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:
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.