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Dietary factors are regarded as exerting major influences on cancer development in various organ sites andin Asia there is particular interest in the potential preventive effects of foodstuffs such as soy products andgingseng. The so-called phytoestrogens, like genistein and daidzein in soy, can bind to estrogen receptors andtherefore interfere with the action of estrogen itself, a well-established risk factor for breast, ovarian andendometrial cancers. Although not all results are consistent, there is good evidence for protective influence ofsoy products against all three of these cancers. In addition, there have been many reports of preventive effects inthe prostate. With ginseng, whether white or red, the included polyphenol compounds and saponins may playroles in many different organs, although preventive potential is perhaps best documented for gastric cancer.The traditional diets in Eastern Asia may need more emphasis in efforts to combat the growing problem ofcancer in this region of the world
We here report the incidence of different types of genitourinary cancers among the Iranian populationaccording to the records of the Iran Ministry of Health and Medical Education. In a population-based cancerregistrystudy in 2005, all recorded data in pathology laboratories, freestanding cancer clinics and treatmentcenters, physician offices, and other state central registries were obtained with the assistanceof Iran Universitiesof Medical Sciences and sent to the Diseases Management Center in the Health Ministry. The prevalences ofurological cancers were as follows: bladder cancer 48.3%; prostate cancer 33.4%; renal cell carcinoma 10.3%;renal pelvis and ureter cancer 0.75%; testicular cancer 6.15%; penile cancer 0.15%; urethral cancer 0.45%;and other unspecified urinary cancers 0.43%. The male to female ratios for the various common urologicalcancers varied between 1.69 (renal cell carcinoma) and 7.75 (unspecified urinary cancers). The incidence ofprostate cancer among our population was dramatically higher than in other countries of Asia. However, bladdercancer was found to be the commonest of the genitourinary cancers, especially in elderly patients, among ourpopulation.
Introduction: Carcinoma of the breast is the most common malignancy of women in Karachi. The currentstudy was conducted with the objective of assessing estrogen receptor (ER), progesterone receptor (PR) andHER-2/neu reactivity patterns of mammary cancers for correlation with histologic grade, tumor size and lymphnode metastasis. Materials and methods: One hundred and fifty modified mastectomy specimens received atthe section of histopathology, Aga Khan University Hospital, were selected using a non-probability samplingmethod. Results: Mean age of the patients was 48.3 years (95%CI 46.5, 50.2). The left breast was more commonlyinvolved (57%). Tumor size ranged from 0.3 to 15.0 cm; 12% were ≤2.0 and 35.3% were ≥ 5.0 cm in diameter.The predominant morphology was infiltrating ductal carcinoma (85.3%). The majority of the cases presentedas grade II (55.3%) lesions with tumor necrosis (70%) and lymph node involvement (71.3%). ER and PR werepositive in 32.7% and 25.3% cases respectively. HER-2/neu was positive (3+) in 24.7%. ER positivity increasedand HER-2/neu positivity decreased with rising age. ER and PR expression was significantly lower in HER-2/neu positive as compared with HER-2/neu negative tumors (ER 83.8% vs 69.8%; PR 91.9% vs 77.8%). In theHER-2/neu positive tumors, ER and PR expression in high grade tumors was significantly decreased comparedwith intermediate grade tumors (ER 5.6% vs 10.5; PR 0% vs 5.3%). ER expression in the HER-2/neu positive,large sized tumors was also significantly decreased compared with smaller tumors (ER 6.3% vs 11.8). Conclusions:ER and PR expression in breast cancers in the current study was found to be comparable to publishedinternational data, but the frequency of HER-2/neu expression was higher, possibly reflecting a young age atdiagnosis. Assessment of prognostic markers for the clinical management of breast cancer patients is stronglyadvocated to provide best therapeutic options.
Introduction: Quality of life (QOL), and pulmonary and nutritional parameters are important outcomemeasures during treatment of lung cancer; however, the effect of chemotherapy on these factors and theirrelationship with clinical response is unclear. Methods: Patients with non-small cell lung cancer (NSCLC) wereevaluated for symptom profile, nutritional status (using anthropometry), pulmonary functions by spirometryand six minute walk distance (6 MWD), and QOL using the WHO-QOL Bref 26 questionnaire, before and afterchemotherapy. Results: Forty-four patients were studied (mean (SD) age, 55 (10) years, 75% males). The majority(98%) had stage III or IV disease and 72% were current / ex-smokers with median pack-years of 27.0 (range,0.5-90). Some 61% had a Karnofsky Performance Scale (KPS) 70 or 80. The commonest symptoms were coughing,dyspnea, chest pain, anorexia and fever (79%, 72%, 68%, 57% and 40%, respectively). The mean (SD) 6 MWDwas 322.5 (132.6) meters. The mean (SD) percentage forced vital capacity (FVC %), and forced expiratoryvolume in one second (FEV1 %) were 64.7 (18.8) and 57.8 (19.4), respectively. The mean (SD) QOL scores forthe physical, psychological, social, and environmental domains were 52.9 (20.5), 56.1 (17.9), 64.5 (21.8), 57.1(16.6), respectively. Fourteen patients (32%) responded to chemotherapy. Non-responders had significantlyhigher baseline occurrence of fever, anorexia, and weight loss, higher pack-years of smoking and poorer KPScompared to responders. Overall, chemotherapy caused significant decline in the frequency of coughing, dyspnea,chest pain, fever, anorexia, weight loss, and improvement in hemoglobin and albumin levels. There was nosignificant improvement in pulmonary functions, nutritional status, or QOL scores after treatment. Conclusions:Lung cancer patients have a poor QOL. Although chemotherapy provides significant symptomatic benefit, thisdoes not translate into similar benefit in respiratory and nutritional status or QOL. Patients with constitutionalsymptoms, higher smoking burden, and poor KPS are less likely to respond to chemotherapy. Management ofNSCLC must include strategies to improve various aspects of QOL, nutritional status and pulmonary reserveto achieve comprehensive benefit.
Objectives. Infection with high-risk human papillomavirus (HPV) is a critical factor associated withcarcinogenesis of the uterine cervix. HPV-16 is most frequently found, and is further subclassified into intratypicvariants based on the nucleotide sequences of the viral genes. Although certain HPV-16 variants are reported tobe associated with the progression of cervical lesions, these relationships remain controversial with differentresults for different populations. To provide data for another population, we investigated the prevalence ofHPV-16 and distributions of its intratypic variants among Mongolian women with cervical intraepithelialneoplasia (CIN) and invasive cervical cancer. Materials and Methods. We analyzed samples from 374 randomlyselected women who attended the National Cancer Center of Mongolia between January 2002 and July 2007,including 147 invasive cervical cancer patients, 127 CIN patients and 100 age-matched controls who werecytologically normal. HPV genotyping was initially conducted, followed by variant analysis for HPV-16-positivesamples by nucleotide sequencing of the E6 gene. The HPV data were evaluated statistically for correlationswith the patients’ clinical data. Results. HPV genotyping detected 101 HPV-16-positive samples. Among thesesamples, 92 were available for subsequent variant analysis, including 66 invasive cervical cancer samples, 25CIN samples and 1 cytologically normal sample. A total of 14 different variants were identified. All 14 variantsbelonged to the European lineage, and the European prototype was detected in 66% (61/92) of the samples.Among the remaining 31 variants, variants with the T350G nucleotide change were predominant (13/31, 42%),followed by variants containing G94A (11/31, 35%), G176A (4/31, 13%) and G274T (2/31, 7%) . There were nosignificant differences among all the variants regarding their distributions in CIN and invasive cervical cancers.Conclusions. HPV-16 variants of the European lineage were exclusively distributed among the Mongolian womenexamined, and the European prototype was overwhelmingly predominant. Since no significant differences werefound between the types of variants and severities of the cervical lesions, it is possible that racial or geographicfactors may have some influences on these relationships.
Background: Nutritional status and healthy lifestyle are important factors not only in cancer etiology butalso for prevention efforts. A good nutritional status contributes to a healthy life with high economic, social andcultural level. Unhealthy eating habits are part of risky behavior seen from adolescence. The present study wastherefore carried out to determine eating habits, level of knowledge about cancer prevention and behavior of agroup of adolescents. Methods: Data were collected using questionnaire covering eating habits and knowledgeof adolescents on prevention from cancer, and special scale (HPLP) to determine the related behavior. Threehundred sixty six of 390 students volunteered for study. Results: Eating habits and the level of cancer preventionknowledge were similar for both genders, except for the exercise issue. The mean total points of adolescents inthe Health Promotion Behavior and Subscales was 113,63. While spiritual growth had the highest score inHPLP subscale, exercise had a minimal score. Exercise was the only HPLP subscale with a statistically significantdifference between male and female genders. Conclusions: Although they have some information, the adolescentssurveyed did not have preventive skills relative to their practical life. In general in order to ensure cancerprevention and a healthy life style social, cultural and sportive activities should be encouraged and educationalprogrammes supporting these goals should be designed and applied for all stages of life, starting in earlychildhood.
This study aimed to evaluate the correlation and agreement between Siriraj liquid-based cervical cytology(Siriraj -LBC) and conventional cytology. A total of 479 women who attended the Department of Obstetric andGynaecology Siriraj Hospital for cervical cancer screening were enrolled. For each woman collection of cervicalcells was performed using VCE technique. After smearing cells on a glass slide for conventional cytology, bothbroken ends of wooden spatula and cotton swabs were then placed into a plastic vial containing a specificpreservative solution for Siriraj-LBC. All specimens were prepared and interpreted by experiencedcytotechnologists at the Gynecologic Cytology Unit. Interpretations of the results from one technique weremade without knowledge of those from the other technique. The results from both techniques were comparedfor agreement and correlation. Colposcopy or histology was used as the gold standard. The overall detectionrate of abnormal cervicovaginal cells was higher by Siriraj-LBC than by conventional cytology (11.1% vs.1.67%, P <0.001). These two techniques had high diagnostic agreement of 89.77%, and minimal to fair correlationwith a Kappa of 0.128 (P< 0.001) and a Spearman rho correlation coefficient of 0.394 (P <0.001). There were 49cases whose Siriraj-LBC revealed higher cytologic grading than did the conventional cytology; there were nocases of the opposite result. The gold standard was available in 45 cases with abnormal cytology by Siriraj-LBC,revealing a positive predictive value (PPV) of 71.1% for Siriraj-LBC and 97.8% for conventional cytology, anda negative predictive value (NPV) of 42.2% for the conventional cytology. In conclusion, The results from Siriraj-LBC and conventional cytology have high diagnostic agreement and minimal to fair correlation. The Siriraj-LBC increases detection rate of abnormal cervicovaginal cells with probable decrease in false negatives butincrease in false positives from the baseline values by conventional cytology. Therefore the screening performanceof Siriraj-LBC is not inferior to the conventional cytology and this approach may be used as an alternativescreening method for cervical cancer.
Background: Cancer is a major cause of disease burden in Pakistan, so that knowledge of physicians aboutall aspects should be adequate, especially for palliative care for end stage management, given the generally latestage presentation. Methodology: A cross-sectional study was conducted in three tertiary care hospitals andareas of general practice in Pakistan. Results: A total of 236 non-oncologist physicians were assessed. Most ofthem claimed to have cared for cancer patients in someway and considered that cancer treatment is often longand protracted. However, one-third were unaware of the fact that cancer is a major disease burden in oursociety. About half of them thought that chemotherapy makes patients miserable. Oncology as a practice wasconsidered financially of low reward by about a quarter. Most physicians, including consultants, were unawareof the term hospice. Many did not know where to refer cases of cancer and about the commonest cancers inPakistani males. Conclusions: Awareness about cancer and palliative care among primary physicians needs tobe improved for cancer prevention and control.
Background: The aim of this study was to estimate some prognostic factors that affect on overall survival ofpatients with early gastric cancer. Methods: A retrospective study had been done on patients diagnosed withearly gastric cancer who registered in cancer registry center, Tehran-Iran, between December 21, 2001 andDecember 21, 2006 and all patients were followed by telephone contacts. The Kaplan-Meier method was performedto describe survival curves and log-rank test to compare the survival rate in subgroups. Cox regression wasused to determine the prognosis factors. Results: The mean age was 57.9 ± 11.9 years and 72.6% of patientswere male. Tumor size (>35mm) and lymph node metastasis were established as significant factors for survivalof patients with EGC in both univariate and multivariate analysis. Conclusion: The findings of this studyindicate that lymph node metastasis and tumor size are the most independent prognostic factors in these patients.
The impact of socio-economic and demographic status (SEDS) factors on the stage of cervical cance ratdiagnosis, symptom duration and delay-time from diagnosis to registration was determined by analysing datafor the year 2006 from the Regional Cancer Centre (RCC), Trivandrum, Kerala, India. Patients (n=349) wereincluded if they were from the states of Kerala or Tamil Nadu. SEDS factors included age, residing district,religion, marital status, income, education and occupation. Associations between SEDS factors by stage atdiagnosis and symptom duration were tested using chi-square statistics with odds ratios (OR) estimated throughlogistic regression modeling. Elevated risks for late stage reporting among cervical cancer patients were observedfor women who were widowed/divorced (OR=2.08; 95%CI: 1.24-3.50) and had a lower education (OR=2.62;95%CI:1.29-5.31 for women with primary school education only). Patients who had symptoms of bleeding/bleeding with other symptoms (77%) were more likely to seek treatment within one month, compared to patientswith other symptoms only (23%) (p=0.016). This analysis helped to identify populations at increased risk ofdiagnosis at later stages of cancer with the ultimate intent of providing health education and detecting cancer atearlier stages.
Kaempferia parviflora Wall. ex. Baker is a Thai herb containing many flavonoids that have anti-inflammatory,anti-allergic and antioxidant activities. The objective of this study was to demonstrate apoptotic effects ofKaempferia parviflora Wall. ex. Baker rhizome ethanolic extract on HL-60 cells in vitro. The extract suppressedHL-60 cell growth and decreased cell viability in a dose- and time-dependent manner. Apoptotic cell death wasdemonstrated by changes in cell morphology, externalization of phosphatidylserine on the cell surface, loss inmitochondrial transmembrane potential and activation of caspase 3. Apoptosis induced by K. parviflora Wall.ex. Baker rhizome ethanolic extract was enhanced by treatment with paclitaxel or doxorubicin, and inhibitorsof Akt, PI3-K and MEK.
The role of social support in functional status to a diagnosis of cancer was examined in 84 patients withbreast cancer. Multivariate techniques were used to assess the relationships among the dimensions of socialsupport, as measured by the Multidimensional Scale of Perceived Social Support (MSPSS), and functionalstatus, assessed with the Inventory of the Functional Status Cancer (IFSA-CA). The results indicated significantindependent associations between support and functional status outcomes, underscoring the importance ofexamining social support to evaluate functional status of patients. Nurses cognizant of breast cancer survivorschallenges and concerns in areas of social support and are in a unique position to enhance functional status.
Background: Chronic hepatitis B and associated liver cancer constitute important health threats with disparityamong Asian/Pacific Islander Americans (APIs). However, many APIs are unaware of and unprotected againstthese diseases. Methods: To inform the development of community-based programs to increase hepatitis B andliver cancer awareness and prevention among APIs, we conducted a series of qualitative focus groups in 2007 toidentify motivations and deterrents related to hepatitis B education, testing, and vaccination among San FranciscoBay Area Chinese Americans. Six focus groups were held in Cantonese, English, or Mandarin for women ormen, respectively. Recorded transcripts were transcribed, translated, and then coded by consensus. Results:Factors that motivated individuals to be tested for hepatitis B included peace of mind, prevention of transmissionto others, informed decision-making ability, convenience, and pre-vaccination screening. Primary motivationsfor hepatitis B vaccination were protection of future health and avoidance of hepatitis B. However, factors thatdiscouraged people from testing or vaccination included costs, lack of health insurance, fear of side effects,worries about reliability or efficacy, poor patient-doctor communication, reliance on professional opinion,apparent good health, inconvenience, and personal preference. Individuals were generally in favor of informingrelatives and friends about hepatitis B testing and vaccination, and offered several reasons for and againsteducating others about these activities. Conclusions: In summary, our study identifies common attitudes andinfluences regarding the decision to take preventive action against hepatitis B and liver cancer. These findingscan be applied toward the design of more effective educational and outreach materials and programs for ChineseAmericans and possibly other APIs.
Objective: The aim of the present study was to assess knowledge and opinions related to oral cancer screeningamong dentists employed in public sector dental services in Sri Lanka. Materials and methods: The studypopulation consisted of a total of 1,020 dentists employed in the public sector dental services as at December2007. The data were collected by means of a postal questionnaire consisting of 23 items focusing on demographiccharacteristics, knowledge and opinions about screening for oral cancer/precancer. Results: 387 completedquestionnaires were returned giving a response rate of 38%. The overall knowledge score for oral cancer screeningwas 2.79 ± 0.76. There were no significant differences between time since graduation, position held and knowledgescores. Around 68-70% of respondents agreed/strongly agreed that their knowledge about oral cancer/pre cancerwas current. Though 77% agreed/strongly agreed that dentists are adequately trained in oral cancer screening,nearly 63% disagreed/strongly disagreed that medical officers are adequately trained to perform oral screening.Nearly 81% agreed/strongly agreed that they were adequately trained in oral cancer screening whilst 70% alsofelt that they needed further training in oral cancer screening. Conclusions: the results revealed that a fairlylarge proportion of respondents were knowledgeable about oral cancer screening but as there was a reasonablepercentage whose knowledge about oral cancer screening was poor there is a need for continuing educationprogrammes.
Environmental lighting conditions affect circadian rhythm and carcinogenesis. The effect ofdiethylnitrosamine (DEN, i.p., 200 mg/kg) on carcinogenesis and circadian rhythmicity under a light-dark (LD)cycle, constant dark (DD) and constant light (LL) was analyzed in rats. After the recognition of entrainment inlocomotor activity rhythm to LD cycle, animals remained under the LD cycle or were released into DD or LL.Liver carcinogenicity, measured by GST-P immunostaining, was higher under the LD cycle than under DD andLL. Two weeks after DEN injection, locomotor activity in 24 hr had increased under the LD. Circadianrhythmicity might be coupled with the carcinogenicity of DEN.
Cervical cancer is caused by persistent infections through “high risk (HR) types” of human HPVs, particularlyHPV 16 and 18. HR-HPV types encode two potent oncogenes, referred to as E6 and E7. Both are required toinduce and maintain neoplastic growth of cervical cancer cells. Cyclin dependent kinase inhibitor genes as forexample p16INK4A were shown to be negative regulated by active pRb. Inactivation of pRb by E7 thus releasesthe p16 gene from its negative transcriptional control and results in significant overexpression of p16 encodedprotein in HPV transformed cells. It has been demonstrated that p16 protein can be detected in cervicalpreneoplasia all high grade SIL or invasive cancers, whereas no expression was detected in normal, metaplasticor inflammatory cervical lesions. Moreover, low grade cervical lesions induced by low risk HPV infection buthistological indistinguishable from low grade lesions induced by HR-HPV-infections could be clearly differentiatedby p16INK4A immunohistochemistry, showing negative staining for p16 protein. The objective of this study isto examine the expression of p16 protein in cervical carcinoma in Thailand. Immunohistochemical analysis ofp16INK4A was performed on 53 formalin – fixed and paraffin – embedded samples of various stages of cervicalneoplastic lesions. There are squamous cell carcinoma in situ 8 cases, squamous cell carcinoma in situ withglandular involvement 16 cases, microinvasive squamous cell carcinoma 13 cases and invasive squamous cellcarcinoma 16 cases. The specimens were taken from cervical biopsy, cervical conization and hysterectomy in theyear 2000 at National Cancer Institute. Strong immunoreactivity for the p16 protein was observed in only thenuclei and cytoplasm of all cervical neoplastic cells. This study supported the idea that immunohistochemicaloverexpression of the p16 protein may be a useful screening test for cervical cancer. In addition, p16immunohistochemistry is useful for helping in the interpretation of cervical histology samples, facilitating morerapid diagnosis.
Human papillomaviruses (HPVs) are small DNA tumor viruses that replicate and assemble exclusively inthe nucleus. Thus their proteins, including E6, must carry nuclear localization signals (NLSs) to enter the nucleus.To analyze and to predict the nuclear localization signals and several post translational modifications bybioinformatics analysis, we obtained 91 E6 protein sequences from available databases. To investigate thelocalization of these sequences, we used Hum-Ploc software. Homology and alignment of sequences wereperformed by Blast software and Multalin server respectively. Prediction of N-glycosylation and serine, threonineand tyrosine phosphorylation sites of HPV E6 protein sequences was accomplished with NetNGlyc and NetPhossoftware. Out of 91 types, the NLSs of 29 types were predicted by signal-3L and signal-CF software. We tried topredict the NLSs of remaining HPV E6 proteins according to the homology of the already predicted NLSs.However, because of considerable variation between E6 protein sequences, we could not classify the NLSs inmonopartite or bipartite. According to the results, all NLSs of HPV E6 proteins could be assigned to 11 categories.NLSs of several HPV E6 protein sequences were also determined by experimental studies. Overall, differenttypes of HPV E6 protein in same category show approximately similar pattern in post translational modificationssuch as N-glycosylation and phosphorylation. Some HPV “early” genes, such as E6, are known to act as oncogenesthat promote tumor growth and malignant transformation. Thus more detailed recognition of nuclear localizingsequences and nucleocytoplasmic transport pathway can play a key role in prevention and treatment of HPVinfection and related cancers. The results also show that bioinformatics technology can direct and simplifyexperimental studies.
Objective: To examine the relationship between tobacco advertisements, counter-advertisements, and smokingstatus among Indian youth. Materials and Methods: Global Youth Tobacco Survey (GYTS) data was used; thedata encompassed a representative two-stage probability sample of 60,001 students aged 13–15 years in 24states in India. These students were interviewed with an anonymous, self-administered questionnaire. Binarylogistic regression analyses were performed with smoking status as the dependent variable, and exposure tocigarette advertisements or counter-advertisements as independent variables. Results: Students watching antismokingmedia messages were less likely to be current smokers, which was true for both boys [OR = 0.89, 95%CI (0.81–0.98)] and girls [OR = 0.79, 95% CI (0.69–0.90)]. This relationship was stronger among past smokersfor boys [OR = 0.56, 95%CI (0.52–0.60)] and girls [OR = 0.49, 95% CI (0.45–0.53)]. On the other hand, studentswho were exposed to cigarette brand names during sports events and other televised programs, newspapers ormagazines, and being offered free cigarette or cigarette-branded merchandise promotions were significantlymore likely to be smokers, with effects ranging from moderate (OR=1.19) to very strong (OR=3.83). Conclusions:This is the first attempt from India to investigate the relationship between smoking and advertising. When thedata were collected, cigarette advertising was legal and highly correlated with smoking behavior. Today, indirectsurrogate advertising still exists; future research should examine its effect, as it is likely to have the same impactas direct advertising on smoking behavior. Finally, counter-advertising has a protective effect on youth and mayfunction as a cessation aid.
Background and aims: The outcomes of nephroblastoma (Wilms’ tumor, WT) in our institute and otherdeveloping countries are notably below results in most developed countries. The objective of this study was toreview treatment outcomes of pediatric nephroblastoma in southern Thailand during the past decade and attemptto isolate factors associated with a poor prognosis. Patients and methods: The records of 34 WT patients, agedless than 16 years, who were operated on in Songklanagarind Hospital, Thailand, during the period from January1996 to December 2007 were reviewed. The management protocol followed the scheme of the US NationalWilms Tumor Study Group (NSWTG). Results: Thirteen cases (38.2%) were diagnosed as stage I, 4 (11.8%) asstage II, 13 (38.2%) as stage III and 2 (5.9%) as stage IV. Two cases with bilateral disease (stage V) had stage Itumors in both kidneys. Four-year overall survival (OS) and event free survival (EFS) rates were 65.2% and52.7%, respectively. Univariate analysis by Log-rank test revealed statistically significant associations betweenOS and nodal status (p- value < 0.01), manifestation of gross hematuria (p-value 0.02), and tumor size of 10centimeters or more (p-value 0.02). Multivariate analysis found only the nodal status to be independentlyassociated with OS at a Hazard Ratio of 16.6 (p-value < 0.01). Eight of 13 stage I cases and 6/13 stage III caseshad relapsed, with two-year post-relapse survival of 42.8%. Significantly poorer outcome was found in caseswith early relapse within 200 days after enrollment (p-value 0.02). Conclusion: The poor outcome of pediatricnephroblastoma in southern Thailand seems to be related at least in part to failures in primary treatment instage I patients. Large tumor size and gross hematuria were associated with risk of a poorer outcome.
Background: In Malaysia, acute leukemia is the most common cancer among children below the age of 15. Acase-control study was here conducted for cases from the Klang Valley, Malaysia, who received treatment at theNational University of Malaysia Hospital (HUKM) and Kuala Lumpur General Hospital (GHKL). The mainobjective was to determine any association with environmental factors. Methods: Case subjects were childrenaged below 15 years and diagnosed with acute leukemia in HUKM and GHKL between January 1, 2001 andMay 30, 2007. Control subjects were children aged below 15 years who were diagnosed with any non-cancerousacute illnesses in these hospitals. A total of 128 case subjects and 128 control subjects were enrolled in this study.The information was collected using a structured questionnaire and a global positioning system (GPS) device.All factors were analyzed using unmatched logistic regression. Results: The analysis showed that the occurrenceof acute leukemia among children was strongly determined by the following factors: family income (odds ratio(OR) 0.19, 95% confidence interval (CI): 0.09–0.42), father with higher social contact (OR 7.61, 95% CI: 3.78–15.35), number of elder siblings (OR 0.36, 95% CI: 0.18–0.77), father who smokes (OR 2.78, 95% CI: 1.49–5.16), and the distance of the house from a power line (OR 2.30, 95% CI: 1.18–4.49). Conclusions: Somesocioeconomic, demographic, and environmental factors are strong predictors of the occurrence of acute leukemiaamong children in Klang Valley, Malaysia. In terms of environmental factors, it is recommended that futurehousing areas should be developed at least 200 m away from power lines.
Objectives : To evaluate interobserver reproducibility of a combined scoring method for immunohistochemicalinterpretation of p16 overexpression in cervical lesions. Materials and methods : p16 immunostaining wasperformed in cervical samples from 183 patients, including 69 normal, 42 low grade squamous intraepitheliallesions(LSIL), 36 high grade SIL (HSIL), and 36 squamous cell carcinomas(SCCAs). Each case was evaluatedby a combined scoring method based on the percentage of positive cells (score 0-3), the intensitiy of staining(score 0-3), and the distribution pattern (score 0-2). Immunoexpression for p16 was considered as positive whenthe combined score was 4-8 and negative with a score of 0-3. Ten pathologists with varied experience ininterpretating p16 immunostains evaluated each slide independently. Results : All normal cervical squamousepithelia (69/69) were uniformly negative for p16. All HSILs (36/36), all SCCAs (100/100), and all but one of theLSILs (40/41, 97.62%) showed positive expression. In 172 of 183 cases (93.99%), p16 interpretation wasconcordant with all pathologists. Eleven cases with discordant results included 10 LSILs and 1 normal mucosasample. Percentage of agreement of each pathologist pair ranged from 96.7-100% (mean 98.1 ± 0.96%) withmean kappa value of 0.96 ± 0.0201 (range 0.93-1.000). Conclusion : The proposed combined scoring methodshows good reproducibility among the participating pathologists and good correlation with the histologicdiagnosis. This method may be a useful guide in the interpretation of p16 expression in cervical epithelial lesions.
Background: It has been proposed that folate and polymorphisms of the enzyme methylenetetrahydrofolatereductase (MTHFR), which regulates influx of folate for methylation reactions for DNA synthesis and repair,are involved in colorectal cancer. This study was designed to determine the influence of a genetic variant (MTHFRG1793A) and folate on colon cancer in Iran. Materials and Methods: We analyzed 227 cases and 239 normalunmatched controls using pyrosequencing. Odds ratios and 95% confidence intervals (95% CI) were calculatedto evaluate associations of the MTHFR gene polymorphism with colorectal cancer risk. Results: A significantlyreduced risk of recurrence was observed in patients heterozygous for the MTHFR G1793A polymorphism (OR:0.17; 95% CI, 0.05- 0.52). The frequency of GG, GA and AA genotypes of MTHFR among the colorectal cancerpatients were 98%, 2% and 0% respectively, while the frequencies among controls were 90%, 10% and 0%,respectively. Furthermore, a significant reduction in recurrence risk was seen in MTHFR G1793A heterozygoteslimited to those who received folate supplements. Conclusion: Our study is compatible with previous findingsconcerning a reverse association between the MTHFR 1793G>A genotype with cancers in different populations.
Breast cancer is the commonest cancer affecting females in Malaysia, contributing 31% of all newly diagnosedcases amongst Malaysian women. The present retrospective cohort study evaluated the relationship between cerbB-2 onco-protein overexpression with various tumour characteristics and survival rate of breast cancerpatients treated at the Universiti Kebangsaan Malaysia Medical Centre (UKMMC) between 1996-2000. CerbB-2 oncoprotein overexpression was determined by immunohistochemistry (IHC) and tumors showing 2+positivity were verified by Fluorescence In Situ Hybridization (FISH). One hundred and seventy two patientswere eligible for the study with a short-term follow-up (median) of 5.1 years. C-erbB-2 oncoprotein overexpressioncorrelated with lymph node positivity, oestrogen receptor (ER) and progesterone receptor (PR) negativity.Univariate analyses showed shorter disease free survival (DFS) and overall survival (OS) in patients with cerbB-2 oncoprotein overexpression, Malay ethnicity, higher tumour grade, lymph node positivity, ER and PRnegativity. In a subgroup of patients with c-erbB-2 oncoprotein overexpression, a shorter OS was observed inthose with lymph node positivity, ER and PR negativity. In multivariate prognostic analysis, lymph node status,ER status and tumour grading were the strongest independent prognostic factors for both OS and DFS. However,c-erbB-2 status was not a significantly independent prognostic factor, even in subsets with lymph node positiveor negative group. C-erbB-2 oncoprotein overexpression correlated well with lymph node status, ER and PR.Shorter OS and DFS were significantly observed in patients with c-erbB-2 oncoprotein overexpression. Lymphnode status, ER status and tumour grading were the only three independent prognostic factors for OS and DFSin this study. Although c-erbB-2 expression is obviously important from a biological standpoint, multivariateanalysis showed that it is not an independent prognostic indicator in breast carcinoma in the local population.
Plausible projections of future burden of cancer in terms of incident cases and requirement of radiotherapytreatment facilities at the national and state level are useful aids in planning of cancer control activities. Thepresent communication attempts to provide a scenario for cancer in India during the year 2001 and its likelychange by 2016 for “all sites of cancer” as well for selected leading sites. Further, a study was made of: (i) thestate-wise distribution of radiotherapy treatment facilities & short falls; and (ii) pattern of investment of financesthrough central assistance by Government of India for cancer control activities during the various plan periods.The age, sex and site-wise cancer incidence data along with populations covered by 12 Indian population basedcancer registries were obtained from the eighth volume of Cancer Incidence in Five Continents (CIV-VIII) andother published reports. Pooled age sex, site specific cancer incidence rates for twelve registries were estimatedby taking weighted average of these registries with respective registry population as weight. Population of thecountry and states according to age and sex for different calendar years viz. 2001, 2006, 2011 and 2016 wereobtained from the report of Registrar General of India. Population forecasts were combined with the pooledincidence rates of cancer to estimate the number of cancer cases by age, sex and site of cancer for the above 5-yearly periods. The existing radiotherapy facilities available in the country for cancer treatment during the year2006 was based on the published reports and updated through personal communication from the Ministry ofHealth of India. During the year 2001, nearly 0.80 million new cancer cases were estimated in the country andthis can be expected to increase to 1.22 million by 2016 as a result of change in size and composition of population.The estimated numbers were greater for females (0.406 millions, 2001) than males (0.392 millions, 2001). Lung,esophagus, stomach, oral and pharyngeal cancers are much higher in men while in women, cancers of cervixand breast are predominant forms followed by those of oral cavity, stomach and esophagus. Considering all thesources, it was noted that during the year 2006, there were 347 teletherapy units in the country as against arequirement of 1059. The state-wise analysis of the distribution of RCCs, and radio-therapy units shows widegaps in the availability of facilities. The existing treatment facilities for cancer control in-terms of radiotherapyand financial allocation are woefully inadequate to take care of even the present load. The only way to fight thisscourge under such circumstances is to have pragmatic programmes and policies based on currently availablescientific information and sound public health principles.
This study was conducted with the objective of providing the pattern of cancer distribution from a hospitalbased tumour registry at CMH, Multan, in comparison with patterns from other National Studies. Theretrospective study of malignant tumours recorded at the pathology department from 2002-2007 featured analysisin terms of age group, gender and type of tumour. Over the six year period the total number of malignancies was930 with a male to female ratio of 1.4:1. The common tumours in males, in order of decreasing frequency wereleukaemia, prostate cancer, urinary bladder cancer, skin cancer and lymphomas. In females they were leukaemia,breast cancer, skin cancer, gallbladder cancer and lymphomas. In both sexes, the most common malignancy wasleukaemia, which is contrary to other studies, pointing to a possible link with extensive use of pesticides andother agricultural chemicals in this region of the country.
Purpose: The aim of this study was to evaluate the role of whole body 18F-FDG PET/CT imaging in thedetection of primary tumors in patients with a metastatic cancer from an unknown primary site. Methods: Thestudy population consisted of 43 patients with a biopsy proven metastatic disease, negative conventional diagnosticprocedures (including CT/MRI/endoscopic procedures) and a whole body 18F-FDG PET/CT examination.Patients’ records were retrospectively analyzed. According to the final pathologic diagnoses, rate of detection ofthe primary tumor site was determined. Additionally, overall patient survival was calculated to evaluate theprognostic value of 18F-FDG PET/CT findings. Results: A primary tumor site was shown by 18F-FDG PET/CTin 24 patients (24/43; 55.8%). In 18 patients 18F-FDG PET/CT scans were negative (18/43; 41.8%). In a patientwith an adenocarcinoma metastasis 18F-FDG PET/CT was falsely positive for an inflammatory lesion in thelung. Among the 18F-FDG PET/CT positive and negative groups median overall survival was not significantlydifferent (log-rank p=0.573). Conclusion: Whole body 18F-FDG PET/CT imaging has a high rate of detectionof a primary tumor in patients with a carcinoma of unknown origin.
Urinary cells obtained from voided urine specimens of 46 patients with urothelial carcinomas (UCs) and 10normal individuals were analyzed with 3 different centromeric fluorescence in situ hybridization (FISH) probes.The overall sensitivity of cytology was 48.9% compared to 95.7%with the FISH technique. The minimumvalues were found for stage Ta and grade 1 (90.5 and 89.4) and sensitivity of FISH in other stages and gradeswas 100%. Chromosome 3 demonstrated the most frequent chromosomal abnormality in all samples (43%),followed by chromosome 17 (32%) and chromosome 7 (25%). There was a statistically significant associationbetween the number of cell abnormalities in chromosome 17 and the tumour stage (p value=0.02). No relationshipwas found between the type of chromosomal abnormality and grade. Thus feasibility and reliability of a FISHbased approach was confirmed for detection of UC in urine samples.
The purpose was to examine the effect of emotional support-focused nursing interventions on the psychosocialadjustment of breast cancer patients. The research was conducted in the Radiation Oncology Department ofEge University Medical Faculty Hospital and at Tülay Aktas Oncology Hospital in Turkey. There were 30 newlydiagnosed breast cancer patients included in the sample. Emotional support-focused nursing interventions wereadministered in seven sessions individually with each patient. A total of 210 hours of meetings with the patientswere conducted. Data were collected by administering a pre-test and post-test in two phases with the patientsusing a Descriptive Information Form and the Psychosocial Adjustment to Illness Scale - Self Report (PAISSR).The patients mean age was 44.5 (SD=6.38) years and the mean duration of illness was 6.46 (SD=1.99)months. In the comparison of the PAIS-SR pretest and post-test mean scores it was determined that there was asignificant increase in patients adaptation to health care orientation (p=0.001), domestic environment (p<0.01),sexual relationships (p<0.05), extended family relationships (p<.001) and social environment (p<0.001), and asignificant decrease in psychological distress (p<0.001). However there was no change in patients vocationaladjustment (p>.05). According to these findings emotional support-focused nursing interventions had a part inincreasing patients psychosocial adjustment.
The traditional classification of infiltrating breast carcinomas into ductal and lobular can be diagnosticallychallenging in a small proportion of cases with equivocal histological features and in in-situ lesions withoverlapping features. Distinguishing between the infiltrating ductal (IDC) and lobular (ILC) carcinomas isclinically important because of the different pattern of systemic metastases and prognostic evaluation. E-cadherinis a potentially useful immunohistochemical marker which may serve to differentiate between the two tumourtypes. We therefore studied E-cadherin expression in 32 cases of breast carcinomas comprising 16 IDCs and 16ILCs. The correlation between E-cadherin expression and the histological grade of IDCs was also analysed. Ourresults showed complete loss of E-cadherin expression in all ILCs, while the IDCs consistently showed variableE-cadherin positivity. No significant correlation was found between E-cadherin expression and the histologicalgrade of IDCs. We conclude from this study that E-cadherin is a useful marker to differentiate between IDCand ILC of the breast. A larger study of IDCs is now needed to further evaluate the correlation between Ecadherinand tumour grade to estimate its prognostic potential.
Objective: We analyzed the distribution of socio-economic and demographic (SEDs) factors among breastcancer patients and assessed their impact on the stage at diagnosis of the disease and symptom duration. Methods:Data for the year 2006 was collected from the Hospital Based Cancer Registry, Regional Cancer Centre (RCC),Trivandrum, Kerala, India. Patients (n=522) were included if they were from native Kerala state or adjoiningTamil Nadu. SEDS factors included age, residing district, religion, marital status, income, education andoccupation. Other study variables were menopausal status, parity, listed symptoms with duration and stage atdiagnosis. Association between SEDs factors by stage at diagnosis and duration of symptoms was tested usingchi-square statistics, with odds ratios (OR) estimated through logistic regression modeling. Results: Forty-fivepercent were reported at early stages and 53% at late stages. Elevated risks for late stage reporting amongbreast cancer patients were observed for women who were unmarried (OR=3.31; 95%CI: 1.10-9.96), widowed/divorced (OR=1.46; 95%CI: 0.89-2.37), with lower education (OR=2.72; 95%CI: 1.06-7.03 for illiterate womenand OR=2.32; 95%CI: 1.05-5.13 for women with primary school education and OR=2.07; 95%CI: 1.02-4.21 forwomen with middle school education) and post-menopausal women (OR=1.45; 95%CI: 0.97-2.19). Conclusions:This analysis helped to identify the target population group for receiving health education for early detection ofbreast cancer.
Introduction: The present study was conducted with the objective of examining epidemiological characteristicsof soft tissue sarcomas (STSs) in Karachi. Patients and methods: Epidemiological data of 96 (63 male and 33female) incident STS cases registered at Karachi Cancer Registry (KCR) for Karachi South (KS), from 1stJanuary 1995 to 31st December 1997, were reviewed. Results: The age standardized rate (ASR) world per100,000 were 3.3 (2.9%) and 2.1 (1.6%) in males and females, respectively, with mean ages of of 41.4 years (95%CI 35.77; 46.97) and 40.2 years (95% CI 31.27; 49.03). The age-specific curves showed a gradual increase in riskfrom the first until the eighth decade in both genders, with the highest peak at 75+ in females and 70-74 years inmales. In males, 8 (12.7%) STS cases were diagnosed in the pediatric age group (0-14), 12 (19.1%) in adolescentsand young adults (15-24 years), 19 (30.1%) in adults 25-49 years of age and 24 (38.1%) in the 50 years+ agegroup. In females the respective frequencies were 11%, 26%, 30% and 33%. The most common histologicaltumor was rhabdomyosarcoma, though the occurrence of the histological subtypes was age-dependent.Rhabdomyosarcomas and Ewing’s sarcomas were more frequent in children and adolescents whereasfibrosarcomas, leiomyosarcomas, liposarcomas, malignant fibrous histiocytomas (MFHs) and schwannomaswere encountered in the elderly. Conclusion: Karachi falls into a high risk region for STS, observed in a relativelyyounger population, with a male predominance, high frequency of rhabdomyosarcoma and advanced stage atdiagnosis. Information on grading and staging remain incomplete for most cases, which negatively affect diseasemanagement and survival.
Aim: To determine the prevalence of high-grade cervical lesion (CIN 2 or worse, CIN 2+) and the prevalenceof invasive cancers in women with LSIL, HSIL and positive for malignancy on cytology, respectively.Methods: A retrospective study of patients undergoing colposcopy in Rajavithi hospital between 2003-2004was performed. The final diagnosis was based on colposcopy and histology. Results: Among 250 women withLSIL and 152 women with HSIL, 28 (11.20%) and 112 (75.70%), respectively, had histology-confirmed highgradecervical lesions. Invasive cancer was diagnosed in 12 (7.9%) of women with HSIL but in none of the LSILcases. Among 19 women with positive smears for malignancy, only 7 ( 36.8 % ) had histology-confirmedinvasive cancer. Conclusion: The present study confirms that women with HSIL have high prevalence ofhigh-grade cervical lesions and malignancy. Women with LSIL may be managed less aggressively because of thenegligible risk of more advanced lesions. Smears positive for malignancy are inconsistent predictors of invasivecancer.
Objective: The aim of this study is to evaluate the results of neoadjuvant chemotherapy (NACT) and theimpact of interval debulking surgery (IDS) on clinical outcomes of patients with advanced-stage ovarian cancer.Methods: We performed a retrospective analysis on 92 patients with advanced ovarian cancer admitted to Vali-Asr Gynecologic oncology departments during 1996–2002. Comparison was made with results of neoadjuvantchemotherapy of 24 patients with unresectable advanced epithelial ovarian cancer treated with platinum- basedNACT followed by IDS and clinical outcomes of 68 consecutive stage III and IV ovarian cancer patients treatedwith primary cytoreduction followed by platinum-based adjuvant chemotherapy. Results: Primary cytoreductivesurgery caused longer survival compared to neoadjuvant chemotherapy. Patients who underwent optimal intervaldebulking surgery (IDS) had a better progression free survival (PFS) (p=0.002) and overall survival (p=0.03)than those who did not. There were not significant differences between the two groups in complications ofsurgery. Conclusion: NACT followed by successful IDS can lead to high survival percentage in patients withchemoresponsive advanced ovarian cancer; although the result is more effective in those with optimal primarycytoreduction, we still got the same results with those with suboptimal primary cytoreduction.
Cancer incidence in North Cyprus (NC), deemed an interesting epidemiological case due to possiblecontrasting prevailing factors in relation to South and North Europe (SE and NE), was evaluated for the period1990-2004. Age standardized rates (ASRs) and average age of incidence (AAI) values were determined for 12different cancers, separately for males and females. Annual trends were analyzed using linear regression slopes.Absolute values were compared by two-tailed t-tests. The order of prevalence for incidences of male (M) cancerswere: lung, skin, colorectal, prostate, brain, bladder, liver and stomach. Similarly, for females (F) they were:breast, gynaecological, skin, colorectal, lung, liver, brain, stomach and bladder. The following cancer cases weremore common than in SE and NE: lung (M) and skin (both genders). Breast (F), prostate, stomach (F), bladder(both sexes), cervix and corpus were less frequent; the rest were comparable. There was no difference in theannual trends of ASR or AAI for NC, compared with SE or NE. Thus cancer incidence in NC shares manyquantitative features with the rest of Europe. The worst cases could be improved by reducing smoking andprotection from the sun.
Acute lymphoblastic leukaemia (ALL) is the most common pediatric malignancy worldwide. The origin ofthis disease may be explained by a combination of genetic and environmental factors. Glutathione-s-transferasesare a multi-gene family of enzymes involved in the detoxification of a wide variety of environmental carcinogens.A total of 92 immunophenotyped cases (below 25 years of age) and 150 cord blood controls were here analysedby PCR for GSTM1(Present/Null) and RQ-PCR allelic discrimination assay for GSTP1(Ile105Val). We found asignificant increased risk for ALL with the GSTM1 null genotype (OR: 1.96, 95%CI=1.08-3.57), but no significantrisk was found with the GSTP1 (Ile/Val) genotype (OR: 1.32, 95%CI = 0.74-2.37) and the GSTP1 Val/Val genotype(OR: 1.41, 95%CI=0.5-3.96) alone. Combined analysis of GSTM1 and GSTP1 showed significant higher riskassociated with the GSTM1 (null/null) and GSTP1 [(Ile/Val)/ (Val/Val)] genotype (OR=2.78: 95%CI=1.16-6.69).
The accuracy of frozen section diagnosis in the intraoperative evaluation of ovarian masses is very importantwith regard to surgeon selection of appropriated operating procedures. For evaluation in our institute, therecords of 127 patients with ovarian masses submitted for intraoperative frozen sections between January 2001and December 2005 were reviewed. After exclusion of 4 completely infarcted masses and 11 cases with deferredfrozen section diagnoses, 112 were analyzed for diagnostic accuracy by comparing with the final histologicresults. We found sensitivity in the diagnosis of benign, borderline and malignant tumors to be 100%, 84%, and92 %, respectively, with specificities of 92.7%, 97.9%, and 100%, respectively. The overall accuracy with frozensections was 94 %. Among 18 patients with deferred or discordant diagnoses, mucinous tumors accounted for72 % of cases. No over-diagnosis of malignancy or misdiagnosis of metastatic lesions as primary ovarian cancerby frozen sections was observed. In conclusion, the accuracy of intraoperative frozen section for the diagnosisof ovarian masses is high. Frozen sections also help in the evaluation of metastatic tumors to the ovary. Mucinoustumors constitute an important group causing diagnostic discrepancies.
This study was conducted to examine the feelings, symptom management, and needs of patients withgynecological cancer receiving chemotherapy at Chiang Mai University Hospital, Chiang Mai, Thailand. Duringthe period July 2006 and June 2007, 286 patients were recruited. The most common chemotherapeutic regimenwas paclitaxel and carboplatin followed by single carboplatin and weekly cisplatin. Five severe and frequentcomplications were as follows: alopecia, anorexia, fatigue, nausea, and vomiting. Some 41.9% could well toleratewith such complications but 50.3% had various feelings including irritability, boredom, dejection, fear, stress,and anxiety. Anorexia was the symptom that the majority of them could best manage, 17.4% by eating as muchas they can and 32.6% by selecting different foods from normal, such as fruit, sweetmeats, noodles, milk. Fornausea and vomiting, 31.3% managed by eating fruit, drinking sour juice, and holding sour fruit in mouth, and16.0% used the breathing method, eating something cold, such as ice-cream, or hot food like noodles. Forhealth needs, 41.0% needed encouragement, care, health education, and information from doctors and nurses,and 5.0% needed care and encouragement from their family, and sympathy from neighbors and colleagues. Inconclusion, gynecological cancer patients receiving chemotherapy experience a variety of feelings, symptommanagement. and health needs. Nurses need to explain the pathology of the occurring symptoms so that thepatients can understand and accept the symptoms to lessen their negative impact.
Objective: Kelantan in Malaysia has a high prevalence of diabetes and colorectal cancer is also on the rise.This study is to determine the association of metabolic diseases, particularly diabetes type 2 [DM2] andhypertension, with colorectal cancer patients in our population. Methods: This retrospective study was conductedon all colorectal carcinomas in Hospital Universiti Sains Malaysia (HUSM) in Kelantan from ythe ears 2001-2006. The data were retrieved from the Registry in Pathology laboratory and the clinical details from the patients’clinical records and analyzed using SSPS Version 12.0, with a value of p<0.05 taken to be statistically significant.Results: 138 CRC cases with complete clinical records were included. The age ranged from 16.0 to 88.0 years,with a mean of 56.9 -/+ SD 15.4. The male 90(65%) to female 48(35%) ratio was 1.7:1.0 and 47.8% weresuffering from metabolic diseases; 18(13.0%) with Diabetes Mellitus Type 2(DM2), and 48(34.8%) withhypertension (HT). Diabetes Type 2 and hypertension also demonstrated significant association [p<0.05] withthe stage and the site of the cancer. Patients with diabetes type 2 88.8%(16/18) and Hypertension 85.4% (41/48)were strongly associated with cancers located in the distal to transverse colon [p<0.001]. Conclusion: There is ahigh proportion of metabolic diseases; hypertension and diabetes type 2 among colorectal carcinomas seen inKelantan population. In this preliminary study we noted a strong association of metabolic diseases with thestage and site of the cancer. To reduce CRC incidence, the high prevalence of DM2 in Kelantan needs to beaddressed.
Background: Approximately 50,000 new cases of cancer occur each year in the Iranian population of 70.4million. The organ system involved with more than 38% of all cancers is the gastrointestinal (GI) tract. Theobjective of this study was to investigate the relation between demographic factors and type of gastrointestinalcancer using probit and logit models. Methods: This study was designed as a cross-sectional survey including allconsecutive GI cancer patients admitted over a one year period in a randomly selected hospital group located inTehran in 2006. Results: The largest number of cases were colorectal cancers (40.0%), followed by gastriccancers (34.5%) and esophagus cancers (17.1%). There was a significant gender effect in the colorectal, gastricand esophagus cancer also there was a significant association between age and gastrointestinal cancers in bothlogit and probit regression. The factor of duration was not significant in gastric cancer. Conclusion: Men aremore likelyhave colorectal cancer than women. Older people are more likely to have gastric cancer than youngerpeople. In esophagus cancer all factors were significant. Results from probit and logit models were similar,indicating that probit analysis can be employed as a logit model to analyze relationships between demographicfactors and cancer type.
Objective: To determine immunohistochemical expression of cyclooxygenase-1 (COX-1) in epithelial ovariancancer (EOC), and its association with clinical features and prognosis. Methods: EOC patients treated in BangkokMetropolitan Administration Medical College and Vajira Hospital during 1996-2003, and with availablepathological tissue sections, were identified. Immunohistochemical staining was accomplished with antibodiesto COX-1 and degree of expression was categorized into low and high for assessment of any. association withclinicopathological factors and survival. Results: One-hundred and seven patients were included in the study,with a median age of 50 years. Most had stage I and III disease. The most common histologic subtype was serouscarcinoma. Overall, we found COX-1 expression in 83.2 %. Non-mucinous lesions had significant higher levelsof expression than mucinous tumors, but there was no link expression with other clinicopathological factors orsurvival. Conclusions: EOCs showed highexpression of COX-1, especially with a non-mucinous histology, butthis appears to lack prognostic significance.
Ruta graveolens belonging to family Rutaceae has long been traditionally used as a medicinal plant as well asa flavoring agent in food. However, very little data are available on the toxicity of the plant. This report presentsevidence on the genotoxic and clastogenic potential of an extract of Ruta graveolens and Ruta 200C, a homeopathicpreparation. Various types of chromosomal aberrations were noted in bone marrow cells after treatment. Thepercentage of aberrated cells in 4the 00mg/kgb.wt extract administered group was found to be 21% and with1000mg/kg.b.wt it was 31%. The 23% for the Ruta 200C treated group was also elevated as compared to the3%for untreated animals. In addition, bone marrow cells had higher incidence of micronuclei induction whentreated with the extract (400mg and 1000mg/kg body weight) and 20μl/animal Ruta 200C for 30 days.Administration of the extract (1000mg/kg.b.wt) over a period of 30 days also resulted in damage to cellular DNAas evidenced by comet formation where the comet parameters such as percentage DNA in tail, tail length, tailmoment of the bone marrow cells were increased several fold over control values. The comet tail moment of thebone marrow cells increased from 4.5 ± 2.5 to 50.2 ± 25.2 after the extract treatment. Administration of 20μl/animal Ruta 200C for 5 consecutive days increased the tail moment to 11.7 ± 2.9. These results indicate that Rutagraveolens and Ruta 200C may induce genotoxicity in animals.
Although tobacco, alcohol abuse and betel nut chewing habit are well recognized risk factors for oral squamouscell carcinoma (OSCC), there is evidence to indicate that human papillomavirus (HPV) may also play someinducing role. The purpose of this study was to investigate the presence of HPV in Thai patients with oralsquamous cell carcinoma, leukoplakia and lichen planus using the polymerase chain reaction (PCR). Biopsies oforal squamous cell carcinoma, leukoplakia and lichen planus were obtained from 65 patients, 15 males and 50females, aged between 30-88 years old. Extracted DNA was evaluated for HPV infections by PCR analysis usingconsensus primers specific for L1 region of HPV. Only one sample (1.54%) was positive, suggesting that HPVmay not play an important role in this group of Thai patients.
The Indian Council of Medical Research (ICMR) started a National Cancer Registry Programme (NCRP)in the year 1982 with the main objective of generating reliable data on the magnitude and pattern of cancer inIndia. There are about 20 Population Based Cancer Registries (PBCR) which are currently functioning underthe network of NCRP. The present paper aims to provide the time trends in the incidence of breast and cervixcancer among females of India. The incidence data collected by Bangalore, Barshi, Bhopal, Chennai, Delhi andMumbai over the period 1990 to 2003 formed the sources of data. In the year 1990, cervix was the leading site ofcancer followed by breast cancer in the registries of Bangalore (23.0% vs. 15.9%), Bhopal (23.2% vs. 21.4%),Chennai (28.9% vs. 17.7%) and Delhi (21.6% vs. 20.3%), while in Mumbai breast was the leading site of cancer(24.1% vs. 16.0%). By the years 2000-3, the scenario had changed and breast had overtaken as the leading siteof cancer in all the registries except in Barshi (16.9% vs. 36.8%). The time trend analysis for these sites suggesteda significant decreasing trend in the case of cervix in Bangalore and Delhi registries, while the registries ofBhopal, Chennai and Mumbai did not show any significant changes. However, in the case of breast cancer, asignificant increasing trend was observed in Bhopal, Chennai and Delhi registries with Bangalore and Mumbairegistries demonstrating no such significant changes. Histopathologic confirmation for both malignancies wasfound to be more than 80% in these registries. It is concluded that in India the cervix cancer rates are decreasingwhile breast cancer is on the increase.
The differentiation between cervical intraepithelial neoplasia 3 (CIN 3) and early squamous cell carcinoma(SCC) of the cervix may be difficult in certain situations. Identification of invasion beyond the basement membraneis the gold standard for the diagnosis of the latter. The objective of this study was to determine whether the useof Ki-67 and p53 could help in solving the above dilemma. This was a retrospective study on 61 cases of cervicalneoplasms comprising of 25 cases of CIN 3 and 36 SCC. All cases were evaluated by immunohistochemistryusing Ki-67 and p53 monoclonal antibodies. Results showed that the differences of Ki-67 and p53 expressionbetween CIN 3 and SCC were statistically significant. In conclusion, Ki-67 and p53 may serve as helpful adjunctsto routinely-stained histological sections in differentiating between CIN 3 and SCC.
The aim of this study was to evaluate the underlying lesions and factors predicting cervical intraepithelialneoplasia (CIN) 2+ in women who had “atypical squamous cells of undetermined significance” (ASC-US) oncervical cytology in the region with a high incidence of cervical cancer. This study was prospectively conductedat Chiang Mai University Hospital, Chiang Mai, Thailand. All women with ASC-US cytology undergoingcolposcopic evaluation between October 2004 and August 2008 were recruited. During the study period, 208women were enrolled. Mean age was 44.4 years. The histopathologic results at the initial evaluation were asfollows: CIN 2-3, 21 (10.1%); adenocarcinoma in situ, 3 (1.4%); cancer, 5 (2.4%); CIN 1, 26 (12.5%); and nolesions, 153 (73.6%). Multivariate analysis revealed that nulliparity (adjusted odds ratio [aOR] =4.09; 95%confidence interval [CI] = 1.04-16.10) and current oral contraceptive use (aOR=2.85; 95%CI= 1.14-7.15) wereindependent predictors for having CIN 2+ at the initial colposcopy. At the median follow-up time of 6.7 months,CIN 2-3 lesions were additionally detected in 2 women. In conclusion, ASC-US cytology in our population has arelatively high prevalence of underlying invasive carcinoma. Nulliparity and current oral contraceptive use areindependent predictors for harboring CIN 2+.
Objective: Hospital-based cancer registry involves complex processing steps that span across multipledepartments. In addition, management techniques and registration procedures differ depending on each medicalfacility. Establishing processes for hospital-based cancer registry requires clarifying specific functions andlabor needed. In recent years, the business modeling technique, in which management evaluation is done byclearly spelling out processes and functions, has been applied to business process analysis. However, there arefew analytical reports describing the applications of these concepts to medical-related work. In this study, weinitially sought to model hospital-based cancer registration processes using the Unified Modeling Language(UML), to clarify functions. Methods: The object of this study was the cancer registry of Osaka UniversityHospital. We organized the hospital-based cancer registration processes based on interview and observationalsurveys, and produced an As-Is model using activity, use-case, and class diagrams. After drafting every UMLmodel, it was fed-back to practitioners to check its validity and improved. Results: We were able to define theworkflow for each department using activity diagrams. In addition, by using use-case diagrams we were able toclassify each department within the hospital as a system, and thereby specify the core processes and staff thatwere responsible for each department. The class diagrams were effective in systematically organizing theinformation to be used for hospital-based cancer registries. Using UML modeling, hospital-based cancerregistration processes were broadly classified into three separate processes, namely, registration tasks, qualitycontrol, and filing data. An additional 14 functions were also extracted. Many tasks take place within thehospital-based cancer registry office, but the process of providing information spans across multiple departments.Moreover, additional tasks were required in comparison to using a standardized system because the hospitalbasedcancer registration system was constructed with the pre-existing computer system in Osaka UniversityHospital. Difficulty of utilization of useful information for cancer registration processes was shown to increasethe task workload. Conclusion: By using UML, we were able to clarify functions and extract the typical processesfor a hospital-based cancer registry. Modeling can provide a basis of process analysis for establishment ofeficient hospital-based cancer registration processes in each institute.
Incidence rates have long been used to assess the burden of different diseases in a population, whereas lossdue to occurrence of diseases is studied using the death rates. Death rates however, are based on and thereforedescribe, only number of lives lost. There have been two approaches to arrive at the actual loss or gain from aparticular cause viz. Person years of life lost (PYLL) approach and cause elimination life table (CELT) approach.This review covers these approaches and the competing risk theory and models focusing on the methodologicaldevelopments. A summary of the conceptual and methodological developments on these concepts has also beenpresented. There are eight possible approaches in dealing with the loss in the presence or gain in the absence ofa particular cause of death depending upon the preferences related to PYLL/CELT approach, modeling/descriptive approach, considering or without considering competing causes. A close look at the two basicapproaches reveals that PYLL and cause elimination are just different terminologies used to address the samequantity, loss in the presence or gain in the absence. As far as descriptive vs. modeling approaches are concerned,all the descriptive procedures can be put in the form of models and all the models can be presented in a descriptiveway. Regarding results using different models, no practical difference exists in the results based on differentmodels for competing risks. However, exclusion of the competing risks may result in a considerable bias in thedeveloping countries where general mortality is relatively higher. This review study suggests freedom in theselection of a modeling or a descriptive approach without any considerable loss of accuracy but at the same timeemphasizes the consideration of the competing risks. An empirical study may be recommended to confirm theconclusions of this study.
Tobacco imposes a colossal burden of disease and death leading to catastrophic health, social, economic andenvironmental effects. Prevalence and practices of tobacco use in India are varied and disparate. Tobaccoconsumption continues to grow at 2–3% per annum, and by 2020 it is predicted that it will account for 13% ofall deaths in the country. India is now demonstrating a steely resolve to contain the menace of tobacco througha comprehensive control strategy that combines several demand and supply reduction measures. India’s antitobaccolegislation, first passed at the national level in 1975, was largely limited to health warnings and provedto be inefficient. The ‘Cigarettes and Other Tobacco Products Bill, 2003’ represented an advance in tobaccocontrol. It included demand reduction measures like outlawing smoking in public places, forbidding sale oftobacco to minors, requiring more prominent health warning labels, and banning advertising at sports andcultural events. India, as a signatory to FCTC, is actively involved in combating the menace of tobacco withrenewed fervor. There is a need to devise innovative methods of mobilizing financial and human resources fortobacco control, establish efficient national coordinating mechanisms, integrate tobacco control into health anddevelopment programs and periodically evaluate these activities. The Government must also introduce policiesto raise taxes, control smuggling, close advertising loopholes, and create adequate provisions for the enforcementof tobacco control laws.
Cancer control aims to reduce the incidence, morbidity, and mortality of cancer and to improve the qualityof life of cancer patients. For rural populations this presents particular problems. This article covers challengesof oncology care in rural areas and solutions via applying information communication technology with specialtytelemedicine for overcoming problems in prevention, early diagnosis, treatment, and palliative care. In addition,telecommunications infrastructures and frameworks for implementation of telemedicine are decribed.
Cancer registration is the base for our understanding of the burden of neoplastic disease in our populations at thelocal, regional and national levels. Comparability of data is essential for interpretation and this in turn depends onstandardization of methodology and the diagnostic and other criteria applied. If this is to be achieved across Asia,some form of international organization is clearly necessary. The question therefore should be whether the existingarrangement is adequate, and if this is not the case how a network in Asia might be established with due considerationof aims and attainable objectives. The present commentary focuses on the contributions made by the InternationalAssociation of Cancer Registries (IACR) and individual country-based or region-based associations already activein Asia. Building on an analysis of the present status in Asia, as well as experience of the European Network ofCancer Registries (ENCR) and the North American Association of Central Cancer Registries (NAACCR), potentialproblems and possible solutions are here reviewed, with coverage of both organizational and financial constraints.An argument is presented here that there is a rationale for some form of an Asian Network of Cancer Registries,supported by the International Agency for Research on Cancer (IARC) and the UICC-Asian Regional Office, workingalongside the IACR and existing national organizations and research institutes.
Three-dimensional (3D) imaging of the large intestine is globally called computed tomography colonography(CTC). CTC has been intensively investigated for application in colorectal cancer screening in Western countriesand with the advent of multi-slice CT (MSCT), which provides effective high resolution in 3D CT images, thediagnostic use of CT for colorectal lesions has become a concept widely accepted throughout the world. Computeraideddetection (CAD) for colorectal polyps using digital CT image data and digital pre-processing are alsoadvancing in the West. Compared with colonoscopy, which depends largely on the skill of the performer, CTCproduces objective and reproducible diagnostic images and presents a high probability of standardizingexamination protocols. Development of effective systems for screening colorectal lesions is expected, leveragingthe excellent processing capability of MSCT to enhance 3D visualization and allow efficient detection.