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> en-US <p>This license lets others distribute, remix, tweak, and build upon your work, even commercially, as long as NJC and the authors are acknowledged.</p> <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> (Nirmal Lamichhane) (Sioux Cumming) Tue, 28 Nov 2023 08:52:06 +0000 OJS 60 Aberrent hepatic arteries, a rare anatomic variant: case report <p>Anatomic variations of hepatic arteries are observed in 12-49% cases. But replaced right and left hepatic arteries are extremely rare (0.8%). We report a 61 years old male patient with the diagnosis of gastric cancer. He underwent distal subtotal gastrectomy with D2 lymphadenectomy. Intraoperatively, both right and left hepatic arteries were replaced and were arising from superior mesenteric artery and aorta, respectively.</p> Rajendra Dhakal, Binay Thakir, Shashank Shrestha, Ashis Kharel, Pankaj Shah, Bibhay Hari Koirala, Shiva Kandel, Deewas Neupane Copyright (c) 2023 Nepalese Journal of Cancer Tue, 28 Nov 2023 00:00:00 +0000 Primary CIC-rearranged Gastric sarcoma: A rare diagnosis <p>Gastric sarcoma is rare, accounting for 1-3% of all gastric neoplasms. WHO has published a new classification of soft tissue tumors and a group of undifferentiated round cell sarcomas, including CIC-rearranged sarcoma has been added. CIC-rearranged sarcoma has not been reported till date. We report a case of CIC-rearranged gastric sarcoma which was managed with chemotherapy and multivisceral resection.</p> Saroj Dhungana, Binay Thakur, Nikesh Bhandari, Shashank Shrestha, Ashish Kharel, Deewash Neupane Copyright (c) 2023 Nepalese Journal of Cancer Tue, 28 Nov 2023 00:00:00 +0000 Primary Leiomyosarcoma of Breast: A case report from Nepal <p>Leiomyosarcoma is an uncommon form of breast cancer, accounting for 5-10% of all breast sarcomas with only 70<sup>4</sup> instances recorded to date. Waterwarth described the first instance of primary leiomyosarcoma breast (PLB) in 1968. This is the first case of PLB documented in Nepal, that we’re aware of. Leiomyosarcoma is a malignant non-epithelial smooth muscle tumor that can occur anywhere in the body. We discuss the case of a 41-year-old female who presented with a breast lump that was subsequently confirmed as Primary leiomyosarcoma and was treated with wide local excision with margins. We've been watching her progress for a year.</p> Manisha K C, Kapendra Sekhar Amatya, Alissa K C, Pratik Bhattarai, Sreya Shah, Nabin Rana Copyright (c) 2023 Nepalese Journal of Cancer Tue, 28 Nov 2023 00:00:00 +0000 Primary Epithelioid Sarcoma of Frontotemporal Scalp: a Rare Case Report with Recent Literature Review <p>Epithelioid sarcoma (ES) is a very rare and aggressive mesenchymal sarcoma subtype which represents less than 1% of soft tissue sarcomas (STS). According to the origin of the site, there are two types of ES: distal-type epithelioid sarcoma and proximal-type epithelioid sarcoma. The clinical diagnosis of ES mainly is confirmed by histopathology examination followed by immunohistochemistry. Radical excisional surgery is the best treatment option for epithelioid sarcoma. According to TNM staging, the treatment option will vary from surgery to surgery accompanied with radiotherapy and chemotherapy. Here in, we presented a 36-year-old man had non-healing ulcer in left frontotemporal scalp extending to involve left orbit. Histopathological confirmed epithelioid sarcoma. Magnetic Resonance Imaging (MRI) of Head and Neck revealed that there was mass in left frontotemporal scalp measuring 6.7 X 5.7 X 2.6 cm extending to zygomatic region and left orbit D/D malignant mass/sarcoma with bilateral (B/L) sinusitis. After that patient undergone for Wide Local excision (WLE) surgery on 11<sup>th</sup> September 2022. Adjuvant Radiation Therapy (RT) 6000 cGy radiation dose in 30 fractions (#) which was 200 cGy per fraction (#) were given during 22<sup>nd</sup> September to 10<sup>th</sup> November 2022 due to local advancement of disease. Patient was asked to follow up after 6 weeks after completion of RT. After 6 weeks of surgery, the patient was undergone for MRI and report revealed normal study.</p> Ganga D Adhikari, Sandip Kumar Mandal, Suman Gnawali, Gyan B  Shrestha, Nitu Sharma, Ajay Kumar Yadav Copyright (c) 2023 Nepalese Journal of Cancer Tue, 28 Nov 2023 00:00:00 +0000 Right ovarian Endodermal sinus tumor and left ovarian Gonadoblastoma in a young female of Turner’s syndrome: a case report. <p>Gonadal dysgenesis includes variety of clinical condition due to abnormalities of sex chromosomes. The most frequent of this condition is Turner’s syndrome, affecting 1 in every 2000 to 2500 live births. Gonadoblastoma is a benign lesion mostly detected in individuals with dysgenetic gonads with Y chromosome and has potential for malignant transformation; or may be associated with malignant germ cell tumors, most commonly dysgerminoma or occasionally immature teratoma, endodermal sinus tumor, embryonal carcinoma, or choriocarcinoma. We report a 22-year-old girl with primary amenorrhea and physical stigmas of Turner’s syndrome presented with huge abdominopelvic mass and abdominal pain. She underwent laparotomy with TAH with BSO with appendectomy with omentectomy with resection of portion of terminal ileum with ileoileal anastomosis with resection of sigmoid colon with colorectal anastomosis and right pelvic lymph node dissection. Patient had anastomotic site leak with sepsis with multi organ dysfunction syndrome and could not be revived. Final histopathology was consistent with endodermal sinus tumor in right ovary and gonadoblastoma in left ovary. Her karyotype analysis revealed 45, X0. Endodermal sinus tumor is a highly malignant gem cell tumor with poor prognosis. Gonadoblastoma associated with endodermal sinus tumor in Turner’s syndrome is very rare and challenging for the clinical management.</p> Manju Pandey, Hemnath Subedi, Nirmal Lamichhane, Greta Pandey, Binuma Shrestha Copyright (c) 2023 Nepalese Journal of Cancer Thu, 30 Nov 2023 00:00:00 +0000 Anastomotic leak after esophagectomy <p><strong>Background: </strong>Esophageal anastomotic leakage (AL) remains a frequent and feared postoperative complication, associated with high mortality and impaired quality of life. The aim of this study was to assess AL rates after esophagectomy with anastomosis at neck for esophageal and gastroesophageal junction cancer (GEJ), and compare the impact of AL on oncological outcome.</p> <p><strong>Methods: </strong>Patients with squamous cell carcinoma and adenocarcinoma of esophagus/ gastroesophageal junction who underwent surgery between 2001-2018 were analyzed for cervical anastomotic leak.</p> <p><strong>Results: </strong>419 patients underwent esophagectomy with anastomosis placed at neck during 2001-2018. AL rate was 16%. AL was not found to be associated with anastomotic technique, surgical approach and technique, organ of conduit and route of conduit. A subgroup of patients (n=93) who had undergone neoadjuvant chemoradiation followed by surgery had AL of 30% vs 12% in rest of the treatment modality group (p&lt;0.001). Median survival was 26 months and 34 months in patients with AL and without AL, respectively (p=0.03). AL was managed successfully in all patients.</p> <p><strong>Conclusion: </strong>Cervical AL after esophagectomy for cancer of esophagus and GEJ can be treated successfully without major complications.</p> Binay Thakur, Ming Yang, Nikesh Bhandari, Zhenpin Sun, Shashank Shrestha, Ashis Kharel, Deewas Neupane, Asha Thapa Copyright (c) 2023 Nepalese Journal of Cancer Tue, 28 Nov 2023 00:00:00 +0000 Clinicopathological profile of breast cancer in young females at tertiary cancer center in Nepal <p><strong>Background:</strong> Breast cancer is one of the commonest cancer in females globally. The scenario in Nepal is also similar. Breast cancers are now not only limited to older age group but younger females are also visiting hospital with breast malignancies. An increase in trend of breast cancer in young females have been noticed. They are reported to have a more aggressive clinical and pathological features.</p> <p><strong>Material and methods</strong>: We conducted a retrospective study of breast cancers in mastectomy specimen with focus on young females of less than or equal to forty years of age. The data collection period was from January 1st to December 31st 2021. Data were collected from the records of department of pathology. All those cases of post neoadjuvant chemotherapy with no residual masses microscopically and cases of male breast carcinoma were excluded.</p> <p><strong>Results:</strong> A total of 273 cases of mastectomies were analyzed. 75 cases were from patients of ≤40 years of age and 198 belonged to age group of &gt;40 years. Invasive breast carcinoma of no special type and histological (Nottingham Histological score) grade of Grade 2 was common in both groups. However grade 3 was more prevalent in younger group. Left breast was most frequent laterality for the cancer. Perineural invasion was found more in older females.</p> <p><strong>Conclusion:</strong> Breast cancer is no longer a disease of older females only. More and more cases are being diagnosed at younger age group and they are more aggressive in them. Hence there is a greater need to spread awareness regarding breast cancer in the younger population as well.</p> Greta Pandey, Ranjan Raj Bhatta, Suraj Upreti, Ishan Dhungana, Bishow Ram Paudel Copyright (c) 2023 Nepalese Journal of Cancer Tue, 28 Nov 2023 00:00:00 +0000 Immunohistochemical Analysis of Breast Cancer at BP Koirala Memorial Cancer Hospital Nepal <p><strong>Introduction: </strong>Immunohistochemistry test is used to characterize intracellular proteins or various cell surfaces in all tissues. It is used to solve diagnostic problems or for determining prognosis and response to therapy in breast pathology. ER, PR and HER2 are well established biomarkers for breast cancer prognosis and for guiding treatment.</p> <p><strong>Materials and methods: </strong>This is retrospective study at Department of Pathology of B P Koirala Memorial Cancer Hospital in Bharatpur, Chitwan, Nepal effective from 15 April 2020 to 14 April 2021. All the data were retrieved and analyzed.</p> <p><strong>Results: </strong>Total 205 breast cancer cases were analyzed, among them 198 cases were females accounting 96.5 % and 7 cases were males accounting 3.5 %. Altogether 125 (60.9%) cases had immunohistochemistry panel of ER, PR and HER2 tests done. 48% cases were ER positive, 42.4% cases were PR positive, 34.4% were HER2 positive and 9.9% cases were triple negative.</p> <p><strong>Conclusion: </strong>Breast cancer is more common in females than in males. Most common affected age group was 41-50 years. Most common histological type was invasive ductal carcinoma NST. In order to improve breast cancer outcomes and survival, early diagnosis, immunohistochemistry hormone analysis and screening tests should be done.</p> Chin Bahadur Pun Magar, Greta Pandey, Suraj Uprety, Ishan Dhungana, Nandita Jha Copyright (c) 2023 Nepalese Journal of Cancer Tue, 28 Nov 2023 00:00:00 +0000 Study of Comparison of conventional ultrasound, RMI 4 score and CT imaging in diagnosis of Ovarian Cancer confirmed by surgical-pathological findings <p><strong>Background:</strong> Ovarian cancer; 5<sup>th</sup> commonest cancer among Nepalese women is the leading cause of gynecologic cancer related death. Proper diagnostic studies therefore assist Gyne-oncologist for appropriate surgery and chemotherapeutic planning, there by optimizing the patient prognosis. Objective of current study was to compare ultrasonography imaging, CT imaging, CA 125 value, RMI 4 score and surgical staging in diagnosis of ovarian cancer correlated with histo-pathological findings.</p> <p><strong>Materials and Methods:</strong> The study was retrospective observational study, carried out between 14<sup>th</sup> April 2019 to 16<sup>th</sup> October 2021, in the department of surgical oncology (Gynecology oncology unit), B.P Koirala Memorial Cancer Hospital, Bharatpur.</p> <p><strong>Results:</strong> 53 patient data were included in the observation. The efficacy of Ultrasound (sensitivity-90.90%, Specificity-60%) and CT (sensitivity-100%, specificity-65%) gave the best result in non-invasive investigations; whereas surgical staging (sensitivity- 96.96%, specificity- 90%) gave the better result when invasive modalities were considered. RMI 4 score had sensitivity 96.96% and specificity 60%.</p> <p><strong>Conclusion:</strong> All modalities had good diagnostic performances and complemented each other in further defining the characterization of the ovarian mass, local spread and distant tumor dissemination.</p> Sebina Baniya, Binuma Shrestha, Bijay Chandra Acharya, Sarita Gurung, Hem Nath Subedi, Manju Pandey, Shristi Tiwari, Pramila Thapa Copyright (c) 2023 Nepalese Journal of Cancer Wed, 27 Sep 2023 00:00:00 +0000 Primary Cytoreductive Surgery versus Neoadjuvant Chemotherapy followed by Interval Cytoreductive Surgery for Advanced Epithelial Ovarian Cancer: A Retrospective Cohort Study <p><strong>Introduction: </strong>Epithelial ovarian cancer (EOC) represents about two-thirds of ovarian malignancies and usually presents with advanced disease. Primary cytoreductive (PCR) surgery is known to be the cornerstone of treatment of advanced EOC, but it might not always be feasible to obtain optimal cytoreduction. Neoadjuvant chemotherapy (NACT) has been proposed as an alternative approach. This study aims to compare the survival of patients, post-operative morbidity and the extent of cytoreduction that was achieved among the two treatment groups.</p> <p><strong>Methods: </strong>A retrospective cohort study was done in Bhaktapur Cancer Hospital of Nepal. All women who underwent surgical management for advanced epithelial ovarian cancer from 2016 to 2019 were included in the study and analyzed using SPSS version 23.</p> <p><strong>Results: </strong>Among 29 cases of advanced EOC, seven cases underwent PCR and 22 cases had NACT followed by interval cytoreduction (ICR). Optimal debulking was achieved in 85.7% of the cases in the PCR group and in 95.5% in the NACT+ICR group. Overall survival of &gt;3 years in the PCR group was 42.9% while in the NACT group was 59.1%. Progression free survival (PFS) of &gt;3 years was seen in 28.6% in the PCR group and in 45.5% in the NACT group.</p> <p><strong>Conclusions</strong>: The current study shows that NACT followed by ICR has better survival outcomes than PCR. Despite the limitations of the study, NACT + ICR can be considered a reasonable alternative to PCR in advanced EOC.</p> Shristee Shrestha Prajapati, Anisha Shrestha, Usha Bade Shrestha, Roshan Prajapati, Sagar Tiwari, Siddinath Gyawali, Guru Sharan Sah Copyright (c) 2023 Nepalese Journal of Cancer Wed, 27 Sep 2023 00:00:00 +0000 Surgical site infection following abdominal cancer surgery: a retrospective study in a tertiary care cancer hospital <p><strong>Background</strong>: Surgical site infections (SSIs) are significant complications following abdominal cancer surgery, resulting in patient discomfort, prolonged hospitalization, and increased healthcare costs. Despite efforts to mitigate their occurrence, SSIs remain a challenge in healthcare settings, particularly in low- and middle-income countries<strong>. </strong></p> <p><strong>Materials and Methods</strong>: This retrospective cross-sectional study aimed to determine the incidence, risk factors, microbiological patterns, and impact of SSIs in patients undergoing open abdominal cancer surgery at a tertiary cancer hospital in Nepal.</p> <p><strong>Results:</strong> A total of 206 patients were included in the study, with an SSI incidence of 35.4%. Superficial SSIs accounted for 87.7% of cases, while 12.2% were deep or organ/space infections. The study explored various risk factors, including patient demographics, wound classification, surgical type, and preoperative conditions, and although certain factors showed associations, none reached statistical significance. Notably, longer surgical duration was linked to a higher risk of SSIs. Patients with SSIs experienced significantly longer hospital stays compared to those without SSIs. The predominant pathogens isolated were Escherichia coli, Staphylococcus aureus, and Citrobacter freundii, many of which displayed multidrug resistance.</p> <p><strong>Conclusions:</strong> These findings highlight the need for tailored prevention strategies, prudent antibiotic use, and enhanced infection control measures in this high-risk population undergoing abdominal cancer surgery.</p> Shashank Shrestha, Binay Thakur, Ming Yang, Zhenpin Sun, Ashish Kharel, Deewash Neupane Copyright (c) 2023 Nepalese Journal of Cancer Tue, 28 Nov 2023 00:00:00 +0000 Thoracoscopic biopsy in the diagnosis of lung and pleural diseases <p><strong>Background: </strong>Thoracoscopy is a useful procedure for evaluation and diagnosis of pleural effusion and other thoracic disorders. Our study aimed to evaluate the scope and use of thoracoscopic biopsy for the evaluation of thoracic disorders and report on the outcomes of this technique.</p> <p><strong>Methods: </strong>Patients undergoing thoracoscopic biopsy procedure from March 2022 to May 2023 were analyzed for indications, complication and outcomes.</p> <p><strong>Results: </strong>85 patients underwent thoracoscopic biopsy over a period of 15 months, of which 38 (44.7%) were males and 47 (55.3%) were females. The mean age was 60 years. Cough, dyspnea and chest pain were the most common presenting symptoms. Thoracosopy was most commonly done on the right side (67.1%). Pleura (57.6%) was the most common biopsy site, followed by lungs (22.4%), lymph node (12.9%) and mediastinum (3.7%). One case was converted to open procedure. Post operative complication rate was 3.5%. Adenocarcinoma (31.8%) was the most common histology, followed by squamous cell carcinoma (9.4%). 36.5% patients had benign disease and 11.8% patients had metastatic extra-thoracic malignancy.</p> <p><strong>Conclusion: </strong>Thoracoscopy is a safe and simple procedure for diagnosis of pleural and other thoracic disorders with the advantage of tissue sampling from lesion under direct visualization. It is a useful tool in the armamentarium of thoracic surgeons.</p> Ashish Kharel, Binay Thakur, Ming Yang, Nikesh Bhandari, Zhenqing Sun, Shashank Shrestha, Bhuwan Ghimire, Deewas Neupane Copyright (c) 2023 Nepalese Journal of Cancer Tue, 28 Nov 2023 00:00:00 +0000 Oncology Nurses’ Knowledge and Attitude towards Palliative Care <p><strong>Introduction:</strong> Palliative care (PC) is considered an integral component of comprehensive cancer care. Insufficient knowledge among nurses was one of the main obstacles to providing high-quality palliative care services. This study assessed oncology nurses' knowledge and attitude toward palliative care.</p> <p><strong>Method: </strong> A cross-sectional study was conducted among 125 oncology nurses working at B.P. Koirala Memorial Cancer Hospital (BPKMCH). A simple random sampling technique was used. The self-administered questionnaire: Palliative Care Quiz for Nursing (PCQN) and “From melt Attitudes toward Care of the Dying Scale (FATCOD) were used to assess knowledge and attitude. The data were analyzed and interpreted using SPSS version 22. The p-value was set at &lt;0.05. </p> <p><strong>Results</strong>: The majority (59.2) of nurses had a poor level of knowledge with a mean PCQN score for was (9.208 ±2.052) out of 20. The lowest score in the psychological/spiritual subcategory. The majority (89.6%) of nurses had good attitudes, with a mean attitude score was (109.816 ± 9.788). There was a significant association found between the level of knowledge with educational status (P = 0.041), current working area (P = 0.017), and working experience (P = 0.008). Likewise, a significant association was also found between the level of attitude and current working area (P = 0.018). </p> <p><strong>Conclusion:</strong> The majority of the nurses working at BPKMCH had poor levels of knowledge, whereas, most nurses had good attitudes toward PC. A significant association was found between the level of knowledge with educational status, current working area, and work experience. </p> Usha Thapa, Sabita Panthi, Laxmi Neupane Copyright (c) 2023 Nepalese Journal of Cancer Tue, 28 Nov 2023 00:00:00 +0000 Pediatric urological malignancies operated at a tertiary cancer center in Nepal: a 5 year experience <p><strong>Introduction:</strong> Pediatric tumor is often an incidental discovery. Improvements in diagnosis modality and treatment have decreased the mortality rates.</p> <p><strong>Materials and</strong> <strong>Method:</strong> We performed a retrospective review of pediatric patients operated in the Department of Urology at B.P. Koirala Memorial Cancer Hospital from January 2018 to December 2022.</p> <p><strong>Results:</strong> A total of 28 pediatric patients were operated for cancers in that time duration. Among them there were 6 cases of Neuroblastoma, 19 cases of Nephroblastoma and 3 cases of Testicular germ cell tumors.</p> <p><strong>Conclusion:</strong> Despite limited resources, a fair number of pediatric tumors are being managed in BPKMCH with good results.</p> Sulav Pradhan, Umesh Nepal, Bharat Mani Pokharel, Binod Babu Gharti, Gyan Prasad Pokharel, Nirmal Lamichhane Copyright (c) 2023 Nepalese Journal of Cancer Tue, 28 Nov 2023 00:00:00 +0000 Role of MDCTA in Bronchial Artery Embolization in patients with Hemoptysis <p><strong>Objective:</strong>To evaluate the role of bronchial artery MDCTA in bronchial artery embolization in the treatment of haemoptysis patients.</p> <p><strong>Methods: </strong>46 patients treated with bronchial artery embolization for haemoptysis was included in the study at 1<sup>st</sup> Affiliated Hospital, Jinzhou Medical University. They were classified into 2 groups, Group A-Preoperative CTA and Group B -Simple DSA. Group A (n=28) is those with preoperative CTA examination performed, while group B (n=18) is those who performed DSA directly without preoperative CTA. The results of CTA and DSA, technical and clinical outcome compared and analyzed.</p> <p><strong>Results: </strong>48 bleeding arteries were identified in group A while 24 bleeding arteries were identified in group B. These arteries were embolized successfully. In the group A total fluoroscopy time, total operative time, and contrast dose were shorter than group B respectively (8.42± 2.82; 28.34± 5.61; 27.86± 6.42 VS. 18.46± 10.34; 40.27±16.32; 62.59±19.48).</p> <p><strong>Conclusion: </strong>Bronchial artery CTA can objectively evaluate haemoptysis associated with vascular origin, number and its shape and it can reduce the operative time and reduce the radiation exposure to doctors and patients too, it increase the success rate of haemoptysis interventional therapy guidance has wide clinical application value</p> Shailesh Kumar Panday, Sandip Kumar Mandal, Suman Gnawali, Nitu Sharma, Ganga Dutta Adhikari, Ajay Kumar Yadav Copyright (c) 2023 Nepalese Journal of Cancer Tue, 28 Nov 2023 00:00:00 +0000 Breast carcinoma among patients undergoing breast ultrasonography in a tertiary care center: A descriptive cross-sectional study <p><strong>Introduction:</strong> Ultrasonography (USG) is one of the modality of choice for detection of breast lesions due to its advantage over radiation exposure, differentiation between solid tumor and cyst filled with fluid, especially for imaging of young age females. The aim of the study is to find out the prevalence of breast cancer among the patients undergoing scanning of USG and estimate its sensitivity, specificity and accuracy to detect breast lesion in comparison with histopathology.</p> <p><strong>Materials and Methods: </strong>A descriptive cross-sectional study was conducted from 15<sup>th</sup> April to 10<sup>th</sup> September, 2022. A sample size of 426 was taken in convenience sampling method. Collected data were entered and analyzed on SPSS 25.0. Sensitivity, specificity and accuracy of USG to detect breast lesion in comparison to histopathology findings.</p> <p><strong>Results: </strong>Among 426 patients sample coming from OPD, breast cancer was seen in 53 (12.44%) patients. Among 426, 418 were female and 8 were male patients. Age ranged from 13-75 years. The sensitivity, specificity, negative predictive value, positive predictive value and accuracy of USG to detect breast lesion are 94%, 100%, 94.23%, 100% and 97% respectively.</p> <p><strong>Conclusion: </strong>The sensitivity, specificity, negative predictive value, positive predictive value and accuracy of USG to detect breast lesion is quite high. USG is highly recommended in examination of breast lesions.</p> Seema Guragain, Sandip Kumar Mandal, Suman Gnawali, Shailesh Panday, Nitu Sharma, Ganga D Adhikari, Ajay Kumar Yadav Copyright (c) 2023 Nepalese Journal of Cancer Tue, 28 Nov 2023 00:00:00 +0000 Frailty Index among Older Adults with Cancer at B.P. Koirala Memorial Cancer Hospital, Chitwan, Nepal <p><strong>Introduction: </strong>The number of older adults is increasing day by day. This fact implies important health challenges. Frailty level in older adults having cancer is a globally important health issue. The concept of frailty has become gradually more accepted as one of the most important factors particularly in patients with cancer who are receiving treatment. The objective of the study was to find out the frailty index among older adults with cancer admitted for surgery at BPKMCH, Bharatpur, Nepal.</p> <p><strong>Methods: </strong>An analytical cross-sectional study was conducted among 111 older adults. Nonprobability purposive sampling technique was used for data collection. Data were collected by face-to-face interview method using Carolina Frailty Index (CFI) developed from a cancer-specific geriatric assessment. Data was entered and analyzed by using SPSS-20, p-value &lt;0.05 was considered as statistically significant.</p> <p><strong>Results: </strong>The age of the respondents ranged from 60 to 87 years with mean <u>+</u> SD: 67.46<u>+</u>6.11. Most common site of cancer was gastrointestinal system (47.7%) and the most prevalent co- morbidities in this study were diabetes mellitus (19.8%) and high blood pressure (18.0%). Based on the CFI score, 82.0% were robust, 11.7% were pre-frail and 6.3% were frail. Increasing age (<em>P</em>=0.033) and ethnicity (<em>P</em>=0. 042) were associated with frailty.</p> <p><strong>Conclusion:</strong> CFI is a practical way to define oncologic frailty. Though it is only a descriptive study, frailty index revealed by this study would provide valuable baseline information for further researchers.</p> Laxmi Neupane, Hari Prasad Upadhyay, Nirmal Lamichhane Copyright (c) 2023 Nepalese Journal of Cancer Tue, 28 Nov 2023 00:00:00 +0000 Clinicopathological profile of Papillary thyroid carcinoma in a tertiary cancer hospital in Nepal <p><strong>Background:</strong> Differentiated thyroid cancers (DTC), including papillary thyroid carcinoma (PTC), are on the rise. This study provides a detailed examination of PTC cases in a tertiary care cancer hospital in Nepal, aiming to understand its clinical characteristics and treatment patterns. We conducted a retrospective analysis of PTC, including demographics, features of tumor, and treatment modalities.</p> <p><strong>Methods:</strong> A retrospective cross-sectional study assessed cases of PTC from January 2022 to December 2022. Patient data were collected and analyzed, focusing on demographics, tumor attributes, and treatment approaches.</p> <p><strong>Results</strong>: Among 105 patients, females were predominant (female-to-male ratio 5.2:1), and ethnic diversity was observed. Most patients were from Lumbini Pradesh. The mean age was 40.78 years. Fine-needle aspiration cytology (FNAC) showed Bethesda VI as the most common classification. Primary treatment involved total thyroidectomy (76.25%). Classical PTC was the major histopathological variant (78.1%). Tumors were frequently located in the right lobe (55.25%). Unifocal tumors were prevalent (74.28%), with an average size of 2.74 cm. Lymph node metastasis occurred in 49.5% of patients. Intermediate-risk patients constituted the majority (53.5%).</p> <p><strong>Conclusion:</strong> This study offers crucial insights into PTC's clinical spectrum in Nepal, aiding in tailored patient care strategies. The findings contribute to informed decision-making for enhanced treatment outcomes.</p> Samyam Parajuli, Dej Kumar Gautam, Anil Bikram Karki, Dilip Karmacharya, Amar Shrestha, Bijay Neupane, Greta Pandey, Kamana Chalise, Subash Devkota Copyright (c) 2023 Nepalese Journal of Cancer Tue, 28 Nov 2023 00:00:00 +0000 Fate of de-functioning ileostomy after left colon and rectal cancer resection: observation from a single unit of a cancer hospital. <p><strong>Background: </strong>De-functioning ileostomy (DS) has been shown to reduce rate of anastomotic leak after left colon and rectal cancer resection and can avoid consequences of leak with its morbidity and possible mortality. Externalisation of bowel is not easily appreciated; patients always inquire about the timing of closure and not all stomas are closed. The aim of the study is to assess the timing of stoma closure and the reasons for stoma becoming permanent. <strong> </strong></p> <p><strong>Methods: </strong>Patients who underwent surgery for left colon and rectal cancer with de-functioning stoma from April 2019 to May 2022 in single unit of Bhaktapur Cancer Hospital, were assessed regarding timing of stoma closure. We have made a policy of stoma closure after completion of adjuvant therapy. De-functioning stoma that was not reversed at follow up were assessed regarding reason for it becoming permanent.</p> <p><strong>Results: </strong>Forty-two patients underwent de-functioning stoma during the study period; 30 after rectal resection, 2 after pouch creation, 6 after anterior resection and 4 after left hemicolectomy. Twenty-eight (77%) stomas were closed, 5 are receiving adjuvant treatment. Closure was not done in 8 patients; 5 due to recurrence of disease; 1 due to patient wish, 2 deaths occurred prior to closure, one due to COVID-19 and another due to acute myocardial infraction. One patient with multiorgan resection died within 30 days of surgery due to other medical cause. The median time of stoma closure after completion of adjuvant treatment is 8 weeks, IQR (7-10). Patients had to stay with stoma for a median period of 6months, IQR (5-8). The median time for discharge after stoma reversal is 9 days, IQR (7-10). There were 4 Grade II Clavien-Dindo complications after stoma closure.</p> <p><strong>Conclusion: </strong>Seventy- seven percent of patients with DS underwent closure in our series. Recurrence was the most common cause for it becoming permanent.</p> Deep Lamichhane, Suraj Suwal, Resham Rana, Rishikesh Narayan Shrestha Copyright (c) 2023 Nepalese Journal of Cancer Tue, 28 Nov 2023 00:00:00 +0000 An analysis of flexible cystoscopic findings among patients visiting Urology outpatient services at a tertiary cancer center in Nepal <p><strong>Introduction:</strong> Cystoscopy is a common urological procedure done for diagnosis and surveillance of patients with urological ailments. With various lower urinary tract symptoms, flexible cystoscopy can be performed with a minimal discomfort to the patient and in a outpatient setting under local anesthesia.</p> <p><strong>Materials and Methods:</strong> We retrospectively analyzed 468 patients undergoing flexible cystoscopy from January 2022 to July 2022 over a period of six months in the outpatient services of B.P. Koirala Memorial Cancer Hospital.</p> <p><strong>Results:</strong> Majority of the patients (56.2%) had some pathology of the lower urinary tract among which urinary bladder mass or malignancy was the predominant findings with 35%. </p> <p><strong>Conclusion</strong>: Flexible cystoscopy is an important tool in urology with high diagnostic yield.</p> Umesh Nepal, Bharat Mani Pokharel, Sulav Pradhan, Binod Babu Gharti, Gyan Prasad Pokharel, Nirmal Lamichhane Copyright (c) 2023 Nepalese Journal of Cancer Wed, 27 Sep 2023 00:00:00 +0000 Role of Neoadjuvant Chemotherapy on Advanced Epithelial Ovarian Cancer <table width="100%"> <tbody> <tr> <td> <p><strong>Correspondence</strong></p> <p>Dr Manju Pandey , Gynecology Oncology Unit, &nbsp;Dept. of Surgical Oncology, BP Koirala Memorial Cancer Hospital, Bharatpur, Nepal. Email: <a href=""></a></p> <p>&nbsp;</p> </td> </tr> </tbody> </table> <p><br><strong>Introduction</strong>: Ovarian cancer is the most lethal gynecological malignancy diagnosed at late stage in most of the cases. Management includes primary debulking surgery with a target of no gross residual disease or ≤ 1cm residual disease followed by paclitaxel and carboplatin-based chemotherapy. Neoadjuvant chemotherapy of at least 3 cycles followed by interval debulking surgery is an alternative option in selected cases of advanced disease. <strong>Material and Method</strong>: A prospective study was carried out at B.P. Koirala Memorial Cancer Hospital, Bharatpur, Chitwan from the period 1<sup>st</sup> November 2022 to 31<sup>st</sup> August 2023 (10 months). Patients diagnosed with advanced ovarian cancer based on clinical and CECT findings and confirmed with cytology or FNAC or biopsy undergoing Interval Debulking Surgery after 3 cycles of NACT (paclitaxel and carboplatin) were included. The role of NACT in terms of response according to RECIST criteria, regression of CA125 value, rate of complete or optimal cytoreduction, and postoperative complications were analyzed.&nbsp; <strong>Results</strong>: A total of 40 cases fulfilling the inclusion criteria were enrolled. Most patients 14(35%) were between 51-60 years with a mean age of 51.45 ± 11.46 SD years. Abdominal pain and/or distension were the most common presenting symptoms. The majority 32 (84.2%) of cases were given NACT based on CT scan findings of advanced disease. Confirmation of malignancy was done by positive USG-guided FNAC from ovarian mass in most cases 23 (57.5%), followed by positive ascitic fluid cytology in 8 (20%) patients. The median CA125 value before and after NACT were 844 U/ml and 27.89 U/ml respectively. After NACT, CA125 was normalized in 24 (60%) patients. Most patients 30 (75%) had complete cytoreduction during IDS; while 7 (17.5%) patients had optimal cytoreduction, and 3 (7.5%) had suboptimal cytoreduction. The median duration of surgery was 147.5 minutes, and the median blood loss was 287.5 ml. The postoperative period was uneventful in most cases. <strong>Conclusions</strong>: NACT followed by interval debulking surgery is an effective alternative in selected cases of advanced ovarian cancer as the complete and optimal cytoreduction rate is higher with fewer postoperative complications.</p> Manju Pandey, Bijaya Chandra Acharya, Hemnath Subedi, Sarita Rana Gurung, Bibek Kandel, Ganga Dutta Adhikari, Binuma Shrestha Copyright (c) 2023 Nepalese Journal of Cancer Tue, 28 Nov 2023 00:00:00 +0000