Open Access Case Report

Carotid Body Tumour a Challenging Management: Rare Case Report in Baghdad Radiation Oncology Center, Medical City, Baghdad, Iraq

Khudair J. Al-Rawaq, Manwar A. Al-Naqqash, Ahmed S. Al-Shewered, Ashraf F. Al-Awadi

Journal of Cancer and Tumor International, Page 1-6
DOI: 10.9734/JCTI/2018/40034

Background: Paragangliomas are rare asymptomatic painless tumours, originating from paraganglionic bodies of autonomous nerve system. The carotid body tumours are the relatively rare tumour but constitute a majority of head and neck paragangliomas about 70%. These tumours are benign but possess aggressive local growth potential.

The Aim of the Study: The purpose of this case report article is to introduce the challenging we exposed to it during management such cases in our country despite lack many conditions, facilities and circumstances found in other parts of the world for treatment of CBT, which is the first time study in Iraq.

Case Presentation: We reported a case of the 27-year-old female patient with a left neck swelling that had persisted for 5 years. She was first diagnosed and treated surgically by local excision in 2012. Histopathology revealed the histology of carotid body tumour. She has complained of hypertension, headache, and palpitation. She was observed the gradual onset of growing and pulsating lump on previous surgical scar site. Five years later, the lesion became larger, and she feeling pulsation on lying on left side resulting in discomfort on sleep and deglutition. On physical examination, a pulsating firm painless mass measuring about 6 x 5 x 4 cm in size was found on the left side of her neck. Pulsations were felt on deep palpation and a faint bruit was heard on auscultation. Work up done for her included laboratory tests, neck US, neck CT scan, carotid angiography and slide review of histopathology. All suggested recurrent carotid body tumour.

Conclusion: Over forty years of working in this field, we have only seen 3 cases of CBTs, so it is a very rare tumour. Management of this tumour is a challenging whether it is treated by surgery or radiotherapy. The main step in management is by excluding others tumours can be found in this region. Surgery is a treatment of choice while radiotherapy is standard treatment for recurrent cases.

 

Open Access Original Research Article

Exocrine Pancreatic Cancer: A Clinico-epidemiologic Study

Hend Ahmed El-Hadaad, Hanan Ahmed Wahba, Waleed Abozeed, Waleed Elnahas, Sameh Roshdy

Journal of Cancer and Tumor International, Page 1-7
DOI: 10.9734/JCTI/2018/31933

Background: Incidence of pancreatic cancer is relatively low compared to other types of cancer but had the lowest survival rate of all cancers.

Objective: To describe clinical-epidemiological features of pancreatic cancer patients recorded in our region and assessed its different prognostic factors.

Materials and Methods: The medical records of patients with pancreatic cancer attended to Clinical Oncology, and Nuclear Medicine department and Oncology centre between 2005-2014 were reviewed. 

Results: This retrospective study included 380 patients with exocrine pancreatic cancer. Median age was 56 years with male predominance (65%). The most predominant histologic type was adenocarcinoma with grade III in 55% of patients. Tumours were located at the head of the pancreas were 75.5%, followed by the body (20.8%). Most patients presented with metastatic disease (57.9%). The pain was the most common presenting symptom (63.9%), while jaundice was found in 47.4% of patients. 23.7% of patients were smokers and 19.7% suffered from diabetes mellitus. 1-year survival rate was 28%. On multivariate analysis; we found significant lower survival rate with male gender (P=0.004), high-grade disease (P=0.002), older age (P=0.001), PC located in tail and body (P=0.006), high level of CA19-9(> 37U/L) (P=0.001), and metastatic cases (P=0.003).

Conclusion: This study is a clinical-epidemiologic survey of pancreatic cancer in our locality. However, because of its relatively small number of patients and retrospective nature; larger prospective studies are needed to study the epidemiologic and genetic basis of pancreatic cancer in our region.

 

Open Access Original Research Article

Clinicopathological Features and Prognostic Outcome of Poorly Differentiated Thyroid Carcinoma: 10 -Year Experience in a Tertiary Care Institute at South India

S. Zahir Hussain, K. Rakesh Chandru

Journal of Cancer and Tumor International, Page 1-7
DOI: 10.9734/JCTI/2018/40857

Introduction: Poorly differentiated thyroid carcinoma (PDTC) is a rare malignancy which accounts for only 1 to 15% of all thyroid cancers. There is only limited literature on PDTC regarding its clinical behavior and treatment consensus, and there was no published data from south Indian population.

Aim: To study the clinicopathological characteristics, treatment and prognostic outcome of PDTC cases treated in our institute.

Materials and Methods: This is a retrospective study over a period of 10 years from 2005 to 2014 at Department of Endocrine surgery, Madras medical college, a tertiary referral center in South India. The following data were collected from medical records: demographics, clinical presentation, treatment given, histopathological characteristics and the clinical outcome of all PDTC cases diagnosed based on Turin’s criteria. The data were analyzed, and statistical analysis was performed.

Results:  Among 626 thyroid malignancies, only 19 cases of PDTC were treated during the study period. The median age of presentation was 54 years, of which 17 were females, and 2 were males. All patients have presented with goiter with a median duration of 6 years. Total thyroidectomy was performed in all cases, and three patients had neck dissection along with total thyroidectomy. The predominant histological subtype was the insular pattern. The cervical lymph node metastasis was seen in 3 cases (15.8%). The distant metastatic rate was 68.4% of which 9 cases had lung and 4 had bone metastasis. Adjuvant radioiodine therapy was given only in 2 patients (10.5%) and the majority received external beam radiotherapy (89.5%). The overall 5-year survival rate was 36%.

Conclusion: Poorly differentiated thyroid cancer is aggressive and rare thyroid cancer. The prevalence rate in our study population was 3%. The tumor behavior in our study population was more aggressive than that of other regions. Surgery remains the mainstay of treatment in the control of loco regional disease. EBRT was the primary form of adjuvant therapy in our study population which showed a better survival advantage than RAI. More extensive studies are required regarding consensus for adjuvant therapy and optimal management of PDTC.

 

Open Access Original Research Article

Patterns of Care and Factors Affecting it in Small Cell Lung Cancer – Analysis of 3 Years Data from a Tertiary Care Hospital in India

Abhishek Basu, Bidyut Mandal, Debjit Ghosh, Avik Maji

Journal of Cancer and Tumor International, Page 1-7
DOI: 10.9734/JCTI/2018/42159

Objective: In India, 75,000 new cases of lung cancer are diagnosed every year, with approximately 35% of them being locally advanced at presentation. Despite numerous advances in recent years in terms of diagnostic methods, molecular changes, and therapeutic interventions, the outcomes of the small cell lung cancer (SCLC) patients remain poor. There is a dearth in our current understanding of the changing epidemiological trends of small cell lung cancer among Indian patients.

Aim of this study is to evaluate the safety and efficacy of standard chemotherapy or chemo radio therapy in elderly patients with SCLC and their outcome and analysis of prognostic factors.

Methods and Materials: 36 cases of SCLC diagnosed either by histopathology or cytology were accrued for the single Institutional retrospective audit and were analysed. Patients with extensive stage disease are planned for six cycles of platinum doublet based chemotherapy and those with limited stage disease are planned for concomitant or sequential chemo radiation depending on various patient related factors. Patients received 4-6 cycles of chemotherapy (cisplatin 80 mg/M2 Day 1, etoposide 120 mg/m2 Day 1-3), following which based on their initial stage & response after Chemotherapy, Thoracic Radiation and PCI (Prophylactic Cranial Irradiation) were given to the suitable candidates.

Statistical analysis was done by bivariate analysis, cox regression analysis, Chi square test, Kaplan Meier survival analysis using IBM SPSS software v.23.

Results: There was a median diagnostic delay of 3 months, about 60% patients presented with extensive stage disease, among which 25% were brain metastasis & 8.2% were having bone mets. Response rate of patients above or below 60yrs were not statistically significant (66% v/s 69%). Median survival were 14 months & 7months for limited & extensive stage.

Conclusion: Elderly Patients can benefit from the EP (Etoposide, Platin) regimen with or without thoracic RT (Radio therapy). Stage, PS (Performance status), Treatment type were notable prognostic factors of median survival. More Prospective, randomised trials are warranted.

 

Open Access Original Research Article

Use of Chemoports in a Comprehensive Cancer Care Center, a Retrospective Study

Manisa Pattanayak, Anshika Arora, Sunil Saini, Akash Narayan Gaind, Upasana Baruah, S. K. Verma, Meenu Gupta

Journal of Cancer and Tumor International, Page 1-8
DOI: 10.9734/JCTI/2018/42732

Aim of the Study: Treatment protocols that use intravenous cytotoxic agents need long term access to large veins, that can be maintained for a prolonged period in a sterile way. Use of implantable devices for this purpose have become the preferred choice these days, but they have their own set of problem s, starting from difficulties in cannulation to safely maintaining the access for a prolonged period of time in a sterile way. Moreover, the patient population undergoing these treatments are mostly immunosuppressed and prone to systemic infections making the care of any implanted device more difficult. The present study evaluates the experience of using chemoports in a comprehensive cancer care center.

Subjects and Methods: We retrospectively reviewed our experience in handling Chemoports inserted at our own hospital over a period of three years, as regards to difficulties during insertion and during administration of venotoxic agents. All patients who were advised more than 4 cycles of cytotoxic drugs were included and approval of the university research and ethics committee was taken prior to data analysis.

Results: Retrospective data of a total of 120 chemoports was evaluated for the study. The most common malignancy was breast cancer, and the commonest chemotherapeutic regimen was Adriamycin/Epirubicin and Cyclophosphamide followed by Taxanes. The preferred site of insertion was right subclavian vein in 52.5% of cases. The average time taken for the procedure ranged from 25 mins to 2 hrs. Procedural difficulties were documented in 48 [40%] insertions, the most common being multiple punctures for venous access. 3 patients developed hematoma during the procedure and, one patient had puncture of carotid artery. Passage of the catheter to the opposite jugular vein was an interesting happening and occurred in 3 patients. None of the patients who had subclavian vessel cannulation had pneumothorax. All the complications were managed conservatively. The median days of catheter life was 265 days. In the follow up period 30 patients [25%] had events related to difficulty of use and port related infection,12 patients had difficulties in canulation of the Chemo port reservoir and 6 Ports could not be used for further chemotherapy and were removed. Infectious complications were seen in 12 ports, the commonest being pocket site infection.

We had a policy of recommending removal of the chemoport 6 months after completion of the planned chemotherapy protocol or 2 years after placement of the port, whichever is earlier. At the end of the study period, 47 of the patients had their chemoports removed, 10 patients were lost to follow up and hopefully got the devices removed elsewhere.

Conclusion: The present day chemoports are simple to insert, and easy to manage with proper asepsis expected in an immunosupressed patient. However, a dedicated team of trained personnel viz. surgeons, anaesthesiologists, clinical oncologists and nursing staff, are necessary so that complications related to these devices are kept to a minimum. This is also important in resource poor countries where these costly devices are difficult to prescribe, so that once inserted, they can last till the end of chemotherapy.