Capecitabine induced cardiotoxicity: a case report and review of literature

Capecitabine is an oral prodrug of 5-fluorouracil [5-FU] which is converted in tumor cells to 5-FU by the enzyme thymidine phosphorylase. Nowadays, it is being widely used into the management of colorectal, breast and head and neck cancers because of its oral route and its comparable efficacy with 5-FU. 5-FU induced cardiotoxicity [angina and myocardial infarction] has been reported the literature, but capecitabine induced cardiotoxicity is less reported event. We report a patient with diagnosis of locally advanced adenocarcinoma of rectum who developed symptomatic bradycardia and acute ischemia while receiving oral capecitabine 825 mg/m[2] twice daily with preoperative radiation

Metastatic prostate adenocarcinoma presenting with bilateral inguinal adenopathy

Metastatic prostate adenocarcinoma generally manifests either as painful bone metastases often in axial skeleton or as bulky iliac and para-aortic lymphadenopathy. The inguinal lymphadenopathy is very rare. Here-in we present an unusual case of metastatic prostate adenocarcinoma with bilateral inguinal adenopathy

Ipsilateral ethmoid sinuses metastasis and proptosis: rare presentation of metastatic prostate cancer

Metastatic paranasal sinuses and orbital cancer is very rare. The patient with sinusitis and orbital symptoms warrants a detailed history, complete physical examination and serial radiological tests [sinus radiographs and CT scan] to rule out any metastatic disease and prompt treatment. We present a case of 65 years old patient with metastatic prostate cancer who presented to us with left ethmoid sinuses and orbital metastasis causing ipsilateral proptosis

Hnpcc hereditary nonpolyposis colorectal cancer in Pakistan

Hereditary nonpolyposis colorectal cancer [HNPCC] is the most common form of hereditary bowel cancer. Multiple generations are affected with colorectal cancer at relatively young age, between 25 and 45 years. To investigate the frequency of HNPCC in Pakistani population, due to the high incidence of colorectal cancer in younger Pakistani adults and prevalence of consanguinity in this region conducted this study. November 2008 and January 2010. Ninty histopathologically confirmed colorectal cancer patients between 12- 50 years and their families were interviewed using a detailed questionaire. The questions about family history of colorectal cancer, history of other cancers, age at diagnosis and consanguinity were asked. The pedigrees were drawn for all families based on given information. Hospital records were also reviewed to confirm cancers reported in relatives. Amsterdam criteria was used to label a family as HNPCC. Seventeen patients [18.9%] had one or more first or second degree relatives under age 50 years with colorectal cancers suggestive of HNPCC. Another 15 patients [16.7%] had first or second degree relatives with a family history of other extra-colonic cancers including ovarian, breast, endometrium, lung, parotid, brain and bladder cancer. Of these 30 patients [33.3%] reported that their parents were first degree cousins. 1. High frequency of HNPCC is seen in Pakistani population. 2. Higher proportion of colorectal cancer is seen in young Pakistanis. Strong prevalence of consanguineous marriages could be important factors for HNPCC occurrence in Pakistan. Future studies with large sample size along with genetic testing and screening programmes are warranted

Metastatic prostate and renal cell carcinoma presenting as supra-clavicular lymphadenopathy: report of two cases

Most metastases of cancers to cervical lymph nodes including supra-clavicular chain are from the head and neck primary tumors. Cancers metastasizing to the supra-calvicular lymph nodes from non-head and neck origin are rare. This occurs most frequently with lung, breast and esophagus. For prostate cancer, the non-regional lymph nodal involvment is very rarely reported. Similarly renal cell carcinoma presents mostly in advanced stage disease with involvment of non-regional lymph nodes is much less common. We present two cases of prostate and renal cell carcinoma who presented with initial manifestation of supraclavicular lymphadenopathy

Fifteen years of experience in the management of non-seminomatous testicular germ cell tumors at a tertiary care center in Pakistan

We evaluated the treatment outcome and associated prognostic factors for patients with nonseminomatous testicular germ cell tumours [NSGCT], who were treated in our hospital during last 15 years. Data was retrospectively analyzed for the 1995 through 2010 period. One hundred and twenty patients with NSGCT were identified. Descriptive Data was analyzed for the age, risk factors, site, histology, stage, chemotherapy regimen, retroperitoneal lymph node dissection [RPLND] and radiological response. The disease free survival [DFS] and overall survival [OS] were determined by Kaplan and Meier method and statistical inferences with the log-rank test. Cox proportional hazards Model was used to find different prognostic factors. Mean age of patients was 29.65 years [16-45]. Pain and swelling of testis was commonest presentation [30%]. Right sided were predominant [63.3%]. Predominant stage was IIIC [55%] and commonest histology was mixed [embryonal cell carcinoma+yolk sac tumor+teratoma] in 45% cases. Majority of patients were poor risk according to International Germ Cell Cancer Consensus Classification [IGCCC], 41.7%. Bleomycin, etoposide and cisplatinum [BEP] chemotherapy was mostly as a first line treatment [87.5%]. Postchemotherapy RPLND was performed in 31 patients [25.8%]. Histology among residuals was fibrosis [48.4%], viable tumors [35.5%] and mature teratoma [16.1%]. Median DFS and OS were 9 and 9.1 years respectively. Stage, IGCCC, RPLND were found important prognostic factors [p < 0.001]. Better outcome with lower disease burden and lower IGCCC and multidiscplinary approach warrants public awareness should be carried out for the testicular self-examination to reduce the time from the beginning of symptoms to time of seeking treatment

Hereditary nonpolyposis colorectal cancer in Pakistan: results of a pilot study

Hereditary nonpolyposis colorectal cancer [HNPCC] is the most common form of hereditary bowel cancer. Multiple generations are affected with colorectal cancer at relatively young age, between 25 and 45 years. We conducted this study to investigate the frequency of HNPCC in Pakistani population, due to the high incidence of colorectal cancer in younger Pakistani adults and prevalence of consanguinity in this region. Ninety histopathologically confirmed colorectal cancer patients between 12-50 years and their families were interviewed using a detailed questionnaire. The questions about family history of colorectal cancer, history of other cancers, age at diagnosis and consanguinity were asked. The pedigrees were drawn for all families based on given information. To confirm cancers reported in relatives, hospital records were also reviewed. Amsterdam criteria were used to label a family as HNPCC. Seventeen patients [18.9%] had one or more first or second degree relatives under age 50 years with colorectal cancers suggestive of HNPCC. Another 15 patients [16.7%] had first or second degree relatives with a family history of other extra-colonic cancers including ovarian, breast, endometrium, lung, parotid, brain and bladder cancer. Of these 30 patients [33.3%] reported that their parents were first degree cousins. High frequency of HNPCC was seen in Pakistani population; higher proportion of colorectal cancer in young Pakistanis, strong prevalence of consanguineous marriages could be important factors for HNPCC occurrence in Pakistan. However future studies with large sample size along with genetic testing and screening programmes are warranted

Primitive neuroectodermal tumor/Ewing's sarcoma in adult uro-oncology: a case series from a developing country

Peripheral primitive neuroectodermal tumor/Ewing's sarcoma [PNET/EWS] is primarily a tumor of soft tissues and bones. Primary localization of PNET/EWS in genitourinary organs is rare. No data on this localization of PNET/EWS are available in literature from Pakistan. We searched our adult uro-oncology records from 1994 till date and identified all cases of adult genitourinary and adrenal PNET/EWS diagnosed on histology and immunohistochemistry. Their case records were reviewed to obtain data on demographics, presentation, pathologic features, management and outcome. Six cases were found; all were young and had aggressive disease at presentation. Four had renal PNET/EWS. One case each of prostate and adrenal PNET/EWS was seen. Surgery and chemotherapy formed the mainstay of management. Three patients [50%] died during treatment, two were lost to follow-up and one case with renal PNET/EWS showed good initial response to chemotherapy but was later on lost to follow-up. In conclusion, PNET/EWS should be considered in the differential diagnosis of genitourinary malignant tumors in young patients. These tumors are aggressive with poor outcome

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