Nepalese Journal of Cancer <p>Nepalese Journal of Cancer (NJC) is the official journal of the B.P. Koirala Memorial Cancer Hospital, Bharatpur, Chitwan, Nepal. The journal is internationally peer reviewed, covering&nbsp; biomedical topics relating to cancer care and research in Nepal and in the Region.</p> B.P. Koirala Memorial Cancer Hospital en-US Nepalese Journal of Cancer 2594-3294 <p>Submission of the manuscript means that the authors agree to assign exclusive copyright to NJC. The aim of NJC is to increase the visibility and ease of use of open access scientific and scholarly articles thereby promoting their increased usage and impact.</p> <p><a href="" rel="license"><img style="border-width: 0;" src="" alt="Creative Commons Licence"></a><br>NJC is licensed under a <a href="" rel="license">Creative Commons Attribution 4.0 International License</a>.&nbsp;This license lets others distribute, remix, tweak, and build upon your work, even commercially, as long as NJC is acknowledged.</p> Progress in the understanding of C1q-like protein 4 (C1ql4) and its use in oncology <p>C1q and tumor necrosis factor (TNF)-related proteins (CTRPs) are a superfamily of proteins secreted in adipose tissues that are highly homologous to lipocalin. Previous studies have shown that this family has important biological functions in diseases such as metabolic disorders, cardiovascular diseases and inflammation in many types of tissues. C1q-like protein 4 (C1ql4) is one of the members of this family, which is mainly expressed in the testis and adipose tissue, and plays an important role in promoting angiogenesis, regulating lipid synthesis, inducting testosterone secretion, inhibiting ovarian granulosa cell apoptosis and myoblast fusion. This article reviews the current progress on molecular structure, tissue expression, and the main biological functions of C1ql4.</p> Zhang Qing Li Qing-Shan Han Wan-Yue Xu Fan Copyright (c) 2022 Nepalese Journal of Cancer 2022-04-03 2022-04-03 6 1 10 18 10.3126/njc.v6i1.44203 Research Progress on the effect of radiotherapy on immune function of tumor patients <p>With the cure rate of 21%, radiotherapy is one of the most effective methods for&nbsp;tumor treatment, and about 70% of solid tumors need radiotherapy.With the in-depth&nbsp;study of human impact by radiotherapy and immune system and tumor&nbsp;microenvironment, radiotherapy is no longer used as a local treatment. It is found that&nbsp;irradiation of tumor can activate body immunity. There exist two different views: one&nbsp;is that radiotherapy inhibits immunity, because it can kill tumor cells and normal cells&nbsp;at the same time.The other is that radiotherapy promotes immunity, causing tumor cell&nbsp;necrosis or apoptosis, releasing immune cytokines or promoting immune cell&nbsp;activation, and bystander effect. In recent years, the idea of radiotherapy promoting&nbsp;immunity has been more and more supported by literatures. Whether radiotherapy&nbsp;promotes or inhibits immunity is a research hot spot in recent years. This paper&nbsp;reviews the research progress of the effect of radiotherapy on immune function of&nbsp;tumor patients.</p> Wenxin Li Xiaolei Yu Qingshan Li Fan Xu Sheng Lin Zhang Xiao Li Copyright (c) 2022 Nepalese Journal of Cancer 2022-04-03 2022-04-03 6 1 42 47 10.3126/njc.v6i1.44208 High-intensity focused ultrasound (HIFU) therapy for pain palliation in advanced stage pancreatic carcinoma: A Meta-Analysis with recent studies <p><strong>Background:</strong> Day by day, High-intensity focused ultrasound (HIFU) therapy is becoming more familiar in medical field because it is non-invasive technique with fewer side effects and provides promising therapeutic results. Several HIFU therapy applications have approved by many approval authorities of deferent countries since last decade. It is a novel, emerging, therapeutic modality that uses ultrasound waves, propagated through tissue media, as carriers of energy. HIFU has great potential for tumor ablation and the main mechanisms of HIFU ablation involve mechanical and thermal effects. Pancreatic adenocarcinoma is currently the fourth-leading cause of cancer-related death. Up to 60–90% of patients with advanced disease suffer cancer-related pain, severely impacting their quality of life. Current management involves primarily pharmacotherapy with opioid narcotics and celiac plexus neurolysis; unfortunately, both approaches offer transient relief and cause undesired side-effects. High intensity focused ultrasound (HIFU) is a non-invasive thermal ablation technique that has been used to treat pancreatic cancer. This meta-analysis aims to evaluate the role of HIFU in pain palliation of advanced unresectable pancreatic adenocarcinoma.</p> <p><strong>Methods:</strong> Paper selection was performed electronically in PubMed up to the end of March 2021, for pain palliation treatment of advanced staged pancreatic cancer with HIFU. Relevant papers were identified through the PubMed search engine using these keywords: HIFU, pancreas, pancreatic cancer, pain and palliation. Additional studies were also done included after manual search of the selected bibliographies. Palliation results reported in studies were analyzed using a logit-transformed random-effects model using the inverse variance method, with the DerSimonian-Laird estimator for t2, and Cochran’s Q test for heterogeneity among studies. The I2 was also calculated to assess the percentage of the total variability in the different effect size estimates that can be attributed to heterogeneity among the true effects and rank correlation test of funnel plot asymmetry was done to assess possible publication bias.</p> <p><strong>Results:</strong> In this meta-analysis, we includes only recent 10 year studies i.e. total number of 16 studies with 687total patients with pancreatic cancer. The total patients enrolled ranges from 7 patients in the smallest series, up to 120 in the largest study. The calculated τ2was 0.187, and I2was 41%, the Q test p-value was 0. 026, is indicating significant heterogeneity among studies. The random effects estimate of the proportion of patients with pain reduction was 0.89.08.</p> <p><strong>Conclusions:</strong> We concluded that HIFU performs to be an effective tool for pain palliation in advanced staged pancreatic cancer. Prospective randomized and standardized studies are necessary to confirm the effectiveness of HIFU in relieving pain, and to evaluate for any potential impact on tumor control and patient survival.</p> Ajay Kumar Yadav Suman Gnawali Sandip Kumar Mandal Gyan Bahadur Shrestha Ganga Dutta Adhikari Bhanu Pratap Shah Gengbiao Yuan Copyright (c) 2022 Nepalese Journal of Cancer 2022-04-03 2022-04-03 6 1 48 66 10.3126/njc.v6i1.44209 Ultrasound Guided Central Chemotherapy Port Insertion by Surgeon in Cancer Patients. <p><strong>Purpose:</strong> The aim of the study is to report early experience in ultrasound guided central chemo port insertion by surgeons in cancer patients who required chemotherapy.</p> <p><strong>Materials and methods:</strong> The procedure was carried out in operation theatre under local anesthesia with intravenous sedation. Linear high frequency ultrasound probe was used to visualize and cannulate left or right internal jugular vein in the neck. The reservoir was kept through a separate incision over anterior chest wall.</p> <p><strong>Results:</strong> Fifty patients with mean age of 48 years underwent chemo port insertion. The indications were neoadjuvant, adjuvant and palliative chemotherapy in 30%, 58% and 12%, respectively. Cannulation was successful in 100% of cases. Two patients (4%) required port removal due to wound infection (one patient) and blockade (one patient). One patient (2%) had kinking of the catheter which required repositioning.</p> <p><strong>Conclusion:</strong> Ultrasound guided central chemo port insertion by surgeons is a safe procedure with 100% success rate and minimal complications.</p> <p> </p> <p> </p> Mukti Devkota Binay Thakur Manish Chaudhary Copyright (c) 2022 Nepalese Journal of Cancer 2022-04-03 2022-04-03 6 1 1 5 10.3126/njc.v6i1.44200 Histopathological spectrum of breast lesions at B.P Koirala Memorial Cancer Hospital <p><strong>Background:</strong> Breast lumps are the commonest presentation in surgical outpatient clinics in females. Breast is a complex organ structure. It shows a wide range of pathologies from benign inflammatory lesions to invasive life threatening lesions. Breast cancer has become the commonest cancer in females after cervix cancer also in Nepal. Modern diagnostic facilities have helped a lot for early detection of breast lesions and treatment. The present study was conducted at a tertiary cancer center in Nepal that focused on the identification of histopathological spectrum of breast biopsies received and their relations with epidemiological variables.</p> <p><strong>Methods:</strong> This is a retrospective study of all the breast biopsies which were received, processed and analysed at Department of Pathology at B.P. Koirala Memorial Cancer Hospital from January to December 2019. The data were retrieved from the Department of Pathology. They were entered in Microsoft excel.</p> <p><strong>Results:</strong> A total 216 breast tissues specimen of true-cut biopsy and lumpectomy were examined in the year 2019. The age range was from 18-75 years. There were 37.1% benign cases and 62.9% of malignant. There were 7 male patients in this study. Most of the cases belonged to age group of 40-49 years.</p> <p><strong>Conclusion:</strong> This study shows the burden of breast cancer in Nepal. It also highlights the importance of histopathology in breast lesions not only in diagnosing the lesion but also in predicting the prognosis. Malignant lesions of breast were frequent in this study due to our center being a cancer referral hospital. This retrospective study shows that a variety of lesions are encountered in breast and histopathology helps to differentiate between various benign and malignant lesions.</p> Greta Pandey Asmita Rana Ranjan Raj Bhatta Suraj Upreti Nandita Jha Ishan Dhungana Copyright (c) 2022 Nepalese Journal of Cancer 2022-04-03 2022-04-03 6 1 19 26 10.3126/njc.v6i1.44205 Importance of Aortic Bifurcation for Pelvic Radiotherapy in Cervical Cancer Patients <p><strong>Purpose:</strong> Radiotherapy is a major modality for treating cervical cancer patients. Conventionally, superior border of treatment portal in cervical cancer is kept at L4-L5 intervertebral spaces; however, newer concepts suggest that aortic bifurcation should be the determining factor for the superior border. This study aims to observe the level of aortic bifurcation in cervical cancer patients.</p> <p><strong>Methods and materials:</strong> A retrospective observational study was conducted in cervical cancer patients undergoing radiotherapy between July 2019 and August 2020 in B.P. Koirala Memorial Cancer Hospital, Bharatpur. Histologically confirmed International Federation of Gynecology and Obstetrics (FIGO) stages II and III carcinoma cervix patients referred for radiation therapy were included in the study. Baseline variables including age group, FIGO stages were noted from the hospital record. Computed Tomography (CT) simulation images were reviewed from the treatment planning system to detect the levels of aortic bifurcations.</p> <p><strong>Results:</strong> Total 281 patients of carcinoma cervix were registered for the study with age ranging from 29 years to 87 years and the commonest age group being 51-60. The maximum patients were of stage IIB (46.6%). The aortic bifurcations levels varied from mid L3 to L5-S1 intervertebral space and the commonest level observed was mid L4 vertebra in 70 (24.9%) patients.</p> <p><strong>Conclusion:</strong> Anatomical variation in the level of aortic bifurcation, considered as the superior CTV border in pelvic radiotherapy in cervical cancer, demands the conventional superior border, L4-L5 intervertebral space, to be shifted more superior to include common iliac nodes in the treatment field.</p> Deepa Gautam Sweta Baral Nitu Sharma Copyright (c) 2022 Nepalese Journal of Cancer 2022-04-03 2022-04-03 6 1 28 33 10.3126/njc.v6i1.44206 Application of SPECT combined with CT and MRI in malignant tumors Clinical value in the diagnosis of bone metastasis <p><strong>Objective:</strong>To evaluate the value of single-photon emission computerized tomography (SPECT) combined with CT and MRI in the diagnosis of bone metastasis of malignant tumors.</p> <p><strong>Method:</strong>Eighty patients with bone metastasis from malignant tumors who admitted to Affiliated Hospital of Chengde Medical College were selected from March 2019 to June 2021. SPECT bone imaging, CT and MRI were used to analyze the regional distribution of primary tumor bone metastasis and the efficacy of three detection methods in the diagnosis of bone metastasis.</p> <p><strong>Results:</strong> A total of 464 lesions were detected by SPECT and CT in the same scanning field,with SPECT detection rate of 92. 5% ( 429 /464) and CT detection rate of 77. 8% ( 361 /464) ( P<0. 05). In addition,143 lesions were detected by SPECT beyond the same scanning field. A total of 321 lesions were detected by SPECT and MRI in the same scanning field,with SPECT detection rate of 95. 6% ( 307 /321) and MRI detection rate of 82. 6% ( 265 /321) ( P<0. 05),and other 286 lesions were detected by SPECT beyond the same scanning field. In all,259 lesions were detected by CT and MRI scans in the wild same scanning field. The detection rate was 71. 4% ( 185 /259) for CT,and 95. 7% ( 248 /259) for MRI( P<0. 05). The sensitivity,specificity and accuracy of SPECT imaging combined with CT and MRI were higher than single SPECT imaging,CT and MRI ( P<0. 05).</p> <p><strong>Conclusion:</strong> SPECT may be the preferred screening modality for suspected bone metastases and when combined with CT and MRI,it can clarify the regional distribution of bone metastasis from malignant tumors and improve the sensitivity,specificity and accuracy of diagnosis with high clinical significance.</p> Xiao Li Wenda Shi Fan Xu Qingshan Li Xu Xiao Copyright (c) 2022 Nepalese Journal of Cancer 2022-04-03 2022-04-03 6 1 35 41 10.3126/njc.v6i1.44207 Sexual and Functional Outcomes after Penile cancer treatment-perspective from a tertiary cancer care hospital in Nepal <p><strong>Background:</strong> The mainstay of treatment for penile cancer is Penectomy with inguinal lymph node dissection following risk stratification followed by chemo-radiotherapy. Despite satisfactory oncological result, penile surgery has significant impact on patient’s functional and sexual quality of life. This retrospective analysis is to evaluate sexual and functional outcome of patient after curative treatment and its possible associations with clinic-pathological characteristics.</p> <p><strong>Methods:</strong> This is a retrospective study conducted at Bhaktapur Cancer Hospital from January 2011 to December 2015 of histologically confirmed cases of carcinoma penis. Clinical and pathological characteristic data included age, history of smoking, clinical presentation, anatomical site, presence of lymph nodes or distant metastasis, primary tumor size (pT ) and TNM staging, surgery involved, length of remaining penile shaft, histopathological type, chemotherapy and radiotherapy patient received and follow ups time. International Index of Erectile Function (IIEF-5) questionnaire was used to assess sexual function which encompasses five questions and addresses the relevant domains of male sexual function respectively erectile function, orgasmic function, sexual desire, intercourse satisfaction and overall satisfaction and Urinary function were noted during follow up .</p> <p><strong>Result:</strong> Among the cases, 64 cases were pathologically proven for penile cancer. The age of patient entering the study group included from 22 years to 88 years with mean age of 58.75±12.30 years. All patients except one were married and sexually active prior to treatment. Vast majority of the patients 63 (98.4%) were not circumcised and majority of cases 42 (65.64%) were smoker. The mean size of the tumor was 3.25±1.208 cm. Majority of patients 54(84.4%) underwent partialam putation of penis while 2(3.1%) patients had undergone total amputation of penis. The multivariate analysis of different factors showed that T staging ≥ T2 and penile shaft(cm) &lt;3cm were independent risk factors for sexual dysfunctions (odds ratio = 13.64; 95% confidence interval = 1.02-181.005), and (odds ratio = 0.03; 95% confidence interval = 00-0.05) respectively. Out of 56 cases, 33(58.9%) had different grades of sexual dysfunction where 15(26.8%) cases were severe, 5(8.9%) cases were moderate, 8(14.3%) cases were mild to moderate and 5(8.9%) cases were mild. 23 (41.1%) cases who did not have any form of sexual dysfunction. One (1.8%) case had urethral stricture, 3(5.4%) cases had meatal stenosis, 2(3.6%) cases had penile edema and 4 (7.1%) cases had penile discoloration.</p> <p><strong>Conclusions:</strong> Amputation of penis with inguinal lymph node dissection which is necessary for curative intent of the disease is disfiguring and has a profound and lasting sexual dysfunction, voiding problems, penile appearance and cosmetic problems, all of which may adversely affect the patient’s quality of life. Emphasis on preventive aspects and early detection should be emphasized to get rid of this disease.</p> Punyaram Kharbuja Utsab Man Shretha Manish Roy Pushpa Bhadel Nirajan Subedi Prakashraj Neupane Copyright (c) 2022 Nepalese Journal of Cancer 2022-04-03 2022-04-03 6 1 68 77 10.3126/njc.v6i1.44210 Use of Indocyanine green (ICG) angiography to minimize anastomotic leak in the neck after esophagectomy <p><strong>Introduction:</strong> Anastomotic leak after esophagectomy for cancer of mid and lower esophagus and gastroesophageal junction (GEJ) still remains a major challenge. Poor perfusion of the gastric conduit remains the main factor for leak. Intra-operative assessment of the gastric conduit with indocyanine green (ICG) angiography helps to select a properly perfused site for anastomosis, thus minimizing the leak.</p> <p><strong>Methods:</strong> Patients undergoing surgery for cancer of esophagus and GEJ either through open or minimally approach were taken up for this study. Stomach was used for reconstruction and anastomosis was made in neck. A 0.1ml of test dose of ICG was given intra-dermally to look for any reaction. After that a dose of 5-10 milligrams was injected intravenously. Perfusion was assessed with infrared light using laparoscopic telescope. The timing of perfusion of the conduit was recorded. Well perfused segment was used for gastroesophageal anastomosis. Different parameters including leak were compared with non-ICG group.</p> <p><strong>Results:</strong> We studied 474 patients. Among these patients 67 were in ICG group and 407 were in non-ICG group. Mean age, mean weight loss and co-morbidities were similar in both groups. 72% of patients in ICG group and 50% of patient in non-ICG groups had multimodality treatment. 67% of patients in ICG group and 46% of patients in non-ICG group underwent minimally invasive surgery (p&lt;0.001). Post-operative complications like pneumonia, recurrent laryngeal nerve palsy and surgical site infection were similar in both groups. Post-operative mortality was seen in 1.5% and 3.7% in ICG group and non-ICG group respectively (p=0.4). Overall leak in ICG group was 9% and 16.5% in non-ICG group (p=0.06). In ICG group with the perfusion time of more than 60 seconds, the leak rate was only 3.5% in comparison to 16.5% in non ICG group (p=0.009).</p> <p><strong>Conclusion:</strong> ICG angiography provides an objective assessment about the perfusion of gastric conduit during the time of anastomosis. Anastomosis at area of gastric conduit with perfusion time less than 60 seconds, minimizes leak rate in neck.</p> Mukti Devkota Binay Thakur Puroshattam Adhikari Yogesh Regmi Copyright (c) 2022 Nepalese Journal of Cancer 2022-04-03 2022-04-03 6 1 79 86 10.3126/njc.v6i1.44212 Geographical Trends in Prevalence of Stomach Cancer in Nepal <p><strong>Background: </strong>Carcinoma stomach is a multifactorial disease accounting for second most common cancer among male and fifth most common cancer among Nepalese population. The prevalence of stomach cancer is partially influenced by geographical variation, social and cultural factors that significantly affect disease reporting and seeking medical care. In this study we have analyzed geographical trends in prevalence of stomach cancer among patients visiting BPKMCH.</p> <p><strong>Materials and Methods: </strong>A single center descriptive retrospective study to analyze the geographical trends among stomach cancer patients visiting BPKMCH from January 2013 to December 2017 was designed and patients’ information available at medical record were obtained. Analysis was completed with SPSS Statistics.</p> <p><strong>Results: </strong>During the period of 5-year total 832 cases of stomach cancer were seen at the Department of Surgical Oncology at BPKMCH. These cases comprised of 349 female and 483 males with male to female (M: F) ratio of 1.4:1. The mean age of presentation was 55 years. Maximum number of cases 57.3% (477) were from terai region of Nepal.</p> <p><strong>Conclusions: </strong>This study provides clue regarding higher cases of stomach cancer among male patients and from terai region of Nepal.<span class="Apple-converted-space">&nbsp;</span></p> <p>&nbsp;</p> Ganga Sapkota Dipendra Kumar Mallik Bhawna Wagle Sunil Dhakal Sapana Bhandari Copyright (c) 2022 Nepalese Journal of Cancer 2022-04-03 2022-04-03 6 1 87 91 10.3126/njc.v6i1.44254 The clinicopathological profile of Renal cell carcinoma at BP Koirala Memorial Cancer Hospital <p><strong>Introduction:</strong> Renal cell carcinoma accounts for 3-5%of all oncological diagnoses. In this study, we aim to assess the clinicopathological profile of Renal cell carcinoma in a cancer hospital of Nepal. <span class="Apple-converted-space"> </span></p> <p><strong>Method:</strong> This is a retrospective study conducted at BP Koirala Memorial Cancer hospital Nepal. All patients with localized and locally advanced RCC who underwent radical or partial nephrectomy at our hospital between Jan 2012 to Dec 2018 were included. Normally distributed continuous variables were expressed as median, mean ± standard deviation (SD). Categorical variables were expressed as frequencies and percentages of an appropriate denominator.<span class="Apple-converted-space"> </span></p> <p><strong>Results:</strong> Among 94 patients with RCC, the median age was 55 years (53.56 ±12.83). Most of the patients were male (56.4%, n=53) and Hindu by religion (67.02%, n=63). Eighty-three percent (n=78) of patients were smokers, 58.5 % (n=55) were hypertensive and 40.4% (n= 38) had history of diabetes mellitus. The most common symptom was incidental renal mass (42.55%, n=40). Ninety-five percent (n=89) of the patients underwent radical nephrectomy and five percent (n=5) of the patients underwent partial nephrectomy. The median duration of postoperative hospital stay was 8 days. The most common histological finding was Clear cell type (86.17, n=81) followed by papillary cell type (10.63%, n= 10) followed by chromophobe type (2.12%, n=2), and duct of Bellini( 1.06%, n=1). Most of the patients had pathological T2 (41.48%, n=39) disease followed by T3 (26.59%, n=25) disease.<span class="Apple-converted-space"> </span></p> <p><strong>Conclusion:</strong> Smoker males in the fifth to sixth decade of life are at risk for developing RCC. Radical Nephrectomy is the standard of care with Clear cell carcinoma as the most common histological subtype.</p> <p> </p> Gyan Prasad Pokhrel Aditya Jalan Erena Pradhan Bharatmani Pokhrel Binod Babu Gharti Umesh Nepal Nirmal Lamichhane Copyright (c) 2022 Nepalese Journal of Cancer 2022-04-03 2022-04-03 6 1 92 95 10.3126/njc.v6i1.44235 Prevalence of Breast Cancer in different geographical regions: A Retrospective Study from Central Nepal <p><strong>Background: </strong>Breast cancer is the second most common malignancy among Nepalese women with prevalence of 28.5 per 100,000 population.<span class="Apple-converted-space"> </span>In Nepal due to lack of uniform health resources and awareness, breast cancer cases reporting is different in three geographical regions. This study aims to look at the difference in prevalence of breast cancer in different geographical regions.</p> <p><strong>Materials and Methods: </strong>A single center descriptive retrospective study to analyze the prevalence of breast cancer in different geographical regions among patients visiting BPKMCH from January 2014 to December 2018 was designed and patients’ information available at medical record were obtained. Analysis was completed with SPSS Statistics.</p> <p><strong>Results:</strong> During the period of 5-year total 2115 cases of breast cancer were seen at the Department of Surgical Oncology at BPKMCH. These cases comprised of 2052 female and 63males. The mean age of presentation was 48 years. Maximum number of cases 65% (1376) were from terai region of Nepal.</p> <p><strong>Conclusions:</strong> This study provides clue regarding higher cases of breast cancer among individuals from terai region of Nepal.</p> Ganga Sapkota Bishwa Ram Poudel Dipendra Kumar Mallik Bhawna Wagle Sunil Dhakal Sapana Bhandari Copyright (c) 2022 Nepalese Journal of Cancer 2022-04-03 2022-04-03 6 1 101 105 10.3126/njc.v6i1.44255 Bronchogenic Cyst in a young Child <p>Bronchogenic cysts are rare cystic disease of the mediastinum in children. They are often asymptomatic and are diagnosed incidentally. Symptoms, if present are due to compression of the adjacent structures or the added infection. A 5 year old female child was referred to our thoracic surgery department with history of fever for 2 days. She had recurrent respiratory tract infection in the past needing treatment. CT revealed a cystic mass in the mediastinum. Video Assisted Thoracoscopic Surgery (VATS) excision of the cyst was done. The patient recovered uneventfully and the histopathological examination revealed it to be a bronchogenic cyst.</p> Niraj Bhattarai Rasesh Shrestha Binay Thakur Copyright (c) 2022 Nepalese Journal of Cancer 2022-04-03 2022-04-03 6 1 6 9 10.3126/njc.v6i1.44202 Adenosquamous Carcinoma of the Pancreas: a Rare Entity <p>Pancreatic Adenosquamous Carcinoma is a rare subtype of pancreatic cancer. Here we present a 51 year old man who presented with features of obstructive jaundice. Radiological imaging studies revealed the presence of solid pancreatic mass. He underwent pancreaticoduodenectomy – superior mesenteric artery (SMA) first approach. Postoperative period was complicated with prolonged ascitic drainage. Histological analysis suggested adenosquamous carcinoma with 30% squamous components, pT2N0M0. Patient is being planned for adjuvant chemotherapy. <span class="Apple-converted-space"> </span></p> <p> </p> Ashish Kharel Shashank Shrestha Rashes Shrestha Niraj Bhattarai Bigyan Acharya Binay Thakur Copyright (c) 2022 Nepalese Journal of Cancer 2022-04-03 2022-04-03 6 1 96 100 10.3126/njc.v6i1.44236