Journal of Cancer and Allied Specialties
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INHERITED GENETIC SUSCEPTIBILITY TO BREAST CANCER IN PAKISTAN
Full text linkBreast cancer is a heterogeneous disease. Several genetic, environmental and lifestyle factors are involved in the aetiology of this disease. Genetic risk factors include alterations (mutations) in genes conferring risks to develop breast cancer. Depending on the associated lifetime risks of this malignancy, these genes are categorised into high-, moderate- and low-risk genes. Women carrying mutations in these genes are at an increased risk to develop breast cancer, ovarian cancer and several other malignancies. Breast carcinoma is the most reported malignancy in Pakistani females. Pakistan is a developing country with most of its population living in rural areas; hence, optimal healthcare facilities are inadequate for the early diagnosis and prevention of this disease. Hence, identification of individuals carrying mutations is clinically relevant as different strategies are available for the early detection, risk reduction and better management of this malignancy. This review summarises the findings of the major studies conducted in Pakistan to investigate the contribution of breast cancer predisposing genes. Furthermore, implications of the current studies and future research potentials are discussed.Key words: Breast cancer gene 1/2, breast cancer, checkpoint kinase 2, genetic susceptibility, Pakistan, RAD51C, tumour Protein p53, Vitamin D recepto
INTRADEPARTMENTAL CONSULTATION CONFERENCE - A GOOD QUALITY CONTROL PRACTICE AND A PROBLEM-SOLVING ACTIVITY
Full text linkObjective: The objective of this study was to evaluate the effectiveness of intradepartmental consultation conference (IDC) as a good quality control measure and problem-solving activity in a busy histopathology department.Methods: This study was done at the histopathology department of a tertiary care hospital over a period of 6 years from 2011 to 2016. IDC is routinely held at 2 pm daily on multi-header microscope. All the difficult and problematic cases are discussed. Discussed cases with the recommendations of IDC are recorded. The cases were extracted from the record of IDC being maintained since 2011. All the record sheets were analysed and the cases were divided organ and system wise.Results: A total of 5766 (6.5%) cases were discussed in this 6-year period of a total of 89,253 cases reported at our centre. Of these, 2198 (38%) were solved on first viewing, 1783 (31%) in the second viewing and 1691 (29%) in thethird viewing. In total, 98% of the cases were resolved until the third viewing, leaving only 94 (2%) cases in which further studies were recommended. A variable number of pathologists were present in the meeting, and an average of4 was present in majority of the occasions.Conclusion: IDC is a good quality control measure to ensure quality in a busy histopathology department and an effective problem-solving activity.Key words: Intradepartmental consultation, histopathology, cance
INDOLEAMINE 2,3 DIOXYGENASE AS AN IMMUNOTHERAPEUTIC TARGET BRINGS A NEW HOPE FOR CANCER PATIENTS
Full text linkTherapeutic manipulation of immune system in cancer has been an extensive area of research in the field of oncoimmunology. Immunotherapy helps the immune system to combat against cancer. Tumour cells take an edge of immunosuppressive mechanisms and inhibit antitumour immune responses. Indoleamine 2,3 dioxygenase (IDO) is an immunosuppressive enzyme which is involved in tumour immune escape mechanism in various cancers. IDO can degrade the tryptophan into kynurenines and has an ability to enhance the immune tolerance through mammalian target of rapamycin pathway general control nonderepressible 2 (GCN2) pathway and induction of regulatory T (T-regs) cells. IDO-induced T-regs suppress the local immune responses in the tumour microenvironment and promote metastasis. IDO overexpression in various cancers is associated with poor prognosis. Several preclinical and clinical trials have been proceeding and recommend that IDO inhibitor may be an influential tool against a wide range of cancers. IDO inhibitors as adjuvant therapeutic agents may also have clinical implications. Thus, IDO has the potential to be used as an immunotherapeutic target. This review discusses the promising role of IDO in cancer and its implication in immunotherapy.Key words: Breast cancer, colorectal cancer, haematological malignancies, immunotherapy, indoleamine 2,3-dioxygenase, pancreatic cancer, prostate cance
PAEDIATRIC RETINOBLASTOMA PRESENTATION IN A REGIONAL CANCER CENTRE IN PAKISTAN
Full text linkPurpose: Retinoblastoma (RB) is a common paediatric intraocular tumour. In the developed world, RB accounts for <5% of all paediatric cancers. In the developing world, RB may comprise about 10–15% of all diagnosed paediatriccancers according to hospital-based retrospective study in India.Methods: Medical records for all diagnoses of RB at our regional cancer centre were retrospectively reviewed from January 2005 to September 2015 after IRB approval.Results: A total of 258 (100%) patient charts were reviewed. More male n = 163 (63.2%) patients were seen than females n = 95 (36.8%). Most patients were diagnosed before the age of 5 years. Positive family history was seenin 20 (7.8%) patients. The total number of bilateral disease was seen in 75 (29.1%) patients and 183 (70.9%) had unilateral diagnoses. Median age at presentation was 24 months for bilateral and 36 months for unilateral disease.Conclusions: The median age at presentation shows a significant delay in the establishment of diagnosis for both unilateral and bilateral RB. Compared to western data, there were a higher number of male patients seen. Financialconstraints, access to primary health care, lack of trained personnel and cultural practices are likely factors, leading to delayed presentation and advanced disease state.Key words: Retinoblastoma, ocular tumours, leukocori
AN UPDATE ON LOW DOSE COMPUTED TOMOGRAPHY FOR LUNG CANCER SCREENING
Full text linkSince the publication of the National Lung Screening Trial (NLST) showing a mortality reduction with use of low dose computed tomography (LDCT) there has been considerable interest about the use of this modality to screen for lung cancer. This article reviews the NLST and current evidence behind screening for lung cancer in smokers. It also attempts to look at different lung cancer risk models to help better define the ideal target population and lastly touches on the cost-effectiveness of LDCT screening in patients at high risk of lung cancer
MULTIDISCIPLINARY MANAGEMENT OF METASTATIC NEUROENDOCRINE TUMOURS
Full text linkA 65-year-old man presented to his GP with right upper quadrant abdominal pain and weight loss. Abdominal ultrasound showed multiple gallstones and some ill-defined liver lesions. Computer tomography scan diagnosed a terminal ileal lesion causing cicatrisation of the terminal small bowel but does liver abnormality. The patient was worked up with serum gut hormone profile and magnetic resonance imaging of the liver which demonstrated multiple liver lesions and biochemical suspicion of neuroendocrine tumour (NET). The patient underwent a right hemicolectomy and excision/ ablation of 44 liver metastases. He made a good post-operative recovery and remains disease free after 18 months. We also present a brief literature review regarding advances in the management of metastatic NET.Key words: Neuroendocrine tumours, Hepatic metastases, Radiofrequency ablation, Computer tomography, Magneticresonance imagin
