Asian Oncology Research Journal

Unmasking Renal Cell Carcinoma: A Comprehensive Review of Histological Signatures and Subtypes

Alexander Obidike Naiho — 2026-01-08

Renal cell carcinoma (RCC) is the most common type of kidney cancer, accounting for over 90% of adult renal cancers. This review aimed to explore renal cell carcinomas, classifications and histological identifications. RCC is a diverse group of kidney tumors and accounts for most adult kidney cancers. A combination of factors, including age, sex, lifestyle, and genetic changes, shapes its development. RCC is subtyped as clear cell, papillary, chromophobe, and the rare collecting duct carcinoma, each with its own unique. Accurate diagnosis depends on careful examination of tissue samples, both under the microscope and through immunohistochemical testing. Common stains, such as H&E, PAS, Masson’s trichrome, and Feulgen, help highlight key structures and cellular details. Immunohistochemical markers such as CK18, vimentin, PAX2, PAX8, and RCC antigen are critical tools for distinguishing RCC from other tumors. However, because some markers can appear in multiple tumor types, interpretation requires experience and caution, particularly when working with small or difficult biopsy samples.

Advancements in Precision Medicine for Myelodysplastic Neoplasms and Acute Myeloid Leukemia: A Review on Genomics to Targeted Therapies

Eric Emmanuel U — 2026-01-16

Myelodysplastic neoplasms (MDS) and acute myeloid leukemia (AML) are clonal hematopoietic disorders characterized by ineffective hematopoiesis and rapid proliferation of abnormal myeloid cells, respectively. Recent advances in molecular biology have significantly enhanced our understanding of the pathogenesis of MDS and AML, leading to improved diagnostic methods and novel therapeutic strategies. This review highlights the latest developments in genetic and epigenetic alterations, the role of the bone marrow microenvironment, advancements in diagnostics, targeted therapies, immunotherapies, and personalized medicine approaches in MDS and AML. Challenges and future directions are also discussed to provide a comprehensive overview of the current landscape and potential advancements in the management of these hematologic malignancies.

Precision Neuro-oncology: A Comprehensive Review of Molecular Diagnostics and Therapies in Glioma Care

Dhruva Trivedi — 2026-01-27

Cancer is the uncontrolled proliferation of abnormal cells that invades adjacent tissues and metastasizes in the lymphatic or bloodstream. Central Nervous System (CNS) tumors, and most notably gliomas are formidable to treat because of their aggressiveness, molecular heterogeneity, and resistance to standard therapy. Gliomas are the most prevalent primary malignant brain tumors and have a poor prognosis due to the limited choices of treatment. The 2021 World Health Organization Classification of CNS Tumors (WHO CNS5) has transformed glioma diagnosis with the inclusion of certain molecular markers like isocitrate dehydrogenase (IDH) mutations, 1p/19q co-deletion, loss of Alpha Thalassemia/Mental Retardation Syndrome X-linked (ATRX), and Tumor Protein 53 (TP53) mutations, in addition to the classic histopathological features. Next generation sequencing (NGS) has also revolutionized neuro-oncology by enabling the specific detection of genetic alterations responsible for tumor formation. NGS makes it possible to detect mutations, amplifications, and gene fusions with increased specificity, opening the door to more personalized and possibly efficacious treatment. In India, the increasing rate of CNS tumors emphasizes the imperative need for better diagnosis and treatment infrastructure. This review summarizes international and Indian trends in cancer epidemiology, developments in glioma classification, current diagnostic challenges, and the emerging roles of targeted sequencing and treatments in CNS tumor precision medicine. These molecular advances enable precise risk stratification and many different targeted therapies like IDH inhibitors and MGMT, which can help the clinicians to integrate NGS with other gold standard diagnostic methods and provide precise treatment and enhance progression free survival.

A Comprehensive Analysis of the Vascular Endothelial Growth Factor (VEGF) Family in Oral Carcinoma: From Molecular Mechanisms to Clinical Translation

Swarnava Chanda — 2026-02-05

Oral squamous cell carcinoma has created a major health burden in developing countries. High incidence of tobacco addiction and limited awareness in the general population leads to its usual presentation in the advanced stage. Angiogenesis, being one of the important factors associated with carcinogenesis, has emerged as a topic of interest for better understanding of the molecular micromechanisms responsible for carcinoma growth and progression. The Vascular Endothelial Growth Factor (VEGF) family acts as a primary regulator of this process. The molecular biology of the VEGF family along with its association with development and progression of oral carcinoma has been explored in this review. Further potential of VEGF as a diagnostic, therapeutic and prognostic marker has also been analysed.

Epigenetic Modifiers as Therapeutic Targets at the Interface of Infectious Diseases and Cancer Progression

Ogechi Cecilia Ofor — 2026-02-06

Epigenetic regulation plays a central role in controlling gene expression programs that govern cellular identity, immune responses, and adaptation to environmental stress. Increasing evidence demonstrates that dysregulation of epigenetic mechanisms is a shared hallmark of both infectious diseases and cancer progression, enabling pathogen persistence, immune evasion, malignant transformation, and therapeutic resistance. Epigenetic modifiers—including DNA methyltransferases, histone-modifying enzymes, chromatin remodelers, and non-coding RNAs—mediate reversible yet stable transcriptional changes that bridge genetic predisposition and environmental influence. In infectious diseases, pathogens actively exploit host epigenetic machinery to suppress antimicrobial responses and establish chronic or latent infections, while host-directed epigenetic reprogramming can shape immune memory and disease outcomes. In cancer, aberrant epigenetic landscapes drive silencing of tumor suppressor genes, maintenance of cancer stem cell plasticity, and resistance to cytotoxic and immune-based therapies. Importantly, the reversibility of epigenetic alterations has enabled the clinical development of epigenetic drugs, particularly in oncology, and has opened new avenues for therapeutic repurposing in infectious diseases, although challenges related to target specificity, context-dependent effects, and potential toxicity continue to limit their broader clinical application. This review provides an integrative overview of epigenetic regulation in health and disease, examines the role of epigenetic modifiers in host–pathogen interactions and cancer progression, and highlights emerging translational strategies, including combination therapies and epigenome editing technologies. By bridging insights from infectious disease biology and cancer research, this work underscores the potential of epigenetic modifiers as unifying and versatile therapeutic targets in complex human diseases.

Oral Mucositis in Cancer Patients: Prevention and Treatment

Rokkam Vanya Sri — 2026-02-17

Oral mucositis is a common and potentially severe complication of cancer therapy, particularly affecting high-risk populations such as pediatric patients, hematopoietic stem cell transplant recipients, and individuals with head and neck cancer. The incidence and severity of oral mucositis vary depending on cancer type, treatment modality, dose intensity, and patient-related factors, with the highest burden observed in head and neck cancer patients undergoing chemoradiotherapy. The pathogenesis of oral mucositis is complex and involves a multistep biological process characterized by epithelial injury, generation of reactive oxygen species, activation of pro-inflammatory cytokines, signal amplification, ulceration, and subsequent healing. These pathological changes compromise oral mucosal integrity and contribute to secondary infections and nutritional difficulties. Various preventive and therapeutic strategies have been investigated to mitigate oral mucositis. Evidence from randomized controlled trials and systematic reviews supports the use of preventive measures such as oral cryotherapy, low-level laser therapy (photobiomodulation), benzydamine mouthwash, and keratinocyte growth factor (palifermin) in selected patient populations. In addition, nutritional supplements and natural agents, including honey, glutamine, zinc, aloe vera, and probiotics, have demonstrated potential benefits, although clinical outcomes remain heterogeneous. Management of established oral mucositis is primarily supportive and focuses on pain control, maintenance of oral hygiene, prevention of infection, and preservation of nutritional status. Current international guidelines emphasize a multidisciplinary, evidence-based approach for optimal prevention and management. Despite advances in supportive care, oral mucositis continues to pose a significant clinical challenge, highlighting the need for standardized assessment tools, personalized interventions, and further high-quality research to improve patient outcomes.

CBX2-Mediated Epigenetic Modulation Drives Proliferation in Gliomas: A Narrative Review

Kai Jandial — 2026-05-19

Gliomas represent some of the most biologically heterogeneous and therapeutically recalcitrant primary brain tumours in human oncology. Despite decades of intensive research effort, the molecular mechanisms underpinning their aggressive proliferative behaviour remain incompletely characterised, and median overall survival for patients with glioblastoma—the most malignant grade—remains dismal even under optimally delivered multimodal therapy. Epigenetic dysregulation has emerged as a central theme in glioma pathogenesis, with Polycomb group proteins occupying a particularly prominent position in this landscape. Chromobox protein homologue 2 (CBX2) is a chromodomain-containing component of Polycomb Repressive Complex 1 (PRC1) that mediates transcriptional silencing through recognition of the repressive histone mark H3K27me3 and facilitation of histone H2A monoubiquitination at lysine 119. Accumulating evidence from pan-cancer transcriptomic analyses and molecular cell biology indicates that CBX2 is aberrantly overexpressed in multiple solid malignancies and that its oncogenic activity encompasses the repression of senescence-associated tumour suppressors, dysregulation of cell cycle progression, and maintenance of stem-like cellular states. Within the glioma context, CBX2 overexpression intersects with established epigenetic drivers—including IDH mutation-associated methylation phenotypes and H3K27M oncohistone mechanisms—to sustain unchecked proliferation and confer resistance to standard therapeutic interventions. This article provides a comprehensive narrative review of the molecular architecture and canonical biology of CBX2, synthesises current evidence concerning its dysregulation and functional consequences in gliomas, examines its interactions with downstream proliferative signalling networks, and considers its emerging potential as a therapeutic target. Whilst the direct experimental evidence specifically linking CBX2 to glioma proliferation remains in relatively early development compared to its better-characterised roles in other cancers, convergent data from epigenomic, transcriptomic, and functional studies make a compelling case for deeper investigation of this Polycomb subunit in neuro-oncological research.

Extracellular Matrix Mechanics in Cancer: Mechanotransduction, Cellular Phenotype, and Therapeutic Resistance

Sharmy Saimon Mano — 2026-09-28

Abnormal extracellular matrix (ECM) stiffening emerges chiefly from enhanced matrix deposition and remodelling by cancer cells and cancer-associated fibroblasts. This biomechanical alteration activates mechanosensitive pathways, principally through integrin-mediated adhesion complexes, which transmit external stiffness cues into intracellular biochemical signals via focal adhesions and the cytoskeleton. A key consequence of this mechanotransduction is the regulation of potent transcription factors such as Yes-associated protein (YAP)/transcriptional co-activator with PDZ-binding motif (TAZ), β-catenin, and nuclear factor kappa-light-chain-enhancer of activated B cells (NF-κB), each of which modulates gene networks involved in proliferation, migration, and cellular plasticity. The amplification of these signalling events alters cell fate and encourages aggressive phenotypes by promoting epithelial-to-mesenchymal transition (EMT), invasiveness, and survival. Moreover, ECM stiffening leads to resistance to conventional therapies by reorganising gene expression profiles that bolster DNA repair and evasion of apoptosis, while simultaneously impairing drug delivery through increased tissue density and vascular collapse. This review highlights mechanotransduction pathways that connect extracellular matrix stiffness with cancer cell phenotypic alterations and the development of therapeutic resistance. As such, the mechanics of the ECM act not only as a physical scaffold but also as a dynamic regulator of the malignant cancer-cell phenotype and therapeutic outcomes. The review further evaluates emerging therapeutic strategies targeting ECM synthesis and cross-linking, cancer-associated fibroblasts (CAFs), integrin-focal adhesion signalling, and downstream mechanotransduction pathways such as YAP/TAZ and β-catenin, while emphasising the limitations of current ECM-targeted approaches and the need for biomarker-guided combination therapies. The significance of this review lies in highlighting ECM stiffness-mediated mechanotransduction as a potentially actionable mechanism linking the physical tumour microenvironment (TME) to cancer progression and therapeutic resistance, thereby providing a rationale for developing novel therapies that target both tumour cells and their mechanical microenvironment.

Genome Editing in Oncology: A Critical Appraisal of CRISPR-Based Approaches to Tumour Evolution

Nalam Vineela Nirmala — 2026-10-01

Clustered regularly interspaced short palindromic repeats (CRISPR) technologies have been described as precision instruments capable of countering the evolutionary adaptability that underlies treatment failure in cancer. The evidence supporting that description is uneven. This critical narrative review examines how CRISPR-based editing contributes to three distinct problems in oncology: the discovery of genetic dependencies and resistance mechanisms, the measurement of clonal and phenotypic dynamics within tumours, and direct therapeutic intervention. Literature was identified through structured searching of biomedical and multidisciplinary scholarly sources, complemented by backward and forward citation searching, with bibliographic details and digital object identifiers verified against registry and publisher records. Evidence was appraised for design adequacy, contextual realism, replication and translational relevance rather than aggregated quantitatively.

Three conclusions emerge with differing degrees of confidence. Pooled and variant-resolution editing screens have reliably and reproducibly identified context-specific vulnerabilities, and the principal methodological weakness is no longer library design but the artificiality of the systems in which screens are performed. Lineage-recording systems have converted tumour evolution from an inference drawn from static sequencing snapshots into a directly observable process, yet nearly all such evidence derives from engineered murine or xenograft settings, and the transfer of these observations to spontaneous human disease remains unproven. Therapeutically, the strongest clinical evidence concerns ex vivo multiplex editing of immune effector cells, where early-phase trials demonstrate feasibility and acceptable short-term safety but limited and inconsistent efficacy in solid tumours; direct in vivo editing of malignant cells remains preclinical, constrained by delivery rather than by editing chemistry.

A persistent contradiction runs through the field: the same double-strand break activity that enables editing imposes selective pressure favouring cells with impaired p53 signalling and can generate large-scale structural rearrangement, so the intervention intended to constrain tumour evolution may itself act as an evolutionary force. Resolving this tension, and testing whether editing-derived insight can be converted into durable evolutionary control rather than transient response, represents the central unmet requirement of the field.

Clinical Utility of Multiple Blood Transfusion Products and the Management of Hematological Complications, Implications and Preventive Strategies among Oncological Patients: A Systematic Review

Jacques Forwah Ndeh — 2026-04-25

Background: Patients with solid tumors and hematological malignancies frequently develop transfusion-dependent anemia from marrow infiltration and cytotoxic therapy. Multiple blood transfusions (MBT) sustain oxygen delivery but increase alloimmunization, iron overload, transfusion-related immunomodulation (TRIM), and thrombosis/bleeding shifts. Practice variation persists on haemoglobin (Hb) triggers, component ratios, and mitigation (phenotyping, chelation).

Objective: To critically appraise the clinical utility of MBT in oncological populations and synthesize hematological implications (alloimmunization, iron metrics, TRIM, survival) and formulate the best management strategies for Haematological complications and prevention.

Methodology: PRISMA-guided critical review (2010–2025).

Search engines (10): PubMed/MEDLINE, Embase, Cochrane Library, Scopus, Web of Science, African Index Medicus, IMEMR, LILACS, WHO Global Index Medicus, Google Scholar were used.

Search terms (sample): ("multiple blood transfusion" OR "repeated transfusion" OR "chronic transfusion") and (oncology OR cancer OR leukaemi OR lymphoma) AND (alloimmun_ OR "iron overload" OR ferritin OR TRIM OR thrombosis OR "hemoglobin trigger")—adapted per engine (MeSH/Emtree; title/abstract).

Selection:350 records → 240 studies included (adult oncology; ≥2 transfusion episodes; report Hb thresholds, alloantibodies, ferritin/MRI iron, Venous Thromboembolism (VTE) occurrence is independently associated with shorter Overall Survival (OS) and Progression-Free Survival (OS/PFS). Appraised via SANRA & Newcastle–Ottawa; thematic synthesis by tumour type/intent.

Results: 240 studies (n≈102,400) and restrictive Hb (70–80 g/L) non-inferior in solid tumours; liberal use retained in Acute Myeloid Leukemia (AML)/Myelodysplastic Syndromes (MDS) induction. Alloimmunization: 14–26% after ≥10 units (↓ ∼38% with leukoreduced & Rh/Kell matching). Iron overload (ferritin>1000 µg/L) in 28% after ≥20 units, associated with higher non-relapse mortality post-HSCT. Transfusion Related Immunomodulation signal bacterial sepsis (RR≈1.18); RBC:plasma >1.5 modestly raised Venous Thromboembolism(VTE).

Main Finding: Management of blood transfusion (MBT) are life-saving in acute settings but show diminishing hematological utility beyond ∼10–12 episodes without Patient Blood Managenent /chelation; alloimmunization and iron loading drive late morbidity more than incremental Hb gain.

Conclusion: Restrictive strategies, extended phenotyping, and early iron monitoring optimize utility. Routine liberal Management of blood transfusion in stable oncology patients is not supported; Curative-intent subgroups often require personalized approaches because patients' responses to treatment can vary widely. Tailored thresholds help identify the most effective treatment strategies for specific groups. Factors influencing these thresholds include: Biomarker profiles, Cancer stage and aggressiveness, Patient overall health and Genetic factors.

Renal Cell Carcinoma with Metastases to Oral Cavity: A Systematic Review

Vaishnavi Marge — 2026-07-29

Introduction: Metastasis of renal cell carcinoma (RCC) to the oral cavity is uncommon but clinically significant and often presents with non-specific features resembling benign or reactive oral lesions. In some patients, the oral lesion may be the first clinical manifestation of an undiagnosed primary renal malignancy, making early recognition essential.

Objective: To systematically evaluate the demographic characteristics, clinical presentation, anatomical distribution, histopathological findings, diagnostic methods, treatment modalities, and outcomes of renal cell carcinoma metastasis to the oral cavity.

Methods: This qualitative systematic review synthesised evidence from published case reports and case series without meta-analysis. A comprehensive literature search was conducted in PubMed, Google Scholar, and ScienceDirect for English-language studies published between 2010 and 2025 using Medical Subject Headings (MeSH) and free-text search terms. Titles, abstracts, and full-text articles were screened according to predefined eligibility criteria. Data were extracted using a standardised form, and methodological quality was assessed using the Joanna Briggs Institute (JBI) critical appraisal tools.

Results: A total of 18 studies comprising 20 patients met the inclusion criteria. Most patients were male and were in the fifth to seventh decades of life. The tongue was the most frequently affected site, followed by the gingiva and jawbones. Lesions commonly presented as rapidly enlarging, highly vascular, ulcerated masses, often mimicking pyogenic granuloma and other benign oral lesions. Histopathological examination most frequently demonstrated the clear cell subtype, characterised by nests of clear cells within a rich vascular stroma. Immunohistochemical expression of paired box gene 8 (PAX8), cluster of differentiation 10 (CD10), and vimentin supported diagnostic confirmation. Surgical excision was the most commonly employed treatment, although the overall prognosis remained variable.

Conclusion: Renal cell carcinoma metastasis to the oral cavity should be considered in the differential diagnosis of unusual oral lesions. Histopathological examination combined with immunohistochemistry is essential for accurate diagnosis and prompt identification of the primary malignancy. Because the findings are derived from published case reports and case series, they should be interpreted in light of the inherent limitations of this level of evidence.

Hyalinizing Clear Cell Carcinoma of Palate: A Systematic Review

Ayushi Goyal — 2026-09-01

Hyalinising clear cell carcinoma (HCCC) is a rare, low-grade malignant tumour of minor salivary gland origin that most commonly affects the palate. This systematic review analysed the demographic profile, clinical presentation, diagnostic features, management, and outcomes of reported HCCC cases. A comprehensive review of English-language studies published between 2000 and 2025 was conducted, with most included studies comprising case reports and small case series. The findings indicated that HCCC predominantly affects middle-aged individuals, particularly those aged 40–60 years, with a slight female predominance. Clinically, it typically presents as a slow-growing, painless palatal swelling that often mimics benign salivary gland tumours. The hard and soft palate were the most commonly involved sites. Radiographic features were variable and non-specific, ranging from well-defined soft-tissue masses to lesions with bone erosion and involvement of adjacent structures. Histopathological examination consistently demonstrated nests and cords of clear epithelial cells within a hyalinised fibrous stroma and an infiltrative growth pattern. Immunohistochemistry was essential for diagnosis, with tumours showing positivity for cytokeratin, p63, EMA, and PAS and negativity for markers such as S100 and SMA. In some cases, EWSR1-ATF1 gene fusion supported the diagnosis. Differential diagnoses included other clear cell neoplasms, particularly metastatic renal cell carcinoma and salivary gland tumours. The mainstay of treatment was wide surgical excision with clear margins, with adjuvant radiotherapy reserved for selected cases. Most patients had favourable outcomes with low recurrence rates, although occasional local recurrence was reported. Overall, HCCC demonstrates indolent behaviour and a good prognosis when diagnosed early and treated appropriately. Regular follow-up is recommended to monitor for recurrence.

Influence of Anaesthetic Technique on Postoperative Cancer Outcomes in Adult Patients Undergoing Solid Tumour Surgery: A Systematic Review of Observational Evidence with an Updated Synthesis of Randomised Trials

Nangah Tabukum — 2026-10-03

Background: Perioperative anaesthetic technique has been proposed as a modifiable determinant of long-term cancer outcomes because propofol and volatile anaesthetics have different immunological and tumour-biological effects. Earlier clinical evidence was dominated by retrospective cohorts and generated inconsistent associations.

Methods: The original systematic evidence set was identified through Ovid MEDLINE and comprised 1,068 records, of which 1,060 were screened and 13 comparative retrospective cohorts were included after full-text assessment. A supplementary PubMed/MEDLINE and citation update was performed on 18 August 2026 to integrate current randomised evidence. Observational studies were appraised with ROBINS-I and synthesised without meta-analysis in accordance with SWiM principles; effect size, precision, sample size, design and risk of bias were considered in interpretation. Randomised evidence was cross-checked against the contemporary 11-trial meta-analysis by Mustafa et al. (2026), which used RoB 2 and GRADE.

Results: All 13 observational cohorts were judged to be at serious overall risk of bias, mainly because anaesthetic exposure was not randomised and residual confounding could not be excluded. Several single-centre cohorts reported associations favouring propofol-based total intravenous anaesthesia (TIVA), whereas large digestive-cancer data and studies in breast, lung and oral cancer were null. Current randomised evidence does not corroborate a clinically meaningful survival advantage. The 2026 meta-analysis of 11 randomised trials (7,811 participants) found no significant difference in overall survival (hazard ratio [HR] 1.05, 95% confidence interval [CI] 0.94-1.17), recurrence-free survival (HR 1.06, 95% CI 0.95-1.19), overall mortality (risk ratio 1.03, 95% CI 0.94-1.13) or cancer recurrence (risk ratio 0.92, 95% CI 0.76-1.12), with high certainty for the principal outcomes.

Conclusions: Observational associations suggesting benefit from propofol-based TIVA are not supported by the stronger randomised evidence available to date. Anaesthetic maintenance technique should therefore not be selected solely with the expectation of improving cancer recurrence or survival. Tumour-specific mechanistic questions and residual uncertainty around recurrence remain appropriate targets for future research.

Managing Persistent Cervical Aneurysmal Bone Cyst with Salvage Radiotherapy: A Case Report

Siddhartha Nanda — 2026-03-28

Aims: Aneurysmal bone cyst (ABC) is a benign yet locally aggressive bone lesion that can lead to significant morbidity when it involves the spine. Cervical spine involvement is particularly rare and poses significant management challenges because of its proximity to the spinal cord and major neurovascular structures, often limiting complete surgical excision. This report aims to highlight the role of salvage radiotherapy in managing residual cervical spine ABC following surgery.

Presentation of Case: A 17-year-old girl presented with progressive swelling in the left side of the neck associated with pain and recent onset weakness in both lower limbs. Imaging revealed a large expansile multiloculated lesion involving the C2–C3 vertebrae, causing spinal cord compression. She underwent C2–C3 laminectomy with excision of the lesion and posterior fixation. Histopathology confirmed aneurysmal bone cyst. Postoperative imaging showed residual disease at the operative site. Considering the anatomical constraints and surgical morbidity, salvage external beam radiotherapy was delivered using three-dimensional conformal radiotherapy to a dose of 30 Gy in 15 fractions. The treatment was well tolerated, with gradual relief of pain and improvement in motor strength. Follow-up imaging demonstrated partial regression of the lesion.

Discussion: Although surgery remains the cornerstone of treatment for ABC, residual or recurrent disease can occur when complete excision is not feasible. In such situations, carefully planned radiotherapy can provide effective local control and symptomatic relief while minimizing risks to the spinal cord.

Conclusion: This case illustrates that moderate-dose conformal radiotherapy may serve as a valuable salvage option for persistent cervical spine ABC, particularly in anatomically complex regions where further surgery carries substantial risk.

Pleural Metastases from Primary Femoral Sarcoma in a Child: A Rare Case Report

Hafsa Riache — 2026-05-26

Background: Primary malignant bone sarcomas are rare but aggressive pediatric tumors with a strong tendency for pulmonary metastasis, while pleural spread is exceptionally uncommon and diagnostically challenging.

Aims: To report a rare case of pleural metastatic dissemination from a primary femoral sarcoma in a pediatric patient and to describe its computed tomography features.

Study Design: Case report.

Presentation of Case: An 8-year-old girl previously treated for malignant sarcoma of the distal femur presented seven months later with acute respiratory distress. Chest computed tomography revealed extensive heterogeneous pleural masses with internal calcifications, peripheral enhancement, and significant compressive effect on the right lung, causing near-complete pulmonary collapse and mediastinal shift. Associated pulmonary nodules were also identified. The imaging findings were consistent with extensive pleural metastatic involvement.

Discussion: Pleural metastases from primary bone sarcomas are extremely uncommon in children. Their radiological appearance may mimic primary pleural malignancies or other thoracic neoplasms, making diagnosis challenging. Recognition of calcified pleural metastatic lesions in patients with known primary bone tumors is essential for accurate diagnosis and appropriate management.

Conclusion: Pleural metastatic dissemination should be considered in pediatric patients with primary bone sarcoma presenting with new thoracic symptoms, particularly when imaging demonstrates calcified pleural masses.

Epithelioid Hemangioendothelioma Presenting as a Leg Mass: A Rare Vascular Tumor Presenting Diagnostic and Management Challenges

Kinzang Dorji — 2026-07-23

Introduction: Epithelioid haemangioendothelioma (EHE) is a rare vascular neoplasm of endothelial origin with biological behaviour intermediate between benign haemangioma and malignant angiosarcoma. Owing to its rarity, variable clinical presentation, and histopathological overlap with other soft-tissue tumours, its diagnosis and management can be challenging. Current evidence is limited, with most available literature derived from case reports and small case series.

Case Presentation: A 48-year-old woman presented with a slowly growing, painless soft-tissue mass over the posterior aspect of the left leg that had been present for seven months. Initial clinical assessment suggested a benign soft-tissue lesion; however, ultrasonography and magnetic resonance imaging raised suspicion of a soft-tissue sarcoma. Core biopsy demonstrated features suggestive of myxoid sarcoma. Further histopathological examination revealed a hypercellular neoplasm composed of cords, strands, and small nests of epithelioid cells within a myxohyaline stromal background, with occasional intracytoplasmic vacuoles. Immunohistochemical staining was positive for the endothelial markers CD31 and CD34, confirming the diagnosis of soft-tissue EHE. The patient underwent wide en bloc surgical excision with negative margins (R0 resection). The postoperative course was uneventful, and the wound healed completely. Surveillance contrast-enhanced computed tomography (CT) of the chest and abdomen demonstrated no evidence of metastatic disease. The patient was followed at three-month intervals for one year, with no evidence of local recurrence or distant metastasis.

Discussion: Soft-tissue EHE is an uncommon vascular tumour with unpredictable biological behaviour, ranging from localised disease to metastatic presentation. Accurate diagnosis requires correlation among clinical, radiological, histopathological, and immunohistochemical findings. Differentiation from epithelioid angiosarcoma and epithelioid sarcoma is essential because their prognoses and treatments differ. For localised, unifocal EHE, complete surgical excision with adequate negative margins remains the mainstay of treatment. The role of adjuvant therapy remains unclear because of limited evidence.

Conclusion: EHE should be considered in the differential diagnosis of soft-tissue masses with atypical clinical or radiological features. Complete surgical resection with negative margins can provide effective local control in localised disease; however, long-term surveillance is necessary because of the potential for recurrence and metastasis.

Primary Conjunctival Embryonal Rhabdomyosarcoma in a 19-Year-Old Man: A Case Report

Lotfi Chaabani — 2026-08-05

Background: Primary conjunctival embryonal rhabdomyosarcoma is an exceptionally uncommon ocular surface malignancy that can resemble benign conjunctival lesions. This report describes its clinical, histopathological, immunohistochemical, radiological and staging features in a young adult.

Presentation of Case: A 19-year-old man with no relevant medical or familial history presented with a rapidly progressive right ocular mass that had progressed over one month. Best-corrected visual acuity was 8/10 in the right eye and 10/10 in the left eye. The right eye showed a large vascularised polypoid mass measuring 28 x 18 x 16 mm, arising from the inferior conjunctival fornix and adjacent bulbar conjunctiva. The left eye was clinically normal. Subtotal excision revealed a malignant small round cell tumour with hyperchromatic nuclei, mitotic activity, myxoid and vascularised stroma, and multinucleated tumour cells. Immunohistochemistry showed strong desmin positivity, supporting embryonal RMS. Orbital MRI showed enhancing inferior conjunctival thickening contacting the inferior and medial rectus muscles without extraocular muscle invasion, deep orbital extension or intracranial involvement. Systemic staging showed no distant metastasis.

Discussion: The tumour was classified as embryonal RMS with residual local disease after subtotal excision, corresponding clinically to Group III disease under the Intergroup Rhabdomyosarcoma Study framework. Management required urgent multidisciplinary oncologic referral for systemic chemotherapy and local-control planning. The main limitations were the absence of a broad immunohistochemical and molecular panel and incomplete long-term oncologic follow-up in the ophthalmology record.

Conclusion: Rapidly enlarging conjunctival masses in young patients should prompt early biopsy, orbital imaging, systemic staging and urgent oncologic referral.

Definitive Radiotherapy for Bilateral Carotid Body Tumors: A Case Report with 3.5 Years Follow-Up

Madhuri Karyampudi — 2026-09-10

Carotid body tumours (CBTs) are rare, slow-growing neuroendocrine neoplasms arising at the carotid bifurcation, and bilateral disease is uncommon. This case report describes the use of definitive radiotherapy for bilateral Shamblin type II CBTs in a 60-year-old man presenting with gradually enlarging, painless bilateral neck swellings. Magnetic resonance imaging demonstrated masses measuring 44 × 42 × 35 mm on the left and 36 × 31 × 32 mm on the right, with intense contrast enhancement, flow voids, and bilateral encasement of the internal and external carotid arteries. Both tumours were treated with a forward intensity-modulated radiotherapy plan. A total dose of 50.4 Gy in 28 fractions was delivered over 5.5 weeks. During treatment, the patient developed Grade II skin reactions by the end of the fourth week and Grade II dysphagia by the end of the fifth week; both were managed conservatively. Follow-up continued for 3.5 years. The left-sided tumour decreased from 64.68 cc to 30.46 cc, corresponding to an approximately 53% reduction, while the right-sided tumour decreased from 35.71 cc to 5.6 cc, representing an approximately 84% reduction. No late side effects were observed up to 3 years after treatment. This case demonstrates sustained bilateral tumour regression after definitive radiotherapy with manageable acute toxicity and supports its consideration in carefully selected patients when surgical morbidity is a major concern.

CEA-Discordant Progression in Metastatic Rectal Cancer: A Case Report

Girin Ray — 2026-09-24

Background: Metastatic rectal carcinoma requires coordinated multimodal management, with treatment decisions informed by disease extent, clinical status, pathology, imaging, and molecular findings.

Case Presentation: A 61-year-old woman presented in November 2022 with progressive constipation, painful defecation, and mucoid rectal discharge. Loop sigmoid colostomy was performed for symptomatic metastatic rectal cancer, and intraoperative assessment demonstrated a mid-rectal growth, multiple omental and peritoneal metastases, ascites, and colonic dilatation. Histopathological examination of a peritoneal deposit confirmed metastatic poorly differentiated carcinoma. The patient received four documented cycles of palliative CapOx plus bevacizumab, followed by chemoradiotherapy and maintenance oral capecitabine. Subsequent records documented microsatellite-stable disease, a PD-L1 tumour proportion score of 17%, a combined positive score of 2, and KRAS/NRAS/PIK3CA profiling, although a complete formal molecular report was unavailable. Serial PET-CT examinations demonstrated persistent and subsequently progressive nodal metastatic disease. In July 2026, progressive para-aortic, aortocaval, left external iliac, and bilateral inguinal nodal disease was reported, with para-aortic nodal encasement of the proximal left ureter and upstream hydroureteronephrosis. Despite radiological progression, serum CEA remained low at 2.2 ng/mL.

Conclusion: This case demonstrates the importance of integrating serial imaging, pathology, clinical assessment, and verified molecular findings when monitoring metastatic rectal carcinoma, particularly when serum CEA does not reflect radiological disease progression.

Irreversible Bilateral Blindness from Compressive Optic Neuropathy Caused by a Left Sphenoid Wing Meningioma Despite Radiological Response to Radiotherapy: A Case Report

Lotfi Chaabani — 2026-09-24

Aims: To highlight the risk of irreversible blindness from delayed recognition of compressive optic neuropathy caused by a sphenoid wing meningioma and to emphasise that radiological tumour control does not necessarily imply visual recovery once optic atrophy is established.

Presentation of Case: An octogenarian woman presented with painless progressive bilateral visual loss over 6 months. Visual acuity was reduced to light perception; the anterior segments were quiet, and fundus examination showed bilateral optic atrophy. Brain magnetic resonance imaging revealed a 27 × 18 mm intensely enhancing left spheno-temporofrontal extra-axial mass compatible with a sphenoid wing meningioma. The lesion encased the left middle cerebral and intracavernous internal carotid arteries while preserving their patency and extended to the lateral aspect of the optic chiasm. Radiotherapy was subsequently administered. Follow-up imaging showed tumour regression, but vision did not recover, and the patient ultimately developed bilateral blindness attributed to irreversible compressive optic neuropathy.

Discussion: Chronic optic nerve or chiasmal compression may progress from potentially reversible dysfunction to permanent axonal loss and optic atrophy. Radiotherapy can achieve tumour control in selected meningiomas affecting the visual pathways, but established optic atrophy markedly limits functional recovery.

Conclusion: Progressive visual loss associated with optic disc pallor requires urgent neuroimaging. Early diagnosis and treatment of compressive optic neuropathy are essential because delayed management may result in permanent blindness despite subsequent radiological tumour control.

Cutaneous Nasal Metastasis of Gastric Carcinoma: An Unusual Case with Review of Literature

Sharath K. Krishnan — 2026-10-03

Cutaneous metastasis from gastric adenocarcinoma is uncommon and usually indicates advanced disease. Nasal involvement is particularly unusual and may clinically mimic benign, inflammatory, infectious, or primary cutaneous lesions. This case report describes a 56-year-old man with a history of moderately differentiated intestinal-type gastric adenocarcinoma who presented with a painless, progressive nasal swelling of one month’s duration. He had previously undergone distal radical gastrectomy for gastric outlet obstruction, followed by capecitabine-based chemotherapy. Clinical examination showed a firm, non-tender mass involving the right ala and tip of the nose with surface ulceration. Fine needle aspiration cytology showed adenocarcinoma. Magnetic resonance imaging demonstrated a well-defined anterior right nasal mass with central cystic and necrotic changes, without involvement of the septum, nasal cavity, underlying bone, or brain. Palliative excision with right nasolabial flap reconstruction was performed for cosmetic improvement. Histopathology revealed a dermal infiltrating neoplasm forming glandular patterns in the nasal skin. Immunohistochemistry showed CK7 positivity and CK20 and GCDFP-15 negativity, supporting metastatic adenocarcinoma consistent with the known gastric primary in the clinical context. Subsequent imaging revealed liver and bilateral lung metastases. This case highlights the need to consider metastatic internal malignancy in unusual, persistent, or rapidly enlarging nasal cutaneous lesions, particularly in patients with a known history of cancer.

Unveiling the Awareness Gap: A Community-Based Cross-Sectional Study to Assess Knowledge and Attitude on Cervical Cancer among the Female Population

Mahima Prakash M D — 2026-01-14

Cervical cancer continues to be a significant public health issue in India, standing as the second most prevalent cancer among women. Despite being largely preventable through regular screening and human papillomavirus (HPV) vaccination, awareness remains inadequate and negative attitudes toward prevention and early detection persist.

Aims: This study aimed to assess the knowledge and attitudes regarding cervical cancer among women attending community pharmacies.

Study Design: Cross-sectional Study

Place and Duration of Study: The study was conducted among women visiting selected community pharmacies over a period of four months.

Methodology: A cross-sectional survey was conducted among 502 women aged 18 years and above who visited selected community pharmacies. Data on socio-demographics, knowledge and attitudes regarding cervical cancer were collected using a pre-validated questionnaire. Descriptive statistics were used to analyze the responses.

Results: Among 502 participants, 73.71% were aware of cervical cancer, with 57.29% healthcare professionals being the most common source of primary information. However, only 28.08% recognized it as a leading cause of cancer-related mortality among women and 44.82% had heard of HPV. While 64.34% believed screening is preventive and 60.75% were willing to be screened, 39.24% were unwilling, due to a lack of awareness and financial constraints.

Conclusion: The study revealed moderate awareness but significant gaps in knowledge of cervical cancer risk factors, symptoms and prevention. Generally positive attitudes toward screening, misconceptions and structural barriers continue to limit participation. There is a need for strengthened community-based educational interventions and accessible screening services to improve women’s participation in cervical cancer prevention programs.

Patterns of Peripheral Cytopenia in Hematological Malignancies: A Single-Center Retrospective Study from Aden, Yemen

Ghada Mohammed Abdulaziz — 2026-01-19

Background: Peripheral cytopenias, including anemia, thrombocytopenia, bicytopenia, and pancytopenia, are common findings in patients with hematological malignancies (HMs) and often necessitate bone marrow evaluation for definitive diagnosis. This study aimed to determine the spectrum of HMs and their association with various patterns of peripheral cytopenia at a major oncology center in Aden, Yemen.

Methods: This descriptive, retrospective study included 70 patients diagnosed with HMs at the Hematology Department of the National Oncology Center, Aden, between January 2019 and December 2020. All patients underwent comprehensive assessment including history, physical examination, full blood count, and bone marrow aspiration/biopsy. Data were analyzed using SPSS version 26, with a p-value < 0.05 considered statistically significant.

Results: Peripheral cytopenia was present in 84.3% (n=59) of HM patients. The median age was 50 years, with a male-to-female ratio of 1.5:1. Bicytopenia was the most common pattern (52.5%), followed by isolated anemia (27.1%), pancytopenia (10.2%), and isolated thrombocytopenia (10.2%). Acute leukemias constituted 61.0% of cases among cytopenic patients, with Acute Lymphoblastic Leukemia (ALL) and Acute Myeloid Leukemia (AML) being the most frequent subtypes. A significant association was found between AML and both pancytopenia (83.3% of pancytopenic cases) and isolated thrombocytopenia (50.0% of isolated thrombocytopenic cases) (p<0.05). Conversely, Multiple Myeloma (MM) was significantly associated with normal peripheral blood counts (36.4% of non-cytopenic cases) (p<0.05). Bone marrow examination in cytopenic patients frequently revealed hypercellularity, decreased erythrocyte precursors, and decreased megakaryocytes, indicative of ineffective hematopoiesis and marrow infiltration.

Conclusion: Peripheral cytopenia is highly prevalent among HM patients in Aden, with bicytopenia being the dominant pattern. The strong association between acute leukemias and severe cytopenias underscores the aggressive nature and advanced presentation of these malignancies in this population. These findings are crucial for guiding diagnostic strategies and clinical management in resource-limited settings and emphasize the importance of prompt bone marrow examination in patients with unexplained multi-lineage cytopenia.

A Statistical Framework for Modelling Breast Cancer Disease Pathways with Multistate and Competing Risks Approaches

Francis Ayiah-Mensah — 2026-02-12

Background: Breast cancer is one of the leading causes of mortality in women in Ghana; prognostic studies are still dominated by single endpoint Kaplan-Meier and Cox models, which do not consider recurrence, progression, and competing mortality. The study aimed to come up with a robust multistate competing risks survival model to define disease processes in Ghanaian breast cancer patients and provide dynamic prognostic profiles.

Objectives: To measure transition-specific hazards between diagnosis and progression, breast cancer event with competing risk death; to obtain the cumulative probability of breast cancer event in the presence of competing mortality; and to obtain state occupation probabilities over follow-up time.

Methods: A retrospective cohort of 558 patients was analysed using cause-specific Cox multistate models, Fine-Gray sub-distribution hazards, nonparametric cumulative incidence functions, and Aalen-Johansen estimators. The baseline predictors were age, stage, grade, lymph node involvement, tumour size, molecular subtype and hormone receptor status in determining the Hazard Ratio (HR) and the Sub-distribution Hazard Ratio (SHR).

Findings: After five years of follow-up with a median of about five years, 241 incidences of breast cancer and 40 competing risks deaths were verified. The advanced stage was a strong predictor of transition adverse outcomes (HR = 1.55, 95% CI: 1.192.01, p = 0.001), whereas lymph node involvement was a strong predictor of adverse outcomes (HR = 1.23, 95% CI: 1.051.44, p = 0.012). The cumulative incidence of breast cancer events was strongly increased by stage (SHR = 2.12, 95% CI: 1.48-3.04, p < 0.001) and lymph node status (SHR = 1.49, 95% CI: 1.25-1.78, p < 0.001), as observed in the Fine-Grey model.

Conclusion: This research integrates progression and competing mortality into a multistate survival model in Ghana to overcome the statistical limitations of single-endpoint models. The evidence supports early diagnosis, expanded molecular profiling, and the implementation of state-based prognostic instruments to strengthen precision oncology and cancer control policy.

Integrative Structural and Network Analysis Identifies CDK9 as a Candidate Therapeutic Target in Short-Term Survivor High-Grade Serous Ovarian Cancer

S. R. Abhishek — 2026-02-24

Background: High-grade serous ovarian cancer (HGSC) exhibits marked clinical heterogeneity, with Short-Term (ST) survivors demonstrating intrinsic resistance to standard chemotherapy and poor outcomes. Understanding tumor-intrinsic transcriptional vulnerabilities in ST-HGSC represents a critical unmet need for precision therapeutic development. This study integrates structural bioinformatics, network topology analysis, and pharmacogenomics to identify druggable master regulators sustaining the aggressive ST phenotype.

Methods: We analyzed transcriptomic data from Kotnik et al. (2023) comparing ST and Long-Term (LT) HGSC survivors, identifying 325 significantly upregulated differentially expressed genes (DEGs) in the ST cohort (log₂FC >1.5, adjusted P<0.05). The ESR1-CCDC170 fusion protein structure was predicted using AlphaFold2 v2.3.1 to assess ligand-binding domain integrity. A protein-protein interaction (PPI) network was constructed from ST-specific DEGs using STRING (confidence >0.4), and master regulatory hubs were identified using the Maximal Clique Centrality (MCC) algorithm in CytoHubba. Survival analysis was performed using Kaplan-Meier Plotter (n=1,435 serous ovarian cancer patients). Functional enrichment of hub neighborhoods was conducted using NetworkSuite v2.1 (Sequensolutions), integrating Gene Ontology, Reactome, WikiPathways, and KEGG databases. Pharmacogenomic repurposing was performed using L1000CDS2, and drug-target interactions were validated through structural analysis.

Results: AlphaFold2 modeling demonstrated that ESR1-CCDC170 retains the DNA-binding domain (pLDDT >85) but completely lacks the C-terminal ligand-binding domain, providing structural evidence for endocrine therapy resistance. Network analysis identified Cyclin-Dependent Kinase 9 (CDK9) as the top-ranked hub (degree=17, highest MCC score), exhibiting both high connectivity and betweenness centrality. Survival analysis confirmed that high CDK9 expression significantly predicted poor overall survival (median OS: 42.5 vs 51.2 months; HR=1.28, 95% CI: 1.10-1.51; log-rank P=0.0088). Functional enrichment of CDK9's 17 first-degree interactors revealed profound overrepresentation in RNA Polymerase II transcriptional elongation pathways (FDR<10⁻¹⁰), supporting a model of elongation-dependent transcriptional addiction. Network stability analysis across multiple STRING confidence thresholds (0.4-0.9) confirmed CDK9's robust central position. Pharmacogenomic analysis identified transcriptional inhibitors as signature-reversing compounds, and structural validation confirmed stable CDK9-alvocidib interaction.

Conclusion: Our integrative computational analysis identifies CDK9 as a candidate master regulator sustaining transcriptional addiction in ST-HGSC, potentially driven by fusion-mediated constitutive transcriptional activation. These findings support CDK9 inhibition as a rational precision therapeutic strategy for this high-risk patient subgroup. Experimental validation through functional studies, including CDK9 knockdown experiments, drug sensitivity assays in HGSC cell lines, and patient-derived xenograft models, is essential to confirm these computational predictions and advance toward clinical translation.

Disparities in Targeted Therapy Access and Survival by Molecular Subtype in Breast Cancer: Evidence from Yemen

Gamal Abdul Hamid — 2026-02-28

Background: Breast cancer management has evolved toward precision medicine based on molecular subtypes. In low-resource settings like Yemen, access to targeted therapies is limited, potentially exacerbating survival disparities. This study examines treatment patterns and survival outcomes across molecular subtypes in a large Yemeni cohort from a conflict-affected setting.

Methods: A retrospective analysis of 1,167 breast cancer patients at the National Oncology Center in Aden, Yemen (2017-2024) was conducted. Patients were classified into four molecular subtypes: Luminal A-like (HR+/HER2-), Luminal B-like (HR+/HER2+), HER2-enriched (HR-/HER2+), and Triple-Negative (TNBC). Treatment patterns (surgery, chemotherapy, endocrine therapy, anti-HER2 therapy) and mortality at last follow-up were compared across subtypes using chi-square tests and multivariate logistic regression. Due to 41.9% loss to follow-up, survival analysis was restricted to 678 patients with documented outcomes.

Results: The cohort comprised 611 (52.4%) Luminal A-like, 168 (14.4%) Luminal B-like, 139 (11.9%) HER2-enriched, and 284 (24.3%) TNBC cases. Significant disparities in treatment access were observed: only (66.2%) of eligible HR+ patients received endocrine therapy; only (61.2%) of HER2+ patients received anti-HER2 therapy. TNBC patients had the highest rate of mastectomy (78.2%) and chemotherapy (98.2%). Mortality at last follow-up varied significantly by subtype: Luminal A-like (61.7% alive), Luminal B-like (54.8% alive), HER2-enriched (48.9% alive), and TNBC (42.6% alive; p<0.001). On multivariate analysis, TNBC subtype (OR 2.8, 95% CI 1.6-4.9) and lack of minimum subtype-specific systemic therapy (OR 3.1, 95% CI 1.8-5.4) were independent predictors of mortality. Median follow-up duration was 24 months (range 1-84 months).

Conclusion: Profound disparities exist in access to precision therapy for breast cancer in Yemen, particularly affecting HER2+ and TNBC patients. The survival disadvantage of TNBC patients persists even in this late-presenting cohort, highlighting the urgent need for equitable access to essential cancer medicines and clinical trial inclusion for aggressive subtypes in conflict settings. These findings provide actionable evidence for global oncology policy and humanitarian cancer care strategies.

Survival and Prognostic Factors in Ewing Sarcoma: Evaluating the Role of Radiotherapy in Multimodality Management

Siddhartha Nanda — 2026-03-21

Background: Ewing sarcoma is an aggressive small round blue cell malignancy that predominantly affects children and young adults. Radiotherapy plays a central role in local control, particularly in anatomically complex or unresectable disease.

Methods: A retrospective cohort study of 51 patients with histologically confirmed Ewing sarcoma treated between January 2022 and December 2024 at a tertiary care centre was conducted. All patients received multi-agent chemotherapy, and radiotherapy was delivered with curative (adjuvant or definitive) or palliative intent. Advanced conformal techniques, including volumetric modulated arc therapy (VMAT) and three-dimensional conformal radiotherapy (3DCRT), were used according to clinical indication. Overall survival (OS) and disease-free survival (DFS) were estimated using the Kaplan–Meier method. DFS was defined as the time from completion of primary treatment to recurrence or last follow-up. Prognostic factors were explored using univariate Cox proportional hazards regression.

Results: The median age was 21 years (IQR 14.5–28.0), and 43.1% of patients were in the paediatric age group. Metastatic disease at diagnosis was present in 27.5% of patients. Radiotherapy was delivered using conformal techniques in 68.6% of cases, most commonly VMAT. The median radiotherapy dose was 45 Gy. With a median follow-up of 28 months, the median OS and DFS were both 25 months. The 2-year OS rate was 75%. Higher radiotherapy dose and use of advanced conformal techniques were associated with improved survival outcomes in univariate analyses. No grade ≥3 acute toxicities were observed.

Conclusion: Radiotherapy contributes significantly to local control and survival in Ewing sarcoma within a multimodality treatment framework. Metastatic disease at diagnosis remains the dominant adverse prognostic factor. Optimisation of local therapy through appropriate dose and modern conformal techniques may improve outcomes; however, larger prospective studies are required to validate these associations.

Assessment of the Outcomes of a Modified Version of the Reverse Hockey Stick Incision (mRHSI): A single Institutional Ambispective Longitudinal Study

Jitendra Kumar Nangal — 2026-04-03

Background: Neck dissection is a cornerstone of head and neck cancer management, requiring an incision design that balances surgical exposure with skin viability and cosmesis. Traditional designs, such as the Y-shaped incision, often suffer from poor blood supply at trifurcation points, leading to vessel exposure and wound breakdown.

Objectives: This study aimed to assess the outcomes of a modified version of the Reverse Hockey Stick Incision (mRHSI). The primary objective was to evaluate its usability and feasibility in a large clinical sample, focusing on intraoperative accessibility and postoperative complications.

Methods: An ambispective longitudinal study was conducted from May 2018 to March 2022, involving 451 patients with oral, oropharyngeal, or parotid malignancies. The mRHSI utilizes a gentle curve 3–4 cm below the angle of the mandible along the skin crease, extending longitudinally toward the mid-clavicle. Parameters assessed included dissection duration, marginal necrosis, wound dehiscence, and long-term cosmesis using the Vancouver Scar Scale (VSS).

Results: The mean dissection time was 22.49 +/- 1.69 minutes, significantly shorter than historical rates for MacFee or Schobinger incisions (p < 0.001). Complication rates remained low, with marginal necrosis at 3.1% and wound dehiscence requiring re-suturing at 2.4%. Scar assessment showed significant longitudinal improvement, with mean VSS scores decreasing from 11.43 at discharge to 2.81 at the three-year follow-up (p < 0.001). Approximately 85.6% of patients reported "good" or "satisfactory" cosmetic feedback.

Conclusion: The mRHSI provides excellent surgical exposure and accessibility while minimizing operative time and flap-related complications. By avoiding acute angles and three-point junctions, the modification ensures superior healing and favorable cosmetic outcomes without compromising oncological radicality.

Barriers to Cervical Cancer Screening in Rural Communities of Rivers State, Nigeria

Nduye Christie Tobin Briggs — 2026-07-14

Background: Cervical cancer remains a leading cause of cancer‑related mortality among women in Sub‑Saharan Africa, yet screening coverage remains critically low, particularly in rural Nigeria. This study assessed the barriers to cervical cancer screening and identified predictors of non‑uptake among women aged 25–65 years in rural communities of Rivers State, Nigeria.

Methods: A community‑based analytic cross‑sectional study was conducted from April to September 2025 among 589 women selected through multistage sampling. A structured, interviewer‑administered questionnaire adapted from a validated tool was used. Data were analysed using SPSS version 27.0. Descriptive statistics, bivariate analysis, and multivariable binary logistic regression with the enter method were used. Statistical significance was set at p < 0.05. Model diagnostics included the Hosmer‑Lemeshow test, Nagelkerke R², Area Under the Receiver Operating Characteristic curve (AUROC), and sensitivity analysis.

Results: The mean age was 41.3 ± 11.7 years; 61.3% were aged 35–54 years. Only 52 women (8.8%) had ever been screened for cervical cancer. The most common individual barrier was lack of knowledge (86.6%), followed by fear of pain or results (65.2%). Husband's disapproval (58.5%) was the leading socio‑cultural barrier, while cost (76.2%) and distance >5 km to a health facility (71.5%) were the predominant health system barriers. Independent predictors of never being screened were no formal education (AOR = 9.84, 95% CI: 3.21–30.15), farming/fishing occupation (AOR = 5.76, 95% CI: 2.10–15.80), monthly income <₦30,000 (AOR = 8.42, 95% CI: 2.98–23.82), never having heard of cervical cancer (AOR = 14.53, 95% CI: 4.87–43.36), and distance >5 km to facility (AOR = 3.21, 95% CI: 1.56–6.60). The model demonstrated excellent discrimination (AUROC = 0.86) and good fit (Hosmer‑Lemeshow p = 0.621).

Conclusion: Cervical cancer screening uptake among rural women in Rivers State is extremely low (8.8%). Multilevel barriers, including knowledge deficits, fear, husband's disapproval, cost, distance, low education, and poverty, strongly predicted non‑screening. Targeted community‑based education, male engagement initiatives, mobile screening services, and subsidised care are urgently needed to address these barriers and improve screening coverage in this underserved population.

Pattern of Cancer and Treatment Modalities among Adult Cancer Patients in Tertiary Hospitals of Bayelsa and Rivers States, Nigeria

Tariebi Katherine Owei-Tongu — 2026-09-01

Background: Facility-based evidence on cancer patterns and treatment profiles is important for planning oncology services in Nigeria. This study described cancer types, disease stage, and treatment modalities among adults managed in two tertiary hospitals in Bayelsa and Rivers States.

Methods: A hospital-based descriptive mixed-methods design was used. Quantitative data were extracted from 350 patient folders, while 30 patients participated in qualitative interviews and focus group discussions. Descriptive statistics were used to summarise socio-demographic characteristics, cancer types, year of diagnosis, disease stage, and treatment received.

Results: Most records were from the University of Port Harcourt Teaching Hospital (59.4%), and females constituted 64.0% of the sample. The largest age group was 60–69 years (33.4%). Breast cancer was the most frequently recorded diagnosis (36.3%), followed by prostate cancer (14.9%) and colon cancer (7.7%). Most patients were diagnosed between 2019 and 2022 (66.3%). Stage 1 disease accounted for 43.4%, while Stages 2 and 3 accounted for 30.9% and 23.4%, respectively. Chemotherapy was the most frequently recorded treatment (89.1%), followed by surgery (80.6%), physiotherapy (61.4%), psychotherapy (56.0%), palliative care (32.3%), and radiotherapy (25.4%).

Conclusion: The findings describe a facility burden dominated by breast and prostate cancers and a treatment profile centred on chemotherapy and surgery. Strengthening cancer registries, multidisciplinary care, and earlier integration of palliative care may improve oncology service planning in the two states.

Knowledge, Attitudes, and Acceptance of Human Papillomavirus Vaccination Among Women of Reproductive Age Attending a Tertiary Hospital in Southeast Nigeria

Emmanuel M. Akwuruoha — 2026-09-07

Background: Human papillomavirus (HPV) infection is a major cause of cervical cancer, particularly in low- and middle-income countries where access to preventive services is limited. Despite the proven effectiveness of HPV vaccination in preventing HPV-related diseases, vaccine uptake remains low in many developing countries.

Aims: This study assessed the knowledge, attitudes, and acceptance of HPV vaccination among women of reproductive age attending a tertiary hospital in Southeast Nigeria.

Methods: A descriptive cross-sectional study was conducted among 366 women aged 15 to 49 years attending Abia State University Teaching Hospital, Aba, Nigeria. Participants were selected through a multistage sampling technique. Data were collected using a structured, interviewer-administered questionnaire that assessed sociodemographic characteristics, knowledge of HPV and HPV vaccination, attitudes towards vaccination, and vaccine acceptance. Data were analysed using IBM SPSS Statistics version 26.0, with statistical significance set at p < 0.05.

Results: Most respondents were 25 to 34 years old (40.17%), married (52.19%), and had tertiary education (50.27%). Awareness of HPV was reported by 76.78% of participants. Overall, 45.63% demonstrated good knowledge, 37.43% had moderate knowledge, and 16.94% had poor knowledge of HPV vaccination. Social media (47.27%) and the internet (34.43%) were the main sources of information. Positive attitudes towards HPV vaccination were reported by 63.39% of respondents, while 59.29% demonstrated high vaccine acceptance. The distributions of knowledge, attitudes, and acceptance were statistically significant (p < 0.001).

Conclusion: Women attending the tertiary hospital demonstrated relatively high levels of knowledge, positive attitudes, and substantial acceptance of HPV vaccination. However, important knowledge gaps regarding vaccine safety, dosage schedules, and potential side effects remain. Strengthening health education and expanding healthcare provider and digital health interventions may further improve vaccine uptake in Southeast Nigeria.

Clinico-Epidemiological Profile of 834 Oral Submucous Fibrosis Cases: A Retrospective Institutional Study

M S Mandale — 2026-09-17

Background: Oral submucous fibrosis (OSMF) is a chronic fibrotic oral potentially malignant disorder strongly associated with areca-nut exposure. Objective: To describe the demographic profile, principal recorded habits, chief complaints, associated oral findings, and documented management in a large institutional series of OSMF cases.

Methods: A retrospective descriptive analysis was performed on 834 institutional case records with a documented clinical/provisional diagnosis of OSMF. Available variables were summarised using frequencies and percentages; age was analysed in predefined bands, and the sex distribution was analysed separately. Carcinoma identified in the records was treated as a concurrent associated diagnosis rather than as a longitudinal malignant-transformation event.

Results: The cohort included 708 males (84.9%) and 126 females (15.1%). The largest age groups were 21–30 years (273; 32.7%), 31–40 years (243; 29.1%), and 41–50 years (203; 24.3%). Principal recorded habits were gutkha use (245; 29.4%), smoked tobacco (237; 28.4%), tobacco chewing (234; 28.1%), betel-quid use (72; 8.6%), and kharra use (46; 5.5%). Burning sensation (279; 33.5%) and reduced mouth opening (247; 29.6%) were the most frequent principal chief complaints. Coexisting leukoplakia was documented in 145 patients (17.4%) and carcinoma in 35 (4.2%). Medicinal treatment was recorded for all 834 cases, habit cessation for 830 (99.5%), and surgical intervention for 35 (4.2%).

Conclusion: This institutional series demonstrates a marked male predominance and substantial representation of young adults with OSMF. The findings support prevention centred on complete cessation of areca-nut and tobacco products, careful assessment of coexisting oral potentially malignant lesions, and long-term surveillance. Concurrent carcinoma in a retrospective case series should not be interpreted as a malignant-transformation rate without longitudinal follow-up.

Serum p27, p53, Lactate Dehydrogenase and Alkaline Phosphatase as Candidate Biomarkers in Breast Cancer in Port Harcourt, Nigeria

Prince Nnabugo Ali-Diogu — 2026-09-17

Background: Breast cancer remains a major cause of morbidity and mortality among women, with a substantial burden in resource-limited settings where access to advanced diagnostic facilities may be constrained. Although p27 and p53 are important tumour suppressor proteins and lactate dehydrogenase (LDH) and alkaline phosphatase (ALP) are routinely measurable biochemical parameters, evidence regarding their combined circulating profiles in breast cancer remains limited. Evaluating these markers may help clarify their potential value as accessible adjuncts in the assessment of breast cancer patients.

Aims: To evaluate selected tumour suppressor biomarkers and biochemical parameters in breast cancer patients attending Rivers State University Teaching Hospital.

Study Design: Analytical cross-sectional study.

Place and Duration of Study: Rivers State University Teaching Hospital (RSUTH), Port Harcourt, Nigeria, February–July 2026.

Methodology: An analytical cross-sectional design was employed. A total of 140 participants (70 breast cancer subjects and 70 apparently healthy controls, aged 20–80 years) were recruited. Serum p27, p53, LDH and ALP were measured using ELISA and spectrophotometry. As the data were not normally distributed, they were analysed using the Mann–Whitney U and Kruskal–Wallis H tests, with Bonferroni-adjusted post hoc comparisons and multiple linear regression, at P=.05.

Results: Breast cancer patients had significantly higher p27 (366.69±146.91 vs 273.30±61.90 pg/mL, P=.001), LDH (62.28±2.69 vs 60.03±1.89 IU/L, P=.001) and ALP (176.71±117.05 vs 117.80±35.96 IU/L, P=.001) than controls; p53 did not differ significantly (211.39±189.16 vs 156.23±102.97 pg/mL, P=.510). LDH varied significantly across cancer stages (P=.009), with the Stage I versus Stage IV comparison remaining significant after Bonferroni correction (P=.007). Cancer duration and treatment regimen independently predicted p53 (R²=0.158, P=.046); no other regression model reached significance.

Conclusion: Serum p27, LDH and ALP distinguished breast cancer subjects from controls in this cohort, while p53 showed limited discriminatory value. LDH was also associated with cancer stage. Larger studies are needed to validate these findings.

Cancer Epidemiology in Zimbabwe: Insights from GLOBOCAN 2020 Estimates on Incidence, Mortality, and Risk Modeling

Nyasha Chin'ombe — 2026-10-15

Zimbabwe, a landlocked, lower-middle-income country in Southern Africa, faces a significant cancer burden. The present study aims to provide a quantitative analysis of cancer epidemiology in Zimbabwe for 2020 using data from the Global Cancer Observatory (GCO). Focusing on the 10 most frequent cancers, the dataset included new cases (Nc), deaths (Nd), age-standardised rates (ASRi, ASRm), rank (Rk), reciprocal rank (1/Rk), and cumulative risk. Gender-specific trends revealed a disproportionate burden on females, with cervical cancer accounting for 3,043 new cases and 1,976 deaths, while breast cancer followed closely. Among males, prostate cancer was most prevalent, with an ASRi of 70.6 and ASRm of 41.7. A strong linear relationship was observed between incidence and mortality, with Nd approximating 63.2% of Nc. High-lethality cancers such as oesophagus (Nc=781, Nd=718) and liver (Nc=678, Nd=648) were identified as critical for intervention. Logarithmic transformations confirmed power-law behaviour, enhancing predictive accuracy. A novel severity metric (σ) facilitated rank-based prioritisation, highlighting cervical (σ=6) and prostate (σ=5) cancers as high-impact, in contrast to lower-burden types like Kaposi sarcoma (σ=1.4). Cumulative risk assessments estimated the lifetime risk for cervical and breast cancers at 6.7% and 3.9%, respectively. Polynomial and non-linear models revealed inflection points in age-standardised rates and cumulative risks, indicating a plateauing effect in high-incidence cancers. These findings underscore the urgent need for targeted interventions for high-burden cancers and equitable allocation of resources for lower-impact cancers, offering evidence-based insights to guide cancer control policy and resource planning in Zimbabwe.

Institution-specific Validation of CTV-PTV Margins in Head and Neck Radiotherapy using Daily Cone Beam Computed Tomography on Halcyon Elite: A Population - Based Study

Jerin Josy — 2026-03-27

Aims: To quantitatively evaluate setup errors in head and neck cancer radiotherapy using Cone Beam Computed Tomography (CBCT) and determine whether the institutional Clinical Target Volume (CTV)–Planning Target Volume (PTV) margin adequately compensates for these uncertainties.

Study Design: Retrospective observational study.

Place and Duration of Study: Sample: Department of Radiation Oncology, Father Muller Medical College Hospital, Mangalore, India, conducted over a period of six months.

Methodology: Twenty patients with head and neck malignancies treated using Intensity‑Modulated Radiotherapy (IMRT) or Volumetric Modulated Arc Therapy (VMAT) were retrospectively analyzed. All patients were immobilized with thermoplastic head and neck masks. Daily setup verification was performed using kV cone‑beam CT on the Halcyon Elite linear accelerator. Translational setup deviations in vertical, longitudinal and lateral directions were recorded. Population systematic (Σ) and random (σ) errors were calculated using individual patient mean and standard deviation values. The CTV–PTV margins were derived using the Van Herk margin formula.

Results: Population systematic errors (Σ) were 0.041 cm, 0.072 cm and 0.076 cm in vertical, longitudinal and lateral directions respectively. Random errors (σ) were 0.148 cm, 0.154 cm and 0.213 cm respectively. The calculated CTV–PTV margins were 0.21 cm (vertical), 0.29 cm (longitudinal) and 0.34 cm (lateral), all smaller than the institutional margin of 3 mm.

Conclusion: Daily CBCT‑based image guidance combined with thermoplastic immobilization provides high setup reproducibility in head and neck radiotherapy. The institutional 3 mm margin remains adequate as it accounts for additional clinical uncertainties beyond setup errors.