Who Needs Level III Lymph Node Dissection in Carcinoma Breast-Study from a Tertiary Care Center

In Indian females, breast cancer is the most common cancer with a late stage of presentation leading to one-third of patients undergoing modified radical mastectomy (MRM). Our study is undertaken to find out predictors of level III axillary lymph node metastasis in breast cancer and who needs complete axillary lymph node dissection (ALND). Retrospective study of 146 patients who undergone MRM or breast-conserving surgery (BCS) with complete ALND at Kidwai Memorial Institute of Oncology was done, and data was analyzed to find out the frequency of level III lymph nodes and the demographic relation and its relation to positive lymph nodes in level I + II. Positive metastatic level III lymph node was found in 6% of patients, with the median age of the patient in our study with level III positivity was 48.5 years with 63% pathological stage II with 88% perinodal spread (PNS)- and lymphovascular invasion (LVI)-positive. Involvement of level III lymph node was associated with gross disease in level I + II lymph node having more than four lymph node-positive and with pT3 stage or more which has higher chances of level III lymph node involvement. Level III lymph node involvement, though rare in early-stage breast cancer, is associated with larger clinical and pathological sizes (T3 or more), more than 4 lymph node-positive in level I + II and with PNS and LVI. Hence, based on these results, we recommend that for inpatient with more than 5-cm tumor size and those with the gross disease in axilla, complete ALND is recommended.

Prognostic Indicators of Oral Squamous Cell Carcinoma

Background:

Oral squamous cell carcinoma (OSCC) is the sixth most common malignancy worldwide and is the major public health problem in the Indian subcontinent, where it ranks among the top three types of cancer in the country. Here, we aimed to analyze the clinical and tumor characteristics which impact the survival of OSCC patients.

Methods:

A retrospective analysis of clinical records of all patients who underwent treatment for OSCC at Kidwai Memorial Institute of Oncology, between January 2009 and January 2012 was analyzed. Age, gender, site of the primary lesion, tumor size (T), nodal status (N), stage of the disease, marginal status, and modality of treatment data were collected and analyzed.

Results:

Data of 147 patients with OSCC were included in the study and analyzed. Of the patients analyzed 61% were male, with 56% were <65 years, and 40% presented with buccal mucosa cancer followed by 30% with tongue cancer. Of all patients, 30% of them presented with Stage 1 and rest were Stage 2 and above. In our study, 40% underwent surgery only followed by regular follow-up and 60% needed surgery with postoperative adjuvant treatment based on the marginal status, the lymph node status, and T status of the disease.

Conclusion:

Our data suggest that age <65 years, female patients, alveolus lesion and tongue lesion and the early T Stage and N0 and negative margin had a significant positive impact on disease-free and overall survival of oral cancer patients.