Spandidos Publications Logo
  • About
    • About Spandidos
    • Aims and Scopes
    • Abstracting and Indexing
    • Editorial Policies
    • Reprints and Permissions
    • Job Opportunities
    • Terms and Conditions
    • Contact
  • Journals
    • All Journals
    • Oncology Letters
      • Oncology Letters
      • Information for Authors
      • Editorial Policies
      • Editorial Board
      • Aims and Scope
      • Abstracting and Indexing
      • Bibliographic Information
      • Archive
    • International Journal of Oncology
      • International Journal of Oncology
      • Information for Authors
      • Editorial Policies
      • Editorial Board
      • Aims and Scope
      • Abstracting and Indexing
      • Bibliographic Information
      • Archive
    • Molecular and Clinical Oncology
      • Molecular and Clinical Oncology
      • Information for Authors
      • Editorial Policies
      • Editorial Board
      • Aims and Scope
      • Abstracting and Indexing
      • Bibliographic Information
      • Archive
    • Experimental and Therapeutic Medicine
      • Experimental and Therapeutic Medicine
      • Information for Authors
      • Editorial Policies
      • Editorial Board
      • Aims and Scope
      • Abstracting and Indexing
      • Bibliographic Information
      • Archive
    • International Journal of Molecular Medicine
      • International Journal of Molecular Medicine
      • Information for Authors
      • Editorial Policies
      • Editorial Board
      • Aims and Scope
      • Abstracting and Indexing
      • Bibliographic Information
      • Archive
    • Biomedical Reports
      • Biomedical Reports
      • Information for Authors
      • Editorial Policies
      • Editorial Board
      • Aims and Scope
      • Abstracting and Indexing
      • Bibliographic Information
      • Archive
    • Oncology Reports
      • Oncology Reports
      • Information for Authors
      • Editorial Policies
      • Editorial Board
      • Aims and Scope
      • Abstracting and Indexing
      • Bibliographic Information
      • Archive
    • Molecular Medicine Reports
      • Molecular Medicine Reports
      • Information for Authors
      • Editorial Policies
      • Editorial Board
      • Aims and Scope
      • Abstracting and Indexing
      • Bibliographic Information
      • Archive
    • World Academy of Sciences Journal
      • World Academy of Sciences Journal
      • Information for Authors
      • Editorial Policies
      • Editorial Board
      • Aims and Scope
      • Abstracting and Indexing
      • Bibliographic Information
      • Archive
    • International Journal of Functional Nutrition
      • International Journal of Functional Nutrition
      • Information for Authors
      • Editorial Policies
      • Editorial Board
      • Aims and Scope
      • Abstracting and Indexing
      • Bibliographic Information
      • Archive
    • International Journal of Epigenetics
      • International Journal of Epigenetics
      • Information for Authors
      • Editorial Policies
      • Editorial Board
      • Aims and Scope
      • Abstracting and Indexing
      • Bibliographic Information
      • Archive
    • Medicine International
      • Medicine International
      • Information for Authors
      • Editorial Policies
      • Editorial Board
      • Aims and Scope
      • Abstracting and Indexing
      • Bibliographic Information
      • Archive
  • Articles
  • Information
    • Information for Authors
    • Information for Reviewers
    • Information for Librarians
    • Information for Advertisers
    • Conferences
  • Language Editing
Spandidos Publications Logo
  • About
    • About Spandidos
    • Aims and Scopes
    • Abstracting and Indexing
    • Editorial Policies
    • Reprints and Permissions
    • Job Opportunities
    • Terms and Conditions
    • Contact
  • Journals
    • All Journals
    • Biomedical Reports
      • Information for Authors
      • Editorial Policies
      • Editorial Board
      • Aims and Scope
      • Abstracting and Indexing
      • Bibliographic Information
      • Archive
    • Experimental and Therapeutic Medicine
      • Information for Authors
      • Editorial Policies
      • Editorial Board
      • Aims and Scope
      • Abstracting and Indexing
      • Bibliographic Information
      • Archive
    • International Journal of Epigenetics
      • Information for Authors
      • Editorial Policies
      • Editorial Board
      • Aims and Scope
      • Abstracting and Indexing
      • Bibliographic Information
      • Archive
    • International Journal of Functional Nutrition
      • Information for Authors
      • Editorial Policies
      • Editorial Board
      • Aims and Scope
      • Abstracting and Indexing
      • Bibliographic Information
      • Archive
    • International Journal of Molecular Medicine
      • Information for Authors
      • Editorial Policies
      • Editorial Board
      • Aims and Scope
      • Abstracting and Indexing
      • Bibliographic Information
      • Archive
    • International Journal of Oncology
      • Information for Authors
      • Editorial Policies
      • Editorial Board
      • Aims and Scope
      • Abstracting and Indexing
      • Bibliographic Information
      • Archive
    • Medicine International
      • Information for Authors
      • Editorial Policies
      • Editorial Board
      • Aims and Scope
      • Abstracting and Indexing
      • Bibliographic Information
      • Archive
    • Molecular and Clinical Oncology
      • Information for Authors
      • Editorial Policies
      • Editorial Board
      • Aims and Scope
      • Abstracting and Indexing
      • Bibliographic Information
      • Archive
    • Molecular Medicine Reports
      • Information for Authors
      • Editorial Policies
      • Editorial Board
      • Aims and Scope
      • Abstracting and Indexing
      • Bibliographic Information
      • Archive
    • Oncology Letters
      • Information for Authors
      • Editorial Policies
      • Editorial Board
      • Aims and Scope
      • Abstracting and Indexing
      • Bibliographic Information
      • Archive
    • Oncology Reports
      • Information for Authors
      • Editorial Policies
      • Editorial Board
      • Aims and Scope
      • Abstracting and Indexing
      • Bibliographic Information
      • Archive
    • World Academy of Sciences Journal
      • Information for Authors
      • Editorial Policies
      • Editorial Board
      • Aims and Scope
      • Abstracting and Indexing
      • Bibliographic Information
      • Archive
  • Articles
  • Information
    • For Authors
    • For Reviewers
    • For Librarians
    • For Advertisers
    • Conferences
  • Language Editing
Login Register Submit
  • This site uses cookies
  • You can change your cookie settings at any time by following the instructions in our Cookie Policy. To find out more, you may read our Privacy Policy.

    I agree
Search articles by DOI, keyword, author or affiliation
Search
Advanced Search
presentation
Oncology Letters
Join Editorial Board Propose a Special Issue
Print ISSN: 1792-1074 Online ISSN: 1792-1082
Journal Cover
June-2017 Volume 13 Issue 6

Full Size Image

Sign up for eToc alerts
Recommend to Library

Journals

International Journal of Molecular Medicine

International Journal of Molecular Medicine

International Journal of Molecular Medicine is an international journal devoted to molecular mechanisms of human disease.

International Journal of Oncology

International Journal of Oncology

International Journal of Oncology is an international journal devoted to oncology research and cancer treatment.

Molecular Medicine Reports

Molecular Medicine Reports

Covers molecular medicine topics such as pharmacology, pathology, genetics, neuroscience, infectious diseases, molecular cardiology, and molecular surgery.

Oncology Reports

Oncology Reports

Oncology Reports is an international journal devoted to fundamental and applied research in Oncology.

Experimental and Therapeutic Medicine

Experimental and Therapeutic Medicine

Experimental and Therapeutic Medicine is an international journal devoted to laboratory and clinical medicine.

Oncology Letters

Oncology Letters

Oncology Letters is an international journal devoted to Experimental and Clinical Oncology.

Biomedical Reports

Biomedical Reports

Explores a wide range of biological and medical fields, including pharmacology, genetics, microbiology, neuroscience, and molecular cardiology.

Molecular and Clinical Oncology

Molecular and Clinical Oncology

International journal addressing all aspects of oncology research, from tumorigenesis and oncogenes to chemotherapy and metastasis.

World Academy of Sciences Journal

World Academy of Sciences Journal

Multidisciplinary open-access journal spanning biochemistry, genetics, neuroscience, environmental health, and synthetic biology.

International Journal of Functional Nutrition

International Journal of Functional Nutrition

Open-access journal combining biochemistry, pharmacology, immunology, and genetics to advance health through functional nutrition.

International Journal of Epigenetics

International Journal of Epigenetics

Publishes open-access research on using epigenetics to advance understanding and treatment of human disease.

Medicine International

Medicine International

An International Open Access Journal Devoted to General Medicine.

Journal Cover
June-2017 Volume 13 Issue 6

Full Size Image

Sign up for eToc alerts
Recommend to Library

  • Article
  • Citations
    • Cite This Article
    • Download Citation
    • Create Citation Alert
    • Remove Citation Alert
    • Cited By
  • Similar Articles
    • Related Articles (in Spandidos Publications)
    • Similar Articles (Google Scholar)
    • Similar Articles (PubMed)
  • Download PDF
  • Download XML
  • View XML
Case Report Open Access

Disseminated carcinomatosis of the bone marrow with disseminated intravascular coagulation as the first symptom of recurrent rectal cancer successfully treated with chemotherapy: A case report and review of the literature

  • Authors:
    • Hiroshi Takeyama
    • Tsutomu Sakiyama
    • Tomoko Wakasa
    • Kotaro Kitani
    • Keisuke Inoue
    • Hiroaki Kato
    • Shinya Ueda
    • Masanori Tsujie
    • Yoshinori Fujiwara
    • Masao Yukawa
    • Yoshio Ohta
    • Masatoshi Inoue
  • View Affiliations / Copyright

    Affiliations: Department of Gastroenterological Surgery, Nara Hospital, Faculty of Medicine, Kinki University, Nara 630‑0293, Japan, Department of Medical Oncology, Nara Hospital, Faculty of Medicine, Kinki University, Nara 630‑0293, Japan, Department of Pathology, Nara Hospital, Faculty of Medicine, Kinki University, Nara 630‑0293, Japan
    Copyright: © Takeyama et al. This is an open access article distributed under the terms of Creative Commons Attribution License.
  • Pages: 4290-4294
    |
    Published online on: April 4, 2017
       https://doi.org/10.3892/ol.2017.5983
  • Expand metrics +
Metrics: Total Views: 0 (Spandidos Publications: | PMC Statistics: )
Metrics: Total PDF Downloads: 0 (Spandidos Publications: | PMC Statistics: )
Cited By (CrossRef): 0 citations Loading Articles...

This article is mentioned in:



Abstract

Disseminated carcinomatosis of the bone marrow (DCBM) is a condition in which bone marrow (BM) metastases diffusely invade the BM, and is frequently accompanied by disseminated intravascular coagulation (DIC). While prostate, lung, breast and stomach malignancies, in addition to neuroblastoma, are the most prevalent non‑hematological malignancies to metastasize frequently to the BM, colorectal cancer is a malignancy that rarely metastasizes to the BM. The present case describes a 65‑year‑old male patient treated by resection and one course adjuvant chemotherapy for stage IIIC rectal cancer who presented with nasal bleeding at 8 months post‑surgery. A blood test exhibited DIC. A BM biopsy was performed and the definitive diagnosis was DCBM with DIC. Promptly, anti‑DIC treatment and chemotherapy with a modified FOLFOX6 (folinic acid, leucovorin (LV), 5‑fluorouracil (5‑FU) and oxaplatin) regimen was started. Following 1 cycle of chemotherapy, DIC was improved and subsequent to 2 cycles of modified FOLFOX6 the patient was discharged. The patient was alive 263 days subsequent to the diagnosis of DIC, but succumbed to carcinomatous meningitis as a result of disease progression. To the best of our knowledge, this is the first report of DCBM with DIC of curatively resected rectal cancer as the first presentation of relapse that was successfully treated with aggressive therapy, including chemotherapy.
View Figures

Figure 1

Figure 2

View References

1 

Kusumoto H, Haraguchi M, Nozuka Y, Oda Y, Tsuneyoshi M and Iguchi H: Characteristic features of disseminated carcinomatosis of the bone marrow due to gastric cancer: The pathogenesis of bone destruction. Oncol Rep. 16:735–740. 2006.PubMed/NCBI

2 

Anner RM and Drewinko B: Frequency and significance of bone marrow involvement by metastatic solid tumors. Cancer. 39:1337–1344. 1977. View Article : Google Scholar : PubMed/NCBI

3 

Jonsson U and Rundles RW: Tumor metastases in bone marrow. Blood. 6:16–25. 1951.PubMed/NCBI

4 

Yoshioka K, Shimizu H, Yokoo S and Andachi H: Disseminated carcinomatosis of bone marrow from submucosal carcinoma in adenoma of the rectum. Intern Med. 31:1056–1059. 1992. View Article : Google Scholar : PubMed/NCBI

5 

Huang WT, Chang KC, Shan YS, Tsao CJ and Lee JC: Successful initial treatment with weekly 24-hour infusion of 5-fluorouracil and leucovorin in a rectal cancer patient with acute disseminated intravascular coagulation. Hepatogastroenterology. 52:1436–1439. 2005.PubMed/NCBI

6 

Misawa R, Kobayashi M, Ito M, Kato M, Uchikawa Y and Takagi S: Primary colonic signet ring cell carcinoma presenting carcinocythemia: An autopsy case. Case Rep Gastroenterol. 2:301–307. 2008. View Article : Google Scholar : PubMed/NCBI

7 

van Bunderen CC, de Weger VA and Griffioen-Keijzer A: Disseminated intravascular coagulation as clinical manifestation of colorectal cancer: A case report and review of the literature. Neth J Med. 72:186–189. 2014.PubMed/NCBI

8 

Nakashima Y, Takeishi K, Guntani A, Tsujita E, Yoshinaga K, Matsuyama A, Hamatake M, Maeda T, Tsutsui S, Matsuda H, et al: Rectal cancer with disseminated carcinomatosis of the bone marrow: Report of a case. Int Surg. 99:518–522. 2014. View Article : Google Scholar : PubMed/NCBI

9 

Naito M, Yoshida Y, Aisu N, Tanimura S, Hoshino S, Tanaka T, Nimura S, Tamura K and Yamashita Y: A report of disseminated carcinomatosis of the bone marrow originating from transverse colon cancer successfully treated with chemotherapy using XELOX plus bevacizumab. Case Rep Oncol. 7:426–434. 2014. View Article : Google Scholar : PubMed/NCBI

10 

Lim DH, Lee SI and Park KW: Bone marrow metastasis of colon cancer as the first site of recurrence: A case report. Oncol Lett. 8:2672–2674. 2014.PubMed/NCBI

11 

Kobayashi N, Maekawa T, Takada M, Tanaka H and Gonmori H: Criteria for diagnosis of DIC based on the analysis of clinical and laboratory findings in 345 DIC patients collected by the research committee on DIC in Japan. Bibl Heamatol. 265–275. 1983.

12 

Pasquini E, Gianni L, Aitini E, Nicolini M, Fattori PP, Cavazzini G, Desiderio F, Monti F, Forghieri ME and Ravaioli A: Acute disseminated intravascular coagulation syndrome in cancer patients. Oncology. 52:505–508. 1995. View Article : Google Scholar : PubMed/NCBI

13 

Sallah S, Wan JY, Nguyen NP, Hanrahan LR and Sigounas G: Disseminated intravascular coagulation in solid tumors: Clinical and pathologic study. Thromb Haemost. 86:828–833. 2001.PubMed/NCBI

14 

Levi M and Ten Cate H: Disseminated intravascular coagulation. N Engl J Med. 341:586–592. 1999. View Article : Google Scholar : PubMed/NCBI

15 

Levi M: Disseminated intravascular coagulation in cancer patients. Best Pract Res Clin Haematol. 22:129–136. 2009. View Article : Google Scholar : PubMed/NCBI

16 

Esmon CT: Possible involvement of cytokines in diffuse intravascular coagulation and thrombosis. Baillieres Best Pract Res Clin Haematol. 12:343–359. 1999. View Article : Google Scholar : PubMed/NCBI

17 

Koopman M, Venderbosch S, Nagtegaal ID, van Krieken JH and Punt CJ: A review on the use of molecular markers of cytotoxic therapy for colorectal cancer, what have we learned? Eur J Cancer. 45:1935–1949. 2009. View Article : Google Scholar : PubMed/NCBI

18 

Kumamoto K, Kuwabara K, Tajima Y, Amano K, Hatano S, Ohsawa T, Okada N, Ishibashi K, Haga N and Ishida H: Thymidylate synthase and thymidine phosphorylase mRNA expression in primary lesions using laser capture microdissection is useful for prediction of the efficacy of FOLFOX treatment in colorectal cancer patients with liver metastasis. Oncol Lett. 3:983–989. 2012.PubMed/NCBI

19 

Altaha R, Liang X, Yu JJ and Reed E: Excision repair cross complementing-group 1: Gene expression and platinum resistance. Int J Mol Med. 14:959–970. 2004.PubMed/NCBI

20 

Shirota Y, Stoehlmacher J, Brabender J, Xiong YP, Uetake H, Danenberg KD, Groshen S, Tsao-Wei DD, Danenberg PV and Lenz HJ: ERCC1 and thymidylate synthase mRNA levels predict survival for colorectal cancer patients receiving combination oxaliplatin and fluorouracil chemotherapy. J Clin Oncol. 19:4298–4304. 2001. View Article : Google Scholar : PubMed/NCBI

21 

Arienti C, Tesei A, Verdecchia GM, Framarini M, Virzi S, Grassi A, Scarpi E, Turci L, Silvestrini R, Amadori D and Zoli W: Role of conventional chemosensitivity test and tissue biomarker expression in predicting response to treatment of peritoneal carcinomatosis from colon cancer. Clin Colorectal Cancer. 12:122–127. 2013. View Article : Google Scholar : PubMed/NCBI

22 

Blake P, Delicata R, Cross N, Sturgeon G and Hargest R: Large bowel obstruction due to colorectal carcinoma can be safely treated by colonic stent insertion-case series from a UK district general hospital. Colorectal Dis. 14:1489–1492. 2012. View Article : Google Scholar : PubMed/NCBI

23 

Lacey DL, Timms E, Tan HL, Kelley ML, Dunstan CR, Burgess T, Elliott R, Colombero A, Elliott G, Scully S, et al: Osteoprotegerin ligand is a cytokine that regulates osteoclast differentiation and activation. Cell. 93:165–176. 1998. View Article : Google Scholar : PubMed/NCBI

24 

Stopeck AT, Lipton A, Body JJ, Steger GG, Tonkin K, de Boer RH, Lichinitser M, Fujiwara Y, Yardley DA, Viniegra M, et al: Denosumab compared with zoledronic acid for the treatment of bone metastases in patients with advanced breast cancer: A randomized, double-blind study. J Clin Oncol:. 28:5132–5139. 2010. View Article : Google Scholar : PubMed/NCBI

25 

Fizazi K, Lipton A, Mariette X, Body JJ, Rahim Y, Gralow JR, Gao G, Wu L, Sohn W and Jun S: Randomized phase II trial of denosumab in patients with bone metastases from prostate cancer, breast cancer, or other neoplasms after intravenous bisphosphonates. J Clin Oncol. 27:1564–1571. 2009. View Article : Google Scholar : PubMed/NCBI

26 

Smith MR, Egerdie B, Hernández Toriz N, Feldman R, Tammela TL, Saad F, Heracek J, Szwedowski M, Ke C, Kupic A, et al: Denosumab in men receiving androgen-deprivation therapy for prostate cacner. N Engl J Med. 361:745–755. 2009. View Article : Google Scholar : PubMed/NCBI

27 

Misso G, Porru M, Stoppacciaro A, Castellano M, de Cicco F, Leonetti C, Santini D and Caraglia M: Evaluation of the in vitro and in vivo antiangiogenic effects of denosumab and zoledronic acid. Cancer Biol Ther. 13:1491–1500. 2012. View Article : Google Scholar : PubMed/NCBI

28 

Henry DH, Costa L, Goldwasser F, Hirsh V, Hungria V, Prausova J, Scagliotti GV, Sleeboom H, Spencer A, Vadhan-Raj S, et al: Randomized, double-blind study of denosumab versus zoledronic acid in the treatment of bone metastases in patients with advanced cancer (excluding breast and prostate cancer) or multiple myeloma. J Clin Oncol. 29:1125–1132. 2011. View Article : Google Scholar : PubMed/NCBI

29 

Scagliotti GV, Hirsh V, Siena S, Henry DH, Woll PJ, Manegold C, Solal-Celigny P, Rodriguez G, Krzakowski M, Mehta ND, et al: Overall survival improvement in patients with lung cancer and bone metastases treated with denosumab versus zoledronic acid: Subgroup analysis from a randomized phase 3 study. J Thorac Oncol. 7:1823–1829. 2012. View Article : Google Scholar : PubMed/NCBI

30 

Fizazi K, Carducci M, Smith M, Damião R, Brown J, Karsh L, Milecki P, Shore N, Rader M, Wang H, et al: Denosumab versus zoledronic acid for treatment of bone metastases in men with castration-resistant prostate cancer: A randomised, double-blind study. Lancet. 377:813–822. 2011. View Article : Google Scholar : PubMed/NCBI

Related Articles

  • Abstract
  • View
  • Download
  • Twitter
Copy and paste a formatted citation
Spandidos Publications style
Takeyama H, Sakiyama T, Wakasa T, Kitani K, Inoue K, Kato H, Ueda S, Tsujie M, Fujiwara Y, Yukawa M, Yukawa M, et al: Disseminated carcinomatosis of the bone marrow with disseminated intravascular coagulation as the first symptom of recurrent rectal cancer successfully treated with chemotherapy: A case report and review of the literature . Oncol Lett 13: 4290-4294, 2017.
APA
Takeyama, H., Sakiyama, T., Wakasa, T., Kitani, K., Inoue, K., Kato, H. ... Inoue, M. (2017). Disseminated carcinomatosis of the bone marrow with disseminated intravascular coagulation as the first symptom of recurrent rectal cancer successfully treated with chemotherapy: A case report and review of the literature . Oncology Letters, 13, 4290-4294. https://doi.org/10.3892/ol.2017.5983
MLA
Takeyama, H., Sakiyama, T., Wakasa, T., Kitani, K., Inoue, K., Kato, H., Ueda, S., Tsujie, M., Fujiwara, Y., Yukawa, M., Ohta, Y., Inoue, M."Disseminated carcinomatosis of the bone marrow with disseminated intravascular coagulation as the first symptom of recurrent rectal cancer successfully treated with chemotherapy: A case report and review of the literature ". Oncology Letters 13.6 (2017): 4290-4294.
Chicago
Takeyama, H., Sakiyama, T., Wakasa, T., Kitani, K., Inoue, K., Kato, H., Ueda, S., Tsujie, M., Fujiwara, Y., Yukawa, M., Ohta, Y., Inoue, M."Disseminated carcinomatosis of the bone marrow with disseminated intravascular coagulation as the first symptom of recurrent rectal cancer successfully treated with chemotherapy: A case report and review of the literature ". Oncology Letters 13, no. 6 (2017): 4290-4294. https://doi.org/10.3892/ol.2017.5983
Copy and paste a formatted citation
x
Spandidos Publications style
Takeyama H, Sakiyama T, Wakasa T, Kitani K, Inoue K, Kato H, Ueda S, Tsujie M, Fujiwara Y, Yukawa M, Yukawa M, et al: Disseminated carcinomatosis of the bone marrow with disseminated intravascular coagulation as the first symptom of recurrent rectal cancer successfully treated with chemotherapy: A case report and review of the literature . Oncol Lett 13: 4290-4294, 2017.
APA
Takeyama, H., Sakiyama, T., Wakasa, T., Kitani, K., Inoue, K., Kato, H. ... Inoue, M. (2017). Disseminated carcinomatosis of the bone marrow with disseminated intravascular coagulation as the first symptom of recurrent rectal cancer successfully treated with chemotherapy: A case report and review of the literature . Oncology Letters, 13, 4290-4294. https://doi.org/10.3892/ol.2017.5983
MLA
Takeyama, H., Sakiyama, T., Wakasa, T., Kitani, K., Inoue, K., Kato, H., Ueda, S., Tsujie, M., Fujiwara, Y., Yukawa, M., Ohta, Y., Inoue, M."Disseminated carcinomatosis of the bone marrow with disseminated intravascular coagulation as the first symptom of recurrent rectal cancer successfully treated with chemotherapy: A case report and review of the literature ". Oncology Letters 13.6 (2017): 4290-4294.
Chicago
Takeyama, H., Sakiyama, T., Wakasa, T., Kitani, K., Inoue, K., Kato, H., Ueda, S., Tsujie, M., Fujiwara, Y., Yukawa, M., Ohta, Y., Inoue, M."Disseminated carcinomatosis of the bone marrow with disseminated intravascular coagulation as the first symptom of recurrent rectal cancer successfully treated with chemotherapy: A case report and review of the literature ". Oncology Letters 13, no. 6 (2017): 4290-4294. https://doi.org/10.3892/ol.2017.5983
Follow us
  • Twitter
  • LinkedIn
  • Facebook
About
  • Spandidos Publications
  • Careers
  • Cookie Policy
  • Privacy Policy
How can we help?
  • Help
  • Live Chat
  • Contact
  • Email to our Support Team