Indian Journal of Cancer Education and Research

Bilateral Breast Carcinoma (BBC) is rare in itself with synchronous carcinoma having incidence of only 2-5% of all breast cancers, which is quite less than metachronous carcinoma. Synchronicity/metachronicity are typically associated with local and lymphatic spread and with hematogenous spread to lungs, bones and liver. Furthermore, BBC are mostly lobular carcinomas, but we report a case of 44-year-old female who presented with lump in left breast since 8-9 months and eruptions in bilateral breast since 20-25 days. Trucut biopsy was done which revealed Mucinous carcinoma in left breast and Infiltrating ductal carcinoma in right breast. Patients are usually treated with bilateral mastectomy but in our case, patient presented with advanced disease so we planned for neoadjuvant chemotherapy first.

Keywords: Bilateral Breast Cancer; Mucinous Carcinoma; Rare Presentation

Head and neck cancer is one of the most common malignancies in India. IMRT technique results in better sparing of OAR and homogenous dose distribution to the target. Adaptive radiotherapy is another step forward in that direction. We did a repeat CT scan during the radiotherapy treatment course followed by recontouring and replanning which resulted in better coverage to PTV and resulted decreased dose to OARs. In our study we found that mean difference between CTV and PTV volumes between Actual Plan and Hybrid Plan is 69.95 (p value 0.001) and 109.24(0.001) respectively. There was a significant reduction in doses received by both parotids. Right parotidgland received 3.03 Gy less in actual plan as compared to hybrid plan and Left parotid gland showed difference of 1.97 Gy between both the plans. Also, the D mean in right Eye was in AP 15.38 ± 10.56 and that of HP19.34 ± 11.27 with a mean difference of 3.96 (p value = 0.001); left eye, the D mean dose with AP 14.43 ± 9.15 and that in HP 18.33 ± 10.24 with a mean difference 3.89 ( p value=0.001).

Keywords: Head and neck cancer; Adaptive radiotherapy; IMRT.

Introduction: Caregiver burden is considered as a “multi-dimensional biophysical reaction resulting from an imbalance of care demands relative to caregiver's personal time, social roles, physical and emotional states,    fnancial resources and formal care resources given the other roles they fulfl. Caregivers usually face multitude of strains, due to varied aspects of life affected by cancer including communication, nursing care, financial concerns and also emotional conflict. It is utmost importance to assess the caregiver burden levels amongst the relatives of cancer patients. Material and Methods: Questionnaire based prospective studywas conducted from January 2019 to May 2020. Descriptive statistics was used for correlation of caregiver burden with clinical and socio-demographic parameters and t-test for comparison of means and p value less than 0.05 was considered as statistically significant. Statistical analysis was done with IBM SPSS Statistics version24.0. Observation and Results: We found 50 caregivers with mean age of the 41.54 ± 13.35years with male (64%) preponderance. Most of the individuals were kins and spouses. Majority had mild to moderate burden (56%). The mean caregiver burden was 33.22 which was significantly correlated with age of caregivers (p=0.012). However, statistically significant correlation was seen with caregiver relation to patient (p=0.036) and their education (p=0.059). Conclusions: Majority caregivers had mild to moderate burdenthis implied that they were aware of the responsibility bestowed upon them. However, severe burden seen among children warrant urgent need of attention towards with counselling, interactive session.Proper counselling centers be set up in cancer hospitals and appropriate interventions and support groups be formed to help caregivers.

Keywords: Caregiver Burden; Relatives; Terminally III Cancer patients

Introduction: Near death experience (NDE) is usually profound and unusual experience mostly reporte dtobeexperiencedinpeopleatterminalillnessstages.Thispersonalexperienceisusually associated with death or impending death. Various studies have been reported in this regard. Cancerdiagnosisitselfbeingaharrowingexp erienceowingtoitsprognosisandpoorlycontrolled pain,functionaldeclineandconfusionusuallydistressesthepatient. Andinitsterminalstagesthe patient is likely to experience nearing death. Material and Methods: Questionnaire based observational study using Greyson NDE score for assessing near death experience in terminally ill cancer patient conducted from January 2019 to May 2020. Descriptive statistics was used for correlationofNDEwithclinicalandsociodemographicparametersandpvalue of lessthan0.05was considered as statistically significant. We divided cases on the basis of mean NDE score of 4.92 into two groups ≤ 4.92 (low NDE score) and > 4.92 (high NDE score) for statisticalanalysis. Observation and Results: We identified 5.0 terminally ill cancer patients with mean age of 51.48 years and age range from 17 years to 82 years. Most were between 46 to 55 years of age. There waspreponderanceofmalepatients. WefoundmeanNDEscoreof4.92withmostofcaseshaving low NDE score of ≤ 4.92 (28/50). Higher NDE score was seen among females (81.2%), Christian religion (50%), widowed (87.5%) and ovarian/cervical carcinoma cases (100%). There was statistically significant correlation of NDE score with gender (p=0.0005), maritalstatus (p=0.009) and primary tumor diagnosis (p=0.008). Conclusion: In accordance with the treatment process of the cancer patient there is need to also look into his mental health also. The mental stress the patient is going through should not be undermined rather should be timely assessed and intervened as required. There must be counselling facility and psychosocial support for all terminally ill patient to improve their quality of life.

Keywords: Near Death Experience; Terminally III; Cancer Patients

Introduction: Cutaneous manifestations may be primary to a hidden primary condition or it can also be secondary to an underlying malignancy. An association between systemic malignancy and cutaneous manifestations has long been recognized. Metastasis to the skin is easily visible and can be detected by the physician with relative ease which enhances and emphasizes the role of the clinician in appreciating various appearance of these lesions. With increase in the incidence of cancer in India in the past few decades, it is essential to recognize neoplasms at early stages Materials and Methods: Retrospective and prospective study was performed on 60 confirmed cases of all malignancies with cutaneous manifestations. Data regarding skin manifestation and malignancies were recorded from duration January 2017 to December 2019. Results: Most of the patients were above 60 years with no sex discrimination. Most common cutaneous marker was paraneoplastic dermatoses (82%) followed by nonspecific manifestations in (18%). Most common cutaneous presentation were generalized pruritus (42%) followed by infections (22%), seborrheic keratosis (20%), xeroderma pigmentosum (8%) and generalized xerosis (8%). In males respiratory tract malignancies (42%), Gastro intestinal malignancies (30%), lymphomas (22%) and leukemias (6%) were main malignancies with skin manifestations and in females reproductive tract malignancies (48%), Carcinoma breast (30%) and oral cavity cancer (22%) were common. Conclusion: Cutaneous manifestation from all malignancies is a relatively uncommon phenomenon but at times, they may be the only presenting feature. Cutaneous paraneoplastic syndromes are important clinical markers that may precede or occur simultaneously or after the diagnosis of a given neoplasm and recognizing them may lead to a higher chance of cure and better prognosis for the patient.

Keywords: Cutaneous Manifestation; Cancer; Paraneoplastic Syndromes

Introduction: Image guided brachytherapy and conformal external beam in the treatment of carcinoma cervix enables calculation and modulation of dose to OARs like the bladder and rectum. In highly conformal techniques, PTV margins are calculated according to the setup error windows of respective individual institutions and it is essential for every institute to evaluate and analyze their setup error. An effective way of producing geometrical margins is by statistical models, which allow for reduction in margin sizes and which are smaller but effective in tumor control. The current study aims to evaluate the various setup errors incurred during treatment and thus calculate the adequate CTV/PTV margins for irradiating cancer cervix patients Objectives: Evaluate setup errors using available immobilization devices. Assess setup imaging and evaluation of interfractional movement. Analyze the total setup error (including setup and interfractional movement) and formation of guidelines for delineation of PTV margins. Materials & Methods: 50 patients undergoing pelvic RT for cancer cervix, using either or IMRT or IGRT technique were included in the study. Immobilization using a four clamp orfit and pelvic base plate, was done. 10 patients were treated by daily image guidance by kVCBCT and 40 patients were treated by weekly kV portal imaging. Translational shift (difference between planned and new coordinates) in all three directions recorded for each patient, separately for IMRT and IGRT groups. Mean and median shift and standard deviation in each direction was calculated. Results: Longitudinal shift was the greatest. Mean Isodisplacement vector calculated for IGRT treatment technique is 0.7 cm and for IMRT treatment technique is 0.96 cm. The difference between the two is statistically significant (p-value = 0.02). The standard deviation of shift in longitudinal direction was found to be 8 mm, 2.5 mm in the vertical direction and 3mm in the lateral direction. PTV margin calculated using the Van-Herk Margin formula for IGRT and IMRT treatments was found to be 0.21 cms and 0.39 cms respectively (Taking into account only random errors and assuming zero systematic errors). (p-value: 0.01).

Keywords: PTV Margin; Cancer Cervix; IGRT Planning.