the descriptive statistic analysis and paired t-test using PASW statistics 18. RESULTS: Through the in-depth interviews, the following is observed: the doctors rarely notify the elderly cancer patients directly; the family members of patients avoids the doctors to do so; and the doctors even show different attitudes or discriminatory actions to the elderly. Based on the in-depth interview results, the questions on notifying methods of the diagnosis and how to explain for treatment were developed and performed as a survey. Through the survey, only 8.4% of the doctors reported they directly notify the elderly cancer patient; moreover, they also reported they provide less information on treatment, side-effects, prognosis, and medical cost to the elderly than the middle-aged. CONCLUSIONS: This research not only discovered the presence of discrimination towards the elderly cancer patients but also suggested the causes of it. In order to resolve the phenomenon, doctors must consider individualized difference and variability of physiological function and should be aware of the psychological change after the cancer diagnosis to better communicate with them. Additionally, the social family culture which overprotects the elderly must be changed.
Aged* ; Ageism* ; Diagnosis* ; Disclosure* ; Discrimination (Psychology) ; Humans ; Methods ; Prognosis

Systemic capillary leak syndrome (SCLS) is a condition that's caused by the shift of fluid and protein from the intravascular space to the interstitial space as a result of repetitive episodes of capillary hyperpermeability. The pathogenesis of SCLS is still unclear, but there's recently been a report showing this syndrome in association with monoclonal gammopathy. This syndrome can be a fatal disease because cardiovascular collapse can occur in the initial capillary leak phase. Although theophylline, diuretics, terbutaline, steroids, calcium antagonist, Ginkgo biloba extracts and plasmapheresis have been suggested as medication, none of them have been proven to be effective. Considering that this disease is self-limiting, conservative treatment in the acute phase is believed to be very important. Because hypoalbuminemia is very a common manifestation of SCLS, Pentastarch, which has a higher molecular weight than albumin, could be efficient to prevent cardiovascular collapse. We used 10% Pentastarch during the acute SCLS attacks of 2 patients and the patients both showed a dramatic response. Pentastarch may be helpful to treat SCLS in its initial capillary leak phase by the elevating blood pressure, and this might contribute to somewhat decreasing the acute mortality of SCLS.
Adult ; Capillary Leak Syndrome/diagnosis/*drug therapy/etiology ; Capillary Permeability ; Female ; Hetastarch/*therapeutic use ; Humans ; Plasma Substitutes/*therapeutic use

Carcinoma of ampulla of Vater is a papillary neoplasm arising in the last centi meter of the common bile duct (CBD) where it passes through the wall of the duodenum and ampulla of Vater. We report the case of an ampulla of Vater cancer with the characteristic extensive invasion to the whole pancreas. A 53-year old female was admitted to our hospital with chief complaint of epigastric pain, steatorrhea, and weight loss for 2 months. On physical examination, epigastric tenderness was detected. Gastroduodenoscopic biopsy from the mass revealed well differentiated adenocarcinoma. Abdominal CT demonstrated intraduodenal protruding mass with diffuse invasion to the whole pancreas. Arterial phase helical CT scan revealed intense heterogenous enhancement of entire pancreas. She underwent the Whipple procedure with total pancreatectomy. Final pathologic diagnosis was adenocarcinoma of ampulla of Vater with invasion of the whole pancreas and metastasis to the large number of regional lymph nodes.
Adenocarcinoma ; Ampulla of Vater* ; Biopsy ; Common Bile Duct ; Diagnosis ; Duodenum ; Female ; Humans ; Lymph Nodes ; Middle Aged ; Neoplasm Metastasis ; Pancreas* ; Pancreatectomy ; Physical Examination ; Steatorrhea ; Tomography, Spiral Computed ; Tomography, X-Ray Computed ; Weight Loss

Kaposi's sarcoma typically occurs in immunocompromised patients, especially those with acquired immunodeficiency syndrome. Human herpesvirus 8 (HHV-8) and human immunodeficiency virus (HIV) may play important roles in the development of Kaposi's sarcoma. We report the case of a 75-year-old male who presented with progressive multiple purplish papules and nodules on the skin for 3 months. Social and past medical histories seemed incompatible with an immunesuppressed condition and tests for HIV antibodies and HHV-8 were negative. He was newly diagnosed with rheumatoid arthritis, according to the 2010 ACR-EULAR criteria. Typical findings of Kaposi's sarcoma were confirmed by biopsy. After treatment with metronomic oral etoposide 25 mg once daily for 9 months, the skin lesions had almost resolved with no serious complication. Thus, we report a rare case of Kaposi's sarcoma developing in a patient with newly diagnosed rheumatoid arthritis who showed a good response to oral etoposide.
Acquired Immunodeficiency Syndrome ; Aged ; Arthritis, Rheumatoid* ; Biopsy ; Etoposide* ; Herpesvirus 8, Human ; HIV ; HIV Antibodies ; Humans ; Immunocompromised Host ; Male ; Sarcoma, Kaposi* ; Skin