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   2022| July-December  | Volume 2 | Issue 2  
    Online since November 18, 2022

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Nuclear Oncology in Northeast India: Current scenario, challenges, and way forward
Kalpa Jyoti Das, Jitendra Kumar Meena, Abhinav Singhal
July-December 2022, 2(2):71-76
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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Cancer cannot stop me
Sarika Mohan
July-December 2022, 2(2):110-111
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Breaking bad news to patients: A qualitative study of views of patients' relatives
Kabindra Bhagabati, Samujjhal Bharadwaj, Anindita Das, Tarun Sonowal, Uttam Changmai
July-December 2022, 2(2):82-91
BACKGROUND: In India, relatives do not want to disclose the diagnosis to patient. The aim of this study is to know what are the views, beliefs, and concerns of patients' relatives about disclosure of the diagnosis and prognosis to patients. MATERIALS AND METHODS: The study was conducted at a tertiary cancer center in India. It was a qualitative research with grounded theory approach to study and understand the matrix of information sharing to cancer patients by the caregiving family members. Information was collected by asking to answer a questionnaire in their own language, which was transcribed to English language. This has been certified and approved by the hospital ethics committee. RESULTS: Fifteen eligible and consenting participants of patients' relatives were recruited during their first visit to the outpatient clinic. Patients were selected randomly from the age group of 18 to 60 years having cancer but without having any metabolic diseases. Although 93.3% of the patients were eager to know the information, only 20% of the relatives wanted to disclose diagnosis and 33.3% wanted to disclose all information to patients. Most of the relatives were concerned about the psychological breakdown and depression of patients. CONCLUSION: Several apprehensions were expressed by relatives regarding breaking bad news (BBN). The importance of BBN to patients in relation to enhance the trust between doctor and patient relationships and to improve the quality of life of patients should be conveyed to relatives, to assure them for improving better patient care.
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Synchronous cribriform morular variant of papillary and follicular carcinoma thyroid: A case series of a rare collision tumor
Zikki Hasan Fatima, Mohd Rafey, Nuzra Fazal, Kafil Akhtar
July-December 2022, 2(2):92-96
The synchronous presence of cribriform-morular variant of papillary thyroid carcinoma with follicular carcinoma is very rare. Collision tumors or the coexistence of histologically distinct malignant tumors in the same organ constitutes only 1.0% of all thyroid malignancies. The postulated hypothetical theories to the collision tumors are stem cell theory, collision theory, and hostage theory, which try to explain the synchronous association of these thyroid neoplasms. We report the case series of a synchronous cribriform-morular variant of papillary thyroid cancer and follicular thyroid carcinoma, which to our knowledge has not been reported till date.
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Air pollution and cancer: Growing concern in low- and middle-income countries
Abhishek Shankar, Deepak Saini, Shubham Roy
July-December 2022, 2(2):66-70
Air pollution has become a major health issue affecting billions of people and effects are more pronounced in low- and Middle-income countries (LMICs). Air pollution is a major contributor to the burden of disease worldwide. Most of the global population resides in places where air pollution levels exceed the WHO acceptable limits, caused by various industries, power generation, transportation, and domestic burning. More than 85% of total air pollution death are observed in LMICs. There are many carcinogens that are found in air pollution. There is substantial evidence from studies of humans and experimental animals as well as mechanistic evidence to support a causal link between outdoor (ambient) air pollution and cancer.
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High-grade carcinoma with neuroendocrine differentiation of the urinary bladder: A case report of a rare variant
Shashank Bansal, Prutha Jinwala, Aditya Elhence, SP Shrivastava, Vikas Asati, Rajesh Patidar, Prakash G Chitalkar
July-December 2022, 2(2):104-106
Neuroendocrine bladder carcinoma is considered a rare variant (<1%) with highly aggressive potential. Because of the rarity of its presentation, available data are mainly from published case reports. A 40-year-old male presented with painless hematuria for the past 3 months. After evaluation, he underwent radical cystectomy with pelvic lymph node dissection with urinary diversion. Histopathology from the postoperative specimen was suggestive of high-grade carcinoma with neuroendocrine differentiation (CK-focal positive, synaptophysin-focal positive, GATA-3, CD-56 positive and Ki-67 85%–90% chromogranin A-negative) stage pT4bN2M0. The case was discussed in the multidisciplinary tumor board and was planned for adjuvant chemotherapy with cisplatin (75 mg/m2) and etoposide (100 mg/m2) Repeated every 21 days. He completed six cycles of adjuvant chemotherapy and was on follow-up. Within 3 months of completing adjuvant therapy, he presented again with a complaint of hematuria and on evaluation found to have a localized recurrence, following which he received radical chemoradiotherapy and is now on follow-up. Our case provides evidence to think us in new dimension, with chemotherapy in adjuvant and radiation in salvage settings instead of adjuvant settings.
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Synchronous Hodgkin's lymphoma and periampullary carcinoma: An unusual association
Syeda Iqra Usman, Kafil Akhtar, Bilal Hussain, Shahid Ali Siddiqui
July-December 2022, 2(2):97-100
Carcinomas arising within 2.0 cm of major duodenal papilla are called periampullary carcinomas. These include carcinomas of the ampulla, distal common bile duct, pancreas, and duodenum. Hodgkin's lymphoma is a malignant neoplasm of lymphoreticular cell origin characterized by the presence of Hodgkin's and Reed–Sternberg cells. We report the case of a 58-year-old male with a 9-month history of abdominal pain, nausea, and vomiting with jaundice and itching all over the body for the past 4 months along with generalized lymphadenopathy and fever for the past 7 months. On ultrasonography, a periampullary mass of size 6.6 cm × 3.5 cm was noted. On computed tomography, an ill-defined soft-tissue mass measuring 7 cm × 3.5 cm × 1.8 cm was seen in the periampullary region with marked dilatation of common bile duct and generalized lymphadenopathy. Fine-needle aspiration and biopsy from both the mass lesions were performed. The patient underwent the Whipple procedure. He was diagnosed with synchronous periampullary carcinoma of the pancreas with Hodgkin's lymphoma based on radiological and histopathological examination of resected mass and excisional biopsy of a lymph node.
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Myxopapillary ependymoma: A rare case presentation
Kafil Akhtar, Rachel Cynthia Tirkey, Bilal Hussain
July-December 2022, 2(2):107-109
Ependymomas are the preponderant glial tumors of the spinal cord. Myxopapillary ependymoma (MPE) is a subtype of ependymoma, first described by Kernohan in 1932. This is a slow-growing, benign tumor. It occurs in the third to fifth decade of life and constitutes 0.5% of cases of ependymomas. MPE is an intradural lesion that arises mainly in the conus medullaris, cauda equina, and filum terminale. The presenting features of these fleshly, sausage-shaped, vascular lesions are chronic low back pain with or without sciatica. Magnetic resonance imaging is helpful in the diagnosis of the primary and recurrent lesions. Regular close follow-up is recommended for better prognosis. We present a rare case of MPE in a 50-year-old male who presented with lower back pain and retention of urine for the last 1 year.
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Tryst with minimally invasive surgery for cancer: Better late than never
Gaurav Das
July-December 2022, 2(2):63-65
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“Wnt/β-catenin-activated Ewing's sarcoma with metastasis to pancreas:” A rare case report
Shilpa Kapoor, Trupti Patel, Kanwalpreet Kaur, Priti Trivedi
July-December 2022, 2(2):101-103
Ewing's sarcoma (ES) family of tumors are aggressive tumors with high metastatic potential. Various unusual sites of metastasis have been reported, with pancreas being one of the exceptional sites. Herein, we report a case of a 21-year-old biopsied for a pancreatic mass and its histopathological evaluation revealed infiltration by a malignant small round cell tumor. Given that the patient was under treatment for ES of the right iliac bone an immunohistochemistry panel applied showed CD99, FLI-1 positivity proving it to be a metastasis. Furthermore, β-catenin put on clinical suspicion of solid pseudopapillary neoplasm was positive. Recent evidence suggest that elevated β-catenin expression is associated with poor outcomes, signifying Wnt/β-catenin signaling pathway contributes to disease progression. We not only report an uncommon metastasis of ES to the pancreas with four other cases reported so far but we also attempt to analyze probable correlation of β-catenin to disease advancement and its prognostic implication.
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Colorectal cancer presenting in young adults in Kamrup Urban District cancer registry (2007–2016)
Debanjana Barman, Arpita Sharma, Chinmoy Misra, Ranjan Lahon, Barsha Roy Deka, Manoj Kalita
July-December 2022, 2(2):77-81
INTRODUCTION: According to the GLOBOCAN 2020 report, colorectal cancers (CRC) comprise 10.6% of all cancers worldwide. Globally, colon cancers are the fourth-most common cancers, and the rectum is the 7th among all cancers in both sexes. However, the recent reports have shown that the incidence rates of CRC are rising in the younger age group. MATERIALS AND METHODS: Population-based cancer registry (PBCR) – Kamrup was established in 2003 under the network of the National Cancer Registry Program of the Indian Council of Medical Research. The data sources for the study have been used from the urban component of PBCR – Kamrup only. The data collected over the 10-year period of 2007–2016 are presented here. RESULTS: A total of 831 cases were diagnosed with CRC cases, of which 434 (52.2%) were colon cancers and 397 (47.8%) were rectal cancers. Of the total 831 cases, 132 cases (15.9%) were below 40 years of age, of which 60 (13.8%) were colon cancers and 72 (18.1%) were rectal cancers. The age-standardized rates of colorectal cancer in India have been estimated to be 6.0 in males and 3.7/100,000 in females. For colon cancers, the Aizawl district had the highest age-adjusted rate (7.2), followed by Mizoram state (5.5) and Kamrup Urban (5.4) in males. CONCLUSIONS: Colorectal cancer, though a disease of the elderly, is seen in younger age groups with increased incidence in the recent years.
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