Combined modality therapy with surgery followed by appropriate adjuvant treatment with radiation therapy with or without concurrent chemotherapy based on risk factors is the standard of care for locally advanced cancers. However, in early cancers with unfavorable features, treatment policies vary across different centers, with decisions often based upon the treating oncologist's clinical discretion and institutional practice. In this review article, we intend to discuss the existing literature on the role of adjuvant treatment intensification in early node-negative and single node-positive oral cavity cancers.

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BACKGROUND: The northeast region of India has an overall high incidence, mortality, and lower survival rate of cancer in the country. Mortality rate is increasing mainly because of difficulties in accessing the facilities for cancer diagnosis and treatment, socioeconomic conditions, lack of awareness, taboo, misconception, and wide disparity in both diagnosis and treatment of cancers in this region. MATERIALS AND METHODS: Data were abstracted from hospital-based cancer registry of a regional treatment center from years 2010 to 2014. A total of 21,793 men were registered with cancer and 44.7% (9738/21,793) were followed up with their vital status. Kaplan–Meier method was used to generate the survival statistics. RESULTS: The 5-year overall survival for all cancers in men is 24.3% with earlier stage at diagnosis has a better survival (Stage I: 52.1%) than later stage (Stage IV: 18.8%). The 5-year survival for completed cancer directed treatment is 27.5% followed by 12.5% for incomplete and 8.5% for those with no cancer-directed treatment group. Inequality in survival was observed among different sites of cancer, as some cancers harm more than others. The 5-year absolute survival for all sites was ranged from 0% to 75.8%. Cancer of liver (0%), pancreas (0%), lung (2.4%), gallbladder (7.9%), and stomach (10.3%) is found as more lethal than other cancers as the 5-year survival was in-between the range 0%–10%. Cancer of Hodgkin lymphoma (75.8%) has the highest 5-year cancer survival rate, followed by testis (60.1%), breast men (55.3%), penis (49.7%), and skin cancer (49.1%). CONCLUSION: With close to 0%–2.6% 5-year overall survival in hospital setting for cancers of liver, pancreas, and lung, respectively, it needs to mobilize resources for these three cancer sites, in terms of treatment, supportive care, and palliation.

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Columnar cell carcinoma variant is a rare aggressive variant of papillary thyroid carcinoma (PTC) with unique histological features. They represent only 0.15%–0.2% of all PTCs. It is difficult to diagnose them on fine-needle aspiration cytology as they lack the classic nuclear features of PTC. Histologically they can mimic metastatic carcinomas from colon, endometrium, and lung. However, characteristic histological features combined with immunohistochemistry (IHC) findings help in accurate diagnosis. We describe the cytological, histopathological, and IHC findings of a rare case of PTC-CCV in a 23-year-old female and review the pertinent literature. It is important to diagnose this variant of PTC accurately, as it has prognostic and therapeutic implications.

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BACKGROUND: Postmastectomy radiation therapy (PMRT) is delivered routinely with photon techniques, chest wall radiation with electron techniques have the advantage of reduced deeper tissue doses and can be tried in suitably selected cases. This study is to retrospectively evaluate the locoregional control, toxicity, disease-free survival (DFS), and overall survival of patients treated with postmastectomy chest wall electron radiation at a single center. MATERIALS AND METHODS: The data of 450 patients who received PMRT with electron therapy from 2004 to 2014 were analyzed. Patients were treated with three-dimensional (3D) conformal radiation therapy with 6–8 MeV electrons to chest wall and 6 MV photons to supraclavicular fossa and medial axilla. Data collection was done from hospital medical records and analyzed with IBM SPSS 20.0. The results are given in mean ± standard deviation for continuous variables or as percentage for categorical variables. Kaplan–Meier survival analysis and log-rank tests were used. P < 0.05 was considered as statistically significant. RESULTS: Patients' median age was 64 years (range: 24–74 years). Early stage accounted for 108 (24%) patients, 306 (68%) were advanced stage, and for 36 (8%) patients, stage was unknown. Of these, 174 (38.7%) patients were offered hypofractionated schedule and 276 (61.3%) with conventional fractionation. No Grade 3–4 skin reactions were reported over the irradiated area on treatment completion. Twenty-three (5.1%) patients had chest wall recurrence and 33 (7.3%) patients developed locoregional recurrence. Overall recurrence including systemic metastasis was 127 (28.2%). Long-term data did not show any cardiac or pulmonary mortality documented as radiation related. The median follow-up of our group was 67 months (6–173 months). DFS at 5 and 10 years was 81.4% and 79.5%, respectively. OS at 5 and 10 years was 85.2% and 79.7%, respectively. CONCLUSION: PMRT with chest wall enface electron is feasible, and the advantage of electron field is better sparing of deeper structures, especially cardia in left-sided postmastectomy irradiation, thus more complex techniques such as Intensity Modulated Radiation Treatment (IMRT) and respiratory gating can be reserved for patients with more complicated anatomy where routine 3DCRT technique is unacceptable in terms target coverage and critical normal tissue sparing.

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Screening of microscopic slides is a manual process that involves its subjectivity. A semi-automated computer-based system can contribute to the detection of screening errors by increasing the reliability measure. Traditional machine learning approach or deep learning approach can be used in the semi-automated digital clinical system. The traditional machine learning approach is not very efficient because it involves a lot of heavy mathematics and not able to learn highly complex features. This article presents a systematic summary of the existing solutions of detection of malignancy (breast cancer detection) from fine-needle aspiration cytology images and the segmentation method of nuclei because malignancy can be observed mainly from nuclei feature. It also reports various research issues, challenges and proposes the future research direction. This analysis is helpful for the better use of existing methods and for improving their performance, as well as designing new methods and techniques.

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The incidence of squamous cell carcinoma arising from pressure ulcers has been reported to be as low as 0.5%. Malignant transformation arising from pressure ulcers is frequently overlooked as they often present with invasive infections. This results in wide defects post-excision which may not be amicable to reconstruction with conventional locoregional flaps. Through this case report, we discuss the versatility of using the bilateral gluteus maximus V-Y advancement flap following resection of sacral squamous cell carcinoma (Marjolin's ulcer).

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BACKGROUND: There have been inconsistent results on the association of body mass index (BMI) with tumor characteristics, hormone, and menopausal status in breast cancer (BC) patients. OBJECTIVE: This study was intended to analyze the association of BMI with menopausal status, tumor characteristics, and hormone receptor status in BC patients. We also analyzed the significance of human epidermal growth factor type 2 receptor (HER-2)/neu status in association with menopausal status, tumor size, tumor grade, and nodal status in patients with BC. MATERIALS AND METHODS: Histologically proven 188 patients of BC with IHC report were included in this study done over 1 year period. Demographic data, pathologic features, and biological receptor status of cases were collected from the patient's records. Chi-square/Fisher's exact test, independent t- and analysis of variance (ANOVA) test were adopted to explore whether BMI differed according to biological receptor status in pre- and post-menopausal women. RESULTS: BMI was found to be significantly associated with the menopausal status of patients (P = 0.02). However, BMI lacks significant association with tumor size, stage, grade, and lymph node status in both pre- and post-menopausal patients. Estrogen receptor, progesterone receptor, and HER-2/neu expression were found to have a statistically significant correlation with tumor size (P < 0.001). Statistically significant correlation was also observed between age at the time of diagnosis and HER-2/neu expression (P = 0.02). CONCLUSION: This study revealed that BMI has a significant association with menopausal status. The frequency of expression of ER/PR was the same as reported in the literature; however, expression of HER-2/neu was high in postmenopausal women. Findings from this study may help to develop patient awareness of potentially modifiable lifestyle risk factors such as overweight and obesity as HER-2/neu positivity is associated with poor prognosis.

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Triple-negative breast cancers (TNBCs) are aggressive tumors with a high risk of visceral metastasis and poor prognosis. Here, we report a case of a 57-year-old postmenopausal female with gBRCA1-positive metastatic breast cancer. She was treated for endometrioid type, Stage IB Grade 2 endometrial carcinoma with pelvic external beam radiation in 2014. In 2016, she developed Stage I TNBC for which she underwent BCS followed by chemotherapy with anthracycline and taxanes. She also received accelerated partial breast irradiation. In 2019, she developed brain and lung metastasis. For the brain disease, she underwent gross total excision followed by whole-brain radiotherapy (WBRT). For the lung lesion, she received stereotactic body radiotherapy. Subsequently, she developed extensive metastases which were treated with cisplatin and vinorelbine chemotherapy and had a complete response. Within 5 months, she developed rapid progression of the disease in brain, lungs, and right adrenal. She was treated with palliative WBRT, but she died of progressive disease within the next 2 months.

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A 45-year-old female was diagnosed with infiltrating duct carcinoma (IDC) left breast in 1982. She underwent a mastectomy followed by locoregional radiotherapy and chemotherapy with cyclophosphamide, methotrexate, 5-fluorouracil. The patient developed left axillary swelling (3 cm × 3 cm) in 2004; fine-needle aspiration cytology (FNAC) was suggestive IDC, metastatic. The patient was started on tablet letrozole 2.5 mg but stopped it due to a cardiac problem. She reported with increase in the size of left axillary swelling in 2008. FNAC was reported as IDC, recurrence. There were no metastases on further workup. She was started on exemestane 25 mg and was also given radiotherapy to the left axilla. In 2012, bone scan was suggestive of multiple skeletal metastases. She was put on exemestane till 5 years. Again in 2013, she had left axillary swelling but the patient was not willing for FNAC. The patient was now started on anastrozole 1 mg. She again had back pain; bone scan was done and it was suggestive of multiple skeletal metastases. She was continued on anastrazole. In February 2015, she developed small nodules in the left axilla and anterior abdominal wall. FNAC of both sites was positive for carcinoma, metastatic. Bone scan again showed multiple skeletal metastases. Positron emission tomography scan did suggest local recurrence with metastatic radiculopathy in left axilla and widespread metastases Biopsy from the left axilla revealed IDC and it was strong estrogen receptor, progesterone receptor positive, and Her 2 neu negative. She was 78 years now with KPS 40 and cardiac morbidity. Her disease progressed rapidly to lungs and she died.

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BACKGROUND: Pelvic masses following hysterectomy are common findings in Gynecologic Oncology centers. Incomplete preoperative evaluation, inadequate surgery (subtotal hysterectomy/only hysterectomy without salpingo-oophorectomy in postmenopausal women), and delay in histopathological diagnosis are few reasons for missing out on malignant etiologies. The diagnostic dilemma exists because of unknown primary malignancy. This study aims to highlight the various pathologies that present as pelvic masses after hysterectomy and their management based on histopathological examination and immunohistochemical (IHC) markers. MATERIALS AND METHODS: This was a retrospective analysis of all women who presented in 1-year duration (January 2019–December 2019) to the gynecologic oncology department with pelvic mass and prior history of hysterectomy done outside. The data of these women were critically analyzed in regard to their demographic profile, preoperative and postoperative characteristics, histopathological and IHC markers of pelvic mass, management of the disease, and their outcome. RESULTS: The total number of patients eligible for the study was 17. The median time to presentation after hysterectomy was 5 years (range: 1–20 years). The origin was female genital tract in 16 women and urothelial in 1 patient. Management options of these patients were concurrent chemoradiation/palliative radiotherapy/palliative chemotherapy/palliative care. The overall survival of these patients was dismal. CONCLUSION: Before proceeding with hysterectomy, thorough evaluation should be done for all patients with even minimal symptoms. Early identification of malignant disease and management by a multidisciplinary team can greatly affect the overall prognosis of the patient.

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A gastrointestinal stromal tumor (GIST) is a most common mesenchymal tumor of the gastrointestinal tract. GIST is more common on the stomach, followed by the small intestine and rarely occur in other locations. We present an unusual case of large jejunal GIST arises from the antimesenteric border. Most of the small intestinal GIST present as a mobile mass in the right iliac fossa. Hence, a patient with mobile right iliac fossa mass without signs of obstruction or minimal signs of obstruction should consider the small bowel GIST as one of the differential diagnosis and plan for prompt intervention. Good preoperative imaging will diagnose small intestine GIST. Proper preoperative diagnosis and timely intervention will reduce the complication such as tumor rupture, spillage, R1 resection, and local recurrence. Postsurgical chemotherapy with Imatinib will reduce the recurrence rate and increase the survival.

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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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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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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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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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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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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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The recent ICMR-NCDIR population-based cancer registry data indicate that India's Northeast (NE) region is a hotbed of cancer cases, and has been dubbed as the “Cancer Capital of India” in the past literature. While the national average for cancer incidence cases is 80–110 per lakh, the Northeast region has almost double the rate at 150–200 cases per lakh population. In addition to a unique cancer profile and high incidence rates, the NE region has reported poor clinical prognosis and cancer survival rates. With the rising cancer burden and inadequate cancer care facilities in the region, a high proportion of patients seek treatment outside the region which further aggravates the physical and economic burden of care. It is high time that relevant stakeholders of the NE region come on board and earnestly address the inequitable status of cancer care services in the region. One important aim in developing a standard multimodality cancer care system in the region that needs immediate redressal is the deficit in Nuclear Oncology services. The Nuclear Oncology facilities host specialized services such as Position emission tomography/Computed tomography (PET/CT), positron emission tomography/magnetic resonance imaging (PET/MR), and Radionuclide therapy, which plays an important role across the spectrum of cancer diagnosis, management, and follow-up and therapy. Nuclear Oncology resources in the NE region are lagging far behind compared to the rest of India, considering the imminent and projected requirements. There is an acute shortage of nuclear medicine facilities, PET/CT, PET-MR, Cyclotrons, and trained men power in the NE region. We have attempted a desk review of the current scenario of Nuclear Oncology in the NE region and have extrapolated the burden-matched Nuclear Oncology resource that is required for the region.

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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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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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We report the challenges faced in the villages' Breast Cancer Hub (BCH) adopted in Cachar, Assam, India, since February 2020 during the coronavirus disease 2019 (COVID-19) outbreak. We also present the overall challenges, during COVID-19, even in the urban sectors, with good financial conditions. We report the challenges faced at the grassroots level and how we addressed the concerns. The villages BCH adopted for door-to-door cancer screening, BCH takes care end to end, starting from generating the income certificate, accompanying the patients to the hospitals, helping with registration, communication with doctors, treatment management, covering all the supplemental expenses, with diligent follow-ups, and counseling, making sure that the re-visits to hospitals are also carried out by the BCH team, or in most cases, the patients are negligent to continue their treatment and miss out on the follow-up dates. COVID-19 pandemic worsened the prevailing difficult situation of cancer diagnosis and treatment in North East India.

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