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Sirohi B.,Kiran Mazumdar Shaw Cancer Center | Shrikhande S.V.,The Surgical Center | Perakath B.,Christian Medical College | Raghunandharao D.K.,Homi Bhabha Cancer Hospital and Research Center | And 10 more authors.
Indian Journal of Medical and Paediatric Oncology | Year: 2014

This document is based on consensus among the experts and best available evidence pertaining to the Indian population and is meant for practice in India. Evaluation of a patient with newly diagnosed colorectal cancer (CRC) should include essential tests: A complete colonoscopy with biopsy, imaging (for colon cancer: Contrast-enhanced computed tomography (CECT) scan of the chest, abdomen and pelvis and for rectal cancer: Magnetic resonance imaging (MRI) of the pelvis, or an endoscopic ultrasound (EUS), with a chest and abdomen CECT), complete blood counts, liver and kidney function tests, carcinoembryonic antigen (CEA) and carbohydrate antigen 19.9 (CA19.9). For patients with localized colon cancer, resection is the treatment of choice, with consideration given to adjuvant chemotherapy for the patient with stage III and high-risk Stage II cancers. In patients with early rectal cancer (T1/T2, N0) surgery is the treatment of choice. Patients with locally advanced rectal cancer (T3/T4, N1, circumferential resection margin (CRM) threatened or involved) benefit from neoadjuvant therapy. Short course radiotherapy can be given if the CRM is not threatened. Others should undergo long course chemoradiotherapy. Adjuvant therapy is given to all patients receiving neoadjuvant therapy. Patients with potentially resectable metastatic liver limited disease should undergo synchronous or staged metastatectomy, along with neoadjuvant and adjuvant chemotherapy. Nonresectable metastatic disease must be assessed for chemotherapy versus best supportive care on an individual basis. Clinical examination and serum tumor markers are recommended at each followup visit, with imaging only done when either is abnormal or rising. Colonoscopic surveillance is also recommended for these patients. Source

Yadav D.S.,Institute of Pathology | Devi T.R.,Institute of Pathology | Ihsan R.,Institute of Pathology | Mishra A.K.,Institute of Pathology | And 9 more authors.
Genetic Testing and Molecular Biomarkers | Year: 2010

Background: Widespread use of tobacco and betel quid consumption and a high incidence of tobacco-associated aerodigestive tract cancers have been reported in different ethnic groups from several regions of Northeast (NE) India. This study was done to explore the possibility of phase II metabolic enzymes being responsible for the high prevalence of cancers in this region of India. Methods: Samples from 370 cases with oral, gastric, and lung cancers and 270 controls were analyzed for polymorphism of glutathione-S-transferase (GST) genes using polymerase chain reaction-restriction fragment length polymorphism-based methods. Results and Conclusions: Tobacco smoking and betel quid chewing were found to be high risk factors for oral and lung cancers but not for gastric cancer, whereas tobacco chewing was found to be a risk factor for oral cancer but not for gastric or lung cancer. The variant genotypes of GSTP1 were not associated with any of the aerodigestive tract cancers. GSTT1 and GSTM1 null genotypes appeared to play a protective role for lung cancer (odds ratio [OR]=0.47, 95% confidence interval [95% CI]: 0.24-0.93, p=0.03) and (OR=0.52, 95% CI: 0.28-0.96, p=0.04), but they were not associated with oral and gastric cancers. However, when data was analyzed in different geographic regions the GSTT1 null genotype was found to be a significant risk factor for oral (OR=2.58, 95% CI 1.01-6.61, p=0.05) as well as gastric cancer (OR=3.08, 95% CI 1.32-7.19, p=0.009) in samples obtained from the Assam region of NE India. This is the first study on the association of GST polymorphisms and aerodigestive tract cancers in the high-risk region of NE India. © 2010, Mary Ann Liebert, Inc. Source

Ihsan R.,Institute of Pathology ICMR | Devi T.R.,Institute of Pathology ICMR | Yadav D.S.,Institute of Pathology ICMR | Mishra A.K.,Institute of Pathology ICMR | And 8 more authors.
DNA and Cell Biology | Year: 2011

The association of TP53 codon 72 polymorphism with cancer susceptibility remains uncertain and varies with ethnicity. Northeast India represents a geographically, culturally, and ethnically isolated population. The area reports high rate of tobacco usage in a variety of ways of consumption, compared with the rest of Indian population. A total of 411 cancer patients (161 lung, 134 gastric, and 116 oral) and 282 normal controls from the ethnic population were analyzed for p53 codon 72 polymorphism by polymerase chain reaction-restriction fragment length polymorphism. No significant difference in genotypic distribution of p53 between cases and controls was observed. Results suggested betel quid chewing as a major risk factor for all the three cancers (odds ratio [OR] = 3.54, confidence interval [CI] = 2.01-6.25, p < 0.001; OR = 1.74, CI = 1.04-2.92, p = 0.03; and OR = 1.85, CI = 1.02-3.33, p = 0.04 for lung, gastric, and oral cancers, respectively). Tobacco smoking was associated with risk of lung and oral cancers (OR = 1.88, CI = 1.11-3.19, p = 0.01 and OR = 1.68, CI = 1.00-2.81, p = 0.04). Interactions between p53 genotypes and risk factors were analyzed to look for gene-environment interactions. Interaction of smoking and p53 genotype was significant only for oral cancer. Interactions of betel quid with p53 genotypes in lung cancer showed significant increase for all the three genotypes, indicating a major role of betel quid (OR = 5.90, CI = 1.67-20.81, p = 0.006; OR = 5.44, CI = 1.67-17.75, p = 0.005; and OR = 5.84, CI = 1.70-19.97, p = 0.005 for Arg/Arg, Arg/Pro, and Pro/Pro, respectively). In conclusion, high incidence of these cancers in northeast India might be an outcome of risk habits; further, tissue- and carcinogen-specific risk modification by p53 gene is probable. © Copyright 2011, Mary Ann Liebert, Inc. Source

Takiar R.,National Cancer Registry Programme | Jayant K.,Barshi PBCR
Asian Pacific Journal of Cancer Prevention | Year: 2013

Background:Prevalence is a statistic of primary interest in public health. In the absence of good followup facilities, it is difficult to assess the complete prevalence of cancer for a given registry area. Objective: An attempt was here made to arrive at complete prevalence including limited duration prevalence with respect to selected sites of cancer for India by fitting appropriate models to 1, 3 and 5 years cancer survival data available for selected population-based registries. Materials and Methods: Survival data, available for the registries of Bhopal, Chennai, Karunagappally, and Mumbai was pooled to generate survival for breast, cervix, ovary, lung, stomach and mouth cancers. With the available data on survival for 1, 3 and 5 years, a model was fitted and the survival curve was extended beyond 5 years (up to 35 years) for each of the selected sites. This helped in generation of survival proportions by single year and thereby survival of cancer cases. With the help of survival proportions available year-wise and the incidence, prevalence figures were arrived for selected cancer sites and for selected periods. Results: The prevalence to incidence ratio (PI ratio) stabilized after a certain duration for all the cancer sites showing that from the knowledge of incidence, the prevalence can be calculated. The stabilized P/I ratios for the cancer sites of breast, cervix, ovary, stomach, lung, mouth and for life time was observed to be 4.90, 5.33, 2.75, 1.40, 1.37, 4.04 and 3.42 respectively. Conclusions: The validity of the model approach to calculate prevalence could be demonstrated with the help of survival data of Barshi registry for cervix cancer, available for the period 1988-2006. Source

Thoudam R.D.,Institute of Pathology ICMR | Yadav D.S.,Institute of Pathology ICMR | Mishra A.K.,Institute of Pathology ICMR | Kaushal M.,Institute of Pathology ICMR | And 11 more authors.
Genetic Testing and Molecular Biomarkers | Year: 2010

Background: Detoxifying glutathione S-transferase (GST) gene polymorphisms show variation in different ethnic populations. GST detoxifies and metabolizes carcinogens, including oxygen free radicals. GST polymorphisms have been associated with susceptibility to different diseases. In the current study, allelic polymorphisms of GSTM1 and GSTT1 were analyzed in three ethnic groups of North East (NE) India where a high prevalence of various cancers and other diseases such as hypertension, tuberculosis, and asthma have been reported. Methods: We compared the prevalence of GSTT1 and GSTM1 deletion genotypes, which were determined by multiplex polymerase chain reaction, in 422 voluntary, healthy NE Indians with those of other populations. The data was statistically analyzed. Results: The GSTT1-null genotype was found in 51%, 34.3%, and 15.7% of individuals (from Mizoram, Sikkim, and Assam regions of NE India, respectively), whereas the GSTM1-null genotype was found in 46.9%, 46%, and 35% of individuals from the same areas. Conclusions: The NE Indians differ from the rest of the Indian population with reference to genotypic distribution of GST polymorphisms but the frequency was found to be similar to that which has been reported from China. This may explain the hypothesis of the common ancestral origin of both the NE Indians and the Chinese and a higher frequency of cancers such as gastric, esophageal, and oral cancers, which has been reported from these regions. This study establishes baseline frequency data for GST polymorphisms for future case control studies on the role these polymorphisms play with regard to diseases. The results presented here provide the first report on GST polymorphisms in the NE Indian population. © 2010, Mary Ann Liebert, Inc. Source

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