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Hypopharyngeal cancer usually presents at a locally advanced stage. Almost all patients are treated with a curative intent. As surgical approaches are functionally and cosmetically morbid, nonsurgical modalities are preferred. This review emphasizes a comprehensive diagnosis workflow, the integration of less toxic induction chemotherapy regimens, and a multidisciplinary approach to patient care. It aims to optimize treatment outcomes while preserving quality of life, particularly in the Indian healthcare context.

Oropharyngeal cancer typically presents at a nonmetastatic stage and is primarily treated with curative intent. While surgical options are available, they are often associated with significant functional and cosmetic morbidity, leading to a preference for nonsurgical modalities. The updated guidelines address the management of oropharyngeal squamous cell carcinoma in the Indian context, emphasizing the importance of a multidisciplinary approach. The guidelines detail diagnosis workflows, treatment protocols for early-stage and locally advanced cancers, and the role of human papillomavirus (HPV) status in guiding therapy. Special attention is given to emerging treatment deintensification strategies for HPV-associated cancers, aiming to optimize outcomes while minimizing treatment-related toxicity.

Oral cavity cancer (OCC) essentially presents at a non-metastatic stage. Almost all patients are treated with a curative intent. Surgical approaches are the mainstay of treatment accompanied by radiotherapy and chemotherapy where applicable. This updated guideline emphasizes a personalized approach to the treatment of OCC, considering tumor characteristics, patient preferences, and the latest advancements in diagnostic methods. These guidelines aim to optimize treatment strategies, improve patient quality of life, and ensure adherence to the most current clinical practices in managing OCC, especially with respect to the Indian scenario.

Head-and-neck squamous cell carcinoma (HNSCC) remains a significant public health concern, particularly in India, where its incidence is disproportionately high due to risk factors such as tobacco and alcohol use. The updated guidelines for the management of HNSCC reflect a comprehensive review of current evidence and practices tailored to the Indian context. They emphasize a multidisciplinary approach and the integration of novel therapeutic modalities, including immune checkpoint inhibitors and metronomic chemotherapy. Enhanced diagnostic protocols and a focus on supportive care underscore the commitment to improving patient outcomes and quality of life. This update aims to provide healthcare professionals with clear, evidence-based recommendations that address the unique challenges faced by patients with HNSCC in India.

Laryngeal cancer typically presents at a nonmetastatic stage, and the majority of patients are treated with curative intent. Due to the functional and cosmetic morbidities associated with surgical approaches, nonsurgical modalities are increasingly favored. This update to the guidelines emphasizes a multidisciplinary approach tailored to the Indian healthcare context, enhancing treatment strategies and optimizing patient outcomes. Key recommendations include the use of concurrent chemoradiotherapy and induction chemotherapy regimens, with a focus on organ preservation whenever feasible.

Nasopharyngeal carcinoma (NPC) is a rare malignancy that poses significant treatment challenges, particularly in the context of curative intent. This updated guideline consolidates contemporary evidence and clinical practices tailored to the Indian healthcare landscape. It emphasizes a multidisciplinary approach to diagnosis and treatment, incorporating advances in chemotherapy, radiotherapy, and supportive care. Key recommendations include the use of induction chemotherapy for locoregionally advanced cases, detailed risk stratification, and specific management strategies for recurrent and metastatic disease, all aimed at improving patient outcomes.

Background and Aim: Conjoined twins, due to their rarity and complex anatomy, pose not only a technical, but also a physiological challenge for their separation, with each case being uniquely distinct. The aim of the present article is to describe the surgical approach and management strategy for two cases of pyopagus conjoined twins operated at our center. Case Report: Case 1: Antenatally detected conjoined twin girls presented postnatally to our centre. They were found to have a common vestibule with single anal opening facing partially away from each other. On evaluation they were found to have a single sacrum and fused conus and filum terminale. They were taken up for separation at 2years of age & the 24hour long surgery, culminated in successful separation. The children had good post-operative outcome at 10months post separation. Case 2: Conjoined pyopagus twin girls presented postnatally, and were found to have fused cords, having a terminal syrinx and partially separate sacrum. They were separated at 2.5 years of age, with a multi-departmental effort and coordination. They are doing well 2 months post-operatively. Conclusion: A multidisciplinary team support with thorough preoperative planning significantly aids in improving the outcome of surgical separation. This has been possible by using modern technology. Each reported case contributes significantly to literature.

PURPOSEHereditary breast and ovarian cancer (HBOC) syndrome is primarily characterized by mutations in the BRCA1/2 genes. There are several barriers to the implementation of genetic testing and counseling in India that may affect clinical decisions. These consensus recommendations were therefore convened as a collaborative effort to improve testing and management of HBOC in India.DESIGNRecommendations were developed by a multidisciplinary group of experts from the Indian Society of Medical and Pediatric Oncology and some invited experts on the basis of graded evidence from the literature and using a formal Delphi process to help reach consensus. PubMed and Google Scholar databases were searched to source relevant articles.RESULTSThis consensus statement provides practical insight into identifying patients who should undergo genetic counseling and testing on the basis of assessments of family and ancestry and personal history of HBOC. It discusses the need and significance of genetic counselors and medical professionals who have the necessary expertise in genetic counseling and testing. Recommendations elucidate requirements of pretest counseling, including discussions on genetic variants of uncertain significance and risk reduction options. The group of experts recommended single-site mutation testing in families with a known mutation and next-generation sequencing coupled with multiplex ligation probe amplification for the detection of large genomic rearrangements for unknown mutations. Recommendations for surgical and lifestyle-related risk reduction approaches and management using poly (ADP-ribose) polymerase inhibitors are also detailed.CONCLUSIONWith rapid strides being made in the field of genetic testing/counseling in India, more oncologists are expected to include genetic testing/counseling as part of their clinical practice. These consensus recommendations are anticipated to help homogenize genetic testing and management of HBOC in India for improved patient care.

Human papillomavirus (HPV) associated head and neck squamous cell cancers (HNSCC) have become increasingly common in the West, but the same cannot be said about India. These cancers have a different biology and confer a better prognosis, however, its current role in the management of patients in India is not clearly defined. At the 35th Indian Cooperative Oncology Network conference held in September 2016, a panel of radiation, surgical and medical oncologists, pathologists, and basic scientists from across the country having experience in clinical research with respect to HPV in HNSCC reviewed the available literature from India. All the ideas and facts were thereafter collated in this report. Various topics of controversy in dealing with the diagnosis and management of HPV-associated HNSCC have been highlighted in this report in context to the Indian scenario. Furthermore, the prevalence of the same and its association with tobacco and high-risk sexual behavior has been touched on. Conclusively, a set of recommendations has been proposed by the panel to guide the practicing oncologists of the country while dealing with HPV-associated HNSCC.

Human epidermal growth factor receptor 2 (HER2)-positive breast cancer is a more aggressive subtype of breast cancer and targeting the HER2 receptor has proven effective in improving the prognosis of these patients. Pertuzumab, a recombinant humanized monoclonal antibody and the first in a class of HER2 dimerization inhibitors approved for treating HER2+ breast cancer. It blocks ligand-dependent heterodimerization and ligand-independent homodimerization of HER2 with other HER members. When used in combination with trastuzumab and taxane, pertuzumab complements the action of trastuzumab and results in a comprehensive blockade of HER2 signaling pathway. This review article traces the development of pertuzumab from concept to its current use in HER2+ breast cancer treatment. A search of Medical Literature Published since 2007 was performed in PubMed using the keywords “pertuzumab,” “HER2+ breast cancer,” “HER2 targeted therapy,” “metastatic breast cancer,” and in search engines for ongoing trials with pertuzumab and incidence of cancer and breast cancer in India. A total of 35 publications and abstracts from the American Society of Clinical Oncology were selected for this review. Pertuzumab is approved in combination with trastuzumab and docetaxel for the treatment of patients with HER2+ metastatic BC, who have not received prior anti-HER2 therapy or chemotherapy for metastatic disease. The dual HER2 blockade of pertuzumab and trastuzumab is now accepted worldwide as a standard of care by various guidelines.

Context: Treatment of patients with cleft lip and palate (CLP) anomaly requires a multidisciplinary approach from birth until adulthood. Many children with cleft anomaly are born in rural areas where resources for treatment and awareness on cleft care are limited. Consequently, many patients may receive limited or suboptimal care due to multitudes of reasons. Aims: The current study was aimed to record the baseline data on the spectrum of clinical profile of cleft patients, treatment protocols, quality of treatment and the residual treatment needs of patients with CLP anomaly visiting three major hospitals across Delhi and National Capital Region (NCR). The experience gained from the three-center study would be used to lay a framework to conduct a nationwide multicenter study in terms of logistics, feasibility and difficulties. Materials and Methods: The study titled "CLP anomaly in India: Clinical profile Risk factors and current status of treatment: A hospital based study" was started in 2010 as a Task Force project of Indian Council of Medical Research. The Pilot phase, which started in 2012, encompassed three cleft centers across Delhi and NCR, namely, All India Institute of Medical Sciences, Safdarjang Hospital and Medanta - The Medicity. Data for 126 non-syndromic CLP subjects was recorded on a specially designed performa. Each case was evaluated by a team of specialists comprising of a Plastic Surgeon, an Orthodontist, ENT Surgeon, Dental Surgeon, Speech therapist and an Audiologist. Clinical records included profile and intraoral photos, dental study models, audiometric and speech evaluation data. The current paper attempts to highlights a few of relevant observations of the pooled data from three centers. Results and Conclusions: The results indicate a lack of uniform protocol followed in providing care to cleft patients. A great variation was found in the quality of treatment received by many of the patients.

Background: Fine needle aspiration cytology (FNAC) of the thyroid is an established first-line test for thyroid lesions. Marginal vacuoles (MVs) have been associated with hyperactivity of the thyroid, but some studies have pointed towards their nonspecific status. Aims: To assess the presence of MVs in diffuse thyroid enlargements and evaluate the strength of correlation between MVs, levels of thyroid hormone and cytological diagnosis. Materials and Methods: Ninety-seven cases of diffuse thyromegaly were studied. Cytomorphological features were examined with special attention to MVs. MVs were graded as scant, moderate and abundant. Hormonal status of the patients was recorded. The presence and grading of MVs was correlated with cytological diagnosis and hormonal status. The strength of association was studied by applying the Chi-square test and test of proportion; a P ? 0.05 was considered significant. ≤ 0.05 was considered significant. Results: Abundant MVs were not associated with hypothyroidism in this study; 79% of these cases were hyperthyroid. The correlation between moderate/insignificant MVs and functional status of the thyroid gland was inconclusive. Further, abundant MVs in thyroid FNACs were seen in cases of primary hyperplasia and Hashimoto′s thyroiditis. There was a significant correlation between the presence of abundant/moderate MVs and primary hyperplasia and their absence in colloid goiter (P = 0.01 and 0.004, respectively). Conclusions: A significant association was found between abundant MVs and a hyperthyroid state. Moderate/absent MVs in diffuse goiters were not found to correlate with thyroid function. Thus, all diffuse goiters with prominent MVs require hormonal evaluation to rule out hyperfunction of the thyroid.

Pressure sore is tissue ulceration due to unrelieved pressure, altered sensory perception, and exposure to moisture. Geriatric patients with organic problems and patients with spinal cord injuries are the high-risk groups. Soft tissues over bony prominences are the common sites for ulcer development. About 95% of pressure ulcers occur in the lower part of the body. Ischial tuberosity, greater trochanter, sacrum and heel are common sites. In addition to these, pressure sores at unusual sites like nasal alae, malar eminences, cervical region and medial side of knee have also been described. Only 1.6% of the patients present with sores in areas outside the pelvis and lower extremity. In a paraplegic patient, pressure sores are usually over extensor surface of knee and heel but pressure ulcer over popliteal fossa are extremely rare. We herein report a case of a 36-years-old diabetic and paraplegic male, who presented with multiple bed sores involving the sacral area, heels and bilateral popliteal fossa. Popliteal fossa is an unusual site for pressure sores. Only one similar case has been previously reported in the literature.

Human epidermal growth factor receptor 2 (HER2)-positive is an aggressive subtype of breast cancer and has historically been associated with poor outcomes. The availability of various anti-HER2 therapies, including trastuzumab, lapatinib, pertuzumab, and trastuzumab emtansine (TDM-1), has remarkably improved the clinical outcomes in patients with HER2-positive metastatic breast cancer (mBC). However, there is a need to optimize treatment within this population, given the wide variability in clinical presentation. Additionally, geographical and socio-economic considerations too need to be taken into account. To clarify and collate evidence pertaining to HER2-positive metastatic breast cancer, a panel of medical and clinical oncologists from across India developed representative clinical scenarios commonly encountered in clinical practice in the country. This was followed by two meetings wherein each clinical scenario was discussed in detail and relevant evidence appraised. The result of this process is presented in this manuscript as evidence followed by therapeutic recommendations of this panel for management of HER2-positive mBC in the Indian population. [ABSTRACT FROM AUTHOR]