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Cancer Statistics
Population in 2008: 28.8m
People newly diagnosed with cancer (excluding NMSC) / yr: 27,800
Age-standardised rate, incidence per 100,000 people/yr: 141.6
Risk of getting cancer before age 75:14.9%
People dying from cancer /yr: 20,000
Data from IARC GlobalCan (2008)
Nepal Cancer Organisations and Resources
Latest Research Publications Related to Nepal

Nepal Cancer Organisations and Resources (4 links)

Latest Research Publications Related to Nepal

Nepal P, Mori S, Kita Y, et al.
Combined endoscopic submucosal dissection and transanal minimally invasive surgery for the management of lower rectal adenoma extending above the dentate line: A case report.
Medicine (Baltimore). 2019; 98(19):e15289 [PubMed] Free Access to Full Article Related Publications
RATIONALE: Minimally invasive surgery is used to treat early colorectal tumors. Endoscopic submucosal dissection (ESD) for resection of tumors extending above the dentate line (particularly those with concomitant hemorrhoids) is technically difficult. We present a case of a patient with a lower rectal adenoma extending above the dentate line, which underwent combined ESD and transanal minimally invasive surgery (TAMIS) to achieve accurate excision and prevent complications.
PATIENT CONCERNS: A 68-year-old man with a history of blood in stool over 2 to 3 years underwent colonoscopy, which revealed an adenoma measuring 3 cm in size in the lower rectum extending above the dentate line. The part extending above the dentate line was a type Is lesion and that of oral side was a type IIa lesion. Histopathologically, the lesion was diagnosed as a low-grade intramucosal tubulovillous adenoma.
DIAGNOSIS: Intramucosal low-grade adenoma with sessile polyp (type Is).
INTERVENTIONS: The cranial portion of the lesion was dissected via ESD and the anal portion via TAMIS with minimal bleeding. En bloc resection of the tumor was performed.
OUTCOMES: His postoperative period was uneventful, and he was discharged and regularly followed-up.
LESSONS: Combined ESD and TAMIS is effective in patients with benign and early neoplastic lesions of the anorectum extending above the dentate line with concomitant hemorrhoids and can prevent complications.

Nava-Castañeda Á, Hernández-Orgaz J, Garnica-Hayashi L, et al.
Management of Ocular Surface Squamous Neoplasia with Topical and Intralesional Interferon Alpha 2B in Mexicans.
Nepal J Ophthalmol. 2018; 10(20):143-150 [PubMed] Related Publications
INTRODUCTION: Ocular surface squamous neoplasia (OSSN) is the most common nonpigmented ocular surface neoplasm and it can originate from the conjunctiva and/ or corneal epithelium. Since the rate of recurrence after surgical excision is high, chemotherapeutic and immunotherapeutic agents such as interferon alpha-2b (IFN α-2b) have been used for its treatment.
OBJECTIVE: Our objective is to describe the demographic variables of patients with OSSN treated with IFN α-2b and to describe the outcomes of its use in Mexican patients, treated between 2011 and 2017 at Instituto de Oftalmología Fundación Conde de Valenciana.
MATERIALS AND METHODS: This is a non-randomized retrospective interventional case series. We reviewed the files of patients older than 18 years, with clinical and/or histopathological diagnosis of OSSN, treated with IFN α-2b alone or in combination with surgery, with a minimum of 6 months follow-up. We studied demographic variables, such as gender, age, eye affected and associated risks factors; we also studied the type of therapy with interferon (topical, intralesional and/or associated with surgery), time of treatment, time of follow up, recurrences and complications.
RESULTS: A total of 39 patients were included. The mean age of diagnosis was 61 ± 16 years and OSSN was more frequent in males (64.1% of cases). Most of the cases (43.6%) had no identifiable risk factors. The mean time of IFN α-2b treatment was 5 ± 2 months, being higher in the intralesional group (6.5 months) than in the topical group (4.2 months). The clinical resolution with the use of IFN α-2b was evidenced between 0.5 and 10 months, being achieved in 87.1% of the patients.
CONCLUSIONS: The use of IFN α-2b is effective for the treatment of OSSN with a high success rate (87.1%) and a low incidence of relapse (5 cases), with no reported complications during follow up.

V K, Bhandari S, Gurung R
Etiologies of Optic Disc Edema in Tertiary Eye Care Centre in Nepal.
Nepal J Ophthalmol. 2018; 10(20):139-142 [PubMed] Related Publications
INTRODUCTION: Optic disc edema is a common clinical finding that can be caused by benign to vision and or life-threatening conditions.
OBJECTIVE: To investigate the etiologies of optic disc edema among patients presenting to Tilganga Institute of Ophthalmology, Kathmandu, Nepal.
MATERIALS AND METHODS: A retrospective chart review of patients with optic disc edema presenting to Neuro-ophthalmology department of Tilganga Institute of Ophthalmology from May 2012 to May 2014, was made.
RESULTS: 98 patients were diagnosed with disc edema. Females (64%) were frequently affected. It was noted more in the 21 - 50 age groups. Papilledema was the most frequent cause (35.7%) of disc edema followed by papillitis (28.6%), pseudopapilledma (18.4%) and ischemia (17.3%), respectively. Brain tumors (13%) were the most common etiology for papilledema.
CONCLUSION: Papilledema along with other causes, are common etiologies for disc edema. A detailed history and careful evaluation are necessary as the treatment strategy highly depends on it's underlying etiologies.

Nepal P, Mori S, Kita Y, et al.
Radial incision and cutting method using a transanal approach for treatment of anastomotic strictures following rectal cancer surgery: a case report.
World J Surg Oncol. 2019; 17(1):48 [PubMed] Free Access to Full Article Related Publications
BACKGROUND: Development of an anastomotic stricture following rectal cancer surgery is not uncommon. Such strictures are usually managed by manual or instrumental dilatation techniques that are often insufficiently effective, as evidenced by the high recurrence rate. Various surgical procedures using minimally invasive approaches have also been reported. One of these procedures, endoscopic radial incision and cutting (RIC), has been extensively reported. However, RIC by transanal minimally invasive surgery (TAMIS) is yet to be reported. We here report a novel application of TAMIS for performing RIC for anastomotic rectal stenosis.
CASE PRESENTATION: A 67-year-old man had suffered from constipation for 6 years after undergoing low anterior resection for stage II rectal cancer 7 years ago. Colonoscopy showed a 1-cm diameter stricture in the lower rectum. Balloon dilatation was performed many times because of repeated recurrences. Thus, surgical management was considered and the stricture was successfully excised via a RIC method using a TAMIS approach. Postoperatively, the patient had minimal leakage that resolved with conservative treatment.
CONCLUSIONS: A RIC method using a TAMIS approach is an effective minimally invasive means of managing anastomotic strictures following rectal cancer surgery.

Pandey AS, Shrestha S
A novel frameshift mutation in the
Indian J Cancer. 2018 Oct-Dec; 55(4):410-412 [PubMed] Related Publications
A novel mutation in the MLH1 gene likely to be pathogenic for Lynch syndrome was discovered in a proband with a family history of colon cancer. Immunohistochemistry showed negative expression of PMS2 and MLH1 in the resected tumor sample. The mutation lies at the highly conserved C-terminus of the MLH1 protein, the region through which it dimerizes with PMS2 to carry out its mismatch repair function.

Rimal J, Shrestha A, Maharjan IK, et al.
Risk Assessment of Smokeless Tobacco among Oral Precancer and Cancer Patients in Eastern Developmental Region of Nepal
Asian Pac J Cancer Prev. 2019; 20(2):411-415 [PubMed] Related Publications
Background: Oral potentially malignant disorders (OPMDs) and oral cancer (OC) are preventable oral mucosal diseases prevalent in Asian region. This epidemiological study aims to identify oral potentially malignant disorders (OPMDs) and oral cancer (OC), confirm histopathologically, and treat or refer these cases among the population of Eastern Development Region (EDR) of Nepal. It also attempts to assess the risk factors associated in order to compare dose–response measurements of oral habits in these patients. Methods: Cross-sectional epidemiological study was conducted over a period of 2 years in 16 districts of EDR. A total of 3,200 people were screened. A brief history was taken and visual screening examination was conducted in two phases as described by British Columbia Oral Cancer Prevention Program. Suspicious oral lesions were biopsied either by punch or scalpel after toluidine blue staining. Tissue specimen was transported to the institutional lab for histopathological processing. The reports were sent to the patients through the local leaders or organizations. Results: More than 40% of the study population either chewed areca nut and/or tobacco. Eighteen percent were smokers. OPMDs were prevalent among 468 study population with male-female ratio of 3:1. Tobacco pouch keratosis (50.4%) was the most prevalent OPMD, followed by OSF (29.1%). Fifty-two had squamous cell carcinoma and 8 had verrucous carcinoma. Conclusion: Chewing areca nut, tobacco, commercial areca nut/tobacco preparation and smoking being the major risk factors, there is high prevalence of oral cancer and OPMDs in the EDR of Nepal.

Jha A, Lohani B
Sonography of Palpable Breast Lumps in a Tertiary Health Care Centre in Nepal.
J Nepal Health Res Counc. 2019; 16(41):396-400 [PubMed] Related Publications
BACKGROUND: With a palpable lesion in the breast, the goal is to diagnose malignancy at the earliest. Ultrasonography is used for evaluating symptomatic patients especially those with dense breasts where mammography gives limited information. The objective of this study was to evaluate the sonographic pattern of the palpable breast lumps and correlate with the final pathological diagnosis.
METHODS: This was a retrospective study done at our tertiary health care center, from July 2016 to March 2017, including 121 patients presenting to the ultrasound department with complaint of palpable breast lump and whose pathological reports could be followed up. Various sonographic features were studied, sonography and final diagnosis compared.
RESULTS: On sonography, about 46% of the cases were benign, 35 % malignant and 18 % indeterminate while tissue diagnosis revealed 63% to be benign, 34% malignant. The most common lesions in each group and sonographic characteristics were evaluated. Of the benign lesions, fibroadenoma was the most common. Most of the indeterminate lesions on sonography were histologically mastitis. We found nearly 58% of the malignant lesions had microlobulated margins. The sensitivity of sonography was 92.9% and specificity 97.5% with diagnostic accuracy 94.8%.
CONCLUSIONS: Most of the palpable lumps were benign in our study, most common being fibroadenoma. We had a relatively higher percentage of malignancy which may be due to patients with obviously benign lesions not undergoing tissue diagnosis in our setting. The sonographic features and diagnosis correlated well with the histological diagnosis.

Shrestha T, Choi W, Kim GE, et al.
Human papilloma virus identification in ocular surface squamous neoplasia by p16 immunohistochemistry and DNA chip test: A strobe-compliant article.
Medicine (Baltimore). 2019; 98(2):e13944 [PubMed] Free Access to Full Article Related Publications
The aim of this study was to identify the association between human papilloma virus (HPV) infection and ocular surface squamous neoplasia (OSSN) using p16 immunohistochemistry (IHC) and deoxyribonucleic acid (DNA) chip test.Thirty-eight patients who underwent surgical excision of OSSN were retrospectively studied using tissue samples. The IHC was performed to assess the expression of p16 and DNA chip test was used to detect 24 HPV serotypes.Among the 38 OSSN samples, 32 cases (84.2%) were histopathologically categorized as pre-invasive type and 6 cases (15.8%) as invasive type. The IHC for p16 showed strong positivity in 12 cases (31.6%), whereas it was negative in 26 cases (68.4%). On the other hand, only one case (2.6%) of invasive OSSN was positive for the HPV16 serotype, as assessed by DNA chip test.In OSSN, p16 expression was positive in approximately 1/3rd of the cases, whereas the majority of the 24 HPV serotypes were negative for p16. Our findings suggest that only a weak association exists between HPV infection and OSSN.

Dhungana A, Shrestha P, Shrestha K, et al.
Endobronchial Ultrasound Guided Transbronchial Needle Aspiration.
J Nepal Health Res Counc. 2018; 16(3):351-353 [PubMed] Related Publications
Evaluation of mediastinal lymphadenopathy is often challenging. Endobronchial Ultrasound (EBUS) is a novel technique which provides real time sonographic guidance during Transbronchial Needle Aspiration (TBNA) from mediastinal and hilar lesions. A 60-year-old smoker presented with two months history of cough and chest pain on the right side. CT thorax revealed a right upper lobe spiculated mass with paratracheal (Station 4R) and subcarinal (Station 7) lymph nodes. Bronchoscopy did not reveal any endobronchial mass. Since EBUS-TBNA is superior to conventional TBNA for malignant mediastinal node, an EBUS- TBNA was performed from both lymph node stations. . Cytopathology and histopathology revealed non-small cell lung cancer. We hereby report the first use of EBUS-TBNA in Nepal, in a patient with lung cancer and mediastinal lymphadenopathy. Keywords: Endobronchial ultrasound; lung cancer; mediastinal lymph node; transbronchial needle aspiration.

Dahal A, Meheta RK
Fatigue Experience and Coping Strategies among Cancer Patients Receiving Chemotherapy.
J Nepal Health Res Counc. 2018; 16(3):285-290 [PubMed] Related Publications
BACKGROUND: Cancer is considered one of the foremost common causes of death. Fatigue is among the distressing symptoms for cancer patients receiving chemotherapy. Adequate coping is essential for individual to deal with the effects of cancer related treatment. The objective of the study was to find out the fatigue experience and coping strategies among cancer patients receiving chemotherapy.
METHODS: A descriptive, cross-sectional research design was used for the study. The samples was taken from day care and medical oncology ward of BP Koirala Memorial Cancer Hospital, Bharatpur. A total of 120 cancer patients receiving chemotherapy of 18 years and above were selected by using non probability consecutive sampling technique. Data was collected by using standard tool, Fatigue Symptom Inventory and Brief Cope. Data analysis was done by descriptive and inferential statistics.
RESULTS: The study revealed that 82.5% of respondents had experienced fatigue and 50.8% respondents had used adequate coping strategies where "self distraction"(2.76±1.02) was the most used coping strategy by the respondents. Fatigue experience and coping strategies had negative correlation (r=-0.490, p=<0.001).
CONCLUSIONS: Majority of the respondents had experienced fatigue, and half of the respondents used adequate coping strategies. The different methods of coping strategies for fatigue and chemotherapy related effects should be expanded as per the best available evidence to lower fatigue and other adverse effects.

Mishra A, Jaiswal R, Amita P, Mishra SC
Molecular interactions in juvenile nasopharyngeal angiofibroma: preliminary signature and relevant review.
Eur Arch Otorhinolaryngol. 2019; 276(1):93-100 [PubMed] Related Publications
BACKGROUND: The molecular profile of juvenile nasopharyngeal angiofibroma (JNA) is extremely variable. In absence of established molecular signature the molecular targeting seems difficult for this heterogeneous disease. To establish a basic molecular signature, this paper analyses the interaction of 7 markers according to their ranks as per the decreasing scale of molecular expression.
MATERIALS AND METHODS: Fourteen samples of JNA were obtained following surgical excision and mRNA expressions were established through real-time polymerase chain reaction (RT-PCR) for vasculoendothelial growth factor (VEGF), fibroblastic growth factor (FGF), c-Kit, c-myc, Ras, platelet-derived growth factor (PDGF) and tumor suppressor gene p53. Nasal polyp was taken as control. The quantitative expressions for every marker were ranked on a decreasing scale and were compared by Spearman's rank correlation test to define the statistically significant interaction. An attempt was also made to overview the basic clinical parameters (age, duration of symptoms, radiological staging, intraoperative haemorrhage and tumor-volume/weight) associated with enhanced molecular expressions for every marker.
RESULTS: Five significant molecular interactions were identified on the basis of rank-correlation: (1) FGF/VEGF (p < 0.01); (2) Ras/FGF (p < 0.01); (3) Ras/VEGF (p < 0.001), (4) FGF/c-Kit (p < 0.05); (5) c-Myc/p53 (p < 0.05). These basic 'molecular signatures' suggested a preliminary 'molecular classification'. The implication of the interactions between FGF, VEGF and Ras were the most outstanding observation that not only revealed a direct relationship but were also consistent with the clinical behaviour. In addition, a non-significant interaction was identified with c-Myc/PDGF and also an inverse relationship between FGF/c-Kit.
CONCLUSIONS: FGF, VEGF, and Ras being significantly interrelated seemed to be the 'most soft' molecular targets for JNA. The other targets observed included FGF/c-Kit and c-Myc/p53 interactions that seemed equally important but only after VEGF/FGF/Ras complex per se. These preliminary signatures are likely to provide a background for further expansion of the molecular classification of JNA.

Mishra A, Mishra SC, Tripathi AM, Pandey A
Clinical correlation of molecular (VEGF, FGF, PDGF, c-Myc, c-Kit, Ras, p53) expression in juvenile nasopharyngeal angiofibroma.
Eur Arch Otorhinolaryngol. 2018; 275(11):2719-2726 [PubMed] Related Publications
BACKGROUND: A molecular surrogate may exist for the clinical behaviour of juvenile nasopharyngeal angiofibroma (JNA).
METHODS: In 9-14 cases, a 'correlation' of clinical behaviour with molecular expression (m-RNA expression through RT-PCR) of VEGF, FGF, PDGF, Ras, c-Myc, c-Kit and p53 was undertaken.
RESULTS: A comparison of the two extremes of expressions characterized some specific clinical phenotypes for every marker except c-Myc. A higher FGF was associated with post-adolescent presentation, smaller tumour size, enhanced haemorrhage and recurrence. A higher c-Kit was associated with adolescents, rapid growth, skull base involvement and recurrence. Enhanced Ras was associated with post-adolescence, smaller tumour size, skull base involvement and recurrence. Enhanced p53 and PDGF were associated with adolescents, early presentation and rapid progression. Higher VEGF expression was associated with skull base involvement and enhanced haemorrhage.
CONCLUSION: This study is currently the only evidence revealing a clinical molecular association in JNA and larger multicentric studies need to be performed to show a statistical significance.

Kumari A, Pankaj S, Choudhary V, et al.
Retrospective analysis of patients of cervical cancer a tertiary center in Bihar.
Indian J Cancer. 2018 Jan-Mar; 55(1):70-73 [PubMed] Related Publications
Objective: A retrospective analysis of all patients with cancer of the cervix attending regional cancer center of Indira Gandhi Institute of Medical Sciences, Patna, from June 2015 to June 2017. The aim of this study was to know patient demographics, histology, age, stage and status of presentation, compliance with treatment and follow-up.
Materials and Methods: Five hundred and eighteen consecutively registered patients with cancer of the cervix were included in the study.
Results: The prevalence of cervical cancer among gynecological malignancy was 52%. It is the second most common cancer after breast cancer at our center. Patients hailed from the various districts of Bihar (89%), India, and from Nepal (10.61%). The majority (>50%) were aged 40-59 years. Stage information was available for 71.81% of the patients, of which Stage I comprised 12.36%, Stage II, 35.21%; Stage III, 50%; and Stage IV, 2.41%. Squamous cell carcinoma was the most common reported histopathology (~90%). A significant proportion of the women defaulted after registration, or after undergoing investigations (17%). Of the 68% cases planned for treatment, 50% initiated it, but only 38% completed it, About 11% of cases underwent Wertheim's hysterectomy and rest of patients were treated by radiotherapy with or without chemotherapy.
Conclusion: The incidence of cervical cancer is still unacceptably high at our center. Organized cervical cancer screening needs to be adopted for early diagnosis.

Sivakumaran N, Samarakoon SR, Adhikari A, et al.
Cytotoxic and Apoptotic Effects of Govaniadine Isolated from
Biomed Res Int. 2018; 2018:3171348 [PubMed] Free Access to Full Article Related Publications
Current breast cancer therapies have limitations in terms of increased drug resistance resulting in short-term efficacy, thus demanding the discovery of new therapeutic agents. In this study, cytotoxic activity and apoptotic effects of govaniadine isolated from

Nepal P, Mori S, Kita Y, et al.
Management of a case of high-risk gastrointestinal stromal tumor in rectum by transanal minimal invasive surgery.
World J Surg Oncol. 2018; 16(1):165 [PubMed] Free Access to Full Article Related Publications
BACKGROUND: Rectal gastrointestinal stromal tumor (GIST) is a very rare tumor of gastrointestinal tract. Surgical management of rectal GIST requires special attention for preserving of anal and urinary functions. Transanal minimal invasive surgery (TAMIS) is a well-developed minimally invasive technique for local excision of benign and early malignant rectal tumors; however, the application of TAMIS for rectal GIST is rarely and inadequately reported. We report the novel application of TAMIS for rectal GIST with considerations for anal and urinary functions.
CASE PRESENTATION: A 67 years old female, who presented with history of per rectal bleeding, was diagnosed with submucosal GIST of 4.5 cm in diameter at right posterior wall of 7 cm from anal verge. Histology of biopsy showed abundant spindle-shaped cells arranged in bundles that were positive for CD34 and negative for C-Kit, desmin, smooth muscle actin (SMA), and S-100. The tumor was excised by TAMIS successfully. Final histopathology showed pT2 tumor with C-Kit positive and mitosis count 10 per 50 HPF. Postoperative period was uneventful, and she was discharged on adjuvant imatinib mesylate for 3 years.
CONCLUSION: TAMIS can be used safely in the management of rectal GIST after appropriate evaluation of tumor size, extent, location, and experience of operating surgeon.

Yadav DK, Chen W, Bai X, et al.
Salvage Liver Transplant versus Primary Liver Transplant for Patients with Hepatocellular Carcinoma.
Ann Transplant. 2018; 23:524-545 [PubMed] Free Access to Full Article Related Publications
The strategy of salvage liver transplantation (SLT) originated for initially resectable and transplantable hepatocellular carcinoma (HCC) to preclude upfront transplantation, with SLT in the case of recurrence. However, SLT remains a controversial approach in comparison to primary liver transplant (PLT). The aim of our study was to conduct a systemic review and meta-analysis to assess the short-term outcomes, overall survival (OS), and disease-free survival (DFS) between SLT and PLT for patients with HCC, stratifying results according to the Milan criteria and donor types. A search of PubMed, EMBASE, and the Cochrane Library was conducted to identify studies comparing SLT and PLT. A fixed effects model and a random effects model meta-analysis were conducted to assess the short-term outcomes, OS, and DFS based on the evaluation of heterogeneity. SLT had superior 1-year, 3-year, and 5-year OS and DFS compared with that of PLT. After classifying data according to donor type and Milan criteria, our meta-analysis revealed: that for deceased-donor liver transplantation (DDLT) recipients, there were no significant differences in 1-year and 3-year OS rate between the SLT group and the PLT group. However, the 5-year OS rate was superior in the SLT group compared to the PLT group. Similarly, SLT had superior 1-year, 3-year, and 5-year OS rate compared to PLT in living-donor liver transplantation (LDLT) recipients. Moreover, 1-year, 3-year, and 5-year DFS were also superior in SLT compared to PLT in both the DDLT and LDLT recipients. In patients within Milan criteria there were no statistically significant differences in 1-year, 3-year, and 5-year OS and DFS between the SLT group and the PLT group. Similarly, in patients beyond Milan criteria, both SLT and PLT showed no significant difference for 1-year, 3-year, and 5-year OS rate. Our meta-analysis included the largest number of studies comparing SLT and PLT, and SLT was found to have significantly better OS and DFS. Moreover, this meta-analysis suggests that SLT has comparable postoperative complications to that of PLT, and thus, SLT may be a better treatment strategy for recurrent HCC patients and patients with compensated liver, whenever feasible, considering the severe organ limitation and the safety of SLT. However, PLT can be referred as a treatment strategy for HCC patients with cirrhotic and decompensated liver.

Thapa N, Shrestha G, Maharjan M, et al.
Burden of cervical neoplasia in mid-western rural Nepal: a population-based study.
J Gynecol Oncol. 2018; 29(5):e64 [PubMed] Free Access to Full Article Related Publications
OBJECTIVE: To assess the burden of cervical neoplasia in mid-western rural, Nepal using cytology, visual inspection with acetic acid (VIA) and visual inspection with Lugol's iodine (VILI).
METHOD: A cross-sectional, population-based study was conducted. Total of 2,279 married, non-pregnant women aged 20-65 years participated in a screening clinic from May 2016 to January 2017. All eligible women completed self-report of socio-demographic and reproductive health data followed by screening tests. Biopsies were obtained from areas on the cervix assessed by VIA and or VILI to be abnormal. Final disease was confirmed by biopsy report.
RESULTS: A total of 96.09% (n=2,190) women were eligible for this study with mean age 32.78±9.33 years. The overall rate of positive cytology, VIA, and VILI were 3.69%, 12.45%, and 16.89%, respectively. Sixty-two cases were biopsy proven cervical neoplasia. Altogether 78 (3.69%) cases were cytologically abnormal: 25 (1.18%) were atypical squamous cells of undetermined significance, 33 (1.56%) were low-grade squamous intraepithelial lesion, 11 (0.52%) were high-grade squamous intraepithelial lesion, and 9 (0.42%) were squamous cell carcinoma. Illiterate women appeared to be at higher risk for cervical neoplasia (p<0.001). Similarly, age ≥46 years (p<0.013), participant's multiple marriages or sexual partners (p<0.005), and positive human immunodeficiency virus status (p<0.001) were significantly associated with abnormal cytology.
CONCLUSION: Based on cytology report, there is 3.69% prevalence of cervical neoplasia among women in a rural region of mid-western, Nepal. A "screen and treat" approach would be more attractive in low resource settings.

Dewan KR, Patowary BS, Bhattarai S, Shrestha G
Barrett's Esophagus in Patients with Gastroesophageal Reflux Disease.
J Nepal Health Res Counc. 2018; 16(2):144-148 [PubMed] Related Publications
BACKGROUND: Barrett's esophagus a is metaplasia of normal squamous cells that line the lower part of the esophagus and carries a major risk for adenocarcinoma of esophagus. In Asian population, the prevalence of Barrett's esophagus and adenocarcinoma are less common than in Western countries but has been increasing.
METHODS: This is a hospital based descriptive study comprising of 120 consecutive patients with symptoms of gastroesophagial reflux disease belonging to both sexes of any age group. The diagnosis of gastroesophagial reflux disease was based on the symptoms like heart burn and regurgitation. Upper gastrointestinal endoscopy was done in all the patients. Four quadrant biopsies were taken from the esophagogastric junction in suspected case of Barrett's esophagus. The diagnosis of Barrett's esophagus was confirmed histopathologically.
RESULTS: There were 44.2% males and 55.8% females, age ranging from 22 to 85 years mean being 44.33+13.37. Of them, gastroesophagial reflux disease was mild in 54.16%, moderate in 21.16% and severe in 16.66%. Upper Gastrointestinal endoscopy revealed non erosive gastroesophagial reflux disease in 50%, erosive in 45%, hiatal hernias in 5% and Barrett's esophagus in 1.6%. Both patients with Barrett's esophagus were elderly and had short segment (<3cm) involvement with no evidence of dysplasia or adenocarcinoma histopathologically.
CONCLUSIONS: Endoscopic surveillance with detailed inspection and systematic biopsies is recommended for most patients with Barrett's esophagus. Esophageal carcinoma if detected should be treated at the earliest.

Thapa N, Maharjan M, Petrini MA, et al.
Knowledge, attitude, practice and barriers of cervical cancer screening among women living in mid-western rural, Nepal.
J Gynecol Oncol. 2018; 29(4):e57 [PubMed] Free Access to Full Article Related Publications
OBJECTIVE: To find out the knowledge, attitude, practice, and barriers of cervical cancer screening in mid-western rural, Nepal.
METHODS: A hospital-based cross-sectional study was conducted. Women aged 20 or more were interviewed using a structured questionnaire regarding the socio-demographic information, knowledge, attitude, practice, and barriers to the cervical cancer screening.
RESULTS: Total of 360 participants were recruited for this study, mean age was 30.13±10.4 years. More than 87% of participants had inadequate knowledge, but around 72% had a favorable attitude towards cervical cancer screening. There was a significant portion of women (86.4%) had never done any cervical cancer screening test. Despite being higher literacy rate of Brahmin and Chhetri ethnic group, they were less likely to attend the cervical cancer screening than Dalit and Janajati (p<0.001); and those who had a positive family history of cancer were more likely to attend the cervical cancer screening (p<0.001). Similarly, married women, who had adequate knowledge and or favorable attitude, were more likely to practice cervical cancer screening, though statistically not significant. Factors such as "No symptoms," "Lack of awareness," "Embarrassment," etc. were the most common barriers for the cervical cancer screening.
CONCLUSION: The adequate knowledge and practice of cervical cancer screening were meager among rural Nepalese women, but most of them had a favorable attitude. There is an imperative need for related awareness programs to promote the uptake of cervical cancer screening tests.

Joshi A
Anorectal Gastrointestinal Stromal Tumour: A Case Treated with Radical Surgery.
J Nepal Health Res Counc. 2018; 16(1):99-101 [PubMed] Related Publications
Gastrointestinal Stromal Tumour involving rectum and anal canal is an extremely rare entity. This is a case report of a 47 years lady presented with fresh rectal bleed associated with rectal pain and foul smelling rectal mucus discharge. On rectal examination, she had a firm mass palpable about 1.5 cm from anal verge. Considering the size of the tumour and its close proximity with cervix and involvement of levator muscles, extralevator abdominal perineal excision of rectum was undertaken with good recovery after surgery. It was followed by imatinib therapy.

Ghimire B, Singh YP, Kurlberg G, Wettergren Y
Comparison of Stage and Lymph Node Ratio in Young and Older Patients with Colorectal Cancer Operated in a Tertiary Hospital in Nepal.
J Nepal Health Res Counc. 2018; 16(1):89-92 [PubMed] Related Publications
BACKGROUND: Colorectal cancer is being diagnosed more frequently in the young and it presents in an advanced stage. In TNM staging, stage depends on tumor size and number of positive nodes, which depend on location of tumor as well as the extent of dissection.The lymph node ratio is regarded as a more reliable marker for prognosis. In this study, we compare epidemiology of colorectal cancer in the young (<40 years) and older patients as well as the LNR.
METHODS: Patients with colorectal cancer operated at the Tribhuvan University Teaching Hospital, Kathmandu, Nepal for a period of 4 years (2012 - 2016) were included in the study. Patients were grouped into young (? 40 years) and older (> 40 years) and clinic-pathological data such as site of lesion, clinical stage, and lymph node ratio were compared.
RESULTS: Of the 95 patients of colorectal cancer, 25 patients were of age ? 40 years (26%) and they had a higher median stage at diagnosis. In patients above 40 years, it was diagnosed at a relatively earlier stage. The mean number of positive nodes was 11.64 in younger patients whereas it was 18.34in those more than 40 years of age,but younger patients had higher lymph node ratio than elderly (0.31 vs 0.13) (P-value ? 0.005).
CONCLUSIONS: Young patients with colorectal cancer tend to have more advanced disease. The lymph node metastasis and lymph node ratio tend to be higher in young patients.

Maharjan M, Thapa N, Adhikari RD, et al.
Quality of Life of Nepalese Women Post Mastectomy
Asian Pac J Cancer Prev. 2018; 19(4):1005-1012 [PubMed] Free Access to Full Article Related Publications
Introduction: Worldwide breast cancer is the common invasive cancer among the females. The quality of life of women after treatment, which is often a mastectomy, is frequently decreased. Objective: To determine the life quality of Nepalese women post mastectomy. Materials and Methods: One hundred seven women after a mastectomy were selected and interviewed by using the European Organization for Research and Treatment of Cancer-Quality of Life Questionnaire and its Breast Specific Module to assess women’s quality of life. Result: The study findings revealed a good score on global health status/quality of life. The respondents performed well on functional and symptom scales. In the Breast Specific Module, all respondents performed poor regarding sexual function and sexual enjoyment. Global Health Status was found useful among the women involved in service/business/agriculture and the survivors using breast prosthesis. In Breast Specific Module, systemic therapy side effects showed strong statistical associations with age, marital status, occupation, education, use of breast prosthesis and co-morbidity. Body image was highly significant with age, occupation, education, use of breast prosthesis and co-morbidity. Conclusion: Based on the study findings, counseling, and a structured educational programme is recommended to improve the QOL of women after a mastectomy.

Jinagal J, Gupta PC, Kakkar N, Ram J
A typical manifestation of conjunctival epithelial inclusion cyst.
Nepal J Ophthalmol. 2017; 9(18):206-207 [PubMed] Related Publications
PURPOSE: To report a case of conjunctival epithelial inclusion cyst with atypical manifestation.
METHODS: A 26-year-old male presented with a blackish-brown, subconjunctival mass located in palpebral conjunctiva of the upper eyelid. En bloc excision of the mass was performed and evaluated on histopathological examination.
RESULTS: The excised mass was well defined, dark brown in colour and simulated a solid foreign body. On histopathological examination, the mass was lined by stratified squamous epithelium with florid hyperkeratosis and haemorrhage inside it, consistent with atypical conjunctival epithelial inclusion cyst.
CONCLUSION: A careful clinical examination and histopathological study is essential for the differential diagnosis of subconjunctival mass as rarely they may present with atypical manifestations.

Majumder PD, Ganesh NG, Tomar VPS, et al.
Pigmented free floating vitreous cyst in a 10 years old child.
Nepal J Ophthalmol. 2017; 9(18):190-193 [PubMed] Related Publications
Pigmented free-floating vitreous cyst in retrolental space is rare. It can represent its congenital origin after spontaneous detachment from the ciliary body epithelium or after trivial injury. We report a case of pigmented, free floating non-infective vitreous cyst in a 10 year old child who presented with compliant of transient blurring of vision three days after she joined swimming class. A thorough eye examination with ultrasound B scan and ultrasound biomicroscopy was done to rule out any other associated conditions.

Shah SP, Chetri ST, Paudyal P, et al.
Lymphoma Maxilla mimicking orbital cellulitis; case report and review of Literature.
Nepal J Ophthalmol. 2017; 9(18):180-186 [PubMed] Related Publications
BACKGROUND: Sinonasal lymphomas are the commonest nonepithelial malignancies of the nasal cavity and paranasal sinuses. They may spread from their site of origin in nasal cavity and invade adjacent structures including orbits leading to varying presentation and a diagnostic dilemma.
CASE: A-77- year old Nepalese male presented with swelling of left eye since 1 month and pain in the same eye since 2 days.
OBSERVATION: Examination revealed axial proptosis, swelling of lids, restricted extraocular movement, diffuse conjunctival and ciliary congestion with chemosis. Visual acuity was grossly decreased. The case was diagnosed as left orbital cellulitis and treated with broad spectrum intravenous antibiotics and oral steriods. There was no response despite 3 days of antibiotics and steroids therefore a computed tomography was planned which showed features of Sinonasal malignancy invading the orbit. Repeated biopsy was suggestive of malignant small round cell tumour. In the view of unclear preoperative biopsy indicating further details on the histologic type of tumor and extensive erosion of maxilla with complete loss of vision in the eye the patient was planned for Total Maxillectomy with Orbital extenteration of the left orbit. Post-operative histopathological and Immunohistochemical report were suggestive of High grade Lymphoma. The patient was advised for Adjuvant Chemotherapy and Radiotherapy, which the patient refused due to financial constraints. He is on occasional follow up since the last 6 months.
CONCLUSIONS: The diagnosis of maxillary sinus lymphoma needs to be borne in mind when a clinician encounters a case of Orbital Cellulitis. It may be difficult to diagnose clinically and require radio-pathological correlation.

Khan L, Malukani M, Saxena A
Conjunctival Lesions: When Should We Perform Biopsy?
Nepal J Ophthalmol. 2017; 9(18):160-169 [PubMed] Related Publications
INTRODUCTION: The conjunctiva is a thin and flexible mucus membrane that provides a protective barrier for the eye. Very few histopathologic studies have been conducted on biopsies from conjunctival lesions (CL) in central India.
OBJECTIVE: To study the spectrum of CL and define those lesions that need attention with regard to need of biopsy in order to prevent grave sequelae and ocular morbidity.
RESULTS: Degenerative conditions such as pterygium followed by pinguicula were the commonest lesions seen in conjunctiva. Out of 129 subjects, youngest in the series was 3 years old while oldest patient was 72 years of age. Commonest age interval for involvement was 35 to 50 years. In children below 8 years, cystic lesions (infective or inclusion), limbal dermoid and choristoma were seen. Vascular lesions were noticed by patients for the first time between mid-teens to 25 years age. Premalignant lesions were dysplasia, actinic keratosis and PAM with or without XP. Malignant lesions in this series were squamous cell carcinoma, basal cell carcinoma and sebaceous carcinoma; which were observed in the age interval 25 to 75 years. In none of the malignant conditions there was deeper penetration into the globe or orbit. Though diagnosed within two weeks duration (by incisional biopsy) from appearance of nodule, unfavourable outcome was seen only in one malignant CL; a case having sebaceous carcinoma. In all pediatric cases outcome was good, except in child having choristoma, where amblyopia ensued before a diagnosis was made. Response to sclerotherapy was excellent as all the epibulbar vascular malformations regressed. All degenerative lesions regressed except one recurrence in a recurred pterygium. Case diagnosed as large B cell lymphoma recurred after one year. Dysplastic changes were seen to occur at limbus on followup in one XP, but in all cases of naevi, neither cellular atypia was seen nor melanoma developed.
CONCLUSION: An overview of various CL disclosed that clinician has to differentiate benign from premalignant and malignant lesions. Early diagnosis, proper histological study and patient education, all are equally important for achieving good outcome.

Petrovic V, Nepal A, Olaisen C, et al.
Anti-Cancer Potential of Homemade Fresh Garlic Extract Is Related to Increased Endoplasmic Reticulum Stress.
Nutrients. 2018; 10(4) [PubMed] Free Access to Full Article Related Publications
The use of garlic and garlic-based extracts has been linked to decreased incidence of cancer in epidemiological studies. Here we examine the molecular and cellular activities of a simple homemade ethanol-based garlic extract (GE). We show that GE inhibits growth of several different cancer cells in vitro, as well as cancer growth in vivo in a syngeneic orthotopic breast cancer model. Multiple myeloma cells were found to be especially sensitive to GE. The GE was fractionated using solid-phase extractions, and we identified allicin in one GE fraction; however, growth inhibitory activities were found in several additional fractions. These activities were lost during freeze or vacuum drying, suggesting that the main anti-cancer compounds in GE are volatile. The anti-cancer activity was stable for more than six months in −20 °C. We found that GE enhanced the activities of chemotherapeutics, as well as MAPK and PI3K inhibitors. Furthermore, GE affected hundreds of proteins involved in cellular signalling, including changes in vital cell signalling cascades regulating proliferation, apoptosis, and the cellular redox balance. Our data indicate that the reduced proliferation of the cancer cells treated by GE is at least partly mediated by increased endoplasmic reticulum (ER) stress.

Singh A, Kamal R, Ahamed I, et al.
PAH exposure-associated lung cancer: an updated meta-analysis.
Occup Med (Lond). 2018; 68(4):255-261 [PubMed] Related Publications
Background: Occupational exposure to polycyclic aromatic hydrocarbons (PAHs) has been shown to be associated with lung cancer in various epidemiological studies in industries such as aluminium reduction/smelting, coal gasification, coke production, iron/steel foundries, coal/coke and related products and carbon/graphite electrodes production.
Aims: To update data on the association between PAH exposure and morbidity and mortality due to lung cancer among workers in different occupations, including smoking data.
Methods: A comprehensive literature search was conducted to retrieve relevant papers for meta-analysis. Cohort studies with standardized mortality ratios or standardized incidence ratios and calculated overall risk ratio with their corresponding 95% confidence intervals (CIs) were included in the analysis. Chi-square test for heterogeneity was used to evaluate the consistency of findings between the studies.
Results: A significant risk of lung cancer was observed among the coal/coke and related product industry 1.55 (95% CI 1.01-2.37) and the iron/steel foundry industry 1.52 (95% CI 1.05-2.20). There was a wide variation in smoking habits and PAHs exposure among studies.
Conclusions: Coal/coke industry and iron/steel industry workers showed a higher risk of lung cancer compared with other occupations exposed to PAHs. The confounding effects of smoking and individual exposure levels of PAH should be taken into account.

Hamal PK, Poudel PR, Singh J
Grade III bone cement implantation syndrome in malignant lung cancer patient: a case report.
BMC Anesthesiol. 2018; 18(1):28 [PubMed] Free Access to Full Article Related Publications
BACKGROUND: Bone cement implantation syndrome is a known complication causing mortality during perioperative period particularly in patients with malignancy. With rise in aging population with malignancy in low income country, the syndrome is more likely to be encountered.
CASE PRESENTATION: We present a case of 66 years old male patient with metastatic bronchogenic carcinoma of lung with pathological proximal femur fracture of left hip that underwent a cemented endoprosthesis under combined spinal epidural anesthesia who succumbed to intraoperative mortality due to grade III bone cement implantation syndrome even after aggressive fluid resuscitation, vasopressor use, and mechanical ventilation.
CONCLUSIONS: Careful identification of risk factors with aggressive vigilance and intervention in part of surgeons and anesthesia both during intraoperative and postoperative period can mitigate the risk of bone cement implantation syndrome.

Pandeya DR, Rajbhandari A, Nepal M, et al.
Comparative Study of Serum Lipid Profiles in Nepalese Cancer Patients Attending a Tertiary Care Hospital
Asian Pac J Cancer Prev. 2018; 19(2):491-495 [PubMed] Free Access to Full Article Related Publications
Significant efforts have been made to study cancer at the biochemical and cellular level and identify factors associated with progression. The aim of this hospital based randomized comparative study at the Nepalese Army Institute of Health science hospital was to assess factors in 52 people diagnosed with different types of cancer and 56 normal control persons. Fasting blood samples were analyzed for serum total cholesterol (TC), high density lipoprotein (HDL), triglycerides (TG) and low density lipoprotein (LDL). We found that biochemical parameter TC, TG, VLDL (very low density lipoprotein), LDL and HDL were significantly different in the cancer patients and healthy controls. Levels of TC, TG, LDL, HDL and VLDL were higher in the age group below 50 and that of TG was found to be higher in women than men. Our results indicate that TC, TG and HDL are increased, while LDL and VLDL are lowered in cancer patients. Our study provides clues to risk factors associated with life style, eating habits, and exercise regimens. Monitoring of these parameters with aging is recommended.

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