Screen patients with broken heart syndrome for cancer

People with broken heart syndrome, also known as Takotsubo syndrome (TTS), should be screened for cancer, suggests a new study published in the Journal of the American Heart Association. And, a history of malignancy might increase the risk for TTS.

In the study of 1,604 people with broken heart syndrome, 16.6% showed an association with malignancy. The most frequent type of malignancy was breast cancer 26.2%, followed by tumors affecting the gastrointestinal system 16.1%, respiratory tract 15.4%, internal sex organs 14.6%, skin 13.1%, lymphatic system 7.1%, endocrine organs 6.7%, urinary tract 5.2%, hematologic 3.0% and the central nervous system 2.2%.

Patients with malignancy were older and more likely to have physical triggers (after a medical intervention or physical trauma), but less likely to have emotional trigger as the inciting event compared with those without malignancy. Long‐term mortality was higher in patients with malignancy while short‐term outcome was comparable. Malignancy was as an independent predictor of long‐term mortality.

C‐reactive protein levels were significantly higher in the TTS patients with malignancy in those without malignancy, while the total white blood cell counts were not different between the groups. The raised CRP levels were attributed to as a marker of the comorbidity.

TTS patients with malignancy on initial presentation experienced chest pain less frequently, but had dyspnea more often.

(Source: Journal of the American Heart Association, Published July 17, 2019)

Dr KK Aggarwal

Padma Shri Awardee

President Elect Confederation of Medical Associations in Asia and Oceania   (CMAAO)

Group Editor-in-Chief IJCP Publications

President Heart Care Foundation of India

Past National President IMA

New Practice Changing Guideline: Laparotomy is the preferred approach for radical hysterectomy in women with cervical cancer

For women undergoing radical hysterectomy for cervical cancer with tumors ≥2 cm, the new recommendation is laparotomy rather than minimally invasive surgery (MIS).

Patients with smaller tumors (<2 cm) may be candidates for robotic-assisted surgery.

MIS approaches are done with the goal of reducing operative morbidity. However, two new studies reported in the New England Journal of Medicine have found worse oncologic outcomes with these procedures.

In a randomized trial of women with cervical cancer who underwent radical hysterectomy, MIS compared with laparotomy resulted in a higher rate of death from cervical cancer at 3 years (4.4 versus 0.6 percent) and a lower rate of disease-free survival at 4.5 years (86.0 versus 96.5 percent) (1).

Another cohort study found that MIS radical hysterectomy was associated with a higher four-year mortality rate (9.1 versus 5.3 percent) (2).

This is a recent recommendation. Any such new information or recommendation should be discussed with the patient and informed decision should be taken before proceeding ahead with the line of management.

References

1.    Ramirez PT, Frumovitz M, Pareja R, et al. Minimally invasive versus abdominal radical hysterectomy for cervical cancer. N Engl J Med 2018;379:1895.

2.    Melamed A, Margul DJ, Chen L, et al. Survival after minimally invasive radical hysterectomy for early-stage cervical cancer. N Engl J Med 2018;379:1905.

Dr KK Aggarwal

Padma Shri Awardee

President Elect Confederation of Medical Associations in Asia and Oceania   (CMAAO)

Group Editor-in-Chief IJCP Publications

President Heart Care Foundation of India

Immediate Past National President IMA