ABSTRACT
Introduction Mucosal malignant melanoma of the anorectum is a rare and aggressive disease, in which early diagnosis is difficult. The prognosis remains extremely poor, irrespective of the treatment. We share our experience in treating this malignancy at our centre in South India. Methods This study describes a retrospective analysis of 31 cases of anorectal melanoma presented to our centre between January 2001 and December 2013. Results Twenty-two patients (71%) presented with metastasis and had a median overall survival of nine months. None of the 22 patients survived for two years. Nine patients (29%) had curative surgery, in the form of abdominoperineal resection (six patients), abdominoperineal resection with bilateral inguinal node dissection (one patient), abdominoperineal resection with liver resection (one patient) and posterior exenteration (one patient). In patients who underwent curative surgery, the median overall survival was 15 months and disease-free survival was nine months, with a two-year overall survival of 22%. Conclusions Anorectal melanoma is an aggressive disease with a poor prognosis. The majority of patients present with distant metastases. Prognosis depends on stage at presentation. Early diagnosis and surgical resection may improve the overall outcome. Newer modalities such as immunotherapy and targeted therapies such as anti-CTLA4 monoclonal antibody and anti-programmed cell death protein 1 monoclonal antibodies have radically changed the management of mucosal melanoma and may, in the future, improve the overall prognosis of anorectal melanoma.
Subject(s)
Anus Neoplasms/therapy , Melanoma/therapy , Rectal Neoplasms/therapy , Adult , Aged , Aged, 80 and over , Anus Neoplasms/diagnosis , Anus Neoplasms/mortality , Anus Neoplasms/pathology , Combined Modality Therapy , Early Detection of Cancer , Female , Follow-Up Studies , Humans , India/epidemiology , Male , Melanoma/diagnosis , Melanoma/mortality , Melanoma/pathology , Middle Aged , Neoplasm Metastasis , Neoplasm Staging , Palliative Care , Prognosis , Rectal Neoplasms/diagnosis , Rectal Neoplasms/mortality , Rectal Neoplasms/pathology , Retrospective Studies , Survival AnalysisABSTRACT
Maintaining quality of life (QOL) is one of the important aims of cancer treatment. Quality of life of a cancer patient is affected by various factors, which may be disease related, patient related, or treatment related. To study changes in health-related quality of life (HRQOL) brought about by treatment of rectal cancer and factors affecting the changes using Malayalam translation of FACT-C (Functional Assessment of Cancer Therapy-Colorectal) Questionnaire. Also to detect the minimally important clinical changes (MICC) in health-related quality of life of patients with carcinoma rectum, who have undergone surgery. Forty-five patients diagnosed with carcinoma rectum, who have undergone curative surgery, were studied. HRQOL was assessed at baseline 2 weeks after surgery and 3 months after surgery. The changes in scores were correlated with various demographic factors like age, sex, marital status, number of children, number of married children, and education and occupation of the patient and spouse. Also the treatment-related factors like presence of stoma, presence of morbidity, previous treatment, stage of disease, and administration of chemotherapy before and after surgery were correlated. All the subscales of FACT-C tool, except emotional well-being, were significantly reduced 2 weeks after surgery and increased slightly above pre-treatment level 3 months after surgery. The Chronbach α values were 0.88, 0.89 and 0.86 on three occasions, respectively, establishing internal validity of the test. Baseline HRQOL scores were better in males compared to females. Among the various subscales, the drops in SWB, FWB, FACT-G, total Score and TOI were significant (P < .05).There were no significant differences in scores between patients who have undergone open surgery and minimally invasive surgery or patients who had permanent colostomy versus no colostomy. The HRQOL scores after surgery reduced 2 weeks after surgery and improved above pre-surgical levels 3 months after surgery. The approach of surgery (minimally invasive versus open) or presence or absence of permanent colostomy didn't make any significant change in HRQOL. But since the sample size of the study was small, we need further larger studies to arrive at definite conclusions.
ABSTRACT
Hepatoid adenocarcinoma is a rare cancer with an extremely poor prognosis. Here, we describe two cases referred to our hospital with suspected gastric cancer. Gastrointestinal endoscopy revealed lesions in the stomach. Biopsy from the lesions was reported as adenocarcinoma. Both the patients underwent exploratory laparotomy. One was an operable lesion and the other was an inoperable lesion. Total gastrectomy was done in the operable lesion and feeding jejunostomy was done in the inoperable case. Histologically, both turned out to be hepatoid adenocarcinomas. Retrospective analysis showed the serum levels of alphafetoprotein (AFP) are markedly elevated in both cases. We describe this rare entity of hepatoid adenocarcinoma of the stomach, and review the literature concerning the clinicopathological aspects of the cases.
