Film Review.

Guzaarish is the story of a quadriplegic, who after 14 years of valiant survival, decides to petition the court to allow him to die. As his health deteriorates, he is clear that he does not want to be dependent on machines. With the knowledge that he will soon be on a ventilator, he wants to be allowed to die peacefully, while he still has a the ability to decide; but will the courts, society, his friend, his nurse and his doctor give him this liberty?

Cervical carcinoma in a Muslim community.

OBJECTIVES: The aim of the research was to review the distributions of age, stage at presentation, and morphology of patients presenting with carcinoma of the cervix in a predominantly Muslim population. STUDY DESIGN: This retrospective study was conducted at a comprehensive cancer diagnostic and treatment facility situated in Lahore, Pakistan, reviewing the medical records of the patients. PATIENTS AND METHODS: Four-hundred and nineteen cervical cancer patients were registered at the hospital during a nine-and a half year time period extending from December 1994 to June 2004. Histology was confirmed by exfoliative cervical cytology typically by means of Papanicolaou smear. The International Federation of Gynecology and Obstetrics classification was used to stage the disease. Univariate analysis on factors as age, stage at presentation, and morphology was conducted. RESULTS: 1) The age distribution of the 419 patient cohort was recorded to be as follows: mean 49.2 years (SD 11.7, range 11-85 years) and mode 50 years (37 patients). Only one patient was less than 18 years. 2) Of these 419 patients, 73.5% (308/419) had squamous cell carcinoma (SCC), 7.9% (33/419) had adenocarcinoma, and 0.7% (3/419) had adenosquamous carcinoma; of the remainder, 1.4% (6/419) had rare types (3 each of sarcoma and small cell carcinoma) and 16.5% (69/419) had unspecified carcinoma. 3) Only two patients (0.5%) were identified as being in stage 0, 49/419 (11.7%) in stage I, 140/419 (33.4%) in stage II, 90/419 (21.5%) in stage III, 52/419 (12.4%) in stage IV, and 86/419 (20.5%) as not being evaluable. CONCLUSIONS: A large proportion of patients (67%) presented in stages II to IV and only 12% presented early at stages 0 or I. This emphasizes the need for early detection of this tumor in our population. Accordingly, the importance of detection of the pre-clinical stage of the disease by considering the possibility of initiating a cost-effective screening measures needs to be emphasized in our setting.

Geographical variation in the epidemiology of esophageal cancer in Pakistan.

STUDY OBJECTIVES: To evaluate whether factors such as the geographic area of residence, sex, and anatomic subsite of esophagus can prognosticate the histologic subtype of esophagus cancer. DESIGN: To study the major histologic subtypes of esophagus cancer stratified by various factors through multivariate analyses using morphology as the dependent factor and gender, province, and subsite of esophagus as independent factors. SETTING: A tertiary care cancer hospital situated in the city of Lahore in Pakistan. PATIENTS: Three hundred and thirty five patients diagnosed either with esophageal squamous cell carcinoma or adenocarcinoma, from December 1994 to April 2004, were included. Subjects were residents of either Punjab or the Northwest Frontier Province in Pakistan. MAIN RESULTS: An excessive likelihood of development of squamous cell carcinoma versus adenocarcinoma was established for the Northwest Frontier Province as compared to Punjab (odds ratio 2.7, 95 percent confidence interval: 1.2, 6.2, p = 0.02), and in the upper-third of the esophagus relative to the lower-third of the organ (odds ratio 8.8, 95 percent confidence interval: 2.8, 28.3, p < 0.001). CONCLUSIONS: This histologic variation may be explained by environmental and lifestyle factors peculiar to geographical regions.