Journal of Cancer and Allied Specialties
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ANALGESIC EFFICACY OF COMBINATION OF BILATERAL SUPERFICIAL CERVICAL PLEXUS BLOCK AND STANDARD ANALGESIA WITH STANDARD ANALGESIA ALONE IN PATIENTS UNDERGOING THYROID CANCER SURGERY. A RANDOMISED-CONTROLLED TRIAL
Full text linkPurpose: This study aimed to determine analgesic efficacy of a combination of bilateral superficial cervical plexus block (BLSCPB) and standard analgesia with standard analgesia alone in patients undergoing thyroid cancer surgery under general anaesthesia.Materials and Methods: It was a randomised-controlled trial conducted at the Anaesthesia Department of the Shaukat Khanum Memorial Cancer Hospital, Lahore. A sample size of 60 patients (30 patients in each group) was calculated with 95% confidence interval and power of 80%.Results: The mean pain-free duration for the Group A (BLSCPB group) was 72 min (SD 30.1) compared to 53 min (standard deviation 30.3) for the Group B. This shows a significant reduction in pain-free duration in Group A. Average NRS pain score in the Group A at q 0, 30, 60, 90 and 120 min was (0.83, 1.83, 0.23, 1.76 and 1.49), whereas the average pain score on NRS in the Group B at the same time interval mentioned above for Group A was (2.1, 2.73, 4.53, 2.44 and 1.85)Conclusion: Administration of BLSCPB resulted in superior analgesia after thyroid cancer surgery.Key words: Analgesia, cervical plexus block, post-operative pain, regional anaesthesia, thyroidectom
HEAD AND NECK CANCER STEM CELL PROTEOMICS
Full text linkIt is critical to identify the cell of origin of cancer and the genes/proteins/transcriptional/epigenetic factors of that cell. Here, we review studies on head and neck cancer stem cells (CSC) in the hope of developing better understanding of their role highlighting their importance as novel drug targets. CSC model has introduced a hierarchical conceptual framework for the interpretation of intratumour heterogeneity within tumour. This, in turn, has culminated in a major paradigm shift in terms of how different types of cancers can be targeted for treatment. Several malignancies conform to the CSC model of tumour growth yet identification of CSC markers remains a profound challenge.Key words: Chemo- and radio-resistance, head and neck cancer stem cells, proteomics, treatment modalitie
CENTRAL NERVOUS SYSTEM RELAPSE OF MULTIPLE MYELOMA
Full text linkMultiple myeloma (MM) is a plasma cell disorder primarily involving bone marrow. Extramedullary involvement is less common, with central nervous system (CNS) myelomatosis being a rare entity and such presentation carries extremely dismal prognosis. We present case of a 40 years old male with MM who was initially treated with 6 cycles of Cyclophosphamide, Thalidomide and Dexamethasone resulting in complete response. 2 years later he presented with CNS myelomatosis and scrotal involvement and was initially treated with Bortezomib and dexamethasone, cranial irradiation and intrathecal Methorexate, Cytarabine, Hydrocortisone (TRIO IT), along with radical orchiectomy and testicular radiation during the course of treatment. However, after initial response his disease showed clinical and radiological progression after 4 months of therapy. He was switched to high dose Methotrexate (HD-MTX) with TRIOITand later Lenalidamide and dexamethasone (Len/dex) was added to the above regimen. He continued to show good clinical response but his cytology remained persistently positive, therefore, HD-MTX was discontinued in the later course of treatment. Subsequently he was started on best supportive care only, when his neurological status deteriorated further. He survived almost 9 months after a diagnosis of CNS myelomatosis. Patients with multiple myeloma, presenting with neurological symptoms should always be investigated for the possibility of CNS MM. CNS relapse is a fatal disease with poor prognosis. Recommended treatment must include a systemic anti-MM regimen that crosses the BBB (ideally Immunomodulatory drugs (IMiDs) IMiDs-dexamethasone based therapy), CNS irradiation and intrathecal chemotherapy.Key words: Multiple myeloma, central nervous system myelomatosis, therap
THE ROLE OF INTRAOPERATIVE FROZEN SECTION OF SENTINEL LYMPH NODES IN UPFRONT BREAST CONSERVATION CANCER SURGERY
Full text linkObjective: Sentinel lymph node biopsy is the standard of care in clinically negative axilla in breast cancer patients for which frozen section (FS) is routinely performed intraoperatively. The objective of this study was to justify the use of FS in terms of number of tests performed and their impact on decision-making and cost saving. Materials and Methods: We retrospectively reviewed our prospectively maintained data from January 2014 to January 2018 for intraoperative FS in upfront breast conservation surgery patients. Results: A total of 357 patients were studied. All were female. Median age was 50 years (24–84). Mean tumour size was 29.11 mm. Numbers of sentinel lymph nodes identified were 1 in 50 (14.2%) patients, 2 in 121 (33.89%) patients and ≥3 in 186 (52%) patients. Number of positive sentinel lymph nodes was 0 in 264 (73.9%) patients, 1 in 62 (17.4%) patients, 2 in 20 (5.6%) patients and ≥3 in 11 (3.08%) patients. Axillary lymph node dissection (ALND) was offered to 30 (8.4%) patients as per the American College of Surgeons Oncology Group Z0011. The results for ALND showed that only 8 (2.3%) out of 30 patients had positive nodes identified in the additional axillary nodes dissected. Sensitivity of FS was 97% and specificity was 98.86%. False-negative rate was 3.22%. Conclusion: Intraoperative FS can be safely omitted in early breast cancer patients undergoing upfront breast conservation cancer surgery due to high sensitivity and specificity leading to low false-negative rates. ALND can be performed as a second operation as warranted only in a minority of patients. Key words: American College of Surgeons Oncology Group Z0011 trial, axillary lymph node dissection, intraoperative frozen section, sentinel lymph node biops
PROGNOSTIC POWER OF INFLAMMATORY RESPONSE SCORING SYSTEMS IN PERIAMPULLARY PANCREATIC CANCER: A SYSTEMATIC REVIEW
Full text linkIntroduction: Assessment of systemic inflammatory response forms the basis of several scoring systems that attempt to prognosticate patients with periampullary pancreatic carcinoma (PPC). We assessed the validity of three of these scoring systems for patients’ prognosis following intervention for PPC: Glasgow prognostic score (GPS) and its modified version (mGPS), platelet-lymphocyte ratio (PLR) and neutrophil-lymphocyte ratio (NLR).Methods: EMBASE and MEDLINE databases were searched for all published studies until September 2018 using comprehensive text word and MeSH terms. Meta-analysis of observational studies in epidemiology guidelines was followed. All identified studies were analysed and relevant studies were included in the review.Results: Three studies which assessed the role of GPS, four studies that evaluated the use of NLR and three that assessed the role of PLR in patients with PPC were identified. None of these studies demonstrated any value in the pre-operative assessment of patients with PPC. The limited number of studies available precluded further statistical analysis.Conclusions: Based on available evidence, GPS, NLR and PLR do not appear to be useful scoring systems to predict prognosis of patients with PPC. Larger studies are warranted before the application of inflammatory scoring systems could be recommended in patients with PPC.Key words: Periampullary cancer, Glasgow prognostic score, modified Glasgow prognostic score, platelet-lymphocyte ratio, neutrophil-lymphocyte rati
PERSISTENT LEFT SUPERIOR VENA CAVA: A DECEPTIVE ANOMALY
Full text linkPersistent left superior vena cava (SVC) is a rare but vital congenital anomaly of the thoracic venous system. It is the persistence of vessel that normally regresses during early foetal life. It has utmost importance in intervention radiology, cardiothoracic procedures and insertion of the central venous line as well as in trauma. The vessel can drain into the right atrium through the coronary sinus, directly into left atrium or through pulmonary veins. It is usually detected during routine investigations and requires surgical treatment. In our case, SVC persists on both right and left sides with enlarged coronary sinus incidentally detected during follow-up for breast cancer.Key words: Persistent left superior vena cava, superior vena cava, vascular varian
GERM CELL TUMOURS OF THE OVARY IN CHILDREN AND ADOLESCENTS: A CLINICAL STUDY OF 109 PATIENTS IN A SPECIALIZED CANCER CENTRE
Full text linkObjective: Paediatric ovarian germ cell tumours (GCTs) are rare tumours withmalignant tumours extremely rare.Methods: All the paediatric patients who received treatment for histology proven ovarian GCT at Shaukat Khanum Memorial Cancer Hospital from January 2006 to December 2014 were retrospectively reviewed. Patients over the age of 18 years were excluded from the study. A total of 109 patients were included in the study. A set of parameters were identified to record initial clinical presentation and examination, imaging and laboratory investigations including tumour marker levels. Decisions of multidisciplinary team meetings, surgical treatment, neo adjuvant, adjuvant chemotherapy and radiation data retrieved. Data analysiscarried out using SPSS 20.Results: In total 109 girls presented to our hospital during the study period, most of them above the age of 5 years, with dysgerminoma being the most common followed by yolk sac tumour. Most of the patients received treatment outside our hospital and were referred here for chemoradiotherapy. Fertility preserving surgery was the most commonly performed surgical procedure with a mean follow-up of 50.4 months and >75% overall 5-year survival.Conclusion: Regardless of histologic types, the outcomes of GCT can be improved with a multidisciplinary approach.Key words: Dysgerminomas, germ cell tumours, ovarian tumour