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P0056 Treatment of non-metastatic colon adenocarcinomas in Morocco
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Abstracts / 50 (2014) e1–e74
Interpretation: The diagnostic and therapeutic management of digestive endocrine tumours requires a multidisciplinary approach to give the patient the best quality of care.
http://dx.doi.org/10.1016/j.ejca.2014.03.099
P0056 TREATMENT OF NON-METASTATIC COLON ADENOCARCINOMAS IN MOROCCO H. Derouich *, M. Elmekkaoui, F. Haddad, W. Badre, M. Bellabah, W. Hliwa, S. Nadir, R. Alaoui. Universitary Hospital, Casablanca, Morocco Background: Adenocarcinoma of the colon is a common cancer and the annual incidence is increasing. Treatment is essentially surgical, combined with adjuvant chemotherapy in advanced cases. Methods: This is a retrospective study of 100 patients with non-metastatic colon adenocarcinoma, treated at the gastroenterology and oncology centre in Ibn Rushd Hospital, Casablanca, over a period of 5 years from January, 2006, to January, 2010. Diagnosis was made after a histological study of biopsies taken during colonoscopy. Findings: One hundred patients were diagnosed with non-metastatic colon adenocarcinoma. The sex ratio was 3:2 (M:F), the average age was 52 years, and approximately 50% of patients were diagnosed after a period of 7 months from the appearance of their first symptoms of rectal bleeding events, melena, and dysentery syndrome. Histologically, non-metastatic colon adenocarcinoma is well-differentiated in 80% of cases. All patients were operated on. The distribution of patients by stage was: 61% classified as stage II, 30% stage III, and 9% stage I. Adjuvant chemotherapy FUFOL, FOLFOX IV, or capecitabine was given in 85% of patients and monitoring without adjuvant therapy in 15%. The immediate follow-up after completion of chemotherapy showed complete remission in 95% of patients and 5% were in disease progression. After a mean follow-up of 30 months, 71% were in remission. 18% had a local or metastatic recurrence treated by second line chemotherapy (FOLFIRI or XELIRI), with remission seen in three patients, stable disease in seven patients, and treatment failure in eight patients. Interpretation: The multidisciplinary approach to all stages of the process requires the involvement of various disciplines to give the patient the best quality of care.
http://dx.doi.org/10.1016/j.ejca.2014.03.100
P0057 AN EVALUATION OF CURRENT MORPHINE PRESCRIBING PRACTICE AT KOMFO ANOKYE TEACHING HOSPITAL, GHANA K.B. Mensah . Directorate of Oncology, Komfo Anokye Teaching Hospital, Ghana Background: There are few opioids available in Ghana. Fentanyl patches and oxycodone, among others, are not affordable in Ghana. Morphine is cost effective and is the only strong opioid paid for by national health insurance, making it easily available for patients with or without health insurance. Oral and parenteral preparations of morphine are the only options for the treatment of severe cancer pain
in our clinical setting. Despite doctors prescribing oral morphine at the directorate, many cancer patients with severe cancer pain do not achieve adequate pain relief. This evaluation was done to look at the current standards of practice in oral morphine prescribing patterns at the directorate of oncology, Komfo Anokye Teaching Hospital. Methods: A review was undertaken to compare morphine prescriptions in 566 new patients with established standard guidelines modified to suit the local population. Findings: Seven per cent of patients were prescribed morphine. Several deficiencies in morphine prescribing were identified. These included prescribing morphine at 8 hourly intervals, absence of review after prescribing morphine, lack of double dosing at night, omission of a breakthrough dose, and often pain location was not indicated in patient records. Interpretation: Although much is known about morphine, there is inappropriate prescribing of the drug which leads to uncontrolled cancer pain. Education and implementation of local guidelines will improve the use of morphine in cancer pain management. A review of guidelines must be carried out to determine whether such guidelines have improved morphine prescription patterns.
http://dx.doi.org/10.1016/j.ejca.2014.03.101
P0058 PRESERVING CARCINOMA
FERTILITY
IN
STAGE
1A
OVARIAN
A.A. Ai, I.F. Fakhr, S.R. Ramzy. National Cancer Institute, Cairo University, Cairo, Egypt Background: This study assessed the role of fertility preserving surgery in the treatment of patients with stage 1a ovarian carcinoma, with or without chemotherapy. Methods: The study was done in NCI-Cairo University and El-Galaa Teaching Hospital from 2006 to 2011. 32 women younger than 35 years, with histologically confirmed early ovarian carcinoma (FIGO stage 1a, G1, or G2), underwent fertility preserving resection for the treatment of their malignancies. Patients with borderline tumours were excluded from the study. Findings: Macroscopic unilateral tumuors were seen in 32 patients. Twenty-six (81%) patients had G1 tumours, among which 18 (69%) tumours were serous, six of 18 (30%) were mucinous, two (7.77%) were endometrioid, and none was clear cell type. Six (19%) patients had G2 tumours, all of which were serous cell type. The median follow up period was 48 months. Two (6%) women were lost to follow up. Three (10%) women went for a second look operation after pregnancy, during cesarean section. All of them were free of any detectable disease. Two (7%) patients had abdominal exploration to investigate abnormal ultrasound finding. One patient with an invasive recurrence had completion to radical surgery with pelvic and para-aortic lymph node dissection, followed by adjuvant chemotherapy, and remained free of disease until the end of the follow up period. Another patient with a borderline tumour underwent ovarian cystectomy with ovarian preservation and continued her follow up period without further events. Since this patient had a borderline tumour, we regarded this study recurrence rate to be only one patient (3%), without any mortality. None of our patients had distant metastases. After treatment, only 18 of 30 (60%) women have recorded attempted conception, 12 of 18 (67%) had full term pregnancy, four of 18 (22%) had mid-trimestric abortion. All patients had normal conceptions and normal vaginal deliveries after full-term pregnancies.
Abstracts / 50 (2014) e1–e74
Interpretation: The diagnostic and therapeutic management of digestive endocrine tumours requires a multidisciplinary approach to give the patient the best quality of care.
http://dx.doi.org/10.1016/j.ejca.2014.03.099
P0056 TREATMENT OF NON-METASTATIC COLON ADENOCARCINOMAS IN MOROCCO H. Derouich *, M. Elmekkaoui, F. Haddad, W. Badre, M. Bellabah, W. Hliwa, S. Nadir, R. Alaoui. Universitary Hospital, Casablanca, Morocco Background: Adenocarcinoma of the colon is a common cancer and the annual incidence is increasing. Treatment is essentially surgical, combined with adjuvant chemotherapy in advanced cases. Methods: This is a retrospective study of 100 patients with non-metastatic colon adenocarcinoma, treated at the gastroenterology and oncology centre in Ibn Rushd Hospital, Casablanca, over a period of 5 years from January, 2006, to January, 2010. Diagnosis was made after a histological study of biopsies taken during colonoscopy. Findings: One hundred patients were diagnosed with non-metastatic colon adenocarcinoma. The sex ratio was 3:2 (M:F), the average age was 52 years, and approximately 50% of patients were diagnosed after a period of 7 months from the appearance of their first symptoms of rectal bleeding events, melena, and dysentery syndrome. Histologically, non-metastatic colon adenocarcinoma is well-differentiated in 80% of cases. All patients were operated on. The distribution of patients by stage was: 61% classified as stage II, 30% stage III, and 9% stage I. Adjuvant chemotherapy FUFOL, FOLFOX IV, or capecitabine was given in 85% of patients and monitoring without adjuvant therapy in 15%. The immediate follow-up after completion of chemotherapy showed complete remission in 95% of patients and 5% were in disease progression. After a mean follow-up of 30 months, 71% were in remission. 18% had a local or metastatic recurrence treated by second line chemotherapy (FOLFIRI or XELIRI), with remission seen in three patients, stable disease in seven patients, and treatment failure in eight patients. Interpretation: The multidisciplinary approach to all stages of the process requires the involvement of various disciplines to give the patient the best quality of care.
http://dx.doi.org/10.1016/j.ejca.2014.03.100
P0057 AN EVALUATION OF CURRENT MORPHINE PRESCRIBING PRACTICE AT KOMFO ANOKYE TEACHING HOSPITAL, GHANA K.B. Mensah . Directorate of Oncology, Komfo Anokye Teaching Hospital, Ghana Background: There are few opioids available in Ghana. Fentanyl patches and oxycodone, among others, are not affordable in Ghana. Morphine is cost effective and is the only strong opioid paid for by national health insurance, making it easily available for patients with or without health insurance. Oral and parenteral preparations of morphine are the only options for the treatment of severe cancer pain
in our clinical setting. Despite doctors prescribing oral morphine at the directorate, many cancer patients with severe cancer pain do not achieve adequate pain relief. This evaluation was done to look at the current standards of practice in oral morphine prescribing patterns at the directorate of oncology, Komfo Anokye Teaching Hospital. Methods: A review was undertaken to compare morphine prescriptions in 566 new patients with established standard guidelines modified to suit the local population. Findings: Seven per cent of patients were prescribed morphine. Several deficiencies in morphine prescribing were identified. These included prescribing morphine at 8 hourly intervals, absence of review after prescribing morphine, lack of double dosing at night, omission of a breakthrough dose, and often pain location was not indicated in patient records. Interpretation: Although much is known about morphine, there is inappropriate prescribing of the drug which leads to uncontrolled cancer pain. Education and implementation of local guidelines will improve the use of morphine in cancer pain management. A review of guidelines must be carried out to determine whether such guidelines have improved morphine prescription patterns.
http://dx.doi.org/10.1016/j.ejca.2014.03.101
P0058 PRESERVING CARCINOMA
FERTILITY
IN
STAGE
1A
OVARIAN
A.A. Ai, I.F. Fakhr, S.R. Ramzy. National Cancer Institute, Cairo University, Cairo, Egypt Background: This study assessed the role of fertility preserving surgery in the treatment of patients with stage 1a ovarian carcinoma, with or without chemotherapy. Methods: The study was done in NCI-Cairo University and El-Galaa Teaching Hospital from 2006 to 2011. 32 women younger than 35 years, with histologically confirmed early ovarian carcinoma (FIGO stage 1a, G1, or G2), underwent fertility preserving resection for the treatment of their malignancies. Patients with borderline tumours were excluded from the study. Findings: Macroscopic unilateral tumuors were seen in 32 patients. Twenty-six (81%) patients had G1 tumours, among which 18 (69%) tumours were serous, six of 18 (30%) were mucinous, two (7.77%) were endometrioid, and none was clear cell type. Six (19%) patients had G2 tumours, all of which were serous cell type. The median follow up period was 48 months. Two (6%) women were lost to follow up. Three (10%) women went for a second look operation after pregnancy, during cesarean section. All of them were free of any detectable disease. Two (7%) patients had abdominal exploration to investigate abnormal ultrasound finding. One patient with an invasive recurrence had completion to radical surgery with pelvic and para-aortic lymph node dissection, followed by adjuvant chemotherapy, and remained free of disease until the end of the follow up period. Another patient with a borderline tumour underwent ovarian cystectomy with ovarian preservation and continued her follow up period without further events. Since this patient had a borderline tumour, we regarded this study recurrence rate to be only one patient (3%), without any mortality. None of our patients had distant metastases. After treatment, only 18 of 30 (60%) women have recorded attempted conception, 12 of 18 (67%) had full term pregnancy, four of 18 (22%) had mid-trimestric abortion. All patients had normal conceptions and normal vaginal deliveries after full-term pregnancies.