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Indian Journal of Medical and Paediatric Oncology
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   2005| December  | Volume 26 | Issue 4  
    Online since May 30, 2009

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Gallbladder cancer : Role of Adjuvant chemotherapy
A Sharma, AD Dwary
December 2005, 26(4):67-69
Gallbladder cancer is the most common biliary tract malignancy. There is a tremendous regional variability in its incidence. Risk factors include genetic susceptibility, gender, presence of gallstones, chronic biliary infections, diet and some anatomical anomalies. Several genetic abnormalities have been described which may be etiologically important as well as carry prognostic significance. These includes mutation in proteins, K-raps and P53 and altered expression of P-glycoprotein, Cox-2 and epidermal growth factor receptor. Most patients present at an advanced stage, overall prognosis is very poor. TNM stage and the extent of surgical resection are the most important prognostic factors. Surgery is the only curative therapy, reserved for the patients with early stage disease. The role of adjuvant therapy, reserved for the patients with early stage disease. The role of adjuvant therapy though employed is not fully defined. The large scale randomized trials are not available. However, data point towards better survival with 5-FU based chemotherapy with or without radiotherapy in node positive cases. The availability of better drugs and combinations may affect the use of chemotherapy in neoadjuvant and adjuvant settings. Novel targeted therapies require exploration alone or in combination with chemotherapy in adjuvant settings. Prospective large scale randomized trials are needed to answer role of adjuvant therapy.
[ABSTRACT]   Full text not available   
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Hepatocellular carcinoma
PM Parikh, R Bhagwat, G Biswas, L Goyal
December 2005, 26(4):43-57
Hepatocellular carcinoma (HCC) is the fourth most common cancer worldwide. Over last two decades there is increased incidence rate and shift toward younger population. HCC is associated with conditions resulting in chronic liver injury. Malignant tumours of liver are primarily adenocarcinomas. Majority of the patients present with advanced disease. Imaging is required to assess operability. Standard treatment for operable tumour is partial hepatectomy or total hepatectomy with liver transplantation. Neoadjuvant chemotherapy; chemo-embolization or immunoembolization may make resection safer. Adjuvant chemotherapy or chemo-embolization has shown no benefit in terms of survival. Surveillance of high-risk population is a must for detection at early stages where curative therapy can be given. Patients with HCC who cannot undergo curative procedures are best treated in the setting of a clinical trial.
[ABSTRACT]   Full text not available  [PDF]
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Clinicopathological features of Jaw tumours
PB Olaitan, BC Jiburum, WIB Onuigbo
December 2005, 26(4):12-17
Background: We reviewed case records of patients diagnosed to have jaw tumours to determine clinical presentation, histological subtypes and difficulties encountered in the management. Patients and Methods: Between Jan 1980 and December 1999, 136 patients were diagnosed to have jaw tumours. Results: Seventy (51.4 percent) patients were males while 66 (48.6 percent) were females. The mandible was most common primary site-77 (56.6 percent) followed by maxilla-59 (43.3 percent). Histopathology- Fibro-osseous tumours were most common-41 (30.1 percent), followed by Ameloblastoma-28 (20.6 percent), cystic tumours-21 (15.4 percent), osteosarcoma-6 (4.4 percent), undifferentiated carcinoma-6 (4.4 percent), fibromyxoma-5 (3.6 percent), Burkitt's lymphoma-4 (2.9 percent), plasmacytoma-3 (2.2 percent) and Odontoblastoma in-2 (1.5 percent).
[ABSTRACT]   Full text not available  [PDF]
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Psychosocial impact of adjuvant therapy in breast cancer
Mohan Indra, HR Pal
December 2005, 26(4):18-26
Breast cancer is one of the most common cancer among women. Following multimodality treatment approach survival has improved significantly proportion of cancer patients will suffer social, emotional and psychological distress as a result of cancer diagnosis and treatment. As survivorship become more prevalent, appropriate consideration of quality of life is increasingly important. The women undergoing adjuvant treatment suffer from anxiety, depression, adjustment problems, sleep loss and various cognitive changes like confusion, loss of concentration etc. In addition it adversely impacts on capacity to cope with disease burden. The financial burden is tremendous compounding the whole situation. Psychosocial interventions have proven efficacious for helping patients and families confront the many issues that arise during this difficult time. Evidence is accumulating that psychological therapies improve emotional adjustment and social functioning, and reduce both treatment and disease-related distress in patients with cancer.
[ABSTRACT]   Full text not available  [PDF]
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Alternative strategies in the management of de-differentiated thyroid cancer
CS Bal, Kumar Ajay
December 2005, 26(4):28-41
Over time, up to 30 percent of differentiated thyroid cancer become de-differentiated and do not respond to traditional therapeutic modalities, posing a therapeutic challenge. Thyroid cancer is characterized by genetic alterations with both, activation of proto oncogenes, and inactivation of tumour suppressors. Over expression and/ or uncontrolled activation of receptor tyrosine kinases, downstream signaling molecules, and inhibition of programmed cell death (apoptosis) are other moleculer mechanisms. Currently a number of various therapeutic approaches are being tested in preclinical and clinical studies based on the pathogenesis of the dedifferentiation and target the altered genes or intracellular molecules involved in these processes. It is hoped that same of novel strategies will probably extend the current therapeutic options and provide a hope for otherwise untreatable patients.
[ABSTRACT]   Full text not available  [PDF]
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Profile of gall bladder cancer cases in Bihar
RR Prasad, JK Singh, M Mandal, M Kumar, SS Prasad
December 2005, 26(4):31-35
Gallbladder cancer cases are commonly seen in state of Bihar in three major cancer centers (treating more than 2000 cancer cases per year each); Patna Medical College (P.M.C.H), Mahavir Cancer Sansthan (MCS), and Regional Cancer Center (RCC). Based on limited hospital-based data from these three cancer centers, a retrospective analysis of cases of cancer of gallbladder was performed to look into patterns of care of such patients. A total of 1203 cases were seen between periods of 1st July 2005 to 30th June 2006. In PMCH, MCS, RCC 141,594,468 cases of cancer of gallbladder were seen, respectively during this period. Most cases presented in advance stages leading to poor outcome. The age range varied from 16 years to 100 years of age, with mean age of 48 years in females and 55 years in male. Jaundice at presentation was in 38.66 percent cases. Adenocarcinoma was the most common variety seen in 99 percent cases. Radical surgery was performed in minority of cases while use of postoperative radiotherapy was infrequent. Various combination regimens of chemotherapeutic drugs used included Cisplatin, 5 Fluorouracil (5-FU), Oxaliplatinum, Gemicitabine, Irinotecan, and Capecitabine etc. However, many patients did not complete proposed chemotherapy cycles on account of progressive disease, toxicities of chemotherapeutic agents and due to logistic reasons. Use of tumour marker was limited to one center and included Ca19-9 and CEA. There are limited research and clinical trial works related to gallbladder, undergoing in these centers.
[ABSTRACT]   Full text not available   
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Gall bladder cancer : Indian Scenario
K Chaudhry
December 2005, 26(4):6-15
Gallbladder cancer is an important malignant disorder for India. The reports of various population based cancer registries were analysed to assess its importance in Indian context, to understand its geographic distribution, gender distribution and trends in occurrence of this disease over time. Published scientific studies providing population based data were also used. The data suggests that gallbladder cancer is common among women. Its incidence increases with age. In areas with lower crude incidence rates, the disease is mainly limited to higher age groups. However, younger persons are affected in case of higher overall incidence rates. In areas with lower incidence rates, both genders are affected to same extent or even men may be affected to a higher extent. An analysis of temporal age specific incidence rates showed that in case of increase in overall incidence rates, all the age groups are affected, suggesting that the operable aetiologiocal/risk factors affect everyone in the region. Increase in incidence rates was observed in Delhi and Mumbai. Other areas also suggested an increase, but the confidence is limited due to small numbers. Cross-sectional data as well as temporal data in incidence rates, suggests that in case of increase in overall incidence rate of the disease, the female: Male (F: M) ratio of incidence rate is likely to go high. Occurrence of gallbladder cancer among younger and increase in F: M ratio of incidence rate may suggest an increasing trend of the disease.
[ABSTRACT]   Full text not available   
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Carcinoma gallbladder : Clinical features and workup
M Sharma, GK Makharia
December 2005, 26(4):25-30
Carcinoma of the gallbladder has aggressive tumour biology. The disease is confined to gallbladder wall at the time presentation in only about 15-20 percent patients and 80 percent have locoregional and/or distant spread making them unresectable at the time of diagnosis. Absence of specific signs or symptoms makes the diagnosis of carcinoma GB difficult at an early stage. Presence of jaundice is a poor prognostic indicator and the cancer is unresectable in about half of patients by the time jaundice appears. There are five types of presentation of carcinoma GB: presentation with features of acute cholecystitis, presentation with chronic cholecystitis, presentation with chronic cholecystitis, presentation with biliary tract symptoms (jaundice, abdominal pain), presentation like malignant tumours outside the biliary tree (invasion of surrounding structures) and benign manifestations outside the biliary tract such as gastrointestinal bleeding. Trans-abdominal ultrasound (US) is a sensitive technique to detect carcinoma GB and US guided fine needle aspiration is almost diagnostic (sensitivity 88 percent and specificity 100 percent). Computed tomography is required to assess resectability and spread of disease. The natural history of disease is quite dismal and survival rates are less than a year once survival lies in early diagnosis of carcinoma of the gallbladder.
[ABSTRACT]   Full text not available   
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Spontaneous splenic rupture : A rare initial manifestation of acute lymphoblastic leukemia
M Narang, Sunita, S Saluja, S Bhasin, M Sharma, DK Gupta
December 2005, 26(4):68-70
Pathologic splenic rupture is a rare and life threatening complication of acute leukemia. It is even more uncommon as initial manifestation and only a few cases have been reported to emphasize the importance of this potentially fatal complication.
[ABSTRACT]   Full text not available  [PDF]
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Gall bladder Cancer : Surgical Management
S Misra, A Chaturvedi, NC Misra
December 2005, 26(4):46-53
Gallbladder carcinoma is one of the commonest cancers seen in North India. Surgical resection has been looked at with pessimism due to the poor results reported in the literature. However, the last decade has seen major progress in the surgical treatment of this disease. This opinion based review is based on the available literature and our own experience of radical surgical procedures. The curative surgery for carcinoma gallbladder has ranged from simple cholecystectomy to radical cholecystectomy to supraradical surgery like hepatopancreatico-duodenectomy. Laparoscopic cholecystectomy should not be done if gallbladder carcinoma is suspected preoperatively. Patients who have inadvertently undergone laparoscopic cholecystectomy require re-exploration and port sites resection in addition to radical cholecystectomy. Patients with Tis and T1a disease are cured with simple cholecystectomy (5 year survival 85-100 percent). Cancers T1b and beyond are best treated with radical cholecystectomy. Patients with T2 cancer have a 61-90 percent 5 year survival with radical surgery. Survival of patients with T3, T4 tumours are poor compared to early stage disease. Encouraging 5-years survivals of 15 to 63 percent and 7 to 25 percent have been reported recently for T3 and T4 tumours, respectively. Debulking surgery has no proven value and is not recommended. Radical resection remains the only potentially curative treatment. Future studies will see the better integration of radical surgery with adjuvant and neoadjuvant treatment in improving survival in gallbladder carcinoma.
[ABSTRACT]   Full text not available   
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Pathology of Gall bladder carcinoma in India : An overview
CS Kiran, P Das, N Aggarwal, SD Gupta
December 2005, 26(4):16-24
In comparison to the western world gallbladder carcinoma (GB) is common in India. Etiology of Gallbladder cancer is of multifactorial in origin. Long history of gall stone diseases ( greater than 20 years), size of stone, high parity, advanced age, ethnicity, chemical carcinogens, specially tobacco and coffee intake, have been attributed. Early point mutation of codon 12 of the K-ras oncogene in gallbladder carcinoma has been identified. Pathology of gallbladder shows wide spectrum of changes starting from inflammatory, metaplastic, dysplastic changes of malignancy. Adenocarcinoma is the most common type of invasive GB carcinoma and shows many variations. Size of GB carcinoma can be tiny to large mass infiltrating the liver. Sometimes thickening of wall is the only evidence. It is required to know the correct technique of processing and sectioning of GB specimens to correctly diagnose the disease, as it has a very high mortality rate.
[ABSTRACT]   Full text not available   
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Chemoreduction helps vision preservation in retinoblastoma
N Choudhury, C Bhuyan, BJ Saikia, M Bhattacharyya, K Bhattacharjee
December 2005, 26(4):6-11
Background: The role of chemotherapy in treating intraocular retinoblastoma (RB) has rapidly progressed since the last decade. With this approach enucleation or external beam radiotherapy can be avoided in selected cases radiotherapy can be avoided in selected cases of intraocular RB. Our study is a retrospective analysis of cases of intraocular retinoblastoma receiving primary chemotherapy and local therapy. Methods: Newly diagnosed cases of intraocular RB were treated with primary chemotherapy followed by local therapy. Out of 75 cases that attended our institution during the period of 6 years from 1998 to 2003, 20 patients had intraocular disease and all of them received primary chemotherapy. 12 of 20 patients had unilateral disease, and 8 had bilateral disease. Reese- Ellsworth grouping was assigned to each of the diseases eye. A total of 28 eyes were treated with primary chemotherapy followed by local therapy. Results: Among 28 eyes, vision could be preserved in 9 eyes (32 percent) while enucleation was carried out in 12 eyes (42.9 percent). Vision preservation was successful in the early stages (RE group I-III) of intraocular disease. Conclusion: Use of chemotherapy followed by local therapy is effective in preserving vision in intraocular retinoblastoma especially in the early stages (Reese Ellsworth Group I-III).
[ABSTRACT]   Full text not available  [PDF]
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Primary bone lymphoma : A case report
RK Seam, MK Gupta, K Sharma
December 2005, 26(4):66-67
Primary bone lymphoma is rare. A 33 year old male presented with pain and swelling of left upper thigh. X-ray left femur revealed pathological fracture of left femur shaft. Biopsy revealed - non Hodgkin's lymphoma, diffuse, intermediate grade, B cell type. Patient received 4 cycles of CHOP chemotherapy followed by radiotherapy. He continues to be disease-free, and functionally normal, 16 months after diagnosis. Conclusion: primary bone lymphoma have excellent prognosis following chemotherapy and radiotherapy.
[ABSTRACT]   Full text not available  [PDF]
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Primary liposarcoma of orbit
PS Sridhar, DN Sharma, PK Julka, GK Rath
December 2005, 26(4):71-72
Primary liposarcoma of orbit is extremely rare. We report 2 cases of orbital liposarcoma who presented with proptosis. Pertinent literature is reviewed.
[ABSTRACT]   Full text not available  [PDF]
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Chemotherapy in gallbladder cancer : A clinical Review
DC Doval, BS Awasthy, AK Vaid, JB Sharma
December 2005, 26(4):61-66
The role of palliative chemotherapy in Gallbladder Cancer (GBC) has been studied in multiple phase II trials utilizing various drugs like 5 Flourouracil, Cisplatin, Gemcitabine, etc. as single agents and in combinations. Most trials have combined biliary tract cholangiocarcinomas along with gallbladder adenocarcinomas. The prognosis and response among these two groups varies enough to warrant focused research on GBC. The available data points towards a role of chemotherapy in GBC. Further research is needed to study the impact of chemotherapy in overall survival, and quality of life in inoperable disease; and to define the role of adjuvant chemotherapy in a subset of patients with operable disease. The optimal choice of chemotherapeutic agents, also needs to be defined.
[ABSTRACT]   Full text not available   
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Status epilepticus and hypertension in a child with ganglioneuroblastoma
P Batra, G Subramanium, KY Vilhekar, P Chaturvedi, A Saha
December 2005, 26(4):63-65
Neurogenic tumours (Neuroblastoma, ganglioneuroma and ganglioneuroblastoma) are common among children. We here report a case of three year old female child with ganglioneuroblastoma who presented with status epilepticus at diagnosis. Such a presentation has been decribed rarely. Pertinent literature is being reviewed.
[ABSTRACT]   Full text not available  [PDF]
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Imaging in carcinoma of the gallbladder
R Shankar, Thulkar, H Kandpal, Kumar Santosh
December 2005, 26(4):36-41
Carcinoma of the gallbladder (Ca GB) is, a common malignancy in North India. Most patients have an advanced disease at the first presentation. Imaging plays a pivotal role in selecting the patients for surgical resection and in planning palliative procedures in unresectable patients. Modalities used in evaluation are Ultrasound (USG), Computed tomography (CT), and Magnetic resonance imaging (MRI). In this review, the role of USG, CT and MRI is emphasized upon. The patterns of CA GB, its local and distant spread are discussed. The recent advances in CT and MRI techniques are noted. The criteria for unresectability in a patients with Ca GB elaborated and finally, a brief note is made on the palliative therapies that improve the quality of life in patients with unresectable disease.
[ABSTRACT]   Full text not available   
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Role of FDG PET-CT in gallbladder Cancer
H Dhanapathi, S Amburanjan, Kumar Rakesh
December 2005, 26(4):42-45
Positron Emission Tomography (PET) is a functional diagnostic imaging technique, which can accurately measure in vivo distribution of various radiopharmaceuticals. 18F fluoro-deoxyglucose positron emission tomography computed tomography (FDG PET-CT) imaging is currently being explored in the diagnosis staging, treatment response and follow up of gallbladder cancer. The purpose of this review is to discuss the role of FDG PET-CT in gallbladder cancer.
[ABSTRACT]   Full text not available   
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Role of Laparoscopy in the management of gallbladder cancer
SK Garg, MC Misra
December 2005, 26(4):54-60
Minimal Access approaches have become established in nearly all fields of surgery, gastroenterology and cardiology because of obvious advantages to the patients. The cardinal benefits include-significantly less post-operative pain, reduced requirement of postoperative analgesia, decreased hospitalization and earlier return to normal activities. Following the development of laparoscopy to treat benign surgical diseases, its role has expanded lately for the surgical management of malignancies. The use of laparoscopy in cancer patients is the subject of increasing excitement and controversy. The issues of safety of laparoscopic procedures in cancer patients have been debated and some settled (port site recurrence). Carcinoma of the gallbladder is a highly fatal disease with a overall 5-year survival rate of 5 percent -10 percent. The mainstay of therapy for gallbladder cancer (GBC) is conventional surgery. Incidental GBC has been reported following laparoscopic/open cholecystectomy for benign gallbladder disease. Laparoscopic cholecystectomy may be therapeutic in patients with incidental gallbladder cancer of early stage (T1a). However gallbladder cancer beyond Stage 1a i.e. Ib, II, III and IV all require completion conventional surgery in the form of liver resection of segment IV and V with portal lymphadenectomy. The role of laparoscopy in the management of GBC is largely diagnostic. The diagnostic laparoscopy is being increasingly used in patients with known or highly suspected GBC to assess the resectability, staging and avoiding unnecessary laparotomy in inoperable cases.
[ABSTRACT]   Full text not available   
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Palliative therapy for gallbladder cancer
S Saluja, PK Garg
December 2005, 26(4):74-83
Pain, obstructive jaundice and gastric outlet obstruction are common symptoms of advanced GB cancer. Presently Endoscopic stenting is commonly used for biliary drainage in patients with obstructive jaundice. It has less morbidity and mortality and is cheaper than surgical methods used in the past. For effective relief of pain it is advisable to follow WHO guidelines. Coeliac plexus neurolysis can provide effective palliation in patients who don't get adequate relief with narcotic analgesics. Gastric outlet obstruction in GB cancer is due to direct infiltration of first and second part of duodenum. Such patients can be benefited with gastrojejunostomy or endoscopically placed enteral stents. In this article, we have elaborated all the common procedures done for the palliative treatment of carcinoma gallbladder.
[ABSTRACT]   Full text not available   
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Radiation therapy for the management of gallbladder cancer in India
BK Mohanti
December 2005, 26(4):70-73
Currently there are no standard treatment guidelines for advanced GB cancer. Recent studies suggest that preoperative chemo radiotherapy or post operative radiation therapy may be associated with improved local control and modest survival benefit. More randomized trials can give definite answers to the exact role of pre and postoperative and palliative radiotherapy for this disease.
[ABSTRACT]   Full text not available   
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Continuing challenges in the management of retinoblastoma [editorial]
Kumar Atul
December 2005, 26(4):4-5
Full text not available  [PDF]
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Gallbladder cancer [editorial]
Kumar Lalit, A Sharma, DC Doval
December 2005, 26(4):4-5
Full text not available   
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Letrozole in male breast cancer [letter]
K Pavithran
December 2005, 26(4):73-74
Full text not available  [PDF]
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