Combined modality therapy with surgery followed by appropriate adjuvant treatment with radiation therapy with or without concurrent chemotherapy based on risk factors is the standard of care for locally advanced cancers. However, in early cancers with unfavorable features, treatment policies vary across different centers, with decisions often based upon the treating oncologist's clinical discretion and institutional practice. In this review article, we intend to discuss the existing literature on the role of adjuvant treatment intensification in early node-negative and single node-positive oral cavity cancers.

Screening of microscopic slides is a manual process that involves its subjectivity. A semi-automated computer-based system can contribute to the detection of screening errors by increasing the reliability measure. Traditional machine learning approach or deep learning approach can be used in the semi-automated digital clinical system. The traditional machine learning approach is not very efficient because it involves a lot of heavy mathematics and not able to learn highly complex features. This article presents a systematic summary of the existing solutions of detection of malignancy (breast cancer detection) from fine-needle aspiration cytology images and the segmentation method of nuclei because malignancy can be observed mainly from nuclei feature. It also reports various research issues, challenges and proposes the future research direction. This analysis is helpful for the better use of existing methods and for improving their performance, as well as designing new methods and techniques.

BACKGROUND: Postmastectomy radiation therapy (PMRT) is delivered routinely with photon techniques, chest wall radiation with electron techniques have the advantage of reduced deeper tissue doses and can be tried in suitably selected cases. This study is to retrospectively evaluate the locoregional control, toxicity, disease-free survival (DFS), and overall survival of patients treated with postmastectomy chest wall electron radiation at a single center. MATERIALS AND METHODS: The data of 450 patients who received PMRT with electron therapy from 2004 to 2014 were analyzed. Patients were treated with three-dimensional (3D) conformal radiation therapy with 6–8 MeV electrons to chest wall and 6 MV photons to supraclavicular fossa and medial axilla. Data collection was done from hospital medical records and analyzed with IBM SPSS 20.0. The results are given in mean ± standard deviation for continuous variables or as percentage for categorical variables. Kaplan–Meier survival analysis and log-rank tests were used. P < 0.05 was considered as statistically significant. RESULTS: Patients' median age was 64 years (range: 24–74 years). Early stage accounted for 108 (24%) patients, 306 (68%) were advanced stage, and for 36 (8%) patients, stage was unknown. Of these, 174 (38.7%) patients were offered hypofractionated schedule and 276 (61.3%) with conventional fractionation. No Grade 3–4 skin reactions were reported over the irradiated area on treatment completion. Twenty-three (5.1%) patients had chest wall recurrence and 33 (7.3%) patients developed locoregional recurrence. Overall recurrence including systemic metastasis was 127 (28.2%). Long-term data did not show any cardiac or pulmonary mortality documented as radiation related. The median follow-up of our group was 67 months (6–173 months). DFS at 5 and 10 years was 81.4% and 79.5%, respectively. OS at 5 and 10 years was 85.2% and 79.7%, respectively. CONCLUSION: PMRT with chest wall enface electron is feasible, and the advantage of electron field is better sparing of deeper structures, especially cardia in left-sided postmastectomy irradiation, thus more complex techniques such as Intensity Modulated Radiation Treatment (IMRT) and respiratory gating can be reserved for patients with more complicated anatomy where routine 3DCRT technique is unacceptable in terms target coverage and critical normal tissue sparing.

BACKGROUND: There have been inconsistent results on the association of body mass index (BMI) with tumor characteristics, hormone, and menopausal status in breast cancer (BC) patients. OBJECTIVE: This study was intended to analyze the association of BMI with menopausal status, tumor characteristics, and hormone receptor status in BC patients. We also analyzed the significance of human epidermal growth factor type 2 receptor (HER-2)/neu status in association with menopausal status, tumor size, tumor grade, and nodal status in patients with BC. MATERIALS AND METHODS: Histologically proven 188 patients of BC with IHC report were included in this study done over 1 year period. Demographic data, pathologic features, and biological receptor status of cases were collected from the patient's records. Chi-square/Fisher's exact test, independent t- and analysis of variance (ANOVA) test were adopted to explore whether BMI differed according to biological receptor status in pre- and post-menopausal women. RESULTS: BMI was found to be significantly associated with the menopausal status of patients (P = 0.02). However, BMI lacks significant association with tumor size, stage, grade, and lymph node status in both pre- and post-menopausal patients. Estrogen receptor, progesterone receptor, and HER-2/neu expression were found to have a statistically significant correlation with tumor size (P < 0.001). Statistically significant correlation was also observed between age at the time of diagnosis and HER-2/neu expression (P = 0.02). CONCLUSION: This study revealed that BMI has a significant association with menopausal status. The frequency of expression of ER/PR was the same as reported in the literature; however, expression of HER-2/neu was high in postmenopausal women. Findings from this study may help to develop patient awareness of potentially modifiable lifestyle risk factors such as overweight and obesity as HER-2/neu positivity is associated with poor prognosis.

BACKGROUND: The northeast region of India has an overall high incidence, mortality, and lower survival rate of cancer in the country. Mortality rate is increasing mainly because of difficulties in accessing the facilities for cancer diagnosis and treatment, socioeconomic conditions, lack of awareness, taboo, misconception, and wide disparity in both diagnosis and treatment of cancers in this region. MATERIALS AND METHODS: Data were abstracted from hospital-based cancer registry of a regional treatment center from years 2010 to 2014. A total of 21,793 men were registered with cancer and 44.7% (9738/21,793) were followed up with their vital status. Kaplan–Meier method was used to generate the survival statistics. RESULTS: The 5-year overall survival for all cancers in men is 24.3% with earlier stage at diagnosis has a better survival (Stage I: 52.1%) than later stage (Stage IV: 18.8%). The 5-year survival for completed cancer directed treatment is 27.5% followed by 12.5% for incomplete and 8.5% for those with no cancer-directed treatment group. Inequality in survival was observed among different sites of cancer, as some cancers harm more than others. The 5-year absolute survival for all sites was ranged from 0% to 75.8%. Cancer of liver (0%), pancreas (0%), lung (2.4%), gallbladder (7.9%), and stomach (10.3%) is found as more lethal than other cancers as the 5-year survival was in-between the range 0%–10%. Cancer of Hodgkin lymphoma (75.8%) has the highest 5-year cancer survival rate, followed by testis (60.1%), breast men (55.3%), penis (49.7%), and skin cancer (49.1%). CONCLUSION: With close to 0%–2.6% 5-year overall survival in hospital setting for cancers of liver, pancreas, and lung, respectively, it needs to mobilize resources for these three cancer sites, in terms of treatment, supportive care, and palliation.

BACKGROUND: Pelvic masses following hysterectomy are common findings in Gynecologic Oncology centers. Incomplete preoperative evaluation, inadequate surgery (subtotal hysterectomy/only hysterectomy without salpingo-oophorectomy in postmenopausal women), and delay in histopathological diagnosis are few reasons for missing out on malignant etiologies. The diagnostic dilemma exists because of unknown primary malignancy. This study aims to highlight the various pathologies that present as pelvic masses after hysterectomy and their management based on histopathological examination and immunohistochemical (IHC) markers. MATERIALS AND METHODS: This was a retrospective analysis of all women who presented in 1-year duration (January 2019–December 2019) to the gynecologic oncology department with pelvic mass and prior history of hysterectomy done outside. The data of these women were critically analyzed in regard to their demographic profile, preoperative and postoperative characteristics, histopathological and IHC markers of pelvic mass, management of the disease, and their outcome. RESULTS: The total number of patients eligible for the study was 17. The median time to presentation after hysterectomy was 5 years (range: 1–20 years). The origin was female genital tract in 16 women and urothelial in 1 patient. Management options of these patients were concurrent chemoradiation/palliative radiotherapy/palliative chemotherapy/palliative care. The overall survival of these patients was dismal. CONCLUSION: Before proceeding with hysterectomy, thorough evaluation should be done for all patients with even minimal symptoms. Early identification of malignant disease and management by a multidisciplinary team can greatly affect the overall prognosis of the patient.

Triple-negative breast cancers (TNBCs) are aggressive tumors with a high risk of visceral metastasis and poor prognosis. Here, we report a case of a 57-year-old postmenopausal female with gBRCA1-positive metastatic breast cancer. She was treated for endometrioid type, Stage IB Grade 2 endometrial carcinoma with pelvic external beam radiation in 2014. In 2016, she developed Stage I TNBC for which she underwent BCS followed by chemotherapy with anthracycline and taxanes. She also received accelerated partial breast irradiation. In 2019, she developed brain and lung metastasis. For the brain disease, she underwent gross total excision followed by whole-brain radiotherapy (WBRT). For the lung lesion, she received stereotactic body radiotherapy. Subsequently, she developed extensive metastases which were treated with cisplatin and vinorelbine chemotherapy and had a complete response. Within 5 months, she developed rapid progression of the disease in brain, lungs, and right adrenal. She was treated with palliative WBRT, but she died of progressive disease within the next 2 months.

Columnar cell carcinoma variant is a rare aggressive variant of papillary thyroid carcinoma (PTC) with unique histological features. They represent only 0.15%–0.2% of all PTCs. It is difficult to diagnose them on fine-needle aspiration cytology as they lack the classic nuclear features of PTC. Histologically they can mimic metastatic carcinomas from colon, endometrium, and lung. However, characteristic histological features combined with immunohistochemistry (IHC) findings help in accurate diagnosis. We describe the cytological, histopathological, and IHC findings of a rare case of PTC-CCV in a 23-year-old female and review the pertinent literature. It is important to diagnose this variant of PTC accurately, as it has prognostic and therapeutic implications.

A 45-year-old female was diagnosed with infiltrating duct carcinoma (IDC) left breast in 1982. She underwent a mastectomy followed by locoregional radiotherapy and chemotherapy with cyclophosphamide, methotrexate, 5-fluorouracil. The patient developed left axillary swelling (3 cm × 3 cm) in 2004; fine-needle aspiration cytology (FNAC) was suggestive IDC, metastatic. The patient was started on tablet letrozole 2.5 mg but stopped it due to a cardiac problem. She reported with increase in the size of left axillary swelling in 2008. FNAC was reported as IDC, recurrence. There were no metastases on further workup. She was started on exemestane 25 mg and was also given radiotherapy to the left axilla. In 2012, bone scan was suggestive of multiple skeletal metastases. She was put on exemestane till 5 years. Again in 2013, she had left axillary swelling but the patient was not willing for FNAC. The patient was now started on anastrozole 1 mg. She again had back pain; bone scan was done and it was suggestive of multiple skeletal metastases. She was continued on anastrazole. In February 2015, she developed small nodules in the left axilla and anterior abdominal wall. FNAC of both sites was positive for carcinoma, metastatic. Bone scan again showed multiple skeletal metastases. Positron emission tomography scan did suggest local recurrence with metastatic radiculopathy in left axilla and widespread metastases Biopsy from the left axilla revealed IDC and it was strong estrogen receptor, progesterone receptor positive, and Her 2 neu negative. She was 78 years now with KPS 40 and cardiac morbidity. Her disease progressed rapidly to lungs and she died.

A gastrointestinal stromal tumor (GIST) is a most common mesenchymal tumor of the gastrointestinal tract. GIST is more common on the stomach, followed by the small intestine and rarely occur in other locations. We present an unusual case of large jejunal GIST arises from the antimesenteric border. Most of the small intestinal GIST present as a mobile mass in the right iliac fossa. Hence, a patient with mobile right iliac fossa mass without signs of obstruction or minimal signs of obstruction should consider the small bowel GIST as one of the differential diagnosis and plan for prompt intervention. Good preoperative imaging will diagnose small intestine GIST. Proper preoperative diagnosis and timely intervention will reduce the complication such as tumor rupture, spillage, R1 resection, and local recurrence. Postsurgical chemotherapy with Imatinib will reduce the recurrence rate and increase the survival.

The incidence of squamous cell carcinoma arising from pressure ulcers has been reported to be as low as 0.5%. Malignant transformation arising from pressure ulcers is frequently overlooked as they often present with invasive infections. This results in wide defects post-excision which may not be amicable to reconstruction with conventional locoregional flaps. Through this case report, we discuss the versatility of using the bilateral gluteus maximus V-Y advancement flap following resection of sacral squamous cell carcinoma (Marjolin's ulcer).