Journal of cancer & allied specialties最新文献

Introduction: Hamartomas are benign masses seen in different organs including breasts. These are well-defined masses with a pseudocapsule and variable tissues from the surrounding organ.It is an uncommonly reported benign breast lesion, the cause and pathogenesis of its development is still not fully understood. The tumour exhibits a female predominance with a mean age of 45.

Case description: We present two cases of breast hamartoma in 51 and 61 years old female who presented to us through screening and symptomatic clinics.Both cases had imaging findings typical for diagnosis of hamartoma however there was a distortion within the hamartoma which raised possibility of malignancy and prompted a core biopsy and MDT discussion.

Practical implication: Many hamartomas have typical benign imaging appearances and require no further investigation. Biopsy is needed in atypical looking hamartomas to exclude a breast carcinoma, which although rare may develop within a hamartoma. Multidisciplinary team discussion is crucial in the management of atypical cases to ensure radiological-pathological concordance.

Introduction: Between 2020 and 2022, Pakistan's population reached 235.7 million, with an average of 120.6 million men and 115.1 million women each year. Balochistan is in the southwest of Pakistan and is the fourth most populous region in the country, with an average annual population estimated at 13.9 m. There were 6.8 m (48.7%) children, 1.4 m (10.3%) adolescents, and 5.7 m (40.9%) adults over 2020-2022. The male population (7.4 m (52.6%)) was higher than the female population (6.6 m (47.4%)).

Materials and methods: We conducted a study from 2020 to 2022, retrospectively evaluating the distribution of cancer in Balochistan on data reported by the collaborating centers, namely, the Pakistan Atomic Energy Commission, Shaukat Khanum Memorial Cancer Hospital and Research Center, and Chughtai Lab. We computed the proportional distributions of the commonly diagnosed cancers by age category.

Results: We recorded 6,492 malignancies from Balochistan over three years from 2020 to 2022. In children (n=214 (3.3%)), 20.1% were Hodgkin lymphomas; in adolescents (n=214 (3.3%)), 19.6% were non-Hodgkin lymphomas (NHL); and in adults (n=6,064 (93.4%)), 17.5% were tumors of the breast.

Conclusion: This is the first report on regional cancer registration in the country's neglected province of Balochistan. It shows that cancer counts were low from 2020 to 2022. However, we can use the information recorded as the foundation to evaluate the statistics over time to see if any changes are recorded. We also need to increase awareness among the stakeholders about the impact of cancer surveillance in the region.

Introduction: Acute Myeloid Leukemia (AML) has a peak incidence in elderly patients with the median age of onset being 68 years. Owing to the advanced age and multiple comorbidities, such patients are not candidates for the standard chemotherapeutic protocols. Here we discuss the treatment strategies employed for newly diagnosed elderly patients with AML at our institution and their associated outcomes.

Materials and methods: We conducted a single institutional retrospective review of cases which included elderly patients aged ≥ 50 years diagnosed with AML and treated with venetolcax in combination with azacitidine. Data relating to patients' characteristics, cytogenetics, molecular aberrations and vital status were extracted. We evaluated the overall survival (OS) as our primary outcome of interest.

Results: This study involved 58 patients with confirmed AML, with a median age of 61.5 years. The majority of patients were male (77.6%). Most patients (75.9%) died, while 15.5% were still under treatment at the end of the study period. The median OS was 7.0 months. There was no significant difference in survival based on comorbid conditions (p = 0.586). However, survival differed by gender, with a median OS of 6 months for males and 16 months for females (p = 0.021). The number of chemotherapy cycles significantly impacted survival, with increased cycles associated with a reduced hazard of death (HR = 0.74, p < 0.01).

Conclusion: Our findings contribute to the growing evidence that venetoclax combined with azacitidine is an effective treatment option for elderly patients with AML who are not eligible for intensive treatment.

Background: EAU guidelines advise patients with intermediate risk Gleason 4+3=7 prostate cancer undergo cross-sectional abdominopelvic imaging and bone scan for metastatic screening. We hypothesised detection rate of extra-prostatic disease in this cohort is low using conventional CT/bone scans and could potentially be avoided.

Materials and methods: Patients with overall Gleason 4+3 histology were identified over 69 months at East Kent University Hospitals NHS Trust. Patients were excluded if PSA >20ng/mL and/or MRI prostate >T3b stage. Primary outcomes were: (a) detection rates of metastatic disease using conventional CT and bone scan and b) the proportion of fully-staged patients with positive lymph nodes at dissection or biochemical recurrence following robotic-assisted laparoscopic prostatectomy (RALP).

Results: A total of 134 patients were identified. Median age was 72 (range 45-83), PSA 7.8ng/mL (range 1.8-19.3) and prostate volume 40cc (range 10-129). 130/134(97%) had MRI scans prior to staging. 124/134(93%) had bone scans and 83/134(62%) had CT scans, of which 77/134(57%) had both. 0/124(0%) bone scans identified metastatic disease and only 2/83(2%) CT scans identified nodal disease not detected by MRI. 0/134(0%) had management changes from staging. 57/134(43%) patients negatively-staged proceeded to RALP. 19/57(32%) had lymph node dissections. 6(11%) had missed metastatic disease at 19 months median follow-up.

Conclusion: Detection of metastatic disease by conventional CT and bone scan was poor in this cohort, despite their presence, and their recommendation by EAU seems unwarranted. Patients could safely avoid these scans and proceed directly to radical treatment, due to the theoretical benefit of treating despite oligometastatic disease.

Introduction: Breast cancer is a major global health concern among all malignancies, with HER2-positive breast cancer representing a particularly aggressive subtype. It affects approximately 20% of patients and is associated with a high risk of relapse. The management of HER2-positive breast cancer has been significantly improved by targeted therapies, though challenges remain, especially in resource-limited settings. Invasive fungal infections are also common and can manifest as metastatic lesions in immunocompromised cancer patients undergoing intensive treatments making the diagnosis challenging for the oncologists.

Case description: We report a case of a 39-year-old premenopausal female with relapsed HER2-positive breast cancer complicated by an invasive fungal infection. The patient initially presented with a 5 × 5 cm right breast lump, which was diagnosed as invasive ductal carcinoma, HER2-positive estrogen and progesterone receptor negative. Despite receiving chemotherapy with doxorubicin, cyclophosphamide, paclitaxel in the neoadjuvant setting and breast conservation surgery, the patient experienced disease recurrence. She was then treated with modified radical mastectomy followed by adjuvant chemotherapy TCH (trastuzumab, carboplatin, and docetaxel) six cycles. After three cycles, she developed high-grade fevers, renal impairment, and altered mental status. Imaging initially suggested ongoing infective vs metastatic process in bilateral renal and CNS parenchyma, so biopsy was performed from brain that revealed Aspergillus flavus infection. Treatment was adjusted to include antifungal therapy with voriconazole, and the patient's condition improved.

Practical implications: This case underscores the critical need for biopsy of new or evolving lesions in cancer patients, particularly when imaging is not convincing enough for a relapse. Accurate diagnosis is essential to differentiate between disease progression and complications such as opportunistic infections. The occurrence of a fungal brain abscess in this patient highlights the importance of considering such invasive opportunistic infections in immunocompromised individuals, especially those undergoing intensive chemotherapy. Furthermore, the challenges faced due to the unavailability of targeted therapies in resource-limited settings emphasize the need for better access to advanced treatments and comprehensive management strategies. This case also calls for heightened vigilance and prompt diagnostic evaluation to address both cancer progression and potential opportunistic infections effectively.

Introduction: Cancer treatment can impose a significant financial burden on patients, impacting their quality of life. The COST-FACIT tool is commonly used to assess financial toxicity (FT) in cancer patients. This study aimed to translate and validate an Urdu version of the COST-FACIT tool in Pakistan.

Materials and methods: A cross-sectional validation study was conducted at four tertiary care hospitals in Karachi, Pakistan, from October to December 2023. We translated and back-translated the 12-item COST-FACIT tool and validated it in accordance with FACIT guidelines. The study included 10 native Urdu-speaking cancer patients as recommended in the guidelines. The analysis included descriptive statistics, content validity indices, and assessment of internal consistency using Cronbach's alpha, analyzed with Stata MP v.14 software.

Results: The study population included 6 females (60%) and 4 males (40%), with most participants aged between 40 and 60 years (4 patients, 40%). The mean FACIT COST score was 16.3 (SD = 11.255, range 4-40), with 6 (60%) patients experiencing moderate (Grade 2) financial toxicity. Internal consistency was good, with a Cronbach's alpha of 0.90, and content validity indices indicated items were relevant and clear (average expert CVI = 0.82 for relevance, 0.90 for clarity).

Conclusion: We have translated and validated an Urdu version of the COST-FACIT tool. It is a valid and reliable instrument to assess financial toxicity experienced by cancer patients in Pakistan.

Introduction: RAD51D has been reported as a breast cancer (BC) and ovarian cancer (OC) predisposition gene, particularly among Caucasian populations. We studied the prevalence of RAD51D variants in Pakistani BC/OC patients.

Materials and methods: In total, 371 young or familial BC/OC patients were thoroughly analyzed for RAD51D sequence variants using denaturing high-performance liquid chromatography pursued by DNA sequencing of differentially eluted amplicons. We also assessed the pathogenic effects of novel variants using in-silico algorithms. All detected RAD51D variants were investigated in 400 unaffected controls.

Results: No pathogenic RAD51D variant was detected. However, we identified nine unique heterozygous variants. Of these, two missense variants (p.Pro10Leu and p.Ile311Asn) and one intronic variant (c.481-26_23delGTTC) were classified as in silico-predicted variants of uncertain significance, with a frequency of 0.8% (3/371). The p.Pro10Leu variant was detected in a 28-year-old female BC patient of Punjabi ethnic background, whose mother and maternal cousin had BCs at ages 53 and 40, respectively. This variant was also detected in 1/400 (0.25%) healthy controls, where the control subject's daughter had acute lymphoblastic leukemia. The p.Ile311Asn variant was identified in a female BC patient at age 29 of Punjabi ethnicity and in 1/400 (0.25%) healthy controls, where the control subject's daughter had Hodgkin's disease at age 14. A novel intronic variant, c.481-26_-23delGTTC, was found in a 30-year-old Punjabi female BC patient but not in 400 healthy controls.

Conclusion: No pathogenic RAD51D variant was identified in the current study. Our study data suggested a negligible association of RAD51D variants with BC/OC risk in Pakistani women.

Introduction: Undifferentiated embryonal sarcoma of the liver (UESL) is an aggressive tumor. There is no established treatment, and it is an uncommon tumor in adults. Treatment usually involves a combination of surgery, chemotherapy, and occasionally liver transplantation (LT). The role of LT in patients with irresectable UESL merits exploration.

Case description: A 20-year-old boy with a large palpable abdominal mass, shortness of breath, and weight loss presented to our clinic. His computed tomography scan showed showed a large cystic lesion measuring 11.5 × 22.7 × 23 cm, predominantly involving the left lobe and right anterior sector, with a biopsy consistent with UESL. The tumor was abutting to the right hepatic vein, with bland main portal vein thrombosis. Due to an irresectable tumor and deteriorating clinical condition, living donor LT was performed. The patient remains in good health at 16 months of follow-up.

Practical implication: In carefully selected patients with UESL, when other options are not feasible, LT might prolong survival and improve quality of life.

Introduction: Malignancy-related hypercalcemia is commonly observed in patients with advanced stages of cancer. It is intricately linked with an unfavorable prognosis among oncology patients. This study aimed to evaluate survival outcomes among individuals diagnosed with hypercalcemia associated with malignancy.

Materials and methods: This retrospective analysis of 173 cancer patients with hypercalcemia who sought treatment at Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, Pakistan, between July 2019 and June 2020. This cohort of patients underwent a longitudinal follow-up for 2.5 years. To assess survival outcomes, the Kaplan-Meier tool was used to construct survival curves and estimate the survival probability over time. The significance of potential survival factors was evaluated using the log-rank test.

Results: All patients exhibited elevated levels of calcium. At admission, the cohort demonstrated varying degrees of hypercalcemia severity attributable to malignancy: Mild hypercalcemia was observed in approximately 61.3% of patients, moderate hypercalcemia in 23.7%, and severe hypercalcemia in 15% of cases. Among the total sample, most patients were female (54.9%), with a median age of 54. The primary tumor site most frequently observed was in cases of breast cancer (35.3%), wherein the prevalent histological subtype was lobular/ductal invasive carcinoma (34.1%). Most of the patients (93.6%) had an Eastern Cooperative Oncology Group (ECOG) performance status (ECOG) >1. In addition, the median overall survival for patients diagnosed with hypercalcemia was 51 days. Notably, there was a significant association between survival factors, including the primary site of malignancy (P = 0.001), bone metastasis (P = 0.04), severity and symptoms of hypercalcemia (P = 0.001), altered mental state (P = 0.001), albumin levels (P = 0.001), and ECOG (P = 0.001).

Conclusion: Malignancy-related hypercalcemia in patients with cancer is a significant predictor of an unfavorable prognosis. The aforementioned survival factors may have the potential to influence patient survival outcomes. Further studies on larger cohorts are warranted.

Introduction: This systematic review investigated strategies to mitigate cardiotoxicity induced by anticancer medications, emphasizing exercise and pharmacological interventions.

Methods: We systematically reviewed three randomized controlled trials, one ATOPE trial, and one retrospective cohort study.

Results: Among 448 patients, exercise interventions, particularly in breast cancer patients, demonstrated significant improvements in left ventricular ejection fraction (LVEF) and cardiotoxicity prevention. Pharmacological interventions, including candesartan and carvedilol, have shown potential in reducing early DOX-induced subclinical cardiotoxicity (DISC). The protective efficacy of candesartan in alleviating DISC was greater than carvedilol and the control group. Combination therapy with lisinopril and bisoprolol effectively preserved the LVEF. A retrospective cohort study demonstrated the cardioprotective potential of sodium-glucose cotransporter-2 inhibitors in reducing cardiovascular events.

Conclusion: This systematic review underscores the promise of exercise and pharmacological interventions for preserving cardiac function in cancer patients receiving chemotherapy. These findings have significant implications for enhancing the quality of care for cancer patients.