【Case】 We report a 59-year-old man with severe pruritus due to hepatocellular carcinoma who responded to oxycodon. 【Discussion】 Pruritus is sometimes significant clinical problem among advanced cancer patients. The cause of pruritus was still unknown；however, increased endogenous opioids and activation of opioid receptors play an important part in its pathogenesis. Systemic administration of mu opioid receptor agonists, such as oxycodon, for patients without pruritus sometimes produces itching. They bind to the mu opioid receptors but stimulate them less than do endogenous opioids. In this situation of increased endogenous opioidergic tone, they may work as competitive inhibitors in comparison with endogenous opioids. As a result, oxycodon behaved an antipruritic drug. Our observation may lead to a new understanding of pruritus in jaundice due to advanced cancer and to new treatment of pruritus.

Background: Gastric and colorectal cancers are the leading cause of cancer-related deaths in Japan. In an attempt to control such cancer-related deaths, gastric and colorectal cancer screenings (GCSs) are readily available in Japan. Despite this, the rate of participation has been lower than expected. Previous studies have reported that some intervention tools can improve participation in cancer screenings and others cannot. Such studies conducted in rural areas are quite rare.
Methods: The subjects were residents of Kozu Island. All subjects were aged 40 and over. In the clinical setting, primary care physicians (PCPs) handed their patients a screening invitation, in an attempt to improve participation in GCSs. We examined participation trends before and after this intervention. In addition, we administered questionnaires to examine subjects' reasons for attendance and relevant characteristics of the subjects.
Results: Following the intervention, participation in GCSs did not significantly improve in the short term. In 2011, the number of participants in gastric cancer screening was 173 (22.1%) and was not significantly different from the 2010 results (P=0.80). Furthermore, the number of participants from year to year (2005-2011) was not significantly different (P=0.07). In addition, the number of participants in colorectal cancer screening was 145 (16.5%) and was not significantly different from the 2010 results (P=0.65). Moreover, the number of participants from year to year (2005-2011) was not significantly different (P=0.17). 172 out of 211 (82%) participants submitted the questionnaire. Results taken from the questionnaires showed that our screening invitation influenced non-elderly people (49.5±3.9 vs. 56.4±6.5, P=0.04) and first-attendance people showed a significant tendency for more gastrointestinal symptoms (4 vs. 2, P=0.03).
Conclusion: On the whole, the screening of invitations from PCPs did not improve participation rates in GCSs in the short term. However, we believe that screening invitations can influence non-elderly people, and this intervention can be effective in increasing the numbers of gastrointestinal-symptomatic people attending for the first time (first-attendance people).