Fir Afroz

A survey of risk factors in carcinoma esophagus in the valley of Kashmir, Northern India.

BACKGROUND/OBJECTIVE Esophageal cancer has a peculiar geographical distribution and shows marked differences in incidence within a particular geographical region. Presently, as there seems little prospect of early detection of this cancer, an understanding of the etiological factors may suggest opportunities for its primary prevention. In this paper, we have tried to determine the role of diet and other life-style related factors in the etiology of cancer of esophagus. MATERIAL AND METHODS A total of 100 confirmed squamous cell carcinoma of esophagus patients were enrolled for the study (Group A). 100 healthy subjects were included as controls (Group B). A predesigned questionnaire dealing with the basic patient data, dietary and smoking habits etc. was distributed among the cases in both groups. The data was thoroughly analyzed to define an association with the development of cancer of esophagus. RESULTS Group A patients included 71 males and 29 females in the age range of 40-70 years. Majority 37% were farmers, 29% house wives. Of the 72% smokers, 66% smoked hookah. 29% had positive family history. More than 90% took salt-tea at breakfast. Meat consumption was low, 44% took it weekly and 42% on monthly basis. 69% took fish yearly. Group B included 75 males and 25 females of which 35.7% were hookah smokers. CONCLUSION Poor socio-economic status resulting in fewer intakes of fresh fruits, vegetables and fish in addition to heavy hookah smoking are suspected to be the major risk factors for the development of esophageal cancer.

Cancer in Kashmir, India: burden and pattern of disease.

BACKGROUND Incidence and prevalence of cancers differ in different regions of the world. To study the profile of different cancers in a particular cancer belt helps to know the exact incidence of different cancers in that region and their likely etiology. The aim of this study was to analyze the incidence of different cancers in Kashmir valley. MATERIALS AND METHODS Retrospective study of patients registered at our Regional Cancer Centre (RCC) from Jan. 2009 to Dec. 2011 was carried out. All patients were histologically proven malignancies and were referred to the RCC for proper staging and treatment. All patients were properly evaluated and treated. RESULTS A total of 8648 patients were registered during this period. Esophageal cancer was the most common cancer followed by cancers of Lung, Stomach, Colorectal, Breast, Non-Hodgkins Lymphoma, Gastro esophageal junction, Ovary, Skin, Gallbladder, Multiple Myeloma, Acute Lymphoid Leukemia, Urinary Bladder, Prostate and Hodgkins lymphoma. CONCLUSION Pattern of malignancies in valley is different from rest of the India. Gastrointestinal malignancies are the commonest malignancies in Kashmir valley followed by lung cancer in males and breast cancer in females.

Hypofractionated radiotherapy as local hemostatic agent in advanced cancer

Purpose: Tumor bleeding continues to remain a challenge in an oncological setting, and radiotherapy has been studied as a local hemostatic agent. We studied the role of local radiotherapy in controlling bleeding at our center. Materials and Methods: We reviewed 25 treated cases (cancer urinary bladder: 12, lung cancer: 5, cervical cancer: 4, uterine cancer: 1, rectal cancer: 2, schwanoma: 1) at our center from March 2008 to December 2010. All patients had either an advanced or recurrent disease. Radiotherapy schedule was either 20 Gray in 5 fractions or 15 Gray in 5 fractions and was delivered with Cobalt 60. Results and Conclusion: Of 25 patients, 22 (88%) responded, and there was complete cessation of bleeding. Both 15 Gray and 20 Gray dose schedule had equal efficacy. Treatment was well tolerated without any intermission. Radiotherapy is a safe and effective option in controlling tumor bleeding.

Clinicoepidemiological analysis of female breast cancer patients in Kashmir

AIM The aim of this study was to analyze the demographic features, reproductive history and stage at disease presentation among the female breast cancer patients. DESIGN AND SETTING The present prospective hospital-based study was conducted in Department of Radiation Oncology, University Teaching and Tertiary Referral Hospital. MATERIALS AND METHODS After approval from the Institutes ethical committee, 132 female breast cancer patients surgically treated either by mastectomy or breast conserving surgery (BCS) and then referred to the department of radiation oncology for further management and/or follow-up as per the hospital protocol, were enrolled in the study (January 2010 to December 2011) after obtaining a written informed consent from the patients. The patients were diagnosed by histology [fine needle aspiration cytology (FNAC), true cut or excision biopsy], mammography and ultrasonography (USG). The patients were analyzed as per the demographic and reproductive history and the stage of disease at presentation. The data collected were expressed as percentage (%), mean, median and standard deviation (SD). RESULTS The mean age at presentation was 46.6 ± 10.2 years. The majority of patients were from rural areas, married, multiparous and post-menopausal. The commonest stage at disease presentation was IIb. CONCLUSION In comparison to the rest of Indian scenario, more awareness related to breast cancer among post-menopausal and the rural females is needed. The role of peri-menopausal status, which represent 10% (n = 14) patients needs to be established in relation to breast cancer.

Incidence of primary hypothyroidism in patients exposed to therapeutic external beam radiation, where radiation portals include a part or whole of the thyroid gland

Introduction: Hypothyroidism is a known consequence of external-beam radiotherapy to the neck encompassing a part or whole of the thyroid gland. In this non-randomized prospective study, we have tried to evaluate the response of the thyroid gland to radiation by assessing thyroid function before irradiation and at regular intervals after irradiation. Aims and Objectives: The aim of this study were to assess in the cancer patients, who were exposed to the therapeutic external beam radiation, where radiation portals include a part or whole of the thyroid gland: the incidence of primary hypothyroidism, the time required to become hypothyroid, any relation between the total dose for the development of hypothyroidism, and whether there are any patient or treatment-related factors that are predictive for the development of hypothyroidism, including the use of concurrent chemotherapy. Materials and Methods: This non-randomized, prospective study was conducted for a period of 2 years in which thyroid function was assessed in 59 patients (cases) of head and neck cancer, breast cancer, lymphoma patients and other malignancies, who had received radiotherapy to the neck region. 59 euthyroid healthy patients (controls) were also taken, who had not received the neck irradiation. These patients/controls were assessed periodically for 2 years. Results: The incidence of hypothyroidism after external beam radiation therapy (EBRT) to neck where radiation portals include part or whole of the thyroid gland was 16.94%, seven cases had subclinical hypothyroidism (11.86%) and three cases had clinical hypothyroidism (5.08%). Mean time for development of hypothyroidism was 4.5 months. There was no effect of age, gender, primary tumor site, radiation dose and chemotherapy, whether neoadjuvant or concurrent with the development of hypothyroidism. Conclusion: In summary, we found that thyroid dysfunction is a prevalent, yet easily treatable source of morbidity in patients undergoing radiation therapy to neck where radiation portals include a part or whole of the thyroid gland.

Breast specific functional and symptom analysis in female breast cancer survivors

Context: The disease and surgery of the breast not only evoke a fear of mutilation and loss of feminity but is also responsible for psychosocial, behavioral, and sexual problems. Aim: To analyze prospectively the time trends in “breast specific functional and symptom scale scores in female breast cancer survivors.” Settings and Design: The prospective study was conducted in the Department of Radiation Oncology at Tertiary Referral Hospital. Materials and Methods: A total of 154 operated (mastectomy) female breast cancer patients who were referred to the Department of Radiation Oncology for chemoradiation ± target therapy (trastuzumab) ± hormonal therapy (tamoxifen) were included in the study. Seven patients were excluded from the final analysis due to their refusal to consent. The patients were assessed by using European Organization for Research and Treatment of Cancer Quality of Life-BR23 questionnaire module (which incorporates five multi-item and three single items scales) at 1st visit (0 month), 6, 12, and 24 months interval, respectively. Results: The symptom scores and future perspectives scale showed improvement with time, but body image and sexual functioning and enjoyment scales showed the deteriorating trend. P < 0.05 was considered as significant. Conclusion: The female breast cancer survivors failed to improve their body image, sexual functioning, and sexual enjoyment scales but did well in other BR23 scales. Besides the family and spousal/marital support these patients got closer to their religion which has been seen to influence their psychosocial well-being optimistically and need further studies to establish the role of religious practices/beliefs.

Profile of malignant spinal cord compression: One year study at regional cancer center

Background and Objectives: Malignant spinal cord compression is an oncologic emergency, unless diagnosed early and treated appropriately, can lead to permanent neurological impairment and compromised quality of life of patients. We analyzed the epidemiology and the effect of common interventions on the outcome in these patients. Patients and Methods: We conducted a prospective study of 77 patients in the year 2014 and recorded relevant patient and disease characteristics. All patients received corticosteroids. Eight patients were operated upon, and radiotherapy was delivered in 62 patients. Results: Most of the patients were in the age group of 41–60 years and there was no gender preponderance in patients. Female breast cancer was the most common incident (15.5%) malignancy followed by multiple myeloma, lung, and prostatic carcinoma. Lower dorsal spine was the most common site of compression (35%) followed by lumbar (31%) and mid-dorsal (26%) spine. 70 (91%) patients had cord compression subsequent to bone metastasis while as other patients had leptomeningeal metastasis. In 31 (40%) patients, spinal cord compression was the presenting symptom. Overall, only 26 patients had motor improvement after treatment. Conclusion: Grade of power before treatment was predictive of response to treatment and overall outcome of motor or sensory functions. Neurodeficit of more than 10 days duration was associated with poor outcome in neurological function.

Renal cell carcinoma presenting as recurrence in vastus intermedius after 22 years of long-term disease free survival: A rare metastatic presentation

Renal cell carcinoma (RCC) has widespread and unpredictable metastatic potential, even when the curative nephrectomy is performed. RCC can metastasize via venous and lymphatic routes virtually to any site but commonly metastasizes to lungs, lymph nodes, bones, liver, and brain. Muscular metastases are rare from RCC. After 22 years of curative radical nephrectomy and disease-free follow-up, the patient presented with discomfort on walking and climbing upstairs and also complained of thigh swelling confirmed on clinical examination. Noncontrast computed tomography showed mass lesion in quadriceps muscle (vastus intermedius), fine needle aspiration cytology revealed metastatic deposits of RCC. Rest of the metastatic evaluation was normal. In long-term survivors of RCC, skeletal muscle survey (SMS) should be included in addition to metastatic evaluation for other sites, as the current case is an eye opener for the inclusion of SMS in the metastatic evaluation of such patients.

Comparative evaluation of gemcitabine concurrent with radiotherapy against cisplatin concurrent with radiotherapy in locally advanced squamous cell carcinoma of esophagus

Background: Several trials using sequential and concurrent chemoradiation have established the role of concurrent chemoradiation in treatment of locally advanced esophageal carcinoma with encouraging but unsatisfactory results. We investigated the efficacy and toxicity of gemcitabine concurrent with radiotherapy against cisplatin concurrent with radiotherapy in locally advanced unresectable squamous cell carcinoma of the esophagus. Materials and Methods: Eighty patients were randomly allocated to two arms during the study. Arm 1 received cisplatin 40 mg/m2 weekly concurrent with external beam radiotherapy to a total dose of 65 Gy while Arm 2 received gemcitabine 200 mg/m2 weekly concurrent with external beam radiotherapy up to a total dose of 65 Gy. Results: Median follow-up was 11 months and 14.5 months in Arm 1 and Arm 2, respectively. Complete response was achieved in 20% of patients in Arm 1 and 32.5% of patients in Arm 2, with manageable acute toxicities in both arms. The progression-free survival in Arm 1 was 5.7 ± 4.7 months and 12.4 ± 6.8 months in Arm 2. The 2-year overall survival was longer in Arm 2. Conclusion: This study demonstrated that both cisplatin and gemcitabine concurrent with radiotherapy in locally advanced squamous cell carcinoma of the esophagus is safe and feasible with better response and progression-free survival with gemcitabine.

Male breast cancer: A 10-year experience of a tertiary care center in North India

Background: Male breast cancer (MBC) is a rare disease and accounts for ∼1% of all cancers in men. Poor level of awareness often results in late presentation and delayed diagnosis. An increased incidence is seen in recent years. However, Indian literature is scant and we hereby present our data analyzed from a tertiary care center in North India. Aim: This study was done to analyze the demographic data, tumor characteristics, and management of MBC in Indian subset of patients and compare it with the literature available. Study and Design: This was a retrospective study from a tertiary care center. Materials and Methods: Data were collected from review of records of all male patients of carcinoma breast over a period of 10 years, i.e., from January 2005 to December 2015, who followed at our Institute. Results: During the study period, 53 cases of MBC were encountered; with ages of patients ranged from 35 to 80 years and a mean age of 60 years. As risk factor; 17 (32%) patients had sedentary life, six (11.3%) patients were obese, and four (7.5%) patients had positive family history. Breast lump was most common presenting symptoms seen in 39 (73.6%) patients. Within each breast, tumor was localized most commonly in central region (43.3%), followed by upper outer quadrant (32%). Stage I, II, III, and IV disease were encountered in 7.5%, 28.2%, 52.7%, and 11.3% of patients, respectively. Follow-up ranged from 1 to 144 months, with a median of 24 months. Conclusion: Male breast carcinoma is a disease of elderly people. Most of the patients presented late and in advanced stage of disease. Bone is the most common site of metastases.