Indian Journal of Cancer Education and Research

Oral squamous cell carcinoma, commonly referred to as oral cancer, is considered to develop as a result of multi-hit process that involves a number of aberrant genetic events. Determining which event leads to the eventual development of oral cancer can be of a great significance in its prevention and control. p53 a tumor suppressor gene, in its mutated form is believed to exert tumorigenic influences and has been a subject of intensive study over several years in order to understand its role in the process of carcinogenesis.
 

Aim: The case report aims to highlight the unusual presentation of Malignant Melanoma. Malignant melanoma is a tumour of melanocytic origin. Lymphatic and haematogenous spread is common in this condition. Objectives: To establish the importance of Immunohistochemistry in order to treat Malignant Melanoma. Material and Method: We present a case of 51 year old male with a lump in left chest region. Imaging done shows a lesion in the right lower lobe of lung and a right suprarenal mass. Histopathology of the lesion in conjunction with immunohistochemical markers FLI1, S 100, HMB 45, Melan confirm the diagnosis of malignant melanoma. Result: Due to its rare presentation and in some cases unusual presentation Malignant Melanoma is often difficult to diagnose or diagnosed late, thereby making it potentially life threatening.In our case report the immunohistochemical examination was done which helped us to establish a solid diagnosis of unusual presentation of Malignant Melanoma, so that the most appropriate therapeutic management can be applied favouring a better clinical outcome. Conclusion: Clinically Malignant Melanoma do not present with distinctive features, therefore there diagnosis can be established with the help of histopathology with specific tissue markers.
 

Background: Rhabdomyosarcoma (RMS), the most common soft tissue sarcoma in children. While most children with localized RMS achieve long-term remission, the prognosis for those with metastatic RMS continues to be challenging, with limited improvements in survival outcomes. Aim: This report aims to highlight a rare case of orbital rhabdomyosarcoma (RMS) initially misdiagnosed as a sinonasal carcinoma. Objectives: Initially suspected to be sinonasal carcinoma, histopathological analysis revealed a malignant round cell tumor. Immunohistochemistry (IHC) further confirmed the diagnosis as embryonal rhabdomyosarcoma. This report studies the role of radiation in orbital Rhabdomyosarcoma. Material: At the SAIMS institute’s Radiation Oncology Department, pathology records were examined for case of Rhabdomyosarcoma. The treatment approach for this patient included a combination of radiation therapy and chemotherapy. Result: We found that throughout the course of radiation therapy patient shows excellent tolerance and patient is on regular follow up in our department. Conclusion: Orbital RMS has a relatively optimistic prognosis due to its favorable location and histology. In cases where surgery isn’t possible, radiotherapy remains essential, offering strong response rates with manageable side effects.
 

This case report presents a rare anomaly observed in an eight-year-old boy of mixed ethnic background. The patient exhibited mandibular left and right permanent first molars, as well as deciduous mandibular first and second primary molars, each possessing three roots. The occurrence of mandibular molars with three roots, known as trifurcation, is relatively uncommon, particularly in deciduous teeth. This case highlights the challenges posed by such anomalies and underscores the importance of early detection and tailored treatment strategies.
 

Bony metastasis from head and neck carcinoma are exceedingly rare. In India, head and neck carcinoma often presents at a locally advanced stage but still bony metastasis are rare. Here, we mention a case which presented with symptoms of bone pain and destruction and on examination we found a primary lesion in the buccal mucosa. Our case report reflects a rare presentation with a unusual site of metastasis along with the management of such rare presentation of the disease.
 

Pancreatic cancer is associated with severe abdominal pain, which significantly impacts the quality of life. Celiac plexus block (CPB) is an effective interventional procedure for managing this pain. This case report presents a 80 year old male patient with advanced pancreatic cancer who underwent CT-guided anterior approach for celiac plexus block, highlighting the procedure’s effectiveness and safety.
 

Prostate cancer is the 2nd most common cancer in males worldwide and 6th most common in Indian males and as per Globocan 2022, 14,66,680 new cases in world and 37,948 cases in India were reported in 2022. Carcinoma prostate has an indolent course and patients usually present with urinary complaints. Widespread use of serum PSA for screening has also led to early diagnosis of the disease but they rarely present with metastatic disease. It often metastasises to regional lymph nodes and bones and rarely spread to supradiaphragmaticnodes. Left Supraclavicular node is commonly associated with gastrointestinal malignancies but association with carcinoma prostate is extremely rare (0.3%). We present a case of a 62 year old male smoker who presented to us with Supraclavicular nodal mass and an incisional biopsy of the same which was suggestive of metastatic adenocarcinoma. On metastatic workup an enlarged prostate and diffuse lymphadenopathy involving mediastinal, abdominal, retroperitoneal, paraaortic, common iliac lymph and left Supraclavicular lymph node was seen. Transrectal biopsy from the prostate was done which implied Adenocarcinoma with a Gleason score of 3+4=7 and high serum PSA was also reported. Metastatic carcinoma prostate with left Supraclavicular lymph node enlargement though a rare case presentation but should be kept as a differential in elderly male patients.
 

Treatments like chemotherapy for cancer have less efficiency and specificity than required; immunotherapy provides one of the best means to have specific and more efficient treatment. With the great advancement in molecular biology, immunology, and cancer biology specific treatments like CAR-T immunotherapy have been introduced. Out of the various cancer immunotherapies discussed here, CAR-T immunotherapy provides the most promising results against certain cancers. CAR-T therapy has been discussed in detail with fundamental discussions of the immune system’s role in cancer and cancer immunotherapy. CAR-T immunotherapy a version of adoptive cell transfer therapy has given outstanding results that were beyond expectations. Some of them are discussed with minute details on CAR-T immunnnotherapy in this paper.
 

Introduction: Non Small Cell Lung Carcinoma (NSCLC) is one of the top ranking cancers in both males and female patients across India. Majority of cases are in advanced stage at presentation. Recent advances in molecular techniques and drug discovery have made the mutation analysis of this carcinoma a part of standard investigation before treatment in NSCLC. In view of cost constraints, a targeted gene panel test is advised for all cases.The purpose of this study is to document the application of this practice at a single tertiary cancer care center in central India. Material and Methods: Two hundred and thirty one cases of NSCLC were reported at our hospital from January 2019 till December 2023. Triage testing was done initially for Epidermal growth factor receptor (EGFR) gene mutations by ARMS RT-PCR/ Targeted NGS. Subsequently EGFR negative cases were tested for Analysis of Anaplastic lymphoma receptor tyrosine kinase gene (ALK), Repressor of Silencing 1 (ROS1) gene by immunohistochemistry (IHC). Results: 106 cases were found to have tested positive for these mutations, 56 were males and 50 were females. The average age for male patients was 60.17 yrs and for female patients was 56.3 yrs. EGFR mutations were found in 40.69% cases, out of which exon 19 deletion and exon 21 L858R were the most frequent (38.09%). Rare cases of single and compound mutations were also seen. ALK and ROS1 gene rearrangements were found in 4.76% and 0.43% respectively. EGFR, ALK and ROS1 mutations were mutually exclusive. Conclusion: Targeted gene mutation testing is a very significant investigation in patients with advanced NSCLC, as it results in tailoring and optimising the treatment for individual patients and offers hope for the best outcome.

Aim: Use of Surface Mould Brachytherapy in the treatment of skin and oral malignancies at our institution. Background: SMB offers a good therapeutic ratio helping in dose escalation of irradiationand higher Biologically equivalent doses. In this study, we share our institutional experience with SMB in different types of cancers. Materials and Methods: 15 Patients with oral, skin, and penile malignancies treated with SMB were analyzed from Jan 2019 to Sept 2023. Treatment was delivered using HDR Co 60 source with a customized mouldto a median dose of 48Gy in the radical setting and 15Gy as a boost with 2.5-3Gy/# twice a day. The treatment-related toxicities and response were noted. Results: 15 patients with various malignancies were evaluated. Eight patients received SMB alone while 7 patients external beam radiotherapy with SMB Boost. A Complete: Partial response ratio of about 80:20 was achieved. There were 3 local failures all in hard Palate patients. The acute toxicity outcomes were as follows - 12 patients of Grade 1 and 3 patients of Grade 2 toxicities. Late toxicities reported were Grade 1 in six patients, Grade 2 in 5 patients, and Grade 3 in one patient. Conclusion: Surface mould brachytherapy provides maximum local tumor control, is well-tolerated, and is a non-invasive, outpatient procedure for treatment in both radical settings and as a boost. It results in organ and function preservation and is a good alternative option for patients who are unwilling for surgery and who present with comorbidities.