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   2022| September-December  | Volume 6 | Issue 3  
    Online since December 21, 2022

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Persistent chronic pain in cancer survivors: An update and future directions
Suman Choudhary, Ashok Kumar Saxena, Megha Bajaj, Ashima Thakur, Mayank Sonkar
September-December 2022, 6(3):59-65
Persistent chronic pain is the most common residual complaint in cancer survivors; its etiology being neoplastic process, postcancer treatment, or any other concurrent disorders. Growing concern about pain management in cancer survivors throws a mammoth challenge because more than 40% of cancer survivors now live longer than 10 years. Due to limited studies on persistent chronic pain in cancer survivors other than breast cancer, this enormous challenge remains in pain management in these cancer survivors. There are innumerable predictive factors for the development of persistent pain after cancer surgeries. It would be more prudent to concentrate on chronic pain mechanisms despite holding on to categorial risk factors and implanting them into patient outcomes. An effort should be made to a more holistic management of nociceptive and neuropathic pain in cancer survivor patients of Head and Neck, Prostate, and Lung carcinoma patients. In this article, we have tried to review the literature on managing chronic persistent pain in all cancer survivors, excluding carcinoma of the breast. In conclusion, we would like to emphasize that for an improved or excellent outcome of chronic persistent pain in cancer survivors, a holistic, multimodal approach encompassing pain relief techniques and pain relief strategies, relaxation exercises, cognitive behavioral therapy, and neuro-rehabilitative strategies would prove to be of immense help. A joint understanding between the pain management expert and the cancer survivors can result in beneficial outcomes.
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Incidence and characteristics of human papillomavirus-positive oropharyngeal cancers by p16 expression
Murugaiyan Nagarajan, Ramesh Banu, Ananthakrishnan Radha, Sasikala Saranya
September-December 2022, 6(3):72-77
Background: Head-and-neck cancers are one of the most common cancers in the Indian subcontinent. The rising incidence of human papillomavirus (HPV), especially in oropharyngeal cancers is likely to increase the burden by many folds. Hence, we decided to study the incidence of HPV in oropharyngeal carcinoma and its characteristics. Materials and Methods: Patients with primary squamous cell carcinoma (SCC) of the oropharynx registered in our hospital between September 2018 and July 2020 were included in the study after obtaining informed consent. A total of 60 patients were included in the study. The evaluation of HPV status was done by immunohistochemistry for p16 expression. Results: The median age of presentation was 60 years (range: 38–85 years). Fifty-four patients were male and six patients were female. The incidence of HPV in oropharyngeal carcinoma was 21.7% (n = 13). There was no difference seen when we compare HPV-positive patients with HPV-negative patients as well as with the entire study population for the demographic characteristics such as age (P = 0.569), gender (P = 0.754), smoker (P = 0.368), history of alcohol consumption (P = 0.558), and history of tobacco chewing (P = 0.781). We did not find any association between HPV-positive and HPV-negative patients with anatomical subsites (P = 0.369), tumor stage (P = 0.397), and nodal stage (P = 0.592). HPV-positive oropharyngeal SCC (OPSCC) patients presented more at early stage as compared to HPV-negative patients (P = 0.005). HPV-positive patients had higher incidence of histological poor differentiation than HPV-negative patients (P = 0.024). Conclusion: The study highlighted the incidence of HPV (21.7%) among OPSCC patients using p16 expression. HPV-positive patients have propensity for early stage of presentation and histological poor differentiation. The demographic characteristics and anatomical subsites of OPSCC had no impact on HPV status.
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Cardiotoxicity in breast cancer patients receiving trastuzumab with or without prior anthracycline-based chemotherapy: A prospective study from a tertiary cancer institute at Guwahati, India
Arpita Ray, Naba Kumar Kalita, Neelakshi Mahanta, Alfarid Shahid Ali, Madhav Kashyap
September-December 2022, 6(3):66-71
Background: Trastuzumab (Herceptin) is used in human epidermal growth factor receptor-2 (HER2)-positive breast cancer patients either alone or in combination with various chemotherapeutic agents in the neoadjuvant, adjuvant as well as palliative settings. Cardiotoxicity remains an issue of concern with the use of trastuzumab which may be enhanced with the prior use of anthracycline-based chemotherapeutic agents. Aim: This prospective study was conducted with the aim of identifying the occurrence of cardiotoxicity in patients receiving trastuzumab with or without a history of prior use of anthracycline-based chemotherapy. Materials and Methods: The study was conducted over a period of 1½ years. All the HER2-positive breast cancer patients who received trastuzumab-based therapy in adjuvant as well as maintenance settings and the cardiotoxicity in terms of drop in left ventricular ejection fraction (LVEF) from the lower limit of normal range were evaluated. A significant drop is defined when LVEF drop is >10%. Cardiotoxicity was compared between those who received prior anthracycline-based chemotherapy versus nonanthracycline-based chemotherapy. Results: A total of 62 HER2-positive breast cancer patients who fulfilled the inclusion and exclusion criteria were enrolled for analysis. Thirty-two patients received prior anthracycline-based chemotherapy and 30 patients received nonanthracycline-based chemotherapy. A significant drop in LVEF of >10% was found in 20 out of 62 patients (32.3%). This significant drop in LVEF was found more in those patients who received prior anthracycline-based chemotherapy (n = 15) versus who did not receive prior anthracycline-based chemotherapy (n = 5) (46.9% vs. 16.7%; P = 0.0109). Conclusion: Trastuzumab-induced cardiotoxicity (LVEF drop >10%) is higher among breast cancer patients who received prior anthracycline-based chemotherapy as compared to those who did not receive prior anthracycline. This clinically significant drop in LVEF warranted an interruption in the treatment till stabilization and improvement of the cardiac function.
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Synchronous collision tumor of malignant phyllodes and invasive ductal carcinoma
Usha K. N Pai, Alfie J Kavalakat, Nikita Thomas
September-December 2022, 6(3):78-81
Phyllodes tumor (PT) constitutes <1% of breast tumors. Malignancy usually arises from the stromal component forming homologous or heterologous elements such as chondrosarcoma, liposarcoma, fibrosarcoma, osteosarcoma, or rhabdomyosarcoma. Rarely, carcinoma can arise from the epithelial cells within the PT. Rarer is the occurrence of collision tumor of malignant phyllodes and carcinoma in the breast which lacks the exact incidence since only few cases are reported in the literature. This is another such rare case of synchronous collision tumor of malignant phyllodes having chondrosarcomatous and osteosarcomatous differentiation associated with invasive and in situ ductal carcinoma having metastatic carcinomatous deposits in axillary lymph nodes in a 43-year-old female. Hence, extensive sampling of the gross specimen is crucial in diagnosing the collision tumors which are not detected either in breast imaging studies or during the surgery. Since malignant PT usually spreads through a hematogenous route, it has to be treated by wide local excision or simple mastectomy without the axillary lymph node dissection. If a PT is associated with carcinoma, the patient management and prognosis depend on the stage of the carcinoma.
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