Spectrum of Breast Diseases: Histopathological and Immunohistochemical Study from North India

Introduction: Breast disorders commonly present as masses, which are mostly benign. However, breast cancer is the most common form of cancer and second leading cause of death among women. The study aimed at analyzing the spectrum of breast diseases especially breast cancers and assess the estrogen and progesterone receptor (ER/PR) and Her2/neu status of breast cancers on immunohistochemistry (IHC).

Materials and Methods: This was a descriptive study of 2 years (Jan 2014 - Dec 2015). All specimens of primary breast diseases received during this period at the Department of Pathology, Shri Ram Murti Smarak Institute of Medical Sciences, Bareilly, UP, India, were analyzed.

Results: A total of 148 breast specimens from 10 males and 133 females, (age range, 15 - 75 years; mean age, 36 years) were selected. Majority of patients presented in 4th (29.7%) and 3rd (27.7%) decades with breast lumps (97.3%), affecting mostly right breast (52%). Benign diseases (60.1%) were the commonest followed by malignant (28.4%) and inflammatory lesions (11.5%). Fibroadenoma (52.6%) and fibrocystic change (21.8%) were the commonest benign diseases and granulomatous mastitis (23.5%), the commonest inflammatory lesion. Malignancy contributed 30.6% of female breast lesions (age range, 25-75 years and mean age, 48.2 years) with 97.6% of cases being infiltrating ductal carcinomas. ER expression was seen in 58%, PR in 54.8% and Her2/neu positivity in 45.2% cases. In males, gynecomastia was the most common breast lesion (90.9%).

Conclusion: Breast diseases affected mostly young people with fibroadenoma and infiltrating ductal carcinoma being the commonest diseases. Malignant breast diseases affected females only. ER/PR hormone receptor expressions are lower compared to western countries.

Keywords: Breast diseases, benign breast diseases, breast cancer, north India

Concurrent Paclitaxel and Radiotherapy for Node Positive Breast Cancer

Asmaa Ali Hassan¹, Noha Yehia Ibrahim¹, Mohamed Abdel Rahman Kassem¹, Abdel Aziz Mostafa Toeama^2
1 Clinical Oncology Department (NEMROCK), Kasr Al-Ainy School of Medicine, Cairo University, Egypt
² Clinical Oncology Department, Al-Azhar University, Egypt

Background: Concurrent chemo-radiotherapy in breast cancer (BC) may yield better local control with minimal toxicity in node positive patients. The feasibility of paclitaxel with radiotherapy was assessed for tolerability, cosmetic outcome as well as local control.

Methods: A prospective feasibility study on forty-three female breast cancer with stage II-III was conducted after definite surgery (modified radical mastectomy and breast conservative surgery). Adjuvant chemotherapy given was 4 cycles AC (Doxorubicin 60mg/m2+ cyclophosphamide 600mg/m2) followed by 4 cycles of Paclitaxel 60mg/m2 weekly for 12 weeks concurrent with 3D Conformal radiotherapy in a dose of 5Gy/20ttt/4wks to the whole breast and supraclavicular nodal region. Boost of 10Gy/5ttt was given to the tumor bed in conservative cases. Evaluation of lung function was done by carbon monoxide diffusion. Radiotherapy toxicity and breast cosmesis were assessed by the RTOG and Harvard criteria respectively. The cosmesis was assessed and scored at the beginning and end of RT and every 6 months thereafter. This was done by patient (subjective score) and physician (objective score) by comparing it with the contralateral untreated breast.

Results: After a median follow up of 36 months, the overall survival and disease-free survival were 95% and 92.5% respectively with no local relapse or radiation pneumonitis. There was no significant change in carbon monoxide diffusion after radiotherapy (p: 0.55). There was 15% delay in radiotherapy mainly due to acute GIII skin toxicity (10%), followed equally by mucositis and wound gap (2.5%). The volume of the irradiated breast was correlated with acute cosmetic effect (p = 0.057) but not on the late skin toxicity (p = 0.56). At the last follow up, the majority of patients declared excellent score in 62.5%, good in 20%, fair in 10% and poor in 7.5%. Subjective patient’s satisfaction for the shape, color and size of the treated breast was 93%.

Conclusion: Concurrent chemo-radiotherapy with weekly paclitaxel minimized the treatment duration with acceptable tolerance, cosmesis and good local control.

Keywords: Paclitaxel, chemo-radiotherapy, breast cancer, node positive

Cancer Control Priorities and Challenges in Saudi Arabia: A Preliminary projection of Cancer Burden

Introduction: Saudi Arabia faces a rapid growth in cancer cases and deaths despite the rapid development and expansion of its healthcare system. No applied national strategies exist, limiting cancer control efforts. Saudi Cancer Registry data lacks cancer specific mortality rates and available data to project the future cancer burden is inadequate.

Methods: This review paper examines the extent which cancer burden will increase by providing an estimate projection of cancer cases and deaths for the year 2025 and 2050. Current cancer burden and gaps are discussed. Saudi population projections were used to predict the burden of cancer types with the highest mortality. Rough estimates of the burden were calculated using incidence and mortality rates adopted from available UK cancer data and population figures from Office for National Statistics.

Findings: For most common cancers in Saudi Arabia, it is expected that the number of new cancer cases will reach 151,719 by the year 2025 and 30,718 cancer deaths are expected for the same year. Evidence from other countries’ efforts to control cancer demonstrates reduced mortality and points out the substantial need to urgently update cancer control strategy.

Discussion and Conclusion: Reviewing current trends in cancer burden in Saudi Arabia and projecting the future burden, especially of breast and colon cancers, proves the need to prioritize cancer control efforts. Planning a multidisciplinary evidence based national cancer control strategy will alleviate the burden and improve cancer outcomes.

Keywords: Cancer control, Cancer burden, Projection, Saudi health system

A Novel Approach to Obtain Follow-up Data on the Vital Status of Registered Cancer Patients: The Kuwait Cancer Registry Experience

Objective: We present an approach to obtain accurate and complete data on the last known vital status, and the date of last known vital status of all Kuwaiti cancer patients. These data are essential for robust estimation of population-based cancer survival.

Methods: Government-issued Civil ID numbers (IDs) of patients registered during 2000-2013 were obtained from the Kuwait Cancer Registry. Missing IDs were traced using the Ministry of Health’s Information System or the patient’s medical records. IDs were manually entered in the Public Authority of Civil Information (PACI) database to ascertain vital status for patients whose vital status was not known in the registry. To obtain the date of death for deceased patients, IDs were then manually entered and searched in the electronic archive of “Death Announcements” at the Ministry of Health’s Central Records Department of Births and Deaths. Patients not found in the “Death Announcements” archive were considered alive as on 31 December 2015.

Results: The traditional method to obtain data on cancer patients’ vital status, restricted to patients whose death was certified as due to cancer, had captured only 62% of all patients’ deaths. This new approach resolved the vital status for 98.3% of patients for whom it was previously unknown. The impact was substantial: the proportion of patients known to be dead rose from 27.9% to 45.0%, while the proportion presumed alive dropped from 72.1% to 53.7%. Only 1.3% of the patients remained lost to follow-up.

Conclusion: This approach substantially improved the quality and completeness of follow-up data for all Kuwaiti cancer patients. We recommend that this approach should be performed routinely in Kuwait to enable accurate estimation and monitoring of population-based survival trends.

Keywords: population-based cancer registry, net survival, vital status, date of last known vital status

Cancer survival trends in Kuwait, 2000-2013: A population-based study

Triple Negative Breast Cancer: 10-Year Survival Update of The Applied Treatment Strategy in Kuwait

Salah Fayaz, Gerges A. Demian, Mustafa El-Sherify, Heba Eissa, Mary Aziz, Sadeq Abuzallouf
Radiation Oncology Department, Kuwait Cancer Control Center, Kuwait

Background: Triple negative breast cancer (TNBC) is recognized as a distinct clinical and biological entity of poor outcome for almost two decades, yet its treatment strategy still needs to be better specified. The study aim is to update the 10-year survival data of our TNBC patients and to find its association with different treatment modalities.

Patients and Methods: We updated the 10-year survival data of 359 women diagnosed with TNBC between 1999 and 2009 in the Kuwait Cancer Control Center (KCCC). The overall survival (OS), disease free survival (DFS), distant metastasis free survival (DMFS) and loco-regional recurrence free survival (LRFS) were estimated using Kaplan Meier method. Survival was correlated with different prognostic factors and treatment modalities. Statistical significance was calculated using the log-rank test and defined as p < 0.05. Cox regression is used for Multivariate analysis.

Results: TNBC represented 12% of breast cancer in Kuwait with a median age of 48 years. The stage distribution was as follow: stage I, II, III, IV in 15%, 43%, 35% and 7% of patients respectively. Regarding surgery, 33% had Conservative surgery; 67% had mastectomy; 82% had axillary clearance. Chemotherapy was neoadjuvant in 25%, adjuvant in 56% and palliative in 5% of patients. Two-thirds of patients (67%) received adjuvant radiotherapy. After a median follow-up of 108 months, the 10-year OS, DFS, DMFS and LRFS were 66%, 59%, 72% and 77% respectively. The 10-year OS was 92%, 80%, 49% and 0% for Stage I, II, III and IV respectively (p =< 0.0001). OS was significantly worse with the presence of lymphovascular invasion (LVI) with p = 0.003. OS was not significantly affected by age, grade or treatment modality. In multivariate analysis, the clinical stage and LVI were still significant (P<0.0001 and 0.04 respectively).

Conclusion: In the absence of biological biomarkers, clinical stage and LVI seem to be the only significant prognostic factors for survival of TNBC patients in our study population. Timing of chemotherapy as well as the extent of surgery do not seem to affect the TNBC patients’ outcome.

Keywords: Triple Negative Breast Cancer; Long-term Survival; Prognostic Factors

Early Calcium Supplementation After Total Thyroidectomy Can Prevent Symptomatic Hypocalcemia - Findings from a Retrospective Study

Introduction: Thyroidectomy for thyroid cancers and central neck dissection are considered as independent predictors of postoperative hypocalcemia. Post-surgical hypocalcemia is the most common and often the most difficult long-term consequence of thyroid surgeries. Management of hypocalcemia is done with calcium supplementation, but there is no consensus on the timing and the amount of calcium supplementation.

Materials and Methods: A retrospective study of all thyroid cancer patients who underwent total thyroidectomy at our Centre, from August 2009 to August 2017 was done to evaluate the prevalence of symptomatic hypocalcemia. The patients were grouped into two based on the early and late supplementation of calcium in the form of intravenous calcium gluconate and oral calcium with calcitriol.

Results: There were 133 patients of which 109 had papillary carcinoma, 11 had follicular, 3 had hurthle cell and 10 had medullary carcinoma. Of these, 49.6% underwent total thyroidectomy alone and the rest with neck dissection. 38 patients (28.6%) had a unilateral neck dissection and 16 patients (12%) had a bilateral neck dissection. 14 out of the 67 patients (20.9%) who underwent neck dissection developed symptomatic hypocalcaemia, in contrast to only 2 patients out of the 66 (3%) without neck dissection. 31.7% of lateral neck dissection and 7.7% of central compartment dissection had symptomatic hypocalcaemia (p value = 0.0053). 22.5% of patients whose parathyroid were not identified had more symptomatic hypocalcaemia than in whom at least one parathyroid gland was seen (p value=0.0004). Eleven out of 73 patients (15.1%) who were treated late with calcium and calcitriol, and one out of 60 (1.7%) who had early calcium supplementation developed symptoms
(p value=0.0073).

Conclusion: Central compartment and lateral neck dissection were significantly associated with higher incidence of symptomatic hypocalcemia. Early intervention with calcium supplementation reduced the symptoms of hypocalcemia. Identification and preservation of parathyroid glands significantly reduces the hypocalcemia.

Keywords: Hypocalcemia, Thyroidectomy, Calcium supplementation

Association between nodal metastasis and histopathological factors in postoperative gingivo-buccal complex squamous cell carcinoma: A Retrospective Study

Sweta Soni¹, Tej Prakash Soni², Nidhi Patni^2
1 Department of Radiation Oncology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
² Department of Radiation Oncology, Bhagwan Mahaveer Cancer hospital and Research Centre, Jaipur,
Rajasthan, India

Impact of HPV on the Pathobiology of Cancers

Cancer Immunotherapy: An Updated Overview of Current Strategies and Therapeutic Agents

An Extremely Giant Ovarian Mucinous Cystadenoma

Hemorrhagic Brain Metastasis as the Initial Manifestation of Esophageal Adenocarcinoma