Evaluation of prevalence of different types of cancer and its chemotherapy in various ethnic groups of Pakistan: A retrospective study

The objective of the study was to evaluate different types of cancer and its chemotherapy in various ethnic groups of Pakistan. Ethnic groups includes, Pukhtoons, Punjabis, Sindhis, Muhajirs, Siraikis, Memoons, Hazaras, Hindkos, Baltis, Gilgitis, Kashmiris, and Afghanis. The data was collected from well reputed hospitals located in the different provinces of Pakistan. The collected data was taken from 15 hospitals where around 8500 patients visited during 2010 to 2017. From the visited patients, 8356 were analyzed for their ethnicity, age and sex while, 144 patients (male 77 and female 67) were excluded from analysis due to incomplete information or loss of follow-up. Among 8356 patients, 3762 were male (45%) whereas, 4594 were female (55%). The chemotherapy was carried out as per National Comprehensive Cancer Network guidelines (NCCN- guidelines). The most common five prevalent cancer among these ethnic groups were Head and Neck, Blood, Respiratory, Genito-urinary and Breast cancer. The most common cancer in female was breast cancer while, head and neck cancer was more prevalent in male. It can be concluded that the prevalence of cancer in Pakistan is very alarming, which may be due to lack of awareness, illiteracy, lack of national cancer control programs, and economics issues.

Case-control study of oral disease indexes in individuals with head and neck cancer after antineoplastic therapy / Estudo caso-controle de índices de doenças bucais em indivíduos com câncer de cabeça e pescoço após terapia antineoplásica

ABSTRACT Objective To evaluate the oral health of patients with head and neck cancer after antineoplastic treatment, and to compare them with patients with no history of cancer. Methods A total of 75 patients, divided into Study Group, composed of individuals after antineoplastic treatment (n=30), and Control Group, with individuals with no history of cancer (n=45), aged 37 to 79 years. The oral health status was evaluated through the index of decayed, missing or filled permanent teeth (DMFT), community periodontal index and evaluation of the use and need of prosthesis. All of these items were evaluated according to the criteria recommended by the World Health Organization. The statistical analysis was descriptive and used the Pearson's χ2 test. Results The community periodontal index was higher in the Study Group when compared to the Control Group (p<0.0001). The need for an upper (p<0.001) and lower (p<0.0001) prostheses was higher in the Study Group. Also, the use of upper prosthesis was higher in the Study Group (p<0.002). The missing or filled permanent teeth index between the two groups (p>0.0506) and the use of lower prosthesis (p>0.214) did not present a relevant statistical difference. Conclusion Periodontal disease and edentulism are the most significant changes in individuals who received antineoplastic therapy for head and neck cancer as well as greater need for oral rehabilitation.

RESUMO Objetivo Avaliar a saúde bucal de pacientes com câncer de cabeça e pescoço após tratamento antineoplásico, e compará-los com pacientes sem histórico de câncer. Métodos Foram avaliados 75 pacientes, divididos em Grupo de Estudo de indivíduos após tratamento antineoplásico (n=30) e Grupo de Controle de indivíduos sem histórico de câncer (n=45), com faixa etária de 35 a 79 anos. A condição de saúde oral foi avaliada pelo índice de dentes permanentes cariados, perdidos e obturados (CPOD), pelo índice periodontal comunitário e por uma avaliação de uso e necessidade de prótese, conforme critérios preconizados pela Organização Mundial da Saúde. A análise estatística foi descritiva e realizada por meio do teste do χ2 de Pearson. Resultados O índice periodontal comunitário foi maior no Grupo de Estudo quando comparado ao controle (p<0,0001). A necessidade de prótese superior (p<0,001) e inferior (p<0,0001) foi maior no Grupo de Estudo. O uso de prótese superior foi maior no Grupo de Estudo (p<0,002). O índice de dentes permanentes cariados, perdidos e obturados entre os dois grupos (p>0,0506) e o uso de prótese inferior (p>0,214) não apresentaram diferença estatística relevante. Conclusão A doença periodontal e o edentulismo são as alterações mais significativas em indivíduos que receberam terapia antineoplásica de câncer de cabeça e pescoço, assim como maior necessidade de reabilitação oral.

Malignant Tumors of the Upper Aerodigestive Tract as Seen in a Nigerian Tertiary Health Institution

Background: Cancers of the upper aerodigestive tract constitute a diverse heterogeneous group of malignant neoplasms with unique epidemiological; pathological; and treatment considerations. Only few studies have been conducted so far on these tumors in Nigeria. This study aims to study in greater detail; the pathological features of these cancers in Nigerian patients. Materials and Methods: The surgical specimens of patients diagnosed with malignant tumors of the upper aerodigestive tracts in the Department of Morbid Anatomy and Forensic Medicine; Obafemi Awolowo University Teaching Hospital Complex (OAUTHC) in Ile-Ife; Nigeria; over a 10-year period; formed the basis of this study. Analysis was done for differences in proportion using the Chi-square test (P is significant at 0.05) by SPSS version 15. Results: There were a total of 62 cases. The overall mean age was 50.7 years; while the age range was from 3 years to 90 years. The male to female ratio was 3.1:1. A majority of the patients (67.7) were older than 40 years. About 30.6; 27.4; and 16.1 of cases occurred in the larynx; nasopharynx; and nasal cavity; respectively; while 93.5 of the tumors were carcinomas. Squamous cell carcinoma was the most common histological variety. Nonepithelial tumors were not seen below the age of 20 years. Conclusion: This study shows that malignant upper aerodigestive tract tumors seen in our environment are mainly diseases of adulthood that tend to occur about seven to nine years earlier than in other populations. Squamous cell carcinoma is the predominant histological variety. Although the larynx is the most frequent anatomic site; the nasopharynx and nasal cavity are more commonly affected than the oral cavity unlike in other populations. Nonepithelial tumors are extremely rare below the age of 20 years

Evaluation of acute radiation effects on mandibular movements of patients with head and neck cancer / Avaliação dos efeitos agudos da radioterapia sobre os movimentos mandibulares de pacientes com câncer de cabeça e pescoço

OBJECTIVES: To evaluate radiotherapy effects (RT) on mandibular movements of patients with head and neck cancer (H&NC) and associate them to the variables: functional capacity, radiation field, disease staging, type of feeding, concomitant chemotherapy and total dose of RT. METHODS: Twenty-six patients with H&NC were followed up at the RT service. Physical examination was performed in 3 follow up time points: before the beginning of RT (T0), between 14th and 17th session of RT (T1) and after the last session of RT (T2). The physical examination consisted of the assessment of the following variables: mouth opening without pain (MO), maximum mouth opening (MMO), right lateral excursion (RLE), left lateral excursion (LLE) and protrusion (PR) of the jaw. The feeding type and the Karnofsky Performance Status Scale (KPS) were evaluated in each follow up time point. Data with regards to the tumor lesion and the RT were collected from the patient's clinical notes. RESULTS: There was a statistical significant reduction in the values of MO (p=0.006), MMO (p=0.001), LLE (p=0.006) and KPS (p=0.001). There was significant a statistical association among the reduction in KPS and decreased measure of MO (r=0.390, p=0.048) and MMO (r=0.435, p=0.026). The mouth and oropharynx radiation fields when combined showed a significant reduction for both the measure of MO (p=0.005) and for MMO (p=0.004). Patients who used nasoenteric tube feeding (NTF) had greater reduction in the measurement of MMO (p=0.031). The remaining variables showed no statistically significant difference. CONCLUSION: Patients with H&NC present reduction of the measures of MO and MMO during the RT, especially if they present reduced functional capacity, have radiation in the mouth and oropharynx fields and used NTF.

OBJETIVOS: Avaliar os efeitos da radioterapia (RT) sobre os movimentos mandibulares de pacientes com câncer de cabeça e pescoço (CCeP) e associá-los às variáveis: capacidade funcional, campo de radiação, estadiamento da doença, tipo de alimentação, quimioterapia concomitante e dose total de RT. MÉTODOS: Vinte e seis pacientes com CCeP foram acompanhados em um serviço de RT. O exame físico ocorreu em três momentos: antes do início da RT (M0), entre a 14º e 17º sessão (M1) e após a última sessão de RT (M2) para verificação de variáveis, como: abertura bucal sem dor (AB), abertura bucal máxima (ABm), excursão lateral direita (EXd), excursão lateral esquerda (EXe) e protrusão (PR) da mandíbula. O tipo de alimentação e a Escala de Karnofsky (EK) foram reavaliados em cada momento. Dados a respeito da lesão tumoral e RT foram coletados do prontuário do paciente. RESULTADOS: Houve redução significativa nos valores de AB (p=0,006), ABm (p=0,001), EXe (p=0,006) e EK (p=0,001). Houve associação estatisticamente significativa entre a redução na EK e a diminuição de AB (r=0,390; p=0,048) e de ABm (r=0,435; p=0,026). Os campos de radiação da boca e orofaringe, quando agrupados, apresentaram redução significativa tanto para a medida de AB (p=0,005) quanto para ABm (p=0,004). Os pacientes que utilizaram sonda nasoentérica (SNE) apresentaram maior redução da medida de ABm (p=0,031). As demais variáveis não apresentaram diferença estatisticamente significativa. CONCLUSÃO: Os pacientes com CCeP apresentam redução das medidas de AB e ABm no decorrer da RT, principalmente se apresentarem redução da capacidade funcional, tiverem irradiação para os campos da boca e orofaringe e fizerem uso de SNE.

Avaliação da abertura bucal em pacientessubmetidos à radioterapia de cabeça e pescoço / Evaluation of mouth opening in patients undergoing head and neck radiotherapy

A radioterapia de cabeça e pescoço quando direcionada à articulaçãotemporomandibular e músculos da mastigação, pode provocar sequelas como redução daamplitude de abertura bucal e trismo, que, muitas vezes, pode ser irreversível.Objetivo: comparar a amplitude de abertura bucal, antes e após a radioterapia da regiãode cabeça e pescoço.Metodologia: foram selecionados 30 pacientes com diagnóstico de tumores malignos decabeça e pescoço para serem submetidos à mensuração da abertura bucal 30 dias antes daradioterapia, e 90 dias após. Também foram observadas as características gerais comotipo histológico do tumor e dose de radioterapia.Resultados: a idade média da amostra foi de 58 anos, sendo que 80,76% eram do sexomasculino e 19,24% do feminino. Na primeira avaliação encontrou‐se limitação deabertura bucal (35,08±8,74), e 90 dias após a radioterapia houve aumento da limitação deabertura bucal (31,5±10,42), porém, sem mostrar significância estatística (p≤0,061).Conclusão: não houve agravamento da limitação de abertura bucal após três meses deradioterapia...

When temporomandibular joint and muscles of mastication are in the fieldof radiation, trismus and restriction of mouth opening are common and often irreversiblesequelae.Aim: compare mouth opening before and after head and neck radiotherapy.Methodology: thirty patients with head and neck malignant tumors were chosen to havetheir mouth opening measured 30 days before and 90 days after radiotherapy. Generalcharacteristics as histological type of the tumor and radiotherapy dose were alsoevaluated.Results: the mean age of the sample was 58 years, 21 subjects (80.76%) were male, and 5(19.24%) were female. At the first evaluation, we found mouth opening restriction(35.08±8.74) and ninety days after radiotherapy the mouth opening increased (31.5±10.42),but without statistical significance (p≤0.061).Conclusion: the mouth opening did not worse after 3 months of radiotherapy...

Primary Childhood Head and Neck Neoplasms: an 8-Year Histopathological Review in a Teaching Hospital

Background: Although infectious diseases remain the leading cause of death among children in our environment; neoplastic diseases have emerged as important cause of childhood morbidity and mortality. Method: A retrospective review of neoplastic lesions of the head and neck region histologically diagnosed at University of Benin Teaching Hospital (UBTH) in children aged 0-14years between 2002 and 2009 was carried out with the aim of determining their incidence and histological patterns. Results: A total of 266 neoplasms were diagnosed in this age group during the period out of hich123(46.2) were located in the head and neck region. Seventy two cases (58.5) were malignant while 51 (41.5) were benign. Lymphoma was the commonest histological type of malignant tumour (51) with Burkitt's lymphoma being the predominant subtype. The commonest benign tumours were haemangioma and neurofibroma each of which accounted for 8 cases (15.7). The commonest sites for these lesions were jaw; eye and adnexa; soft tissues; peripheral nerves; and lymph nodes. Conclusion: It is concluded that Burkitt's lymphoma remains the commonest childhood head and neck malignancy in the study population. The oral sites constituted about 40of the tumours studied

Tumores de cabeza y cuello / Head and neck tumors

Los tumores de cabeza y cuello corresponden a un heterogéneo grupo de enfermedades, destacando entre ellas el carcinoma epidermoide de laringe, faringe y cavidad oral, así como las neoplasias glandulares (tiroides y glándulas salivales). Constituyen una patología altamente desafiante, considerando la complejidad anatómica de la región cérvico-facial y las repercusiones funcionales y estéticas que pueden producir tanto la enfermedad como su tratamiento. Estos tumores se manifiestan clínicamente como masas palpables o por la producción de síntomas persistentes en la vía aéreo-digestiva superior. La imagenología y los estudios endoscópicos complementan la evaluación del paciente; la histopatología es esencial para determinar el diagnóstico definitivo. El manejo de los tumores de cabeza y cuello debe estar a cargo de equipos multidisciplinarios, siendo la cirugía y la radioterapia los pilares del tratamiento. El pronóstico de esta enfermedad está determinado, principalmente, por el tipo histológico y el estadio tumoral.

Níveis de depressão em portadores de câncer de cabeça e pescoço / Depression level in patients with head and neck cancer

Objetivos: avaliar os níveis de sintomas depressivos em pacientes com dor orofacial crönica por câncer de cabeça e pescoço e verificar a associação destes com a gravidade da dor crônica. Método: o protocolo seguido foi observacional transversal. A casuística foi composta de sessenta pacientes com diagnóstico de câncer na região da cabeça e pescoço, divididos igualmente em portadores ou não de dor orofacial crônica realcionada ao processo de câncer. Os níveis de sintomas depressivos e a intensidade e severidade da dor foram avaliados pelo eixo II do RDC/TMD. Resultados: não foram encontradas diferenças estatisticamente significantes entre os níveis de sintomas depressivos presentes nos dois grupos de pacientes com câncer de cabeça e pescoço, havendo uma moderada correlação estatisticamente significante entre os níveis de sintomas depressivos e a severidade da dor crônica sentida nso pacientes com dor. Conclusões: podemos concluir que esiste uma correlação positiva moderada entre os níveis de severidade da dor e de sintomas depressivos

Objective: to assess the levels of depression symptoms in head and neck cancer patients with chronic orofacial pain and to verify the association between them and the chronic pain severity. Methods: it was an observational and sectional protocol. The sample consisted of sixty patients, uniformly divided in having chronic orofacial pain related to cancer process or not. Depression levels, pain intensity and severity were assessed with RDC/TMD axis II. Results: the study did not demstrate statiscally significant difference in depression levels in both head and neck cancer paind groups, with the occurrence of moderate statiscally significant correlation between depression levels and chronic pain intensity felt in pain patients. The study demonstrated a moderate statiscally sifnificant correlation between chronic pain severity and depression levels presented by pain patients. Conclusion: there is a positive moderate correlation between chronic pain severity graduation and derpession levels

Determinação do perfil de expressão dos mRNAs da família das Smads e dos componentes do complexo AP-1 em carcinoma de célula escamosa de cabeça e pescoço / Smads and AP-1 messenger RNA expression pattern in head and neck squamous cell carcinoma

A expressão de Smads e de membros da família AP1/ jun-fos podem refletir alterações da via de TGF, uma via importante para o câncer epidermóide de cabeça e pescoço (HNSCC). Encontramos expressão aumentada dos mRNAs das Smads1-8 em HNSCC em comparação com tecido normal adjacente, por RPA. Além disso, as curvas de sobrevida de Kaplan Meier e a análise multivariada mostraram que a Smad6+ parece ser um fator determinante de bom prognóstico em HNSCC. Quanto a família AP-1, mensurado por Northern blot, somente Fra-1 mostrou-se aumentado no tumor e associado à presença de linfonodos comprometidos. Nossos dados sugerem que a positividade de Smad6 possa ser marcador de bom prognóstico em HNSCC / Smad and AP1 messenger RNA expression may underlie disruptions affecting TGF signaling in head and neck squamous cell carcinoma (HNSCC). Analysis of Smads1-8 mRNA expression by RPA has shown Smad expression is globally increased in tumor as compared to adjacent normal tissue. Kaplan Meier survival curves and multivariate analysis revealed that Smad6 positivity in tumor was an independent good prognostic factor in HNSCC. In relation to AP-1, as measured by Northern blot, only Fra-1 was overexpressed in tumor and directly related to the presence of lymph node involvement. Our data suggest that Smad6 may be a marker of good prognosis in HNSCC...

Reliability & validity of the Malayalam Functional Assessment of Cancer Therapy for Head & Neck Cancer.

BACKGROUND & OBJECTIVES: The need for quality over quantity in cancer survival is increasingly being recognised in the developing countries, and the efforts to monitor quality of life (QOL) are increasing. However, the non-availability of a valid and reliable tool in the local language is a common problem. Cross-culturally sensitive tools enable the researchers to compare different patient populations and identify cultural differences and variations. The present study was carried out to translate, validate and test for reliability a reliable QOL tool for the head and neck cancer patient population in a tertiary care hospital in south India. METHODS: The functional assessment of cancer therapy for head and neck cancer (FACT-H&N) was translated into the local language (Malayalam) and tested for reliability in 140 patients of head and neck cancer. RESULTS: The translated tool showed substantial psychometric sensitivity. The Cronbach's alpha for the total FACT-H&N was 0.94. The alpha scores for the five subscales ranged from 0.81-0.92. Significant correlations were observed amongst the total QOL and subscale scores and patient's demographic, disease and treatment variables. INTERPRETATION & CONCLUSION: The Malayalam translation of the FACT-H&N questionnaire was developed, tested and validated. It was found to satisfactorily measure QOL in head and neck cancer patients.

Lesão fibroinflamatória tumefativa cervical em criança: relato de caso / Tumefactive Fibroinflammatory Lesion of the Cervical Region in a Child: case report

A lesão fibroinflamatória tumefativa (LFT) é uma desordem fibroesclerosante, rara e idiopática, que tem aspecto clínico maligno, com crescimento rápido e invasivo, apesar do quadro histológico benigno. Acomete indivíduos com idade entre 10 e 70 anos. Este relato descreve um caso de LFT em região cervical de criança com seis anos de idade, caracterizada, macroscopicamente, por uma massa firme, branco-acinzentada, com textura homogênea simulando neoplasia. Histologicamente, era representada por um tecido conjuntivo fibroso permeado por linfócitos e polimorfonucleares. Esse padrão assemelha-se a outros processos fibroinflamatórios como a tireoidite de Riedel, colangite esclerosante, fibrose retroperitoneal e pseudotumor de órbita. Principalmente em crianças, a LFT pode simular neoplasias como os sarcomas. Ela também possui uma terapêutica diversificada e um potencial de recidiva alto, o que dificulta o controle clínico desses pacientes. A criança do caso em questão evoluiu bem após a ressecção da lesão, sem sinais de recidiva.

Tumefactive fibroinflammatory lesion (TFL) is a rare idiopathic fibrosclerosing disorder, which resembles a malignant invasive process, but is histologically benign, ranging in age from 10 to 71 years. This report describes a case of TFL in cervical region in a six-year-old girl, roughly characterized by a white to graytan firm mass, with a homogenous texture simulating neoplasia. Microscopically, it was represented by a proliferating fibrous tissue with lymphocytes and polymorfonuclear leukocytes. This appearance is similar to that seen in other idiopathic fibrosing syndromes, such as Riedel's thyroiditis, sclerosing cholangitis, retroperitoneal fibrosis and orbital pseudotumor. Mostly in children, the TFL can simulate neoplasias like sarcomas. It also has diverse therapies and a high local recurrence rate, which makes the clinical management of these patients difficult. The patient of this case evolved well, without signs of recurrence.

Tumoraciones no ganglionares del cuello: evaluación por tomografía computada / Non lymph nodal neck tumors: computed tomography evaluation

El propósito fundamental de los estudios de imagen es definir la localización precisa de la lesión y evaluar su agresividad. Con objeto de determinar la relación entre la apariencia radiológica y la agresividad, se realizo un escrutinio en forma ciega por dos observadores de cuatro parámetros de imagen en 60 lesiones no ganglionares de cuello estudiada por tomografía computada. Se evaluó la extensión, contorno, reforzamiento y lesión vascular, asignando un valor a cada característica empleando una escala ordinal. Estos parámetros fueron correlacionados con los diagnósticos definitivos clasificados en congénitos, inflamatorios, tumores benignos y tumores malignos. Se empleo la prueba Rho de Spearman, la Formula Kappa, y la Prueba T para análisis estadístico. La presentación mas común de las lesiones fue la de un solo espacio cervical. Se encontraron contornos infiltrantes en el 83 por ciento de las lesiones inflamatorias, el 63 por ciento de los tumores malignos y el 27 por ciento de los tumores benignos. Se observo contornos no infiltrantes en el 37 por ciento de los tumores malignos. Hubo lesión vascular en 6 casos. Se concluye que el contorno es el parámetro radiológico que mayor correlación tiene con la agresividad y que la TC porporciona información anatómica substancial para una valoraicón terapéutica

Capillary perfusion--a study in two groups of radiated patients for cancer of head and neck.

Laser Doppler velocitometry is novel non-invasive technique to assess cutaneous microcirculation. Patients undergoing radiation therapy for head and neck cancer with convention and accelerated fraction action were evaluated under normal condition before and after radiation. A total of 70 sites in group A (conventional fractionation) and 35 sites in group B (accelerated fractionation were evaluated. Increase in perfusion was noted in patients undergoing radiation with accelerated fractionation.

Factores pronósticos en el cáncer de cabeza y cuello / Prognostic factors in head and neck cancer

Se recopilan las experiencias y resultados publicados en la literatura médica sobre los tumores de cabeza y cuello, basados en factores pronósticos, que permiten el surgimiento de la terapéutica electiva antineoplásica en la enfermedad subclínica y la utilización de terapia médica inductiva y adyuvante. Debido a su mayor accesibilidad al clínico, el territorio de cabeza y cuello permite la mejor identificación de los factores pronósticos relacionados con paciente, tumor e interacción de ambos. Se analizan localización, etapa clínica, espesor tumoral, grado nuclear y grado de queratinización, número de mitosis, respuesta inflamatoria y desmoplásica, patrón de invasión vascular y perineural. Las modificaciones de algunos esquemas y momentos terapéuticos tradicionales se basan en los factores pronósticos de los tumores. Esto ha permitido incrementar el tiempo libre de enfermedad, disminuir la frecuencia de recurrencias locales y de metástasis y mejorar la calidad de vida y la supervivencia

Tumores malignos de cabeza y cuello (31 casos) / Malignant tumors of head and reck (3) cases

El objetivo de este trabajo es analizar nuestra propia experiencia en los últimos 6 años, en el manejo de los tumores malignos de cabeza y cuello, utilizando un tratamiento combinado de cirugía más radioterapia post operatoria. Se realizo exenteraciones oculares solo en 2 pacientes, 1 por invasión de contenido orbitario y otro por recidiva de tumor, luego de 8 meses post-cirugía.

Melanoma de mucosa de cabeza y cuello: experiencia en el Instituto Nacional de Cancerología / Melanoma of the mucous membranes of head and neck. Experience in the Instituto Nacional of Cancerología

Se presenta el análisis clínico-patológico de 20 casos de melanoma de la mucosa de cabeza y cuello, estudiados en el Instituto Nacional de Cancerología en el período de 1973-1989. Se recolectó información de parámetros demográficos, clínicos e histopatológicos en este grupo de pacientes. De los 20 casos incluidos en este estudio hubo 11 mujeres y 9 hombres; la edad promedio fue de 56 años con intervalo de 27-96. Catorce casos fueron de localización en cavidad oral, cinco nasal, y uno en región larigo-faringea. Desde el punto de vsita histológico, 10 casos presentaron patrón mixto, ocho de tipo epidermoide y dos de patrón fusiforme, ningún parámetro histológico fue predictor de comportamiento biológico. El tratamiento fue variable, con pobre seguimiento lo que impidió evaluar sobrevida en estos enfermos. Esta neoplasia representa un reto para el cirujano oncólogo, y un campo de interés para el suso de inmunomoduladores en estos pacientes.