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Indian Journal of Medical and Paediatric Oncology
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   2015| April-June  | Volume 36 | Issue 2  
    Online since June 16, 2015

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Indian Council of Medical Research consensus document for the management of gall bladder cancer
Hari Shankar Shukla, Bhawna Sirohi, Anu Behari, Atul Sharma, Jahar Majumdar, Manomoy Ganguly, Mallika Tewari, Sandeep Kumar, Sunil Saini, Peush Sahni, Tomcha Singh, Vinay Kumar Kapoor, V Sucharita, Tanvir Kaur, Deepak Kumar Shukla, Goura Kishor Rath
April-June 2015, 36(2):79-84
DOI:10.4103/0971-5851.158829  PMID:26157282
  • The document is based on consensus among the experts and best available evidence pertaining to Indian population and is meant for practice in India.
  • All postcholecystectomy gallbladder specimens should be opened and examined carefully by the operating surgeon and be sent for histopathological examination.
  • All "incidental" gall bladder cancers (GBCs) picked up on histopathological examination should have an expert opinion.
  • Evaluation of a patient with early GBC should include essential tests: A computed tomography (CT) scan (multi-detector or helical) of the abdomen and pelvis for staging with a CT chest or chest X-ray, and complete blood counts, renal and liver function tests. magnetic resonance imaging/positron emission tomography (PET)-CT are not recommended for all patients.
  • For early stage disease (up to Stage IVA), surgery is recommended. The need for adjuvant treatment would be guided by the histopathological analysis of the resected specimen.
  • Patients with Stage IVB/metastatic disease must be assessed for palliative e.g. endoscopic or radiological intervention, chemotherapy versus best supportive care on an individual basis. These patients do not require extensive workup outside of a clinical trial setting.
  • There is an urgent need for multicenter trials from India covering various aspects of epidemiology (viz., identification of population at high-risk, organized follow-up), clinical management (viz., bile spill during surgery, excision of all port sites, adjuvant/neoadjuvant therapy) and basic research (viz., what causes GBC).
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Management of solitary and multiple brain metastases from breast cancer
Addison Willett, J Ben Wilkinson, Chirag Shah, Minesh P Mehta
April-June 2015, 36(2):87-93
DOI:10.4103/0971-5851.158835  PMID:26157284
As local and systemic control of breast cancer improves, metastasis to the brain remains a common event requiring a specialized management approach. Women diagnosed with breast cancer who develop brain metastases have superior overall survival compared to patients with other forms of metastatic carcinoma. This article summarizes some of the unique aspects of care for patients with breast cancer metastases to the brain.
  4,357 413 -
Knowledge, attitudes and practice toward cervical cancer screening among Sikkimese nursing staff in India
Hafizur Rahman, Sumit Kar
April-June 2015, 36(2):105-110
DOI:10.4103/0971-5851.158840  PMID:26157287
Objectives: To assess baseline knowledge of cancer cervix, screening and practice of Pap smear screening among Sikkimese staff nurses in India. Materials and Methods: Between April 2012 and February 2013, a predesigned, pretested, self -administered multiple responses questionnaire survey was conducted among staff nurses' working in various hospitals of Sikkim. Questionnaire contained information about their demographics, knowledge of cervical cancer, its risk factors, screening methods, attitudes toward cervical cancer screening and practice of Pap smear amongst themselves. Results: Overall, 90.4% nurses responded that they were aware of cancer cervix. Three quarter of the staff nurses were not aware of commonest site being cancer cervix in women. Of the 320 participants, who had heard of cancer cervix, 253 (79.1%) were aware of cancer cervix screening. Pap smear screening should start at 21 years or 3 years after sexual debut was known to only one-third of the nursing staff. Age was found to be a significant predictor of awareness of Pap smear screening among nursing staff. Awareness was significantly more prevalent among older staff (P < 0.007). Married nursing staffs were significantly more likely to be aware of screening methods, and nursing staff of Christian and Buddhist religion were 1.25 times and 2.03 times more likely to aware of screening methods than Hindu religion respectively. Only 16.6% nurses, who were aware of a Pap smear (11.9% of the total sample), had ever undergone a Pap smear test. Most common reason offered for not undergoing Pap smear test were, they felt they were not at risk (41%), uncomfortable pelvic examination (25%) and fear of a bad result (16.6%). Conclusion: Knowledge of cancer cervix, screening and practice of Pap smear was low among Sikkimese nursing staff in India. There is an urgent need for re-orientation course for working nurses and integration of cervical cancer prevention issues in the nurses' existing curriculum in India and other developing countries.
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Role of triple test score in the evaluation of palpable breast lump
Smita Sushil Kachewar, Suryakant Dattatraya Dongre
April-June 2015, 36(2):123-127
DOI:10.4103/0971-5851.158846  PMID:26157290
Introduction: Fine-needle aspiration cytology (FNAC) method is safe, reliable and time saving outdoor procedure with little discomfort to the patient for detecting Carcinoma breast. The efficacy can further be enhanced when physical breast examination, mammography and FNAC (the triple test [TT]) are jointly taken into consideration. Aims and Objectives : The aim was to evaluate the role of TT score (TTS) in palpable breast masses. Materials and Methods: This prospective study was carried out from May 2010 to April 2012. In the subjects referred to the Department of Pathology for FNAC of the breast mass, the TTS was calculated, and histopathological findings were noted. Results: In the study period TTS score was calculated in 200 cases out of 225 FNAC's of breast. Of 124 benign cases on cytology, only three showed discordant TTS. Out of 62 malignant cases, 61 showed concordant TTS and one case of mastitis on histopathology showed TTS of five. Out of all the benign lesions, two cases of fibrocystic disease and a single case of phylloides tumor gave a TTS ≥6. These cases were diagnosed as infiltrating ductal carcinoma and angiosarcoma respectively on histopathology. Histopathological correlation was possible in only 70 patients. Of these 70, 28 were from the benign category and 42 were from the malignant category. TTS of ≥6 has a sensitivity of 97.44%, specificity of 100%. FNAC has a sensitivity of 88.37%, specificity of 96.42%. Conclusions: TT reliably guides evaluation of palpable breast masses. Histological correlation indicated TTS to be better diagnostic tool than FNAC alone.
  2,826 443 -
Hormone receptor status (estrogen receptor, progesterone receptor), human epidermal growth factor-2 and p53 in South Indian breast cancer patients: A tertiary care center experience
Rashmi Patnayak, Amitabh Jena, Nandyala Rukmangadha, Amit Kumar Chowhan, K Sambasivaiah, Bobbit Venkatesh Phaneendra, Mandyam Kumaraswamy Reddy
April-June 2015, 36(2):117-122
DOI:10.4103/0971-5851.158844  PMID:26157289
Breast cancer, in India, is the second commonest cancer in females. Receptor status with ER/PR/Her 2 is now routinely done in patients with invasive carcinoma. The tumour suppressor gene, p53, is also present in most breast cancers. Proteins produced by a mutated p53 gene, accumulate in the nucleus of tumour cells and are detected by immunohistochemistry (IHC). We have undertaken this study with the aim to evaluate the ER, PR, HER-2 and p53 expressions in invasive breast carcinomas by IHC and to compare the HER-2 expression with various clinicopathological parameters. Materials and Methods: In this retrospective single institutional study from January 2001 to December 2010, 389 cases of histopathologically diagnosed infiltrating carcinoma of breast were evaluated taking into account various parameters like age, tumour size, grade, lymph node involvement, ER and PR. HER-2 and p53 was done in 352 cases. Results: The age range was 23-90 years with a mean of 50.7 years. Majority of tumours were T2 (79.6%) and Grade II (60.9%). Our data showed overall 47.6% ER, 48.8% PR, 29.6% HER-2 and 69.2% p53 positivity. There was no significant correlation between HER-2 and age, tumour size, lymph node status, ER, and PR. There was significant correlation between HER-2 and tumour grade (P = 0.031), p53 (P < 0.001). There was no inverse correlation between HER-2 and combined ER, PR status. Triple-negative breast cancers which constituted 22.7% of our cases did not reveal any correlation with various parameters. Conclusion: In our study, ER status was low, and incidence of p53 was high. These findings suggest that many of the tumours in Indian females may be of an aggressive type, and novel treatment approaches may be tried. We conclude that the assessment of all four markers is desirable.
  2,677 339 1
Transforming growth factor-β1 and TGF-β2 act synergistically in the fibrotic pathway in oral submucous fibrosis: An immunohistochemical observation
Venkatesh Viswanath Kamath, Shruti Krishnamurthy, Krishnanand P Satelur, Komali Rajkumar
April-June 2015, 36(2):111-116
DOI:10.4103/0971-5851.158842  PMID:26157288
Background and objectives: Oral Submucous Fibrosis (OSF) is a potentially malignant oral disorder which leads to fibrosis of the oral mucosa and has a high rate of malignant transformation. The consumption of various forms of areca nut is causatively linked to the condition. The constituents of areca nut activate several pro-fibrotic cytokines, chiefly transforming growth factor-β1, β2, which leads to an increased deposition and decreased degradation of extracellular matrix and collagen. TGF-β1, β2 probably represent the major pathway in the deposition of collagen fibres in this condition. The present study aims to identify and correlate the expressions of TGF-β1 and TGF-β2 immunohistochemically on paraffin sections of various stages of OSF. A comparison was also made between normal oral mucosa and scar tissue and OSF to judge the mode, extent and type of expression of TGF β1, β2. Methods: The expression of TGF-β1 antibody (8A11, NovusBio, USA) and TGF-β2 antibody (TB21, NovusBio, USA) was detected immunohistochemically on paraffin sections of 58 and 70 cases of OSF respectively, 10 cases of normal oral mucosal tissue and 4 cases of scar tissue. A mapping of the positivity of the two cytokines was done using JenOptik camera and ProReg image analysis software. The results were statistically analysed using one way ANOVA and students "t" test. Results: Expression of TGF-β1 and TGF-β2 was more in OSF as compared with normal oral mucosa, scar/keloid tissue showing highest values. Positivity for both the markers was seen in epithelium, around the blood vessels, in areas of inflammatory infiltrate, fibroblasts and in muscles. TGF-β1 expression was higher and more intense than that of TGF-β2 in all the cases. TGF-β2 was restricted in its expression to submucosal area with minimal involvement of the epithelium and the deeper muscle tissue. Conclusion: TGF-β1 is the most prominent cytokine in the fibrotic pathway and TGF-β2 plays a contributory role.
  2,525 390 -
Updates from Gastrointestinal ASCO 2015
Shaheenah Dawood
April-June 2015, 36(2):133-136
DOI:10.4103/0971-5851.158852  PMID:26157293
This year at ASCO GI we saw important data presented that has continued to shape the way we treat GI malignancies. Several important questions were addressed. Can we avoid surgery among patients with rectal tumors? Data from a provocative retrospective study indicated that certain subgroups of patients might not need surgery thereby preserving the rectum without compromising survival outcome. What is the role of ramicurumab among patients with advanced colorectal cancers? Data from the phase III RAISE trial revealed that the addition of ramicurumab to second line therapy significantly improved median overall survival. What is the role of immunotherapy in GI malignancies? Interesting results from the KEYNOTE-012 trial was presented that looked at the efficacy of pembriluzumab among patients with advanced gastric cancer with the investigators reporting interesting results of an objective response rate of 22.1% and a 6 months progression free survival of 24%. In this review we will briefly present these and other important highlights of the ASCO GI meeting.
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Outcomes of pediatric glioblastoma treated with adjuvant chemoradiation with temozolomide and correlation with prognostic factors
Supriya Mallick, Ajeet Kumar Gandhi, Nikhil P Joshi, Anupam Kumar, Tarun Puri, Daya Nand Sharma, Kunhi Parambath Haresh, Subhash Gupta, Pramod Kumar Julka, Goura Kisor Rath, Chitra Sarkar
April-June 2015, 36(2):99-104
DOI:10.4103/0971-5851.158838  PMID:26157286
Background: Pediatric glioblastoma (pGBM) patients are underrepresented in major trials for this disease. We aimed to explore the outcome of pGBM patients treated with concurrent and adjuvant temozolomide (TMZ). Materials and Methods: 23 patients of pGBM treated from 2004 to 2010 were included in this retrospective analysis. Adjuvant therapy included conformal radiation 60 gray at 2 gray/fraction daily over 6 weeks with concurrent TMZ 75 mg/m 2 followed by six cycles of adjuvant TMZ 150-200 mg/m 2 (day 1-5) every 4 weeks. Kaplan-Meier estimates of overall survival (OS) were determined. Univariate analysis with log-rank test was used to determine the impact of prognostic variables on survival. Results: Median age at presentation was 11.5 years (range: 7-19 years) and M:F ratio was 15:8. All patients underwent maximal safe surgical resection; 13 gross total resection and 10 sub-total resection. At a median follow-up of 18 months (range: 2.1-126 months), the estimated median OS was 41.9 months. The estimated median OS for patients receiving only concurrent TMZ was 8 months while that for patients receiving concurrent and adjuvant TMZ was 41.9 months (P = 0.081). Estimated median OS for patients who did not complete six cycles of adjuvant TMZ was 9.5 months versus not reached for those who completed at least six cycles (P = 0.0005). Other prognostic factors did not correlate with survival. Conclusions: Our study shows the benefit of TMZ for pGBM patients. Both concurrent and adjuvant TMZ seem to be important for superior OS in this group of patients.
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The fight against cancer: Is it worthwhile?
Savio George Barreto, Merlyn Barreto, Rohan Chaubal, Amit Dutt
April-June 2015, 36(2):85-86
DOI:10.4103/0971-5851.158833  PMID:26157283
This article alludes to the findings of Tomasetti and Vogelstein and argues that for clinicians and scientists no matter how difficult understanding the pathogenesis of cancer may be, they remain the only hope for patients suffering from the disease. Data citing wide differences in cancer incidence in different parts of the world is presented to drive home the point that 'Bad luck' is not a good enough explanation for cancer pathogenesis. There remains a lot to be uncovered in cancer and clinicians and scientists should strive to this end.
  2,441 249 1
The changing nature of end of life care
Katrine Cauldwell, Paddy Stone
April-June 2015, 36(2):94-98
DOI:10.4103/0971-5851.158836  PMID:26157285
Good end of life care (EOLC) for patients with incurable cancer is becoming a greater priority for oncologists in recent years. Frameworks such as the Liverpool Care Pathway (LCP) have often been helpful in guiding good care at the end of life. However, in the past year, the LCP has been phased out of use in the United Kingdom (UK), following concerns that it was poorly implemented. This review describes the LCP's origins in the UK, its strengths and limitations, and the concerns that prompted a review of its use. It describes the recommendations for change made by an independent review, and the alternative strategies now being developed in the UK to guide good EOLC. Although the LCP is still being widely used worldwide, the lessons learned from the UK can be widely applied in other countries.
  2,341 257 1
Prophylactic cranial irradiation in breast cancer: A new way forward
Ajeet Kumar Gandhi, Daya Nand Sharma, Goura Kishor Rath
April-June 2015, 36(2):77-78
DOI:10.4103/0971-5851.158822  PMID:26157281
  2,231 250 -
Pancreatic cancer - lessons from the past decade
Ihsan Ekin Demir, Helmut Friess
April-June 2015, 36(2):73-76
DOI:10.4103/0971-5851.158821  PMID:26157280
  2,102 254 -
Delivery of cancer care in rural India: Experiences of establishing a rural comprehensive cancer care facility
Shripad D Banavali
April-June 2015, 36(2):128-131
DOI:10.4103/0971-5851.158848  PMID:26157291
  2,029 237 -
Excellent response to oral Metronomic chemotherapy in unresectable adenocarcinoma of external auditory canal
Vanita Noronha, Amit Joshi, Vijay Patil, Sachin Dhumal, Vivek Agarwala, Kumar Prabhash
April-June 2015, 36(2):132-132
DOI:10.4103/0971-5851.158849  PMID:26157292
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