Journal of Cancer and Allied Specialties
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COMPARISON OF MAMMOGRAPHY AND ULTRASOUND COMBINED VERSUS ULTRASOUND ALONE IN EARLY EVALUATION OF SYMPTOMATIC BREAST CANCERS IN PAKISTAN
Full text linkPurpose: The purpose of this study was to detect diagnostic accuracy of mammography and ultrasound combined versus ultrasound alone in early evaluation of symptomatic breast lesions.Materials and Methods: All new patients who presented to the breast clinic with symptomatic breast lesions, during the year 2012, were included in the study. A total of 695 patients were registered. Their clinical findings, mammogram, ultrasound and histopathology were reviewed.Results: Mammogram and ultrasound combined detected 693 (99.71%) lesions in total. Mammogram failed to detect lesions in 1.43% of patients, whereas the failure rate of ultrasound was 0.43%. The incidence of microcalcifications on mammogram was 19.13%.Conclusion: Ultrasound is a useful tool in the initial evaluation of symptomatic breasts. For places such as Pakistan where mammogram is not available at every centre, ultrasound can be used as an effective alternative for the assessment of symptomatic breast lesions.Key words: Breast cancer, mammography, ultrasoun
WHAT IS YOUR UNDERSTANDING OF SPINAL AND EPIDURAL ATTEMPT?
Full text linkBackground: The practice of spinal and epidural anaesthesia is well established the world over for a number of years. Sighting of spinal or epidural is conducted through various approaches at various levels of the spinal column. The number of attempts has its correlation with the post-spinal and epidural complications.Aim: The aim is to gather information about the understanding among the anaesthetists about the spinal/epidural attempt.Materials and Methods: A pro forma comprising of nine closed-loop questions was distributed to all the participants in the study, and they were requested to fill it anonymously and placed it back in a designated sealed box in anaesthetic office.Results: A total of 20 pro formas were distributed, and all of them received back with 100% responses. All the participants accepted universally that attempting through another space makes it a second attempt. One of the respondents thought any backward movement means 2nd attempt, the majority of the responders thought it does not count as an attempt. Almost everyone considered another attempt if a needle is completely withdrawn and enters through another puncture site whether through a midline or paramedian approach.Conclusion: Most of the complications after neuraxial blockade are associated with the number of attempts alongside other factors that may play a role. A universal definition of a spinal and epidural attempt may decrease the complications associated with the central neuraxial blockade.Key words: Epidural, single attempt, spina
HYBRID BONE SCINTIGRAPHY IN GASTROINTESTINAL MALIGNANCIES – INSTITUTIONAL EXPERIENCE
Full text linkObjective: Bone metastases in gastrointestinal (GI) malignancies are uncommon and known to be predominantly lytic thus rendering a limited role for conventional bone scintigraphy. The aim of the study is to review Tc99m MDP bone scans performed in patients with known GI malignancy and the utility of Single-photon emission computed tomography (SPECT)/CT in characterization of bone lesions.Methods: Retrospective review of bone scans was done from June 2014 to December 2016 in patients with known GI malignancy, using electronic Hospital Information System.Results: A total of 110 patients (60 males, 50 females; Age range: 22–84 years, Mean Age 51.4 years with SD of 14.8) had bone scan over a period of 30 months. The commonest indications for referral were suspected bone metastasis on other imaging modalities including [CT (n = 56), Magnetic resonance imaging (n = 10), Positron emission tomography/CT (n = 6)], musculoskeletal pain (n = 37), pathological fracture (n = 1), neurological symptoms (n = 1), hypercalcemia (n = 1) and others (n =14) including restaging workup etc. Metastatic lesions were identified in 32 (29%) patients whereas 78 (71%) patients had benign non-aggressive lesions leading to normal bone scans. Among 32 patients with osseous metastasis, 8 (25%) patients had unifocal lesion; axial skeleton (n = 2) appendicular skeleton (n = 6), 24 (75%) patients had multifocal lesions; axial skeleton (n = 6), appendicular skeleton (n = 6) and both axial + appendicular (n = 12). Four (12%) patients had concurrent visceral metastases. In our cohort, based on the location of primary tumour, the frequencies of osseous metastasis were; esophagus = 15 out of 43 (35%), gastric = 7 out of 18 (39 %), gastro-esophageal junction = 1 out of 8 (1.5%) and colorectal = 9 out of 40 (22.5). SPECT/CT was acquired in 29 out of 110 patients, which characterized metastatic lesions (n = 12) and benign looking non-aggressive entities (n =17). Overall, bone scan upstaged disease in 31% and down staged 15% patients.Conclusion: Bone metastases in GI malignancies, though uncommon, show an aggressive pattern, with axial and appendicular involvement, and can be readily identified with hybrid bone scintigraphy in symptomatic patients. Key words: Hybrid imaging, Tc99m MDP, bone metastases, gastrointestinal malignancie
A PICTORIAL REVIEW OF ONCOPLASTIC & RECONSTRUCTIVE BREAST SURGERY
No full textOncoplastic surgery (OPS) of the breast has revolutionised the surgical practice in the past few years worldwide and has become an integral part of the breast cancer surgical treatment. OPS blends the principals of good local oncological control with plastic surgery techniques for immediate breast reshaping to provide best cosmetic results as well as oncological safety. It helps in extending the boundaries of breast-conservation treatment to include a group of patients who would otherwise require mastectomy to achieve complete excision of the tumour. OPS is a broad concept that can be used for several different combinations of oncological breast-conserving surgery and reconstructive surgery in the form of breast re-shaping/re-modelling. Careful patient selection and pre-operative planning are key components for the success of any OPS operation for breast cancer. Thorough surgical planning is mandatory including clinical assessment and breast measurements with reference to tumour/breast volume ratios. Mastectomy and total breast reconstruction are an option for patients that cannot have breast conservation. In this article, we provide a pictorial review of various oncoplastic and reconstructive breast operations, explaining the indications, essential principles, concepts and techniques of various surgical procedures.Key words: Breast cancer, oncoplastic surgery, breast reconstructio
Retracted: Diagnostic Dilemma of a Diaphragmatic Hernia
Full text linkDiaphragmatic hernia post esophagectomy is a rare complication but a reality in its existence. It is typically difficult to diagnose but highly depends on keeping high index of suspicion. In our case report, the young male who underwent esophagectomy for esophageal carcinoma, remained disease free and stable in his 9 months follow up, suddenly presented in the emergency department with the symptoms of shortness of breath, chest pain, vomiting and tachycardia. The case was typically complicated by the initial treatment given for acute ischemia and cardiogenic shock. Radiological findings proved to be helpful and turning point in the diagnosis and overall management
HEAD AND NECK CANCER IN A DEVELOPING COUNTRY- A HOSPITAL BASED RETROSPECTIVE STUDY ACROSS 10 YEARS FROM PAKISTAN
Full text linkPurpose: Head and neck cancers (HNC) are among the most common cancers in developing countries, especially in the Southeast Asia. Oral cavity is the most commonly affected site. The risk factors are tobacco, betel nut and alcohol. The dimensions of the disease are quite different in developing countries than the western world. Poor socioeconomic status, poverty, lack of healthcare facilities and illiteracy are the factors that pose a major challenge to the management of the disease. The aim of this study is to analyse the database that has been collected over a period of 10 years showing the trends of the disease and the management outcome of these individuals.Methods: Men and women diagnosed with HNC from 2004 to 2014 from Cancer Registry Database of Shaukat Khanum Memorial Cancer Hospital and Research Centre have been retrospectively analysed.Results: In the 10 year period a total of 5027 patients presented to the head and neck clinic at our institution with a mean age + standard deviation of patients of 58.33 + 20.54. Oral cavity (42.6%) and larynx (13%) were the two mostcommon sites followed by the less frequent ones. Squamous cell carcinoma ranked as the most common histological type presented to our institute (69.2%), followed by basal cell carcinoma (6.6%), mucoepidermoid carcinoma (4%), adenoid cystic carcinoma (3.6%) and 1.9% adenocarcinoma.Conclusions: Being a third world country, the burden of the disease on the healthcare system is enormous. With limited resources and funding, there is a need to train people in the speciality and develop the National Cancer ControlProgram (NCCP) for better monitoring and disease control.Key words: Developing country, head and neck cancer, health infrastructur
DIAGNOSIS OF CUSHING’S SYNDROME; BIOCHEMICAL INVESTIGATIONS
Full text linkCushing’s syndrome remains an uncommon diagnosis with majority of non-specific and few specific clinical features suggestive of the condition. Results of biochemical investigations are often affected by confounding factors making diagnosis of Cushing’s syndrome difficult and localisation of the disease even more challenging. Careful assessment of the individual patient and use of the most suitable test in that patient may allow improved outcome in diagnosing and localising the condition to devise an appropriate management plan.Key words: Cushing’s syndrome, hypercortisolism, dexamethasone suppression test, Pseudo-Cushing’
DOES PATHOLOGICAL T3A UPSTAGING OF CLINICAL T1 STAGE HAS ANY DIFFERENCE ON LONG-TERM SURVIVAL WHEN COMPARED TO PATHOLOGICAL AND CLINICAL T1 STAGE RENAL CELL CARCINOMA
Full text linkBackground: A high number of clinical T1 (cT1) stage renal cell carcinoma (RCC) is upstaged to pathological T3a (pT3a) stage on histopathological findings. Several study results show that there is no survival difference among those cT1 stage who are upstaged on histopathological findings to those who remain pT1 stage RCC.Objectives: The objectives of this study were to assess any survival difference for cT1 stage renal cell carcinoma (RCC) which is upstaged to pT3a stage as compared to those which remain pT1 stage RCC on histopathological findings.Materials and Methods: It was a retrospective cohort study looking at patient aged ≥18 years with cT1 RCC who underwent nephrectomy between January 2006 and December 2016. Patients were divided into two groups based on histopathological findings (pT1 vs. pT3a). Survival was analysed for the two groups using Kaplan–Meier method, and the difference in survival was calculated using log-rank model.Results: The study included 187 patients. The mean age at presentation was 52.56 years, with 58.3% of the patients being male while 41.7% were female. The most common presentation was incidental diagnosis (50.3%). Overall5-year survival for cT1a and pT1a RCC was 68% while that for cT1a and pT3a RCC was 100%. There was no significant survival difference among the two groups (P = 0.316). The overall 5-year survival for cT1b and pT1b RCC was 81% while that for cT1b and pT3a was 65%. There was no significant survival difference among the two groups (P = 0.136).Conclusion: We found no survival difference in cT1 RCC who were upstaged to pT3a on histopathology as compared to cT1 RCC-staged pT1 on histopathology.Key words: Clinical T1 stage, pathological T3a stage, radical nephrectomy, renal cell carcinoma, surviva
