Cancer scenario in North-East India & need for an appropriate research agenda

CECT and CT Perfusion Correlation with Pathological Differentiation of Pharyngeal and Laryngeal Cancers: Study from a Tertiary Care Center in Northeast India

Introduction  Pharyngeal and laryngeal carcinomas, included under head and neck cancers, pose a significant challenge in India, accounting for around one-third of all cancer cases. Noninvasive techniques like contrast-enhanced computed tomography (CECT) and CT perfusion (CTp) can help explore the correlation between tumor differentiations, which can greatly benefit in the diagnosis, understanding of recurrence postintervention, and monitoring of the progress of the disease. Materials and Methods  A hospital-based cross-sectional study was conducted for a duration of 18 months in a tertiary care center of northeast India with a sample of 40 patients. CECT and CTp were done and the variables were correlated with pathological differentiation of tumors. Results  The mean age of the study population was 54 years. No statistically significant associations were noted between the age, size, margins, location, and T-staging of tumors with the pathological differentiation of tumors. However, significant association was found between the CTp parameters, namely blood flow (BF), blood volume, mean transit time, time to drain, and time to peak with respect to the pathological differentiation of tumors ( p  < 0.05). Conclusion  The addition of CTp to conventional CT sequences in the evaluation of pharyngeal and laryngeal cancers offers significant benefits in understanding the tumor physiology and behavior.

Clinicopathological Study of Intracholecystic Papillary Neoplasm of the Gall Bladder: a Case Series

Intracholecystic papillary neoplasm (ICPN) is defined as a grossly visible, mass-forming, non-invasive epithelial neoplasm arising in the mucosa and projecting into the lumen of the gallbladder. Since the northeastern part of India has a high incidence of gall bladder cancer, ICPN being a precursor lesion is important to be diagnosed on biopsies. Nine cases with Intracholecystic papillary neoplasm of the gall bladder were studied. The clinicoradiological findings of these patients, gross and microscopic findings of H&E-stained sections were recorded and immunohistochemistry was done for Ki 67. The median age of diagnosis was 60 years with a male-to-female ratio 1:3.5. The most common presenting symptom was pain abdomen, other symptoms included vomiting, weight loss, and jaundice. Associated gall stones were seen in 6 of the cases. Radiological investigations revealed gall stones in 6 cases, intraluminal mass lesion/polyp was reported in 4 cases. Gross examination of the cases showed a polypoidal lesion in 4 cases, papillary projections from the wall in 2 cases. Focal wall thickening was seen in 2 cases while one case showed diffuse wall thickening. Microscopic examination revealed presence of intracholecystic papillary neoplasm which was associated with invasive adenocarcinoma in 7 out of the nine cases. Histologically, the most common type of ICPN in our study was gastric foveolar type (5 cases) followed by biliary type (3 cases) and intestinal type seen in 1 case. ICPN is a known precursor lesion of gall bladder carcinoma. Our case series is an attempt to add to our knowledge of the clinicopathological features of this entity, particularly in the ethnically distinct and heterogeneous population of northeastern India.

Downregulation of SMAD2 and SMAD4 is associated with poor prognosis and shorter survival in esophageal squamous cell carcinoma

BACKGROUND

Esophageal Squamous Cell Carcinoma (ESCC) presents a serious global health challenge, ranking among the most prevalent cancers worldwide. Small mothers against decapentaplegic 2 (SMAD2) and SMAD4 play a significant role in various types of cancer.

METHODS

This study performed relative mRNA expression level profiling of SMAD2 and SMAD4 using Real time quantitative polymerase chain reaction (qPCR) in tissue and blood of ESCC patients and analyzed their associations with numerous clinical and lifestyle parameters for evaluating prognostic significance along with survival and hazard outcomes.

RESULTS

SMAD2 and SMAD4 relative expression level showed downregulation in both tissue (85% and 87% respectively) and blood samples (80% and 79% respectively), and a significant positive correlation (p < 0.05) between their relative expression level was observed in both tissue and blood levels. Various clinicopathological parameters and food habits revealed significant association (p < 0.05) with SMAD2 and SMAD4 relative expression level. While analyzing survival and hazard in ESCC patients, various parameters revealed significant association (p < 0.05) in univariate model and histopathology grade, node stage, stage of metastasis, betel nut consumption, smoked food consumption and altered SMAD2 and SMAD4 relative expression level in tissue samples revealed significant association (p < 0.05) in the multivariate model, indicating their direct association with ESCC patients' survival and this makes them reliable predictors for ESCC prognosis.

CONCLUSIONS

This study's results revealed that downregulation of SMAD2 and SMAD4 is associated with poor prognosis and ESCC progression emphasizing their potential as potent prognostic factors for survival prediction as well as reliable biomarkers for screening.

Potential Risk and Protective Factors in High- and Low-incidence Breast Cancer Populations in Northeast India: A Cross-sectional Study

OBJECTIVE

The case-control study aims to identify the potential risk and protective factors contributing to breast cancer risk in the high-incidence Aizawl population and the low-incidence Agartala population, using age-specific prevalence data of established reproductive factors and body mass index (BMI) among healthy women.

METHODS

A risk profile survey was conducted on asymptomatic women aged 30-64 in Aizawl and Agartala towns. Data was analysed using SPSS software. A descriptive statistical analysis characterised variable distribution, and bivariate inferential analyses of variable differences including birth cohort study across two states were conducted. Logistic regression determined odds ratios of mean values of reproductive factors and BMI.

RESULTS

The study reports that in Aizawl, a high prevalence of delayed marriages, late pregnancies, postmenopausal obesity and family history are potential risk factors for breast cancer in women, while an elevated mean age at menarche, high parity, and extended breastfeeding are protective factors. Conversely, in Agartala, early marriage, early first childbirth, high parity, prolonged breastfeeding, and healthy BMI are associated with low breast cancer risk in women. The study underscores the potential risk factors of early menarche and an extended reproductive period for women in Agartala.

CONCLUSION

The study emphasizes the importance of conducting age-specific prevalence studies in healthy women to identify critical risk and protective factors for breast cancer. Such information is crucial for healthcare professionals to develop prevention strategies, raise public awareness, and facilitate early detection of breast cancer in different populations. The study results will also set the stage for more extensive research on risk and protective factors for breast cancer in the Northeast region of India.

Uncovering novel pathogenic variants and pathway mutations in triple-negative breast cancer among the endogamous mizo tribe

PURPOSE

The incidence of triple-negative breast cancer (TNBC) in India is higher compared to Western populations. The objective of this study is to identify novel and less reported variants in TNBC in Mizoram, a state with a high cancer incidence in India.

METHODS

We analysed whole exome sequencing data from triple-negative breast cancer (TNBC) patients in the Mizo population to identify key and novel variants. Moreover, we analysed reported breast cancer-related genes and pathway alterations.

RESULTS

Somatic mutation analysis revealed that TP53 was the most frequently mutated gene and TP53, CACNA1E, IGSF3, RYR1, and FAM155A as significantly mutated driver genes. Based on the ACMG guidelines, we identified a rare pathogenic germline variant of BRCA1 (p.C1697R) in 13% and a likely pathogenic frameshift insertion in RBMX (p.P106Ffs) in 73% of the patients. We also found that the ATM, STK11, and CDKN2A genes were significantly mutated in germline TNBC samples compared to healthy samples. Moreover, we identified novel somatic variants in CHEK2 (p.K182M) and NF1 (p.C245X), and novel germline variants RB1 (p.D111G), CDH1 (p.A10Gfs), CDKN2A (p.V96G), CDKN2A (p.S12Afs*22), MAP3K1 (CAAdelins0), MSH6 (p.L1226_L1230del), and PMS2 (TTCdelins0). Pathway analysis revealed that most somatic mutations were highly associated with PI3K-Akt signalling pathway and MAPK signalling pathways in TNBC.

CONCLUSIONS

These findings identified novel variants and key genes contributing to disease development and progression. Further analysis of less studied genes, including RBMX, MRC1, ATM, CTNNB1, and CDKN2A, in TNBC may reveal new potential genes for targeted therapeutic strategies and contribute to clinical advancements in the treatment of TNBC.

Burden of oral cancer and associated risk factors at national and state levels: A systematic analysis from the global burden of disease in India, 1990-2021

BACKGROUND

Oral cancer is the sixth most prevalent cancer globally, posing a significant health concern, especially in India, where it accounts for one-third of the global cases. Despite high incidence and mortality rates, comprehensive national and regional data on risk factors and trends are scarce.

METHODS

This study analyzed data from the Global Burden of Disease (GBD) 2021 report, focusing on the age-standardized incidence rate (ASIR), mortality rate (ASMR), disability-adjusted life years (ASDR), and prevalence rate (ASPR) of oral cancer in India from 1990 to 2021. Joinpoint regression analysis was used to assess trends, and ARIMA models were applied to forecast future trends from 2022 to 2031.

RESULTS

From 1990 to 2021, India experienced a moderate increase in oral cancer mortality, with ASMR rising from 5.32 to 5.92, reflecting an annual percentage change (APC) of 11.18 %. ASDR increased from 152.94 to 163.61 (APC of 6.98 %), and ASPR showed a marked rise from 15.71 to 25.46 (APC of 62.06 %). The burden varied significantly across states. Gender disparities were observed, with males consistently exhibiting higher incidence and mortality rates. ARIMA forecasts projected an upward trend in oral cancer metrics from 2022 to 2031, with ASIR expected to reach 10.15 per 100,000 and ASPR 29.38 per 100,000 by 2031.

CONCLUSIONS

The study reveals a persistent and growing burden of oral cancer in India, highlighting the influence of lifestyle and socioeconomic factors. Targeted strategies to mitigate risk behaviors, improve early detection, and address disparities are urgently needed to reduce the disease's impact.

CareHPV, Papanicolaou Positivity Status, and Their Association With Behavioral Risk Factors in Rural Women of Kamrup District, Assam, India

BACKGROUND AND OBJECTIVES

Screening of rural women of Assam by careHPV test for high-risk HPV (hr-HPV) DNA and Papanicolaou (PAP) test for abnormal cytology.

METHOD

This prospective cross-sectional study included 480 non-pregnant women participants aged 20-70 years from Kamrup District, Assam. Two cervical scrap samples were obtained from eligible enrolled women. The Hr-HPV DNA test by CareHPV was performed with one cervical scrap, and a second cervical scrap sample was used for the Papanicolaou (PAP) test. The statistical analysis was done using RStudio for variables. A p-value < 0.05 was considered to be statistically significant.

RESULTS

Women having positive hr-HPV DNA outcomes were 3.33% (16/480) and 7.7% (37/480) women had positive PAP. Tobacco chewing was significantly associated with positive hr-HPV DNA (p = 0.04) and positive PAP (p = 0.03) status. Alcohol-consuming women have a significantly higher risk of positive hr-HPV DNA (p < 0.00001) and positive PAP (p-0.04) outcomes. Irregular menstruation (p = 0.004) and urogenital tract infection (p = 0.008) also have significant risk for a positive hr-HPV DNA status. The positive hr-HPV DNA status was also significant in women having > 3 numbers of children birth (p = 0.003).

CONCLUSION

We found that the positive hr-HPV DNA status among rural women in Kamrup, Assam, was significantly associated with alcohol consumption, tobacco chewing, irregular menstruation, urogenital tract infection, and more than three children birth. The abnormal cytology outcome was also substantially associated with tobacco chewing and alcohol consumption.

Debating the Optimal Preoperative Approach: NACRT vs NACT in Locally Advanced Oesophageal Cancer

Oesophageal cancer (EC), ranking 11th in incidence and 7th in mortality globally, presents a significant health challenge, with a notable prevalence in India, especially in the northeastern region. This article examines the efficacy of neoadjuvant chemoradiotherapy (NACRT) versus neoadjuvant chemotherapy (NACT) in treating locally advanced EC, analyzing data from randomized controlled trials (RCTs) between 2000 and 2024. NACRT, involving preoperative chemoradiotherapy followed by surgery, has shown improved survival rates, notably in the CROSS trial, which reported a 10-year overall survival benefit of 13%. Conversely, NACT is supported by key trials like the OE02 and MAGIC trials, demonstrating comparable survival outcomes. Key points of debate include compliance, complications, response and resection status, survival rates, and health-related quality of life (HRQOL). Compliance rates are similar for both modalities, though disease progression is more common after NACT. Postoperative complications and mortality rates are comparable, with NACTRT showing higher pathologic complete response (pCR) and R0 resection rates, potentially avoiding additional adjuvant radiation. While NACRT shows marginally better 3-year survival rates, particularly for squamous cell carcinoma, 5-year survival rates and HRQOL outcomes are similar for both treatments. NACTRT is associated with more respiratory symptoms, whereas NACT patients experience more gastrointestinal issues. Both NACT and NACTRT are viable options, with the choice depending on patient-specific factors and a thorough assessment of potential benefits and risks. Further research is needed to optimize treatment protocols for EC.

Empowering health: exploring the vital role of facilitator organisations in supporting chronic disease patients in Assam, India

BACKGROUND

The research centers on an underrated type of mediator organization namely facilitator organizations (FO) that work in the health care setting. These organizations are mediators that bridge the gap between patients (healthcare customers) and medical services. The facilitator organizations considered for the study are non-governmental organizations situated in Assam that works in align to chronic diseases, particularly cancer.

METHODS

The data collection was done through organizational referrals for the study making it a snowball sampling, progressively incorporating additional contemporary entities. The study's respondents were facilitator organizations (i.e.Non-Government Organizations) actively involved in addressing chronic disease. Data were gathered from these facilitator organizations situated in Assam, India, supporting healthcare customers specifically those with cancer. Key informant interviews and semi-structured questionnaires were used for data collection, the responses were documented using a field diary and the Lovelock service model was used as a reference for the construction of the questionnaire and developing the research framework.

RESULTS

The analysis of data shows that facilitator organisations maintain continuity in relationships, which enhances health management and outcomes for customers. The shift in cancer care towards a patient-centred approach and the crucial role of FOs in providing comprehensive and individualized care, addressing diverse patient needs thereby addressing the holistic development of the health care customer is vital. In addition, effective patient-centred communication, incorporating trust, compassion, respect and comprehensive support including mental health therapy, occupational therapy, and rehabilitation plays a crucial role in leading a normal life. ` CONCLUSION: The facilitator organizations dealing with Cancer have to meet a broad range of services outside the core medical service providers for their healthcare customers. These efforts contribute to the overall recovery of both the healthcare customer with cancer and their family.

Expression of Interleukin-8, Interleukin-12 and Interleukin-13 in Esophageal Squamous Cell Carcinoma: Biomarker Potentiality and Prognostic Significance

PURPOSE

Interleukin-8 (IL8), Interleukin-12 (IL12) and Interleukin-13 (IL13) are cytokines that play regulatory role in cancer pathogenesis. We analysed their expression profile to evaluate as molecular biomarkers of esophageal squamous cell carcinoma (ESCC) and their association with different parameters and patient survival.

METHODS

Expression analysis was performed by Real time quantitative polymerase chain reaction and receiver operating characteristic (ROC) curve analysis was done. The expression profiles were associated with different clinicopathological and dietary factors. Survival and hazard analysis were also performed.

RESULTS

IL8 expression showed upregulation in tissue (p = 0.000) and blood samples (p = 0.481), IL12 expression showed downregulation in tissue samples (p = 0.064) and upregulation in blood samples (p = 0.689) and IL13 expression showed upregulation in tissue (p = 0.000) and blood samples (p = 0.006). IL13 expression in tissue showed the highest area under the curve (AUC) value (0.773) for ESCC diagnosis, followed by IL8 expression in tissue (0.704) and IL13 expression in blood (0.643). This study also reveals the correlation of studied cytokines in tissue and blood level. Different clinicopathological and dietary factors showed significant association (p < 0.05) with IL8, IL12 and IL13 expression and with survival of ESCC patients. IL8 expression in blood and IL12 expression in tissue and blood showed significant association (p < 0.05) with patient survival.

CONCLUSION

Altered expression of IL8, IL12 and IL13 may be associated with ESCC progression. Overexpression of IL8 and IL13 in tissue samples may be potential biomarkers for ESCC screening. Additionally, both survival and hazard analysis data indicate the effects of different parameters on the prognosis of ESCC patients.

Association of Epstein-Barr virus (EBV) with nasopharyngeal carcinoma: Experience from a North Indian tertiary care hospital

INTRODUCTION

Nasopharyngeal carcinoma (NPC), arising from nasopharyngeal epithelium is caused by Epstein-Barr virus (EBV). It is common in South China, South East Asia and North East India. The aim and objectives of this study were to determine the prevalence of EBV in formalin-fixed paraffin-embedded (FFPE) tissue sections of clinically suspected NPC patients, correlate the results of polymerase chain reaction (PCR) with histopathology findings, and to determine the utility of tissue EBV DNA as a diagnostic bio-marker.

MATERIALS AND METHODS

31 FFPE tissue samples were collected from clinically suspected NPC patients from April 2018-December 2019. Histopathological diagnosis was done by examination of Hematoxylin and Eosin stained slides. Presence of EBV was detected by EBNA-1 PCR. IHC was performed using EBV Latent Membrane Protein 1.

RESULTS

Of the 31 clinically suspected NPC cases, 15 (48.4 %) were histopathological confirmed NPC. Of these15, 13 (86.6 %) were non-keratinising undifferentiated NPC, and one each were keratinising NPC and non-keratinising differentiated NPC respectively. EBV EBNA1 PCR was positive in 35.5 % (11/31) of clinically suspected NPC cases. Of the 11 PCR positive cases, 9 (81.8 %) were histopathological confirmed NPC. Of the 31 clinically suspected NPC cases, IHC was indicated in 23 biopsies. Of which, 12 (52.2 %) were positive for LMP1 in the abnormal cells. Of the 12 IHC positive samples, 10 were NPC cases.

CONCLUSION

EBV DNA as an indicator towards NPC among clinically suspected cases had a sensitivity of 60 % and specificity of 87.5 %. In this study, addition of EBV DNA detection by PCR from FFPE tissue sections could confirm EBV association in 20 % of cases where it was not detected by EBV LMP1 IHC, thus helped in increasing the detection of EBV positivity in NPC cases. Early diagnosis of NPC will improve the cure rate and hence reduce the morbidity and mortality rates.

Factors influencing delayed cancer health seeking in Meghalaya, Northeast India: A qualitative study

Background & objectives India accounts for about seven per cent of the global cancer burden with the highest cancer incidence reported from the North-Eastern Region (NER), including Meghalaya. Despite this, there is paucity of published studies on health seeking behaviour for cancer in the NER. To address this gap, this study used a qualitative approach to document patient, caregiver and provider perspectives to understand the factors influencing healthcare seeking for cancers in Meghalaya. Methods In-depth interviews were undertaken with 37 individuals diagnosed with one of the top five cancers in Meghalaya, namely, oesophageal, breast, oral, cervical and lung cancer. They were identified from the State referral cancer hospital. Twelve caregivers and five healthcare providers were also interviewed. All interviews were conducted in the local language using semi-structured interview guides. Transcripts were translated to English, coded, categorized and analyzed using thematic framework content analysis approach. Results A key factor influencing delayed cancer treatment in Meghalaya included misconceptions regarding the causes of cancer and cultural concepts such as bih and skai (Khasi language), i.e. notions of a figurative 'poison' or ill intent that makes one susceptible to illness. A general reluctance to discuss cancer diagnoses, perceived stigma, apprehension of treatment methods influenced their decision. Other factors included negligence and misinterpretation of early symptoms of cancer, self-management, preference for traditional medicines, financial constraints and health system-related factors. Interpretation & conclusions This study underscores the importance of addressing barriers to cancer diagnosis and treatment in indigenous populations in northeast India, advocating for culturally appropriate messaging, capacity building for healthcare workers, integration of traditional healers, and community involvement to enhance early healthcare seeking and improve outcomes.

Clinicopathological Characteristics of Multiple Primary Malignancies Involving Female Genital Tract at a Tertiary Cancer Institute of Northeast India

Background

The term "Multiple Primary Malignant Neoplasms (MPMNs)" refers to two or more unrelated primary malignant neoplasms that originate from single or different organs and occur in one patient. MPMNs have been divided into synchronous and metachronous based on time duration after first malignancy.

Materials and Methods

This was a hospital-based retrospective study conducted at a tertiary cancer institute in Northeast India. Clinicopathological factors of patients with multiple primary malignancies with at least one female genital tract malignancy attending the gynecological oncology outpatient department were observed. Those with ambiguous status of primary malignancy and incomplete treatment of first primary malignancy were excluded from the study.

Results

A total of 57 patients with MPMN, including one case of triple primary malignancy, were included in the study. 59.18% of cases had metachronous, and 40.81% had synchronous malignancies. The median time to the development of second primary malignancy was 60 months. Among the first diagnosed malignancies, cervix was the most common site (26.5%), followed by endometrium (20.4%) and ovary (14.28%), whereas ovarian malignancy was more commonly diagnosed second malignancy (38.77%), followed by endometrium (14.28%) and cervix (10.2%). In an analysis of synchronous malignancies, the most common genital tract involvement was seen with endometrium and ovary, with a predominance of low-grade endometrioid histology in 75% of cases.

Conclusions

As the cancer survivor population continues to increase in future, these patients must be comprehensively evaluated on follow-up, and a cognizance of prior treatment taken should be kept. In addition, it is vital that the clinicians keep a lookout for high-risk population in which genetic testing may be beneficial.

Outcomes of Resectable Gallbladder Cancer: A Retrospective Analysis From a Tertiary Care Centre in India

Background Gallbladder carcinoma (GBC) has deleterious outcomes, but due to its reduced incidence in Western countries, there is a paucity of data on this disease. Here we report the outcomes of a retrospective analysis of resectable gallbladder cancer from a tertiary cancer centre in eastern India. The primary objective of this study is to evaluate the overall survival (OS) and relapse-free survival (RFS) rates among patients with resectable GBC. Methods A retrospective analysis was carried out on patients who underwent radical surgery between 2007 and 2022 and received various neoadjuvant and adjuvant chemotherapy methods. Patients who had adjuvant chemoradiotherapy concurrently or who did not receive adjuvant therapy were excluded. All the baseline clinicopathological characteristics were retrieved from electronic medical records. The survival data were collected from records of follow-up visits as well as telephonic calls to the patients who were lost to follow-up. Simple proportions were used for baseline characteristics, and the Kaplan-Meier method was used for survival analysis. Results A total of 161 patients were identified, and data were captured from electronic medical records. The included patients' ages ranged between 26 and 80 years, with a median age of 56 years. Among the participants, 103 were female (64%) and 58 (36%) were male. Among the 161 patients, the median number of lymph nodes harvested was nine (ranging from one to 43), and only three patients were margin-positive. The tumour, nodes, and metastasis (TNM) distributions were as follows: pT2 in 111 patients (70.25%), pT3 in 44 patients (27.85%), and pT4 in three patients (1.90%). The nodal statuses were pN0 in 91 patients (61.9%), pN1 in 51 patients (34.69%), and pN2 in five patients (3.4%). The majority (64%) received single-agent capecitabine, 27% received gemcitabine-based platinum doublet therapy, and 4.3% received neoadjuvant therapy. Of the full sample, 2.4% received concurrent adjuvant chemo plus radiation therapy, and three patients did not receive any adjuvant therapy. Additionally, among the 161 patients, 34.16% had a relapse, with 47% being local and 52% being distant relapses. The median follow-up was 49 months (interquartile range (IQR) 23-71 months). The 24-month RFS rate was 67.1% (SD+/- 4.3%), and the 24-month OS rate was 78.1% (SD+/- 4.1%). Conclusion Our data, which is from one of the largest samples from India, show that resectable gallbladder cancer has very good outcomes after radical surgery and adjuvant chemotherapy. There was a higher proportion of T2 and node-negative disease, which could have led to better survival compared to published literature.

A Descriptive Cross-Sectional Study on Clinical Epidemiology of Different Types of Cancer in a Tertiary Care Centre: Insights From Eastern India

Background and aim Cancer poses a significant burden in India, with a considerable number of people living with the disease and a substantial increase in new cases every year. Hence, considering the unique challenges faced by developing nations regarding the disease burden, this study has been designed. The aim of this work was to carry out a descriptive retrospective cross-sectional study on various types of cancer conducted in a tertiary care centre in India. Methods One thousand cancer patients who attended the outpatient department (OPD) from tertiary care cancer hospitals from July 2019 to December 2023 in Eastern India were enrolled. Patients included were of either gender, with their demographic details and the disease duration, who visited the OPD of hospitals meeting the eligibility criteria. Exclusion criteria were terminally ill cancer patients and patients who did not visit the outpatient department of the studied site. Descriptive analysis and chi-square test were carried out using the SPSS statistical software, version 20.0 (IBM Corp., Armonk, NY) for data analysis. Ethics committee approval was taken. Results Gastrointestinal tract cancer (31.3%, n=313) and breast cancer (19.8%, n=198) were found to be the most common types of cancer among all. Out of the total patients studied, 41.1% were males and 58.9% were females. Among regions, North Chotanagpur had the highest (40.5%) prevalence, followed by South Chotanagpur (26.0%). The majority of individuals belonged to 41 to 60 years (49.0%, n=490), followed by 21-40 years (28.9%, n=289). Gastrointestinal cancer was more prevalent among males (35.5%, n=146), while breast cancer was predominant among females (31.4%, n=185). Conclusion Cancer is more prevalent among rural females (58.9%), providing valuable insights into the prevalence of various cancers and highlighting differences between regions, age groups, and genders.

Real-World Experience of Patient's Compliance and Clinical Outcomes for Trimodality Treatment for Esophageal Cancer: a Study from a Cancer Center in North-East India

Preoperative chemoradiotherapy is a standard treatment for patients with locally advanced, resectable esophageal cancer. The treatment completion rates impact the survival outcomes (Eyck et al J Clin Oncol 39(18):1995-2004, 2021). Thus, we aimed to estimate the effect of neoadjuvant chemoradiotherapy (NACRT) in terms of treatment completion rates and survival in this subset of patients and bring out the clinical outcomes in that context. This was a retrospective study done at a tertiary cancer center in North-East India. The study period was from 1 January 2018 to 31 December 2021. We included patients diagnosed with locally advanced and resectable esophageal cancer (cT2-3NanyM0) involving the middle and/or lower thoracic esophagus and who were planned for trimodality treatment in the Joint Tumor Board. Out of the 82 patients who were planned for trimodality treatment, all were squamous cell carcinomas. We found that 54.9% of patients completed the entire trimodality treatment. The median age was 56 years (range 34 to 73 years). The male to female ratio was 59:23. Adverse events, of any grade, were seen in 76% of patients who received NACRT. Fatigue (66%) was the most common toxicity. The common hematologic toxicities were neutropenia and anemia (7.3% each). A total of 45 patients (54.9%) were able to complete all the three modalities of treatment. Transthoracic esophagectomy was the preferred approach (84.4%). The site of anastomosis was in the neck of all the patients. Anastomotic leak was seen in 17.7% of patients. Postoperative pulmonary and cardiac complications occurred in 31.1% and 8.9% of patients respectively. The 30-day mortality was 6.7% (three deaths). A pathological complete response was seen in 35.6% among patients who underwent an esophagectomy. R0 resection was achieved in 93.3% of patients. The median overall survival and disease-free survival were 19 months and 17 months respectively. The completion rate of trimodality treatment in the real-world scenario was found to be low in our study, the reasons for which need to be identified and effectively resolved. Oncological outcomes were similar to the published literature.

A Glimpse into the Epidemiology of Geriatric Cancers in India: Report from the Indian Population Based Cancer Registries

INTRODUCTION

Indian population is aging and the cancer rates are rising.  Older adults (OAs)(≥60 years) with cancer require specialized care.  However, data on geriatric cancer epidemiology is scarce.

METHODS

The study compiled the geriatric cancer data from the published reports(2012-2014) of Indian population-based cancer registries(PBCRs).

RESULTS

Of the 1,61,363 cancers registered in the Indian PBCRs, 72,446(44.9%) occur in OAs, with  21,805(30.1%), 18,349(25.3%), 14,645(20.2%), and 17,647(24.4%) occurring in 60-64, 65-69, 70-74, and ≥75year age groups.  The truncated incidence rates for OAs are 555.9,404.5, and 481.9 for males, females, and OA populations respectively.  The common cancers are lung, prostate, and esophagus cancers in males, breast, cervix, and lung in females.  The overall common cancers are lung, prostate, and breast.  While  >50% of the incident cases of prostate, and bladder cancers occurred in OAs, <20% of Hodgkin lymphoma and thyroid cancers occurred in OAs. OA cancer epidemiology has a regional variation, highest in South India and lowest in Western India.

CONCLUSION

The current study quantifies the cancer burden in the Indian geriatric population. Understanding the epidemiology of geriatric cancers is vital to health program planning and implementation. Increased awareness, focused resource allocation, research, and national policies for streamlining care will all help to improve geriatric cancer outcomes.

Identification of novel AKT1 inhibitors from Sapria himalayana bioactive compounds using structure-based virtual screening and molecular dynamics simulations

Through the experimental and computational analyses, the present study sought to elucidate the chemical composition and anticancer potential of Sapria himalayana plant extract (SHPE). An in vitro analysis of the plant extract was carried out to determine the anticancer potential. Further, network pharmacology, molecular docking, and molecular dynamic simulation were employed to evaluate the potential phytochemical compounds for cervical cancer (CC) drug formulations. The SHPE exhibited anti-cancerous potential through inhibition properties against cancer cell lines. The LC-MS profiling showed the presence of 14 compounds in SHPE. Using network pharmacology analysis, AKT1 (AKT serine/threonine kinase 1) is identified as the possible potential target, and EGFR (Epidermal Growth Factor Receptor) is identified as the possible key signal pathway. The major targets were determined to be AKT1, EGFR by topological analysis and molecular docking. An in silico interaction of phytoconstituents employing molecular docking demonstrated a high binding inclination of ergoloid mesylate and Ergosta-5,7,9(11),22-tetraen-3-ol, (3.beta.,22E)- with binding affinities of -15.5 kcal/mol, and -11.3 kcal/mol respectively. Further, MD simulation and PCA analyses showed that the phytochemicals possessed significant binding efficacy with CC protein. These results point the way for more investigation into SHPE compound's potential as CC treatment.

Cancer awareness, diagnosis and treatment needs in Mizoram, India: evidence from 18 years trends (2003-2020)

Background

Despite being the second least populated state, Mizoram exhibits the highest incidence rate of cancer in India. Its inhabitants, constituting an endogamous and isolated population, have embraced their own distinct culture, way of life and dietary preferences, setting them apart from the rest of mainland India. In 2003, the Mizoram Population Based Cancer Registry (PBCR) was established under the auspices of the National Centre for Disease Informatics and Research (NCDIR), a division of the Indian Council of Medical Research (ICMR), in collaboration with the Department of Health & Family Welfare of the Government of Mizoram, India.

Methods

Cancer incidence and mortality data were extracted from the Mizoram PBCR spanning the years 2003-2020. The Age Standardized Incidence Rate (ASIR) and Age Standardized Mortality Rate (ASMR) were computed per 100,000 individuals, utilizing Segi's World Standard Population as the benchmark. The trajectory of these changes was analysed employing the Joinpoint Regression Analysis Program, Version 4.9.1.0.13, to unveil the Annual Percent Change (APC) with a 95% Confidence Interval and a Significance test (p < 0.05) using Monte Carlo Permutation. The resulting graphical visualizations were generated using Flourish Studio.15.

Findings

The overall ASIR for all cancer sites among men was 197.2 per 100,000, while for women, it was 164.9 per 100,000. Among men, the most prevalent cancer site was the Stomach (ASIR = 41.4), followed by Head & Neck, Lung, Oesophagus, Colorectal, Liver, Urinary, Non-Hodgkin's Lymphoma and Prostate cancers. Conversely, among women, Lung cancer exhibited the highest incidence (ASIR = 26.7), succeeded by Cervical, Breast, Stomach, Head & Neck, Colorectal, Oesophagus, Liver and Ovarian cancers. Stomach cancer emerged as the leading cause of death among men (ASMR = 22.6) and among women, Lung cancer held the highest ASMR (15.9). Joinpoint regression analysis revealed a rising trend in incidence and mortality over time for overall cancer sites. Among the primary cancer sites contributing to incidence and mortality, an increase in APC was observable for all, except Stomach cancer, in both men and women. The diagnostic approach, except for cases of cancer with unknown primary sites, involved a microscopic method.

Interpretation

This cross-sectional study examines PBCR reports spanning from 2003 to 2020, shedding light on a consistent uptick in cancer incidence and mortality trends in Mizoram. Stomach cancer emerges as the most prevalent and primary cause of cancer-related deaths among men, while Lung cancer takes a parallel role in women. The elevated cancer incidence and the growing trend among younger generations might stem from the static lifestyle and dietary patterns prevalent within the endogamous tribal population, potentially contributing to a genetic predisposition. The escalation in mortality rates could be attributed to a dearth of specialized diagnostic facilities and skilled human resources, treatment strategies guided by genomic research and transportation challenges. This underscores the urgent requirement for comprehensive scientific exploration across diverse facets. The implementation of easily accessible diagnostic facilities in proximity and genetic testing for pharmacogenomics to enhance prognoses would also aid in mitigating the burden and advancing the healthcare system's effectiveness.

Funding

Population Based Cancer Registry (PBCR) was supported by National Centre for Disease Informatics and Research (NCDIR) of the Indian Council of Medical Research (ICMR), India.

Epidemiology of cancers among older adults in India: findings from the National Cancer Registry Programme

OBJECTIVE

This study describes the epidemiology, clinical extent of disease at diagnosis and treatment modalities of cancer among older adults (aged 60 years and older) in India.

STUDY DESIGN

Secondary data analysis of the National Cancer Registry Programme, which includes 28 Population-Based Cancer Registries (PBCRs) and 96 Hospital-Based Cancer Registries (HBCRs).

METHODS

PBCR data were used to estimate the incidence in terms of crude rate (CR), age-adjusted incidence rate (AAR), age-specific rate (ASpR) and cumulative risk. Trends in the AAR were calculated with the Annual Percentage Change (APC) using join-point regression. HBCR data were used to describe the clinical extent of the disease at diagnosis and the treatment modalities.

RESULTS

There is a wide heterogeneity across the country for the incidence of cancer and for the leading cancer sites among older adults. Males had a higher incidence rate compared to females in the majority of the registries. Aizawl had the highest AARs among both genders (males: 1388.8; females: 1033.0). Females had the highest ASpR at 65-69 years (482.8), whereas for males it was above 75 years (710.4). Cervical, stomach and oesophageal cancers were on the decline. The incidence of cancer among older adults was estimated to increase by 13.5% in 2025 as compared to 2020.

CONCLUSION

The increasing cancer incidence among older adults in India poses a huge burden on the health system. There is a need to increase their participation in clinical trials, advocating comprehensive geriatric assessment and strengthening geriatric oncology within programs addressing older adult's care to deal with the rising cancer burden on the health system borne by them.

Head and neck cancer burden in India: an analysis from published data of 37 population-based cancer registries

Head and neck cancer (HNC) is a major public health problem in India. This article presents the HNC burden in different regions of India. The published population-based cancer registries (PBCRs) data from the National Cancer Registry Programme, Bengaluru, and the Tata Memorial Centre, Mumbai, India, were utilised. The 37 PBCRs were divided into six regions including central, east, north, northeast, west and south. The age-standardised incidence rate of HNC was 25.9 (95% CI 25.7-26.1) and 8.0 (95% CI 7.9-8.1) per 100,000 population, respectively, in males and females. HNC accounted for about 26% of all cancer cases in males and 8% in females. The risk of developing HNC was 1 in 33 for males and 1 in 107 for females. The northeastern registries reported the highest incidence rate 31.7 per 100,000 population in males followed by northern (28.5), central (28.3), western (24.4), southern (23.9) and eastern (18.3). In females, the incidence was in the range of 6.2-10.1 per 100,000 population. For all PBCRs together, the HNC burden was two to three times higher in the age group 60+ as compared to 20-39 years. The HNC burden in India is higher than in the USA, UK, Australia, Africa and Brazil. The PBCRs from the south-east Asia region such as the Colombo district, Sri Lanka, as well as Siraha, Saptari, Dhanusha and Mohattari - Nepal have also reported a high burden of HNC. All regions reported mouth as a leading cancer site followed by tongue, larynx, hypopharynx and tonsil except the northeastern region registries where hypopharynx was the top leading cancer. The burden of other sites of HNC is low. Raising awareness of the disease and associated risk factors, providing early detection services, as well as easy access to diagnosis and treatment are required. The government should focus on building the infrastructure and capacity building to control this disease.

Early-Onset Gastric Cancer from a Geographic Area of High Gastric Cancer Incidence in North-East India: a Retrospective Study

We aim to report about the clinico-pathological characteristics of early-age gastric cancer in North-East India. It is a retrospective and observational study conducted in a tertiary care cancer centre in North-East India. We reviewed physical case records and the hospital electronic medical record system. The study population included all patients of age 40 years or less, with a confirmed diagnosis of gastric adenocarcinoma, who received treatment in the institute. The duration of the study was from 2016 to 2020. Data was collected using a pre-designed proforma, and the results were presented as percentages, ratios, median values and range. A total of 79 patients with early-age gastric cancer were found during the study period. There was female preponderance (45:34). Out of the total, 43% presented in stage IV. Most of them had good performance status (87.3% had ECOG 0-2), and none of them had documented co-morbid illness. Poorly differentiated adenocarcinoma and signet ring cell carcinoma were seen in 36.7% and 25.3% patients, respectively. Only 25 patients (31.6%) underwent definitive surgery, and they had a high nodal burden with a median metastatic lymph nodal ratio of 0.35 (range 0 to 0.91). Out of them, 40% developed systemic recurrence within a short span of time (median time to recurrence being 9.5 months). Peritoneal recurrence was the most common site of failure (80%). Early-age gastric cancer has been associated with aggressive pathological features and poor clinical outcomes in North-East India.

A Review of the Current State of Global Surgical Oncology and the Role of Surgeons Who Treat Cancer: Our Profession’s Imperative to Act Upon a Worldwide Crisis in Evolution

Worldwide, the capacity of healthcare systems and physician workforce is woefully inadequate for the surgical treatment of cancer. With major projected increases in the global burden of neoplastic disease, this inadequacy is expected to worsen, and interventions to increase the workforce of surgeons who treat cancer and strengthen the necessary supporting infrastructure, equipment, staffing, financial and information systems are urgently called for to prevent this inadequacy from deepening. These efforts must also occur in the context of broader healthcare systems strengthening and cancer control plans, including prevention, screening, early detection, safe and effective treatment, surveillance, and palliation. The cost of these interventions should be considered a critical investment in healthcare systems strengthening that will contribute to improvement in the public and economic health of nations. Failure to act should be seen as a missed opportunity, at the cost of lives and delayed economic growth and development. Surgeons who treat cancer must engage with a diverse array of stakeholders in efforts to address this critical need and are indispensably positioned to participate in collaborative approaches to influence these efforts through research, advocacy, training, and initiatives for sustainable development and overall systems strengthening.