Asian Pacific Journal of Cancer Care

Evaluating the Response of Hypofractionated Radiotherapy verses Conventional Radiotherapy with Concurrent Cisplatin in Advanced Fixed Node Head and Neck Carcinoma

Tue, 23 Apr 2024 05:27:47 +0000

Background: The evolution of radiotherapy over recent decades has reintroduced the hypofractionation for many tumour sites with similar outcomes to those of conventional fractionated radiotherapy. The use of hypofractionation in locally advanced head and neck cancer (LAHNC) has been already used, however, its use has been restricted to only a few countries. The aim of this trial was to evaluate the safety and feasibility of moderate hypofractionated radiotherapy (HYP-RT) with concomitant cisplatin (CDDP).

Objectives: To evaluate the efficacy of hypofractionated radiotherapy in advanced unresectable head neck cancer, in terms of response rate and evaluate the local and systemic toxicities of hypofractionated regimen with symptomatic improvement of radiotherapy and treatment compliance.

Methods: A total of 50 cases of locally advanced head and neck cancer (stage cT4b and/or N3) without any evidence of distant metastasis were included in this study. These 50 cases were randomly distributed into study and control group containing 25 each. Radiotherapy consists of a single fraction of 6 Gy Per week for a total of 6 weeks. If the patient received less than 6weeks of treatment, he/she was excluded from study. Total dose given was 36 Gy in 6 fractions. All the patients were treated by unilateral or bilateral portal till 24 Gy and then off cord planning was done. Patients with complete disease regression after initially planned 36 Gy (BED-57.6Gy, considering alpha/beta of 10 and corresponding EQD2-48Gy) were offered further dose escalation depending upon tumour regression status, tolerability and toxicity according to institutional guidelines. Partial responders are given no treatment up to end of treatment period.

Results: Among the study and control group, incidence of carcinoma of tonsil was 12% and 20%, carcinoma of base of tongue was 24% and 16%, carcinoma larynx 16% and 24%, respectively and Hematological toxicities (reference to blood hemoglobin level), Renal (reference to blood urea) were assessed according to WHO toxicity criteria in all cases weekly up to six weeks Among the study and control group, 8% and 12% had no acute hematologic reactions (χ2 = 0.22, p > 0.05), 56% and 48% had grade I hematologic reactions (χ2 = 0.32 p > 0.05,), 28% and 36% had grade II hematologic reactions (χ2 = 0.36, p > 0.05) and 8% and 4% had grade III hematologic reactions (χ2 = 0.35, p > 0.05) respectively. No patient had had grade IV hematological toxicity. Among the study and control group, 80% and76% had no acute renal toxicity. (χ2 = 0.11, p > 0.05), 20% and 24% had grade I hematologic reactions (χ2= 0.11 p > 0.05). No patients from either group develop grade II, III and IV renal toxicity.

Conclusions: HYP-RT with concomitant CDDP was considered feasible for LAHNC, and the rate of acute toxicity was comparable to that of standard concomitant chemoradiation. A feeding tube was necessary for most patients during treatment. Further investigation of this strategy is warranted.

Intraoperative Normothermic Intraperitoneal Chemotherapy Following Optimal Cytoreduction in Advanced Ca Ovary: A Feasibility Study

Upasana Baruah, Partha Sarathi Roy, Debabrata Barmon (Author) — Tue, 14 May 2024 04:47:27 +0000

Introduction: Extrapolating the results from the studies using HIPEC, EPIC and normothermic intraperitoneal chemotherapy, we proposed that normothermic chemotherapy instilled after optimal cytoreduction will improve survival in patients who underwent optimal cytoreduction. We undertook this feasibility study with the aim of studying the effectiveness of intraoperative normothermic intraperitoneal chemotherapy in patients with advanced-stage epithelial carcinoma ovary.

Methods: This was a single institutional feasibility study. The primary objective was progression-free survival (PFS) following the instillation of normothermic chemotherapy following optimal cytoreduction in cases of advanced ovarian cancer after neoadjuvant chemotherapy. The secondary objective was to study tolerability and toxicity. The study received institutional ethical committee clearance.

Results: A total of 24 patients were included in the pilot study over two years. The short-term analysis was made by comparing 45 patients who underwent interval cytoreductive surgery (ICS) with CC 0 and 1 during the same period. The most common side effect was prolonged post-operative ileus which was seen in six patients. The median PFS among patients who received IP chemotherapy was significantly better in comparison to patients who received ICS alone (34.0 vs. 13.0 months, p=0.018).

Conclusion: Uniform state-of-the-art management of advanced epithelial ovarian cancer may not be accessible to all due to global resource limitations. Although the evidence is weak due to the small sample size and short follow-up of patients, the findings are encouraging. This feasibility study has provided substantial evidence to work further with this approach in our institute and plan an randomised controlled trial to gain more evidence.

Risk Factors for Locoregional Recurrence Following Mastectomy for Localized Breast Cancer in a Nigerian Teaching Hospital

Julius G Olaogun, Olayide S Agodirin, Samuel A Dada, Olusola Akanbi (Author) — Tue, 14 May 2024 04:57:44 +0000

Background: Mastectomy is an integral part of the management of breast cancer, especially in resource-limited centers. This study aimed to describe the outcomes in terms of locoregional recurrence (LRR) and distant metastasis (DM) after modified radical mastectomy (MRM) for breast cancer and factors associated with them.

Methods: This was a retrospective study of patients who underwent mastectomy between October 2012 and September 2017. Data generated were analyzed using SPSS version 23.0. The results were presented using descriptive statistics. Inferential statistics was done using the chi-square test with statistical significance set at p <0.05.

Results: Sixty-three (88.7%) of 71 patients who had MRM over the study period were eligible. Their ages ranged from 24-80 years with a median of 49 years (IQR, 43-59years). Lump size ranged from 2-18 cm (mean, 7.8±3.5 cm) and the lump duration was 1-48 months (median 6.0, IQR, 4.0-10.0 months). Sixteen (25.4%) patients developed LRR. The interval to occurrence of LRR after mastectomy ranged from 4-36 months (median, 9 months, IQR, 6.0-20.0). Eighteen (28.6%) patients developed distant metastasis 9-60 months after surgery (median 19, IQR 12.0-37.0 months) and 50% of those with LRR were among. Metastasis mostly affected the lungs and pleura in 55.6%. Mean tumour size ≥10cm (p <0.000), mean lump duration >11months, advanced disease T3/4 (p=0.01) and higher number of positive lymph nodes (p=0.011) were significantly associated with LRR. Both tumour size (p=0.01) and positive lymph nodes (p=0.015) are predictors of LRR.

Conclusion: LRR and metastasis are common occurrences after mastectomy. Early presentation and availability of more adjuvant therapies can reduce the rate.

Feasibility and Toxicity of Hypofractionated Radiation Therapy in Patients Undergoing Post Mastectomy Radiation Therapy

Kanmani Velarasan, Deivanayagam Ramasundaram, Gopi Prasad (Author) — Wed, 15 May 2024 00:00:00 +0000

Introduction: Post mastectomy radiation (PMRT) plays major role in breast cancer treatment. Hypofractionated radiation is a relatively newer modality. Hypofractionation is more commonly used after breast conservation surgery. Landmark trials that studied hypofractionation had fewer PMRT subjects. Here we report our study on feasibility and toxicity profile of hypofractionated PMRT.

Aim: To describe the clinical and toxicity profile of patients undergoing hypofractionated 3D conformal radiation therapy in breast cancer patients.

Materials & Methods: This study included patients who are eligible for post mastectomy radiation therapy above 18 years planned for adjuvant PMRT (40.05Gy in 15 fractions delivered over 3 weeks in 3D conformal radiation) to the chest wall and supraclavicular nodes between April 2021 to October 2022., active lung infection, patient preference for conventional fractionation. Dosimetric parameters to target & organs at risk were analyzed. Toxicities including hematologic, dermatitis, pharyngitis & other were monitored.

Results: Of 71 patients, 70 patients were female and 1 is male. Majority (46%) of patients belonged to 46-55 years age group. Age ranged from 34 to 85 years. Mean age is 52 years. Clinical Stage IIIA was the most common stage with 29.5% patients followed by Stage IIB with 25.3% patients. Majority received adjuvant chemotherapy (52%). Mean treatment time is 21 days. All patients completed treatment without any major complications. Follow up ranged from 17 months to 27 months. Out of 71 patients, 1 patient expired on follow up after 4 months of radiation therapy due to non cancer related cause (Chronic pancreatitis). On follow up, 3 patients had distant metastasis alone (lung, bone metastasis, brain metastases) and 1 patient had both local disease and distant metastasis. 3 patients who progressed had stage IIIC disease & 1 had stage IIIB disease. The V90 to the Planned Target volume (PTV) ranged from 90.4% to 99% to right sided disease, 90.3% to 96.5% to left sided disease. Heart V17Gy ranged from 1.27% to 12.5% & heart V35Gy was 0.16% to 7.2%. Dermatitis was the most common adverse effect in this study. 31 patients (43.6%) developed fatigue during treatment. They continued their daily activities without any limitations. 35 patients (49.2%) had throat pain, of which 2 patients had it in 1^st week, 21 patients had it in 2^nd week and 12 patients had it in 3^rd week. They were treated with non opioid analgesics. Shoulder pain was observed in 10 patients (14%) during treatment. Blood parameters were monitored weekly during treatment. No changes were observed.

Conclusion: Hypofractionated post mastectomy radiation therapy is well tolerated in our study group. None of them developed any major acute reactions during and post treatment in the follow up period. Patients completed their treatment without any breaks during treatment. Respiratory motion management especially left sided disease patients should be used for achieving dose constraints.

Prognostic Significance of Double-Expresser Status in Diffuse Large B-cell lymphoma: Experience from a Tertiary Care Cancer Centre in India

Wed, 29 May 2024 06:21:20 +0000

Background: Diffuse large B-cell lymphoma (DLBCL) is a neoplasm of medium or large B lymphoid cells with a diffuse histopathologic growth pattern. Co-expression of MYC and BCL2 proteins in DLBCL by immunohistochemistry (IHC) is referred to as the double-expresser (DE) phenotype and is associated with inferior survival. Objectives of this study were to assess the DE status in DLBCL and to assess its utility in predicting the prognosis in DLBCL.

Methods: This was a retrospective study conducted in a tertiary care cancer centre. Study population included all the cases of DLBCL, NOS diagnosed in the centre in 2012. MYC and BCL2 protein expression were analysed by immunohistochemistry. The prognostic significance of double-expressers was analysed by comparing progression free survival (PFS) and overall survival (OS) of double-expressers and non-double expressers using appropriate statistical methods. All the data were analysed using SPSS 11 software. Kaplan-Meier method was used to estimate the survival probability. A significant difference in survival between various prognostic factors was tested using the log-rank test. Prognostic factors were assessed using univariate and multivariate Cox-regression model. A P- value < 0.05 was considered to be statistically significant.

Results: Double-Expresser lymphoma (DEL) constituted 22.2% (n=18) of all cases of DLBCL, NOS. DE status was associated with shorter PFS (P-value = 0.049) and OS (P-value = 0.015).

Conclusion: DE status is associated with poor prognosis in DLBCL, NOS. Assessment of MYC and BCL2 by IHC represents a rapid and inexpensive approach to risk-stratify patients with DLBCL at the time of diagnosis.

A Comparative Study of Palliative Hypo-fractionated vs Conventional Fractionated Radiotherapy in Locally Advanced Non Small Cell Lung Cancer

Mon, 24 Jun 2024 05:14:04 +0000

Purpose: To compare the compliance, tumor response, quality of life and survival between a hypo-fractionated and a conventional fractionated RT schedule in locally advanced NSCLC patients.

Materials and Methods: Total 50 patients with unresectable stage III NSCLC were given 3 cycle of neoadjuvant chemotherapy. After 3-4 weeks of completion of 3^rd cycle, 25 patients received a total 17Gy in 2 fr (8.5Gy/fr) on day 1 and day 8 in study arm, 25 patients received a total 50 Gy in 25 fr (2Gy/fr) administered daily (5days/week) for 5 weeks. Disease response was evaluated by RECIST criteria at 1, 3 and 6 month. Then follow up was done after 1yr, 2yr and 3yr to evaluate the overall survival.

Result: none of patients in both arms had complete response at any follow up. Locoregional disease control was observed in 18% & 27% in study and control arm respectively (p value>0.05). Median survival was 10 months and 12.5 months in study and control arm respectively which was not statistically significant. There was no statistically difference in grade of toxicities. OS rates at 1, 2 and 3years were 40%, 10% and 0% in study arm and 50%, 20% and 5% in control arm but difference in OS was not statistically significant.

Conclusion: Many patients were lost to follow up in our study; although among the patients followed, we found to concluded that for improvement of quality of life in locally advanced NSCLC patients with poor PS and short life span, the palliative hypo-fractionated regimen of short duration (17Gy/2fr) could be considered as a reasonable alternative and also economically feasible & required shorter duration of stay in the hospital. In conclusion, large number of patients with strict follow up need to be done to ascertain the need and benefits of this palliative TRT.

Factors Militating Against Family Caregivers on Cancer Patients Health in Selected Teaching Hospitals in Ogbomoso Area, Oyo State, Nigeria

Amoo Patience Ofuoma, Busisiwe Ncama (Author) — Mon, 24 Jun 2024 05:17:13 +0000

Introduction: Cancer is gradually becoming a chronic disease, which brings important needs and difficulties to both patients and caregivers.

Objective: The study examines factors militating against family caregivers on cancer patients health in selected teaching hospitals in Ogbomoso area, Oyo State, Nigeria.

Materials and Methods: Both questionnaire and interviewed techniques were used for data collection from 120 respondents chosen through stratified sampling techniques. In analyzing the data, logit regression model was employed in addition to conventional descriptive statistics such as tables, frequency distribution and percentages.

Results: The result of regression model has coefficient of five (5) variables that were statistically significant at 1%, and 5% probability levels. The results revealed that variables with positive signs indicate that the chances of factors militating against family caregivers on cancer patients health increase with education (2.15), social support (2.76), communication, (2.67), and financial support (4.92) whereas, variables with negative sign indicates that the chances of factor militating against family caregivers on cancer patients health decreases with socio-cultural beliefs (-2.64).

Conclusion: It identified that factors militating against family caregivers on cancer patients health strongly influenced by gender, age, education, marital status and religion. Hence, recommendation was made that regular systemic assessment of effects of caregiving and shared care responsibility among family members to provide a respite for a particular caregiver.

Prevalence of Malnutrition and Associated Factors in Newly Diagnosed Upper Gastrointestinal Cancer Patients Before Treatment

Ho Chiou Yi, Ban Zhen Hong (Author) — Mon, 24 Jun 2024 05:20:52 +0000

Introduction: Upper gastrointestinal cancers (UGIC) related malnutrition has been found to harm cancer prognosis and treatment outcomes. The study purposed to investigate the prevalence of malnutrition and associated factors in newly diagnosed upper gastrointestinal cancer patients before treatment.

Material and Methods: A cross-sectional study included newly diagnosed UGIC patients from October 2020 to March 2022. Sociodemographic, clinical (type, stage, and comorbidities), functional [Eastern Cooperative Oncology Group (ECOG) Performance Status Scale], anthropometric measures [weight, height, the percentage of weight loss past 1-month], biochemical profiles [full blood count and albumin], total daily energy protein intake, and malnutrition level [Subjective Global Assessment (SGA)] were assessed.

Results: The study recruited 409 participants, and 92.1% were malnourished. The mean for age, weight, percentage of weight loss past 1-month, total daily energy and protein intake, SGA score, and serum albumin of participants were 60.3±12.5years, 57.8±15.1kg, -8.2±6.0%, 17±5kcal/ kg/day, 0.7±0.1g/kg/day, 12.2±4.5 and 35.6±6.1g/L respectively. About 88% and 96% experienced vomiting and dysphasia, respectively; 51.3% was ECOG scale 2. According to a multiple linear regression test, the percentage of weight loss past 1 month, serum albumin, dyspepsia, dysphagia, lymphocytes, and gender (male) were the significant factors associated with malnutrition.

Conclusion: UGIC patients are especially susceptible to malnutrition which might cause a decrease in therapy sensitivity, quality of life, and survival rate. Currently, proposed factors associated with malnutrition can assist in identifying UGIC-related malnutrition. Early nutrition screening and assessment followed with timely nutrition intervention is important to identify malnutrition and optimize nutrition status before treatment.

Unnecessary Pancreatic Resection for Non-cancerous Lesions Masquerading as Pancreatic and Peri-ampullary Cancers: An Inevitable Circumstance

Mon, 24 Jun 2024 05:31:33 +0000

Background: Pancreatic and peri-ampullary cancers are deadly and require surgery. Some non-cancerous conditions, especially those that do not require surgery, have imaging findings similar to pancreatic and peri-ampullary carcinoma. The proportion of non-cancerous lesions that undergo pancreatic resection for suspected pancreatic or peri-ampullary cancer is scarce in eastern countries, especially when bile duct tumors are common. This study examined the proportion of non-cancerous lesions removed during pancreatic resection for suspected pancreatic or peri-ampullary cancer.

Materials and Methods: The retrospective study included January 2013–December 2017. We investigated the medical and pathological data of 148 pancreatic resection patients at Srinagarind Hospital, Khon Kaen University.

Results: Nine patients (6.1%) had postoperative pathology diagnoses that did not require surgery. The discordant group was significantly larger among distal pancreatectomy or enucleation patients (15%, 4/27) than pancreaticoduodenectomy patients (4.1%, 5/121). The concordant and discordant groups had similar clinical features for pancreaticoduodenectomy, except for gender (p=0.031). There were no clinical differences between concordant and discordant patients after distal pancreatectomy or enucleation.

Conclusion: Pancreatic excision for non-cancerous conditions may be inevitable. Western and Eastern countries have different non-cancerous disorders that mimic pancreatic or peri-ampullary cancer. Western countries had more pancreatic conditions, especially inflammatory ones, but Eastern countries had more ampullary and bile duct conditions in pancreaticoduodenectomy patients and benign cystic lesions in distal pancreatectomy patients.

Treatment Outcomes of Stereotactic Body Radiotherapy for Early-stage Non-small Cell Lung Cancer and Lung Metastasis

Mon, 24 Jun 2024 05:43:40 +0000

Background and rationale: Stereotactic body radiotherapy (SBRT) is a highly precise localized high-dose per fraction radiation treatment used mainly in lung cancer. Despite SBRT's increasing use, no clear predictive factors of outcome exist.

Objectives: To report local control rates, patterns of failure, and incidence of treatment-related toxicity, and to determine factors predicting SBRT outcomes for primary and secondary lung tumors at Ramathibodi Hospital using competing risk analysis.

Materials and methods: This retrospective study included all patients diagnosed with primary early non-small cell lung cancer (NSCLC) and lung metastasis in our radiosurgery and radiotherapy database registry between January 2009 and September 2018.

Results: Fifty-nine patients (98 lung tumors) were studied; primary NSCLC and lung metastasis were 15.3% and 84.7%, respectively. Median follow-up was 16.8 months. The overall 1-year local control rate was 90.8%. The most common pattern of failure was distant failure (46.9%). The incidence of radiation pneumonitis (RP) grade ≥2 was 9.2%, and one of four patients with an ultra-central tumor developed grade 5 pulmonary toxicity. The predictive factor for local failure was the mean biological equivalent dose (BED) of the planning target volume (PTV), and for RP grade ≥2, the tumor's maximal diameter. BED PTV mean <100 Gy had higher local failure than BED PTV mean ≥100 Gy (adjusted subdistribution hazard ratio 8.26; 95% confidence interval (CI) 1.76–38.68, p=0.007). Patients with tumors with maximal diameters ≥5 cm compared with those with maximal diameters <5 cm had more RP grade ≥2 (adjusted subdistribution hazard ratio 5.34; 95% CI 1.52–18.69, p=0.009). The overall 1-year survival rate was 73.5%.

Conclusions: Local control of lung tumors using SBRT was high with acceptable toxicity. BED PTV mean was a local control predictor. Large tumors correlated with symptomatic RP grade ≥2. SBRT should be used judiciously for ultra-central lung tumors.

Evolving Prostate Cancer Radiotherapy: Exploring Gonadal Doses in 3DCRT and IMRT with Testicular Shielding

Mon, 24 Jun 2024 05:55:51 +0000

Objective: To compare the dosimetry of IMRT versus 3DCRT in prostate cancer, with a focus on testicular dose using lead testicular shielding.

Materials and Methods: From January 2021 to January 2022, twenty patients with localized prostate cancer underwent IMRT treatment. Plans for 3DCRT were generated for each patient. Comparison was made between 3D-CRT and IMRT regarding target volume dose uniformity, sparing of critical organs, and testicular doses.

Results: Significant differences were observed in dose uniformity and sparing of critical organs between the two modalities (p<0.005), demonstrating the superiority of IMRT over 3DCRT. However, with lead testicular shielding, comparable testicular doses were achieved with both techniques.

Conclusion: IMRT offers superior dosimetric advantages compared to 3DCRT. Nevertheless, the testicular dose remains nearly equivalent between the two techniques when utilizing lead testicular shielding.

Constipation - A Disregarded Symptom in Patients Undergoing Radiotherapy for Head and Neck Cancer – A Clinical Audit on Management

Sapna Krishnamurthy, Imtiaz Ahmed (Author) — Sat, 29 Jun 2024 05:09:40 +0000

Background: In clinical practice, constipation in patients undergoing Radiotherapy (RT) for head and neck cancer is not only very common, but many a times left unattended. Unrelieved constipation results in patient distress and poor compliance to treatment. Most of the patients are empirically treated with poor symptom control. The aim of this audit was to find out the burden of constipation and to treat them effectively.

Methods: Standard based clinical audit was undertaken in the department of Radiation Oncology from July 2021 to January 2022, in patients with complaints of constipation who are undergoing RT for head and neck cancers. The intervention planned (criteria) was to follow the European Society for Medical Oncology (ESMO) 2018 flowchart for the management of constipation, which were divided into 4 checkpoints for the ease of quantification – 1. history taken, 2. documentation of type of laxative used, 3. review for symptom relief and 4. maintenance therapy prescription. The standard set was 65%.

Results: A total of 48 patients in the initial assessment (retrospective) and 44 patients in the re-assessment (prospective) were evaluated. The mean age in both the audit was 54 years, 32 (66.6%) patients in the initial assessment and 26 (60%) patients in the re-assessment reported constipation during RT. Comparing the pre intervention and post intervention, the 4 checkpoints of the ESMO flowchart were never addressed (0%) as compared to 92%, 92%, 77% and 77% respectively. The mean number of days for complete symptom relief were 7 v/s 2 days respectively. Mean number of days to report constipation was 5 days v/s 3 days respectively. The mean number of active reviews till complete symptom relief was 0 v/s 2 times.

Conclusion: Empirical management of constipation occurring during RT for head and neck cancers gives poor results. Guideline based treatment help manage the constipation better thus enhancing the patient care.

A Review of Literature on Thymoma: An Indolent Tumor of Anterior Mediastimum

Tue, 23 Apr 2024 05:58:10 +0000

Thymic tumours are a heterogeneous group of malignancies with a range of clinical presentations. The most common types are thymoma and thymic carcinoma, but overall it remains a rare cancer, and one without a clear aetiology. About 50% are diagnosed incidentlly with chest radiography. Thymoma is classified into different stages, which determine the prognosis and type of management. Different types of treatments are available for patients with thymoma. Thymectomy to remove the tumor is the most common treatment of thymoma. We present a case of 20 yr old male presented with shortness of breath, cough, chest pain and fever for past 15 days. Mediastinal widening and modratly pleural effusion in right sided chest seen on chest xray. CECT chest show soft tissue density lesion in anterior and superior mediastinum. FNAC was done that showed feature of thymoma. Biopsy also done that confirmed lymphocytic rich type B thymoma.

The Structure and Function of Oral Cancer Control in Kerala, India: A Narrative Review of Cancer Control Policy Documents from 1988 to 2020

Phinse M Philip, Srinivasan Kannan (Author) — Mon, 24 Jun 2024 05:49:23 +0000

The government of Kerala was the first state in India to come out with a comprehensive plan for cancer control based on National Cancer Control Program. The purpose of this review was to identify the structure and function of cancer control in Kerala, India with specific reference to oral cancer. A systematic search was done in PubMed using the keywords “Health Policy”, “Cancer”, “Oral cancer”, “Guiding document” and “Kerala”. All government of Kerala health-related websites were searched electronically for cancer-related policy documents. The medical library catalogs of the two government Comprehensive Cancer Care Centres in the state were searched. All available Government documents, institutional documents, other online resources related to cancer prevention were collected. A checklist was prepared to review the documents. Out of 18 documents identified, two cancer-specific policy documents and two health policy documents were included in the review.
The cancer control strategies outlined in the reviewed documents presented a pragmatic vision for cancer control in low-resource settings. The concept called the ‘Kerala Cancer Care Grid’ outlined in one of the documents is a novel strategy to address the geographical inequality in access to cancer care. It recognized interdepartmental coordination and partnership with private sector institutions and community organizations as crucial for achieving comprehensive cancer control. In the reviewed documents, oral cancer was discussed mainly in the context of early detection, health education, and capacity building at the primary care level.

“A Concealed Malignancy” A Case Series on Primary Fallopian Tube Carcinoma

Lorene Kate M. Sereño, Jimmy A Billod (Author) — Tue, 14 May 2024 05:07:34 +0000

Background: As rare as it is, primary fallopian tube carcinoma presents with a varied range of nonspecific signs and symptoms making its preoperative diagnosis a clinical challenge. It is often missed and is usually recognized later by histopathology. This paper aims to present four cases of fallopian tube cancer managed in our institution in a 5-year period with varied presentation and to discuss updates in diagnosis, management and prognosis in the light of recent literature.

Methods and Results: All of the four cases were of different age group, presented differently and were diagnosed preoperatively to be of another etiology. The first case, 44 year old, initially presented with recurrent vaginal discharge. The patient then presented with supraclavicular nodes to be of metastatic origin. The second case, 58 year old, presented with vaginal spotting and on imaging, a pelvic mass that may represent ovarian new growth. The third and fourth case, 71 and 66 year old respectively, presented with a history of gradually enlarging abdominal mass with an imaging showing an adnexal mass. Intraoperatively, the first and third case revealed a fallopian tube that was thinned out and dilated to a granular and friable tissue. The second case had a right fallopian tube that cannot be grossly identified but an adnexal mass was noted. The fourth case showed a left fallopian tube that was converted to a tan irregular mass. Histopathology revelaed all of these cases as high grade fallopian tube serous carcinoma.

Conclusion: To raise suspicion in the diagnosis of this rare carcinoma preoperatively should be given more importance so that a prompt investigation would be made and catching this disease in an early stage would be achieved. This paper showcased the varied presentation of this disease so as to avoid preoperative misdiagnosis and have a better head start on proper management.

Rare Carcinomas of Lung - A Case Series and Rreview of Literature

Mon, 24 Jun 2024 05:51:41 +0000

Lung cancer remains a leading cause of mortality and morbidity related to cancers. Apart from common subtypes of lung cancer like Non-small cell carcinoma (NSCLC) and Small cell lung carcinoma (SCLC), there are clinical entities that are very rare in occurrence and differ in diagnostic workup, treatment, and prognosis. The symptoms or clinical presentation of such rare tumors may be similar to the commoner varieties. However, their diagnosis is a clinical challenge in common practice. Hence, early suspicion, and prompt diagnosis by histopathological, immunohistochemical analysis, and imaging studies are of paramount importance. Here we present a trilogy of rare carcinomas of the lung.

Small Cell Carcinoma of Anal Canal: A Rare Case Report from a Tertiary Cancer Centre

Tue, 23 Apr 2024 06:33:29 +0000

Extrapulmonary small cell carcinoma (EPSCC) is very rare with an incidence of 0.1 to 0.4% in the United states and the exact incidence in other regions is unknown. Anal canal involvement is extremely rare contributing to < 1% of all EPSCC. Inspite of its rarity, it is of clinical importance due to its aggressive nature. Most of the patients present with lungs and liver metastasis at diagnosis even in early stage tumors. It has a dismal survival rate of 58% at 6-month and 6% at 5-years in contrast to squamous cell carcinoma of anal canal. Exact ethiopathogenesis is unknown. Association with HIV has been seen like squamous cell carcinoma of anal canal. There is very little literature evidence and management is not clear like that of squamous cell carcinoma anal canal. Here we present the case of a 63 year old HIV positive male who presented with small cell carcinoma of anal canal to our institute and the challenges we faced in diagnosis and management.

Radical Radiotherapy in Primary Extra Nodal Lymphoma of Tonsil: A Rare Case Report

Mayadevi K Poojari, Rajeev Srivastava (Author) — Tue, 23 Apr 2024 06:52:48 +0000

Primary non-Hodgkin’s lymphoma (NHL) usually arises within the lymphnodes, but 20-30% account for extranodal sites. Non-Hodgkin’s lymphoma (NHL) of the Waldeyer’s ring is a clinical rarity. Among these tumors, palatine tonsils are most frequently involved. Most common high-grade rapidly growing NHL is diffuse large B-cell lymphoma (DLBCL), reaching about 80% in some of the studies. For aggressive localized Extranodal Lymphoma, systemic therapy is the primary treatment modality unless patients are unfit for, or refuse, such therapy. Here, we report a 71 years old elderly gentleman who presented with complaints of left tonsillar swelling, difficulty in swallowing and change in voice since 10 days. He was diagnosed as localised Primary Extra nodal NHL - DLBCL of left tonsil. But he was unfit for chemotherapy in view of elderly age and multiple comorbidities, hence he received radical radiotherapy. During the treatment, he had symptomatic relief. He responded to radical radiotherapy well & is on regular follow up.

Breast Carcinoma with Isolated Orbital Metastasis –A Rare Clinical Entity

Tue, 14 May 2024 05:21:16 +0000

Breast cancer with isolated orbital metastasis is a rare clinical entity.We hereby present a rare case report of 35 year old premenopausal lady with known case of carcinoma breast right side (operated for right modified radical mastectomy in year 2017 with final histopathology of pT2N2M0, hormone receptor-positive and Her2-negative disease). She completed adjuvant 8 cycles of standard dose chemotherapy with 4 cycles of Cyclophosphamide, Adriamycin followed by 4 cycles of Paclitaxel followed by local Radiation therapy. She was initiated Tab. Tamoxifen 20 mg once daily and was continued same for 4 years when in July 2021, she complained of sudden decreased visual acuity and diplopia of right eye lasting from last 1 month. Ophthalmological examination confirmed the findings with decreased visual acuity of 6/36 of right eye while visual acuity of left eye was normal. CT scan of orbits revealed 28 × 18mm heterogeneous enhancing soft tissue mass in right orbital compartment,extrabulbar, occupying postero-superior quadrant inseparable from lateral rectus muscle with optic nerve effacement. PET-CT scan was performed which revealed no metastasis elsewhere in the body. She was offered surgical oophorectomy followed by switch to another hormonal therapy of aromatase inhibitors. She showed complete response to treatment and is now disease from last 2 years.

Solitary Fibrous Tumor of Mediastinum-A Rare Clinical Entity and Review of Literature

Manish Sahni, Anula Sisodiya, Apurva Shah, Sanjeev Devgarha (Author) — Tue, 14 May 2024 05:24:14 +0000

Solitary fibrous tumour is an uncommon mesenchymal tumour with indolent clinical behaviour as compared to its malignant counterpart. There are very few case reports of extra-pleural malignant SFT arising from the mediastinum.We hereby present a rare case report of solitary fibrous tumor arising from mediastinum and reviewing the literature of this entity.