Journal of Integrative Oncology

Leg cramps are a very common complaint in primary care office. More than 50% of the patients are found to have diabetes who presented with leg cramps and up to 80% of pancreatic cancer patients present with either new-onset type 2 diabetes or impaired glucose tolerance at the time of diagnosis. Leg cramps should be worked up to look for new-onset diabetes that could essentially lead to and unmask underlying pancreatic cancer. The data linking high glucose levels with an elevated risk of pancreatic cancer have led some to suggest that the new onset of diabetes in a thin older adult should prompt consideration of screening for early diagnosis of a potentially resectable pancreatic cancer. But so far no clear-cut guidelines over there that suggest which parameters should be taken to consideration for CT screening for pancreatic cancer in a newly diagnosed diabetic patient.

Background: Cervical cancer is the commonest gynecologic cancer in the developing world. Screening remains the cornerstone of prevention. The study sought to assess the knowledge, attitudes, and practice of cervical cancer screening among female health workers in a tertiary health facility.
Methods: It was a cross-sectional study carried out among forty female health workers at the National Obstetric Fistula Centre, Abakaliki. Data was collected from the subjects using self-administered questionnaires. The frequencies and proportions of the responses were calculated and entered on a Likert Scale of 1 to 5. The range, median and mean of the variables were also determined. Values ranging from 1-2 points were considered low, 3 was considered average while those from 4-5 points were considered high.
Results: A total of 40 respondents completed the questionnaire. The mean age of the respondents was 35.5 years. The mean of the knowledge of the respondents about cervical cancer screening was between 4.55 and 4.68 on a Likert Scale of 1-5. The mean of the attitudes of the respondents about cervical cancer screening was between 4.39 and 4.81 on a Likert Scale of 1-5. The practice of cervical cancer screening was found to be 2.89 on a Likert Scale of 1-5.
Conclusion: While the knowledge and attitudes of the female health workers about cervical cancer screening were good, the practice was found to be poor in this study.

The premise of immune surveillance was scripted by Burnet. The theory declares that the immune system may demonstrate a capacity to recognize and eradicate nascent and contemporary malignancies. Tumefaction may be generated by the cells of a particular organism or homo-sapiens which represent as specific antigens identifiable by the immune system. Individuals with a poor or defective immune system may engender subcategories of malignancy. The White Blood Corpuscles (WBCs) identify and ineffectively eliminate tumor cells in immune compromised subjects, in contrast to immune competent persons. Numerous immune procedures are implicated for malignant conversion with a primary immune deficiency such as enhancement and manifestation of immune cells, viral infections, modifications and reactivity to bone marrow tissue and chronic inflammation. The incidence of emerging lymphoma is augmented in congenital and acquired immune deficiency. Chronic antigenic stimulation incited by the oncogenic viruses and a lack of appropriate "antibody feedback mechanism" cogitating the lymphoid proliferation elevates the percentage of quantifiable lymphoid malignancies.

Phosphatase and Tensin Homolog (PTEN) is a protein that is encoded by the PTEN gene. Mutations of this gene are a step in the development of many cancers. A decrease or loss of PTEN expression has been described in many types of malignancies. This study was designed to evaluate by immunohistochemistry the relationship of Phosphatase and Tensin (PTEN) homolog expression and clinicopathological parameters of thirty-two archival tumor tissues of Malignant Fibrous Histocytoma (MFH) patients as well as analyzing the relationship of its expression with response to therapy. Hematoxylin and eosin-stained sections from 32 MFH cases were classified according to well-defined criteria into 4 groups. Then, they stained immunohistochemically with PTEN protein. Quantitation of immunoreactivity was performed using an Olympus light microscope interfaced via a Sony camera to an image analysis system. The tendency was observed for positive PTEN expression to be associated with both storiform and giant cell subtypes. Moreover, the loss of PTEN in the 10 patients with recurrent disease who underwent salvage chemotherapy had a poor response to chemotherapy. The present study has demonstrated that loss of PTEN may serve as a reliable biological marker of high malignancy potential in of malignant fibrous histiocytoma. Moreover, loss of PTEN is an important event in regulating sensitivity to chemotherapy in those cases. Thus, our results suggest that the PTEN gene may be a therapeutic target for the treatment of malignant fibrous histiocytoma PTEN MFH cases and its expression help to predict the treatment response.

There are 2 major subtypes of CNS lymphoma: secondary CNS lymphoma (involvement of the CNS by systemic lymphoma) and Primary CNS Lymphoma (PCNSL). Two-thirds of secondary CNS lymphomas have leptomeningeal involvement, while parenchymal CNS lymphoma represents one-third of secondary CNS lymphomas and almost 100% of PCNSLs. We present a case of a 49-year-old male patient that was diagnosed with systemic lymphoma that presented initially with neurological symptoms (secondary CNS lymphoma). Lymphoma comprises a heterogeneous group of diseases; important advances have been made in diagnosis and treatment. Imaging features may help distinguish between primary and secondary CNS lymphoma, playing an important role in planning therapy and prognostication.

Objectives: The present study was carried out to analyze the genetic alterations among primary malignant salivary gland tumors and pleomorphic adenoma using RAPD to identify new genetic markers of clinical relevance to these tumors.
Methods: DNA was extracted from paraffin-embedded tissue biopsies of the studied cases. RAPD-PCR was performed using 8 different primers. The isolated genes were sequenced by the automated gene sequencer.
Results: In the current study, the identified genes were collagen type IV, alpha 4, polyprotein, large tumor suppressor (LATS) gene, cytokinin receptor at CKI2-like protein or kinesin family member 3C, isoform and tumor susceptibility gene 101(TSG 101).
Conclusion: The results of the current work explored that retroviruses may play a role in salivary gland tumors. Moreover, there are common gene markers, pathways and themes shared among the various types of salivary gland tumors. In addition, effective drug development should focus on targeting these key players upon which multiple oncogenic pathways converge.

Objective: To evaluate the correlation between squamous cell abnormalities by liquid-based cytology and histopathology, and to evaluate the accuracy of liquid-based cytology in detecting cervical squamous cell abnormalities.
Methods: A total of 943 patients with squamous cell abnormalities by liquid-based cytology underwent colposcopic examination from June 2014 until May 2017. The final histopathology was defined as the most severe lesion from colposcopic directed biopsy, excision procedure or hysterectomy.
Results: A majority of abnormal cytology was LSIL (45.6%), followed by ASCUS, HSIL, ASC-H and SCC (29.6%, 13.5%, 9.7%, and 1.7%, respectively). LSIL/ASCUS cytology was confirmed to be CIN1 or less in approximately 90% of patients but coexisting high-grade lesions (CIN2/3) occurred in about 10% and invasive cancer was less than 1%. HSIL and ASC-H cytology yielded about 50% and 25% high-grade lesions, respectively; coexisting invasive cancer was diagnosed in 10.2% and 1.1%, respectively. Invasive cancers were diagnosed in 43.8% of patients with SCC cytology. The accuracy of liquid-based cytology for detecting cervical squamous cell abnormalities was 79.8%. There was a moderate correlation between cervical cytology and histopathology (Kappa=0.43, 95% CI=0.36-0.50).
Conclusion: The correlation between cervical cytology and histopathology remained moderate. Despite, acceptable accuracy rate, it should only be used as a screening test. About 10% of the high-grade lesion was found in low-grade cytology and 10% of invasive lesion co-existed in high-grade cytology. Therefore, pathological confirmation should be made before definitive management especially in areas with high incidence of cervical cancers.

Background: Currently, the standard treatment for locally advanced cervical cancer patients is concurrent chemoradiotherapy. A number of chemotherapeutic drugs have been used in a concomitant setting along with radiotherapy in the management of cervical cancer. Docetaxel and cisplatin have shown improved overall response rates with acceptable side effects. Here we aim to compare tumor control, side effects and treatment-related toxicity in two concomitant chemoradiation schedules.
Methods: The patients were divided randomly into two groups of thirty patients each. Both the groups were treated with a combination of External Beam Radiotherapy (EBRT) with 50 Gy/5 weeks/25 fractions to the whole pelvis along with concomitant chemotherapy. Group I (study group) received concomitant chemotherapy with injection docetaxel (20 mg/m²) and injection cisplatin (50 mg/m²) intravenously weekly for 5 weeks followed by HDR brachytherapy. Group II (Control Group) patients received concurrent cisplatin 40 mg/m² intravenously weekly for five weeks followed by HDR brachytherapy.
Results and Conclusion: The survival difference in the two groups was not statistically significant (p-value=0.718). Acute hematological and lower gastrointestinal toxicities were higher in the study group than the control group but these were not statistically significant. There was a trend towards better local control and better disease-free survival with doublet chemotherapy (docetaxel plus cisplatin) as compared to a single agent (cisplatin), but it was not statistically significant.

Nonmetastatic hepatic dysfunction known as Stauffer’s syndrome is a rare entity. It is commonly associated with clear cell carcinoma of the kidney. Rarely it has been reported in cases of prostatic carcinoma, bronchogenic tumor, and lymphoproliferative diseases. Stauffer’s syndrome presents an elevated alkaline phosphatase, aminotransferases, and prolonged prothrombin time without jaundice. However, a very rare variant of Stauffer’s syndrome presenting with jaundice has been reported in few case reports of clear cell carcinoma of the kidney. But such a presentation in cases of renal sarcomas has not been reported so far. Here we report a unique case of primary synovial sarcoma of kidney presenting as nonmetastatic cholestatic jaundice.