Showing papers in "Indian Journal of Cancer in 2010"

Profile of breast cancer patients at a tertiary care hospital in north India.

Abstract: Background and Aims: We carried out this study in order to know the epidemiology and management strategies for breast cancer patients in our patient population. Settings and Design: The epidemiological data pertaining to demography and risk factors for carcinoma breast were analyzed retrospectively in patients admitted to a tertiary care hospital of North India. Materials and Methods: Hospital records of 304 patients admitted for over a period of five years (January 1998 to December 2002) were used for data analysis. Statistical Analysis Used: Paired T-test . Results: Mean age of our female breast cancer patients was found to be lower compared to the western world, with an average difference of one decade. A majority of the patients were from a rural background and had a longer duration of symptoms compared to urban patients. Lump in the breast was a dominant symptom. Familial breast cancer was uncommon. Left sided breast cancer was slightly preponderant. Screening by mammography and staging procedures such as bone scan, Computed Tomography (CT) scan, and Magnetic Resonance Imaging (MRI) were sparsely used. The most common histology was infiltrating duct carcinoma. Conclusion: Modified radical mastectomy was found to be a safe operative procedure. Breast conservative surgery, although considered the gold standard in early breast cancer, was found unsuitable for our patients, due to the social background and lack of intensive radiotherapy and chemotherapy backup. Infiltrating duct carcinoma was more commonly associated with positive lymph nodes compared to other histopathologies. Cases operated by surgical oncologists had better axillary clearance. Neoadjuvant chemotherapy was used mainly by surgical oncologists suggesting a more rational approach toward the management of breast carcinoma.

Capsaicin: a novel chemopreventive molecule and its underlying molecular mechanisms of action.

Abstract: Capsaicin (trans-8-methyl-N-vanillyl-6-nonenamide) is the a principal pungent ingredient of hot red and chili peppers that belong to the plant genus Capsicum (Solanaceae). Capsaicin is a cancer-suppressing agent. It blocks the translocation of nuclear factor kappa B (NF-kB), activator protein 1 (AP-1), and signal transducer and activator of transcription (STAT3) signaling pathway that are required for carcinogenesis. The anti-inflammatory potential of capsaicin is attributed to its inhibitory effect on inducible COX-2 mRNA expression. Cytochrome P4502E1 mediates the activation of xenobiotics such as vinyl carbamate and dimethyl nitrosamine to their toxic metabolites. This metabolic activation of xenobiotics by Cytochrome P4502E1 has been shown to be inhibited by capsaicin. Capsaicin also generates reactive oxygen species in cells with resultant induction of apoptosis and cell cycle arrest, which is beneficial for cancer chemoprevention. Therefore, the use of capsaicin as a chemopreventive agent is of immense benefit for cancer chemoprevention. The search strategy included printed journals, pubmed, and medline, using the terms 'capsaicin' and 'anticancer' citations, relevant to anticancer properties of capsaicin.

Tobacco cessation services in India: recent developments and the need for expansion.

Abstract: Tobacco use is a major cause of preventable death and disease in India. Unfortunately, very few people in India quit tobacco use. Lack of awareness of harm, ingrained cultural attitudes, and lack of support for cessation maintains tobacco use in the community. The significant addictive property of nicotine makes quitting difficult and relapse common. Health professionals have received little training, and very few thus carry out proper assessments and interventions among tobacco users. Evidence from the developed countries suggests that brief interventions delivered by diverse health professionals are effective in tobacco cessation. Combining pharmacologic approaches with behavioral counseling produces better results than a single strategy. In India, early experiences with tobacco cessation occurred in the context of primary community education for cancer control. More recently, tobacco cessation clinics have been set up to develop models of intervention, and train health professionals in service delivery. These need to be expanded at the primary, secondary, and tertiary care levels, and cost-effective community tobacco cessation models need to be developed. Tobacco cessation forms one of the critical activities under the National Tobacco Control Program. Tobacco cessation needs to be urgently expanded by training health professionals in providing routine clinical interventions, increasing availability and subsidy on pharmacotherapy, developing wide-reaching strategies, such as quitlines and cost-effective strategies, such as group interventions.

Fine needle aspiration cytology of thyroid swellings: How useful and accurate is it?

Abstract: Background: Fine needle aspiration cytology (FNAC) is widely considered as the diagnostic technique of choice in the assessment of thyroid lesions. Aims: The aim of this study is to determine the utility and diagnostic accuracy of FNAC of thyroid lesions performed at our institution and to compare our experience with that of the experts from other regions of the world. Setting and Design: The present study is a five-year retrospective study of FNAC of thyroid lesions performed in the Pathology Department of our institute, during the period January 2004 to December 2008. The FNAC findings were correlated with the histopathological diagnosis, wherever available. Materials And Methods: 0 The records of 252 patients who had undergone FNAC during the study period were retrieved and information about age, sex, FNAC, and Histopathological diagnoses were extracted and the corresponding original slides were reviewed. The cytological results were classified as inadequate, benign, suspicious, and malignant. The histopathology diagnosis was classified as non-neoplastic (benign) and neoplastic (malignant). Results: A total of 252 FNACs of thyroid lesions were done during the study period. The results of the FNA cytological diagnosis showed that four (1.6%) of the patients had FNAs, which were inadequate for cytological assessment, 228 (90.5%) patients had benign lesions, 17 (6.7%) had lesions that were suspicious for malignancy, and three (1.2%) had malignant neoplasms. The correlation of the FNAC findings with the histopathological diagnosis, showed that our FNAC diagnostic accuracy rate was 96.2%, with a sensitivity of 66%, and specificity of 100%. Conclusions: The results of our study are comparable with the current published data and demonstrate that FNA cytology is a sensitive, specific and accurate initial diagnostic test for the preoperative evaluation of patients with thyroid swellings in our setting as well. The clinicians should be encouraged to embrace this procedure in the initial management of such patients.

Blood stream infections in cancer patients: a single center experience of isolates and sensitivity pattern.

Abstract: Background : Up to 10% of patients who develop a nosocomial blood stream infection (BSI) in the hospital have an underlying malignancy. The treatment of infections in patients with malignancy often relies on the use of established guidelines along with the consideration of the local microbiology and antibiotic sensitivity patterns of possible etiologic agents. AIMS: This study attempts to identify the likely etiologic agents and the antibiotic sensitivity profile of BSIs in cancer patients. Settings and Design: This was a retrospective study. Methods and Material: The study was conducted at a tertiary care center for cancer patients, in which samples representing blood stream infections sent from the Medical Oncology services of the hospital during the year of 2007 were analysed. The microbiological profile and antibiotic sensitivity pattern of these isolates was studied. Results: There were 484 isolates that represented BSIs. The most common bacterial isolates from patients with cancer were Pseudomonas spp. (30.37%), Staphylococcus aureus (12.6%) and Acinetobacter spp. (11.57%). Meropenem was the most effective antibiotic with 71.2% sensitivity to the bacterial isolates it was tested against. Oxacillin resistance was seen in 18% of S. aureus isolates. Conclusion: Gram-negative bacteria were more common as etiologic agents of BSIs in cancer patients. The poor activity of the primary empirical agents for infections in cancer namely ceftazidime and piperacillin-tazobactam is alarming.Strict regulation of vancomycin use should be considered in areas where there is a low prevalence of methicillin-resistant S. aureus (MRSA).

ErbB-2 expression and its association with other biological parameters of breast cancer among Indian women.

Abstract: Overexpression of the epidermal growth factor receptor family genes, which include ErbB-1, 2, 3 and 4, has been implicated in a number of cancers. We have studied the extent of ErbB-2 overexpression among Indian women with sporadic breast cancer. Methods: Immmunohistochemistry and genomic polymerase chain reaction (PCR) were used to study the ErbB2 overexpression. ErbB2 status was correlated with other clinico-pathological parameters, including patient survival. Results: ErbB-2 overexpression was detected in 43.2% (159/368) of the cases by immunohistochemistry. For a sub-set of patients (n = 55) for whom total DNA was available, ErbB-2 gene amplification was detected in 25.5% (14/55) of the cases by genomic PCR. While the ErbB2 overexpression was significantly higher in patients with lymphnode (χ2 = 12.06, P≤ 0.001), larger tumor size (χ2 = 8.22, P = 0.042) and ductal carcinoma (χ2 = 15.42, P ≤ 0.001), it was lower in patients with disease-free survival (χ2 = 22.13, P ≤ 0.001). Survival analysis on a sub-set of patients for whom survival data were available (n = 179) revealed that ErbB-2 status (χ2 =25.94, P ≤ 0.001), lymphnode status (χ2 = 12.68, P ≤ 0.001), distant metastasis (χ2 = 19.49, P ≤ 0.001) and stage of the disease (χ2 = 28.04, P ≤0.001) were markers of poor prognosis. Conclusions: ErbB-2 overexpression was significantly greater compared with the Western literature, but comparable to other Indian studies. Significant correlation was found between ErbB-2 status and lymphnode status, tumor size and ductal carcinoma. ErbB-2 status, lymph node status, distant metastasis and stage of the disease were found to be prognostic indicators.

Quality of life among younger women with breast cancer: study from a tertiary cancer institute in south India.

Abstract: Background : The incidence of breast cancer in young patients less than 35 years is less than 1%. The physical and psychosocial morbidity may affect their ability to successfully function in their social roles. Hence we studied the quality of life (QOL) issues in this subset. Materials and Methods :Younger women with age less than 35 years, diagnosed with non-metastatic breast cancer at our Institute, from 1995 to 2005, were included in the study. Quality of life issues were studied during the follow-up using EORTC QOL C30 and BR23. Descriptive and inferential statistics were used in order to analyze the data. Results : A total of 51 patients were included for the study. The mean age at diagnosis was 30 years. The effect of breast cancer on the occupation and marital status was minimal. The global health status and the functional scores were high, while the overall sexual function was lower. The global health status was higher in the mastectomy group. The arm symptoms (P = 0.027) and pain were higher in the Breast conservation surgery (BCS) group. The sexual symptoms appeared to be higher in the ovary ablated group when compared to the ovary preserved group. The sexual functional scores (P = 0.02) and sexual enjoyment scores (P = 0.003) were better in the mastectomy group. Conclusion : The overall QOL in younger patients with breast cancer appeared to be good. The QOL and sexual function were marginally worse in the breast conservation group when compared to mastectomy group.

Surgical voice restoration after total laryngectomy: An overview

Abstract: Total laryngectomy is potentially a debilitative surgery resulting in compromise of some of the most basic functions of life including speech and swallowing. This may have a profound adverse effect on the patient's physical, functional, and emotional health, and may result in a decreased quality of life (QOL). Until the 1980s, total laryngectomy was regarded as a dreadful, but often, life-saving procedure for which there was little alternative, and was used as a last resort. At that time survival at any cost in terms of QOL was paramount and many laryngectomies were forced into an isolated life as a mute and dysphasic recluse. Most attempts at voice restoration produced inconsistent results and often techniques were laborious, expensive, and ineffective, particularly when carried out as a salvage procedure after failed radiotherapy. Progress in voice rehabilitation, following total laryngectomy, over the last 30 years, has made an enormous difference in the whole concept of the management of laryngeal cancers. Currently there are several options available for these patients, namely, esophageal speech, artificial larynx, and tracheoesophageal speech. The choice of speech rehabilitation varies from patient to patient, but tracheoesophageal voice has become the preferred method. This article provides a brief account of surgical voice restoration after total laryngectomy. Special emphasis has been given to the surgical technique, special considerations, complications, and the prevention / treatment of tracheoesophageal voice restoration.

Microspheres in cancer therapy.

Abstract: Cancer microsphere technology is the latest trend in cancer therapy. It helps the pharmacist to formulate the product with maximum therapeutic value and minimum or negligible range side effects. Cancer is a disease in which the abnormal cells are quite similar to the normal cells, with just minute genetic or functional change. A major disadvantage of anticancer drugs is their lack of selectivity for tumor tissue alone, which causes severe side effects and results in low cure rates. Thus, it is very difficult to target abnormal cells by the conventional method of the drug delivery system. Microsphere technology is probably the only method that can be used for site-specific action, without causing significant side effects on normal cells. This review article describes various microspheres that have been prepared or formulated to exploit microsphere technology for targeted drug therapy in various cancers. We looked at the usefulness of microspheres as a tool for cancer therapy. The current review has been done using PubMed and Medline search with keywords.

Non-FDG PET in the practice of oncology.

Abstract: Fluoro-2-deoxy-D-glucose-positron emission tomography (FDG-PET) is utilized in more than 90% of cancers in staging, re-staging, assessing therapy response and during the follow-up. However, not all tumors show significant increase of metabolic activity on FDG-PET imaging. This is particularly true for prostate cancer, neuroendocrine tumors and hepatic tumors. In this review we have considered those already used for clinical applications such as 11C- and 18F-Choline, 11C-Methionine and 18F-FET, 18F-DOPA, 68Ga-DOTA-somatostatine analogues, 11C-Acetate and 18F-FLT. Choline presents a high affinity for malignant prostate tissue, even if low grade. Choline can be labeled with either 11C or 18F, the former being the preference due to lower urinary excretion and patients exposure. The latter is more useful for possible distribution to centers lacking in on-site cyclotron. Methionine is needed for protein synthesis and tumor cells require an external supply of methionine. These tracers have primarily been used for imaging of CNS neoplasms. The most appropriate indication is when conventional imaging procedures do not distinguish between edema, fibrosis or necrosis and disease relapse. In addition, the uptake of 11C-Methionine is proportional to the tumor grade and, therefore, the maximum small unilamellar vesicles (SUV) inside the brain mass before therapy is somehow considered a prognostic value. Neuroendocrine tumors (carcinoids, pheocromocytoma, neuroblastoma, medullary thyroid cancer, microcytoma, carotid glomus tumors, and melanoma) demonstrate an increased activity of L-DOPA decarboxylase, and hence they show a high uptake of 18FDOPA. For the study of NETs, 68Ga-DOTA-TOC/DOTA-NOC has been introduced as PET tracer. This compound for PET imaging has a high affinity for sst2 and sst5 and has been used in the detection of NETs in preliminary studies; 68Ga-DOTA-NOC PET is useful before metabolic radiotherapy in order to evaluate the biodistribution of the therapeutic compound; 18F-FLT is a specific marker of cell proliferation and the most important field of application of FLT is lung cancer. Other tracers are used in PET utilized as markers of hypoxia inside big neoplastic masses include 18F-MISO, 64Cu-ATSM, 18F-EF5, which highlight the presence of hypoxic areas are useful for patients that must be treated with radiotherapy.

Frequency of breast cancer among sudanese patients with breast palpable lumps

Abstract: Background: Breast cancer mortality is high in Sudan and most patients are detected at later stages of the disease due to the lack of awareness and absence of screening programs. This study aimed to determine the pattern and frequency of breast cancer among patients presenting with palpable breast lumps within one year duration. Settings and Design: As a part of the continuous development in cancer management, this descriptive longitudinal study was conducted in Khartoum, Sudan. Methods and Materials: We obtained information (patient's personal data) and Fine-Needle Aspiration (FNA) materials, for occurrence of 200 breast lesions in patients. Statistical Analysis Used: Data were analyzed by using a computer SPSS program. Results: The diagnoses of the 200 breast lesions were as follows: 68 (34%) were malignant, 56 cases (28%) were fibroadenoma, 23 cases (11.5%) were fibrocystic change, 22 cases (11%) were inflammatory lesions (including mastitis and abscess formation), 12 cases (6%) were benign cysts and the remaining 19 patients (9.5%) were with lactation changes (8 cases), lipoma (6 cases), gynecomastia (3 cases) and phyllodes tumor (2 cases). Regarding gender, only 6 patients (0.03%) were males of whom 3 (50%) were diagnosed with gynecomastia. Conclusions: The frequency of advanced breast cancer among patients with breast lesions is high, in this subset of patients, which signals the urgency for implementation of breast screening programs.

Cancer profile in Kolar: a ten years study.

Abstract: Context: Cancer profile varies in different regions and depends on race, lifestyle and diet. The study of a cancer profile helps to know the common cancers in a particular population, its probable risk factors and also helps in cancer control programs. AIM: To study the cancer profile at Kolar, based on Pathology Department records. Settings and Design: Retrospective study from January 1997 to December 2006. Materials and Methods: Cancer cases diagnosed by fine needle aspiration cytology (FNAC) and histopathology in the Department of Pathology were included in the study. The relevant history, clinical findings, and sociodemographic information of each case was retrieved from hospital records. Statistical Analysis Used: Descriptive statistics. Results: Out of a total of 19,615 cases reported at the Department of Pathology, 2,744 (13.98%) were cancer cases. The peak incidence was in the fifth decade in females and the seventh decade in males. Male : Female ratio was 0.7 : 1. Overall there was a steady rise in the number of cases from year 1997 to 2006. The top ten cancers in males were of oral cavity, stomach, esophagus, bone, non-Hodgkin's lymphoma (NHL), prostate, liver, larynx, penis, and Hodgkin's disease / bladder and those in females were oral cavity, cervix, breast, stomach, esophagus, thyroid, ovary, bone, rectum, and melanoma. Conclusions: Oral cavity and upper gastrointestinal cancers predominated in both genders. In females, cervical cancer predominated over breast cancer. Thyroid cancers were relatively more common in this region especially in females.

Incidence rate of ovarian cancer in Iran in comparison with developed countries.

Abstract: Background: Ovarian cancer is one of the most common gynecologic malignancies. The present study was designed to compare age-standardized incidence rate (ASR) of ovarian cancer in Iran with that in Australia and some other developed countries. Materials and Methods: Data from the Cancer Registry Program of Iran, as a base, were compared with the cancer registry reports of surveillance, epidemiology and end results program in the USA, considering the population of the USA in the year 2000 as the standard population. Results: In all the age groups, ASR of ovarian cancer was much lower in Iran. Overall rates of ovarian cancer in Iran and the USA were 3.9 and 16.2 per 100,000, respectively. Conclusion: Age-standardized ovarian cancer rate in Iran was much lower in comparison with high incidence areas in the world. Encouraging oral contraceptive use and reduction in fat intake may be effective in decreasing the rate of ovarian cancer or keeping its rate constant in Iran.

Clinical applications of positron emission tomography-computed tomography in oncology.

Abstract: Positron emission computed tomography (PET) is a functional diagnostic imaging technique, which can accurately measure in vivo distribution of a variety of radiopharmaceuticals. The ability of PET to study various biological processes (glucose, amino acid, phospholipids, receptors etc.) opens up new possibilities for both day-to-day clinical use and research applications in the practice of oncology. Addition of CT to PET has resulted in better specificity and sensitivity than either of the modalities alone, as the combined approach has the ability to demonstrate functional and structural details in the same setting. F-18 fluoro-2-deoxy-D-glucose (FDG), an analogue of glucose, is the most commonly used radiotracer in PET-CT imaging. The F-18 FDG uptake in tumor cells is directly proportional to glucose metabolism in the cells. Since glucose metabolism is increased several folds in the malignant tumors, PET-CT images show preferential higher FDG uptake in malignant cells as compared to normal cells. F-18 FDG PET-CT has been found to be useful in the initial staging, detection of recurrent disease and monitoring the response to the therapy in malignancies including lung cancer, colorectal cancer, lymphoma, melanoma, esophageal cancer, head and neck cancer, breast cancer.

p 53 codon 72 polymorphism in stomach and colorectal adenocarcinomas in Iranian patients.

Abstract: Background: The association of a functional single nucleotide polymorphism at codon 72 of the p53 gene (Arg72Pro) with malignancy is a subject of controversy. We analyzed this polymorphism in 224 patients with gastrointestinal cancers (92 with stomach cancer and 132 with colorectal cancer) and in 163 healthy controls. Material and Methods: DNA was extracted from peripheral blood mononuclear cells and amplified with an allele-specific polymerase chain reaction. Results: There was no significant association between p53 alleles and gastrointestinal cancers. The frequency of the Arg allele was 59.7, 58.8, and 59.2% in the stomach cancer patients, colorectal cancer patients, and controls, respectively. Frequencies of the Pro allele were 40.3% in patients with stomach cancer, 41.2% in patients with colorectal cancer, and 40.8% in controls. Likewise, genotype frequencies did not differ significantly between the two patient groups and controls. There were no differences in genotype or allele frequencies by gender, age, or histological grade. Conclusions: The data do not support the association of the p53 codon 72 polymorphism with stomach or colorectal cancers in Iranian patients.

Sociodemographic correlates of male chewable smokeless tobacco users in India: a preliminary report of analysis of National Family Health Survey, 2005-2006.

Abstract: Objective : To estimate the prevalence, the socioeconomic and demographic correlates of chewable smokeless tobacco consumption among males in India. Design : A cross-sectional, nationally representative population-based household survey. Subjects : 74,369 males aged 15-54 years who were sampled in the National Family Health Survey-3 (2005-2006). Data on tobacco consumption were elicited from male members in households selected for the study. Materials and Methods : The prevalence of various smokeless tobacco use currently was used as outcome measures. Simple and two-way cross tabulations and univariate logistic regression analysis were the main analytical methods. Results : Thirty-four percent of the study population (15 years or older) used chewable smokeless tobacco. Smokeless tobacco consumption was significantly higher in poor, less educated, scheduled castes, and scheduled tribe populations. The prevalence of tobacco consumption showed variation with types. The prevalence of chewing also varied widely between different states and had a strong association with an individual's sociocultural characteristics. Conclusion : The findings of the study highlight that an agenda to improve the health outcomes among the poor in India must include effective interventions to control tobacco use. Failure to do so would most probably result in doubling the burden of diseases-both communicable and noncommunicable-among India's teeming poor. There is a need for periodical surveys using more consistent definitions of tobacco use and eliciting information on different types of tobacco consumed.

Evaluation of colposcopy vs cytology as secondary test to triage women found positive on visual inspection test.

Abstract: Background: Colposcopic evaluation and guided biopsy is an important diagnostic step and standard of management for abnormal cytology smears in developed countries. Aim: The present study evaluates the performance of colposcopy vs conventional cytology in estimating the presence and grade of cervical disease against the reference standard of histopathology as a secondary test modality to triage women found positive on primary screening by visual inspection with 5% acetic acid (VIA). Settings and Design: Colposcopy and directed biopsy were performed after primary screening for cervical cancer in an urban hospital cancer screening clinic between January 2000 and June 2005, in Mumbai, India. Materials and Methods: Healthy women (8863) in the age group of 35-65 years participated in the cervical cancer early detection program in the hospital and community cancer screening clinics in Mumbai. Women found positive on the primary screening test by VIA underwent diagnostic evaluation by Pap smear cytology and colposcopy evaluation with directed biopsies. Statistical Analysis: Accuracy parameters and their 95% confidence intervals were calculated using 2 Χ 2 tables and standard formulae. Results: The test range of sensitivity of colposcopy for the detection of histologically confirmed cervical intraepithelial neoplasia grade 1+ (CIN1+) or CIN2+ was 58.0-74.7% and that of specificity was 57.5-92.9%. The sensitivity and specificity of cytology to detect CIN2+ was 57.4% and 99.4%, respectively. Conclusion: Colposcopy is a good sensitive test for the detection of CIN and can be considered as a secondary testing tool to triage women found positive on VIA.

Methylenetetrahydrofolate reductase gene polymorphisms and risk of acute lymphoblastic leukemia in children

Abstract: Methylenetetrahydrofolate reductase (MTHFR) is a critical enzyme in folate metabolism and is involved in DNA synthesis, DNA repair and DNA methylation. Genetic polymorphisms of this enzyme have been shown to impact several diseases, including cancer. Leukemias are malignancies arising from rapidly proliferating hematopoietic cells having great requirement of DNA synthesis. This case-control study was undertaken to analyze the association of the MTHFR gene polymorphisms 677 C"T and 1298 A"C and the risk of acute lymphoblastic leukemia in children. Materials and Methods: Eighty-six patients aged below 15 years with a confirmed diagnosis of acute lymphoblastic leukemia (ALL) and 99 matched controls were taken for this study. Analysis of the polymorphisms was done using the polymerase chain reaction -restriction fragment length polymorphism (PCR-RFLP) method. Results: Frequency of MTHFR 677 CC and CT were 85.9% and 14.1% in the controls, and 84.9% and 15.1% in the cases. The 'T' allele frequency was 7% and 7.5% in cases and controls respectively. The frequency of MTHFR 1298 AA, AC, and CC were 28.3%, 55.6% and 16.1% for controls and 23.3%, 59.3% and 17.4% for cases respectively. The 'C' allele frequency for 1298 A→C was 43.9% and 47% respectively for controls and cases. The odds ratio (OR) for C677T was 1.08 (95% CI 0.48- 2.45, p = 0.851) and OR for A1298C was 1.29(95% CI 0.65-2.29, p = 0.46) and OR for 1298 CC was 1.31 (95% CI 0.53-3.26, p =0.56). The OR for the combined heterozygous status (677 CT and 1298 AC) was 1.94 (95% CI 0.58 -6.52, p = 0.286). Conclusion: The prevalence of 'T' allele for 677 MTHFR polymorphism was low in the population studied. There was no association between MTHFR 677 C→T and 1298 A→C gene polymorphisms and risk of ALL, which may be due to the small sample size.

Risk of colorectal cancer in relatives: a case control study.

Abstract: Introduction: Although increased risk of colorectal cancer in individuals with family history of the disease has been observed consistently in past studies, limited information is available on the colorectal cancer associated with family history in Iran. The purpose of this study is to define colorectal cancer risk associated with family history cancer. Methods: The present study was designed as an unmatched case control study. Cases were 393 patients that histologically confirmed colorectal carcinomas and 393 controls were randomly selected from among the healthy participants in a health survey. For the cases, the family history was extracted from a standard history form completed by the patients and for the controls; it was obtained through interviews conducted by trained health care providers. Mantel-Hansel Odds Ratio was computed to remove the confounding effect of age and sex. Results: A positive family history was reported by 36.4% and 24.4% of cases and controls, respectively. Colorectal cancer risk increased two-fold for subjects reporting any first degree relative with cancer. The adjusted odds ratio was 4.8 (0.95CI: 2.1-8.1), indicating that having a positive family history of colorectal cancer among relatives increases one's risk of colorectal cancer about 4.8-fold. Conclusion: According to our findings, family history of cancer increases risk of CRC. As there is no current colorectal cancer screening program in Iran, it is recommended that first degree relatives of patients with colorectal cancer be prioritized for screening programs.

Association of gastric cancer incidence with MDR1 gene polymorphism in an ethnic Iranian population.

Abstract: Background: The allele frequency of the multidrug resistance 1 (MDR1) gene C3435T polymorphism differs with different ethnic populations, such as Asian, African, and Caucasian. This polymorphism has been reported to be associated with the increase of gastric cancer. Objectives: The objective of this study was to find out the association of gastric cancer incidence with MDR1 gene polymorphism in an ethnic Iranian population. Materials and Methods: In this study, 48 gastric cancer patients were diagnosed. Genomic DNA was extracted by a salting-out method. The MDR1 polymorphism was studied by a polymerase chain reaction (PCR)-restriction fragment length polymorphism method, using a standard method. Results: The polymorphic homozygote (T/T) genotype showed significantly an association with the incidence of gastric cancer compared with controls (P < 0.05). Conclusions: This study suggests that C3435T polymorphism of the MDR1 gene may be associated with gastric cancer in an ethnic Iranian population.

PET/CT in pediatric oncology.

Abstract: Radionuclide functional imaging has become a central part of pediatric oncological practice. There have been a number of major advances in imaging technology in recent years, but multislice CT with PET is the modality generating most interest in cancer imaging. In this review, we discuss the common uses and specific issues with regard to PET-CT imaging in pediatric practice. Brain tumors form a significant percentage of pediatric oncology. Use of FDG-PET in brain tumors has helped distinguish viable, residual, or recurrent tumor from post-therapeutic changes and necrosis. High-grade tumors show high uptake of FDG at diagnosis. FDG-PET results may also not accurately correlate with tumor progression after intensive radiation therapy. FDG-PET has been applied to accurate biopsy of infiltrative tumors, tumor grading, and prognostication. Limited available data also suggest that FDG-PET findings correlate well with histopathology and clinical outcome in children. FDG uptake is generally greater in higher grade lymphomas than in lower grade lymphomas. FDG-PET reveals disease sites that are not detected by conventional staging methods, resulting in upstaging of disease with potential therapeutic review. FDG-PET is useful for assessing need for marrow biopsy, residual or recurrent soft tissue masses seen on CT after therapy. The primary role of FDG-PET in neuroblastoma is in non-MIBG concentrating tumors. [11C]-Hydroxyephedrine ([11C]-HED), an analogue of norepinephrine, and [11C]-epinephrine PET have also been used in evaluating neuroblastoma. Uptake of these tracers is demonstrated within minutes after tracer administration, an advantage over MIBG imaging. The exact roles of FDG-PET in osteosarcoma and Ewing's sarcoma are not definitive. FDG-PET may play an important role in monitoring response to therapy Another diagnostic role may be in assessing patients with suspected metastatic disease.

Smokeless tobacco consumption among school children.

Abstract: Background : More than one-third of the tobacco consumed regionally is of smokeless form. Aims : To determine the prevalence and pattern of smokeless tobacco use among school children. Settings and Design : This cross-sectional study was conducted among children in 5 randomly selected high schools in Kannur district, Kerala, India. Materials and Methods : This cross-sectional study was conducted among 1200 children. A self-administered questionnaire was used for data collection. Statistical Analysis : PASW 17 software was used for data analysis. Results : The mean age of the students was 14.4 years with a standard deviation (SD) of 1.2 years, and 8.5% (CI, 7.1-10.2) of the participants were tobacco users. Smokeless tobacco was used by 2% (CI, 1.2-3.4) of the participants. None of the female students used tobacco products. Among the tobacco users, the mean age at the start of any tobacco use was 12.8 years with an SD of 1.1 years. The minimum age was 12 years and the maximum was 14 years. More than 50% smokeless tobacco users started their habit at the age of 12 years; 38.5% of them started at the age of 13 years and remaining at the age of 14 years. The 84.6% smokeless tobacco users were using it 2-3 times a week and 39% of them revealed that the tobacco products were purchased from shops located near the schools. Among the users, one used to keep the quid in the mouth for more than half an hour. Conclusion : The study concludes that there is a need to educate the children regarding the hazards associated with tobacco consumption.

Estrogen and progesterone hormone receptor status in breast carcinoma: Comparison of immunocytochemistry and immunohistochemistry

Abstract: Context : Estrogen receptors (ER) and progesterone receptors (PR) play a significant role in the prognosis of breast cancer. For preoperative chemotherapy in locally advanced lesions, trucut biopsy is used to localize the ER and PR receptors by immunohistochemistry. Immunocytochemistry can be a better alternative to immunohistochemistry as it better fixes cells. AIMS : To evaluate the degree of correlation between immunocytochemical (ICC) and immunohistochemical (IHC) determination of ER and PR in breast cancer. Settings and Design : Fine needle aspiration cytology (FNAC) was performed on 100 primary breast cancers immunostained for ER and PR during a period of 1 year 7 months, i.e., from January 2006 to July 2007. Materials and Methods : Papanicolaou-stained slides were destained, fixed in cold acetone and submitted for immunocytochemistry. In the prospective analysis, FNAC smears were straightaway fixed in cold acetone and submitted for ER and PR. Peroxidase, antiperoxidase technique was used for immunocytochemistry. Statistical Analysis : Spearman Rank correlation test was used. Results : Differences between groups were analysed and correlations were studied. Concordance for ER was 50% and for PR was 29%. Both ER and PR were positive in four cases: ER only in three and PR in one, and both were negative in nine cases. Use of the least best buffer and technical errors contributed to the lower ICC rate. Conclusion : Although Immunocytochemistry removes the derogatory step of antigen deterioration, technical errors can cause hindrance in achieving the best of the results.

Biological response modifiers: current use and future prospects in cancer therapy.

Abstract: Over the past few decades, considerable success has been achieved in the field of cancer treatment with biological response modifiers (BRM), which are agents that improve the body's ability to fight cancer by immunostimulation. Biological agents, such as interferons and interleukins, provide nonspecific active immunity, whereas the monoclonal antibodies provide passive immunity. Apart from this, other biological agents, such as antiangiogenic agents, matrix metalloprotease inhibitors, tyrosine kinase inhibitors, and tumor vaccines, are also increasingly being used in cancer treatment. Hematopoietic factors, such as granulocyte colony-stimulating factor, are used to increase the general immunity and prevent opportunistic infection. BRM are basically used alone or as adjuvants to cancer chemotherapeutic agents. This review sheds light on the current use and the future development of cancer immunotherapy. Search strategy included Pubmed, using the terms "Biological response modifiers in cancer" citations relevant to the topic were screened.

Testicular relapse in childhood acute lymphoblastic leukemia: the challenges and lessons.

Abstract: Background : Relapse of disease is documented in 15-20% of children with acute lymphoblastic leukemia (ALL). Although testicular relapse is rare with modern risk-adapted treatment protocols, earlier, the testes were a frequently encountered site of relapse and were designated as drug sanctuaries. Purpose : This descriptive study was designed to assess the pattern of testicular relapse and to identify high-risk factors. Materials and Methods : Data obtained from case records of 407 boys with ALL were analyzed. Fine needle aspiration cytology was carried out in children presenting with painless enlargement of testi(e)s. Bone marrow aspiration and cerebrospinal fluid examination were performed concomitantly to confirm or exclude disease at these sites. Results : Testicular relapse was documented in 30 boys. It was isolated in 17 patients and associated with bone marrow and/or central nervous system relapse in 13. At relapse, nine boys were over the age of 10 years. The majority were very early and early relapsers. Hyperleucocytosis was documented in five of 30 and seven of 137 relapsers and nonrelapsers, respectively (P = 0.04). Twelve of the 30 boys with testicular relapse were treated with testicular irradiation, reinduction and maintenance therapy. The estimated median overall survival was 33 months. Conclusion : Testicular relapse, which depends on the therapy administered, may manifest several months/years after completion of treatment. The high incidence of testicular relapse in our series implicates the need of revaluation of our protocol and incorporation of high/intermediate dose methotrexate therapy upfront.

Prepubertal testicular tumors: Our 10 years experience

Abstract: Background: Testicular tumors in the pediatric population are distinct from those of the adults. In contrast to the prevalence data reported in tumor registries, several studies have shown that a majority of the prepubertal testis tumors are benign. We retrospectively analyzed a series of prepubertal testicular tumors. Materials and Methods: A retrospective review of all testicular tumors at our institution was done from Jan 1999 to Dec 2008. Data relating to presentation, evaluation, and management were collected. Results: A total of 22 children with prepubertal testicular tumors were identified. The mean age at presentation was 4.6 years. Mature teratoma, epidermoid cysts, immature teratoma, and yolk sac tumor accounted for 49.94%, 13.62%, 9.08%, and 18.16%, respectively. All surgeries were successful with respect to cancer control and testicular preservation. Conclusions: Benign tumors formed the majority (72.64%) of the tumors that were encountered, with yolk sac tumors (18.16%) being a minority. Testicular preserving surgery appears to be a feasible option for benign tumors and is safe and efficacious in long-term follow-up.

Call centre employees and tobacco dependence: making a difference.

Abstract: Context : India is known as the Business Process Outsourcing (BPO) capital of the world. Safeguarding health of millions of youngsters employed in this new growing economy is an occupational health challenge. Aims : This study was initiated in June 2007 in India with the objectives to assess the prevalence of tobacco use and study the factors responsible for initiating and continuing its use. The main aim, however, was to assess the effect of different tobacco cessation intervention strategies, thus identifying effective methods to assist these employees to quit tobacco. Materials and Methods : This is a 4-arm cluster randomized trial of 18 months duration among 646 BPO employees, working in 4 different BPO units. The employees were invited to participate in interviews following which tobacco users of each BPO were offered specific tobacco cessation interventions to assist them to quit tobacco use. Results : The prevalence of tobacco dependence is 41%, mainly cigarette smoking. The tobacco quit rate is similar (nearly 20%) in the 3 intervention arms. Significantly higher reduction in tobacco consumption of 45% is seen in Arm 4 with the use of pharmacotherapy. BPO employees change jobs frequently, hence follow-up remains a major challenge. Conclusion : Inaccessibility of pharmacotherapy in the developing countries should not deter tobacco cessation efforts as good tobacco quit rates can be achieved with health education and behavioral therapy. Tobacco cessation should be an integral activity in all BPOs, so that the employees receive this service continuously and millions of our youths are protected from the hazards of tobacco.

Sister Mary Joseph's nodule of the umbilicus: is it always of gastric origin? A review of eight cases at different sites of origin.

Abstract: Objective : The aim of this analysis was to evaluate our management and outcome of eight cases of Sister Mary Joseph's Nodule of the umbilicus (SMJN). Methods : Between 2002 and 2009, we collected eight cases of SMJN and their clinical data were studied in a retrospective manner. Results : The mean age of the patients was 50.6 years (range, 34-58). There were three males and five females. Five cases were discovered preoperatively during an abdominal examination and in the remaining three patients, the umbilical nodule was noticed during surgery. Most patients presented with abdominal pain. Various signs were discovered during clinical examination. Exhaustive investigations done included ultrasound, computed tomography, magnetic resonance imaging, endoscopic retrograde cholangiopancreatography, magnetic resonance cholangiopancreatography, gastrointestinal endoscopy, mammogram, bone scan, and a panel of tumor markers. The primary tumors were gastric adenocarcinoma (two patients), ovarian adenocarcinoma (two patients), pancreatic carcinoma (one patient), colonic adenocarcinoma (one patient), gallbladder adenocarcinoma (one patient), and cholangiocarcinoma (one patient). As the disease was advanced and metastatic in all patients, only palliative therapy was offered. All patients died within a short period after clinical presentation, ranging from four to 58 weeks (mean, 20 weeks). Conclusion : SMJN is a rare manifestation of a variety of advanced malignancies, usually of gastrointestinal origin. A majority of the patients present at a late stage and many harbor distant metastases. The patient's survival is very short (mean, 20 weeks) leading to a poor outcome. We believe that if the primary cancer is discovered at an early stage, the prognosis may improve.