Carcinoma caecum; metastasis to ileostomy from mucinous adenocarcinoma

Most of patients with colorectal carcinoma end up with colostomies and ileostomies. Different complications are described pertinent to ileostomies. We are presenting a very rare presentation of ileostomy, the metastasis from mucinous adenocarcinoma of caecum, without ileostomy dysfunction, local bleeding as presenting complaint along with a ileostomy growth

Present and future of radiotherapy in Pakistan

Incidence of cancer is rising worldwide with highest burden in the developing countries including Pakistan. Ensuring that these patients receive standard radiotherapy is a major challenge. To see existing radiotherapy services in Pakistan and suggest future strategies for radiotherapy services. Various technical personnel from 22 radiotherapy centers were contacted through phone calls and emails and asked about the number of therapy machines, simulators, number of technical staff and radiotherapy technologists that they had in their centre in the year 2009. Inconsistencies in the data collection were resolved through frequent phone calls. Main outcome measure was the current radiotherapy services per million populations. Each radiotherapy center covers a mean population of 1.96 million [3.54-19.63] with more access of cancer patients to the public sector due to low costs of radiotherapy treatment. At present, there are only 56 radiation oncologists, 55 medical physicists and 145 radiotherapy technologists. Further only 20 Cobalt-60, 17 linear accelerators, 12 fluoroscopic simulators and 4 CT simulators are present. Majority of modern equipment and treatment delivery is available in private sector. It was estimated that 55-60% of all new cases of cancer are currently being referred for radiotherapy each year and existing services are inadequate. The increase need of radiotherapy services demands unified, better and effective measures to deliver state of art radiotherapy to each patient to improve the outcomes of treatment. More radiotherapy services should be provided to public to reduce accessibility issues

Ulcerative cutaneous metastasis from primary transitional cell carcinoma of urinary bladder

Transitional cell carcinoma of urinary bladder with skin metastasis is extremely rare presentation. Skin metastases are considered as poor prognostic factors with low survival rates. We report a case of skin metastasis in patient with bladder cancer

Epistaxis and proptosis - unusual primary manifestations of metastatic renal cell carcinoma

Metastasis to the paranasal sinuses is rare presentation. We report a case of a patient with metastasis to the maxillary antrum from renal cell carcinoma

Penile cancer; skin metastasis

Carcinoma of the penis has a well documented metastatic pattern, regional lymph nodes being the predominant site of involvement. Distant metastasis is extremely rare, with a reported incidence of 1-10%. Skin metastasis is even rarer and three cases of metastasis to the skin have been reported previously worldwide. We present a case of carcinoma of the penis metastasizing to the skin of trunk

Neoadjuvant chemo-irradiation in un-resectable carcinoma of rectum

Rectal cancer is one of the most frequent gastrointestinal cancers. Conventionally surgery is the mainstay of treatment, however after surgery alone, local recurrence is high especially in locally advanced rectal cancer, i.e. tethered and fixed rectal cancer. This study was conducted to determine the role of neo-adjuvant [pre-operative] chemo-irradiation in locally advanced carcinoma of the rectum to improve resectability, local control and survival. Study was conducted in Radiation Oncology department of Shaukat Khanum Memorial Cancer Hospital and Research Center from May 97-Oct 99. Thirteen patients with unresectable/ locally advanced adenocarcinoma rectum received neo-adjuvant chemoirradiation, 50 Gray to pelvis by box technique on Cobalt-60 machine with concomitant 5-Flurouracil 500mg/m2 for first three and last three days followed by abdomino-perineal /low anterior resection. Neo-adjuvant chemoirradiation resulted in resectability rate of 92% and clinical down staging in 11/13 [84%] patients and pathological complete response in 2/13 [15%] patients and a local recurrence rate of 2/13 [15.38%]. Non hematological toxicity [diarrhea grade 4-15%, erythema grade3-23%, dysuria gradel-2-38%] were main problems observed during neo-adjuvant chemoirradition. Concomitant preoperative chemoirradiation for locally advanced rectal cancer is associated with considerable clinical and pathological down staging. Tumor resectability is improved with potential for improved local control and is relatively safe with acceptable morbidity