L'annonce d'une mauvaise nouvelle en oncologie [Breaking bad news]

Breaking bad news is one of the most stressful duties of the physician in oncology. Among other issues, it includes discussion of cancer diagnosis or the failure of therapy. The oncologist is often puzzled by an apprehension regarding the delivery of bad news. The fear to be exposed to unexpected strong emotional reactions by the patient, such as aggression or despair, may cause the oncologist to adopt unproductive coping strategies such as discussion about technical details while avoiding to deliver the main message. However, good communication skills are the key for a satisfying conversation with the patient. The oncologists' discomfort induced by the above mentioned apprehension is one of the most important barriers for a successful conversation.

Une nouvelle Classification des néoptasies intraépithélates vulvaires [A new classification of vulvar intraepithelial neoplasia (VIN)]

Vulvar cancer is a rare disease and its screening is depending on the quality and the relevance of our clinical examination. Incidence of vulvar cancer and especially precancerous lesions, vulvar intraepithelial neoplasias (VIN), increased during these last years. The new terminology of vulvar intraepithelial neoplasia will help us to identify high risk groups which could develop a cancer: usual and differentiated VIN. An early diagnosis is essential to propose an adequate treatment. Management is a major point according to the rising incidence of these lesions in younger women. Until we can observe a benefit from the vaccination against human papillomavirus, we must increase the quality of screening by a careful examination of the vulva.

Immunothérapie: une nouvelle arme contre le cancer de la prostate [Immunotherapy: a therapeutic revolution against prostate cancer?].

The interaction between the immune system and cancer was an area of research interest for several decades. The recent U.S. Food and Drug Administration approval of sipuleucel-T and ipilimumab stimulated broader interest in manipulating immunity to fight cancer. In the context of prostate cancer, the immunotherapy strategies under development are therapeutic vaccination strategies, such as sipuleucel-T and PROSTVAC-VF, or immune checkpoint blockade of CTLA-4. Improved understanding of the immune responses generated by the development of predictive biomarkers for patient selection will guide rational combinations of these treatments and provide new treatment options in prostate cancer.

Hyperferritinémie associée au syndrome métabolique: une nouvelle cible thérapeutique [Dysmetabolic hyperferritinemia: a new target for treatment?].

Dysmetabolic hyperferritinemia is currently the most frequent cause of elevated ferritin levels in the general population. Whether dysmetabolic hyperferritinemia is a cause or an effect of insulin resistance is still a matter of debate. Still, several findings have been well established: increased iron intake or elevated ferritin levels are individual risk factors for diabetes, metabolic syndrome or gestational diabetes. When in presence of dysmetabolic hyperferritinemia, a small number of randomized controlled trials have suggested that therapeutic measures aimed at reducing ferritin levels such as low red meat consumption, deferoxamin or therapeutic phlebotomies have shown a beneficial effect on glucose homeostasis, lipid profile and impaired hepatic markers observed in non-alcoholic steatohepatitis.