A multicentre cohort study was held in Morocco, designed to evaluate the quality of life of cancer patients. The aim of this paper is to report the assessment of the quality of life of early colorectal cancer patients, before and after cancer treatment, to identify other factors which are related to this quality of life.

Introduction: Anorectal location of melanomas is rare and aggressive. The discovery that the KIT oncogene may be aberrantly activated in a subset of patients creates a realm of possibility for the development of targeted molecular therapy. The aim is to show the epidemiologic, clinico-radiological, histological features and treatment management especially in patients with over-expression of CKIT treated by Imatinib. Methods: Retrospective study conducted in medical oncology department at Hassan II University Hospital, Fez, Morocco, between January 2007 and January 2014, including patients with anorectal melanoma. CKIT Assessment was performed in all patients. Results: Twenty patients were collected, 11 men and 9 women, the mean age was 57 years (45-81ans). The symptoms were mainly rectal bleeding, proctalgia, rectal syndrome, and transit disorders. Colonoscopy was performed in all cases and revealed a circumferential non-pigmented burgeoning tumor in all cases and stenotic tumor in 17 cases. The radiological assessment included a thoraco-abdomino-pelvic scan in all cases and 13 patients underwent a pelvic MRI. Seventeen patients had a metastatic disease at the diagnosis, sites of metastases were: liver, lymph node and lung. Only three patients were not metastatic, and proceeded to surgery, they underwent an abdomino-perineal resection with lymphadenectomy; but the evolution was marked by occurrence of pulmonary and hepatic metastases less than 12 months later. First-line chemotherapy was received in all patients; it was based mainly on paclitaxel, carboplatin and dacarbazine, with only 5 partial responses, 6 disease stabilities, and 9 patients with disease progression. Five patients had over-expression of CKIT and they received Imatinib as second line of treatment with significant improvement of symptoms and significant radiological response in all patients reaching 60%. Their median survival was 14,3 months vs 10 months for patients without CKIT overexpression. Conclusion: Anorectal melanoma is an aggressive rare cancer. The prognosis remains poor for metastatic stage despite the systemic therapy. Treatment is still big challenge. Results of targeting CKIT with Imatinib were very hopeful and encouraging to develop new targets.

Ewing’s sarcoma is a round cell malignancy of bone and soft tissue that occurs predominately in adolescents and young adults.It is an uncommon malignancy, but is recognized as the second most prevalent primary bone tumor worldwide. Extraosseous Ewing’s sarcoma is extremely rare and can affect the skin, soft tissues, or viscera. Prognostic and therapeutic features of Ewing’s extraosseous tumors are similar to those of Ewing’s sarcoma. A primary Ewing’s sarcoma arising from the cervix is highly rare. Most of these patients presented with abnormal vaginal bleeding. We report a case of extraskeletal Ewing’s sarcoma arising in the cervix in a 25-year-old woman.

In 2013, at the congress of the European CanCer Organization and the European Society for Medical Oncology, colorectal cancer was the subject of various oral presentations and posters. In this article, we have selected the most innovative studies that are likely to change our daily practice.

In 2013, at the congress of the European CanCer Organization and the European Society for Medical Oncology, colorectal cancer was the subject of various oral presentations and posters. In this article, we have selected the most innovative studies that are likely to change our daily practice.

Chemotherapy and targeted therapy remain the cornerstone of treatment of locally advanced and metastatic non-small cells lung cancer (NSCLC). Given the intrinsic chemoresistance of tumor cells, new treatment options have been developped. The knowledge of the molecular mechanisms of tumor biology, and signal transduction pathways activating cancer cells led to the identification of a new targeted therapy such as Crizotinib. The small molecule Crizotinib is a selective inhibitor of the receptor tyrosine kinase ALK (anaplastic lymphoma kinase) and its oncogenic variants (ALK fusion gene and some mutations of ALK). Phases I and II trials showed the efficacy of Crizotinib in the treatment of locally advanced and metastatic NSCLC expressing ALK. Thereafter, randomized Phase III trial confirmed the significant superiority of Crizotinib versus standard chemotherapy in terms of progression free survival and objective response with good tolerance; therefore, it has been approved by the Food and Drug Administration (FDA) as the standard treatment for locally advanced and metastatic ALK-positive NSCLC.

Il est estimé qu’environ un tiers de la population mondiale a été en contact avec le virus de l’hépatite B (VHB) avec une prévalence qui varie d’une zone géographique à une autre. Cette prévalence est d’autant plus élevée chez les patients ayant une pathologie néoplasique, ce qui pose le problème du risque de réactivation virale B au cours ou au décours d’une chimiothérapie. La réactivation est définie par une augmentation importante de la réplication virale chez des patients ayant une hépatite chronique B inactive ou « guérie » souvent accompagnée d’une augmentation des transaminases sériques. Le tableau clinique peut être limité ou être à l’origine d’une insuffisance hépatique fulminante voire fatale. La réactivation du VHB conduit également à l’arrêt prématuré de la chimiothérapie ou du retard des protocoles thérapeutiques. Ainsi, la sérologie VHB (AgHBs, anti-HBc, anti-HBs) est recommandée pour tous les patients recevant une chimiothérapie. Les patients ayant un AgHBs et/ou un ADN viral B positif devraient recevoir une prophylaxie anti-VHB. Ce traitement préemptif, fondé sur les analogues nucléosidique/nucléotidiques (NUC), a prouvé son efficacité à diminuer la réactivation du virus et les taux de mortalité. Chez les patients AgHBs négatifs/Anti-HBc positifs, ne recevant pas une immunosuppression puissante, une surveillance étroite des transaminases et de l’ADN du VHB doit être instaurée. Un traitement antiviral peut être commencé quand une réactivation du VHB est confirmée. Quant aux patients ayant les AgHBs, les anti-HBc et les anti-HBs négatifs une vaccination anti-VHB devrait être instaurée avant la mise en place de la chimiothérapie quand cela est possible. Une concertation multidisciplinaire regroupant au moins un oncologue et un hépatologue demeure nécessaire pour une meilleure prise en charge de ces malades.

Background: Gastrointestinal stromal tumors (GIST) are the most common mesenchymal tumors of the gastrointestinal tract. GIST are rare during pregnancy. We report here the case of a patient who was admitted in our university hospital for GIST discovered during the second trimester of pregnancy. She was 42 years old, in the fifth months of pregnancy. She was admitted for biliary colic pain with vomiting. On abdominal examination, we objectified a distended abdomen with uterine height of 18 cm and epigastric mass of 10 cm. Abdominal ultrasound and magnetic resonance imaging (MRI) showed a hepatic, tissue and cystic mass, developing at the expense of the left liver. Endoscopy objectified an aspect of extrinsic compression at the front of the stomach. A cesarean was scheduled at the 35th month of pregnancy for fetal extraction and rescue. Exploration of the peritoneal cavity during surgery has objectified a hepatic highly vascularised mass reaching up to the umbilicus. This mass was unresectable. A postoperative CT scan revealed a large bilobed epigastric mass adhering to the stomach and the left liver. Histological and immunohistochemical study of hepatic process showed a gastrointestinal stromal tumor of high risk of malignancy. Conclusion: few cases have been reported in the literature on GIST during pregnancy showing the rarity of the condition that requires multidisciplinary care.

Background: The rectal carcinoma accounts for approximately 30% of all colorectal carcinomas. Its incidence and disease pattern have wide geographical variation. The majority of patients in developing countries present with advanced disease. Present study describes the patient profile and treatment results from a regional tertiary care cancer center in Morocco. Methods: This is a retrospective study of 88 patients with rectal adenocarcinoma received at the department of medical oncology between 2007 – 2012, and treated using multimodality protocols involving surgery, concomitant radiochemotherapy and chemotherapy. Results: The mean age of patients was 54.4 years [19-86] and 64,6% of them had tumor in lower third of rectum with evidence of extrarectal spread. 62,6% of patients presented with metastatic disease, 31,8% were stage III and 15,5% of them were stage II. Median time to diagnosis was 8,5 months. 42 patients underwent curative resection with abdominoperineal resection being the commonest procedure. 38 of them were given short course preoperative concomitant radiochemotherapy. A total of 28 patients received adjuvant chemotherapy. Only 28 out of 45 patients planned for first line chemotherapy could receive the treatment. After a median follow up of 18 months, disease free survival was 20,6 months, and a total of 13 patients had relapse disease (local n = 5, distant n = 8). The progression free survival was 4,4 months. 4 patients were died of disease. The chemotherapy was well tolerated, and most side effects were grade I and II (anemia n = 28, diarrhea n = 15, peripheral neuropathy n = 11). Conclusion: A significant number of rectal cancers patients in our region present with advanced stage of disease and probably due to referral bias, majority had low rectal cancers. By advocating multimodality protocols a good locoregional and systemic control can be achieved despite the advanced stage of presentation.

Listeriosis is a frequent infection affects specially subjects with weak immunity like patients treated with immunosupressors. We report a case of Listeria monocytogenes septicaemia characterized by severe diarrhoea in a 42 years old female who was undergoing breast cancer chemotherapy. The bacteriological diagnoses as and the antibiogram directly carried out from blood culture allowed us to obtain results in less than 24 hours. Concerning our case, an early diagnosis leads us to ensure rapidly a more effective therapeutic care.

Primary leiomyosarcoma of the breast is an extremely rare neoplasm. Only few cases have been reported in the literature. We report here a case of breast leiomyosarcoma in a 44-years-old female and we discuss the data of the existing literature.

Background: Gastrointestinal stromal tumors (GISTs) are rare mesenchymal neoplasm affecting the gastrointestinal tract. The incidental occurrence of mesenchymal tumors and other primary tumors has not been well described in literature. The aim of this study was to evaluate the clinical and pathologic features of GIST occurring synchronously with other primary tumors. Methods: 78 patients with diagnosis of GIST treated surgically with curative intent at the department of medical oncology at HASSAN II university hospital of FEZ MOROCCO, from 2001 to 2012 were included. The patient clinical data and pathological reports were reviewed. Results: Of the 78 patients, there were 5 (6,4%) cases of synchronous GIST and other primary tumors discovered as coincidental findings. The synchronous GISTs analysed were located in the peritoneum (n = 3), and stomach (n = 1) and small intestine (n = 1), size ranging from 3 to 20 cm (median 7,4 cm). Two of the concurrent primary tumors were from gastrointestinal origin (n = 2), and the other three synchronous cancers were prostate adenocarcinoma, uterine leiomyosarcoma and germ cell carcinoma of the ovary. The synchronous GISTs immunophenotype shows positivity for CD117 (100%) and CD34 (40%). According to GIST risk category for aggressive behavior three were classified as high risk and tow low. Conclusion: The synchronous occurrence of GISTs and other primary neoplasm is not an uncommon entity and usually they are discovery incidentally. Epithelial tumors of the gastrointestinal tract are the most associated with concomitant GISTs. Further studies are required to clarify the molecular and genetic mechanisms of carcinogenesis and progression associating GIST and synchronous tumors.

Background: The few studies in the literature have been published and demonstrated that the serum levels of markers such as carcinoembryonic antigen (CEA) and carbohydrate antigen 19-9 (CA 19-9) are elevated in patients with advanced gastric cancer. The aim of this study were to evaluate, retrospectively, the value of CEA and CA 19.9 in the diagnosis of gastric cancer in Moroccan population. Methods: 114 patients with gastric cancer were analyzed in this retrospective study from 2008 to 2012. Correlations between CEA and CA 19-9 at diagnosis and clinicopathologic features were evaluated. Serum CEA and CA19-9 levels were measured at diagnosis. The cut-off values for CEA and CA 19-9 were 5.0 ng/ml and 37 U/ml respectively. Results: On initial diagnosis, the positive rates of CEA and CA19-9 were 31% and 18% respectively. The CEA was eleved in 30% of T4 (23/76), 31% of T3 (10/32), 60% of T2 (3/5) and CA19.9 was eleved in 23% of T4 (18/76), 9% of T3 (3/32). In patient with lymph node metasatsis CEA and CA19.9 were eleved in 33% (26/78) and 21% (17/78) respectively. The CEA and CA19.9 were eleved in 25% (2/8), 0% in stage II of TNM classification, 23% (5/21), 9% (2/21) in stage III and 34% (29/85), 22% (19/85) in stage IV respectively. In patient with peritoneal metastases CEA and CA19.9 were elevated in 29% (15/51) and 25% (13/51) respectively. The CA19.9 and CEA were eleved in 12% (6/50), 22% (11/50) of patients with singnet ring carcinoma and in 23% (15/64), 40% (25/64) of patients with adenocarcinoma respectively. No correlation was found between the positive rates of CEA and CA19-9 and the T stage, N stage, peritoneal metastases or extent of disease. Conclusion: In this study, the majority of patients have advanced and metastatic gastric cancer at diagnosis. But, serum levels of CEA and CA19.9 were normal at the majority of them. That suggests no relationship between rate of these tumour markers and advanced or metastatic gastric cancer in our population. Further studies are required to confirm these findings.

Vaginal metastases of renal cell carcinoma have been rarely described. We report a case of a 75-year old woman, who underwent radical right nephrectomy for a renal cell carcinoma. Tumour was classified pT3bN0M0 and grade III of Furhmann grading. One year later, scanner discovered mediastinal and lombo-aortic lymph nodes. She received 2 months of immunotherapy associated with bevacizumab, but stopped because of intolerance. She was readmitted in our institute for vaginal bleeding. Clinical investigations showed a vaginal mass and biopsy revealed a renal cell carcinoma metastasis. This case suggests that retrograde venous dissemination may be at the origin of vaginal metastasis of renal cell carcinoma and emphasized the preventive value of early ligature of renal vein.

Askin’s tumor is a primitive neuroectodermal tumor developing from the soft tissues of the chest wall. Its diagnosis approach is complex and requires a multidisciplinary team. Given the rarity of this entity, no regimen has been validated in the literature. We report two cases of Askin’s tumor with a major response to polychemotherapy and surgical resection in one case. These cases show that treatment of Askin’s tumor should be multimodal, requiring discussion in multidisciplinary tumor working groups.

Background: Therapy resistance is the main cause of therapeutic failure and death in patients with gastric carcinoma. The aim of this study was to identify predicting factors of resistance to chemotherapy in gastric cancer on the Moroccan population. Methods: A retrospective study was conducted from 2009 to 2011 in the department of medical oncology at Hassan II university hospital Fez, Morocco, during witch all patients with gastric cancer who received systemic chemotherapy were analyzed. We evaluated the influence of clinico-pathologic factors on the response to chemotherapy. Results: We selected 76 cases studies. There were 40 women and 60 men. The mean age was 50 years (range: 22-80). 76% of patients were T4, 21% were T3 and 3% were T2.9% of patients were stage II of TNM classification, 21% were stage III and 70% were stage IV. 20% of patients have peritoneal metastases and 24% have visceral metastases. Signet-ring cells were found in 43% of patients. All patients received systemic chemotherapy: perioperative in 10 patient, adjuvant in 9 patients and the rest received palliative chemotherapy. The protocols of systemic chemotherapy were: fluoropyrimidine (5 FU or capecitabine) monotherapy in 10 patients, fluoropyrimidine combined with cisplatin and epirubicin in 49 patients, 5 fluorouracil combined with cisplatin in 13 patients, fluoropyrimidine combined with oxaliplatin and epirubicin in 2 patients and fluoropyrimidine combined with cisplatin and taxane in 2 patients. Average follow-up was 8 months: 5% of patients presented a complete response, 15% presented a partial response, 10% were stable and 26% presented a progressive disease. The median progression-free survival was 5 months and the median disease free survival was 10 months. The prognostic factors associated of resistance to chemotherapy were the degree of gastric wall invasion (disease progression was observed at 70% of T4 versus 40% at T3 versus 0% at T2; p = 0.03) and the tumor histology (70% of progression was observed in signet ring carcinoma versus 40% in adenocarcinoma; p = 0.02). Conclusion: Resistance to chemotherapy remains a significant barrier in patients with gastric cancer. It is major contributors to the poor prognosis of gastric cancer. The prognostic factors associated with resistance to chemotherapy in gastric cancer in our study were the degree of gastric wall invasion and the tumor histology.

We report the case of a patient of 30 years with primary choriocarcinoma of the ovary. This patient referred for abdomino-pelvic mass suspected clinically and sonographically. Exploratory laparotomy was performed with the presence of two latero-uterine mass adherents to the highly vascularised uterus and difficult to resects deep plane with a mass left hepatic bleeding. A biopsy of both masses was performed and histological examination with immunehistochemical study returned for a primary ovarian non-gestational choriocarcinoma and the patient received 4 cycles of chemotherapy after hepatic artery embolization with good clinical, biological and radiological evaluation.