Cancer registration is pivotal for cancer epidemiology and for planning and implementation of cancer policy and research. Morbidity and mortality burden of cancer in India is one of the highest in the world. India has a network of cancer registry distributed across the country, a process which began in the 1960s. The cancer registration in India has expanded including many new hospital-based and population-based cancer registries. Some new initiatives such as cancer atlas and online software programmes have been started for streamlining the process. However representativeness, urban-centric data, timeliness, and quality of cancer data are some of the problems still troubling the process of cancer registration in India. In this context, we should look for a unified systemic framework using newer information and management systems for capturing a complete and clear picture of cancer in India.

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Aim: The aim of this study is to analyze the correlation/diagnostic accuracy of cytology and frozen section (FS) preparations in the intraoperative diagnoses of central nervous system (CNS) lesions. Materials and Methods: A total of 63 cases of CNS lesions were included in the study from July 2012 to January 2015 at a tertiary care referral hospital. Intraoperative specimens were used for crush/squash smears and FS and correlated with the final histopathological diagnosis. Results: Majority of the patients (73.02%) were presenting in the age range of 21–50 years. There was a slight female preponderance with male-to-female ratio of 1:1.1. Two out of 63 cases were excluded from the cytology correlation analysis due to inadequate materials and 3 out of 63 cases were excluded from the FS correlation analysis due to freezing artifacts. The diagnostic accuracy of cytological preparation was 80.33% for complete correlation with histopathology and was increased to 93.44% for adding the partial correlations. The corresponding figures for FS were 81.67% and 93.33%, respectively, and the difference was insignificant (P = 0.971). The sensitivity, specificity, positive predictive value, and negative predictive value in detecting neoplastic condition on cytology were 94.4%, 85.7%, 98.07%, and 66.67%, respectively, and that of FS were 96.15%, 75%, 96.15%, and 75%, respectively. The corresponding P = 0.872, 0.652, 0.986, and 0.561, respectively. Conclusion: Crush and FS preparation are considered as effective diagnostic procedures for rapid intraoperative diagnosis in CNS lesions without any significant difference in results and when applied simultaneously can produce a higher diagnostic accuracy complementing each other's results.

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Osteosarcoma is an aggressive primary bone tumor arising from primitive bone-forming cells. The most frequent site of metastasis is the lung followed by bone. However, osteosarcoma presenting as malignant pleural effusion during the initial presentation is extremely rare. Involvement of more than one bone at the time of initial presentation is rare and it is confusing whether these multiple lesions represent multiple primaries or metastasis. We report the case of a 17-year-old male who presented with fever and breathlessness of 1-month duration. Examination revealed massive pleural effusion. Pleural fluid cytology showed malignant cells. On examination, a scalp swelling was also noted. Radiological evaluation revealed multiple bony lesions involving the skull, femur, humerus, and vertebrae. Biopsy of the lesion in the humerus confirmed the diagnosis of osteosarcoma.

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Background: Hematopoietic stem cell transplant (HSCT) recipients are particularly prone to bloodstream infections (BSIs). This has been attributed to neutropenia and immune-suppression. Regardless of the improvements made in the management perspective, infection still plays a major role in morbidity and mortality in these patients. It has been related to the rise of multidrug-resistant organisms. Aim: The aim of this study was to determine the pattern of BSIs and the burden of antibiotic resistance in HSCT patients. Materials and Methods: We conducted this retrospective study for 2 years in 438 transplant events among 429 HSCT recipients who developed febrile neutropenia. Paired blood culture samples were collected on the onset of fever. Carbapenem-resistant Enterobacteriaceae (CRE) carriage rate was also determined in 127 patients. Results: BSIs were detected in 131 transplant events, which were classified as mucosal barrier injury laboratory-confirmed BSIs in 61, central line-associated, and other primary BSIs among 35 each. A diverse variety of 145 isolated organisms included Gram-negative and Gram-positive bacteria with 4 Candida species. All the Gram-negative isolates were susceptible to colistin, while 68.83% of CRE was detected. CRE carriage rate was observed in 37.80% of 127 individuals. Vancomycin resistance was noticed in 40% Enterococcus species. The overall mortality rate was 20.05%. Conclusions: Screening for CRE carriage in these patients could help in timely initiation of empirical colistin therapy. However, local epidemiology plays an important role in deciding the empirical antibiotic therapy.

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Carcinosarcoma or mixed Müllerian malignant tumors are a rare entity representing 1% of all the malignant ovarian neoplasms. It has poor prognosis, and the survival outcome is worst. We report a case of carcinosarcoma of the ovary in a 68-year-old female. The patient was treated with cytoreductive surgery followed by platinum- and taxane-based combination chemotherapy regimen. Now, the patient is under regular follow-up with long-term overall survival for 76 months without any disease. Therefore, our case highlights the importance of cytoreductive surgery followed by adjuvant chemotherapy with platinum- and taxane-based combination regimen in the form of improved survival demanding a long-term follow-up for such cases.

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Aim of the Study: The aim of this study is to evaluate the demographic and clinicopathological profile of the patients with gallbladder cancer (GBC). Materials and Methods: A total of 68 diagnosed cases of GBC were taken in the study during the study period from January 2016 to December 2017. A detail questionnaire was filled through the counseling to take demographic profile including socioeconomic status, nonclinical characteristics, dietary, and other risk factors apart from clinicopathological profile of patients. Results: We found most of the patients were females with median age 51.8 years. More than half of them were postmenopausal (56.60%), and high parity was seen in 39.62% of females. Obesity was associated factor mainly in females (28/53), and none of the males were obese. Nearly 83.82% (57/68) of patients had advanced stage disease, with metastatic disease in 72.06% (49/68) patients. Majority of the patients had at least two sites of metastasis (73.47%), with liver (57.14%), omentum (40.82%), and nonregional lymph nodes (53.06%) being common sites of dissemination. Bony metastasis, being rare in literature, was found in 6 (12.24%) of patients, most of them developed it later during the disease course. Conclusion: Majority of the patients was female within the age group of 41–60 years, associated with gallstones and had advanced disease. We did not find greater impact of diet on the incidence as vegans and nonvegans were almost equally divided in our study. A high index of suspicion and health education seems to be the only answers available for early detection and improvement of survival.

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Primary synovial chondromatosis (PSC) is an uncommon benign disease process of unknown etiology in which the synovium undergoes metaplasia, leading to cartilaginous nodules that progressively undergo detachment, mineralization, and even ossification forming loose bodies. It is usually a monoarticular disease with involvement of large joints with knee being the most common. Involvement of smaller joints such as distal radioulnar, tibiofibular, metacarpophalangeal, and metatarsophalangeal joint has also been reported. This disease process is usually intra-articular. Involvement of extra-articular tissues such as bursae and tendon sheaths is rare, and combination of intra- and extra-articular diseases described here is an extremely rare condition. Herewith, we report a male patient with PSC of left knee with involvement of suprapatellar bursa who presented with recurrent knee swelling and pain with diagnostic delay of 2 years. We have also highlighted the role of imaging in the early diagnosis of this disease and briefly reviewed relevant literature.

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Acral metastasis is rare in incidence with poor prognosis due to presence of widespread metastases during presentation. Lung is the most common primary for acral metastases followed by breast and kidney. Acrometastasis with head and neck primary is an extremely rare situation with only few cases reported in the literature. Here, we present a case of acral metastases in a 40-year-old male. The patient was previously diagnosed as a case of squamous cell carcinoma of gingivobuccal sulcus on the left side, and for which, he had undergone radical surgery followed by adjuvant concurrent chemoradiation 6 months back. The patient had local recurrence with multiple metastatic pleural nodules during diagnosis of acral metastasis. The patient was treated with one cycle of palliative chemotherapy followed by amputation of the metastatic finger. However, after 2 months of treatment, the patient was died due to the disease progression.

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Groin node metastases are predominantly seen in primary malignancies of infradiaphragmatic location. However, sparse cases of inguinal metastases from tumors above the diaphragm have been reported in the medical literature. Here, we report a case of small-cell carcinoma of the lung with metastatic inguinal lymph node at the initial presentation in a 57-year-old man. The case was diagnosed and managed congruously as per the stage of the disease, which was metastatic. However, the patient was died due to disease progression after 8 months of diagnosis. This case edifies to a clinical oncologist's knowledge that patients with commodious and disseminated malignancies of supradiaphragmatic location may present with lymph nodes in the inguinal region.

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Aim of the Study: The present study attempts to explore various types of lesion of the uterine cervix and to find target age groups in which screening efforts can be concentrated for early detection of cervical cancers. Materials and Methods: The study was carried out at a tertiary care institute during the period from May 2016 to December 2017. All the previously conducted cervical Papanicolaou (Pap) smears were analyzed and reported as per the 2001 Bethesda system. The data were noted in a structured pro forma and evaluated. Results: A total of 5025 Pap smears were examined. Maximum number of patients was in the age group of 31–40 years (33.25%). Out of 5025 pap smears, 6.60% (332) of cases were found to be unsatisfactory or inadequate samples, 90.97% (4571) cases were reported as negative for intraepithelial lesion or malignancy, and 2.43% (122) cases had epithelial cell abnormality (ECA). Premalignant lesions such as: atypical squamous cells of undetermined significance (ASCUS), low-grade squamous intraepithelial lesion (LSIL), high-grade intraepithelial lesion (HSIL) and atypical squamous cells-cannot exclude HSIL (ASCH), and malignant lesions such as squamous cell carcinoma and adenocarcinoma were reported under the ECA positive cases. Majority of premaligant lesions found in the age group of 41–50 years and constitute 44.64% (25/56). Whereas, majority of frank malignancy cases found in the age group of 51–60 and >60 years constituting 43.94% and 37.88%, respectively. Among all the ECA positive cases, 54.10% of cases found to be with malignancies. Conclusion: Proper implementation of Pap smear screening examination can decrease the incidence of cancer cervix along with its downstaging by early detection of precancerous lesions.

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Background: Metaplastic carcinoma of the breast (MCB) is a rare histological subtype of breast carcinoma containing glandular and nonglandular components with mixed epithelial and mesenchymal differentiations. Aim of the Study: The study aimed to report clinical, radiological and pathological profiles, treatment and outcome of patients diagnosed with MCB from a tertiary care institute along with literature review. Materials and Methods: Diagnosed cases of MCB were obtained from the record over a period of January 2010 to December 2017, and data were recorded in a structured pro forma. Results: A total of 9 (0.9%) cases of MCB were identified out of 1031 breast cancer patients with the median age of presentation of 53 years. The palpable lump was the most common presentation (77.78%). The mean tumor size was 4.9 cm in greatest dimension. Sonographically, most of the lesions were solid (44.44%) followed by cystic (33.33%). Mammographically, microcalcifications were absent in eight cases. Histologically, 55.56% of cases were purely epithelial subtype (3: pure squamous and 2: adenosquamous) and 4 (44.44%) cases were mixed epithelial and mesenchymal subtypes (3: carcinosarcoma and 1: invasive lobular carcinoma with sarcomatous component and osseous metaplasia). All the cases were having triple-negative receptor status. Modified radical mastectomy (MRM) was performed in all cases and 33.33% of cases had axillary node positive. About 77.88% and 88.89% of cases received adjuvant chemotherapy and adjuvant radiotherapy, respectively. At median follow-up of 27 months, local recurrence and distant metastases were seen in 1 and 3 cases, respectively. At present, 33.33%, 22.22%, and 44.45% of patients were died, alive, and lost for follow-up, respectively. Conclusion: MCB is a rare histologic subtype of breast cancer with larger tumor size at presentation and MRM is the preferred surgical procedure over breast conservation surgery. Long-term and regular follow-up is necessary to know the outcome.

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Background: Inflammatory myofibroblastic tumor (IMT) is a rare entity and has wide anatomical sites of origin. Because of overlapping clinical and radiological features, histopathology study followed by immunohistochemistry (IHC) analysis is necessary for confirmation of the diagnosis. Aim of the Study: This study aimed to present the demographic, histopathological, and IHC analysis of patients diagnosed with extrapulmonary IMT. Materials and Methods: Patients diagnosed with extrapulmonary IMT were analyzed from January 2017 to July 2018. Results: A total of six cases were included in our series, with the mean age of presentation being 37 years. Male-to-female ratio was 1:2. The primary site of origin was distributed as follows: two cases of face and neck (one mandible and one naso-orbital), three cases of abdominal location (one spleen, one periaortic node, and one paraaortic node), and one case of cervix. There was no local invasion or metastasis found. Microscopically, all the cases revealed a common pattern of finding of the presence of intersecting fascicles of spindle cells with intervening collagenous to myxoid matrix along with infiltration of plasma cells and aggregates of lymphocytes. There were no atypical cells or mitosis in all the cases. All six cases were smooth muscle actin and vimentin positive and S100, desmin, and cytokeratin negative on IHC study. All the cases were anaplastic lymphoma kinase (ALK) negative, except one case with cervical primary where it was positive for ALK-1. Conclusion: Extrapulmonary IMT is a rare entity with diagnosis by exclusion on histopathological examination, and IHC should be done for confirmation of the diagnosis as well as ALK expression status.

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Introduction: Breast cancer being a multifactorial disorder outcome depends on various clinicopathological and molecular factors. Neoadjuvant chemotherapy (NACT) is increasingly used before surgery to obtain pathological complete response (pCR) as it is associated with increase event-free survival and overall survival. Aim: The aim of this study is to evaluate the response to NACT in locally advanced breast cancer (LABC) in association with various clinicopathological factors in a tertiary care setting. Materials and Methods: LABC patients (clinical Stage IIB and III) who underwent either modified radical mastectomy or breast conservative surgery after NACT treatment in a 1-year period were retrospectively reviewed for the clinical and pathological response. Effect of clinicopathological and molecular factors on treatment response were evaluated. pCR was evaluated on final histopathology. Results: Fifty LABC patients fulfilled the study criteria and were reviewed. pCR was present in 6 (12%) cases. All the pCR cases were invasive ductal carcinoma. A statistically significant association between the presence of tumor necrosis in initial biopsy and pCR to NACT was observed (P = 0.024) with a high negative predictive value of 94%. All the 11 patients (100%) with positive lymphovascular emboli (LVE) on initial biopsy did not show pCR. Four out of 6 pCR cases had preclinical tumor size ≤5 cm. Ductal carcinoma in situ (DCIS) was present in 15 cases and only 1 pCR patient had the presence of DCIS. Conclusion: Preclinical tumor size, histopathological tumor type, DCIS, and presence of tumor necrosis and LVE on initial core biopsy are some of the notable factors for pCR among LABC patients who received NACT.

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Sarcomatoid carcinoma of the larynx is a rare and aggressive tumour with a unique biologic behavior and histogenesis. They were earlier called as collision tumors. They are classified under “epithelial tumors” in the World Health Organization classification. Due to the aggressive clinical behavior, they obstruct the airways soon and the patients present early. We present a case of a 55-year-old female who presented in acute state to the emergency department with dyspnea. On evaluation, a locally advanced laryngeal malignancy was detected radiologically. The biopsy was performed wherein a spindle cell pleomorphic tumor was seen which was positive for AE1/AE3 and vimentin, thus rendering a final diagnosis of sarcomatoid carcinoma. We discuss the clinical features, biological behavior, and management of these rare carcinomas.

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Hidradenoma papilliferum (HP) is an uncommon benign cutaneous adnexal neoplasm of the anogenital region commonly seen in middle-aged, Caucasian females. Anastomosing and branching tubules, lined by columnar cells, and a basal layer of myoepithelial cells are the characteristic histopathological features. We report a case of HP in a 60-year-old female presented with a vulvar lesion. The case was evaluated for malignancy, with the initial histopathology showing extensive squamous metaplasia but ultimately found to have HP.

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Most cases of chronic myeloid leukemia (CML) manifest in chronic phase with high granulocyte count. Medical management with imatinib renders complete hematological and cytogenetic remission in almost all patients. Only 5%–10% of the patients progress to accelerated phase and terminal phase, i.e., blast crisis. Blast crisis is defined as the presence of ≥20% blasts in the bone marrow (BM) or peripheral blood, or a large focus of blasts in the BM, or presence of extramedullary infiltration with blast cells. The penetration of imatinib in the central nervous system (CNS) is very poor, and thus, CNS may become a sanctuary site in patients on prolonged treatment with imatinib. The CNS as a site of extramedullary crisis is extremely rare. We report a case of Philadelphia-positive CML on imatinib with cerebrospinal fluid cytology positive and approach to its management.

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Primitive neuroectodermal tumors (PNETs) are a group of small round cell malignancies of neural crest origin. Renal PNET (rPNET) is a rare entity affecting young adults and children with a poor prognosis, and involvement of inferior vena cava (IVC) is extremely uncommon. Nonspecific clinical features often preclude preoperative diagnosis which ultimately depends on microscopy and immunohistochemistry. The preferred treatment for rPENT is surgical resection associated with chemotherapy and radiotherapy. We report a case of rPNET in a 16-year-old male which was preoperatively thought to be of renal cell carcinoma and underwent radical nephrectomy with IVC venotomy. The case on histopathology study revealed features of malignant small blue round cell neoplasm and further immunohistochemical examination diagnosed the case as rPNET.

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Colorectal cancer and lung cancer are the most common malignancies in the world. However, not all pulmonary nodules in a case of colon cancer are considered as metastasis, especially with features suggestive of limited colon disease without any nodal or liver involvement. The morphology of the pulmonary nodules is also an important consideration before subjecting the patient to another invasive procedure, as solitary pulmonary nodule with irregular margins, suggestive of another primary lesion. We describe a case of a patient with colon cancer, nonsmall cell lung cancer with single bone lesion, and neuroendocrine tumor of appendix. Initially suspected to be a case of metastatic colon cancer, the patient was later diagnosed as epidermal growth factor receptor-mutant metastatic pulmonary adenocarcinoma, with localized microsatellite instability high phenotype colon cancer.

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Background: Metallic implant in radiotherapy leads to difficulty in tumor target and critical organ delineation. Four-field box technique is conventional approach to treat pelvic malignancies. Aim of the Study: The aim of study is to evaluate the dosimetric impact of calculation algorithms in the treatment of carcinoma cervix with metallic implants. Materials and Methods: A paraffin wax-coated iron rod was used to evaluate the beam characteristics under the influence of metallic implant. Beam characteristics such as tissue phantom ratio (TPR2_0,10) were measured and analyzed. 15 patients with and without metallic prosthesis of carcinoma cervix were compared in the study. Planning was done for the prescription dose of 45 Gy/25 fractions. Plans were calculated using AAA algorithm and recalculated using Acuros XB (AXB) and pencil beam convolution algorithms for the same monitor units. RTOG and Quantec Protocol were used for plan evaluation. Results: Transmission and TPR_20,10increases with field size and beam energy. Surface dose D_salso increases with field size. D_98%and D_2%of planning target volume showed a significant difference for AAA versus AXB. 4FN (AAA) are significantly better for all the 4F plans, calculated by three algorithms in case of V_15Gyof small bowel. Analyzed data indicated the significant attenuation caused by high-Z material. Analyzed value of conformity index showed that value of index comes >1 in all the cases. Conclusion: The results indicate that when creating treatment plans for cervical cancer lesions with metallic prosthesis, the AAA algorithm would be a more appropriate choice.

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Background: Bloodstream infections (BSIs) account for large-scale morbidity and mortality among cancer patients requiring a rational antibiotic policy. In India, there is a paucity of data regarding incidence and pattern of BSI in such patients. Aim: The study was conducted to evaluate the pattern of BSI in cancer patients and their sensitivity and resistance toward antibiotic. Materials and Methods: All the blood culture-confirmed infections among cancer patients treated at a tertiary care institute in Bhubaneswar, Odisha, India, were retrospectively analyzed during the year 2018. Results: A total of 82 patients/episodes had confirmed BSI. Gram-negative bacteria accounted for 43 (52.4%) cases, followed by Gram positive 38 (46.4%) cases and 1 case of candida species. The most common organisms isolated were Klebsiella pneumoniae and Staphylococcus aureus consisting of 17 cases each. The Gram-negative bacterial isolates (n = 43) were sensitive to cefoperazone plus sulbactam, piperacillin plus tazobactam, carbapenem, and colistin in 18 (41.9%), 19 (44.2%), 29 (67.4%), and 40 (93%) episodes, respectively. The sensitivity of Gram-positive bacteria (n = 38) to vancomycin, linezolid, and teicoplanin was seen in 37 (97.3%), 37 (97.3%), and 35 (92.1%) episodes, respectively. Multidrug-resistant bacteria accounted for 17 (39.5%) cases of Gram-negative isolates and 9 (53%) of which were K. pneumoniae. Extended-spectrum beta-lactamase activity was seen in 11 of 26 episodes of Enterobacteriaceae. Four of 17 S. aureus and 3 of 11 coagulase-negative Staphylococci were methicillin resistant, and 1 of 2 cases of Enterococcus was vancomycin resistant. Conclusion: Gram-negative bacteria are the predominant cause of BSI in cancer patients and development of a high degree of resistance to commonly used antibiotics is challenging.

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Context: Gastric cancer is the fifth most common malignancy, with a high incidence in Eastern Asian countries. Diet is an important risk factor in the genesis of gastric cancer, and the fact that it is modifiable warrants it to be studied extensively in relation to various clinicopathological parameters of gastric cancer. Aims: The present study was undertaken to study the dietary habits (vegetarian/nonvegetarian) among gastric carcinoma patients in the Indian context. Materials and Methods: We studied 100 consecutive cases of gastric carcinoma excluding tumors at gastroesophageal junction. Clinical data regarding food habits in the patients were collected by personal enquiry. Pathological characteristics including size, site, gross appearance, Lauren's histological type, and the World Health Organization (WHO) histological type were noted. Data analysis was done using Chi-square test. Results: Sixty-nine percent of gastric cancer patients were vegetarians and 31% were nonvegetarians. Statistically significant association between nonvegetarian diet and gastric cancer location at the lesser curvature was found (P ≤ 0.001). No statistically significant association between diet and gross appearance, Lauren's, and WHO histological type of gastric cancer was found. Conclusions: For anatomical locations, most gastric cancers located at lesser curvature had been developed among nonvegetarian patients, whereas we did not observe diet to be related to gross appearance and histological type of gastric carcinoma.

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Background: Undocumented observations suggest a rising incidence of gastrointestinal tract cancers (GITc) among urban dwellers in Nigeria. Aim: The aim is to report on the incidence and clinic-pathological characteristics of GITc in Port Harcourt and its environs. Materials and Methods: Clinical, pathological, and demographic information on cancer patients obtained from various hospitals, radiology centers, and pathology laboratories within Port Harcourt and Obio-Akpor local government areas of Rivers state between 2008 and 2017 were reviewed. The information was coded using the International Classification of Diseases for Oncology, 3^rd Edition and stored in Canreg 4 software in the Port Harcourt cancer registry. Results: GITc constituted the third-most common systemic cancers consisting of 12.2% (328 cases) with a male-to-female ratio of 1.05:1. The annual age-standardized rate ranged between 1.1–21.6/100,000 for females and 1.8–15.9/100,000 for males, with the highest rate recorded in 2017. The mean age was 51.2 ± 15.8 years with bimodal peak age groups of 50–54 and 55–59 years. The most common sites for GITc were colorectal followed by the liver and stomach consisting of 44.5%, 16.5%, and 15.2% of cases, respectively. Epithelial malignancies, i.e., carcinomas markedly predominated over malignancies of other cell types such as mesenchymal cell malignancies, lymphoreticular cell malignancies, and germ cell malignancies and constituted 92.4% of total GITc. Conclusion: GITc is posing a public health challenge in Port Harcourt and environs. A government-sponsored health plan on cancer control, including awareness campaigns on the adoption of more healthy lifestyles, hepatitis B vaccination, colonoscopy screening with prompt treatment, is advocated.

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Aim: Gallbladder carcinoma (GBC) is a common cancer in women in North India. This prospective observational study aimed at systematically studying the clinical features, treatment response, and survival pattern of GBC patients, in a North Indian population. Materials and Methods: The clinical profile, staging of disease, and treatment outcomes of 116 consecutive patients with histologically confirmed GBC, presenting to a tertiary care hospital in Lucknow from June 2013 to August 2015, with a follow-up period of 2 years till August 2017, were studied. Data were captured on a predesigned study proforma and analyzed with appropriate statistical tools. Results: The median age at presentation was 60 years and 67 patients had coexisting gall stones. Patients were divided into three treatment groups for the analysis. Group A comprised patients who underwent radical cholecystectomy followed by adjuvant chemotherapy. Group B included patients who received the best supportive care and Group C consisted of patients who received palliative chemotherapy. The median overall survival (mOS) was 16, 2, and 9 months for Group A, B, and C patients, respectively. The mOS was 8 months for all patients, irrespective of treatment groups. On univariate analysis, factors having an adverse impact on mOS included obstructive jaundice, elevated liver enzymes, treatment groups, and advanced stage of disease. On multivariate analysis, only factor found significantly associated with mOS was treatment group (P < 0.05). Conclusions: GBC was found to be the second most common malignancy among females in our hospital registry with a uniformly poor prognosis. Patients receiving radical surgery and adjuvant chemotherapy were the longest survivors in this study. Better screening and early diagnosis are the cornerstones of improving outcomes in this aggressive malignancy.

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India is going through a significant epidemiological transition with the rising of chronic diseases such as cancer. An accompanying aspect is social stigma and negative perceptions regarding cancer. This not only affects cancer care and treatment but also puts a strain on prevention efforts. It is particularly worrisome in a low- and middle-income country like India with low levels of health literacy and the lack of access to cancer care. There have been attempts by the government and positive changes toward mitigating stigma, but a lot needs to be done to address this issue. The family and the community need to be significant players in synergy with the health system in the efforts to minimize the stigma in cancer.

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The biological heterogeneity of breast cancer accounts for variations in natural course of disease and differences in response to various therapeutic modalities. These variations pose as major challenges in clinical management of patient. The quest for markers that would accurately define prognosis and response to particular therapeutic modality has led us to the molecular makeup of these tumors. The technique of gene expression profiling has been pivotal in this regard. With the study of thousands of genes simultaneously in breast cancer patients, a molecular classification of breast carcinoma was proposed in the early 21^st century. High-throughput commercial assays proved to be useful in predicting prognosis for the patients but are expensive. Classification of breast cancers using immunohistochemistry that can be used as a surrogate of this molecular classification is inexpensive, easier, and more convenient to use. However, the accuracy of this classification is closely dependent on accurate immunohistochemical measurement of estrogen receptor, progesterone receptor, human epidermal growth factor receptor 2, and Ki67. The initial surrogate classification has undergone revisions to make it more relevant in the 13^th St Gallen International Breast Conference. Newer molecular subtypes such as claudin low have also been identified but are included in the basal-like subtype in surrogate classification due to its triple-negative nature. The utility of the surrogate classification in the Indian setting is immense due to limited access to molecular techniques. This review covers in detail the evolution, prognostic, and therapeutic implications of the surrogate molecular classification of breast cancers.

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