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   Table of Contents - Current issue
Coverpage
July-December 2021
Volume 1 | Issue 2
Page Nos. 67-119

Online since Wednesday, December 22, 2021

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EDITORIAL  

Covid era and cancer care p. 67
Amal Chandra Kataki
DOI:10.4103/aort.aort_30_21  
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PATIENT PERSPECTIVE Top

My experience p. 68
Ruby Ahluwalia
DOI:10.4103/aort.aort_22_21  
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REVIEW ARTICLES Top

Review of the application of dMMR and microsatellite instability in the diagnosis and treatment of endometrial cancer p. 71
Guangjie Liao, Jingqiu Yang, Xinke Zhang
DOI:10.4103/aort.aort_20_21  
Mismatch repair genes are responsible for discovering and repairing base mismatches during DNA replication in cells. Defects in mismatch repair function will lead to accumulation of gene mutations, microsatellite instability, and ultimately tumorigenesis. Mismatch repair genes are closely related to the biological behavior, patient prognosis, and related treatments of endometrial cancer. This article reviews the research progress of mismatch repair defect (dMMR) in the diagnosis and treatment of endometrial cancer.
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Delineating the role of autophagy in driving the resistance to cancer chemotherapy p. 78
PA Shantanu, NP Syamprasad, Bishal Rajdev, Basveshwar Gawali, Avdhesh Kumar Rai, Tashnin Rahman, VG M. Naidu
DOI:10.4103/aort.aort_26_21  
The development of resistance is one of the major complications faced by an oncologist for cancer treatment. Autophagy plays a crucial role in driving this resistance against most antineoplastic therapies. The evolutionarily conserved autophagy process meant for quality control of cellular organelles and protein complexes is overwhelmed by proliferative signals from various carcinogens. This leads to the accumulation of defective oncogenic proteins leading to carcinogenesis. As the tumor proliferates and grows in size, it reboots its autophagy pathways to supplement its ever-growing need for nutrients, oxygen, and energy supply. This review will discuss various molecular mechanisms of how physiological and metabolic stressors modulate autophagy, which drives the cancer cell's journey from dormancy to survival by fuelling the metabolic pathways involving internal cell restructuring and reshaping the tumor microenvironment. Considering the preclinical success of autophagy modulators for cancer treatment, this review will bring a new perspective and mechanistic explanation for using autophagy inhibitors for curtailing tumor progression and later using autophagy inducers for preventing cancer remission. This review will also help to formulate or repurpose safer and effective stand-alone and combination anticancer treatment strategies involving autophagy modulators.
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Chimeric antigen receptor T-cell therapy in the treatment of acute myeloid leukemia: Possible challenges p. 86
Rahul Jagdishchandra Mittal, Kanishk K Adhit, Naga Praneeth Vakkalagadda, Divya Bala A. M R. Salibindla, Tarun Kumar Suvvari
DOI:10.4103/aort.aort_18_21  
Cancer, which is considered one of the most dangerous diseases, can arise from any part of the human body. We are still lacking the effective and curable treatment modalities for many cancers that can affect the life of patients adversely. One such is acute myeloid leukemia (AML) that arises from the myeloid cells due to the somatic gene mutation that can disturb that particular cell lines or many cell lines together, thus causing overcrowding or inhibitory suppression of bone marrow. The biggest challenge that we are facing in terms of AML is not having an effective cure and increasing rates of relapse and recurrence. However, one of the therapeutic methodologies that are emerging nowadays is the chimeric antigen receptor T-cell (CAR T-cell) which have shown promising results, especially in the case of acute settings such as acute lymphoblastic leukemia and few relapsed cancers such as Ph negative ALL and multiple myeloma. CAR T-cells are the types of living drugs that are prepared from the T cells of patient's bodies and are cultured and grown artificially in the laboratory. They are also provided with artificially engineered receptors so that they identify the specific cancerous cells and kill only them without harming normal cells. No matter how novel it may sound, this modality is also not free from side effects, and some of the severe ill effects have been described and reported with the usage of CAR T-cells. Some of them may include severe cytokine storms, toxicities and failed treatment. Thus, we need to improvise on our techniques and there is a huge scope of future research in making CAR T-cells an effective and regular treatment option for patients suffering from AML.
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ORIGINAL ARTICLES Top

Health-related quality of life of patients after breast cancer treatment: A cross-sectional study p. 91
Maninder Deep Kaur, Budhi Singh Yadav, Divya Dahiya, Sukhpal Kaur, Akhilesh Sharma, Sushmita Ghoshal
DOI:10.4103/aort.aort_17_21  
BACKGROUND: Survival for breast cancer (BC) patients has improved significantly because of better treatment availability. However, patients may experience side effects after the completion of the treatment, which consequently affect their quality of life (QoL). The present study was planned to assess the QoL of BC patients after the completion of treatment. SUBJECTS AND METHODS: One hundred patients of BC after the completion of treatment from the Department of Radiation Oncology, PostGraduate Institute of Medical Education and Research, Chandigarh, India, were enrolled in the study during December 2017 to December 2018. EORTC QLQ C30/+BR23 questionnaires were used to quantify the QoL of these patients. RESULTS: The mean age of the participants was 49.35 ± 8.66 years. Mean global health status (GHS) QoL score was 64.6 ± 13.6. Functional scales, in most of the domains were high, whereas symptom scales were moderate to low for most items, showing better QoL. Pain (40.6 ± 19.1) and fatigue (54.8 ± 16.1) were the most disturbing symptoms. Patients exhibited higher scores for sexual functioning, whereas the least score was for future perspective. CONCLUSIONS: There was significant overall improvement in the QoL of patients with BC after the completion of treatment regarding functional scales and symptom scales as per EORTC QLQ-C30 questionnaire. As per EORTC QLQ-BR23 questionnaire, there was deterioration of the QoL concerning future perspectives for functional scale and hair loss for symptom scales.
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Prevalence and characteristics of abnormal Papanicolaou smear: A retrospective study from Sikkim, India p. 100
Tseten Wangyal Bhutia, Lhakit Lepcha, Ashok Tshering Sherpa, Priya Darshini Pradhan
DOI:10.4103/aort.aort_23_21  
BACKGROUND: Cervical intraepithelial neoplasia and cervical cancer remain chief health complications for women globally. Cervical cytology by Papanicolaou (Pap)-stained smears is an effective means of screening for cervical premalignant and malignant situations. This study was designed to determine and assess the prevalence and characteristics of abnormal Pap smears in this region of Sikkim, India. MATERIALS AND METHODS: This retrospective study was conducted in the Departments of Pathology at Multi-Specialty Hospital in Gangtok, Sikkim. All Pap smears screened during 2018 and 2020 were included in this study. Approximately 1256 Pap smears were reported based on Bethesda III System (2001). All abnormal smears patients' data were collected and evaluated accordingly. RESULTS: Most of the patients screened during the 2 years belonged to the ethnic group of Bhutias (15.45%), followed by Rai (12.90%), and the majority were aged 31–40 years (43.78%). Epithelial abnormalities categorized as atypical squamous cells of undetermined significance, atypical squamous cells-high-grade lesions, low grade squamous intraepithelial lesion, and high grade squamous intraepithelial lesion were found in 18.07%, 15.04%, 7.25%, and 4.77% of the women, respectively. The majority of the women with abnormal Pap smear were associated with inflammatory response, with moderate inflammation (33.07%), followed by severe (30.75%) and mild (24.36%) inflammation. The most common pattern was inflammatory which includes neutrophilic infiltration and reactive cellular changes with 66.6% of the case having irregular uterine bleeding (P = 0.002) followed by abnormal vaginal discharge (P = 0.3) and lower abdominal pain (P = 0.005). CONCLUSION: Prevalence of abnormal Pap smears in Sikkim, India is relatively low compared with other states of India. In contrast, the prevalence of progressive glandular anomalies with inflammation was observed to be high.
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Elevated mRNA expression levels of inflammation-related genes in triple-negative breast cancer: A pilot study from North East India p. 105
Rizwana Sultana, Syed Javed Salman Chisty
DOI:10.4103/aort.aort_25_21  
BACKGROUND: The prevalence of Triple-Negative breast cancer (TNBC) accounts for a large percentage of breast cancer cases in India. TNBC is associated with poor prognosis, higher mortality rate, ill-defined molecular etiology, and hence limited therapeutic interventions. AIM: The aim of this study is to evaluate the association of certain inflammatory markers with TNBC pathogenesis. MATERIALS AND METHODS: Prospectively collected resected breast cancer tissue samples along with adjacent normal control (n = 100) were prospectively collected in RNA Later. Differential mRNA expression analysis of inflammatory-related genes namely; inducible nitric oxide synthase (iNOS), endothelial nitric oxide synthase (eNOS), cyclooxygenase-2 (COX2), and Nuclear Factor Kappa B (NFκB) and were evaluated in non-TNBC and TNBC tissues samples along with adjacent normal control tissue samples with the help of mRNA specific primers using reverse transcription-polymerase chain reaction. Statistical analysis was performed using SPSSv13.0 software. RESULTS: A total of 60 non-TNBC and 40 TNBC tissue samples along with adjacent normal control were included for the study with informed consent and clinical details. The mean age of the TNBC patients was 39 ± 9 years, All the breast cancer cases were clinically staged as Infiltrating Duct Carcinoma (non-TNBC-invasive ductal carcinoma [IDC] II [n = 29 cases], non-TNBC-IDC III [n = 31 cases], TNBC-IDCII [n = 22 cases], TNBC-IDC III [n = 18 cases]). The results showed an upregulation of all the markers in TNBC cases compared to non-TNBC vis-avis non-neoplastic adjacent control area. Second, significant changes in iNOS mRNA expression were found to be associated with severity of TNBC cases (P = 0.020), while the expression of constitutively expressed eNOS was comparative between IDC-II and IDC-III stages of TNBC. CONCLUSIONS: The present study indicates that the mRNA-based differential expression results showed an upregulation of all the markers (iNOS, eNOS, COX2, and NFκB) in TNBC cases compared to non-TNBC cases vis-a-vis non-neoplastic adjacent control area. Significant changes in iNOS mRNA expression were found to be associated with severity of TNBC cases (P = 0.020), depicting the role of iNOS-induced inflammation in the pathogenesis of TNBC.
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Prevalence of Epstein–Barr virus in North-East Indian breast cancer patients' blood p. 111
Kamalika Bhandari Deka, Pallavi Sarma, Anupam Sarma, Gaurav Das, Subhradip Karmakar, Goura Kishore Rath, Avdhesh Kumar Rai
DOI:10.4103/aort.aort_24_21  
BACKGROUND: Breast cancer (BC) has been the most frequently diagnosed cancer among women and it has multiple risk factors. Epstein–Barr virus (EBV) has been shown to be associated with BC as one of the risk factors. Our aim was to detect EBV DNA in blood samples of BC patients of North-East India. MATERIALS AND METHODS: A total of 53 eligible BC patients' samples were analyzed by Nested polymerase chain reaction for EBV Antigen-1 (EBNA1) gene. All statistical analysis was carried out using the software of statistical package for social sciences (SPSS) version 21. RESULTS: 20.8% (11 of 53) BC patients' blood samples have EBNA1 gene DNA. The median age of BC patients was 42 and 43 years for EBV-positive and EBV-negative groups. 96.22% EBV-positive BC patients were diagnosed with high-grade malignancy. 54.54% of EBV-positive BC patients were diagnosed with T3 and T4 stage cancer. EBV-positive patients have not shown statistically significant association with ER positive (P-0.877, odds ratio [OR]: 1.111), PR positive (P-0.256, OR-2.16), Her-2/neu positive (P-0.93, OR-1.017), Ki-67 positive (P-0.487, OR: 1.8), and AR positive (p-1.000, OR-0.836). CONCLUSION: We conclude from our study that EBNA1 gene was found in the blood samples of subset of BC patients of North-East India. Further studies with BC tissue and adjacent normal tissue samples of BC patients will be required to provide evidence about EBV's role with BC of North-East India.
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CASE SERIES Top

Anorectal malignant melanoma – Case series p. 116
Jayabal Pandiaraja
DOI:10.4103/aort.aort_13_21  
Anorectal melanoma is a rare tumor of the anal canal. It is <1% of all anorectal malignancies and 1%–2% of melanoma. Because of the presentation and aggressive nature of the tumor, the prognosis remains poor. The patient often presents with nonspecific complaints such as bleeding per rectum or altered bowel habits. Because of the late presentation and aggressiveness, the selection of treatment modality is limited. This case series reviews the clinical features and management of patients with anorectal malignant melanoma.
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SPECIAL SECTION Top

Editorial clarification p. 119
Manigreeva Krishnatreya
DOI:10.4103/aort.aort_27_21  
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