Introduction
Currently, malignant neoplasms are the No. 1 mortality and mortality by type of death cause, malignant neoplasms are death by about 1 in 3.5 people. Moreover, it is increasing trend year by year. Looking at malignant neoplasms by organs, gastric cancer is the second largest in both males and females. In other words, gastric cancer is not a special disease, it can be said that it can happen to anyone.
First of all, what we can do is to grasp and prevent the risk factors of gastric cancer and to discover it at a time when cure is possible.


What is stomach cancer
The wall of the stomach is divided into several layers. Stomach cancer is a cell of its innermost layer (mucous membranes secreting gastric juice and mucus) has been mutated to various cancer cells as a result of various factors. Also, stomach cancers are classified into several types by inspection with a microscope. Even with the same stomach cancer, personality is different little by little depending on its type, there are differences in treatment method · treatment effect etc.

Causes of stomach cancer
At present, reliable risk factors include smoking and H. Pylori infection. Especially for H. Pylori infection, the risk of cancer is 5.1 times higher than non-infected persons. Besides, taking too much salt, diabetes etc as a risk factor is said to be said. Conversely, green tea, vegetables and fruits are considered as inhibitors of gastric cancer.
* Currently, for H. Pylori infection, eradication therapy is insurance indication. The risk of developing gastric cancer will be reduced by sterilization (it can not completely suppress gastric cancer).

Symptoms of stomach cancer
The main symptoms are stomach pain / stomach discomfort, heartburn, nausea, loss of appetite, frequent occurrence of belching etc. However, neither symptom is unique symptoms of stomach cancer. In addition, it is asymptomatic in most cases at early stages, and it may be asymptomatic even if it progresses.

Diagnosis
Firstly, if any symptoms are recognized, please consult a medical institution earlier.
Various inspections are selected as necessary. Currently, when it is judged that there is a possibility of gastric cancer, in many cases upper endoscopy is chosen. If it is diagnosed as stomach cancer (including suspicion) by endoscopic examination, a cancer tissue is collected and a tissue examination (examination by a microscope) is carried out to make definite diagnosis as stomach cancer. When the diagnosis of stomach cancer is confirmed, investigate the presence or absence of metastasis by conducting contrast CT or PET-CT examination to determine treatment policy.

Treatment
The treatment of stomach cancer is determined based on the degree of progress (stage, stage) of cancer. Currently, there are three focused on endoscopic therapy, surgical therapy, chemotherapy (anticancer drug treatment).At present, gastric cancer is found to be a curable disease if it is found early and appropriate treatment is done. In addition to striving to prevent gastric cancer, it is important to undergo periodic examinations, and to consult a medical institute as soon as you feel any discomfort or symptoms.

Efforts about stomach cancer at our hospital
Our hospital proactively recommends endoscopic examination for patients who have been consulted with complaints of discomfort in the stomach. As a result, there are cases that lead to the discovery of ultra early cancer. Also, depending on the stage, we are actively working on endoscopic treatment as well.
Currently, we regularly hold a study group on diagnosis / treatment selection and treatment outcome for each case, mainly of gastroenterology internal medicine, surgery and clinical pathology science, and are working together in mutual cooperation.

About lung cancer
The first cause of death in Japan is cancer, among which lung cancer is the largest. About 70,000 people have died in 2012, and the number of lung cancer deaths is increasing year by year. There is smoking as a risk factor for lung cancer, and smoking cessation is the most important to prevent lung cancer. For lung cancer screening, chest X - ray examination for people over 40 years old and sputum cytology for heavy smokers are conducted once a year, and the mortality reduction effect is recognized. In the United States, a large-scale study (NLST: National Lung Screening Trial) was conducted for people with severe smoking between 55 and 74 years old, and the mortality rate of lung cancer in the low dose CT screening group was examined in chest x-ray examination group It was reported that it decreased by 20% in comparison.


Lung cancer can be found by symptoms of lung cancer originally such as cough, sputum, blood sputum, dyspnea, chest pain, or symptoms due to metastasis of lung cancer, such as headache or bone pain, or chest X-ray examination. To confirm the diagnosis of lung cancer, it is necessary to chest CT and then take tissues or cells by bronchoscopy, CT lower lung biopsy, thoracoscopy etc. For the staging diagnosis, we performed an examination of the thoracoabdominal CT, PET (or bone scintigraphy), head MRI, etc., and examined TNM consisting of T (tumor), N (Lymph Node, lymph node), M (Metastasis, metastasis) Clinical stage is decided by classification. Lung cancer is classified as small cell carcinoma (about 15%), adenocarcinoma (about 50%), squamous cell carcinoma (about 30%), large cell carcinoma (several%) depending on the pathological tissue, Small cell lung cancer and non small cell lung cancer (adenocarcinoma, squamous cell carcinoma, large cell carcinoma). Small cell lung cancer uses the classification of localized type (LD: limited disease) where the lesion is confined only to the thorax of the primary lesion side and advanced type (ED: extensive disease) where the tumor is beyond the range of LD Often it is.
Treatment of lung cancer is progressing more than before. Guidelines for lung cancer clinical practice from Nippon Lung Cancer Society are published, updated every year, last year is 2014 version, can be seen by anyone on the Japan Lung Cancer Association website. The 2014 version is also published as a book. For patients and their families, "Japanese Lung Cancer Q & A" is approved by the Japan Society of Lung Cancer and published by the West Japan Cancer Research Organization (WJOG) as a book in 2014.
First of all, it is treatment of small cell lung cancer, but in stage I we will perform adjuvant chemotherapy after surgery plus surgery. For localized small cell lung cancer, chemotherapy and chemoradiotherapy are conducted at the same time as chemotherapy, and for patients who are judged that cancer has almost disappeared (complete remission, CR: complete response), recurrence to the brain is confirmed Radiation therapy (preventive whole-brain radiation) will be performed throughout the brain to prevent it. Evolutionary small cell lung cancer carries
out chemotherapy, but cure is difficult, chemotherapy aims to alleviate symptoms and prolong survival time.
6
If the general condition is bad like PS4 (see Fig. 1), there is no indication for chemotherapy, treatment with palliative care is the main treatment.
Next, treatment of non-small cell lung cancer, but I will perform surgery on stage I, II, resectable stage IIIA. For surgical resection of postoperative pathologic stage IA and IB patients in Japan, oral administration of tegafur / uracil (UFT) was reported to extend survival time compared to surgery alone in Japan It is. For surgical resection of postoperative pathologic stage II and IIIA, it is a report abroad, but surgery is more effective if adjuvant chemotherapy with cisplatin + vinorelbine is performed after surgery. In stage III which can not be resected, radiation therapy is performed with chemotherapy and radiation therapy.
I will do chemotherapy at stage III and stage IV for curative irradiation. Cure is difficult, chemotherapy aims to relieve symptoms and prolong survival. Currently non-squamous cell carcinoma is examined for EGFR (Epidermal growth factor receptor) gene mutation, ALK (Anaplastic lymphoma kinase) gene translocation, and if it is positive, we will administer molecular targeted drugs. There are three kinds of molecular targeting drugs such as gefitinib, erlotinib, and afatinib in the EGFR gene mutation positive, and a significant prolongation of progression free survival time is recognized in primary treatment as compared with cytotoxic anticancer drug. At ALK gene translocation positive there are two types of molecular targeted drugs such as crizotinib and alectectinib. Currently, crizotinib shows a significant prolongation of progression-free survival as compared with cytotoxic anticancer agent in primary treatment It is. For EGFR gene mutation negative in non-squamous cell carcinoma, in combination with platinum preparations and third generation anticancer drugs developed after the 1990s when ALK gene translocation is negative. In addition, bevacizumab, an angiogenesis inhibitor, may be used in combination with three drugs. Recently, there is a method called "maintenance therapy" that chemotherapy is continued to the first chemotherapy, chemotherapy with pemetrexed is continued unless the cancer is worse after 4 courses of cisplatin + pemetrexed combination therapy and there is no problem in side effects I will. For squamous cell carcinoma, we will use platinum formulation together with third generation anticancer drugs.
Currently, patients with PS3-4 (see Fig. 1) are non-small cell carcinoma EGFR gene mutation negative, ALK gene translocation negative, there is no indication for chemotherapy, treatment for palliative care main subject. However, in the future, there is a possibility that molecular targeted drugs targeting other than EGFR gene mutation positive and ALK gene translocation positive will come out and become able to be treated.
Cisplatin, a platinum formulation, has side effects such as vomiting, nausea, and kidney injury, but it is a key drag of chemotherapy for lung cancer. There is a report that the extent of renal impairment becomes lighter by adding magnesium, and cisplatin short hydration that infuses a small amount in a short time are reported. There are reports of two clinical trials positively evaluating the safety of short hydration in the TRIPLE test showing the effectiveness of 3 antiemetic therapies in combination with advanced emetogenic chemotherapy in Japan, due to the progress of antiemetic drugs and short hydration , Cisplatin combination chemotherapy for patients with lung cancer has become outpatient treatment possible. This hospital is a hospitalization therapy, but in February 2014 we introduced a short hydration that added magnesium, and in January 2011 I compared the toxicity in combination chemotherapy with cisplatin (≥ 60 mg / m 2). Shows cisplatin (CDDP) plus pemetrexed (PEM) short hydration

On the other hand, with short hydration, fever neutropenia decreased in one patient with Grade 3 and no increase in creatinine was observed. In short hydration, we could safely enforce without increasing creatinine. Prior to administration of cisplatin, chemotherapy is performed with general condition, kidney function, cardiac function (electrocardiogram, echocardiogram, BNP), but 3 cases with atrial fibrillation was confirmed in the conventional regimen. There was a report that atrial fibrillation developed due to cisplatin administration, it was possible to appear also in short hydration, I thought that checking of symptoms such as palpitations and electrocardiogram is necessary. We plan to verify kidney function, cardiac function, etc. by carrying out cisplatin short hydration in the future. At present, cisplatin + S1 is also spreading in outpatient treatment for stomach cancer. Recently, cisplatin short hydration has been carried out at the outpatient chemotherapy center, and we hope to increase the number of introductions and contribute to the improvement of QOL of cancer patients.

Introduction

Three major blood cancer

In recent years, gastric cancer, lung cancer, colon cancer, breast cancer, liver cancer have been called five major cancers and became widely known about the outline of diseases. On the other hand, although blood cancer is often the theme of movies and dramas, it seems that it is still not well understood unexpectedly. It occupies most of blood cancer, and is called "three major cancers" "leukemia" "malignant lymphoma" "multiple myeloma". Among them, malignant lymphoma occurs frequently next to the five major cancers and is not a rare illness. Below, I will outline the three major cancers of blood.

leukemia

Acute leukemia
Acute leukemia is a disease that immature hematopoietic cells in the bone marrow are cancerous, normal differentiation / maturation ceases, and it rapidly proliferates. Depending on the origin of the cancer cell, it is divided into "myeloid" and "lymphatic". Although there is a difference in degree between the two, the main symptoms are all fever, bleeding, anemia, all caused by injury of normal hematopoiesis. Fever is an infection caused by leukocyte (neutrophil) reduction, bleeding is thrombocytopenia (sometimes in addition to blood coagulation abnormality), and anemia is caused by red blood cell reduction. In the case of lymphocytic leukemia, lymph nodes may swell.
Although it is a disease seen from children to the elderly, in both children and adults, neither the nature of leukemic cells nor the prognosis (course of disease) are greatly different, so it is not discussed at the same time. In the case of the same adults and elderly people, about 70% does not occur suddenly, it is characterized by the onset of the disease after a period called "myelodysplastic syndrome" of the preleukemia state. When saying leukemia, it tends to have the image that cancer cells are increasing in blood a lot. Of course there are cases like that, but cancer cells in the blood are small (it is increasing in the bone marrow), and in many cases only a decrease in normal cells is conspicuous. It is especially true in leukemia derived from myelodysplastic syndrome.
In our facility, we participate in the "Japanese Adult Leukemia Treatment Group JALSG" founded in 1987 and are conducting standard and therapeutic research. For treatment of acute leukemia, strong chemotherapy with anticancer drugs is mainstream. Treatment is quite different between myeloid and lymphatic. Both have types that are easy to cure and types that are difficult to cure depending on the type of chromosome or genetic change. For example, acute promyelocytic leukemia type has retinoic acid (vitamin A derivative) and magic acid, a magic bullet, which improves at a high rate without much administration of other highly toxic drugs. On the contrary, there are also types that are very difficult to lead to healing with existing therapies. Even if it is apparently healed (called remission), if it is predicted that recurrence will occur, hematopoietic stem cell transplantation may be added after usual chemotherapy (although it is a relatively young person and donor Is found). Recently, a part of acute myeloid leukemia was treated with an antibody (gemtuzumab ozogamicin) labeled with an anticancer agent, a part of acute lymphocytic leukemia, a tyrosine kinase Inhibitors have been used, and even this facility has been effective.
However, in acute leukemia, powerful chemotherapy with anticancer drugs is still carried out for the purpose of forcing all leukemic cells with force, even now it involves high risk of treatment itself. As the molecular pathology becomes clearer, more effective and safer treatments are being sought that stratify and individualize each type and incorporate molecular target therapy.

Chronic leukemia
Chronic leukemia also has "myeloid" and "lymphatic" depending on the cell from which it originates. "Chronic lymphocytic leukemia" is a very popular disease in Europe and the United States, molecular-level pathological analysis and treatment are progressing rapidly. However, it is one of the rare diseases in Japan, so I will only talk about "chronic myelogenous leukemia" below.
Even in chronic myelogenous leukemia, immature hematopoietic cells (hematopoietic stem cells) in the bone marrow are cancerous as well as acute myelogenous leukemia. The difference is that cancer cells maintain their ability to differentiate and maturity. However, if the life expectancy comes first, the cells that are supposed to die will survive through cancerification, and will gradually increase in the body as a result. Therefore, the progress of the disease is slow and there are few symptoms in the early stages of the disease. Therefore, in the blood test of medical examination, incidentally, it is almost always found that it is pointed out an increase in white blood cells and platelets. However, as it progresses, the spleen and liver will swell. Also, although it is chronic, there is a time when cancer cells start to proliferate abruptly (blast crisis).
The causative gene and molecular abnormality are well understood, and the tyrosine kinase inhibitor TKI, which is a representative of molecular targeted drugs, is a so-called magic bullet. It is the first time that this medicine has been used for more than ten years, but very good therapeutic effect can be obtained for a long time. Even at this facility, we are using it from the time of its release, but all the patients are still fine now. Even after that, highly effective TKI has been developed one by one, and it is used separately considering various conditions of patients. However, among many patients, it becomes TKI resistant by mutation of further genes, TKI therapy can not be adequately treated due to side effects, and an example of shifting to the stage of treating a very difficult acute inversion there is. At that time, other hematopoietic stem cell transplantation is indicated.

Malignant lymphoma
Malignant lymphoma is a disease that lymphocytes, a type of leukocyte, become cancerous and increase, and unlike leukemia, it has the property of forming lumps. Subjectively, lymph nodes such as the neck, armpits, and the base of the foot are swollen and often found, but since lymphatic tissues are distributed throughout the body, it does not matter where they come from anywhere in the body. Sometimes it involves general symptoms such as fever, weight loss, night sweats. Hodgkin's lymphoma and non-Hodgkin's lymphoma are classified roughly, but in Japan, Hodgkin's lymphoma is less than 10%, and non-Hodgkin's lymphoma accounts for the majority.
Non-Hodgkin's lymphoma is distinguished by being called B cell type, T cell type, NK cell type etc depending on the type of lymphocyte derived. Furthermore, it is classified into many kinds from the difference of pathological tissue image, chromosome, gene, cell surface trait etc. Why is this cumbersome and difficult classification necessary? Although bad lymphoma is a malignant lymphoma, it is diversified from a rapidly progressing type to a slowly advancing type on a yearly basis, and is immediately hospitalized and requires treatment In some cases it may be better to observe without treatment for many years. Of course, the treatment medicine will also be different.
Diagnosis includes "pathological diagnosis" in which lesion sites are examined excised "biopsy" and investigated, "staging" by PET / CT and others. Both are essential for definitive diagnosis, treatment policy decisions, prognostic predictions, etc. First and foremost the first diagnosis is very important.
For treatment, chemotherapy which combines multiple anticancer drugs is common. In the case of B cellularity, it has become possible to combine rituximab, an antibody against the cell surface antigen, and the treatment outcome has improved greatly. Antibody therapy called Mogamurizumab may be used for T cellularity, especially in adult T cell leukemia / lymphoma with high malignancy. In malignant lymphoma, radiotherapy is also generally effective, but it is mainly done as supplementary treatment. Depending on the case, there is also a method of treating the radioactive isotope with an antibody labeled. If recurrence occurs or the possibility of recurrence is high, the selection of autologous hematopoietic stem cell transplantation may also be considered. Even in malignant lymphoma, the elucidation of the molecular pathology has advanced, and various molecular targeted drugs, including therapeutic drugs that control intracellular signals, have been developed and it is nearly impossible to put it into practical use in Japan.

Multiple myeloma
Multiple myeloma is a disease in which "plasma cells" are cancerous and increase mainly in the bone marrow of the whole body. Plasma cells are cells differentiated and matured from lymphocytes (B cells), a type of leukocyte, and originally are cells that make "antibodies" (proteins called immunoglobulins) that protect the body from pathogens. Normally, cancerous cells also maintain this characteristic, so antibodies called M protein are detected in blood and urine (although this antibody is not resistant)
Elderly people, especially men Many diseases, it is increasing every year. The most common symptom is bone pain. The main reason is that cancer cells are increasing while destroying bones, in fact, the bones of the whole body are weak and easily breakable. Gradually, normal hematopoiesis is injured, anemia, leucopenia, thrombocytopenia, etc. occur. Symptoms due to renal disorder, immunodeficiency (decreased resistance), hypercalcemia are also characteristic of this disease. However, recently, it is asymptomatic and sometimes happens to find the aforementioned M protein.
Treatment regimen will be decided taking into consideration factors such as age (degree of progress), age, general condition of the condition. If there is no organ injury early in the disease, it is standard to follow without treatment. From the general concept of cancer, "early detection and early treatment", there may be many who feel strange, but considering the nature of this disease, that person is better (though There is a possibility that the way of thinking will change). Currently, only the patient who has an organ disorder called "symptomatic myeloma" is treated. And for patients with relatively young (under 65 years), without serious complications and with normal cardiopulmonary function, consider (1) high-dose chemotherapy plus autologous hematopoietic stem cell transplantation. For other patients ② Perform standard dose chemotherapy.
Recently, effective drugs used in (1) transplantation introduction therapy and (2) standard amount chemotherapy have appeared. Thalidomide, bortezomib, lenalidomide are three drugs. Each one alone or in combination with existing or new drugs shows a very good therapeutic effect and an obvious survival extension is seen. Even at this institution, we actively treat these drugs with full use of these drugs. More effective administration methods and development of more effective medicines are underway, and treatment methods are changing year by year.

To the end
Over, I have reviewed the three major blood cancers. There is no alternative that any disease is a life-threatening scarier, but the treatment is steadily progressing. Especially, recently, it is called "molecular target drug", and a series of medicines that are targeted for cancer cells and their genetic and molecular abnormalities unique to their environment are drawing attention. Some of these drugs have pushed up conventional treatment results at once and changed standard treatment. On the other hand, problems such as new side effects and expensive drug expenses are occurring. Including these problems, we can not keep an eye on trends in the development of new therapies.
Since its establishment, Kumamoto City Hospital Blood and Tumor Internal Medicine has seriously taken care of these three major blood cancers. Since the establishment of this department, we are aiming for more accurate diagnosis by combining flow cytometry, chromosome / genetic diagnosis, etc. in addition to cell / pathological diagnosis. In treatment, we introduced the molecular target therapy early, including introducing and succeeding peripheral blood stem cell transplantation method for the first time in 1992 in Kumamoto prefecture. Continue, we will endeavor to provide the latest and best treatment appropriate for each patient.

Two major viruses spreading in the summer

The main diseases prevailing in the summer are caused by viruses called enterovirus and adenovirus. Herpangina and hand and foot mouth disease are caused by Coxsackie virus of Enterovirus genus, and the cause of pharyngeal conjunctival fever (pool fever) and epidemic keratoconjunctivitis is adenovirus. There are also about 50 types of adenoviruses, some of which are pharyngeal conjunctiva fever, others whose eyes are red and give only germs, and others appear as gastrointestinal symptoms. It is transmitted from people to people by splashing or touching such as sneezing, and any symptom appears in any disease, but there is little to do with life. There is no specific medicine, treatment is mainly symptomatic treatment according to symptoms.



Hand foot and mouth disease mainly occurring only in summer and Helpangina