Epidemiological trends of colorectal cancer cases in young population of Eastern India: A retrospective observational study.

BACKGROUND: Colorectal cancer (CRC) is a disease of the older population in developed countries where the incidence among the young is rising despite the decline in the overall incidence. Contrary to this, in India, which is a low-incidence country for CRCs, the incidence among all age groups including the young is rising. This study aimed at describing the clinico-demographic profile of young CRC cases and the epidemiological trend of the proportion of young cases from 2014 to 2021 in a tertiary cancer center in Eastern India. METHODS: This retrospective observational study was conducted at Department of Radiation Oncology, State Cancer Institute, IGIMS Patna, India a prominent tertiary cancer care center of Bihar. All histopathologically confirmed CRC cases in the 0-39 years age group were considered young and evaluated for the clinical, demographic profile as well as yearly trends in proportion out of total CRC cases. Microsoft Excel (2021) was used for statistical analysis. A P value of 0.05 was considered significant. RESULTS: Young colorectal (less than 40 years) patients constituted a third (n = 344, 33.4%) of total colorectal (n = 1028) cases. The median age among the young CRC cases was 30 years (range: 12 to 39 years). Rectum was the most common subsite noted (n = 255,74.1%) among this group of young patients. The most commonly encountered stage of the disease was III (n = 107, 31.1%) and chemotherapy was the most common treatment offered (n = 153, 44.5%). The proportion of young (0-39 years) CRC cases ranged between 29.4 and 37.4 (mean 33.5 ± 2.77, P value = 0.725) over the calendar years of the study period. CONCLUSION: The proportion of young (<40 years of age) cases out of total CRC cases in our study is higher than that in developed countries. However, the trends of this proportion have been consistent over the study period, i.e., from 2014 to 2021 without any significant change in our hospital-based cancer registry. Rectal cancer affected nearly three out of every four CRC patients in this age group. More advanced disease at presentation emphasizes the need for measures of screening, early diagnosis, and adequate infrastructure for treatment.

Cancer trends in Eastern India: Retrospective hospital-based cancer registry data analysis.

BACKGROUND: Trends of cancer cases vary across several hospital-based cancer registries (HBCRs). There is a paucity of demographic data to evaluate trends of cancer in Eastern India. AIM: The aim of this study is to evaluate trends and pattern of cancer cases with respect to time from HBCR from Bihar. OBJECTIVES: The objective of this study is to evaluate the numbers of consecutive patients registered with eight most common type of cancer in our HBCR in Regional Cancer Centre, Bihar, and to evaluate trends of cancer cases registered with respect to time. MATERIALS AND METHODS: Demographic profile of consecutive cancer patients registered from January 2014 to December 2016 (3 years) in HBCR was obtained. Patients diagnosed with common malignancies including head-and-neck cancer, gallbladder, breast, cervix, ovary, esophagus, stomach, hematolymphoid, and colorectal were analyzed. Frequency distribution, crosstabs, and line diagram were used to evaluate the trends of these common cancers with respect to time. RESULTS: Sixty-six thousand and twenty-nine consecutive patients were registered between 2014 and 2016. Carcinoma gallbladder was the most common malignancy (21%), followed by head-and-neck cancer (19%) and breast cancer (15%). Median age at the diagnosis was 55 years for carcinoma gallbladder while 53 years and 46 years for head-and-neck and breast cancer, respectively. Male-to-female ratio was 0.6 for carcinoma gallbladder and 1.8 for head-and-neck cancer. A number of gallbladder and head-and-neck cancer registered increased by 36% (between 2014 and 2015) and 5% (between 2015 and 2016) and 24% (between 2014 and 2015) and 4% (between 2015 and 2016), respectively. Carcinoma breast and cervix showed decreasing trend with fall in registration up to 13% (between 2015 and 2016) and 27% (between 2015 and 2016), respectively. CONCLUSION: Carcinoma gallbladder is the most common cancer in Bihar. Head-and-neck cancer and carcinoma gallbladder are increasing while breast and cervical cancers are decreasing with respect to time.

Prognostic Value of HER-2/neu Gene Amplification in Epithelial Ovarian Carcinoma.

BACKGROUND: Human epidermal growth factor receptor 2 (HER2) has tyrosine kinase activity and is a member of the epidermal growth factor receptor family. This initiates a variety of signal for pathways which leads to cell proliferation and tumourigenesis. In approximately 15-30% of breast cancers and 10-30% of gastric/gastroesophageal cancers, amplification or overexpression of HER2 occurs, and it serves as a prognostic and predictive biomarker. HER-2/neu is one of the most frequently studied molecular biological parameters in epithelial ovarian cancer (EOC), but its prognostic impact has not been fully assessed. The objective of the current study was firstly to analyse the presence of HER-2 overexpression in EOC patients and secondly to evaluate association between human epidermal growth factor receptor 2 (HER-2/neu) expression and progression-free survival in patients with EOC. METHOD: In this prospective study of 2 years in our department, 186 gynaecological cancers were operated out of which 98 cases were operated for epithelial ovarian cancer and rest for cervical cancer, endometrial cancer, and other subtypes of ovarian cancer. In this study, HER2 gene status was evaluated in EOC by immunohistochemistry analysis, and overall survival of these patients was evaluated. RESULTS: HER-2 overexpression was found in 22 of the 98 investigated cases (22.45%), in which 14 OC (14.29%) were weakly positive and 8 OC (8.16%) were moderately to intensely positive. In the study, increased HER2 expression was associated with decreased progression-free survival (PFS) and hence poor prognosis (P 0.054). CONCLUSIONS: The introduction of HER2-directed therapies has dramatically influenced the outcome of patients with HER2 positive breast and gastric/gastroesophageal cancers. The present study findings provided that HER-2/neu expression in patients with OC has an adverse impact on the PFS. Therefore, our results show that the decision algorithm usually used in breast cancer by HER2 may be appropriate in ovarian cancer.

Geographical pattern of carcinoma gallbladder in Bihar and its association with river Ganges and arsenic levels: Retrospective individual consecutive patient data from Regional Cancer Centre.

BACKGROUND: Indo-Gangetic basin is known to have higher incidence of gallbladder cancer. Proximity to River Ganga and high heavy metal in soil exposure have been postulated as risk factors. AIM: This study aims to evaluate the geographical pattern of gallbladder cancer from consecutive patient database enrolled in hospital-based cancer registry (HBCR). OBJECTIVES: To evaluate demographic profile and districtwise/zonewise dispersion of gallbladder cancer cases registered in HBCR from year 2014 to 2016. To evaluate association of carcinoma gallbladder (CaGB) due to proximity of Ganges, districts of high soil arsenic levels and referral bias. MATERIALS AND METHODS: Demographic profile and district-based location of individual consecutive gallbladder cancer patient registered in Regional Cancer Centre from the year 2014 till 2016 were analyzed. Population data from 2011 census and arsenic soil content data from central groundwater body were obtained. Frequency distribution, cross tabulation, and odds ratio were used to analyze risk of CaGB across population subsets in Bihar. RESULTS: A total of 1291 consecutive patients of CaGB were registered from 2014 to 2016. Median age at diagnosis was 55 years (range 18-95 years). Male to female ratio was 0.6. Patna (16%) followed by Vaishali (5.8%), Sitamarhi (5%), Madhubani (4.7%), Gaya (4%), and Samastipur (4%) had highest cases. Districts along main central River Ganga (n = 12) and those exposed to high arsenic soil content (n = 15) had higher odds ratio for CaGB, 1.72 (95% confidence interval [CI]: 1.54-1.91, P = 0.001), and 1.45 (95% CI: 1.30-1.62, P = 0.001), respectively. Districts within 100 km radius of our institute had higher gallbladder cancer cases, odds ratio 1.81 (95% CI: 1.62-2.03, P = 0.001), suggesting significant referral bias predominantly contributed by cases registered under Patna and Vaishali districts. CONCLUSION: CaGB is major public health problem in Bihar. Exposure to high soil arsenic levels and proximity to River Ganga are strongly associated with gallbladder cancer. Systematic population-based longitudinal studies are needed to explore above hypothesis.

Sarcomatoid Carcinoma of Renal Pelvis with Abundant Heterologous Osteosarcomatous Element: A Case Report.

A 47-year-old male presented with haematuria and flank pain for two weeks. Ultrasonography and renal scan revealed a poorly functioning left kidney with multiple calculi. Simple nephrectomy was performed and the specimen revealed a mass in his renal pelvis which showed both carcinomatous and sarcomatous components on microscopy. The sarcomatous component consisted of diffuse pleomorphic osteoblasts with intervening lacy osteoid, giving an osteosarcoma-like appearance. These areas of tumour were strongly positive for vimentin and osteopontin. The carcinomatous component was transitional cell carcinoma. Patchy areas of squamous cell carcinoma which were positive for pancytokeratin on immunostaining were also seen. Few weeks later, the patient presented with metastatic lesions in the sacrum. After nephrectomy, the patient underwent palliative radiotherapy of the spine followed by sunitinib therapy. A month later, there was recurrence at the site of surgery. The patient succumbed to his illness within five months of diagnosis. This report describes an extremely rare case of carcinoma, renal pelvis with predominantly osteosarcomatous areas.