Practical Clinical Consensus Guidelines for the Management of Cancer Associated Anemia in Low- and Middle-Income Countries.

Purvish M. ParikhCancer-associated anemia (CAA) remains a major unmet need that compromises overall survival (OS) and quality of life (QoL). Currently, available guidelines do not take into consideration the unique challenges in low- and middle-income countries (LMIC). Our CAA patients have to battle preexisting impaired nutritional status, depleted body iron stores, financial limitations, and difficulty in having easily accessible affordable healthcare. Hence, we fulfilled the need of guidelines for LMIC. A group of subject experts were put together, given background literature, met in a face-to-face discussion, voted using Delphi process, and finally agreed on the contents of this guideline document. As many as 50% of cancer patients will have significant anemia (hemoglobin < 10 g/dL) at initial diagnosis. It is most commonly seen with gastrointestinal malignancies, head and neck cancers, and acute leukemias. The hemoglobin falls further after initiation of cancer directed therapy, due to chemotherapy itself or heightened nutritional deficiency. Its evaluation should include tests for complete blood count, red blood cell morphology, reticulocyte count, Coombs test, and levels of vitamin B12 and folic acid. Iron status should be monitored using test to measure serum iron, total iron binding capacity, transferring saturation, and serum ferritin levels. A minimum of 50% of cancer patients with anemia require iron supplements. The preferred mode of therapy is with intravenous (IV) iron using ferric carboxymaltose (FCM). Most patients respond satisfactorily to single dose of 1000 mg. It is also safe and does not require use of a test dose. Significant anemia is found in at least half of all cancer patients in India, South Asian Association for Regional Cooperation region, and other LMIC countries. Its awareness among healthcare professionals will prevent it from remaining undiagnosed (in up to 70% of all cancer patients) and adversely affecting OS and QoL. The benefits of treating them with IV iron therapy are quick replenishment of iron stores, hemoglobin returning to normal, better QoL, and avoiding risk of infections/reactions with blood transfusions. Many publications have proven the value of single-dose FCM in such clinical situations. CAA has been proven to be an independent prognostic factor that adversely affects both QoL and OS in cancer patients. Use of FCM as single IV dose of 1000 mg is safe and effective in the majority of patients with CAA.

Clinicopathological profile of lung cancer at a tertiary care center.

BACKGROUND: Lung cancer is one of the most common malignancies with high morbidity and mortality. Nonsmall cell lung cancer (NSCLC) accounts for majority of cases. AIMS: This study aims to study the clinical and pathological features of lung cancer patients treated at our institute between January 2011 and December 2016. SUBJECTS AND METHODS: It is a retrospective study. 446 patients of lung cancer were retrospectively analyzed for demographic data, history of smoking, histological type, and presence of epidermal growth factor receptor (EGFR) mutation/anaplastic lymphoma kinase (ALK) mutations. RESULTS: Of the 446 patients analyzed, 304 (68%) were males and 142 (32%) were females, with the ratio being 2:1. Most of our patients had a lesion localizing to the right side (45.7%) than left (37.8%). NSCLC was reported in 81.1% of our patients. EGFR mutation was found in 60 (24%) patients, the most common mutation being the deletion of exon 19 (73%) followed by L858R mutation (21.6%). CONCLUSIONS: EGFR and ALK mutation testing of all the lung cancer patients is to be encouraged as these mutations form druggable targets.

Indian Council of Medical Research Consensus Document for the Management of Non-Hodgkin's Lymphoma (High Grade).

This consensus document is based on the guidelines related to the management of Non Hodgkin's Lymphoma (High grade) in the Indian population as proposed by the core expert committee. Accurate diagnosis in hematolymphoid neoplasm requires a combination of detailed history,clinical examination, and various investigations including routine laboratory tests, good quality histology section (of tumor and also bone marrow aspirate/biopsy), immunostaining, cytogenetic and molecular studies and radiology investigations. The staging system used for adult high grade lymphomas is based on the Ann Arbor system and includes various parameters like clinical, haematology, biochemistry, serology and radiology. Response should be evaluated with radiological evaluation after 3-4 cycles and at the end of treatment based on criteria including and excluding PET. Treatment of high grade lymphomas is based on histologic subtype, extent of disease, and age of the patient. Autologous stem cell transplantation after high dose chemotherapy is effective in the treatment of relapsed NHL. Newer RT techniques like 3 dimensional conformal radiation therapy (3D-CRT) and intensity modulated radiation therapy (IMRT) can significantly reduce radiation doses to surrounding normal tissues in lymphoma patients. Patients should be followed up every 3 to 4 months for the first 2 years, followed by 6 monthly for the next 3 years and then annually.

Granulosa cell tumor induced massive recurrence of post hysterectomy leiomyoma.

The authors report a very unusual occurrence of a massive recurrence of leiomyoma from post hysterectomy stump diagnosed on fluorine-18 fluorodeoxyglucose positron emission tomography/computed tomography (F-18-FDG PET/CT). The case also has an additional complexity of granulosa cell tumor (GCT) of ovary probably contributing to the recurrence and massive size.

Metastatic colorectal cancer-prolonging overall survival with targeted therapies.

This review provides an updated overview of the management of metastatic colorectal cancer (CRC). With widespread application of personalized therapy based on specific patient and tumor characteristics, this will enable the oncologists to optimize overall survival while maintaining quality of life. The role of k-ras and braf testing in helping select systemic therapy that includes cetuximab or bevacizumab is clarified. Current management of metastatic CRC is based on careful attention to these finer points, explained in this article.