Survival of patients with cervical cancer in India - findings from 11 population based cancer registries under National Cancer Registry Programme.

Background: Cancer survival data from Population Based Cancer Registries (PBCR) reflect the average outcome of patients in the population, which is critical for cancer control efforts. Despite decreasing incidence rates, cervical cancer is the second most common female cancer in India, accounting for 10% of all female cancers. The objective of the study is to estimate the five-year survival of patients with cervical cancer diagnosed between 2012 and 2015 from the PBCRs in India. Methods: A single primary incidence of cervical cancer cases of 11 PBCRs (2012-2015) was followed till June 30, 2021 (n = 5591). Active follow-ups were conducted through hospital visits, telephone calls, home or field visits, and public databases. Five-year Observed Survival (OS) and Age Standardised Relative Survival (ASRS) was calculated. OS was measured by age and clinical extent of disease for cervical cancers. Findings: The five-year ASRS (95% CI) of cervical cancer was 51.7% (50.2%-53.3%). Ahmedabad urban (61.5%; 57.4%-65.4%) had a higher survival followed by Thiruvananthapuram (58.8%; 53.1%-64.3%) and Kollam (56.1%; 50.7%-61.3%). Tripura had the lowest overall survival rate (31.6%; 27.2%-36.1%). The five-year OS% for pooled PBCRs was 65.9%, 53.5%, and 18.0% for localised, regional, and distant metastasis, respectively. Interpretation: We observed a wide variation in cervical cancer survival within India. The findings of this study would help the policymakers to identify and address inequities in the health system. We re-emphasise the importance of awareness, early detection, and increase the improvement of the health care system. Funding: The National Cancer Registry Programme is funded through intra-mural funding by Indian Council of Medical Research, Department of Health Research, India, Ministry of Health & Family Welfare.

Breast cancer survival in India across 11 geographic areas under the National Cancer Registry Programme.

BACKGROUND: Population-based cancer survival is a key indicator for assessing the effectiveness of cancer control by a health care system in a specific geographic area. Breast cancer is the most common cancer among women in India, accounting for over one quarter of all female cancers. The objective of this study was to estimate the 5-year survival of female patients who were diagnosed with breast cancer between 2012 and 2015 from the existing Population-Based Cancer Registries (PBCRs) in India. METHODS: In total, 17,331 patients who had breast cancer diagnosed between 2012 and 2015 from 11 PBCRs were followed until June 30, 2021. Active methods were used to track the vital status of registered breast cancer cases. The study conducted survival analysis by calculating the difference between the date of first diagnosis and the date of death or censoring to estimate observed survival and relative survival using the actuarial survival approach and the Ederer-II approach, respectively. RESULTS: The 5-year age-standardized relative survival (95% confidence interval [CI]) of patients with breast cancer was 66.4% (95% CI, 65.5%-67.3%). Mizoram (74.9%; 95% CI, 68.1%-80.8%), Ahmedabad urban (72.7%; 95% CI, 70.3%-74.9%), Kollam (71.5%; 95% CI, 69.2%-73.6%), and Thiruvananthapuram (69.1%; 95% CI, 67.0%-71.2%) had higher survival rates than the national average. Conversely, Pasighat had the lowest survival rate (41.9%; 95% CI, 14.7%-68.6%). The 5-year observed survival rates for localized, regional, and distant metastasis in the pooled PBCRs were 81.0%, 65.5%, and 18.3%, respectively. CONCLUSIONS: The overall disparity in survival rates was observed across 11 PBCRs, with lower survival rates reported in Manipur, Tripura, and Pasighat. Therefore, it is imperative to implement comprehensive cancer control strategies widely throughout the country.

Breast carcinoma in young females below the age of 40 years: A histopathological perspective.

BACKGROUND: Breast cancer among young women is a rare pathology, but is known to have a more aggressive behavior and poorer outcome. AIMS: The objective of this study was to evaluate the clinicopathological characteristics of breast carcinoma below 40 years in comparison to that over 40 years in Manipur, India. SETTINGS AND DESIGN: This retrospective study from the period of January 2005-December 2010 was conducted in the Department of Pathology, Regional Institute of Medical Sciences, Imphal, Manipur. MATERIALS AND METHODS: All cases of mastectomy specimens of carcinoma breast from the period of January 2005-December 2010 were included in the study. Clinical and histopathological data of all cases were reviewed and correlated. RESULTS: A total of 507 mastectomy specimens were received, among which, 160 cases (31.56%) were below 40 years; whereas 347 cases (68.44%) were above 40 years of age. Stage III was the commonest stage (47% versus 18%) in the younger group; while in the older group, Stage II was the commonest (64% versus 34%). CONCLUSION: This study shows that young females with breast cancer have higher stage of tumor.

Proptosis and facial palsy as an unusual clinical presentation of acute myeloid leukemia.

Simultaneous proptosis and facial palsy as the clinical presentation of childhoodAcute Myeloid Leukaemia (AML) is very rare. To date, no case have beenreported anywhere to the best of our knowledge. Extra medullary leukemic deposits or Granulocytic Sarcoma (GS) is a rare manifestation in about 3% of childhood AML, 9.3% of GS manifested as orbit deposits causing proptosis in one or both eyes. CNS infiltration or acute otomastoiditis subsequent to leukemic infiltration of the temporal bone may be implicated with facial paralysis. We are here with reporting the case in a 3-year-old boy who presented with proptosis and facial palsy in a case of AML. The purpose of reporting this case is to emphasize the need of examining the peripheral blood and bone marrow in children presenting as proptosis and facial palsy for early diagnosis of childhood AML.

Pattern of salivary gland tumors in Manipur, India: A 10 year study.

BACKGROUND: Salivary gland lesions, especially the neoplastic lesions constitute a highly heterogeneous histopathologic group. Several studies have reported a significant difference in the global distribution of salivary gland tumors, but no formal study has been carried out in this part of the globe. OBJECTIVES: To document the pattern of various salivary gland tumors in Manipur, a state in North Eastern India. MATERIALS AND METHODS: This is a 10 years (2002-2011) retrospective study of all salivary gland specimens received at our referral teaching hospital in Manipur, India. All the histopathology slides of salivary gland specimens during the study period were reviewed and clinical details were obtained from the archives. Restaining of slides and fresh sections of tissue blocks were performed whenever required. Data thus collected were analyzed. RESULTS: A total of 104 cases of salivary gland lesions were studied during the study period. Age ranged from 5 years to 78 years with an overall slight female preponderance (M:F = 1:1.08). Parotid (56.65%) was the commonest gland involved followed by submandibular gland (31.73%).Neoplastic lesions comprised of 78 (75%) cases and non-neoplastic lesions constituted 25% (26 cases). Among the neoplastic lesions, benign lesions (53.85%) predominated over malignant lesions (21.15%). Pleomorphic adenoma was the commonest benign neoplastic lesion and mucoepidermoid carcinoma was the commonest malignant tumor. Chronic sialadenitis was the predominant lesion in the non-neoplastic group. CONCLUSION: The principal site for salivary gland tumors was the parotid gland and pleomorphic adenoma outnumbered all the other tumors. Females are more affected in the malignant group.

Urothelial tumors of the urinary bladder in Manipur: a histopathological perspective.

OBJECTIVE: To study the histomorphological pattern of urothelial tumors of the urinary bladder in Manipur and to evaluate whether any correlation exists between tumor grade and muscle invasion. METHODS: A 10 year retrospective study of all consecutive cases diagnosed in the Department of Pathology RIMS - Imphal, between 1st January 2001 to 31st December 2010. RESULTS: The study included 26 cases of transitional cell tumors of urinary bladder. The male to female ratio was 1.5: 1 and the ages ranged from 38 years to 73 years (medians of 60 and 64 years, respectively). Of the total, 14 (53.9%) cases were low grade, 9 (34.6%) were high grade, 2 (7.7%) were papillomas and 1 (3.9%) was a papillary urothelial neoplasm of low malignant potential (PUNLMP). Pathological staging showed that 14 (53.9%) of the cases were stage PTa, four (15.4%) PT1, and eight (30.9%) PT2. Some 18.2% of low grade tumors and 75% of high grade tumors were invasive to the detrusor muscle layer. CONCLUSION: Bladder cancer is an uncommon disease, transitional tumors being the only histological type observed. It was more common in males than females, with peak incidence in seventh decade. Most of the tumors were non- invasive (PTa) and invasion to the detrusor muscle layer was seen in more than half of the high grade tumors. There is a definite correlation between advancing tumor grade and muscle invasion.

Nasopharyngeal carcinoma--a clinico-pathological study in a regional cancer centre of northeastern India.

OBJECTIVES: To study the clinico-pathological pattern of nasopharyngeal carcinoma (NPC) with dietary, smoking and tobacco consumption habits in the Northeastern region of India. METHODS: This is a retrospective study on 200 patients with nasopharyngeal carcinoma who were registered in Regional Cancer Centre, Regional Institute of Medical Sciences, Manipur from July 2004 to July 2009. RESULTS: There were 139 males and 61 females (ratio 2.2:1). with a mean age of 49.7±15.9 years. The commonest presenting symptoms were neck swelling (78.0%) followed by nasal obstruction (35.5%) and epistaxis (27.5%). Histopathologically, undifferentiated carcinoma type (Type III, WHO) was the commonest (75.0%) followed by differentiated non-keratinizing squamous cell carcinoma (15.0%) and keratinizing squamous cell carcinoma (10.0%). 25% of total patients had cranial nerve(CN) involvement, the commonly involved CN being V (28.8%) followed by VI 26.9%) and X (25.0%). Of the total 200 patients, 88.0% had history of regular intake of smoked meat, 62.0% admitted regular intake of poorly preserved fermented foods, only 19.0% consumed fresh fruits (at least 4 times a month). Majority of patients (47.0%) chewed tobacco in different forms and (51.0%) smoked at least for 15 years. 186 patients (93.0%) lived in poorly ventilated houses with history of exposure to household smoke from burning firewood. CONCLUSION: High incidence of NPC in Northeastern India is highlighted in this study. Early detection and early treatment to reduce the morbidity and mortality associated with NPC in addition to imparting awareness on how to prevent the disease to general population is needed in this region.

Penicillium marneffei--an indicator disease of AIDS: a case report.

Penicillium marneffei (PM), the only dimorphic species of the genus penicillium is the etiological agent of penicilliosis marneffei. This opportunistic fungal infection occurs among human immunodeficiency virus (HIV) infected and other immunocompromised patient in several regions of South-east Asia, where the infection is considered as an indicator disease of AIDS. A case of penicilliosis marneffei is reported in a patient whose HIV status was unknown and later turned to be in the late stage of AIDS. This demonstrates that it is indeed an indicator disease of AIDS. In India, penicilliosis has been reported among the inhabitants of Manipur state where the prevalence of HIV infection / AIDS is very high. The causative agent was first isolated from a captive bamboo rat. Investigation of the prevalence of the organism among bamboo rats of different countries of South East Asia revealed four species of bamboo rats to be harboring the organism. These four species of bamboo rats are Rhizomys sinensis, R. pruinosus, R. sumatrensis and Cannomys badius. In Manipur, Penicillium marneffei has been isolated from Cannomys badius. Any patient presenting with penicilliosis marneffei should be subjected to HIV counselling and testing if the HIV status is not known and further study regarding the ecology and epidemiology of the fungus is needed.