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   Table of Contents - Current issue
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July-September 2021
Volume 58 | Issue 3
Page Nos. 315-478

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EDITORIAL  

Time for colorectal cancer screening in India! p. 315
Viraj Lavingia, Adwaita A Gore
DOI:10.4103/ijc.ijc_918_21  
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REVIEW ARTICLES Top

Screening for cervical cancer in HIV-infected women: A review of literature p. 317
Veena G Rahatgaonkar, Aditi A Deshpande, Gauri A Oka
DOI:10.4103/ijc.IJC_888_19  PMID:34380862
Globally, the cervical cancer burden is huge, more so in low-resource countries. Human immunodeficiency virus (HIV) infection increases a woman's risk of human papillomavirus (HPV) infection and cervical cancer. There is a lack of opportunistic, as well as, organized cervical cancer screening structure for HIV-positive women. A large proportion of women have invasive cervical cancer as their initial acquired immune deficiency syndrome (AIDS)-defining illness. There is an especially high-incidence in countries where there are no organized cervical cancer prevention programs. Additionally, there are cultural, social, psychological, and system barriers that women living with HIV have to overcome when accessing healthcare services. We believe that educating women and healthcare providers regarding the need for screening, early detection, and treatment is as important as bringing about a systematic change in healthcare services to improve participation of HIV-positive women in screening for cervical cancer.
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Grossing and reporting of bone tumor specimens in surgical oncology: Rationale with current evidence and recent updates p. 326
Bharat Rekhi, Shantveer Uppin, Jayasree Kattoor, Nirmala A Jambhekar, Pradyumn Singh, Vinita Pant, Satish Rao, Nishat Afroz
DOI:10.4103/ijc.IJC_59_21  
Primary bone tumors, including sarcomas, are rare tumors and require a multidisciplinary approach, including inputs from a radiologist, pathologist, medical oncologist, and surgical and radiation oncologist, for optimal management. Over the years, there has been a paradigm shift toward the treatment of bone sarcomas, from radical resections to conservative surgical procedures, to achieve improved clinical and functional outcomes. This has led to receiving and processing various types of specimens in orthopedic oncopathology. Grossing and reporting of bone tumors require expertise. This review focuses upon the types of biopsies, grossing techniques of various specimens in orthopedic oncology and reporting, with rationale and recommendations from pathologists, actively involved in reporting and pursuing a special interest in bone tumors, based on current evidence. Furthermore, there is a section on some of the updates in the diagnosis of bone tumors, based on the recent fifth edition of the World Health Organization classification of tumors of soft tissues and bone.
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GYNECOLOGIC CANCER Top

Does educational-supportive program affect anxiety in women with endometrial cancer? Result from a randomized clinical trials p. 336
Soudabeh Niroomand, Samaneh Youseflu, Mitra Modares Gilani, Anoshirvan Kazemnejad, Leila Neisani Samani
DOI:10.4103/ijc.IJC_741_18  PMID:34380854
Background: Following a diagnosis of cancer, distress is a common reaction. For Iranian women with endometrial cancer, treatment and survivorship can result in disabling symptoms of depression, anxiety, social, and spiritual crises. The aim of this study was to determine whether a combination of education and support intervention as a comprehensive program focusing on education, coping, and support had better short- and long-term effects on anxiety of these patients. Methods: The current randomized clinical trial was performed on a sample of 140 women with endometrial cancer. A two-part instrument was used - a demographic information form and “Beck's Anxiety” questionnaire. The intervention was an educational-supportive program in 3 weekly sessions in experimental group (N = 70), whereas control group (N = 70) received routine care. Descriptive statistics, Chi-square test, t-tests, and repeated measure analysis of variance were used to analyze data. P value less than 0.05 was considered as statistically significant. Results: The total scores of anxiety (mean± standard deviation) was significantly lower in the experimental group immediately after intervention (8.46 ± 5.17, P < 0.001), 1 month (7.78 ± 4.59, P < 0.001) and 2 months (7.55 ± 4.55, P < 0.001) after intervention to compare with before intervention (16.82 ± 10.19). Conclusion: In this study, this program could decrease the anxiety in women with endometrial cancer.
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Long-term survival outcome of advanced epithelial ovarian cancer: A single institutional study p. 342
Patel Viral, Anupama Rajanbabu, Keechilat Pavithran, K Chithrathara, Indu R Nair, Renjitha Bhaskaran, Paleth Gangadharan, DK Vijaykumar
DOI:10.4103/ijc.IJC_165_19  PMID:33402564
Background: A number of patients with advanced-stage epithelial ovarian cancer do survive beyond 5 years. The long-term follow-up data are limited, especially for the Indian setting. We evaluated the 10-year survival outcome and influencing clinicopathological factors. Methods: A retrospective analysis of advanced-stage epithelial ovarian cancer patients who underwent primary cytoreductive surgery (PCS) or interval cytoreductive surgery (ICS) from 2005 to 2008 was conducted. Survival analysis was performed with the Kaplan–Meier method, and the Cox proportional hazards model was used for prognostic clinicopathological factors analysis. Results: Ninety-four patients with a median age of 54.5 (18–79) years were evaluated. The median follow-up period was 11.2 years. The overall survival (OS) rates at 5, 7, and 10 years were 37%, 23%, and 18%, respectively. The median OS (MOS) was 46 (95% confidence interval [CI], 36–55.8) months and progression-free survival (PFS) was 19.5 (15.3–23.6) months. Long-term survival was significantly predicted by R0 resection (complete cytoreduction with no macroscopic residual disease) and PFS >20 months while prolonged PFS was influenced by age ≤55 years and R0 resection. For the R0 resection group, patients who underwent PCS had better overall survival in comparison with ICS [72.1(25.2-119) months vs 47.4 (34.9–59.9)months] on 10 years follow-up but was not significant statistically. Conclusion: Patients with age ≤55 years, R0 resection, PFS >20 months have a better 10-year survival outcome. Among R0 resection, patients undergoing PCS have clinically a better outcome on 10-year follow-up.
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COLORECTAL CANCER Top

Effect of multimodal analgesia on perioperative insulin resistance in patients with colon cancer p. 349
Yuxuan Zhang, Tao Su, Ruixuan Li, Qiang Yan, Wen Zhang, Guiping Xu
DOI:10.4103/ijc.IJC_197_19  PMID:34380842
Background: High risk of post-surgery complications have always been related with uncontrolled blood glucose, while the relationship between blood glucose and analgesia has not been compared on radical resection of colon cancer. The aim of this study is to investigate the effects of multimodal analgesia on perioperative insulin resistance in patients undergoing radical resection of colon cancer. Methods: Sixty patients with colon cancer scheduled for radical resection surgery were equally divided into two groups randomly, the control group (TAP group) received general anesthesia and the transversus abdominis plane block analgesia, and the experimental group (GEA group) received extra epidural anesthesia. The analgesic efficacy was evaluated with visual analog scale (VAS). Insulin resistance indicators like fasting plasma glucose (FPG), resistin (RESIS), fasting insulin (FINS), homeostasis model assessment (HOMA) levels, and inflammation indicator interleukin-6 (IL-6) were evaluated during the surgery. Results: IL-6 increase was significant in the TAP group than that in GEA group (P < 0.01). The insulin resistance increased significantly in TAP group than that in GEA group including HOMA (P < 0.05) and FPG (P < 0.05). There was no significant difference in RESIS levels and VAS scores in the two groups. Conclusion: Epidural anesthesia leads to less inflammation in radical resection of colon cancer and the insulin level and insulin resistance increased after the surgeries based on FINS and HOMA..
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Clinical characteristics and survival profile of young versus old colorectal cancer patients at a tertiary cancer center in North India over a period of 5 years Highly accessed article p. 355
Smreti Vasudevan, Anurag Mehta
DOI:10.4103/ijc.IJC_246_19  PMID:33402579
Background: Colorectal cancer (CRC) is mostly considered a disease of the elderly. But the rate is increasing among young adults and is associated with different clinical patterns. The objective was to study the frequency of CRC in young patients and compare the clinicopathological profile and survival with the older cohort. Methods: Five-year (2012–2016) data of the 912 consecutive CRC cases treated at the center were analyzed. Clinical and histopathological characteristics were compared in young (≤40) and older (>40) patients. Descriptive statistics were used for data presentation. Categorical data were compared by the Chi-square test; survival analyses were performed by Kaplan-Meier method. Results: In total, 231 (25.3%) and 681 (74.7%) cases were in the young and older age groups, respectively. Male predominance was noted. Young patients presented predominantly in stage III (46%). Majority of the young patients harbored left-sided tumors (75.8% vs 63.7% in old patients, P = 0.001) and rectum was the favored site in young patients (53.7% vs 37%; P < 0.001). Poorly differentiated adenocarcinoma was more common in the young age group (46.88% vs 24.16% in old patients, P < 0.001), also signet-ring cell morphology occurred more often in young patients (11.7% vs 4%, P < 0.001). Survival was inferior in the patients presenting at an advanced stage or with adverse histology or poor tumor grade. However, stage-specific survival showed no significant difference between both groups. Conclusion: This study shows that though young CRC patients present with higher stage, aggressive morphology, and predominantly rectal localization, the overall survival and stage-specific survival did not differ significantly from the older patients.
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SOFT TISSUE SARCOMA Top

Pazopanib in metastatic soft tissue sarcomas: Testing the waters in developing world p. 365
Jyoti Bajpai, Sujith Kumar Mullapally, Akhil Kapoor, Jaya Ghosh, Bharat Rekhi
DOI:10.4103/ijc.IJC_314_19  PMID:33753596
Background: In metastatic soft tissue sarcoma (M-STS), pazopanib has demonstrated promising activity; however, there is dearth of data from lower and middle income countries. It is important to explore the feasibility (toxicity, acceptance), efficacy (response rates, survival), and optimal dose requirement of pazopanib in M-STS in India. Methods: All patients who received pazopanib for M-STS in 2013–2018 in Tata Memorial Centre were included. Institutional ethics committee approval was obtained. Assessment for response with contrast computed tomography scans was done as per the response evaluation criteria in solid tumors (RECIST) 1.1 criteria. Pazopanib was continued until progression or unacceptable toxicity. Clinical benefit rates and survival were evaluated by Kaplan-Meier method. All statistical calculations were done using SPSS version 21.0. Results: Seventy-two consecutive patients with a median follow-up of 17 (4–40) months were included in this study. Median lines of prior therapy were 2 (0–2). Among 50 evaluable patients, there were 12/50 (24%) partial responses, 25/50 (50%) stable disease, and 15/50 (30%) progressive disease. Median progression-free survival was 5 (95% confidence interval (CI) 3–6.9) months and median overall survival was 11 (95% CI 6.8–15.2) months. Adverse effects (G2/G3) in patients: hand foot syndrome-28%, hyperbilirubinemia/transaminitis-10%, diarrhea-20%, hypertension-17%, hypothyroidism-15%, anemia-6%, and fatigue-17%. Notably, 40% patient required dose reduction and median dose was 600 (200–800) mg daily. Conclusion: Pazopanib was found a feasible treatment option for M-STS in India with internationally comparable outcomes. However, significant patients required dose modifications, and median tolerated dose was lower than the standard 800 mg dose. This novel finding merits confirmation in larger cohorts for reproducibility.
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HEAD AND NECK CANCER Top

Evaluation of quality of life in patients surgically treated for potentially malignant oral lesions p. 371
Neharika Kapur, Nishu Singla, Adarsh Kudva, Evit Rajan John
DOI:10.4103/ijc.IJC_361_19  PMID:33402597
Background: The oral potentially malignant disorders (OPMDs) can impair the quality of life (QOL) of an individual. The evaluation of various aspects of life getting affected will help the health service providers to better comprehend the problems faced by the patients. This study aimed to evaluate the postoperative QOL of surgically treated patients for OPMDs. Materials and Methods: It was a cross-sectional study done on 45 follow-up patients, aged 24–80 years, who were surgically treated for OPMDs. A performa with questions regarding sociodemographics, personal, and abusive habits and a questionnaire on QOL was used. Oral examination was done to analyze the oral mucosa for recurrence. Data were analyzed using frequency analysis and unpaired student's t-test to compare the mean scores. Results: Several patients reported to have experienced a lot of pain (15, 33%), burning sensation on having spicy food (36, 80%), great difficulty in opening mouth (15, 33%), alteration in taste sensation (36, 80%), limiting of eating desired food (24, 53%), and dryness of mouth (7, 16%). Many patients felt very frustrated, depressed (9, 20%), and reported their condition to have affected their satisfaction with life (19, 42%). However, neither did social relationship with family and friends got affected by this nor did it add discomfort to them at parties, social functions, or get together. Their main concern was the likelihood of their oral condition progressing into cancer. There was a statistically significant difference in the QOL scores for habit of areca nut chewing (P = 0.05), erythroplakia lesions (P = 0.05), and recurrence of lesion (P = 0.02). Conclusion: OPMDs affected the physical, functional, and psychological well-being of study patients, caused discomfort, and affected their daily activities. However, the social well-being of patients was unaltered and a large number of patients were reportedly satisfied with their treatments. The timely diagnosis and management can improve the quality of life and prevent its progression to malignancy.
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PEDIATRIC CANCER Top

Pediatric ependymoma: A single-center experience from a developing country p. 378
Mahmoud Hammad, Maryhan Hosny, Ehab M Khalil, Ahmad S Alfaar, Mohamed Fawzy
DOI:10.4103/ijc.IJC_373_19  PMID:33402598
Background: Ependymomas are the third most common pediatric central nervous system (CNS) tumors, accounting for 6–12% of brain tumors in children. Management of these tumors remains challenging and recurrence occurs in over 50% of cases, mainly when complete resection is not achieved before radiotherapy. The 5-year overall survival (OS) ranges from 39 to 64%, with a 5-year progression-free survival (PFS) rate of 23–45%. The study aimed to describe the OS and PFS rates of cases of pediatric ependymoma. It also aimed to evaluate the effects of different variables on disease outcomes. Variables examined included patient age, the extent of surgical resection, radiotherapy and chemotherapy delivered, the histopathological subtype of the tumor, primary tumor location, and extent of the disease at presentation. Last, the challenges that potentially compromise treatment outcomes in resource-limited countries were to be highlighted. Methods: This is a retrospective cohort study, representing a single-center experience that included 47 pediatric patients treated at the National Cancer Institute, Cairo University, between January 2009 and December 2014. Results: Median follow-up stood at 23.5 months (range: 2–77 months). The average 3-year OS and PFS rates were 43.7 and 43.3%, respectively. Conclusion: The extent of surgical excision (maximal resection) and the adequacy of postoperative radiotherapy were the only two factors that had significantly affected the outcome. Understandably, treatment outcomes for ependymomas in developing countries still lag behind best reported outcomes, mainly due to inadequate surgical excision and postoperative radiotherapy.
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PANCREATIC CANCER Top

Incidence and age-standardized rates of pancreatic cancer in Sri Lanka from 2001 to 2010: An analysis of national cancer registry data p. 387
Umesh Jayarajah, Isuru Almeida, Ashan Fernando, Sanjeewa Seneviratne, Dharmabandhu Nandadeva Samarasekera
DOI:10.4103/ijc.IJC_238_19  PMID:33402567
Background: Varying trends in the incidence of pancreatic cancer (PC) are observed in many Asian countries. This study aimed at describing the incidence and age-standardized rates of PC in Sri Lanka from 2001–2010. Methods: A retrospective cohort evaluation of patients with PC from 2001 to 2010 was performed using the population-based data published by the Sri Lanka National Cancer Registry. The trends in the incidence of PC was analyzed by age and sex using joinpoint regression analysis. Results: A total of 808 PC patients studied from 2001–2010, of which males were 438 (54.2%). The mean (±standard deviation) age of the total population was 55.7 (±13.8) years [males = 56.5 (±13.3) vs. females = 54.8 (±14.3), P=0.07]. The World Health Organization (WHO) age-standardized incidence of PC in Sri Lanka increased marginally from 0.44 per 100,000 in 2001 (95% confidence interval (CI) = 0.34-0.54) to 0.58 per 100,000 in 2010 (95% CI = 0.46-0.69) which is a 1.3-fold increase (P < 0.05 for trend) with an estimated annual percentage change (EAPC) of 3.5 (95% CI = 0.5-6.6). The proportional increase in incidence was more significant in females compared to males. The analysis of the overall cohort rates of PC in Srilanka between 2001–2010 showed the highest rates in the 60-70-year category with an EAPC of 5.06 (95% CI = 1.3–9.0). Conclusion: In our study, we found that there was a marginal rise in the incidence of PC in Sri Lanka with a higher proportional increase in females compared to males.
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PREVENTIVE ONCOLOGY Top

Socio-demographic correlates of quit attempts and successful quitting among smokers in India: Analysis of Global Adult Tobacco Survey 2016-17 p. 394
Jaya Prasad Tripathy
DOI:10.4103/ijc.IJC_213_19  PMID:33402565
Background: MPOWER is a policy package of six components intended to assist in the country-level implementation of effective tobacco control interventions. One of the six components of MPOWER strategy is to offer help to quit tobacco use. Majority of the smokers want to quit, but quitting is difficult due to the addictiveness of nicotine. They make multiple quitting attempts with little success. There is a need to know what proportion of smokers make a quit attempt, and among those who make an attempt, how many become successful quitters and their sociodemographic correlates. Methods: Secondary analysis of data from the Global Adult Tobacco Survey (GATS-2) 2016–17, India was done. This nationally representative survey was conducted among persons aged 15 years or older. Weighted estimates were calculated after adjusting for clustering and stratification. Results: A total of 35.5% adults who smoked tobacco during the past 12 months have made a quit attempt in the last 12 months. Around 14.2% of ever daily smokers currently do not smoke (which indicate successful quit rate). The study demonstrated strong associations of sociodemographic characteristics such as age group, educational attainment, caste, religion, geographic region, wealth quintiles, and visit to health care provider with the attempt to quit tobacco and successful quitting. The majority of quit attempts were made without any assistance (71.1%). Conclusion: The study provides robust national evidence on attempts to quit tobacco, the success rates of those attempts, and their sociodemographic correlates. The study highlights the need to provide more cessation support to young, less educated people in the northern part of India.
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Second-hand smoke exposure and its determinants among nonsmoking adolescents residing in slum areas of Bhubaneswar, India p. 402
Dheeraj Sharma, Ansuman Panigrahi
DOI:10.4103/ijc.IJC_265_19  PMID:33402582
Background: Second-hand exposure (SHS) is a significant public health problem and accounts for over 600,000 deaths among non smokers worldwide every year. The study aimed to estimate the prevalence and determinants of SHS exposure among nonsmoking adolescents residing in slum areas of Bhubaneswar, India. Methods: Multistage cluster random sampling was used to select 259 nonsmoking adolescents from eleven slum areas. We used descriptive statistics to determine the prevalence of SHS exposure and inferential statistics using multivariable logistic regression model to identify factors associated with SHS exposure. Results: Of the 259 adolescent participants, 67 (25.9%) were exposed to SHS inside home and 97 (37.5%) were exposed outside home. About 47.5% adolescents were exposed to anti-smoking media messages and 22.8% were unaware of the harmful effects of exposure to SHS. SHS exposure inside home was associated with smokeless tobacco use (adjusted odds ratio [aOR]: 10.64; 95% confidence interval (CI): 2.57-43.48), illiteracy of father (aOR: 5.40; 95% CI: 1.51-19.32), non-exposure to antismoking media messages (aOR: 3.53; 95% CI: 1.06-11.72), and absence of knowledge regarding harmful effects of SHS (aOR: 3.72; 95% CI: 1.15-12.05). Also, variables like male gender (aOR: 10.31; 95% CI: 4.50-23.81), smokeless tobacco use (aOR: 2.43; 95% CI: 1.05-5.65), illiteracy of father (aOR: 4.58; 95% CI: 1.23-17.14), and non-exposure to antismoking media messages (aOR: 4.04; 95% CI: 1.49-10.89) had increased SHS exposure outside home. Conclusion: The findings underscore the urgent need to implement comprehensive smoke-free policies to reduce SHS exposure among slum adolescents.
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Evaluating the feasibility of utilizing Gynocular-triage-to-diagnose application with VIA (Visual inspection with Acetic acid) in community cervical cancer screening programs in rural Mysore, India p. 409
Vijaya Srinivas, Holly M Nishimura, Poornima Jayakrishna, Karl Krupp, Purnima Madhivanan, SubbaRao V Madhunapantula
DOI:10.4103/ijc.IJC_162_19  PMID:33402563
Background: Cervical cancer is the third most common cancer among women in India. The aim of the study is to determine the feasibility of using the Gynocular-triage-to-diagnose (Gynocular T2D/GT2D) in conjunction with visual inspection with acetic acid (VIA) in community-based cervical cancer screening programs in rural Mysore, India. Methods: Between November 2015 and August 2016, the Public Health Research Institute of India (PHRII) implemented a mobile cervical cancer-screening in Mysore district using VIA and GT2D. Women underwent speculum exams and VIA positive cases were identified. Swede score was assessed using GT2D and a score >4 indicated further monitoring or referral for treatment. Papanicolaou (Pap) smears were conducted for selected cases. Statistical analysis was performed using Chi-square and Fisher's exact tests. Results: Among 199 women registered in the camp, 176 were included in the final analysis. 23 women were excluded due to vaginal bleeding. The average age of women was 39 years (range = 27-59 years). Among the 176 cases, 38 (21.6%) were VIA positive and 138 (78.4%) were VIA negative. Swede score of >4 was observed in 6 VIA positive and 7 VIA negative women. Two cases among VIA negative with a score of >4 were suggested biopsy. Conclusion: Gynocular triaging prevented overtreatment of 32 (18.1%) participants, and identified 7 subjects with >4 Swede score even in VIA negative cases, which would have been ignored if VIA alone was used. In summary, our study demonstrates that Gynocular triaging is feasible in community cervical cancer screening programs.
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Feasibility, uptake and real-life challenges of a rural cervical and breast cancer screening program in Vellore, Tamil Nadu, South India Highly accessed article p. 417
Shalini Jeyapaul, Anu M Oommen, Anne George Cherian, Tobey Ann Marcus, Thabitha Malini, Jasmin H Prasad, Kuryan George
DOI:10.4103/ijc.IJC_271_19  PMID:33402583
Background: Early detection of breast and cervical cancer by organized screening has been found to reduce mortality rates in trials, but documentation of programme results and challenges is rarely done from non-trial settings. This study reports results of a population-based cancer control programme in a rural block in Vellore, Tamil Nadu, population size (116,085), targeting a population of 18,490 women aged 25–60 years, between November 2014 and March 2018. Methods: Village-based health education sessions were conducted by social workers, using trained volunteers and health workers to motivate eligible women. Screening was done at a secondary level hospital, by trained general physicians using visual inspection with acetic acid and clinical breast examination, followed by colposcopy, radiological imaging (breast) and biopsy as required. Results: A total of 8 volunteers and 17 health workers motivated women for 93 health education and screening sessions, in 46 out of 82 villages. While 1,890/18,490 (10.2 per cent) were screened for breast cancer, 1,783 (9.6 per cent) were screened for cervical cancer, with a yield of 3.4/1,000 for cervical pre-cancer/cancer. The main challenges were creating time for screening activities in a busy secondary hospital and difficulty in ensuring treatment completion of screen-detected cases. Conclusions: Population-based cancer screening programs can be offered by secondary hospitals that also run primary care services, to increase screening rates. Clear referral systems need to be established, bearing in mind that social factors, especially poor family support, may pose a threat to treatment, in spite of easy availability of cure.
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MCQS Top

MCQs on “Feasibility, uptake and real-life challenges of a rural cervical and breast cancer screening program in Vellore, Tamil Nadu, South India” p. 425
HS Darling, Pradeep Jaiswal, Nishant Lohia, Nishant R Tiwari
DOI:10.4103/ijc.ijc_1020_21  
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CASE REPORTS Top

Isolated Richter's transformation in central nervous system in a patient with refractory chronic lymphocytic leukemia p. 428
Tugba Cetintepe, Fusun Gedız Kobak, Sadi Bener
DOI:10.4103/ijc.IJC_31_19  PMID:34380835
A 67-year-old woman was diagnosed with Chronic Lymphocytic Leukemia (CLL) and chemotherapy was started. Due to epileptic seizure and left hemiplegia that developed on the twenty first day of the treatment, cranial magnetic resonance imaging was performed and a markedly increased mass of a diameter of 5 cm in the right frontal lobe was seen. Diffuse large B-cell non-Hodgkin lymphoma was concluded at diagnostic brain biopsy. Repeated bone marrow biopsy implemented simultaneously, was reported as CLL. Based on the diagnosis of isolated Richter transformation in the CNS secondary to CLL, R-IDARAM (Rituximab, idarubicin, dexamethasone,cytrabine, methotrexate) treatment was initiated. The patient died on the eighteenth day of treatment due to neutropenic fever and septicemia caused by pulmonary infection.
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JAK2 V617F mutation to calreticulin mutation in an essential thrombocythemia patient: A case report p. 431
Su-Yun Wang, Ning Yang, Li-Jun Zhang, Zhi-Yong Cheng
DOI:10.4103/ijc.IJC_106_20  PMID:34380850
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Oropharyngeal carcinoma in fanconi anemia patient - Radiation treatment, toxicity, and a year follow-up: Case report p. 434
Febin Antony, Jomon C Raphael, Mathew K Varghese, Paul Gopu
DOI:10.4103/ijc.IJC_162_20  PMID:34380851
Fanconi anemia (FA) is an inherited bone marrow failure disorder. In patients with FA, there is a high incidence of head and neck squamous cell carcinoma (HNSCC). As there is a defective DNA repair mechanism, radiotherapy (RT) or chemotherapy has an increased risk of toxicity in FA patients with HNSCC. We report the radiation treatment for oropharyngeal carcinoma in a FA patient. Our patient was treated with RT to a total dose of 60 Gy in 30 fractions. She developed grade 3 oral mucositis, grade 3 neutropenia, and thrombocytopenia at 20 Gy which resulted in treatment break of 11 days. She again developed grade 3 mucositis, grade 2 dermatitis, grade 3 thrombocytopenia, worsening of odynophagia at 44 Gy which resulted in a treatment break of 19 days. She completed RT and is now disease-free for 1 year with a good quality of life.
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Numb chin syndrome secondary to infiltration of inferior alveolar nerve as a presentation of relapse in treated testicular lymphoma—diagnosis on PET/CT and MR neurography p. 437
Ayush Jain, Shilpa Sankhe
DOI:10.4103/ijc.IJC_364_20  PMID:34380845
Numb chin syndrome (NCS) is a rare presentation of primary or recurrent malignant neoplasms among other non-neoplastic causes. The syndrome is characterized by altered sensations in the distribution of the mental nerve and presents with pain and paresthesias along the distribution of the inferior alveolar nerve and its branches. The primary diagnosis is indicated while following up patients through positron emission tomography/computed tomography (PET/CT) when a hypermetabolic focus is seen in the vicinity of the angle of the mandible. Further anatomical localization is performed using magnetic resonance (MR) neurography and postcontrast MR imaging, which demonstrates neural involvement. We hereby describe a case of a 56-year-old man, a treated case of DLBCL (diffuse large B-cell lymphoma), presenting with NCS and diagnosed with perineural invasion through PET/CT and further MR evaluation. To our knowledge, there are no other reports in the literature describing the MR neurography appearance of the inferior alveolar nerve in NCS. We hereby stress on the use of MR neurography followed by postcontrast 3D sequences with multiplanar reformatting for adequate lesion detection.
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Diagnosis of pseudomyogenic hemangioendothelioma of scapula on limited biopsy: A rare and challenging entity p. 441
Sahithi Shilpa Arya, Sudha S Murthy, Murali Krishna Puppala, Rajeev B Reddy, A Krishnam Raju
DOI:10.4103/ijc.IJC_428_20  PMID:34380853
Pseudomyogenic hemangioendothelioma (PHE) is a soft-tissue tumor of intermediate malignant potential, recognized as a separate entity in the WHO (World Health Organization) classification of tumors of soft tissue and bone, in 2013. This is a case report of a 33-year-old man with intraosseous scapular PHE reported on small biopsy and immunohistochemistry. The patient presented with local recurrence and metastases even after wide local excision and adjuvant radiotherapy after 14 months. The rarity of this lesion at this site and morphologic clues to diagnosis are important for optimizing the treatment protocol.
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PERSPECTIVE Top

A mortal prosody p. 445
Anindita Das
DOI:10.4103/ijc.IJC_1102_20  PMID:33753625
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VIEWPOINT Top

Regional anesthesia prevents cancer recurrence after oncosurgery! What is wrong with the hypothesis? p. 447
Abhijit S Nair, Vibhavari Naik, Mohammed Salman Saifuddin, Harini Narayanan, Basanth Kumar Rayani
DOI:10.4103/ijc.IJC_331_20  PMID:34380844
Several studies have investigated the hypothesis of the efficacy of regional anesthesia (RA) techniques in preventing cancer recurrence when used perioperatively during oncological surgeries. Although theoretically, the association appears beneficial, the patient outcomes after cancer surgeries with or without RA were comparable, that is, the use of RA did not improve patient survival or prevent cancer recurrence after surgery. Another problem with this data is its retrospective nature which makes its interpretation difficult. Moreover, there are a lot of other confounding factors like comorbidities, tumor biology, nosocomial infections, duration of hospital stay, and baseline immunity, which is not comparable, and hence make standardization for a well-designed prospective study difficult. Return to intended oncologic therapy (RIOT) involves treatment in the form of radiation or chemotherapy which, if received on time after the planned oncosurgery, could provide a better chance of preventing cancer recurrence and improved survival. However, none of the retrospective studies have correlated cancer recurrence with delay in RIOT or not receiving RIOT as a cause of cancer recurrence. This paper discusses why even a well-designed, prospective trial could possibly never establish the efficacy of RA in preventing cancer recurrence and improving survival due to the complexities involved in a patient undergoing oncosurgery.
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IMAGES IN ONCOLOGY Top

Follicular variant of papillary thyroid carcinoma with metastasis to the kidney p. 455
Magdalena Chrabańska, Michał Kępiński, Bogna Drozdzowska
DOI:10.4103/ijc.IJC_514_20  PMID:33402592
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LETTERS TO THE EDITOR Top

Mental nerve paresthesia in non-Hodgkin lymphoma: A subtle sign of occult malignancy p. 458
Adarsh Kudva, Ravindranath Vineetha, Shruti Gunashekhar, Ranjini Kudva, Mathangi Kumar
DOI:10.4103/ijc.IJC_225_20  PMID:34380843
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Lipid profile during chemotherapy in children with acute lymphoblastic leukemia p. 461
Dolly Madan, Priyanka Aggarwal, Anubha Jain, Vineeta Gupta
DOI:10.4103/ijc.IJC_280_20  PMID:34380832
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Philadelphia-positive de novo myelodysplastic syndrome: A new entity with review of literature p. 463
Rashmi Kushwaha, SP Verma, Geeta Yadav
DOI:10.4103/ijc.IJC_282_20  PMID:34380833
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Testing for latent tuberculosis before starting patients on immune checkpoint inhibitors p. 469
Chirag Dhar
DOI:10.4103/ijc.IJC_283_20  PMID:34380834
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COMMENTARIES Top

Epidural or TAP block to curtail insulin resistance in colorectal cancer surgeries: The jury is out! p. 471
Anju Gupta, Nishkarsh Gupta
DOI:10.4103/ijc.IJC_497_20  PMID:34380846
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Not just the tip of the iceberg: Commentary on Numb Chin syndrome p. 473
Aditya Jandial, Kamal Kant Sahu
DOI:10.4103/ijc.IJC_737_20  PMID:34380849
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NEWS Top

News from the world of oncology p. 476

DOI:10.4103/ijc.ijc_1064_21  
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