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      Spontaneous regression of pancreatic cancer: A case report and literature review

      case-report

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          Highlights

          • Spontaneously regressing cancers are extremely rare, but been known to occur in almost all types of malignant tumors.

          • Spontaneous regression of pancreatic cancer is especially rare as compared to other types of malignancies.

          • Importance correlating factors with spontaneous of cancer include infection, febrile episodes, and hormonal influences.

          • This case report documents spontaneous resolution of pancreatic cancer after a myocardial infarction.

          Abstract

          Introduction

          Spontaneous regression of cancer is defined as the partial or complete disappearance of malignant disease without treatment, or in the presence of therapy that is deemed inadequate to exert an influence on malignant disease, as composed by Tilden Everson and Warren Cole in the 1960s. It has been a topic of major interest in the field of medical and surgical oncology. It is poorly understood and scantily documented. Factors associated and postulated pathogeneses are at best, hypothetical.

          Presentation of case

          We report a case of spontaneous resolution of a head of pancreas carcinoma in a 77-year-old gentleman after a myocardial infarction event delayed planned surgery.

          Discussion

          A literature review of previously reported cases of spontaneous regression of pancreatic cancer was performed. The possible predisposing factors to spontaneous regression of pancreatic and other forms of malignancies was reviewed.

          Conclusion

          This is a novel case of spontaneous regression of pancreatic carcinoma after an episode of myocardial infarction. The pathophysiology to spontaneous resolution of cancer is not well understood, may be multifactorial and requires further study

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          Most cited references16

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          The toxins of William B. Coley and the treatment of bone and soft-tissue sarcomas.

          In 1891, William B. Coley injected streptococcal organisms into a patient with inoperable cancer. He thought that the infection he produced would have the side effect of shrinking the malignant tumor. He was successful, and this was one of the first examples of immunotherapy. Over the next forty years, as head of the Bone Tumor Service at Memorial Hospital in New York, Coley injected more than 1000 cancer patients with bacteria or bacterial products. These products became known as Coley's Toxins. He and other doctors who used them reported excellent results, especially in bone and soft-tissue sarcomas. Despite his reported good results, Coley's Toxins came under a great deal of criticism because many doctors did not believe his results. This criticism, along with the development of radiation therapy and chemotherapy, caused Coley's Toxins to gradually disappear from use. However, the modern science of immunology has shown that Coley's principles were correct and that some cancers are sensitive to an enhanced immune system. Because research is very active in this field, William B. Coley, a bone sarcoma surgeon, deserves the title "Father of Immunotherapy".
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            CONTRIBUTION TO THE KNOWLEDGE OF SARCOMA

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              Dr William Coley and tumour regression: a place in history or in the future.

              Spontaneous tumour regression has followed bacterial, fungal, viral, and protozoal infections. This phenomenon inspired the development of numerous rudimentary cancer immunotherapies, with a history spanning thousands of years. Coley took advantage of this natural phenomenon, developing a killed bacterial vaccine for cancer in the late 1800s. He observed that inducing a fever was crucial for tumour regression. Unfortunately, at the present time little credence is given to the febrile response in fighting infections-no less cancer. Rapidly growing tumours contain large numbers of leucocytes. These cells play a part in both defence and repair; however, reparative functions can also support tumour growth. Intratumoural infections may reactivate defensive functions, causing tumour regression. Can it be a coincidence that this method of immunotherapy has been "rediscovered" repeatedly throughout the centuries? Clearly, Coley's approach to cancer treatment has a place in the past, present, and future. It offers a rare opportunity for the development of a broadly applicable, relatively inexpensive, yet effective treatment for cancer. Even in cases beyond the reach of conventional therapy, there is hope.
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                Author and article information

                Contributors
                Journal
                Int J Surg Case Rep
                Int J Surg Case Rep
                International Journal of Surgery Case Reports
                Elsevier
                2210-2612
                02 December 2017
                2018
                02 December 2017
                : 42
                : 55-59
                Affiliations
                [a ]Yong Loo Lin School of Medicine, National University of Singapore, Singapore General Hospital, Hospital Drive 1, S169608, Singapore
                [b ]Department of General Surgery, Singapore General Hospital, Singapore General Hospital, Hospital Drive 1, S169608, Singapore
                [c ]Department of Hepatopancreatobiliary and Transplant Surgery, Singapore General Hospital, Singapore General Hospital, Hospital Drive 1, S169608, Singapore
                [d ]Duke-National University of Singapore (NUS), Medical School Singapore, 8 College Road, S169857, Singapore
                Author notes
                [* ]Corresponding author at: Singapore General Hospital, Hospital Drive 1, S169608, Singapore. lee.ser.yee@ 123456singhealth.com.sg
                Article
                S2210-2612(17)30634-X
                10.1016/j.ijscr.2017.11.056
                5724984
                29216532
                832328ce-8b5a-4bd7-8aa8-1a63cc230a3b
                © 2017 The Authors

                This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

                History
                : 14 November 2017
                : 24 November 2017
                : 28 November 2017
                Categories
                Article

                case report,pancreatic carcinoma,spontaneous regression,fever,infection,leukocytes

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