Management
There are no established guidelines for managing a cyst during
chemotherapy for patients who have both cancer and a cyst. This is a
rare scenario. However, a comprehensive table has been created to
describe the treatment and follow-up of such patients. The Table 1
includes the patient’s clinical symptoms, hydatid cyst stage, and
treatment approaches based on literature review and our patients treated
who had cancer and cyst at the same time 6,10-12.
The our patients with hydatid cysts that has been diagnosed with hydatid
cyst based on serology testing or imaging ,including one men with
gastrointestinal cancer and three women with breast cancer were observed
.The average age of these patients was 50 years ,in one case of gastric
cancer ,the patient had a calcified liver cyst ,and chemotherapy was
initiated without treating the hydatid cyst due to complete
calcification, resulting in a complication- free two-year fallow-up .In
the remaining three cases, the hydatid cysts were in transitional stage
,and oral albendazole treatment was administered alongside chemotherapy
,with no hydatid cyst-related problems during one-year and two-year
fallow-ups (Table 1).
Based on literature review and our experiences, in the case of a patient
having both cancer and a hydatid cyst, the management of the hydatid
cyst primarily depends on the stage of the cyst. The type of
chemotherapy or its management strategy does not require any changes.
The treatment criteria specific to each stage of the hydatid cyst are
followed to manage it.
In general, there are options for treating cystic echinococcosis:
- Percutaneous treatment involves using a technique called PAIR
(puncture, aspiration, injection, re-aspiration) to treat the hydatid
cysts.
- Surgery, specifically resection, can be used to remove the cysts.
- Anti-infective drug treatment
can be employed to address the infection.
- ”Watch and wait” involves monitoring the cysts over time without
immediate intervention.
For liver cysts, a stage-specific approach is recommended. CE1 and CE3a
cysts should be treated with either albendazole alone (if they are less
than 5 cm in diameter) or percutaneous treatment combined with medical
therapy (if the cysts are 5-10 cm in diameter). For cysts larger than 10
cm, continuous catheterization may be a viable option. Inactive
uncomplicated cysts can be managed expectantly, especially if they
become spontaneously inactive (as opposed to treatment-induced
inactivity) (Figure 3 &Table 2) 13.