Open Access Case Report

Postmenopausal Bleeding with an Accidental Discovery of an Ovarian Strumal Carcinoid Tumor: A Case Report

Eman M. Ibrahim, Salma S. El Ashwah, Fatma I. El-Saeed, Hosam A. F. Halim, Amal A. F. Halim

Journal of Cancer and Tumor International, Page 20-24
DOI: 10.9734/jcti/2021/v11i130141

Aim: Ovarian strumal carcinoid is a tumor formed of thyroid tissue and carcinoid elements. It represents less than 2% of all ovarian tumors and less than 5% of mature teratomas. Physicians in many lacations may not be aware about this pathology.

Presentation of Case: A multiparous 78-year-old woman presented    by postmenopausal vaginal bleeding. The abdomen& pelvic sonar detected   atrophied endometrium and a right adnexal mass      with mixed echogenicity and increased blood flow, a finding that was confirmed later with a pelvic MRI which revealed a well-defined mass of abnormal signal at the right adnexa showing cystic changes contacting anteriorly the related intestinal loops and the urinary bladder, while contacting posteriorly the recto-sigmoid.  It measured8x6x6cm. Biopsy revealed atypical epithelial proliferation.  CA125 was 90KU/L (normal range,0-35KU/L) while the levels of CEA, CA19-9 and alpha feto protein were normal. After discussion with the family, exploratory hysterectomy and bilateral salpingioophorectomy, along with omentectomy, peritoneal washing and peritoneal sampling were performed. Grossly, the right ovary was    largely occupied by an ovoid mass (9cmx6cmx2 cm). The tumor was staged as IA according to AJCC 2010. Histological examination of the adnexal mass revealed admixture of benign thyroid tissue and tumor tissue formed of trabeculae & nests of monotonous round cells. Such cells showed positivity for thyroglobulin, synaptophysin, chromogranin and low positivity for ki67 and so a diagnosis of   strumal carcinoid tumor was documented. The patient was set to a close follow up. The last follow up was at August 2020 and was satisfactory.

Discussion and conclusion: Strumal carcinoids are rare. Pelvic sonar and CA125 are not specific diagnostic tools. They should be considered in the differential diagnosis of any ovarian mass. The disease usually presents at an   early stage.

Open Access Original Research Article

Neoadjuvant Chemotherapy and Concomitant Boost Radiotherapy in the Treatment of Locally Advanced Rectal Cancer

Mai AbdAllah Abdelazez, Soumaya Mohamed Eteba, Eman Hamza Elzahhaf, Sameh Roshdy Abdel Aziz, Rehab Omar, Eman Awad Abdallah

Journal of Cancer and Tumor International, Page 1-19
DOI: 10.9734/jcti/2021/v11i130140

Aims: This study aimed to examine the efficacy and toxicities of concomitant boost three-dimensional conformal radiotherapy along with multidrug chemotherapy (capecitabine and oxaliplatin) in neoadjuvant course for locally advanced rectal cancer (LARC).

Study Design: A phase II interventional nonrandomized study.

Place and Duration of Study: This Study was conducted at Clinical Oncology and nuclear medicine department of Mansoura University Hospitals (Egypt) between November 2016 and October 2019.

Methodology: Thirty patients (18 women, 12 men; age range 18-75 years) with (cT3-T4 and/or cN+) histologically confirmed rectal adenocarcinoma located within 12 cm of the anal verge were included in this study. Patients received three-dimensional conformal radiotherapy (3DCRT) to the pelvis of 45 Gy and a concomitant boost of 10 Gy to the primary tumor in 25 fractions, and concurrent with oxaliplatin (50 mg/m2 d1 weekly) and capecitabine (625 mg/m2 bid d1–5 weekly). Radical surgery was scheduled six to eight weeks after chemoradiation. Acute toxicities were recorded according to Common Terminology Criteria for Adverse Event (CTCAE) v5.0. Potential prognostic factors were evaluated using a binomial logistic regression. Survival curves were estimated using the Kaplan-Meier method and compared with Log-rank test.

Results: All patients received chemoradiation. Twenty-seven patients underwent surgical resection. Twenty-five patients underwent sphincter-sparing surgery (92.6%) and nine patients (33.3%) achieved pathological complete response (pCR). The incidences of grade III neutropenia, diarrhea, and radiation dermatitis were 6.7%, 6.7%, 3.3% respectively. The three-year local recurrence (LR), disease-free survival (DFS) and overall survival (OS) rates were 7.4%, 63% and 74.1%, respectively. We found pre-surgical negative nodal status to be significantly associated with pCR (p=0.009). The pathological nodal stage was an independent prognostic factor to DFS.

Conclusion: The combination of oxaliplatin, capecitabine, and dose escalation using concomitant boost 3DCRT is safely administrated in patients with locally advanced rectal adenocarcinoma and it offers high pCR and sphincter preservation rate.

Open Access Original Research Article

Childhood Cancers in a Tertiary Centre, Southern Nigeria: Spectrum and Outcome of Treatment

G. K. Eke, N. Ugwueze, N. A. Akani

Journal of Cancer and Tumor International, Page 25-34
DOI: 10.9734/jcti/2021/v11i130142

Introduction: Though childhood cancers are often amenable to cure even with simple and safe protocols, survival rate is still very low in many low- and middle-income countries where nearly 80% of children with cancer reside.

Objective: To ascertain the pattern and outcome of treatment of childhood cancers in a tertiary centre in southern Nigeria.

Methodology: All cases of childhood cancer admitted into the Paediatric Oncology unit of the University of Port Harcourt Teaching Hospital from January 2011 to November 2019 were reviewed. Their demographics, diagnosis, treatment modalities and outcomes were analyzed using SPSS version 25.0.

Results: A total of 266 cases were analysed: 151(56.8%) males and 115(43.2%) females, with M:F ratio of 1.3:1, aged 1 month to 14 years. Majority (44.7%) were in the 1-4 years age bracket. The majority of children who presented more than 20 weeks after onset of symptoms had retinoblastoma. The most common cancers were acute leukaemias (23%), nephroblastoma (22.1%) and rhabdomyosarcoma (11.6%). Many subjects abandoned treatment (44.4%), and mortality was recorded in 45.1% of the study population.

Conclusion: The distribution of the childhood cancers in this study is similar with report of the population based Port Harcourt Cancer Registry, with acute leukaemias, nephroblastoma and rhabdomyosarcoma as most common malignancies encountered. Rates of abandonment of treatment and mortality were high.

Open Access Original Research Article

Induction Chemotherapy Followed by Concurrent Chemo-Radiotherapy for Locally Advanced Gastro-Esophageal and Gastric Carcinoma

Nora Shaband, Niveen Abo-Touk, Mohamed Elawadi, Saleh Ta-Ema

Journal of Cancer and Tumor International, Page 35-44
DOI: 10.9734/jcti/2021/v11i130143

Aims: To assess the safety and efficacy of chemo-radiotherapy before radical surgery in locally advanced gastric and gastroesophageal adenocarcinoma.

Study Design: This was a prospective phase Ⅱ single arm study.

Place and Duration of Study: Department of Clinical Oncology and Nuclear Medicine, Mansoura University Hospital, Mansoura, Egypt, between May 2017 and June 2019.

Methodology: Patients with pathologically proven gastric or gastroesophageal junction adenocarcinoma are included. They received one cycle of induction chemotherapy paclitaxel-carboplatin, [paclitaxel dose of 175 mg/m2, carboplatin dose of (AUC: 5)], followed by CCRT [RT 45 Gy over 25 fractions over 5 weeks concurrent with weekly paclitaxel at a dose of 50 mg/m2, carboplatin at a dose of (AUC: 2)], followed by surgery and 2 cycles of paclitaxel-carboplatin for responders.

Results: The study included 24 patients. Most of the patients were diagnosed at stage III (83.3%). There were no major side effects of the induction chemotherapy cycle. There were no reported grade 3 or 4 toxicities for the CCRT. Only two patients suffered from late radiation toxicities (distal esophageal stenosis). Pathological complete response was achieved in seven patients (31.8%). Twenty-two patients had surgical resection with a 95% resection margin zero. The median follow-up time was 22.5 months. The median progression-free survival (PFS) and overall survival (OS) were 23, 23.5 months, respectively.

Conclusion: The preliminary data suggested good efficacy of the studied treatment design with acceptable adverse-event rates, however a larger multicentric phase 3 trial with a longer follow-up duration is recommended.

Open Access Original Research Article

The Study of Prevalence, Knowledge, Attitude, Beliefs and Practice of Cervical Cancer in HIV Positive Women in Purdah and HIV Positive Women Not in Purdah in Gombe State Nigeria

S. Umar, J. O. Adisa, O. O. Okechi, U. Abubakar, A. B. Imam

Journal of Cancer and Tumor International, Page 45-57
DOI: 10.9734/jcti/2021/v11i130144

Introduction: Purdah or pardah is a Persian word which translated loosely to mean ‘curtain’, is a religious and social practice of female seclusion prevalent among some Muslim communities.  In stating the reasons for the need of purdah, the Qu’ran declares that “the observance of hijab is so that the (pure and pious women) may be recognized and not be molested” Cervical cancer is a malignant disease of the cervix. The disease has a pre-malignant stage which usually occurs in younger women.  Carcinoma of the cervix is associated with the following risk factors; early age at first sexual intercourse, multiple male sexual partners,  male sexual partners who have had multiple partners, early age at first birth, multiparty, smoking, long-term use of oral contraceptive pills, immunosuppressed states. Cervical cancer is preventable through vaccination and can be easily diagnosed, but prevention and diagnostic programmes are not widely available in the developing world (Branca et al., 2003). Rates of cervical cancer are four to five times higher among women living with HIV than among HIV negative women, while the overall risk of acquiring HIV among women doubles when women are infected with the human papillomavirus, a cause of cervical cancer.

Aim: To study the Prevalence, Knowledge, Attitude, Beliefs and Practice of cervical cancer in HIV positive women in purdah and HIV positive women not in purdah, and relate this to the prevalence of cervical cancer.

Methods: The study was a cross-sectional study to determine the prevalence of cervical cancer among HIV positive women in purdah attending the anti retroviral therapy (ART) Clinic of the Federal Teaching Hospital, Gombe. A sample size of 150 each was used for both the subject group and controls. HIV positive women in purdah=150 subjects, HIV positive women not in purdah= 150 subjects and HIV negative women not in purdah =150 subjects. Sample size equals 450 to give room for alteration.

Results: Results collected using the questionnaire revealed that only a mean of about 41 (27.3%) HIV positive women in purdah had correct knowledge of Cervical Cancer as compared with HIV positive women not in purdah who had a mean of 129 (86.0%)  and 114 (76.7%)  for  HIV negative women not in purdah.  Large percentage of 61.3% of HIV positive women in Purdah, 86.0% of HIV positive women not in purdah and 76.7% of HIV negative women not in purdah, had previous knowledge of Cervical Cancer. The knowledge about the link between early marriages to increased risk of cervical cancer was not low amongst HIV positive women in purdah (34.7%) but this was not the case with their counterparts as 86.0% of HIV positive women not in purdah and 80.7% of HIV negative women in purdah were knowledgeable about the link. Not less than 95% of women in all groups expressed   indifference towards the gender of the personnel collecting the Pap smear nevertheless some still showed some reluctance towards having their pap smear collected by personnel of the opposite sex. Women in purdah showed the highest percentage of this reluctance (4.7%).  As regards to practices, the women in purdah had a mean positive practice of 63.3% as against 58.7% and 60.8% respectively of the control group (HIV positive women not in purdah and HIV negative women not in purdah). Women in purdah had a higher positive practice in all cases except the issues of husbands deciding the number of children (16.7% -HIV positive women in purdah, 88.0% -HIV positive women not in purdah and 100% -HIV negative women not in purdah) and husbands deciding when to stop having children (35.5% -HIV positive women in purdah, 52.0% -HIV positive women not in purdah and 43.3% -HIV negative women not in purdah).

Conclusion: The prevalence of cervical lesions in HIV positive women in purdah (42.0%) is higher than that of HIV negative women not in purdah (16.0%), but lower than that of HIV positive women not in purdah (56.0%).Hiv positive women in purdah had the lowest knowledge of cervical cancer with a mean score of (27.3%) while the control groups had a higher knowledge of 86.0% and 76.7% respectively. This implies that there is need for comprehensive and correct knowledge, positive attitude/ beliefs and positive behavioral practice are important in the control of cervical cancer and diseases in general.