GÝRÝÞ ve AMAÇ: Ýleri evre küçük hücreli dýþý akciðer kanser (KHDAK)’li hastalarda tedavilerdeki geliþmelere raðmen çoðunda ilk tedavi sonrasý hastalýk progresyon geliþmektedir. Çoðunlukla hastalar ikinci basamak kemoterapi tedavisi almaktadýrlar. Çalýþmamýzda, birinci basamak kemoterapi tedavisi sonrasý progresyon geliþen ileri evre KHDAK’li hastalarda, ikinci basamak kemoterapi alanlar ile sadece destek tedavisi alanlarda yaþam kalitesini karþýlaþtýrýlmasý amaçlanmýþtýr.
YÖNTEM ve GEREÇLER: Yaþam kalitesi deðerlendirilmesinde EORTC QLQ-C30 Version 3.0 Türkçe anket formu kullanýldý. Hastalara çalýþmaya alýndýðý tarihte bazal olarak ilk anket yapýldýktan sonra, ayný anket ayda bir olmak üzere iki kez daha tekrarlandý.
BULGULAR: Ýkinci basamak kemoterapi alan 24 ve sadece destek tedavisi alan 16 hasta olmak üzere toplam 40 hasta deðerlendirildi. Genel saðlýk durumu, toplam fonksiyon, toplam semptom, fiziksel fonksiyon, uðraþ fonksiyon, duygusal fonksiyon, sosyal fonksiyon, yorgunluk semptom ve aðrý semptom skorlarý ikinci basamak kemoterapi alanlarda anlamlý þekilde daha iyi bulundu. Kavrama fonksiyon ve nefes darlýðý semptom skorlarý ikinci aydan itibaren ikinci basamak kemoterapi alanlarda daha iyi saptandý. Bulantý-kusma, iþtahsýzlýk, konstipasyon, diyare semptom skorlarý açýsýndan birinci ve ikinci aylarda iki grup arasýnda anlamlý fark bulunmadý. Uykusuzluk ve mali zorluk semptom skorlarý birinci ayda, ikinci basamak kemoterapi alanlarda anlamlý olarak iyi bulunurken, ikinci ayda iki grup arasýnda anlamlý fark saptanmadý.
TARTIÞMA ve SONUÇ: Ýleri evre KHDAK hastalarýnda, ikinci basamak kemoterapinin, sadece destek tedavisine göre yaþam kalitesinde genel olarak anlamlý iyileþme saðladýðý gösterildi.

INTRODUCTION: Advances in non-small lung cancer (NSCLC) treatment is limited. Disease progression is seen in most patients after first line chemotherapy and many patients receive second line chemotherapy. A prospective study is planned to compare the life quality of NSCLC patients who received second line chemotherapy and those without second line chemotherapy.
METHODS: EORTC QLQ-C30 Version 3.0 (Turkish version) is used to evaluate the quality of life of the patients. The questionnaire is given to the patients at baseline and repeated two times with monthly intervals.
RESULTS: Twenty-four of the total 40 patients entered the study received second line chemotherapy and 16 patients received only supportive care. The general health status, overall function, overal symptom, physical function, role function, emotional function, social function, fatigue symptoms and pain symptoms scores were significantly better in patients who received second line chemotherapy. Cognitive function and dyspnea symptom scores were significantly better after second month in the patients who received second line chemotherapy. There were no statistical difference for nausea, vomiting, anorexia, constipation, diarrhea symptom scores between groups during the first and second month. While insomnia and financial difficulty symptoms scores were significantly better at first month in patients who received second line chemotherapy; no difference is seen in second month.
DISCUSSION AND CONCLUSION: Our findings shows that second line chemotherapy in advanced NSCLC patients significantly improve the general quality of life when compared to only supportive care.

GÝRÝÞ ve AMAÇ: Bu çalýþmada tersiyer bir referans merkezi olan Onkoloji Hastanesi genel cerrahi kliniðinde malignite tanýsý ile yatarak tedavi edilmiþ 100 ardýþýk hastanýn yatýþ anýndaki nütrisyonel durumunun deðerlendirilmesi amaçlanmýþtýr.
YÖNTEM ve GEREÇLER: Hastalarýn tanýlarý, cinsiyetleri, vücut kitle indeksleri (VKÝ), nütrisyonel risk taramasý (NRS 2002) ve nütrisyon durumunun subjektif global deðerlendirmesi (SGD) yapýlmýþtýr. Nütrisyon durumunda bozulma açýsýndan hastalar normal (skor 0), hafif bozulma(skor 1), orta bozulma (skor 2) ve þiddetli bozulma (skor 3) olarak gruplandýrýlmýþtýr. VKÝ açýsýndan; <20 zayýf, 20-25 arasý normal kilolu, 25-30 arasý kilolu, 30-40 arasý þiþman ve >40 morbid obez olarak deðerlendirilmiþtir. SGD açýsýndan; A iyi beslenmiþ, B hafif-orta beslenme bozukluðu ve C ise þiddetli beslenme bozukluðu olarak deðerlendirilmiþtir.
BULGULAR: VKÝ açýsýndan deðerlendirildiðinde; 46 hasta normal kilolu, 34 hasta kilolu, 12 hasta þiþman, 7 hasta zayýf ve bir hasta da morbid obez olarak saptanmýþtýr. Nütrisyon durumunda bozulma açýsýndan deðerlendirildiðinde; hastalarýn 42’si normal bulunurken, 40’ýnda þiddetli bozulma, 12’sinde orta bozulma ve 6’sýnda hafif bozulma saptanmýþtýr. SGD açýsýndan deðerlendirildiðinde; 50 hasta iyi beslenmiþ olarak deðerlendirilirken, 40 hastada hafif-orta derecede beslenme bozukluðu ve 10 hastada ise þiddetli beslenme bozukluðu saptanmýþtýr.
Hastalar taný sýklýðýna göre deðerlendirildiðinde; 34 hastanýn meme kanseri, 24 hastanýn mide kanseri, 16 hastanýn kolon kanseri ve 8 hastanýn da rektum kanseri tanýsý ile kliniðe yatýrýldýklarý saptanmýþtýr.

TARTIÞMA ve SONUÇ: Onkoloji kliniklerine yatan hastalarda beslenme bozukluklarý sanýlandan daha sýktýr. Bu bozulma hastalýðýn primer olarak yerleþtiði organa göre de deðiþiklik göstermektedir. Bu hastalarýn tümü yatýþ sýrasýnda beslenme durumu açýsýndan deðerlendirilmeli ve geliþmiþ olan bozukluklar tedavi edilmeli ve geliþebilecek yeni sorunlar engellenmelidir.

INTRODUCTION: In this study, the nutritional status of 100 consecutive patients with a diagnosis of malignancy at theadmission to general surgery clinic of a tertiary oncology reference center was evaluated.
METHODS: The diagnosis, gender, body mass index (BMI), nutritional risk screening (NRS 2002), and subjective global assessment of nutritional status (SGA) were evaluated.. Patients in terms of malnutritiion were grouped as normal (score 0), mild impairment (score 1), moderate impairment (score 2), and severe impairment (score 3). In terms of body mass index, the patients were grouped as underweight (<20), normal weight (20-25), overweight (25-30), obese (30-40) and morbidly obese (>40). In terms of subjective global assessment, the patients grouped as well-nourished (A), mild -to-moderate malnutrished (B) and severely malnourished (C ).
RESULTS: In terms of BMI, 46 patients were normal in weight, 34 patients were overweight, 12 patients were obese, 7 patients were underweight and one patient was morbidly obese. In terms of nutritional status, 42 patients were normal, severe impairment was present in 40 patients, moderate impairment in 12 patients and mild impairment in 6 patients..In terms of subjective global assessment, 50 patients were considered well nourished, 40 patients had mild-to-moderate malnutrition and severe malnutrition was found in 10 patients.Malnutrition was much more prevalent in patients with gastrointestinal tumors, as expected.
DISCUSSION AND CONCLUSION: Malnutrition is much more common than expected in patients admitted to oncology clinics. This impairment varies according to the location of primary disease. Malnutrition should be treated and possible new challenges should be avoided.

GÝRÝÞ ve AMAÇ: Bu çalýþmada Malign Melanom tanýlý hastalarýn Klinikopatolojik özelliklerini incelemeyi amaçladýk.
YÖNTEM ve GEREÇLER: Bu çalýþmada Dokuz Eylül Üniversitesi Hastanesi Týbbi Onkoloji bölümünde 1991-2011 Yýllarý arasýnda takip edilen malign melanom tanýlý 166 hasta retrospektif olarak deðerlendirilmiþtir.
BULGULAR: Hastalardan 87’si erkek, 79’u kadýndýr. Tüm hastalarýn ortanca yaþý 52 (21-81) dir. En sýk extremite bölgesinde malign melanom görülürken daha az sýklýkta baþ boyun ve gövdede gözlenmiþtir. Primer tümör bölgesi ile breslow kalýnlýðý arasýnda istatistiksel bir anlamlýlýk saptanmamýþtýr(p=0.109). Ancak breslow kalýnlýðý ile sað kalým arasýnda istatistiksel bir fark bulunmuþtur. Breslow kalýnlýðý 0-2 mm arasýnda olanlarýn ortalama saðkalýmý 125,6 ay(99-151), 2-4 mm arasýnda olanlarýn ortalama saðkalýmý 121,2 ay(92-151), 4 mm ve üstünde olanlarýn ortalama saðkalýmý 89 ay(68-111) olarak saptanmýþtýr ve aradaki fark istatistiksel olarak anlamlý saptanmýþtýr(p=0,012). Tüm hastalarýn 1 yýllýk saðkalým oraný %96, iki yýllýk saðkalým oraný %92.1 ve 5 yýllýk saðkalým oraný %82.7 saptanýrken; ortalama saðkalým süresi 89,74±6,9 ay olarak saptanmýþtýr. Kadýn cinsiyette ortalama saðkalým 108.8 ay, erkeklerde ortalama saðkalým 72.7 ay saptanmýþ olup aradaki fark istatistiksel olarak anlamlý bulunmuþtur(P=0,001). Melanomun primer yerleþim yerine göre saðkalýmlarý sýrasýyla baþ-boyun yerleþiminde 69.6 ay, gövde 114.1 ay, extremite yerleþiminde 82.0 ay olup aradaki fark istatistiksel olarak anlamlý saptanmamýþtýr(P=0,32).
TARTIÞMA ve SONUÇ: Malign melanom en kötü seyirli deri tümörü olup prognozu etkileyen faktörler birden fazladýr. Bu çalýþmada en önemli prognostik faktörler breslow kalýnlýðý, primer tümör yerleþim bölgesi ve cinsiyet olarak saptanmýþtýr.

INTRODUCTION: Our aim in this study is to analyse patients with malign melanoma clinicopathologically.
METHODS: In this study, 166 malign melanoma patients that followed by Dokuz Eylul University Hospital Medical Oncology Clinic in years between 1996 and 2011 were evaluated retrospectively.
RESULTS: 87 of patients is male, 79 is female. The median age is 52 (21-81). The most common site for malign melanoma is extremity; head, neck and body are less commonly involved. There is no statistically significant difference between primary tumor site and breslow thickness (p=0.109). Breslow thickness and survival are related statistically significant. Average survival time for Breslow thickness between 0 and 2mm is 125,6 months (99-151), 2 and 4 mm is 121,2 months (92-151) and over 4mm is 89 months (68-111) and difference between groups are statistically significant (p=0,012). 1 year survival rate for all patients is 96%, 2 year survival rate is 92.1% and 5 year survival rate is 82.7%. Average survival time is detected as 89,74±6,9 months. Mean survival time for female patients is 108.8 months, 72.9 months for male patients which is statistically significant (P=0,001). There is no significant difference in survival due to melanom primary site (P=0,32). The mean survival time for head-neck malign melanoma is 69.6 months, 114.1 months for body involvement and 82.0 months for extremity involvement.
DISCUSSION AND CONCLUSION: Malign melanoma has the worst progress in all skin cancers and there are several factors affecting the prognosis. The most important prognostic factors detected in this study are breslow thickness, primary tumor site and sex.

Mikrobiyota vücudumuzu paylaþtýðýmýz tüm mikroorganizmalar olup bu ekosistem insan saðlýðýnda besinlerin ve K vitaminin saðlanmasý, sindirim gibi önemli bir rol oynar. Mikrobiyota immün fonksiyonu biyolojik aktif metabolitler sayesinde etkiler ve mikrobiyotanýn deðiþimi (disbiyozis) pek çok hastalýðýn geliþiminde kritik rol oynar. Son yapýlan çalýþmalarda mikrobiyotanýn immün kaçýþ sayesinde karsinojenezisin önemli bir parçasý olduðunu ve kanser tedavisinde de etkisi olduðu bildirilmiþtir.

Microbiota is all microorganisms that share our body and microbiota ecosystem plays an important role in human health such as spplying nutrients, K vitamin, digestion, Microbiota affects many immun functions by biological molecules and change of the microbiota (disbiosis) has a critical roles development of multple diseases. Recently it has been reported that microbiota is an important part of carcinogenesis cause by immun evasion and has effect on the treatment of cancer.

Kanser hastalýðý olan çocuklarýn uzun süreli izleminde biliþsel, duygusal ve sosyal alanda sorunlar yaþanmaktadýr. Kanser tanýsý konulan çocuklarda depresyon, posttravmatik stres bozukluðu ve somatizasyon bozukluðu gibi önemli ruhsal hastalýklara sýk rastlanmaktadýr. Bu olgu sunumunda Ewing Sarkomu tanýsýndan sonra uzun bir tedavi süreci geçiren ve kanser sekeli sonucu yaþadýðý psikiyatrik sorunlar için kliniðimize baþvuran 16 yaþýnda bir ergenin izleminde uygulanan destekleyici psikoterapötik yaklaþýmlar ve sonuçlarý tartýþýlmýþtýr.

Cognitive, emotional and social problems are being experienced to long-term follow up of children with cancer. Children diagnosed with cancer are frequently suffered from major mental illnesses such as depression, post-traumatic stress disorder and somatization disorder. This paper reports, in substantial details, a 16-year-old female adolescent case who had exposed to a long time period of medical treatment after the diagnosis of Ewing’s Sarcoma and was admitted to our clinic for psychiatric symptoms related to sequelae of cancer. In this manuscript we are discussing supportive psychotherapeutic approaches implemented to this adolescent and its follow-up therapeutic results.

Solid tümörlerin meme metastazýna çok sýk olmasa da klinik pratik hayatýmýzda rastlamaktayýz ancak servikal kanserin memeye yayýlýmý literatürde de çok nadir bildirilmektedir. Olgumuz 65 yaþýnda, evre IV yassý hücreli serviks kanseri nedeni ile 3 kür birinci seri kemoterapi aldýktan sonra meme metastazý geliþti. Primer meme kanseri düþünülerek alýnan biyopsinin patolojik incelenmesinde az diferansiye yassý hücreli kanser metastazý olduðu görüldü. Bu olgu kanser öyüsü olan hastalarda doðru tedavi kararý verebilmek için ayýrýcý tanýnýn önemini bir kez daha vurgulamaktadýr.

Breast metastasis from other solid tumors are infrequent, and cervical cancer is the extermely rare primary site. We describe a case of 65 years old women with stage IV cervical squamous cell carcinoma. After three cycles of the first line chemotherapy, she developed breast metastasis mimicking the primary breast cancer. Histopathological examination of the breast trucut biopsy performed and less differantieted epidermoid carcinoma was deteremined. Differential diagnosis from primary breast cancer is crtical to decide most appropriate treatment especially in patients with previous cancer history.

Tail gut kistleri embriyonik hindgut kalýntýlarýndan geliþen ve retrorektal bölgede yerleþen nadir konjenital lezyonlar olup sýklýkla orta yaþlý kadýnlarda perirektal semptomlarla kendilerini gösterirler. Her ne kadar tail gut kistleri benign konjenital lezyonlar olsa da nadiren malign transformasyon bildirilmiþtir. Bu vaka takdiminde hastaneye 2 aydýr olan asemptomatik palpabl perirektal kitle ile baþvuran 48 yaþýnda bir bayan hastayý sunduk. Tail gut kistinin radyolojik görünümü 3 lobülden oluþmakta idi ve kombine perineal ve abdominal yaklaþým ile baþarýlý bir þekilde eksize edildi.

Tail gut cysts are rare congenital lesions located in retrorectal area arising from the vestiges of the embryonic hindgut and often present in middle-aged women with perirectal symptoms. Although tail gut cysts are usually benign congenital lesions, malignant transformation has been rarely reported. In this case report we present a 48 year-old woman who was admitted to hospital with an asymptomatic palpable perirectal mass for two months. The radiological appearance of tail gut cyst was three lobulated and it was successfully excised with combined perineal and abdominal approaches.

Literatürde malign neoplazmlarýn dural metastazlarý ile ilgili az bilgi bulunmaktadýr. Kesin etyopatogenezleri ve tedavi stratejileri tartýþmalýdýr. Dura matere en sýk metastaz meme kanserinden olmaktadýr. 41 yaþýnda bayan hasta kliniðimize baþ aðrýsý ve sol parietalde þiþlik þikayeti ile baþvurdu. Hasta 3 yýl önce infiltratif duktal kanser nedeni ile opere edilmiþti. Sol kalvaryal ve dura metastazý tespit edildi ve sol parietal kraniotomi ile cerrahi rezeksiyon uygulandý. Hasta operasyondan sonra tüm beyin radyoterapi aldý. Bu yazýda kafatasý ve duraya metastaz yapan bir kanser vakasýný ve bu nadir hastalýðýn ana özelliklerini tartýþtýk.

There is little information about the dural metastasis of malign neoplasms in the literature. The exact ethiopathogenesis and treatmentstrategies are contraversial. The most common site for breast cancer metastasis is dura matter. Forty one years old female patient admitted to our clinic with headache and left parietal swellingcomplaints. The patient was operated due to infiltrative ductal cancer three years ago. A left parietal calvarial and dural metastasis determined and surgically resected via left parietal craniotomy. The patient underwent whole brain radiotherapy after this operation. In this report we present an unusual case of cancer metastasis to the skull and dura and discuss the main features of this disease.

Leptomeninksler, solid tümörlerde nadir rastlanýlan bir metastaz bölgesidir. Leptomeningeal metastaz’a en sýk neden olan tümörler; meme kanseri, akciðer kanseri, melanom ve lösemi-lenfomalardýr. Mide kanserine baðlý leptomeningeal metastaz, oldukça nadir görülen ancak hýzlý seyirli ve kötü prognozlu bir tablodur. Taný beyin omurilik sývýsýnýn biokimyasal ve sitolojik incelenmesi ve görüntüleme yöntemleri ile konulmaktadýr. Leptomeningeal metastaz tedavisinde intratekal kemoterapi ve/veya radyoterapiyi içeren çeþitli seçenekler vardýr. Bu yazýda spinal leptomeningeal metastaza yol açan metastatik mide kanserli bir kadýn hastayý sunduk. Godalinyumlu kranial manyetik rezonans görüntülemede patoloji saptanmazken, torakal spinal vertebra manyetik rezonans görüntülemede Th1-6 düzeyinde leptomeningeal tutulum izlendi. Beyin-omurilik sývýsýnýn sitolojik incelemesi taþlý yüzük hücresine benzeyen tümör hücrelerini saptadý. Bulgular leptomeningeal metastaz ile uyumluydu.

Leptomeninges are a rare region for metastasis in solid tumors. The most common causes of leptomeningeal metastasis are breast cancer, lung cancer, melanoma and leukemia-lymphomas. Leptomeningeal metastasis associated with gastric cancer is an exceedingly rare condition but it is rapidly progressive and poor prognosis. The diagnosis is confirmed by examination of the cerebrospinal fluid and imaging methods. There are several treatment options for patients with LMC, including intrathecal chemotherapy with or without radiotherapy. In this report, we present a women patient with metastatic gastric cancer leading to spinal leptomeningeal metastasis. While magnetic resonance imaging of the brain showed no pathology, magnetic resonance imaging of the thoracal spinal vertebrae showed leptomeningeal enhancement of Th1-6 level. Cytological examination of the cerebrospinal fluid revealed the tumor cells like signet ring cell. These findings were consistent with leptomeningeal metastasis.