Causes of delay in cancer diagnosis

Objectives: To assess the causes of delay In cancer diagnosis in lower Sindh, Pakistan and to suggest solutions to the problem

Study Design: ADescriptive study

Place And Duration: At Nuclear Institute of Medical Radiotherapy, Liaquat University of Medical and Health Sciences, Pakistan over a period of six months from May 2011 to December 2011

Methodology: 100 diagnosed cases of cancer admitted to hospital for diagnosis and treatment included in the study

All patients were interviewed regarding cause of delay in cancer diagnosis and findings were recorded on a printed Performa

Results: The causes for delay were divided into two groups. Delay in diagnosis [9.24 months] and delay in treatment [1.9 months]. Major causes of delay in diagnosis were consulting various doctors [n=85%], financial problems [n=80%], conveyance problem [n=60%] and lack of education [n=65%]. Major cause of delay in treatment was that a lot of time was taken to carry out the investigations to assess the extent of the disease reach to a final diagnosis. Partly the delay occurred [n=60%] because the patients could not keep their appointments due to transport and financial problems

Conclusion: Major causes of delay in cancer diagnosis and treatment indicate the pivotal role of primary doctor's ability to suspect, detect and refer patients with cancer to proper cancer care facility

Primitive neuroectodermal tumor of tongue - a case report

A very rare case of Primitive Neuroectodermal tumor [PNET] occurring at the tip of the tongue is reported. The patient presented at a private dental clinic at Hyderabad, Sindh, [Pakistan] with a tiny nodule at the tip of the tongue. Fine needle aspiration was carried out followed by excision biopsy and marker studies which confirmed the diagnosis. It was concluded that the possibility of PNET tumor should be kept in mind while evaluating lesions occurring on tongue

Fine needle aspiration cytology of oral lesions

This study was carried out to introduce the use of fine needle aspiration cytology for the early and quick diagnosis of oral lesions. All patients were referred to a private clinic for Fine Needle Aspiration Cytology by Dental Surgeons. A total number of 86 patients were included in this study. These patients had a mass in oral cavity, in salivary glands or in sub mental / sub mandibular area. The duration of study was two years, from January 2010 to December 2012. Fine needle aspiration was done and smears were made for cytopathological diagnosis. All patients were followed up and a biopsy report was obtained for correlation. Age range was 1-85 years. Mean age being 39 years. Lesions were equally distributed between male and female patients. Out of 86 patients majority n=27 [31.3%] presented with a parotid mass, n=18 [20.9%] presented with a submandibular mass, n=14 [16.2%] had cheek swelling and n=11 [13.6%] had a mass on mandible. Cytopathological analysis showed an equal frequency of benign and malignant tumors n=30 [34.8%] each, n=18 [20.9%] were inflammatory lesions and n=8 [9.5%] nonneoplastic non-inflammatory lesions. Out of 30 benign tumors most common was Pleomorphic Adenoma n=24 [80%] arising in Parotid, out of 30 malignant tumors most common was Squamous cell carcinoma n=22[73.3%]. Out of 18 inflammatory lesions most were either tuberculosis or abscess n=7 [38.8%] each. Histopathological diagnosis was available in 50 patients. Overall accuracy for diagnosis of malignant tumors and inflammatory lesions was 100%, for benign tumors it was 92% and for non-inflammatory non-neoplastic lesions it was 33.3%. Fine needle aspiration is a very useful, cost effective, quick and painless procedure for early diagnosis of oral lesions and in many cases obviates the need for incisional I excisional biopsy

Role of fine needle aspiration cytology for the diagnosis of tuberculosis and frequency of its presentation as cold abscess in lower Sindh

This study was carried out to evaluate the role of Fine Needle Aspiration Cytology [FNAC] for the diagnosis of Tuberculosis and to estimate the frequency of its presentation as cold abscess in lower Sindh. A total number of 73 patients were included in this study. These patients were all referred to a private clinic for FNAC of swellings in lymphoid regions, chest wall, Abdomen, breast and lower back. Duration of study was six months from January to June 2013. Fine needle aspiration was done and smears were made for cytopathological diagnosis. All patients were clinically followed up to see the response to treatment. Age range was 2 to 70 years. Mean age being 29 years. Lesions were more common in females [72.60%].Out of 73 patients majority n=26 [35.26%] presented with cervical lymphadenopathy, n=11 [15.06%] presented with a supraclavicular mass, n=10 [13.70%] had submandibular swelling and n=06 [8.21%] had axillary lymphadenopathy. Other sites included preauricular / retro parotid areas, chest wall swelling and breast, each accounting for 4 [5.48%] cases. Less common sites were Lumbar area on back, posterior auricular area and swelling on thumb, n=1 each [1.36%]. Cytopathological analysis showed n=30 [41.10%] diagnosed as Tuberculous lymphadenitis while n=23 [31.51%] were labeled as cold abscess, n=17 [23.29%] were reported tuberculosis with extensive Caseation necrosis and n=3 [4.10%] were reported as Tuberculous Mastitis. All patients were put on ATT with clinical follow up. Fine needle aspiration is a very useful, cost effective method for early and rapid diagnosis of tuberculosis and cold abscesses. This obviates the need for incisional / excisional biopsy and patients can directly be put on ATT with strict clinical follow up

Presentation of histological types and common sites of oral cancers in lower Sindh

Objectives: to determine the frequency of histological types and common sites of oral cancer nin our population of lower Sindh

Study design: descriptive study

Setting: patients reporting at Liaquat University Hospital, Dental Out-patient Department, Jamshoro and Hyderabad Sindh Pakistan, over a period of one year from January 2007 to December 2007

Subjects and methods: biopsy specimens were obtained from patients who were suspected for oral cancer on clinical grounds. All specimens were processed routinely and stained by Hematoxylin and Eosin method

Main outcome measures: histopathological analysis was carried out to confirm the diagnosis and to evaluate the histological types

Results: mean age of oral cancer patients was 46.28 years. It was more common in males. Most common site was cheek mucosa. Histopathological analysis showed 47 [44.3%] patients having well-differentiated invasive squamous cell carcinoma while 24 [22.6%] patients had moderately differentiated squamous cell carcinoma. Twelve [11.4%] patients had micro invasive carcinoma and 11 [10.5%] specimen revealed mucoepidermoid carcinoma. Verrucous carcinoma was observed in 06 [5.7%] patients and 03 [2.8%] patients showed poorly differentiated anaplastic carcinoma. The frequency of carcinoma in situ, neuroendocrine tumor and carcinosarcoma was 1 [0.9%] each

Conclusion: this study gives a detailed account of the histological types of oral cancer along with their frequency and reports two rare malignant tumors occurring in oral cavity. Oral cancer occurred at a younger age with male preponderance. A higher frequency of mucoepidermoid carcinoma was observed

Frequemcy of Breast Diseases at a tertiary Hospital of Karachi

To see the pattern of breast diseases at our set up. A descriptive study. Jinnah Postgraduate Medical Centre, Karachi - Pakistan for a period of three years. A total of 300 patients attending breast care clinics were evaluated. They were followed up till biopsy. All patients were females between 11-90 years of age. Majority of the patients belonged to the lower socioeconomic group. Data was collected through a specifically designed proforma. Most common presenting complaint was breast lump with other symptoms. Majority presented to the clinician within 6 months of development of lump. Most of the patients were married [69%] and majority [67%] was in the reproductive age while 32% were postmenopausal. Only 1% of the patients were in premenarche age. Most common site was upper and outer quadrant of left breast. Most common breast disease was carcinoma [30%] followed by inflammatory diseases [25%], fibroadenoma [24%] and fibrocystic disease [20%]. Only 1% of patients had no disease. Invasive ductal carcinoma NOS was the most common histologic type [51%]. Breast cancer in this study shows a higher frequency of this disease in Pakistan when compared to the world standards and to the other studies carried out in our country

Histopathological presentation of squamous cell carcinoma - a study

This study was carried out to review biopsies of patients with positive Squamous Cell Carcinoma SCO and to determine the histopathological features with different clinical presentation of SCC. A total of 27 patients were included in this study with a positive biopsy report of SCC. Age ranged from 25-80 years. All the specimens were sent to a single pathologist. Well-differentiated lesions were in greater frequency and mostly the site of the lesion was buccal mucosa and tongue. In this study most of the tumors were well-differentiated

Report on oral cancers patients at atomic energy medical center, Jamshoro during the year 2002. A pilot study

The purpose of this study was to report a pilot study in relation to the most common presentation and habits related to oral cancer. MATERIALS and METHOD: Records of oral cancer patients with a habit of chewing betel leaves / tobacco were seen in 2003 at Atomic Energy Medical Center [AEMC], Jamshoro were reviewed. Forty three patients were diagnosed with oral cancers. Males being 24 and females 19, mostly of age 40 and above. Insides of the cheek was the most common site of the lesion. Early detection of oral cancer can improve the prognosis and prevention is the best approach