Introduction: Bilateral breast cancer BCC is relatively uncommon with an overall incidence of 5–20% in women with early breast cancer. They are divided into synchronous if cancers are detected simultaneously or within 6 months of each other and metachronous if they are detected more than 6 months apart from each other. Family history and hereditary cancers multicentricity and lobular histology are some of the factors associated with BCC. In this background, we sought to evaluate the incidence, clinicopathological profile, and management of women with bilateral primary breast cancer at our institute. Materials and Methods: We retrospectively reviewed the medical records of women who underwent surgery for BCC at the breast services unit at our institute from October 2010 to April 2015. The clinicopathological profile and outcomes were analyzed using SPSS 22 software and appropriate statistical tests. Results: Out of 1330 women who underwent surgery for early breast cancer between October 2010 and April 2015, 44 were bilateral. Twenty-eight were synchronous and 16 were metachronous. Mean age of the presentation of patients was 53 years (range 30–79 years). The histological type were same in 82.14% of synchronous tumors and 87.5% of metachronous tumors ( P = 0.496). The grades were similar in 42.85% of synchronous tumors and 56.25% of metachronous lesions ( P = 0.294). The stage concordance among synchronous tumors was 39.28%, whereas it was 60% among metachronous lesions ( P = 0.164). Conclusions: The management of BCC is complex and has to be tailored to the individual based on characteristics of index and second tumor, prior therapy, adjuvant treatment, and risk stratification. Moreover, the concordance of receptor expression is higher in synchronous cancers than metachronous cancers.
Objective Colorectal cancer (CRC) development involves underlying modifications at genetic/epigenetic level. This study evaluated the role of Kras gene mutation and RASSF1A, FHIT and MGMT gene promoter hypermethylation together/independently in sporadic CRC in Indian population and correlation with clinicopathological variables of the disease. Methods One hundred and twenty four consecutive surgically resected tissues (62 tumor and equal number of normal adjacent controls) of primary sporadic CRC were included and patient details including demographic characteristics, lifestyle/food or drinking habits, clinical and histopathological profiles were recorded. Polymerase chain reaction - Restriction fragment length polymorphism and direct sequencing for Kras gene mutation and Methylation Specific-PCR for RASSF1A, FHIT and MGMT genes was performed. Results Kras gene mutation at codon 12 & 13 and methylated RASSF1A, FHIT and MGMT gene was observed in 47%, 19%, 47%, 37% and 47% cases, respectively. Alcohol intake and smoking were significantly associated with presence of Kras mutation (codon 12) and MGMT methylation (p-value <0.049). Tumor stage and metastasis correlated with presence of mutant Kras codon 12 (p-values 0.018, 0.044) and methylated RASSF1A (p-values 0.034, 0.044), FHIT (p-values 0.001, 0.047) and MGMT (p-values 0.018, 0.044) genes. Combinatorial effect of gene mutation/methylation was also observed (p-value <0.025). Overall, tumor stage 3, moderately differentiated tumors, presence of lymphatic invasion and absence of metastasis was more frequently observed in tumors with mutated Kras and/or methylated RASSF1A, FHIT and MGMT genes. Conclusion Synergistic interrelationship between these genes in sporadic CRC may be used as diagnostic/prognostic markers in assessing the overall pathological status of CRC.
The management of locally advanced rectal cancer has changed over the years with an emphasis on neoadjuvant chemo radiation therapy (CT-RT) followed by surgery. This study is undertaken to evaluate the efficacy of this treatment in our set of patients with a special focus on the outcome in large circumferential tumors.The study included patients who underwent neo adjuvant CT-RT between Jan 2006 and Oct 2009 in our institution. They received radical radiotherapy with conventional fractionation to a dose of 45-50 Gy along with continuous two cycles of 5-FU infusion. All patients were assessed at four weeks clinically and by CT scan and underwent surgery if the tumor was resectable followed by adjuvant chemotherapy.A total of 52 patients received the neoadjuvant treatment in form of CT-RT out of which 13 patients had undergone defunctioning colostomy before commencing treatment for severe obstructive symptoms. Only 73% patients underwent surgery in form of AR (anterior resection) or APR (abdominoperineal resection) and adjuvant chemotherapy was delivered in 28 (53.8%) patients only. The patients who underwent diversion colostomy had worse disease-free survival (DFS) as compared to those who received definitive treatment (33% vs. 74.9%, P<0.009).This study represents Indian experience with standard neoadjuvant chemo radiotherapy followed by surgery in rectal cancer. Large circumferential tumors in our set of patients lead to poor outcome leading to more APR. Also this study supported the need for an abbreviated protocol which can be economically suited and organ preservation protocols have a long way to go.
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