La dépression est une affection fréquemment associée à la maladie cancéreuse, sa prévalence varie considérablement du fait de l’hétérogénéité des populations étudiées et des différentes méthodes d’évaluation utilisées. La prévalence de la dépression chez les patients atteints de cancer varie de 0 à 58 %. L’étude que nous avons menée avait pour objectifs d’estimer la prévalence de la dépression chez une population de patients atteints de cancer, de décrire leur profil sociodémographique et clinique et de déterminer les facteurs éventuels influençant la survenue de la dépression chez ces patients. L’étude a été menée au niveau du service d’oncologie du CHU Mohamed-VI de Marrakech et a concerné 100 patients ayant des cancers de différents sites et stades. Les instruments utilisés étaient le MINI (DSM-IV) pour poser le diagnostic de la dépression et l’échelle de Beck pour évaluer sa sévérité. Les résultats ont montré que la prévalence de la dépression était de 15 %, dont 26,7 % était sévère, 60 % modérée et 13,3 % légère. La dépression était fréquemment rencontrée chez les femmes, d’un âge allant de 37 à 50 ans, mariées, n’ayant jamais été scolarisées ou ayant un niveau universitaire, atteintes d’un cancer de stade localisé, dont la découverte a été faite très précocement (un à trois mois) ou dépassant 49 mois. La dépression a été également plus présente chez les patients qui avaient un entourage familial indifférent à leur maladie, et pour ceux que le coût de la prise en charge ne constituait pas la principale cause de gêne. Une plus grande attention devra être prodiguée à ces patients atteints de cancer, avec un dépistage et un traitement précoce de la dépression, afin d’assurer une prise en charge globale et multidisciplinaire et une meilleure qualité de vie.

19672 Background: The association between cancer and deep venous thrombosis (DVT) has been known for a century. The goal of this retrospective study is to evaluate the risk factors and the characteristics of patients presenting with a DVT to determine the interest of a malignancy work up. Methods: This is a monocentric retrospective study of 405 DVT’s ± pulmonary embolism reported between January 2003 and July 2006, confirmed by sonogram and spiral CT. The risk factors for the embolic events as well as the diagnosis work up done to determine the origin of the embolism were analyzed. Results: In our population the mean age was 50 years, 300 patients (74 %) presented with at least one risk factor for thrombosis event, 68 cases were found to have a malignancy (16.8%) from which 9 were occult malignancies (found among 109 cases of idiopathic DVT’s).The mean age of the patients diagnosed with cancer was significantly higher with a female predominance. These malignancies were distributed as follow: 50% gynecologic origin, 25% gastrointestinal, 10% pulmonary, 9 % urologic and 6% of hematologic origin. The risk factors identified were: Surgery (OR = 4) and Chemotherapy (OR=6). The occult malignancies were mentioned during the encounter with 6 patients. The physical exam, abdomino-pelvic sonograms were sufficient for the etiologic diagnosis in 8 cases. Other exams like (tumor markers, gastrointestinal endoscopies) were non contributive, a part of the clinical orientation they provided. Conclusions: DVT’s do occur more frequently in operated cancer patients or those who received chemotherapy. The malignancies are more frequently of gynecologic or gastrointestinal origin. It appears that an extensive diagnosis work up is not cost effective, a basic work up including: a thorough history, a complete physical exam, simple blood tests (inflammatory markers and CBC) as well as a abdomino-pelvic sonogram are sufficient for the screening of a malignancy, extensive work up should be done as a second option. No significant financial relationships to disclose.

16536 Background: Larynx cancer is one of the most frequent cancers of the superior airways. Narrowly linked to the chronic tobacco use, often associated with other addictive behaviours notably chronic alcoholism. It touches males in more than 90% of cases, with preponderance between 40 and 59 years old. It is often epidermoïd carcinoma of which the overall prognosis is one of the better within the cancers of the superior airways. Methods: Our study concerned 58 cases of larynx cancer treated at the oncology department of Mohamed VI university hospital in Marrakech between October 2002 and December 2005. Results: The mean age was of 55 years. 90% patients were males and 62% of urban origin. The tobacco use was discovered in 91% of the cases and the alcoholism in 40%. Symptoms at diagnosis were essentially dysphonia in 95% and dyspnea in 88% of case the lather having necessitated a tracheotomy in urgency in 55% of cases. The pathology showed that it was exclusively an epidermoïd carcinoma, well differentiated in 80% of the cases, 80% of the patients were initially locally advanced (T3 - T4), while 5% only had a localized stage . 27% of patients received a radiation therapy after surgery (total laryngectomy + lymphadenectomy in all cases) and 61% an exclusive radio-chemotherapy. 5% were lost from view before the beginning of the radiotherapy. On the assessable patients, 73% were in complete remission. Conclusions: The delay to the diagnosis in our country strongly darkened the prognosis of this cancer. The adoption of an information and sensibilisation strategy (anti-tobacco campaign) is necessary. No significant financial relationships to disclose.

15535 Background: The nasopharyngeal carcinoma (NPC) has a high incidence in north Africa and in southeast Asia. The goal of this study is to analyze the implication of nutritional and environmental factors in the raise of this cancer. Methods: It is a retrospective investigation with 274 affected by the NPC and 394 witnesses. Results: The nasopharyngeal carcinoma affects mens more then womens with a sex ratio of 1.8. We observed a peak between 20 and 29 years with the women and between 40 and 49 years with the men. We noted also a high frequency of the young population touched by this disease: 10.5% less than 20 years old, which was also observed in Tunisia, Algeria and Sudan while the young patients are rarerly affected in the Asian southeast. The patients have mostly rural origin with agricultural parents, having lived during their childhood in precarious habitat and hygiene conditions and with an instruction level generally low, often without function or exercising in the primary or secondary sector. The study of nutritional and environmental risk factors showed a statistically meaningful relation between this cancer and some factors bound to the food: consumption of pickle, of smen (butter fermented), and to the environment: life in agricultural environment, practice of the farm, absence of drinkable water and contact with toxic substances. Conclusions: It seems that the exposition to environmental risk factors could increase the risk to contract this cancer, especially with the already exposed persons to nutritional risk factors. We observed a territorial variability of the exposition to the NPC risk factors that explains the gradient south north of the incidence of this cancer in Morocco. The results of this study show the complexity of factors being able to take to a cancerogenesis. No significant financial relationships to disclose.

La première édition du Guide des procédures de radiothérapie externe, parue en 2007, avait comme objectifs de produire des recommandations visant à optimiser, harmoniser et homogénéiser les pratiques. Cette seconde édition, incluant la curiethérapie, garde les mêmes objectifs en tenant compte des développements technologiques actuels (radiothérapie conformationnelle avec modulation d’intensité, radiothérapie stéréotaxique, curiethérapie en trois dimensions) et des résultats récents de la littérature. Dans la première partie sont abordés des principes généraux d’intérêt quotidien (rappels réglementaires, qualité–sécurité, gestion des risques, partage des tâches) et dans la seconde les étapes de prise en charge pour chaque localisation tumorale.In 2007, a first edition was published with the objective to produce guidelines for optimization, harmonization and homogenization of practices in external radiation therapy in France. The second edition, including brachytherapy, has the same objective and takes into account recent technologic improvements (intensity modulation radiation therapy, stereotactic radiotherapy, and 3-dimension brachytherapy) and results of literature. The first part is about daily use of general principles (quality, security, image-guided radiation therapy) and the second is to describe each treatment step in main cancers.

Le statut ganglionnaire constitue un facteur pronostique important ainsi qu'un critère décisionnel majeur de traitement adjuvant, rendant l'exploration ganglionnaire indispensable. La détection du ganglion sentinelle qui s'est développée dans le but de réduire la morbidité de la chirurgie et améliorer la stadification, représente une avancée majeure dans la prise en charge chirurgicale des cancers. Cette technique a rapidement été adoptée dans le mélanome, le cancer de la vulve et le cancer du sein. Dans le cancer de l'endomètre, cette procédure est au stade de faisabilité. Dans cet article, nous évoquons les aspects techniques, les résultats, implications potentielles ainsi que les limites de la technique du ganglion sentinelle dans les cancers de l'endomètre.In cancer research, regional lymph node status is a major prognostic factor and a decision criterion for adjuvant therapy. The sentinel node procedure, which has emerged to reduce morbidity of extensive lymphadenectomy, remains a major step in the surgical management of various cancers. Sentinel node procedure has become a standard technique for the determination of the nodal stage of the disease in patients with melanoma, vulvar cancer and in breast cancer. In endometrial cancer, the sentinel node biopsy is still at the stage of feasibility. In this article, we review the technical aspects, results, clinical implications and limitations of sentinel node procedure in endometrial cancers.

UNLABELLED:The frequency of the adenocarcinoma of cervix uteri is increasing.AIM OF THE STUDY:To define the characteristics of the entity.PATIENTS AND METHODS:Between 1986 and 1992, 83 adenocarcinoma of cervix uteri, were treated at the Ibn Rochd Oncology Centre in Casablanca. It's a retrospective study with univariate analysis of the prognostic factors. This analysis was done for patients who were followed until the death or have 5 years or more follow up and the survival was calculated according the Kaplan & Meier method at 5 years. The local and regional recurrence factors were evaluated statically according the chi 2 and those for survival rate according the Logrank test.RESULTS:The frequency increased during the period with 2.1% in 1986 and 8.2% in 1992. The median of aged was 49 years. Fifty one patients have localised stage. Combined radiotherapy and surgery was performed in 66 cases and 17 received radiation alone. The loco-regional control was obtained in 83% among 73 available patients for results. The univariate analysis showed that the histological type was not a significant factor. However, age, tumor size, stage, histological grade and lymph node involvement were significant factors. These factors, the degree of differentiation and the lymph node involvement were significant for the 5-years survival.CONCLUSION:The prognosis factors of the cervix uteri adenocarcinoma are, size tumor more than 4 cm, lymph node involvement, microscopic involvement to the parameters and positives excision merges.

L’adénocarcinome du col utérin est de plus en plus fréquent.

Nous rapportons l'observation d'un jeune homme de 36 ans traité au centre d'oncologie Ibn-Rochd de Casablanca pour un séminome primitif du médiastin avec métastases révélé par une symptomatologie faite de toux, dyspnée, tuméfactions latérocervicales, douleurs rachidiennes et troubles de la marche. Le bilan initial objective un élargissement médiastinal important avec pleurésie droite et des métastases vertébrales, les marqueurs tumoraux étaient normaux. Le diagnostic de séminome a été confirmé après examen anatomopathologique et immunohistochimique des adénopathies cervicales. Le traitement a consisté en une chimiothérapie type BEP et une radiothérapie lombaire, médiastinale et sus-claviculaire. La réponse après quatre cures de chimiothérapie et radiothérapie a été estimée à 25 %, le patient est décédé dans un tableau de détresse respiratoire cinq mois après le début du traitement.

In this study, the case has been reported of a 36-year old male who was treated at the Ibn Rochd Oncology Center in Casablanca for a primary mediastinal seminoma revealed by a symptomatology including cough, dyspnea, laterocervical swelling, rachidial pain and gait disorder. The preliminary investigation showed significant mediastinal enlargement with a right pleuritis and vertebral metastases; tumor markers were normal. The diagnosis of seminoma was confirmed by pathological and immunohistochemical analysis of the cervical adenopathy. Disease management consisted of BEP/cisplatin type chemotherapy and lumbar, mediastinal, and supraclavicular radiotherapy. The response after four courses of combined chemo-/radiotherapy was estimated at 25%, but the patient died from respiratory failure five months after the initiation of treatment.

Entre 1988 et 1994, 326 patients ont été traités pour un cancer rectocolique au centre d’oncologie Ibn Rochd de Casablanca, parmi lesquels 88 étaient âgés de moins de 40 ans (27 %). Le sex-ratio était de 0,9. Des antécédents familiaux de cancers rectocoliques ont été notés chez 5 % des patients. Le cancer a été révélé dans 71 % des cas par un syndrome rectal et des rectorragies. La tumeur était rectale chez 70 patients. Il s’agissait le plus souvent sur le plan anatomopathologique d’une tumeur de stade C ou D de Dukes. Un carcinome colloïde muqueux a été retrouvé chez 24 patients. Une chirurgie a été pratiquée chez 71 patients et a été associée à une radiothérapie chez 59. Une chimiothérapie adjuvante a été délivrée chez 44 patients et un traitement palliatif chez 17. Une récidive est survenue chez 14 patients et des métastases à distance chez six autres. Le taux de survie globale à cinq ans était de 24 % et celui de survie sans maladie de 17 %. Le carcinome colloïde muqueux, l’adénocarcinome peu différencié et les stades C et D de Dukes étaient associés à un pronostic défavorable.

Between 1988 and 1994, 326 patients with colorectal cancers were treated at the Ibn Rochd Oncology Centre in Casablanca; 88 patients were less than 40 years old (27%). There were 79 males and nine females. A family history of colorectal cancer was noted in 5%. The most frequent symptoms were bleeding and rectal pain. The localisation of the tumour was the rectum in 70 cases. According to the anatomopathological profile, Dukes stages C and D were the most frequent and mucosal adenocarcinoma was noted in 24 cases. Seventy patients had surgery, associated with radiation therapy in 59 cases. Adjuvant chemotherapy was given in 44 cases and palliative treatment in 17 cases. Recurrence occurred in 14 cases and metastasis in other six cases. At five years, overall survival and disease-free survival rates were 24% and 17%, respectively. Worse prognostic factors were mucosal adenocarcinoma, poor differentiated adenocarcinoma and Dukes C and D stages.

BACKGROUND:Nasopharyngeal carcinoma constitutes comprises up to 5% of primary childhood cancers but literature lacks modern uniformly treated large series.PATIENTS AND METHODS:A retrospective review was performed of sixty-five previously untreated patients younger than 16 years of age diagnosed and treated at the Ibn Rochd Centre in Casablanca between 1988 and 1992. Forty-four percent of them were stage T3 to T4 and 66% stage N2 or N3. All patients were irradiated. Prior adjuvant chemotherapy was administered in 33 patients. Thirteen patients were lost to follow-up.RESULTS:Local control was obtained in 85% of the 52 evaluable patients. The five-year overall survival was 42% and disease-free survival 38%. Ten relapses occurred at local and/or regional sites. Six patients have distant metastases. All 24 patients with relapse or persistent disease died despite salvage therapy. Stage, histology and dose of radiation, were statistically significant prognostic variables. Patients treated with chemotherapy followed by irradiation had a better outcome than those treated with radiation alone.CONCLUSIONS:Nasopharyngeal carcinoma in children is a rare chemosensitive tumor. However, conclusive treatment guidelines cannot be drawn from this series and prospective co-operative studies are needed for the development of more effective and less toxic therapeutic strategies.