Breast cancer-related lymphedema (BCRL) is a long-term, debilitating sequelae of breast cancer management. Aim of this study was to explore the risk factors associated with BCRL and identify high-risk individuals for early intervention and prevention strategies. One hundred seventy-one radically treated breast cancer patients registered at our institute between 2018 and 2025 were enrolled. The analysis of risk factors for BCRL was categorized into four main groups: treatment-related factors (type of axillary surgery, number of lymph nodes dissected, regional nodal irradiation, dose of radiation per fraction, cumulative dose of taxane and hormonal therapy), lifestyle-related factors (body mass index, physical activity), socioeconomic status (per capita income), and disease-related (nodal stage). Pearson’s Chi-square test was applied to evaluate the impact of independent variables. To account for potential confounding variables, multivariable logistic regression analysis was performed. The observed incidence of BCRL was 33.3
Endoscopic ultrasound-guided liver biopsy (EUS-LB) is an emerging technique for liver tissue sampling that offers a minimally invasive alternative to conventional percutaneous liver biopsy (PCLB), with advantages including shorter recovery time and the ability to sample both hepatic lobes. This study compared EUS-LB and PCLB using detailed histopathological assessment based on the Royal College of Pathologists guidelines for liver biopsy adequacy. This observational study included retrospective and prospective liver biopsies performed between 2021 and 2024. A total of 200 biopsies were analysed, comprising 100 PCLB and 100 EUS-LB specimens. Histopathological adequacy was assessed using total specimen length (TSL) and number of complete portal tracts (CPTs). Additional parameters including fragmentation, fibrin deposition, and non-liver tissue contamination were also evaluated for their impact on diagnostic interpretation. The mean TSL was significantly greater in EUS-LB compared with PCLB (3.8 cm vs. 2.3 cm; p < 0.00001). However, the mean length of the largest fragment was significantly higher in PCLB specimens (1.23 cm vs. 0.78 cm; p < 0.00001). Mean CPT counts were comparable between the groups (9.4 vs. 9; p = 0.65). Diagnostic adequacy was similar in EUS-LB and PCLB (81 and 80 adequate biopsies, respectively). Fragmentation, fibrin deposition, and non-liver tissue contamination were more frequently observed in EUS-LB specimens, potentially affecting architectural assessment and histological interpretation in selected challenging cases. EUS-LB demonstrates diagnostic adequacy comparable to PCLB on detailed histopathological evaluation. Although EUS-LB yields greater total specimen length, increased tissue fragmentation may limit fibrosis assessment and staging. Recognition of these histopathological features may improve interpretation and aid in selecting the optimal biopsy technique in clinical practice.
Oligometastatic breast cancer (OMBC) describes a limited metastatic state in which all radiologically evident disease may be technically amenable to local treatment. Its recognition has revived the question of whether surgery to an intact breast primary can alter the course of metastatic disease, or whether its value is confined to local control. Retrospective series and registry analyses have often reported longer survival after resection of the intact primary tumour. Randomised evidence is more cautious. The Tata Memorial/Badwe trial, ABCSG-28 POSYTIVE, E2108 and JCOG1017/PRIM-BC did not show a consistent overall-survival advantage for routine locoregional treatment. MF07-01 remains the main randomised trial suggesting a long-term survival signal, particularly in favourable subgroups, but its interpretation is limited by upfront surgical sequencing, baseline imbalance and an older systemic-therapy context. Contemporary pooled randomised evidence supports improved locoregional control without consistent improvement in overall survival, progression-free survival or quality of life. In 2026, breast surgery in OMBC should be regarded as a selective local-control intervention rather than a routine survival-directed procedure. It is clearly appropriate for palliation of bleeding, ulceration, fungation, infection or pain. Elective surgery may be considered after systemic response in carefully selected patients with favourable biology, low metastatic burden and feasibility of treating all visible disease. Circulating tumour DNA, circulating tumour cells and molecular biomarkers may refine future selection, but they are not yet validated as independent surgical decision tools.
Hereditary breast and ovarian cancer (HBOC) arises from germline alterations that disrupt multiple molecular networks, including BRCA1/2-regulated microRNA (miRNA) pathways. MicroRNAs in peripheral blood cells (PBCs) represent accessible, minimally invasive biomarker candidates; however, their clinical relevance in HBOC remains insufficiently defined. This study evaluated the diagnostic and prognostic significance of four BRCA-linked miRNAs, namely miR-125b, miR-146a-5p, miR-155, and miR-17, in PBCs from an Indian HBOC cohort. Peripheral blood samples from 63 HBOC patients and 41 matched healthy individuals were subjected to quantitative real-time PCR profiling. Differential expression was assessed using non-parametric statistics. Diagnostic performance was quantified using ROC analyses, and survival associations were explored through a Kaplan–Meier survival model. Correlation patterns among miRNAs were examined to assess potential co-expression. HBOC patients exhibited significant downregulation of miR-125b, miR-146a-5p, and miR-155, alongside notable overexpression of miR-17. miR-125b demonstrated the highest diagnostic accuracy (AUC = 0.707), with miR-146a-5p showing comparable discriminative value (AUC = 0.693). Although elevated miR-155 and miR-17 expression trended toward reduced overall survival, these associations were not statistically significant. Positive correlations among the profiled miRNAs suggested possible shared upstream regulatory mechanisms, potentially linked to BRCA-mediated signalling. This study identifies a distinct PBC miRNA signature in HBOC and highlights miR-125b and miR-146a-5p as candidate blood-based markers warranting further diagnostic validation. The observed patterns for miR-155 and miR-17 are exploratory and require confirmation in larger, prospectively followed cohorts before any prognostic value can be inferred. These findings provide a rationale for future validation studies of PBC miRNAs as minimally invasive adjuncts in HBOC risk assessment, rather than evidence sufficient for clinical implementation at this stage.
Gallbladder cancer (GBC) ranks as the 25th most prevalent cancer globally, with notable disparities across genders and regions. In India, northern areas like Delhi exhibit higher incidence rates compared to southern cities such as Bengaluru. Cholecystectomy is the most common routinely performed procedure for benign gallbladder disease worldwide and incidental gall bladder cancer is mostly detected in post- cholecystectomy specimens. This retrospective study emphasizes on the need for routine surveillance of post-cholecystectomy specimens by evaluating the incidence of incidental findings of carcinoma in cholecystectomy specimens done for benign gallbladder disease. A total of 565 patients were evaluated over a period of 1 year, out of which, 5 patients were diagnosed with incidental gall bladder carcinoma with an incidence of 0.9
Cancer caregiving imposes significant psychological burden on family members. This study assessed prevalence and severity of anxiety, depression, and caregiving burden among primary caregivers of onco-surgical patients, along with associations of demographic/socioeconomic factors and correlations with patient clinical status. The present cross-sectional study was conducted among primary caregivers of adult cancer patients undergoing tumor resection. Caregivers with diagnosed psychiatric and physical disability and forms with incomplete responses were excluded. Data was collected using a structured questionnaire including demographic and clinical variables, the Generalized Anxiety Disorder-7 (GAD-7), Patient Health Questionnaire-9 (PHQ-9), and the Short Zarit Burden Interview (S-ZBI). Correlation and multiple linear regression analyses were conducted to identify predictors of caregiver burden. A total of 141 primary caregivers corresponding to 141 patients were included in the analysis. Most caregivers were < 50 years (77.3
Surgical treatment for breast cancer may affect long-term body image, pain, and satisfaction, yet the relative contribution of surgical approach and patient-level factors remains uncertain. We evaluated patient-reported outcomes after breast-conserving surgery, mastectomy without reconstruction, and mastectomy with reconstruction. In this cross-sectional cohort study, 230 women treated between 2015 and 2021 at a single Israeli tertiary center completed an investigator-developed Hebrew telephone questionnaire a mean of approximately 4 years after surgery. Composite and item-level outcomes for body image, pain intensity, pain-related quality of life, and satisfaction were analyzed using multivariable regression adjusted for demographic and clinical covariates. Breast-conserving surgery was associated with more favorable adjusted positive body-image, negative body-image, and satisfaction scores than both mastectomy groups (positive body image: 3.7 vs. 2.8 and 3.1, global P = 0.00053; negative body image: 2.1 vs. 3.1 and 2.9, global P < 0.001; satisfaction: 2.7 vs. 2.2 and 2.4, global P = 0.021 for breast-conserving surgery, mastectomy without reconstruction, and mastectomy with reconstruction, respectively). Adjusted pain intensity (2.3, 3.1, and 1.9; global P = 0.439) and pain-related quality-of-life scores (1.0, 1.9, and 1.6; global P = 0.275) did not differ significantly by surgical type. Higher BMI was associated with lower odds of favorable positive body image (OR, 0.91; 95
Oncoplastic breast-conserving surgery (OBCS) is increasingly adopted to enhance cosmetic outcomes after breast-conserving surgery (BCS). However, whether it provides superior patient-perceived benefit over well-executed conventional BCS remains unclear, particularly in resource-constrained settings. This prospective pilot study compared patient-reported outcomes after conventional BCS and OBCS using the BREAST-Q breast-conserving therapy module. Consecutive women undergoing BCS at a public tertiary teaching centre in central India were prospectively enrolled. Fourteen patients underwent conventional BCS and 14 underwent OBCS. BREAST-Q assessments were completed preoperatively and postoperatively. The primary outcome was postoperative satisfaction. Between-group comparisons were performed using the Mann–Whitney U test, and within-group changes were analysed using the Wilcoxon signed-rank test. Baseline clinicopathological characteristics were comparable between groups, except for more frequent neoadjuvant chemotherapy in the OBCS group (35.7
Total neoadjuvant therapy (TNT) is widely used in locally advanced rectal cancer but is considered to increase the risk of anastomotic complications, leading to routine use of diverting stomas. We explored the feasibility of a multidisciplinary strategy centered on clip-guided, individualized radiotherapy field optimization intended to spare the bowel segments used for anastomosis, applied in conjunction with a standardized robotic surgical technique that provided a consistent platform for intraoperative verification, to omit diverting stoma in selected patients. We retrospectively reviewed three consecutive patients with stage III rectal cancer who underwent TNT followed by robot-assisted low anterior resection without diverting stoma. Endoscopic clips were placed before radiotherapy to guide individualized radiation field design, aiming to spare bowel segments intended for anastomosis. Surgical procedures incorporated intraoperative verification, including perfusion assessment and endoscopic evaluation of anastomotic integrity. No statistical analysis was performed due to the small sample size. All three patients had tumors located in the upper or middle rectum and were carefully selected based on clinical and treatment response factors. No anastomotic leakage or major postoperative complications were observed. Histopathological examination demonstrated radiation-related changes within the tumor bed, whereas proximal and distal resection margins showed only mild mucosal alterations, suggesting segmental sparing. The median hospital stay ranged from 8 to 10 days. At a follow-up of up to 12 months, no recurrences were observed. This small case series suggests that omission of diverting stoma after TNT may be feasible in highly selected patients when radiation exposure and surgical risk are carefully controlled. However, these findings are preliminary and should be interpreted with caution. Further studies are required to validate this strategy and define appropriate patient selection criteria.
Extranodal extension (ENE) is a significant prognostic marker in oral cavity squamous cell carcinoma (OCSCC). This study explores the hypothesis that the anatomical level of cervical lymph nodes harboring ENE may influence recurrence patterns and survival outcomes. This retrospective study analyzed 567 patients with OCSCC treated with curative intent. Patients were stratified by ENE presence and the level of involved lymph nodes (IA/IB vs. II–IV). Kaplan-Meier and Cox regression analyses were conducted to assess disease-free survival (DFS), overall survival (OS), and recurrence patterns. ENE was observed in 248 (43.74
Oral cavity squamous cell carcinoma (OCSCC) frequently metastasizes to cervical lymph nodes, significantly impacting treatment planning and prognosis. Dissection of level IIb lymph nodes is performed in proximity to the spinal accessory nerve (SAN), which may increase the risk of postoperative shoulder dysfunction due to traction injury or compromised vascular supply. The need for routine level IIb lymph node dissection remains uncertain due to its low reported involvement and risk of SAN-related morbidity. A prospective study was conducted on 50 patients with OCSCC undergoing primary tumour resection and neck dissection from November 2019 to November 2021. Patients treated with neoadjuvant chemotherapy were excluded. Level IIb lymph nodes were dissected in all cases along with IIa and labelled separately, and examined histopathologically. Clinicopathological variables and postoperative outcomes were analyzed. Out of 50 patients, Unilateral and bilateral neck dissection was performed in 47 and 3 patients respectively. Level IIb metastasis was detected in 2 patients (4
Anaplastic large cell lymphoma (ALCL) is a CD30-positive mature T-cell lymphoma that may present with extranodal involvement, particularly in children and young adults. Although systemic ALK-positive ALCL commonly involves the skin and soft tissues, an ulceroproliferative mass mimicking a poorly differentiated carcinoma is an uncommon and diagnostically challenging presentation. A 16-year-old female presented with a rapidly enlarging ulceroproliferative mass over the anterior aspect of the left leg for 1.5 months following trivial trauma. Imaging revealed a large infiltrative soft tissue lesion involving the superficial and intermuscular compartments, along with multiple bilateral pulmonary nodules and mediastinal/hilar lymphadenopathy, suggesting systemic disease. An initial biopsy was diagnosed elsewhere as poorly differentiated squamous cell carcinoma. On histopathological review, the epidermis was largely intact and non-dysplastic, with focal ulceration, while the dermis showed a diffuse discohesive infiltrate of large pleomorphic cells with irregular nuclear contours, vesicular chromatin, brisk mitotic activity, apoptosis, and extensive necrosis. Immunohistochemistry demonstrated strong and diffuse expression of CD45, CD4, and CD30, along with diffuse nuclear and cytoplasmic ALK-1 positivity, establishing the diagnosis of ALK-positive anaplastic large cell lymphoma. Systemic ALK-positive ALCL can rarely present as an ulceroproliferative soft tissue mass closely mimicking carcinoma. In young patients, particularly when the clinical presentation is atypical for carcinoma, the diagnosis of poorly differentiated squamous cell carcinoma should be approached cautiously. Recognition of the underlying lymphoid morphology and appropriate immunohistochemical evaluation, including CD45, CD30, ALK, and lineage-specific markers, are essential for accurate diagnosis and timely initiation of appropriate systemic therapy.
Global demand for cancer surgery is rapidly increasing, especially in low- and middle-income countries (LMICs), where the cancer burden is rising disproportionately. About 80
Enhanced Recovery After Surgery (ERAS) protocols reduce surgical stress and improve perioperative outcomes. Evidence supporting ERAS in head and neck oncology remains limited. This study evaluated the impact of a structured ERAS pathway on perioperative outcomes in adult patients undergoing head and neck cancer surgery. In this prospective quasi-experimental study, perioperative outcomes were compared in patients undergoing head and neck cancer surgery before and after implementation of an ERAS protocol at a tertiary care cancer centre. Adult patients received either conventional perioperative care (C-CAP; n = 115) or an ERAS pathway (E-CAP; n = 116). The primary outcome was length of hospital stay (LOHS). Secondary outcomes included intensive care unit (ICU) stay, postoperative complications (graded by the Clavien–Dindo classification), and 30-day readmission. Analysis of covariance (ANCOVA) adjusted for prespecified covariates. ERAS was associated with a significantly reduced LOHS (adjusted mean difference 2.48 days; 95 www.ctri.nic.in ) dated 30 March 2022.
Colorectal cancer is a major global health concern, with rectal cancer comprising approximately 30
Neck dissection is essential to managing head and neck cancers. It is associated with morbidity that affects quality of life. The Neck Dissection Impairment Index, available in English, assesses QOL following neck dissection. We translated it into Hindi and Marathi and validated it. The study was conducted in three phases. In phase I, the questionnaire was translated into Hindi and Marathi in accordance with standard guidelines. Phase II was cognitive debriefing conducted with 15 Hindi- and 15 Marathi-speaking patients to assess correctness, acceptability, relevance, and understandability. Phase III was a pilot testing in which it was administered twice: first within 1 month of surgery and again 1 week later to 20 Hindi- and 20 Marathi-speaking patients. The questionnaire was successfully translated into Hindi and Marathi. Minimal changes were made to the Hindi questionnaire during Phase II. The questionnaire had high internal consistency, with Cronbach’s alpha of 0.93 for Hindi and 0.88 for Marathi. The mean scores for Hindi and Marathi were 68.38 and 53.59, respectively. The Spearman’s correlation for test–retest reliability of the overall score was strong: 0.73, P < 0.001 for both Hindi and Marathi. The average intraclass correlation coefficient for the overall score was good: 0.87 (P < 0.001) for both Hindi and Marathi. The NDII questionnaire has been successfully translated and validated in Hindi and Marathi and can be used to assess patients with head and neck cancer who have undergone neck treatment.
