Journal of cancer & allied specialties最新文献

Introduction: An abdominal binder is an elastic or non-elastic belt applied to the abdomen in post-operative patients with abdominal surgery. These provide support and splintage to the operative wound, reducing incision site pain. The present work aims to investigate the institutional practices regarding the use of abdominal binders, gain insight into the expected benefits that these practices are targeted to achieve, and determine if current practices are in accordance with the available evidence.

Materials and methods: It is a survey-based questionnaire study conducted at the Department of Surgical Oncology at Shaukat Khanum Memorial Cancer Hospital and Research Centre. Respondents were inquired about designation, frequency of binder usage, reasons for prescribing/not prescribing binders, duration of the prescription, clinical factors that influence the decision to use binders and the estimated cost of the device.

Results: The questionnaire was emailed to 85 surgeons working in the department of surgical oncology. Out of these, 34 responded, resulting in an overall response rate of 40%. Twenty-two (64.7%) of the respondents used abdominal binders regularly in post-operative patients. Eight (22.5%) reported using it occasionally, while 4 (11.7%) did not use abdominal binders in their clinical practice. About 67.8% and 50% of the respondents believed that it helped early mobilisation and better pain control, respectively. About 60.7% of the respondents believed that binders prevent incisional hernia formation, while 46.4% were of the view that these prevented wound dehiscence. Up to 60% of the respondents reported using an abdominal binder for 1 week-1 month after discharge, whereas 23.3% preferred using it only till discharge.

Conclusion: This survey demonstrates a gap between the evidence and actual practice. These gaps are often overlooked because of busy clinical practice. Equally important is the issue of surgical conservatism and the intrinsic desire to resist change by continuing old practices.

Introduction: The esophageal squamous papilloma (ESP) is a rare cause of dysphagia and hematemesis. The malignant potential of this lesion is uncertain; however, the malignant transformation and concurrent malignancies have been reported in the literature.

Case description: We report a case of esophageal squamous papilloma in a 43 years old female who had a background diagnosis of metastatic breast cancer and liposarcoma of the left knee. She presented with dysphagia. Upper gastrointestinal (GI) endoscopy showed a polypoid growth, and its biopsy confirmed the diagnosis. Meanwhile, she presented again with hematemesis. A repeat endoscopy showed that the previously seen lesion had likely broken off, leaving behind a residual stalk. This was snared and removed. The patient remained asymptomatic, and a follow-up upper GI endoscopy at six months did not show any recurrence.

Practical implications: To the best of our knowledge, this is the first case of ESP in a patient with two concurrent malignancies. Moreover, the diagnosis of ESP should also be considered when presenting with dysphagia or hematemesis.

Introduction: The impact of age on the prognosis of patients with gastric cancer is controversial. This study aimed to investigate the clinicopathologic features and prognosis of elderly advanced gastric cancer patients without serosal invasion compared to their younger counterparts.

Materials and methods: We retrospectively evaluated 43 elderly patients with advanced gastric cancer without serosal invasion. The clinicopathologic findings were compared between the elderly (age >70 years) and young (age <36 years) patients.

Results: Significantly higher numbers of elderly patients had tumours with differentiated histology, whereas more young patients had tumours with undifferentiated histology (P < 0.01). Curability (risk ratio, 3.122; confidence interval, 1.242-4.779; P < 0.001) was an independent prognostic factor of survival. The 5-year survival rates were not significantly different between the elderly and the young patients according to the absence of serosal invasion (80.0% vs. 77.9%; P = 0.654) and undergoing curative resection (82.0% vs. 78.9%; P = 0.312). Meanwhile, among the elderly patients, those who underwent curative resection had a better survival rate than those with non-curative resection (82.0% vs. 67.8%; P < 0.001).

Conclusion: Elderly patients with advanced gastric cancer without serosal invasion do not have a worse prognosis than their younger counterparts, indicating that age does not impact the prognosis of advanced gastric cancer. The important prognostic factor was whether the patients underwent curative resection.

Introduction: Acute lymphoblastic leukaemia (ALL) is the most common malignancy in children, with a male predominance. Paediatric ALL is usually of B-cell lineage; T-cell leukaemia is uncommon and extremely rare under 1 year of age. Mixed-lineage leukaemia gene rearrangement is the best-known hallmark of infantile leukaemia and is a poor prognostic indicator. While multiagent high-dose chemotherapy remains the first line of treatment for paediatric T-cell lineage ALL (T-ALL), there are numerous side effects of these regimens, and most patients undergo relapse. Due to the rarity of the disease, treatment protocols for infantile T-ALL have not been established to date.

Clinical description: We present a case of a 7-month-old Pakistani male that presented with fever and cough and was subsequently diagnosed with T-cell ALL. T-ALL was diagnosed on flow cytometry. Due to poor prognosis, the patient was assigned palliative care.

Practical implications: Management of infantile leukaemia has yet to be studied in-depth. With a lack of clear treatment guidelines, the approach toward these patients remains challenging. Further research and clinical trials in this area of study are paramount to improving clinical outcomes for these young patients.

Introduction: Colon cancer is one of the leading malignancies globally and continues to be one of the most typical causes of cancer-related mortality. The clinical outcome of the disease depends on the primary tumour stage, regional nodal involvement and distant disease dissemination. It often presents with haematogenous spread to the liver at the time of diagnosis. Another factor for increased mortality is the presence of extramural venous invasion. This is exceedingly important as it has significant prognostic significance and helps predict survival.

Case description: A middle-aged female with a recent history of caesarean delivery presented with abdominal pain and occasional constipation, which led to a series of investigations. Initial computed tomography scan showed proximal to mid-transverse colonic tumoural thickening with locoregional lymphadenopathy and solitary distant metastasis in the left hepatic lobe. This was followed by extended right hemicolectomy and hepatic metastasectomy. The patient remained on follow-up and later presented with thrombus formation in the splenoportal circulation. Initially, this was considered a bland thrombus, and the patient was advised a close follow-up. However, the patient was lost to follow and later presented with extensive thrombosis of the portal and splenic veins.

Practical implications: Confident differentiation of the bland versus malignant thrombosis is crucial to ascertain disease stage and appropriate management. Invasive tissue sampling gives a confident diagnosis of benign versus malignant thrombus. However, using a non-invasive imaging modality, we can still distinguish between the two with reasonable certainty.

Background: The most common pituitary adenoma presentation is a visual field defect and inappropriate pituitary hormone secretion. The compression of the optic chiasm causes visual impairment. Large pituitary adenomas can rarely cause diplopia and ptosis secondary to adenoma's lateral extension into the cavernous sinus. Myasthenia gravis is an autoimmune disorder involving neuromuscular junctions. It is characterised by skeletal muscle fatigability, commonly involving extraocular muscles, face and limbs. It is estimated that 75% of myasthenia gravis patients present with ptosis and diplopia. The association of myasthenia gravis with pituitary adenoma is very rare.

Case description: A 30-year-old lady presented with headache, diplopia and ptosis of the left eye for 2 months. She was diagnosed with acromegaly secondary to pituitary adenoma. Ptosis is a rare presenting feature in pituitary adenoma. Her case was discussed in a multidisciplinary meeting, and the consensus was that her ptosis is likely secondary to pituitary adenoma, which was involving the left cavernous sinus. She underwent transsphenoidal resection of pituitary macroadenoma. Three weeks post-surgery, she developed bilateral ptosis, dysarthria and dysphonia, which was diagnosed as myasthenia gravis.

Clinical implications: Ptosis is a rare manifestation of pituitary adenoma. Nonetheless, pituitary tumour patients presenting with ptosis should be evaluated for the neuromuscular disorder. A high index of suspicion is required for early diagnosis and prompt treatment of myasthenia gravis.

Introduction: A critical result of an investigation is considered a representation of a pathophysiological state deemed to be high risk or life threatening for the patient. Therefore, such results should be addressed in an appropriate and timely manner. Unfortunately, routine closed chart audits suggested that the compliance of physicians in documenting critical alerts in patient notes was poor. This prompted the hospital to conduct a continuous quality improvement (CQI) project to improve the physicians' compliance.

Materials and methods: A cause-and-effect analysis was conducted using a fishbone diagram to identify the reasons for poor compliance. Based on the analysis, several modifications were made, including, but not limited to, hospital-wide educational sessions on the standard operating procedures of receiving and documenting critical alerts for the physicians, daily audit of critical alerts to review the appropriateness of documentation and introduction of a new module in the hospital electronic medical record to acknowledge and document receiving critical alerts.

Results: Before implementing the strategies to improve physicians' documentation compliance, the average compliance rate was 57% in April 2020, and the median compliance rate was 52% (January 2020-April 2020). However, afterward, within a couple of months of implementing changes, the average compliance rate increased to 88%. This improvement was sustained for the next 8 months (median of 89%).

Conclusion: This study found that CQI approach can be used to improve the compliance of the physicians for appropriately and timely documenting critical alerts, in this case, by continued education and training process and incorporating changes into the electronic hospital information system.

Introduction: Rhabdomyosarcoma (RMS) is the most common soft tissue sarcoma in children. This paper aimed to assess the stage, site and treatment outcome among RMS patients.

Materials and methods: A retrospective chart review was completed from January 2011 to December 2017 of patients that presented to the Department of Paediatric Oncology, Shaukat Khanum Memorial Cancer Hospital, Lahore, Pakistan, for the management of RMS. Data collection included clinical characteristics, staging, grouping, risk stratification, treatment plan, radiotherapy doses and treatment outcome.

Results: Among 24 subjects, there were a total of 13 (54.2%) males and 11 (45.8%) females. The median age at the time of diagnosis was 2.5 years (range: 0.75-17 years). The majority of the subjects (91.7%) were <10 years of age. The median follow-up time was 0.6 years. According to the Children's Oncology Group Classification, 4 (16.7%) subjects were classified as low risk, 14 (58.3%) subjects were rated as intermediate risk and 6 (0.25%) subjects were stratified as high risk. The most common primary tumour site was genitourinary (62.5%) and abdomen/retroperitoneal (20.8%) regions. At the time of analysis, nine (37.5%) subjects had died because of the disease, 12 (50%) were alive with no evidence of disease and one subject had a recurrence of disease and was alive. One subject had abandoned the therapy and another was lost to follow-up.

Conclusion: Patients with RMS presented at the late stages of the disease and it most frequently affected genitourinary and abdomen or retroperitoneal areas. Overall, RMS was found to have a poor outcome to therapy.