Relevance of risk factors of breast cancer in women: An Eastern Indian scenario.

AIMS AND OBJECTIVE: Incidence of breast cancer is on the rise in developed as well as in developing countries. In India it has superseded cervical cancer as the commonest malignancy in women in urban areas. A lot of risk factors have been proposed from time to time that play a causative role in the natural course of this disease. However, they are based on data accumulated from studies conducted mostly in developed countries. Aim of this study was to find out whether these known and/or presumptive breast cancer risk factors hold true for women of developing countries like India also. MATERIALS AND METHODS: From 2008 to 2012; 1,463 breast cancer patients were compared side by side with 1,440 matched controls by predetermined questionnaire and anthropometric variables. Data were analyzed by Statistical Package for Social Sciences (SPSS) V19 software todetermine whether selected risk factors were more common in the patient group than the control group. RESULTS AND ANALYSIS: The risk factors under study were also found to be statistically significant for the study populationexcept duration of breastfeeding and family history of breast and ovarian cancers. CONCLUSION: Risk factors for breast cancer do not differ significantly between developed and developing countries. Hence appropriate time has come for developing countries to incorporate breast cancer risk factors in health education and to consider pharmacological interventions in high risk women.

Acute complications following intracavitary high-dose-rate brachytherapy in uterine cancer.

PURPOSE: Almost 30% of malignancies in women of developing countries are gynecological and brachytherapy is an integral part of management of these patients. Reports of complications (both acute and late) of high-dose-rate (HDR) intracavitary brachytherapy are sparse in world literature due to relatively small number of gynecological malignancies, particularly in advanced stage, in developed countries. High-dose-rate brachytherapy is gaining popularity in developing countries due to scientific and economic reasons. Here we are reporting our experience regarding acute complications of intracavitary brachytherapy (events occurring within 30 days of insertion needing hospitalization or death) and their causes to improve the quality of management, so that the already low incidence of acute complications can be further reduced. MATERIAL AND METHODS: From February 2004 to December 2012, a total of 1947 patients with uterine cancer were treated by HDR intracavitary brachytherapy in the Department of Radiotherapy, of a tertiary cancer centre of a developing country, 86% of them were cervical cancer and 14% endometrial cancer. Excluding the post-operative patients, a total of 4285 insertions were done in 1527 patients with intact uterus (eligible for analysis) and acute complications were analyzed. RESULTS: Out of 4285 intracavitary brachytherapy insertions in gynecological malignancy patients, only 12 mortality and 239 morbidity instances needing hospitalization were documented and most of them were in cervical carcinoma patients. CONCLUSIONS: Our results have indicated that acute complications can be minimized by pre-treatment management of co-morbidities, decreasing the time of operative lithotomy position and bed rest, avoidance of 'conscious sedation' in selected cases etc. Routine post insertion CT scan if done in all patients in all insertions, then only, uterine perforations can be detected early and prompt management can reduce both the mortality and morbidity to a great extent.

Bone metastasis.

Rectal cancers may rarely metastasize in bone and when it occurs, is usually preceded by lung and/or liver metastasis. However, whether it may ever bypasses other organs, particularly lung and liver and metastasizes directly to bone or not, is debatable. Some authors have described the presence of isolated bone metastasis from colo-rectal cancers, whereas others have questioned its' existence in the absence of lung or liver metastasis. A case of isolated bone metastasis from rectal cancer in the absence of lung or liver metastasis is reported here.

Neoodjuvant imatinib mesylate for advanced primary and metastactic/recurrent gastro-intestinal stromal tumour (GIST).

Therapy of gastro-intestinal stromal tumour (GIST) has changed significantly with the use of imatinib mesylate. Disease progression remains a complicated clinical issue, suggesting the need for multimodality management. This is a prospective clinical study evaluating the neoadjuvant use of Imatinib mesylate in primary GIST. There is pre-operative use of imatinib in 10 patients with operable advanced and metastatic GIST. The follow-up continued postoperatively for maximum period of two years and postoperative imatinib was given for two years. Ten patients were accrued in the study. Following imatinib mesylate therapy, the median reduction of tumour volume was 45% (range 20-60%). Six of the ten patients underwent complete resection of the tumour following neoadjuvant imatinib for a median period of three months, and are disease-free for a median follow-up of eleven months (range 6-24 months). Three patients in whom the tumours were deemed to be operable after downsizing and who refused surgery are also continuing imatinib. Imatinib did not produce serious toxicity in any patient.

'Proptosis'--may be the only presenting feature of small cell lung cancer: a case report.

Orbital metastasis from solid tumours is an uncommon entity and lung, breast and nasopharyngeal cancers are the common sites causing such a metastasis. Proptosis as the only presenting feature without any symptom suggesting lung as the primary site is very rare. Here is a report of a patient who presented with proptosis as the only complaint and subsequent investigations proved it to be due to small cell lung cancer metastasis and without metastatic spread to any other site.

Squamous cell carcinoma of lung metastasizinig in breast.

Metastasis in breast from extra-mammary malignancy is rare and lung is the third most common primary site when such a metastasis occurs. Small cell carcinoma and adenocarcinoma are two histological varieties of lung carcinoma that may metastasize to breast and squamous cell type is very rare. Here we report a case of squamous cell carcinoma of lung that metastasized in the breast and mimicked primary breast carcinoma.

Adenoma malignum of the uterine cervix--an enigma.

Adenoma malignum is a rare variant of cervical adenocarcinoma which presents a great diagnostic and therapeutic challenge to an oncologist. A 31-year-old woman presented with a mass filling up whole of the vagina which showed no evidence of malignancy by scraping cytology or punch biopsy. But histological examination of the resected mass turned up to be adenoma malignum of the cervix. The patient was subsequently treated by Wertheim's hysterectomy and radiotherapy.

Colorectal carcinoma in a ten-year-old girl: a case report.

Colorectal carcinoma is very rare in childhood. In this case report, we depict a ten-year-old girl who presented with features of intestinal obstruction which turned out to be due to poorly differentiated mucin secreting adenocarcinoma of descending colon. Only increased awareness of this malignancy in this age-group and a high index of suspicion can help when a child complains of persistent pain of abdomen, altered bowel habits or rectal bleeding, and may provide diagnosis at an earlier stage, thereby improving the prognosis.

Diagnostic enigma in retroperitoneal paraganglioma--a case report.

Paragangliomas and pleomorphic undifferentiated sarcoma/malignant fibrous histiocytomas are examples of uncommon tumours in retroperitoneum. Where malignant fibrous histiocytoma is to be treated aggressively to save the life, long-term follow-up after surgery is the basic management for paraganglioma. Hence an inappropriate diagnosis of malignant fibrous histiocytoma in place of a paraganglioma which in most cases behave as benign tumour, can lead to a significant complication related to postoperative therapy. Here in this case a patient of retroperitoneal tumour having discrepancies between pre-operative cytological and postoperative histopathological diagnosis is reported. After careful review of clinical, radiological and histopathological features, the appropriate diagnosis of paraganglioma was rendered and the patient was kept for long-term close follow-up instead of aggressive therapy. The appropriate clinicopathologic correlation of the case by a group of experienced oncologists and pathologists revealed the diagnostic enigma and offered the appropriate management which may otherwise lead to iatrogenic complications.

Primary fallopian tube carcinoma with metastasis in the contralateral ovary.

Primary malignant neoplasm of the fallopian tube is one of the rarest gynaecological malignancies and a pre-operative diagnosis is often missed due to its diagnostic confusion with the tubo-ovarian mass, hydrosalpinx, ectopic pregnancy and ovarian malignancy. Transcoelomic, lymphatic, transluminal and haematogenous spread may occur to the other abdominal and pelvic organs as well as to the distant sites. Though the body of the uterus, ovaries and the contralateral fallopian tube are frequently involved, in the present case the contralateral ovary was the only site of involvement which is very unusual.

Treatment of cervical carcinoma with high-dose rate intracavitary brachytherapy: two years follow-up study.

AIMS: This study focused on pelvic recurrence rate and late complications following treatment with high dose rate brachytherapy with a three fractionation scheme. SETTING AND DESIGN: This retrospective observational study was conducted from 1st November 2003 to 31st March 2005 at a tertiary care centre. METHODS AND MATERIALS: Women were treated with external beam radiotherapy and three fractions of high dose rate brachytherapy, divided into two broad groups IIB+ IIIA and IIIB+IVA. Duration of follow-up was 2 years and main outcome measures were recurrence and rectal and urinary bladder complications. Results were assessed with the Chi square test and P-values using an alpha level of 0.05 for Type I error. RESULTS: Of the total of 286 women, 72 (25.4%) developed central-regional recurrence. Overall two year pelvic control rate was 74.6%, with values of 78.1% and 72.8% for stages IIB+ IIIA, IIIB+IVA, respectively. Five women developed distant metastasis and 21.5% suffered low grade rectal complications. After two years the prevalence of bladder complications was only 5.4%. CONCLUSION: Using a three fraction scheme, high dose rate brachytherapy is safe and effective in the management of cervix cancer.

Plesiotherapy for non-melanoma skin cancer: innovating to overcome!

BACKGROUND: The non-surgical management of non-melanoma skin cancers is an area requiring clinical investigation. Radiotherapy has a role in treatment for a defined subset of patients. AIMS: The application of radiotherapy is subject to availability of proper equipment, non-availability of which precludes appropriate radiotherapy in most centers in third world countries. MATERIALS AND METHODS: The introduction of innovations is needed to circumvent this. Plesiotherapy is such a mode of therapy for non-melanoma skin cancer. METHODS: The introduction of innovations is needed to circumvent this. Plesiotherapy is such a mode of therapy for non-melanoma skin cancer. RESULTS: In this paper we present successful management of a cohort of non-melanoma skin cancer patients with plesiotherapy using stepping source(192) Ir HDR source. CONCLUSIONS: Plesiothrapy is an effective mode of therapy for non-melanoma skin cancer.

Neo-adjuvant chemotherapy with cisplatin and short infusional 5-FU in advanced head and neck malignancies.

BACKGROUND: Combination of radical surgery and radiotherapy is the standard management of head and neck malignancies. But due to considerable morbidity of surgery and associated cosmetic and functional deficiencies, often aggravated by adjuvant radiotherapy, many patients prefer only radiotherapy with its' decreased chance of survival. Proper surgical facilities are also not accessible to most of our patients. Neo-adjuvant chemotherapy and loco-regional management by surgery and / or radiotherapy have emerged as a viable alternative. AIMS: The purpose of this study is to find out the survival outcome as well as toxicity profile of Neo-adjuvant chemotherapy with cisplatin and short infusional (3 hours) 5-FU followed by radiotherapy in advanced head and neck malignancies. MATERIALS AND METHODS: From June 2002 to December 2003, seventy four patients with advanced head and neck malignancies were planned to be treated with Cisplatin (50 mg / sq. meter) on Days 1 and 2 and 5 - FU (600 mg / sq. meter) on Days 1, 2 and 3 by 3 hour infusion on Day care basis. On completion of four cycles of chemotherapy at 21 days interval, all patients were destined to receive 6000 cGy of radiotherapy to the loco - regional site. RESULTS: At one year follow up on completion of therapy, 57% patients were alive and 31% patients were disease free. These 31% patients enjoyed a good quality of life in terms of cosmetic and functional deficits. Toxicities were moderate and easily manageable. CONCLUSION: The study indicated that neo-adjuvant chemotherapy with Cisplatin and short infusional 5 - FU may be delivered on day care basis and results are comparable with Cisplatin and 96 hours continuous infusional 5 - FU. Thus avoiding the continuous infusional 5 - FU, 7 to 10 days in-patient hospitalization during each cycle may be avoided which is a constrain in developing countries like us.

Iatrogenc hypothyroidism: a consequence of external beam radiotherapy to the head & neck malignancies.

BACKGROUND: Hypothyroidism is a known consequence of external beam radiotherapy to the neck encompassing part or whole of the thyroid gland for over 40 years. Still thyroid function tests are not a part of routine follow up of head - neck cancer patients treated with radiotherapy with or without surgery and / or chemotherapy. AIM: Aim of this study was to find out the incidence of hypothyroidism in head - neck cancer patients treated with radiotherapy with or without chemotherapy where radiation portals included most or whole of the thyroid gland. MATERIALS AND METHODS: From September 2001 to November 2003, 187 patients with head-neck malignancies were treated with external beam radiotherapy whose radiation portals included part or whole of the thyroid gland with / without chemotherapy. Thyroid function tests were done at the beginning of treatment, at six weeks after completion of radiotherapy and thereafter at six weeks interval for two years. RESULTS: Out of 187 patients, five were excluded from the study as they were found to be hypothyroid before the initiation of treatment. Another four were excluded from result analysis because they underwent laryngectomy for uncontrolled disease. Of the patients attending the follow up clinic, 17.8 % and 21.8 % were found to have clinical and sub-clinical hypothyroidism at two year. CONCLUSION: As a significant number of patients develop hypothyroidism following radiotherapy to the neck, thyroid function tests should be included in the routine follow up protocol of such patients. But certain questions have emerged from this study which need a large randomized study to find out the answers.