Indian Journal of Cancer
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LETTER TO EDITOR
Affordable image analysis using NIH Image/ImageJ
V Girish, A Vijayalakshmi
January-March 2004, 41(1):47-47
PMID:15105580
  74 19,362 995
REVIEW ARTICLE
Oral squamous cell carcinoma: Etiology, pathogenesis and prognostic value of genomic alterations
Ravi Mehrotra, S Yadav
April-June 2006, 43(2):60-66
DOI:10.4103/0019-509X.25886  PMID:16790942
Tumours of the head and neck comprise an important group of neoplasia, the incidence of which is increasing in many parts of the world. This increase remains high, despite all the advances in modern medicine. This malignancy is more prevalent in the developing world and unfortunately, has not received satisfactory attention as the more prevalent cancers of the developed world, like lung, breast, or colon cancer. Recent advances in diagnosis and therapeutic techniques of these lesions have yielded novel molecular targets, uncovered signal pathway dominance and advanced early cancer detection. This review covers recent advances in our understanding of the etiology, molecular changes and the possible role that genomic and proteomic research might play in the diagnosis and effective cure of this modern-day scourge.
  45 21,230 2,659
Cancer preventive role of selected dietary factors
Amitabha Ray
January-March 2005, 42(1):15-24
DOI:10.4103/0019-509X.15095  PMID:15805687
Dietary behavior seems to be an important modifiable determinant for the risk of cancer. The evidences from several epidemiological studies suggest that higher intakes of fruits and vegetables have been associated with lower risk of cancer. Dietary phenolic and polyphenolic substances, terpenoids, dietary fibers, fish oils, some micronutrients present in foods of both plant and animal origin, and a reduction of caloric intake appear to inhibit the process of cancer development. Many dietary factors possess antioxidant and anti-inflammatory properties and cause induction of phase II enzymes like glutathione-S-transferases. It has been suggested that cruciferous vegetables play an important role in cancer prevention, and their chemopreventive effects are due to high glucosinolate content which under enzymatic hydrolysis produces bioactive compound isothiocyanates. Further, isothiocyanates of a wide variety of cruciferous vegetables are powerful inhibitors of carcinogenesis in experimental animal models. Several flavonoids present in fruits, tea, soya beans, etc. may be useful as cancer preventive agents. Similarly, ellagic acid, perillyl alcohol and resveratrol found in various fruits may have chemoprotective effect. Moreover, different vanilloids such as curcumin and gingerol have been shown to possess antioxidative properties. Nevertheless, in spite of several studies, still the effects of various ingredients are not clearly distinguished. In human, little convincing evidence has been established for the proposed protective effects of dietary constituents. It is an important future research goal to provide necessary evidences to support the chemopreventive role of different dietary factors, and also to clarify misunderstandings in this perplexing area.
  44 15,782 4
SPECIAL ARTICLE
Tobacco use among students in the eight North-eastern states of India
DN Sinha, PC Gupta, MS Pednekar
April-June 2003, 40(2):43-59
PMID:14716119
OBJECTIVES : To obtain baseline information about prevalence of tobacco use among school children in eight states in the North-eastern part of India. MATERIAL AND METHODS : A two-stage probability sample of students in grades 8-10 corresponding to 13 to 15 years of age was selected in each state and surveyed through an anonymous, self-administered questionnaire. RESULTS : Among the sampled schools, the school response rate was 100% in all states except Tripura (92%) and Meghalaya (96%). Among the eligible students, over 80% participated in the survey. Among the respondents, the proportion of boys ranged between 50% to 55%. Ever tobacco users ranged from 75.3% (Mizoram) to 40.1% (Assam). Over 65% of users reported initiation at 10 years of age or earlier in all states except Mizoram (23.1%). The range of current tobacco use (any product) was 63% (Nagaland) to 36.1% (Assam). Current smokeless tobacco use ranged from 49.9% (Nagaland) to 25.3% (Assam). Mizoram reported the highest current smoking (34.5%, mainly cigarette) and Assam reported the lowest (19.7%, again mainly cigarette). Current smoking among girls (8.3% to 28.2%) was also quite high. Over half of current cigarette smokers (53.2% to 96.3%) and a high proportion of current smokeless tobacco users (38.5% to 80.8%) reported feeling like having tobacco first thing in the morning. Only about 20% of students reported having been taught in school about the dangers of tobacco use, except in Mizoram (around 50%). Tobacco use by parents and close friends was positively associated with students' current tobacco use. CONCLUSIONS : Tobacco use including smoking was very high, even among girls, in all eight states in the North-eastern part of India. Signs of tobacco dependency were already visible in these students, more among those who smoked. In general schools did not educate students about the hazards of tobacco use.
  43 10,782 1
ORIGINAL ARTICLE
Clinical features and prognostic factors of early breast cancer at a major cancer center in North India
Vinod Raina, Manisha Bhutani, Rajeev Bedi, Atul Sharma, Suryanarayana V.S Deo, Nootan K Shukla, Bidhu Kalyan Mohanti, Goura K Rath
January-March 2005, 42(1):40-45
DOI:10.4103/0019-509X.15099  PMID:15805691
BACKGROUND : Data on the clinical profile of early breast cancer (EBC) from India is scant. Due to differences in genetics, environment, lifestyle, socio-demographic structure and ethnicity, the presentation and behavior of breast cancer in India may be different. AIMS : To analyze the clinical presentation and outcome of EBC patients. SETTINGS AND DESIGN : A single center retrospective study. MATERIALS AND METHODS : Data from 487 EBC patients registered and treated at our institute from 1993 through 1999 were analyzed. Cox's multivariate regression test was used to determine prognostic factors for overall and disease-free survival (OS & DFS). RESULTS : The median age was 47 years and 49.7% patients were pre-menopausal. Ninety-six per cent patients presented with a lump. Stages I, IIa, and IIb comprised 7.8%, 38.8%, and 47.6% respectively. Only 11.3% patients opted for breast-conserving surgery (BCS) while the remaining 88.7% underwent modified radical mastectomy (MRM). Adjuvant chemotherapy was administered to 275 (56.5%), and radiotherapy to 146 (29.9%). Estrogen receptor status was known in 173, of whom 93 (53.7%) were positive. Most patients were prescribed Tamoxifen for 5 years. At a median follow-up of 48 months, 126 (25.9%) patients had relapsed (systemic 107, loco-regional 19) and 94 (19.3%) had died. Five-year DFS and OS were 73% and 78%, respectively. On multivariate analysis, four positive nodes adversely influenced survival (P<0.01). CONCLUSIONS : The median age at presentation was 47 years, significantly lower than most Western figures. The majority (86.4%) had a lump size > two cm. BCS was done in only 11% and the rest underwent MRM. Nodal involvement was the significant prognostic factor.
  39 9,228 4
REVIEW ARTICLE
Capsaicin: A novel chemopreventive molecule and its underlying molecular mechanisms of action
AA Oyagbemi, AB Saba, OI Azeez
January-March 2010, 47(1):53-58
DOI:10.4103/0019-509X.58860  PMID:20071791
Capsaicin (trans-8-methyl-N-vanillyl-6-nonenamide) is the a principal pungent ingredient of hot red and chili peppers that belong to the plant genus Capsicum (Solanaceae). Capsaicin is a cancer-suppressing agent. It blocks the translocation of nuclear factor kappa B (NF-kB), activator protein 1 (AP-1), and signal transducer and activator of transcription (STAT3) signaling pathway that are required for carcinogenesis. The anti-inflammatory potential of capsaicin is attributed to its inhibitory effect on inducible COX-2 mRNA expression. Cytochrome P4502E1 mediates the activation of xenobiotics such as vinyl carbamate and dimethyl nitrosamine to their toxic metabolites. This metabolic activation of xenobiotics by Cytochrome P4502E1 has been shown to be inhibited by capsaicin. Capsaicin also generates reactive oxygen species in cells with resultant induction of apoptosis and cell cycle arrest, which is beneficial for cancer chemoprevention. Therefore, the use of capsaicin as a chemopreventive agent is of immense benefit for cancer chemoprevention. The search strategy included printed journals, pubmed, and medline, using the terms 'capsaicin' and 'anticancer' citations, relevant to anticancer properties of capsaicin.
  38 10,313 1,159
ORIGINAL ARTICLE
Desmoplastic small round cell tumor: Extra abdominal and abdominal presentations and the results of treatment
G Biswas, S Laskar, SD Banavali, S Gujral, PA Kurkure, M Muckaden, PM Parikh, Chandrika N Nair
April-June 2005, 42(2):78-84
DOI:10.4103/0019-509X.16696  PMID:16141506
BACKGROUND: Desmoplastic small round cell tumor (DSRCT) is a rare malignant neoplasm of adolescent males. Current multimodality treatment prolongs life and rarely achieves cure. Aim: To review the presenting features, histopathology and outcome of 18 patients with DSRCT treated at a single institution. Setting and Design: This is a retrospective observational study of patients with DSRCT who presented at the Tata Memorial Hospital between January 1994 to January 2005. Materials and Methods: Eighteen patients of DSRCT seen during this period were evaluated for their clinical presentation, response to chemotherapy and other multimodality treatment and overall survival. The cohort of 18 patients included 11 males (61%) and 7 females (39%) with a mean age of 16 years (Range 1½ - 30 years). Majority (83%) presented with abdomino-pelvic disease. The others, involving chest wall and extremities. There were 6 patients (33%) with metastatic disease at presentation. Results:The treatment primarily included a multimodality approach using a combination of multiagent chemotherapy with adjuvant surgery and radiotherapy as applicable. A response rate of 39% (CR-1, PR-6), with chemotherapy was observed. The overall response rate after multimodality treatment was 39% (CR-5, PR-2). The overall survival was poor except in patients who had complete excision of the tumor. Conclusion: Abdomino-pelvic site was the commonest presentation, the disease can occur at other non-serosal surfaces also. Despite aggressive treatment the outcome was poor. However, complete surgical excision seems to provide a better survival.
  34 7,511 712
REVIEW ARTICLES
Epidemiology of childhood cancer in India
RS Arora, TOB Eden, G Kapoor
October-December 2009, 46(4):264-273
DOI:10.4103/0019-509X.55546  PMID:19749456
There has been enormous progress in the treatment of childhood cancer in the developed world and the epidemiology in these countries is well described. Hitherto, there has been no attempt to systematically study the burden of childhood cancer in India or to understand how the occurrence and outcome of the disease varies across the country. We have reviewed the epidemiology (incidence, survival, and mortality) of childhood cancer across different population-based cancer registries in India and also compared it with data from the resource-rich countries. Incidence and mortality data were obtained from the National Cancer Registry Program Reports and the Cancer Incidence in 5 Continents publications. Further, a comprehensive review of medical literature was done for information on individual cancers as well as survival data. 1.6 to 4.8% of all cancer in India is seen in children below 15 years of age and the overall incidence of 38 to 124 per million children, per year, is lower than that in the developed world. The considerable inter-regional variation in incidence and mortality rates across India suggests a possible deficiency in ascertainment of cases and death notification, particularly in rural areas. The marked male preponderance of Hodgkin's disease, lower incidence of central nervous system tumors, and higher incidence of retinoblastoma merit further analysis.
  34 15,252 1,693
ORIGINAL ARTICLE
Prevalence and risk factors for development of lymphedema following breast cancer treatment
S VS Deo, S Ray, GK Rath, NK Shukla, M Kar, S Asthana, V Raina
January-March 2004, 41(1):8-12
PMID:15105573
BACKGROUND : Early detection and multimodality therapy has resulted in an overall improvement of survival among breast cancer patients. Despite a significant shift in the treatment approach from radical mastectomy to breast conservation a significant number of patients develop lymphedema. This study was conducted to evaluate the prevalence and risk factors for development of lymphedema. SETTINGS AND DESIGN : Retrospective analysis for prevalence of lymphedema in a tertiary care regional cancer centre. MATERIAL AND METHODS : Three hundred treated breast cancer patients with a minimum follow up of one year were evaluated for the prevalence and risk factors for lymphedema. Lymphedema was assessed using a serial circumferential measurement method. More than 3 cm difference in circumference is considered as clinical significant lymphedema. Univariate and multivariate analysis were performed for evaluating the risk factors by using the Chi square test and Cox logistic regression analysis. RESULTS : The prevalence of clinically significant lymphedema was 33.5 % and 17.2 % had severe lymphedema. The prevalence of lymphedema was 13.4 % in patients treated with surgery only where as the prevalence was 42.4% in patients treated with surgery and radiotherapy. Stage of the disease, body surface area > 1. 5 m2, presence of co-morbid conditions, post operative radiotherapy and anthracycline based chemotherapy were significant risk factors in univariate analysis where as axillary irradiation and presence of co-morbid conditions have emerged as independent risk factors in multivariate analysis (P < 0.001). CONCLUSION : Post treatment lymphedema continues to be a significant problem following breast cancer therapy. Presence of co-morbid conditions and axillary radiation significantly increases the risk of lymphedema. A combination of axillary dissection and axillary radiation should be avoided whenever feasible to avoid lymphedema.
  32 14,802 454
Prophylactic beclomethasone spray to the skin during postoperative radiotherapy of carcinoma breast: A prospective randomized study
PN Shukla, M Gairola, BK Mohanti, GK Rath
October-December 2006, 43(4):180-184
DOI:10.4103/0019-509X.29424  PMID:17192690
Background and Aims: Radiation induced wet desquamation of skin in carcinoma breast patients is a painful condition. In this study topical beclomethasone dipropionate spray was used as prophylaxis with the purpose of reducing risk of the wet desquamation of skin in irradiated field. Materials and methods: Sixty patients of carcinoma breast were planned for postoperative loco regional radiotherapy (50 Gy in 25 fraction over five weeks) were prospectively randomized into two groups (1) steroid group-patients were advised to use beclomethasone dipropionate spray in irradiated axilla from day one of radiotherapy, (2) control group-patients were not allowed to use any topical agent in irradiated area. Radiation induced skin reaction was noted in terms of erythema, dry desquamation and wet desquamation weekly till end of prescribed 50Gy dose of the radiation therapy. Statistical Method: Chi-square test was used to see the statistical significance of the difference in wet desquamation between two arms of the study. Chi-square value and P -value was calculated for the difference of wet desquamation in two study arms. Result: In steroid group 4/30 (13.33%) patients developed wet desquamation of the axillary skin at the end of the radiotherapy. For the control group, this figure was 11/30 (36.66%). The difference in wet desquamation of the axillary skin in the two groups was statistically significant ( P -value= 0.0369). Conclusion: Topical steroid (beclomethasone dipropionate spray) for skin during radiotherapy significantly reduces the risk of wet desquamation of the skin.
  32 6,308 528
LETTERS TO EDITOR
Changing trends in incidence of breast cancer: Indian scenario
NS Murthy, K Chaudhry, D Nadayil, UK Agarwal, S Saxena
January-March 2009, 46(1):73-74
DOI:10.4103/0019-509X.48603  PMID:19282574
  31 14,446 1,414
ORIGINAL ARTICLE
Mitochondrial DNA 4977 BP deletion mutations in lung carcinoma
Ji Gang Dai, Ying Bin Xiao, Jia Xin Min, Guo Qiang Zhang, Ke Yao, Ren Jie Zhou
January-March 2006, 43(1):20-25
DOI:10.4103/0019-509X.25771  PMID:16763358
BACKGROUND: The most common and also the most often assayed mtDNA deletion mutation, °mtDNA 4977 has been demonstrated in various types of human cancer. However, knowledge about °mtDNA 4977 in lung carcinoma is poor. AIM: To study the 4977 bp deletions of mitochondrial DNA (°mtDNA 4977) in lung cancer, adjacent histologically normal and normal lung tissue and its potential roles in the development of cancer. MATERIALS AND METHODS: Thirty-seven matched lung cancer/adjacent histologically normal and 20 histologically normal lung tissue samples in subjects without lung cancer were analyzed by PCR technique. RESULTS: °mtDNA 4977 deletions were detected in 54.1% (20/37) of lung cancers, 59.5% (22/37) of adjacent normal and 30.0% (6/20) of normal lung tissue samples. No significant difference was found in the frequency of °mtDNA 4977 deletions between the tumor and adjacent normal lung tissues ( P value = 0.815). Moreover, no significant difference was found in the frequency of °mtDNA 4977 deletions between the tumor and histologically normal lung tissues in subjects without lung cancer ( P value = 0.101). However, the correlation between °mtDNA 4977 deletion and age and smoking factors was present in our data. STATISTICAL ANALYSIS: Fisher's exact test was used to assess the difference in different groups by the Scientific Package for Social Sciences (SPSS), version 10.0, Statistical analysis software. CONCLUSINS: Mitochondrial DNA 4977 bp deletion, which is not specific to lung cancer, may reflect the environmental and aging process influences operative during tumor progression.
  31 7,063 595
Trends of prevalence and pathological spectrum of head and neck cancers in North India
Ravi Mehrotra, Mamata Singh, Raj Kishore Gupta, Manish Singh, Anil K Kapoor
April-June 2005, 42(2):89-93
DOI:10.4103/0019-509X.16698  PMID:16141508
BACKGROUND: Head and neck neoplasia constitute one of the commonest cancers in India. Use of smokeless tobacco (Pan masala, Zarda etc.) is on the increase in North India, especially in Uttar Pradesh, and is responsible for the large majority of these tumours. AIM: To assess the patients' characteristics, yearly prevalence and histopathological subtypes of the head and neck neoplasia (excluding oral cavity) in Allahabad and surrounding regions. SETTINGS AND DESIGN: A retrospective study of 11 years from 1990 to 2000 was designed. Data was collected year-wise using the tumor registry data. MATERIAL AND METHODS: All biopsies submitted for histopathology to the Pathology department were reviewed and analyzed for demographic data, site and diagnosis. STATISTICAL ANALYSIS: The Kolmogorov-Smirnov Two-Sample Test was utilized to determine whether two distributions are the same. RESULTS: A total of 40559 biopsies were examined in the department, of which, lesions of the head and neck region, excluding the oral cavity, constituted 694 biopsies (409 males and 285 females). One hundred and forty-four malignant lesions were reported, 114 being males and 30 females. A comparison of the age-specific prevalence rates of cancer during the study period showed that the prevalence was highest in patients belonging to the 50-59 years age group and squamous cell carcinoma Grade II was the most prevalent type. On an average, 58 new biopsies per annum were received. CONCLUSIONS: Properly structured site-specific data like this can augment the National Cancer Registry Programme and is an essential indicator for the magnitude and the pattern of the cancer problem in India.
  29 7,404 880
Visual inspection for cervical cancer screening; evaluation by doctor versus paramedical worker
Neerja Bhatla, A Mukhopadhyay, S Joshi, A Kumar, A Kriplani, RM Pandey, K Verma
January-March 2004, 41(1):32-36
PMID:15105577
BACKGROUND : In the absence of an effective cervical cancer screening programme, efforts are being made to explore the feasibility of using the existing infrastructure to develop effective low-cost screening methods. AIMS : To evaluate and compare test performance of visual inspection of the cervix by a doctor and a paramedical worker. SETTING AND DESIGN : Gynaecology outpatient department (OPD), All India Institute of Medical Sciences, New Delhi; cross-sectional study. MATERIAL AND METHODS : One hundred women with complaints of vaginal discharge, irregular bleeding, post coital bleeding or unhealthy cervix underwent visual inspection with acetic acid (VIA) and Lugol's iodine (VILI) by a doctor and nurse, followed by colposcopy and biopsy. STATISTICAL ANALYSIS USED : Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were calculated for each test and compared. Concordance was determined by kappa statistics. RESULTS : VIA by nurse had a higher sensitivity (100% versus 87.5%), but lower specificity (53% versus 63%) when compared with the doctor, but it was not statistically significant. There was moderate agreement between their VIA findings (kappa=0.56). VILI findings were comparable to that of the VIA, both by the doctor and nurse. There was almost perfect agreement (kappa=0.89) between VILI by the doctor and nurse. CONCLUSION : Visual inspection can be performed reliably by trained paramedical workers and doctors and is an effective screening option in low resource settings.
  27 11,371 302
ORIGINAL ARTICLES
Clinical significance of matrix metalloproteinase 2 and 9 in breast cancer
FD Shah, SN Shukla, PM Shah, HK Shukla, PS Patel
July-September 2009, 46(3):194-202
DOI:10.4103/0019-509X.52953  PMID:19574670
Background: Invasion and metastasis are the most strenuous problems in the management of breast cancer. These events require diverse proteolytic enzymes, among which MMP-2 and MMP-9 play a significant role in degradation of type IV collagen, the major component of the basement membrane. Therefore, the major objective of the study is to evaluate the clinical usefulness of MMP-2 and MMP-9 with respect to malignant tumor growth, invasion, and metastasis in breast cancer. Materials and Methods: Gelatin zymography was performed on 157 tissue extracts of malignant and adjacent normal breast tissues as well as negative and positive lymph nodes from 49 breast cancer patients. Statistical analysis was carried out using SPSS statistical software (version 10). Results: ProMMP-2 levels were significantly higher in adjacent normal tissues. Active MMP-2 and MMP-9 levels were higher in malignant breast tissues. Activation ratios of MMP-2 and MMP-9 were significantly higher in malignant breast tissues and in patients with lymph node metastasis. ProMMP-2, active MMP-2, and active MMP-9 could significantly discriminate between malignant and adjacent normal breast tissues. The MMP-2 activation ratio showed significant discriminatory efficacy between patients with and without lymph node metastasis and significant association with increased risk of lymph node metastasis in node-negative patients. Conclusion: The results indicate significant clinical utility of these proteolytic enzymes in malignant tumor growth, invasion, and metastasis in breast cancer.
  26 4,880 660
ORIGINAL ARTICLE
Polymorphism of GSTM1 and GSTT1 genes in prostate cancer: A study from North India
Rama Devi Mittal, D SL Srivastava, A Mandhani, A Kumar, B Mittal
July-September 2004, 41(3):115-119
PMID:15472409
BACKGROUND : Glutathione-S-transferases (GSTs) are active in the detoxification of wide variety of endogenous or exogenous carcinogens. The genetic polymorphisms of GSTM1 and GSTT1 genes have been studied earlier to evaluate the relative risk of various cancers. AIM, SETTING AND DESIGN : In the present study, we examined the association of the GSTM1 and GSTT1 gene polymorphisms with sporadic prostate cancer patients in north Indian population. MATERIAL AND METHODS : This case control study was undertaken over a period of 24 months and included 103 prostate cancer patients and 117 controls; both patients and controls originated from northern part of India. The GSTT1 and GSTM1 genotypes were identified by multiplex PCR in peripheral blood DNA samples. STATISTICAL ANALYSIS : Difference in genotype prevalence and association between case and control group were assessed by the Chi square and Fisher Exact tests. RESULTS : Frequencies of null genotypes in GSTT1 and GSTM1, was 11% (13/117) and 30% (35/117) respectively in control individuals. The frequencies of GSTT1 and GSTM1 null genotypes in prostate cancer patients were 34% (35/103) and 53% (55/103) respectively. CONCLUSION : Our study demonstrates that the null genotypes of GSTT1 and GSTM1 are substantially at higher risk for prostate carcinoma as compared to the normal healthy controls. The GSTT1 and GSTM1 null genotypes did not show significant association with tobacco usage in prostate cancer patients. However, the null genotypes were significantly stratified in 50-60 year-old patients when incidence of prostate cancer is high.
  24 5,633 289
ORIGINAL ARTICLES
Awareness of breast cancer in women of an urban resettlement colony
P Somdatta, N Baridalyne
October-December 2008, 45(4):149-153
DOI:10.4103/0019-509X.44662  PMID:19112202
Background: Breast cancer accounts for 19-34% of all cancer cases among women in India. There is a high mortality due to late stage diagnosis as patients usually present at an advanced stage because of lack of awareness and non-existent breast cancer screening programs. Aim : To determine the awareness about breast cancer among women in an urban resettlement colony in Delhi. Settings and Design: A community based, cross-sectional study carried out in a resettlement colony in South Delhi. Materials and Methods: Semi-structured interview schedule was used to collect information regarding breast cancer. Modified Kuppuswamy scale was used for assessing the socio-economic status. Results and Conclusions: A total of 333 women were included. The mean age was 36 years±15.1 and 46% were illiterate. Only 185 (56%) women were aware of breast cancer; among them, 51% knew about at least one of the signs /symptoms, 53% were aware that breast cancer can be detected early, and only 35% mentioned about risk factors. Thus, awareness about breast cancer is low amongst women in this community. There is a need for awareness generation programs to educate women about breast cancer, propagation of correct messages and promote early detection of breast cancer.
  24 7,662 832
Mutation pattern of K-ras gene in colorectal cancer patients of Kashmir: A report
AS Sameer, NA Chowdhri, S Abdullah, ZA Shah, MA Siddiqi
July-September 2009, 46(3):219-225
DOI:10.4103/0019-509X.52956  PMID:19574674
Background and Aim: Colorectal cancer (CRC) is one of the leading malignancies worldwide. CRC has been reported to show geographical variation in its incidence, even within areas of ethnic homogeneity. The aim of this study is to identify K-ras gene mutations in CRC patients among the Kashmiri population, and to assess whether they are linked with the clinicopathological parameters. Materials and Methods: Paired tumor and normal tissue samples were collected from a consecutive series of 53 patients undergoing resective surgery for CRC. In addition blood was also collected from all the cases for ruling out germline mutation. Results: Colorectal patients, 22.64% (12 of 53), presented with mutations in K-ras constituting 13 missense mutations out of which 11 were G→A transition, one G→C transversion, and one G→T transversion. 61.5% percent of the mutations occurred in codon 12 and 38.5% in codon 13. One tumor contained missense mutations in both codons. K-ras mutations were significantly associated with advanced Dukes' stage (P < 0.05) and positive lymph node status (P < 0.05). Moreover Codon 12 K-ras mutations were associated with mucinous histotype (P < 0.05). Comparison of the mutation profile with other high-risk areas reflected both mucinous histotype differences and similarities indicating coexposure to a unique set of risk factors. Conclusion: Mutation of the K-ras gene is one of the commonest genetic changes in the development of human CRC, but it occurs in a rather low frequency in Kashmiri population.
  24 6,270 667
Spirituality, distress, depression, anxiety, and quality of life in patients with advanced cancer
A Kandasamy, SK Chaturvedi, G Desai
January-March 2011, 48(1):55-59
DOI:10.4103/0019-509X.75828  PMID:21248445
Objective: To study the influence of spiritual well being (Sp WB) on symptoms of distress, depression, and other dimensions of quality of life in advanced cancer patients receiving palliative care. Materials and Methods: The study was cross-sectional in nature. Fifty patients with advanced cancer from a hospice were assessed with the following instruments: the visual analog scale for pain (VAP), M.D. Anderson symptom inventory (MDASI), Hospital Anxiety Depression Scale (HADS), Functional assessment of cancer therapy - Palliative Care (FACT-pal), and Functional assessment of chronic illness therapy-spiritual well-being (FACIT-sp). We studied the correlations between spirituality and other variables on these scales. Results: Depression and anxiety were negatively correlated with spiritual well-being (Sp WB). Sp WB was significantly correlated with fatigue (r = -0.423, P = 0.002), symptom distress (r = -0.717, P < 0.001), memory disturbance (r = -0.520, P < 0.001), loss of appetite (r = -0.399, P = 0.004), drowsiness (r = -0.400, P = 0.004), dry mouth (r = -0.381, P = 0.006), and sadness (r = -0.720, P < 0.001). Sp WB was positively correlated with all the other aspects of QOL measures. Predictors such as palliative care well-being (t = 2.840, P = 0.008), distress (t = -2.582, P = 0.015), sadness (t = -2.765, P = 0.010), mood (t = 2.440, P = 0.021), and enjoyment in life (t = -3.586, P = 0.001) were significantly correlated with Sp WB, after regression analysis. Conclusions: This study suggests that spiritual well being is an important component of the quality of life of advanced cancer patients, and is closely related to the physical and psychological symptoms of distress. It should be addressed appropriately and adequately in palliative care settings.
  24 9,728 985
SYMPOSIUM
Non-FDG PET in the practice of oncology
P Caroli, C Nanni, D Rubello, A Alavi, S Fanti
April-June 2010, 47(2):120-125
DOI:10.4103/0019-509X.62998  PMID:20448372
Fluoro-2-deoxy-d-glucose-positron emission tomography (FDG-PET) is utilized in more than 90% of cancers in staging, re-staging, assessing therapy response and during the follow-up. However, not all tumors show significant increase of metabolic activity on FDG-PET imaging. This is particularly true for prostate cancer, neuroendocrine tumors and hepatic tumors. In this review we have considered those already used for clinical applications such as 11C- and 18F-Choline, 11C-Methionine and 18F-FET, 18F-DOPA, 68Ga-DOTA-somatostatine analogues, 11C-Acetate and 18F-FLT. Choline presents a high affinity for malignant prostate tissue, even if low grade. Choline can be labeled with either 11C or 18F, the former being the preference due to lower urinary excretion and patients exposure. The latter is more useful for possible distribution to centers lacking in on-site cyclotron. Methionine is needed for protein synthesis and tumor cells require an external supply of methionine. These tracers have primarily been used for imaging of CNS neoplasms. The most appropriate indication is when conventional imaging procedures do not distinguish between edema, fibrosis or necrosis and disease relapse. In addition, the uptake of 11C-Methionine is proportional to the tumor grade and, therefore, the maximum small unilamellar vesicles (SUV) inside the brain mass before therapy is somehow considered a prognostic value. Neuroendocrine tumors (carcinoids, pheocromocytoma, neuroblastoma, medullary thyroid cancer, microcytoma, carotid glomus tumors, and melanoma) demonstrate an increased activity of L-DOPA decarboxylase, and hence they show a high uptake of 18FDOPA. For the study of NETs, 68Ga-DOTA-TOC/DOTA-NOC has been introduced as PET tracer. This compound for PET imaging has a high affinity for sst2 and sst5 and has been used in the detection of NETs in preliminary studies; 68Ga-DOTA-NOC PET is useful before metabolic radiotherapy in order to evaluate the biodistribution of the therapeutic compound; 18F-FLT is a specific marker of cell proliferation and the most important field of application of FLT is lung cancer. Other tracers are used in PET utilized as markers of hypoxia inside big neoplastic masses include 18F-MISO, 64Cu-ATSM, 18F-EF5, which highlight the presence of hypoxic areas are useful for patients that must be treated with radiotherapy.
  24 7,135 1,034
ORIGINAL ARTICLES
Changing trends in oral cancer
N Sherin, T Simi, PM Shameena, S Sudha
July-September 2008, 45(3):93-96
DOI:10.4103/0019-509X.44063  PMID:19018111
Context: No study highlighting the incidence of oral squamous cell carcinoma (OSCC) in young adults has been reported from North Kerala until now. Aims: To study the cases of OSCC reported at our institution, with emphasis on the clinicopathologic variables in young adults. Settings and Design: This was a retrospective study of OSCC cases reported from 2002 to 2007. Materials and Methods: Data of oral cancer cases reported between 2002 and 2007 were retrieved from the records. The cases in patients below 40 years of age formed a separate study group. The data obtained was tabulated and comparisons drawn on the observed variables between the two groups. Results: Results showed a high incidence of OSCC among young adults. The demographic and anatomic location of these cases showed significant variations from cases of oral cancer in older patients. In addition, a significant number of these cases failed to show any relation with the commonly implicated etiologic agents of oral cancer. Conclusion : The findings of our study indicate a high incidence of oral cancer among young adults in our region. The tongue is the most common site in these cases with a significant number showing no possible etiological factors.
  22 4,996 1,076
p 53 codon 72 polymorphism in stomach and colorectal adenocarcinomas in Iranian patients
Z Mojtahedi, MR Haghshenas, SV Hosseini, MJ Fattahi, A Ghaderi
January-March 2010, 47(1):31-34
DOI:10.4103/0019-509X.58856  PMID:20071787
Background: The association of a functional single nucleotide polymorphism at codon 72 of the p53 gene (Arg72Pro) with malignancy is a subject of controversy. We analyzed this polymorphism in 224 patients with gastrointestinal cancers (92 with stomach cancer and 132 with colorectal cancer) and in 163 healthy controls. Material and Methods: DNA was extracted from peripheral blood mononuclear cells and amplified with an allele-specific polymerase chain reaction. Results: There was no significant association between p53 alleles and gastrointestinal cancers. The frequency of the Arg allele was 59.7, 58.8, and 59.2% in the stomach cancer patients, colorectal cancer patients, and controls, respectively. Frequencies of the Pro allele were 40.3% in patients with stomach cancer, 41.2% in patients with colorectal cancer, and 40.8% in controls. Likewise, genotype frequencies did not differ significantly between the two patient groups and controls. There were no differences in genotype or allele frequencies by gender, age, or histological grade. Conclusions: The data do not support the association of the p53 codon 72 polymorphism with stomach or colorectal cancers in Iranian patients.
  22 3,427 492
REVIEW ARTICLE
Positron emission tomography imaging in evaluation of cancer patients.
R Kumar, P Bhargava, MF Bozkurt, H Zhuang, S Potenta, A Alavi
July-September 2003, 40(3):87-100
PMID:14716112
Positron emission tomography (PET) is a diagnostic imaging technique that has progressed rapidly from being a research technique in laboratories to a routine clinical imaging modality. The most widely used radiotracer in PET is Fluorine18-fluorodeoxyglucose (F18-FDG), which is an analogue of glucose. The FDG uptake in cells is directly proportional to glucose metabolism of cells. Since glucose metabolism is increased many fold in malignant tumors PET has a high sensitivity and a high negative predictive value. PET with FDG is now the standard of care in initial staging, monitoring the response to the therapy, and management of lung cancer, colonic cancer, lymphoma, melanoma, esophageal cancer, head and neck cancer and breast cancer. Other indications of PET like bone tumor, ovarian cancer and cancer of unknown primary (CUP) has also been discussed in brief. The aim of this review article is to review the clinical applications of PET in various malignancies and only limited number of important studies will be discussed for this effort.
  22 8,612 16
REVIEW ARTICLES
Role of chelates in treatment of cancer
Laxmi Tripathi, Praveen Kumar, AK Singhai
April-June 2007, 44(2):62-71
DOI:10.4103/0019-509X.35813  PMID:17938483
Chelates are used in cancer as cytotoxic agent, as radioactive agent in imaging studies and in radioimmunotherapy. Various chelates based on ruthenium, copper, zinc, organocobalt, gold, platinum, palladium, cobalt, nickel and iron are reported as cytotoxic agent. Monoclonal antibodies labeled with radioactive metals such as yttrium-90, indium-111 and iodine-131 are used in radioimmunotherapy. This review is an attempt to compile the use of chelates as cytotoxic drugs and in radioimmunotherapy.
  22 12,326 1,184
ORIGINAL ARTICLE
Endocrine cancer in Iran: Based on cancer registry system
V Haghpanah, B Soliemanpour, R Heshmat, AR Mosavi-Jarrahi, SM Tavangar, R Malekzadeh, Bagher Larijani
April-June 2006, 43(2):80-85
DOI:10.4103/0019-509X.25889  PMID:16790945
BACKGROUND: A population-based registry of endocrine cancer cases in four Iranian provinces, was performed for the years 1996-2000. MATERIALS AND METHODS: Patients in each province were grouped according to age, gender and tumor specifics (site, morphology, behavior) and the data was coded according to the international classification of diseases for oncology. STATISTICAL ANALYSIS USED: Person-years of population at risk were calculated and the results were presented as incidence rates by sex, age, age specific rates and age standard rate (ASR) per 100,000 person-years, using direct method of standardization to the world population. RESULTS: A total of 319 cases of primary endocrine cancer were found and registered, including 313 cases of thyroid carcinoma and 6 cases of adrenal cancer. The thyroid carcinoma group cases consisted of papillary (82.7%), follicular (8.6%), medullary (7.0%) and anaplastic (1.6%) carcinomas. The ASR for thyroid carcinoma was 1.289 (0.627 for men, 1.59 for women), with the highest incidence rate in Kerman (ASR 1.643) and the lowest incidence rate in Golestan (ASR 0.735). For the 6 cases of adrenal cancer, 4 were neuroblastoma and 2 were pheochromocytoma. CONCLUSIONS: Iran was considered as an endemic, iodine-deficient area, until fairly recently. Iodinization of salt has been started about 12 years ago, in the nation. Considering the effect of improvement in the iodine intake in previously deficient communities, which is associated with an increase in the incidence of papillary carcinoma compared to other histologic types, the frequency and distribution of histologic types of thyroid carcinoma was closer to what can be seen in iodine-rich areas.
  20 5,445 569
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