ABSTRACT
Background: The eighth edition of the American Joint Committee on Cancer (AJCC) for oral cancer has incorporated additional pathological features like depth of invasion (DOI) and extranodal extension (ENE) into T and N staging. The incorporation of these two factors will impact the staging and, hence, the treatment decisions. The aim of the study was to clinically validate the new staging system in predicting the outcome in patients treated for carcinoma oral tongue. The study also examined the correlation of pathological risk factors with survival. Methods: We studied 70 patients with squamous cell carcinoma of the oral tongue who underwent primary surgical treatment at a tertiary care center in the year 2012. All these patients were restaged pathologically according to the new AJCC eighth staging system. The 5-year overall survival (OS) and disease-free survival (DFS) were calculated using the Kaplan–Meier method. Akaike information criterion and concordance index were calculated between both staging systems to identify a better predictive model. Log-rank test and univariate Cox regression analysis were conducted to find out the significance of different pathological factors on outcome. Results: Incorporation of DOI and ENE resulted in 47.2% and 12.8% stage migration, respectively. DOI less than 5 mm was associated with a 5-year OS and DFS of 100% and 92.9%, respectively, compared to 88.7% and 85.1%, respectively, when the DOI was more than 5 mm. Presence of lymph node involvement, ENE, and perineural invasion (PNI) were associated with inferior survival. The eighth edition had lower Akaike information criterion and improved concordance index values compared with the seventh edition. Conclusion: The eighth edition of AJCC allows better risk stratification. Restaging of cases based on the eighth edition AJCC staging manual resulted in significant upstaging with difference in survival.
ABSTRACT
Background: The proportion of elderly population is increasing considerably world over. The health and socio-economic issues of this section is to be considered separately and in depth insights about them is needed for formulating elderly friendly health policy. This study intends toidentify the important health concerns of elderly population above the age group of 70 years in a rural area in North Kerala, India.Methods: It is a community based cross-sectional descriptive study involving all individuals above the age group of 70 years in a randomly selected panchayath ward from rural North Kerala. The data regarding demography, socioeconomic aspects, medical history, access to health care and treatment of chronic illnesses were collected through interview of study participants by a trained health care volunteer using a pre-validated questionnaire.Results: A total of 93 individuals above the age group of 70 years were included in the study out of which 63% were females and 37% males. In the study population 55.9% of the elderly were widowed and 87.1 % were staying along with their children. Almost 75% of the elderly received social welfare pension from government agencies and 14.3% received service pensions. 67.74% of the study population were hypertensive and 35.56% were diabetic. Other health issues included arthritis, coronary artery disease, chronic kidney disease, genito urinary symptoms and cerebrovascular accident.Conclusion: The study provide valuable insights into the health and social issues of elderly in Kerala and points to the importance of formulating an elderly friendly health policy in the state.
ABSTRACT
Background: Cytological evaluation and diagnosis of lymphadenopathy plays an important role in distinction between reactive hyperplasia and malignancy. Being a tertiary cancer care centre, lymph node enlargement clinically suspected to be due to malignancy constitute the commonest indication for fine needle aspiration cytology [FNAC] at our centre. The aim of this study was to determine the utility of FNAC in evaluating enlarged lymph nodes and to categorizethe causes of lymphadenopathy diagnosed by FNAC at our centre
Material and Methods: Data was collected from the records of department of Pathology over a period of three months from January to March 2014. The data was analyzed and various parameters studied
Results: There were 2000 aspirates over a period of three months of which 270 [13.5%] were from lymph nodes. Of these, 130cases [48.2%] have metastatic deposits.We also came across 16 cases [5.9%] of lymphoma, 5 cases[1.9%] of granulomatous lymphadenitis, 2 cases[0.7%] of suppurative lesion and 99 cases [36.7%] of reactive hyperplasia during this period. In 3 cases [1.1%], the lesion turned out to be of salivary gland origin. Aspirates were suboptimal for diagnosis in 15 cases [5.5%]. Aspirates were more in males [181] as compared to females [89]. The most common site of aspiration was the cervical lymph node[64.5%],followed by supraclavicular=81[30%], inguinal=33[12.22%], axillary=19[7.04%] sub mental=1[0.37%] and others=7[2.59%]. Apart from metastatic carcinomas other metastatic malignancies we came across were malignant melanoma, neuroblastoma, germ cell tumor and synovial sarcoma
Conclusion: FNAC of lymph nodes helps in rapid diagnosis of lymphadenopathy. Categorizing the cause of lymph node enlargement as metastatic malignancy,lymphoma, reactive change, inflammatory cause,suppuration etc. can be done by FNAC.In patients with known histologically proven malignancy in whom a subsequent enlargement of lymph node occurs,a cytological diagnosis of metastasis helps in avoiding unwanted surgery for confirming metastasis.In patients without a previous diagnosis of malignancy, FNAC not only confirm metastatic deposit but in most conditions give a clue regarding site of primary. The use of immunocytochemistry and cell block preparations have increased the scope of FNAC