Global and regional cancer epidemiology: according to world cancer report 2012 and others

The International Agency on Cancer [IARC] has initiated World Cancer Report 2012 in 2014. The report estimates the worldwide incidence and mortality for 27 major cancers and for all cancers combined for 2012 and is available in the

GLOBOCAN series of the International Agency for Research on Cancer. Overall, there were 14.1 million new cases and 8.2 million deaths in 2012. The most commonly diagnosed cancers were lung [1.82 million], breast [1.67 million], and

colorectal [1.36 million]; the most common causes of cancer death were lung cancer [1.6 million deaths], liver cancer [745,000 deaths], and stomach cancer [723,000 deaths]. In Pakistan, there are over 1.4 million cancer patients. Annually there are 139,200 new cancer cases and 101,600 deaths. Incidences of cancers are different in different parts of Pakistan as depicted by reports generated by two major cancer registries in the country

Role of tobacco metabolism in the causation of oral squamous cell carcinoma in a high-incidence area of South Asia

Objective: To establish the association between CYP1A1 MspI polymorphism, tobacco-habit and oral cancer

Methodology: 150 Oral squamous cell carcinoma [OSCC] and 108 controls were enrolled, comprising of individuals without

and with tobacco habits which match in frequency and duration with patients. Study subjects were divided into four groups, namely: exclusive chewers, exclusive smokers, mixed-habit and no habit. Lifetime tobacco exposure was calculated as chewing and smoking index. After age adjustment, 140 OSCC cases and 90 controls were subjected to genetic analysis. White blood cells were used for DNA isolation while CYP1A1 MspI polymorphism was detected with the PCR-RFLP technique. Three polymorphisms were tested namely wild type, heterozygous variant and homozygous variants. Odds Ratios [ORs] were calculated while the precision of ORs was adjusted by 95% confidence interval [CI]. The risk was determined by binary logistic regression model with CYP1A1 m1/m1 as the reference category

Results: Out of all 258 studied subjects, 60.85% subjects were exclusive tobacco chewers which turned out to be the most

prevalent tobacco habit. Cheek was the most common site [56%] followed by tongue [21%]. The frequencies CYP1A1MspI wild-type, heterozygous and homozygous variants were found to be 18.57%, 62.85% and 18.57% among OSCC cases and 26.53%, 62.24% and 11.22% in controls. The homozygous [m2/m2] variant of CYP1A1MspI conferred an increased risk to OSCC with an OR of 2.36 [95% CI, 1.0-6.20, p=0.05]. OR further increased to 7.2 [95% CI, 1.8-27.5, p=0.003] when considered in exclusive tobacco chewer.s and 26 [95% CI, 2.2-304.5, p=0.009] in the above median exposure group

Conclusion: Present analysis showed a clear association between CYP1A1MspI polymorphism and the increased risk for oral cancer and this risk seems to be tobacco modulated. Hence CYP1A1MspI homozygous genotype could be a major determinant of high rates of oral cancer in the indigenous population of Karachi

Conventional clinical and prognostic variables in 150 oral squamous cell carcinoma cases from the indigenous population of Karachi

Objective: To analyze clinical and prognostic variables of Oral Squamous Cell Carcinoma [OSCC] cases from the indigenous population of Karachi and to correlate with the common risk factor of tobacco habit

Methods: The study was conducted at Ziauddin University, Karachi. One hundred fifty OSCC cases were collected from the Oncology Department of Ziauddin University Hospital, North Nazimabad, Karachi and Otolaryngology ward of Civil Hospital, Karachi, during 2011 and 2015. The reporting included demographic details and variables like intra-oral subsites, clinical stage and histological grade. Recurrence of tumor after initial resection was also documented

Results: The patient's population comprised of 98 males and 52 females. The mean age was 47.1 +/- 12.22 [range:20-78 years]. Maximum numbers were seen in the 41-50 years age group. Urdu-speaking community was the most affected ethnic group [n=75]. Clinico-pathological analysis revealed that majority of cases were moderately differentiated [59%] and were either clinical stage II [35%] or IV [29%] tumors. The most common intra-oral subsite came out to be buccal mucosa of cheeks [56%] followed by lateral borders of tongue [21%], lips [13%], alveolar [6%], palate [2.6%] floor of mouth [1.3%], etc. Recurrence was observed in 08 out of 150 cases. All patients underwent primary resection +/- neck dissection and reconstruction where possible

Conclusions: Overall experience with oral squamous cell carcinoma shows that it has a high tendency for local invasion as well as dissemination to regional lymph nodes, i.e. cervical lymph nodes, both are associated with a poor prognosis. Preventable risk factor of tobacco chewing has been observed in majority of these cases

Clinico-pathological parameters of 50 Oral Squamous cell carcinoma cases in Karachi

Background: The incidence of oral squamous cell carcinoma remains high in Indo-Pak region. Worldwide oral and oropharyngeal carcinomas are the sixth most common cancers. A number of clinic-pathological parameters have been implicated in prognosis, recurrence and survival for this tumor. As a very high frequency reported in major hospitals of Karachi, this study documented some of the well known clinicpathological parameters in the indigenous population of Karachi

Objective: To analyze the clinicopathological parameters of cases of OSCC in the population of Karachi

Methods: The study protocol was approved by the Ziauddin University ethics committee for human research. The patients' data was entered onto questionnaires. The reporting included a range of clinical, operative and histopathological variables. Recurrence of tumor after initial treatment was also documented

Results: The patients' population comprised 31 males and 19 females. The mean age was 45.56 [SD + 12.08]. Minimum age was 15 years, while maximum was 75 years. Pathological analysis revealed that majority of SCC cases were moderately differentiated SCC with clinical stage T2 or T3, N0,M0/N1,M0. Most common oral sites came out to be buccal mucosa of cheeks followed by lateral borders of tongue and lips. All patients underwent primary resection +/- neck dissection and reconstruction when necessary

Conclusion: Overall experience with OSCC shows that it has a high tendency to disseminate to regional lymph nodes, i.e. cervical lymph nodes, as well as to re-emerge at the primary site after resection

Incidence of colorectal carcinoma: is there a "shift to the right"?

This study was carried out in Department of Pathology, Basic Medical Sciences Institute, Jinnah postgraduate Medical Center, Karachi over a period of five years. 124 cases of colorectal adenocarcinoma were studied with respect to age, gender and location. Relationship of these variables to each other was also analyzed. Patients with an age range of 10 - 80 years were divided into different age groups. Most of the patients were in 41 - 60 years age group [55; 44.5%]. Gender distribution revealed male predominance with a male to female ratio of 2.54:1. Incidence of colorectal cancer in both the male and female patients is more in 41 - 60 years age group. Relationship of location of tumor to age and gender reveal a male predominance in all the locations with highest number of both male and female patients, [59; 47.6%] seen the in rectum in 21 - 40 years age group [44; 40.7%]. Tumors in distal locations are much more common in this study than tumors in proximal subsites indicating that no 'shift to the right' is seen. In conclusion, incidence of colorectal carcinoma is more in young patients less than 60 years of age with a male predominance and a distal location specifically the rectum

Cell death induced by Morarah and Khaltita in hepatoma cancer cells [Huh-7]

To compare the combined and isolated growth inhibitory effects of Morarah and Khaltita [herbs] on hepatoma cell lines [Huh-7], through induction of apoptosis or necrosis. Comparative controlled in-vitro study. The Molecular Biology Laboratory, The Aga Khan University, Karachi, from June to December 2006. The growth of hepatoma cell lines [Huh-7] was checked by adding Khaltita and Morarah to the cells before culture in a 24 well plate. Six wells were selected and labeled for each of the four variables [controls, Khaltita, Morarah and mixture]. After 2 days, cells were studied under an inverted phase contrast microscope and fields were recorded. Approximately four fields per slide of higher intensity were selected randomly to determine the dead cell density, and the procedure was repeated 10 or more times. Frequency and percentages were calculated for dead or alive cells in controls, Morarah, Khaltita and their mixture. Chi-square was used to compare the qualitative variables. P-values < 0.05 were considered significant. Morarah and Khaltita were found to induce statistically significant [p < 0.001] cell death in hepatoma cell lines [Huh-7]. At a magnification of 40x, the controls showed 1% dead cells compared to 91% in Morarah, 83% in Khaltita and 73% in combined mixture of Khaltita and Morarah. At magnification of 20x, the controls showed 4% dead cells compared to 44% in Morarah, 47% in Khaltita and 49% in the combined mixture of Khaltita and Morarah. Morarah and Khaltita induced cell death in cultured hepatoma cells [Huh-7]

extrahepatic manifestations of hepatitis B virus

Hepatitis B Virus [HBV] leads to a number of hepatic complications, from acute to chronic hepatitis, cirrhosis and hepatocellular carcinoma, is a well-established fact. Upcoming clinical research, over the years, associates numerous extrahepatic manifestations during the acute and chronic episodes of hepatitis B with significant morbidity and mortality. A causal relationship between HBV and serious autoimmune disorders has also been observed among certain susceptible vaccine recipients in a defined temporal period following immunization. The cause of these extrahepatic manifestations is generally believed to be immune mediated. The most commonly described include skin rash, arthritis, arthralgia, glomerulonephritis, polyarteritis nodosa, and papular acrodermatitis etc. The serum-sickness like "arthritis-dermatitis" prodrome has also been observed in approximately one-third of patients acquiring HBV infections. Skin manifestations of HBV infection typically present as palpable purpura reported to be caused by chronic HBV, although this association remains controversial. To consider the relationship between HBV and other clinically significant disorders as well as serious autoimmune disorders among certain vaccine recipients is the topic of this review. Variable factors that influence extrahepatic manifestation are discussed, including possible synergy between hepatitis B virus and the immune system

Potential role of preoperative chemotherapy in breast cancer

This is a retrospective and prospective study carried out in the Department of Eljtelogy, Basic Medical Sciences Institute, Jinnah Postgraduate Medical Centre, Karacnr from October 2000 to October 2002. A total of fifty-breast carcinoma specimens were investigated comprising of forty invasive ductal carcinomas and ten invasive lobular carcinomas. Ki-67 antigen was immunostained on formalin-fixed paraffin embedded tissue and the positivity index in tumors of various sizes was determined. Thirty-three cases showed positive nuclear staining. Group-I contained tumors equal to or less than 2 cm in size. In ILC, 0.3 out of 08 cases and in IDC 07 out of 25 cases, showed a mean Ki-67 index of 13.9 +/- 0.4% and 15.65 +/- 11.65%, respectively. Group-II contained tumors between 2.1-5cm in size. In ILC, 02 out of 08 cases and in IDC, 07 out of 25 cases, showed a mean Ki-67 index of 10.9 +/- 3.2% and 14.04 ± 5.34%, respectively. Group-Ill contained tumors equal to or more than 5.1 cm in size. In ILC 03 out of 08 cases and in IDC 11 out of 25 cases, showed a mean Ki-67 index of 14.2 +/- 9.3% and 17.38 +/- 11.30% respectively. The results of ILC versus IDC in all three groups were statistically insignificant [P>0.05]. So it is concluded that preoperative chemotherapy is a useful therapeutic strategy for operable breast cancer of any size