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We present the 2017 Oncology Gold Standard Practical Consensus Recommendation for use of monoclonal antibodies in the management of advanced squamous cell carcinoma of head neck region., Competing Interests: There are no conflicts of interest.

Background & Objective: The current study aimed to perform an immunohistochemical analysis of patterns of apoptotic and cell proliferative related protein expression in different histological grades and immune phenotypes of malignant lymphomas and other lymphoproliferative disorders., Methods: This observational study was carried on 60lymph node biopsies of lymphoproliferative disorders. The biopsies were analyzed histologically and immunohistochemically., Results: A total of 60 lymph node biopsies were included in the study, of which 81.6% were of malignant lympho-proliferative lesions. The majority of the biopsies were B-cell (66%) and were grouped in the intermediate grade. Bax and BCL-2 protein expression was presented by percentage of immune positive neoplastic cells per 10fields and graded on a scale of 1 to4. A Bcl-2, Bax Protein Ratio (BBPR) was determined for each case by dividing the estimated Bcl-2 protein (percentage of Bcl-2 positive cells x Bcl-2 staining intensity) by the estimated Bax protein (percentage of Bax positive cells x Bax immunostaining intensity). The mean BBPR was found to be significantly higher in indolent lymphomas (2.64 ± 1.3) as compared to aggressive lymphomas (0.47 ± 0.9) (P<0.01). The expression of P53 and PCNA in 35 biopsies of Non Hodgkin Lymphomas (NHL) was found to increase from low to high grade tumors., Conclusions: A significant correlation was found between BBPR and predicted biological behavior of indolent and aggressive lymphomas. This indicates the important role of Bcl-2 and Bax in biological behavior of lymphomas. Furthermore, P53 and PCNA expression were found to increase from low to high-grade tumors suggesting their prognostic value in NHL., Competing Interests: All the authors contributed to the study with no conflict

Background: Radiotherapy for head and neck cancers (HNC) causes alteration of oral mucosal barrier predisposing it to colonization and infection. Such infections often result in pain and burning sensation thus contributing to major morbidity., Objective: MATERIALS AND METHODS: Study was done on 50 patients of HNC treated with concurrent chemoradiotherapy. Three samples (throat, urine, blood) were collected for fungal culture and sensitivity. These samples were collected before the start of radiotherapy, during radiotherapy (2nd and 6th week) and post radiotherapy (10th week)., Results: Only 49 patients were available for analysis. Fungal infection was found in 27/49 patients (55.10%) out of which Non-albicans Candida was isolated in 18/49 (36.73%) and Candida albicans in 9/49 (18.36%) cases. About 66.66% (18/27) isolates were sensitive to fluconazole. Maximum isolation of yeast was during 6th week of radiotherapy. All grade 4 and 71.42% of grade 3 oral mucositis were found in patients who were positive for fungal infection., Conclusion: The spectrum of fungal species in throat swab was: Non-albicans Candida and Candida albicans observed in 36.73% and 18.36% of patients respectively. Higher rate of fungal colonization and infection was found in patients with grade 3/4 oral mucositis. Prophylactic fluconazole in HNC patients on concurrent chemoradiotherapy has the potential to reduce emerging invasive fungal infection and its associated morbidity., (Copyright © 2017 National Cancer Institute, Cairo University. Production and hosting by Elsevier B.V. All rights reserved.)

Radiotherapy is one of the modalities of treatment of malignancies. Radiation-induced malignancies (RIMs) are late complications of radiotherapy, seen among the survivors of both adult and pediatric cancers. Mutagenesis of normal tissues is the basis for RIMs. The aim of this review of literature was to discuss epidemiology, factors affecting and different settings in which RIM occur., Competing Interests: All authors declare that they have no conflicts of interest.

Background: Patients of head and neck malignancies often develop oral mucositis and invite various pathogens to colonize over it., Objectives: The objective of this study is to identify the fungi isolated from patients undergoing radiotherapy (RT) for head and neck cancer, to determine the antifungal susceptibility of these isolates and to determine the time and week of fungal colonization., Patients and Methods: Three specimens (throat, urine, and blood) were collected from each of the head and neck cancer patients, who were advised RT. These specimens, which were collected before the start of RT, during RT (2nd and 6th week), and post-RT (8th week) were inoculated into fungal culture media. Candida species were identified by standard methods and antifungal susceptibility of the candidal isolates was done., Results: Candida infection was found in 24/42 patients (57.14%) out of which Candida albicans was isolated in 14.28%, Candida tropicalis (28.57%) and Candida parapsilosis (14.28%). Maximum isolation of yeast was in the 6th week of RT. Fungemia was found in 3/42 patients. All the yeast isolates were sensitive to fluconazole except two., Conclusion: Prophylactic antifungal therapy in patients undergoing RT for head and neck malignancy is particularly important to prevent intraoral colonization and infection by Candida. Screening of such patients on RT for fungal infections can prevent fatal mold infections.

Carcinoma tonsil with visceral metastasis is a rare entity, and cutaneous metastasis is seen even more infrequently. We present a case of a 55-year-old male with carcinoma tonsil having received concurrent chemo radiotherapy, presenting with multiple cutaneous metastases to the scalp and thigh. To the best of our knowledge, till date only two similar cases of carcinoma tonsil with cutaneous metastasis have been reported in the English literature., (Copyright © 2016 National Cancer Institute, Cairo University. Production and hosting by Elsevier B.V. All rights reserved.)

Traditional approaches to palliative care may not meet the unique needs of poor cancer patients in developing countries. Cancer patients treated in India are often unable to make repeat visits to the hospital, pay for drugs, or understand and follow complex treatments. Many are from rural areas and may lack basic financial or social support. Our palliative care clinic has taken a series of innovative first steps towards meeting these unique needs, from providing treatment without complete diagnosis, accelerating through the World Health Organization (WHO) analgesic schedule, systematically simplifying prescriptions, and providing treatment free of charge. This paper describes these first steps, presents an initial evaluation of their impacts, and articulates a number of opportunities for additional improvements.

Introduction: Metastatic lesions to oral cavity from distant tumours account for 1% of all oral cavity malignancies. Oral cavity is a rare site of metastasis from the breast. We describe case report of breast cancer patient with metastasis to buccal mucosa., Presentation of Case: We report a case of pre-menopausal woman with left side infiltrating ductal carcinoma breast - T4aN1M0. She received three cycles of neo-adjuvant chemotherapy followed by modified radical mastectomy (MRM) and three cycles of adjuvant chemotherapy and loco-regional EBRT. She presented with a lump in region of MRM scar and a painful swelling in the right cheek, one year afterwards. Core needle biopsy from scar site revealed infiltrating ductal carcinoma. CECT revealed a heterogeneous lesion (1.1cm×1.7cm) in right masticator space, which on biopsy revealed metastatic deposit consistent with infiltrating ductal carcinoma., Discussion: Metastatic lesions to oral cavity from distant tumours are uncommon. They mainly involve bony structures. Primary metastases to soft tissues are rare and accounts for 0.1% of oral malignancies. In our case, patient presented with scar recurrence and distant metastasis at an unusual site. Had it not been for scar recurrence, patient might not have presented to the OPD with oral swelling. A high degree of clinical suspicion and previous history of breast cancer led to detection of metastatic deposit., Conclusion: Diagnosis of a metastatic lesion in buccal mucosa is challenging and requires a high degree of clinical suspicion., (Copyright © 2013 Surgical Associates Ltd. Published by Elsevier Ltd. All rights reserved.)

Context: Pain and palliative care clinic (PCC)., Aims: The primary object of this study was to enumerate the demographic characteristics of patients attending a newly organized PCC. The secondary purpose was to detect symptom prevalence and frequency of different cancers in these patients., Settings and Design: Prospective cross-sectional descriptive study., Materials and Methods: A prospective cross-sectional descriptive study was done on patients referred to the PCC of a tertiary hospital in North India. Comprehensive details of all patients were recorded systematically on the first visit on a proforma specially prepared for the newly established palliative care clinic., Statistical Analysis Used: The descriptive statistics of palliative care data was presented in terms of frequencies and percentages (%) for categorical variables., Results: The data collected at our PCC showed that out of 156 patients, 87 were males and 69 were females. Patients of all ages varying from 6 to 85 years were seen. Most patients (82.1%) lived with their families, and 28 (17.1%) patients lived alone and had no financial support. The most common primary diagnoses were head and neck cancers (38.5%), carcinoma cervix (15.4%), breast cancer (10.3%), colorectal cancer (6.4%), and lung cancer (4.5%). Frequency of seven most common symptoms was pain (100%), insomnia (64.1%), loss of appetite (34.6%), nausea (32.7%), vomiting (32.1%), constipation (31.4%) and sore mouth (28.8%)., Conclusions: Population-based studies determine the actual magnitude of sufferers and suffering and show that palliative care services should be included as an essential component in a tertiary care hospital. The objective should be to reach out to the patient and help in improving the patent's quality of life in every way possible.

A primary thoracic origin occurs only in 20% of neuroblastomas, and their classical presentation is mediastinal or cord compression. Skeletal metastases of neuroblastomas are characteristically multiple, and calvarial deposits usually show simultaneous involvement of orbit. Solitary metastases in neuroblastoma, is an unusual entity and its presentation as a large calvarial mass, especially from a thoracic primary, is rare. Furthermore, calvarial metastases are relatively uncommon in children compared to adults. We discuss the clinical, radiographic, CT features, and differential diagnosis of a large calvarial mass with sunray spiculation in a child, which was due to a solitary metastases from an occult thoracic neuroblastoma. The possibility of neuroblastoma presenting in this unique fashion and the importance of considering a chemosensitive tumor such as neuroblastoma in the differential diagnosis of a solitary calvarial mass in a child is highlighted by our report.

50 patients of advanced squamous cell carcinoma of the head and neck were randomised cither to receive chemotherapy followed by radiation therapy or chemoimmunotherapy followed by radiotherapy. In the chemoimmunotherapy arm, the patients received recombinant interferon alpha 2b 3 M.U. subcutaneously, thrice a week on alterante days for 5 weeks from Day 1, Cisplatinum 70 mg/ m(2) on Day 1 and 21, and 5 - flurouracil 1000mg/m(2) on Day 1, 2, 3 and Day 21, 22, 23, followed by from Dav 36, radiotherapy'by Co bait 60 to a tumour dose of 65 Gy in 30 # over 6 weeks. In the control arm, patiens received Cisplatitnum 70 mg/ m(2) on Day 1 and Day 21, 5 flurouracil 1000 mg/ m(2) on Dav 1, 2, 3 and Day 21, 22, 23 followed by radiotherapy by Cobalt 60 to a tumour dose of 65 Gy in 30 # over 6 weeks from Day 36. Only Grade II and III toxicity was observed in the two arms which were manageable Patients treated with chemoimmunotherapy followed by radiotherapy showed 60% complete response, 20% partial response and 12% no change/ progressive disease; while the patients on the control arm treated with chemotherapy and radiotherapy showed 12% complete response 44% Partial response and 32% no change" progressive disease. This trial concludes that chemoimmunotherapy followed by radiotherapy is an excellent alternative therapeutic strategy for the management of advanced head and neck cancers with manageable toxicity.

One thousand six hundred ninety-four (1694) cases of carcinoma cervix have been reviewed out of a total of 11919 malignancies, over a period of 4 years (1992-1995), in the department of radiotherapy, Safdarjung Hospital, New Delhi. The epidemiological features studied showed that there was a gradual decline in the total number of cases, age at presentation and parity. There has been a definite increase in the proportion of adenocarcinoma cases. Adenocarcinoma of cervix showed statistically significant preponderance in comparatively younger age group viz, 40-60 years (p < 0.005); 76% of overall cases were illiterate; 77% of cases belonged to rural/urban slum settings compared to 23% which were purely urban in origin. About 65% cases had haemoglobin levels below 10 g/dl at the time of presentation.

Hematological and lymphoid malignancies rarely present with manifestations outside these tissues. We report a patient with chronic lymphocytic leukemia (CLL) presenting with jaundice and generalized lymphadenopathy. The liver profile was suggestive of hepatitis; biopsy showed mild cholestasis. The findings suggest paraneoplastic jaundice with CLL.