Day :
- Cancer Therapy | Breast Oncology | Neurological Cancer | Pancreatic and Colorectal Cancer
Location: Singapore
Session Introduction
Tarang Krishna
Dr. Krishna’s Cancer Healer Center, India
Title: Efficacy of oral immunotherapy in a case of Non-Hodgkin’s Lymphoma (NHL)
Biography:
Abstract:
Non-Hodgkin’s lymphoma is one of the most common cancers worldwide. It primarily affects adults above the age of 50 years but it is not uncommon in children. Non-Hodgkin’s lymphoma is the cancer pertaining to lymphocytes, one of the types of leucocytes. As the lymphocytes multiply abnormally, of thymus, spleen, bone marrow and the lymph nodes present in the body tend to get affected. It has been associated with various risk factors like autoimmune disorders, smoking, immunosuppressive treatments and frequent infections. The recommended treatment for Non-Hodgkin’s lymphoma is an integrated chemotherapy and immunotherapy treatment. This treatment has considerable side effects like severe hair fall, allergic reactions; decrease in blood count especially the neutrophils that protect the body from infections. Other alternatives include radiotherapy, bone marrow transplant and radio immunotherapy. Many studies have been conducted in relation to the treatment of Non-Hodgkin’s Lymphoma with immunotherapy but the possibility of emergence of alternate effects has also not been entirely ruled out. This case report aims to establish the efficacy of oral immunotherapy treatment in a patient of Non-Hodgkin’s lymphoma in terms of the following: Relieving the patient of his presenting complaints, removing the evidence of the disease completely from the body without any side effects, ruling out relapse of the disease and ensuring a normal life to the patient.
Aalapti Singh
Institute of Medical Sciences & SUM Hospital, India
Title: The cancer in our mind: An insight into why it must be treated
Biography:
Abstract:
The International Agency for Research on Cancer (IARC) in the GLOBOCAN 2018 report suggests that the global cancer burden has risen to 18.1 million cases and 9.6 million cancer deaths. This calls for an exponential increasing demand for treatment both physical and emotional. In this course, we must not forget to treat the cancer of our minds in the disease’s course from diagnosis to survivorship/palliative care. Psycho-oncology is a practice of going beyond traditional medical treatment and serves lifestyle, psychological and social aspects of cancer. It addresses two major dimensions: (1) psychological responses of patients (families and caregivers) to cancer at all stages of the disease; (2) psychosocial factors influencing the disease process. Cancer-related distress is defined as a multifactorial unpleasant emotional experience of a psychological (cognitive, behavioral, emotional), social and/or spiritual nature that may interfere with the ability to cope effectively with cancer, its physical symptoms and treatment. It expands through a continuum from normal sadness to existential crisis, thereby endorsed as the sixth vital sign. Evidence shows, 60% to 80% cancer patients (including families/caregivers) report distress, whereas only a meagre 20% receive help. Hence, distress screening is crucial in identifying individuals to be referred for help. Psycho-oncological interventions have proven to reduce distress, enhance quality of life and increase participation in medical treatment. The most unattended group is the oncology personnel (doctors-surgical, medical, radiation oncologists; nursing staff and other related specialists), who deal with death on a daily basis. Staff burnout is at a tipping point due to extreme stress. Distress screening for them is a necessity, with strengthening practices like open discussions, cut-off time, experience sharing and a conducive working environment should be implemented. Cancer is undoubtedly a disease of the body and mind, likewise. The mind aspect of it needs equal attention and effort, as the physical part.
Amabelle Trina Gerona
St. Luke’s Medical Center, Philippines
Title: Single center study in the Philippines on Eribulin mesylate in metastatic breast cancer from 2013- 2016
Biography:
Amabelle Trina Gerona is working as Medical Oncology Fellow at St. Luke’s Medical Center, Philippines.
Abstract:
Introduction: There is no standard sequence in giving treatment for metastatic breast cancer. Eribulin mesylate has been approved for heavily pretreated patients in the second line setting.
Method: Case series from a single institution in the Philippines including all metastatic breast cancer patients given eribulin in both out-patient and in-patient services in St. Luke’s Medical Center Quezon City from 2013-2016.
Results: Thirty-four patients were given eribulin from January 2013- December 2017 in our institution for Metastatic Breast Cancer. Median age was 59.1 (37-84). Hormone receptor status were mostly: triple negative 12(35.29%) and ER(+) PR (+) Her2 (-) with 9 (26.47%). Most 24(70.59%) had received prior one line of treatment while 6 (17.64%) had received prior two lines of treatment. There were 3 out of 34 patients who had ER(+) PR (+) Her2 (-) subtype, one patient had 2 months response while two patients had 3 months response to Eribulin. Hormone receptor subtype ER (+) PR(+) Her2 (+) had 3/34 patients which response to eribulin in 2, 3, 3 months while triple negative subtype, had the most number of patient 12/34 had one patient with 5 and 12 months each response, two patients with 0.5, 3 and 4 months each response, four patients with 2 months response, and four patients with 2 months response each with eribulin. Common adverse events to eribulin were neutropenia 17(50%) and fatigue 15(44.11%). Reasons for discontinuation of Eribulin were due either to adverse events 7(25.92%) or disease progression 24 (70.59%).
Conclusion: Eribulin Mesylate in our institution was used mostly as a second line setting and was used not only in triple negative breast cancer but as well as other breast subtypes as well. Most common metastatic site were lung and liver. Most patients had stable disease. One patient had achieved complete response when eribulin was used as second line metastatic setting. Most common cause of discontinuation were due to progressive disease, while only modest had discontinuation due to adverse effects.
Hemish Kania
Dr. B. Borooah Cancer Institute, India
Title: Chemo port insertion without image guidance via. Rt IJV: A single center experience on periprocedural complications
Biography:
Hemish Kania is working as surgical Oncology Fellow at Dr. B. Borooah Cancer Institute, India.
Abstract:
Aim: To report our early experience in chemo port insertion without image guidance by surgeons.
Methods: This was a cross-sectional study conducted in a tertiary center with 19 chemo port insertions done from November 2017 to May 2018. The chemo ports were inserted at the operation theater unit. All the chemo ports had right internal jugular vein (IJV) as the entry site. Other entry sites included the left IJV, subclavian veins and the inferior vena cava were not used. Immediate and early complications were recorded. None of the port insertions were performed under image guidance with the aid of ultrasound and fluoroscopy.
Results: The technical success rate was 100%. In terms of immediate complications, there were only two cases of arterial puncture that resolved with local compression. No pneumothorax or air embolism was documented. No case of early complications was recorded. The most common early complication was catheter blockage (2/19; 10.52%), followed by catheter-related infection (2/19; 10.52%). No incidence of catheter malposition, venous thrombosis and catheter dislodgement or leak was recorded. A total of 1 (5.26%) chemo ports had to be removed within 30 days; most of them were due to infections that failed to respond to systemic antibiotic therapy. In terms of place of procedure, there were no significant differences in complication rates between the chemo port catheter placements via. image guidance in comparison to the one done without image guidance.
Conclusion: Chemo port insertion without image guidance by surgeons gives low periprocedural complication rates in comparison to chemo port insertion done by image guidance. Using right IJV as the entry site, the image guidance gives good success rate with least complication. The advantage of doing it without image guidance is that it saves a lot of time. Also, it can be done under local anesthesia. It doesn’t require any radiological assistance during the procedure. And it requires lesser number of skilled personals in terms of manpower. To our best knowledge, this is the first publication of chemo port insertion without image guidance.
Armheel Klein Baldonado
Cardinal Santos Medical Center, Philippines
Title: Primary leptomeningeal metastasis in a pediatric with high grade glioma
Biography:
Armheel Klein Baldonado is currently the Chief Resident of Radiation Oncology at a Training Institution in the Philippines.
Abstract:
The objective of this case report is to present a case of leptomeningeal metastasis at the time of diagnosis of the primary high-grade glioma in a child and to describe the course of diagnosis, treatment and outcome. A 13-yearold girl presented with signs and symptoms including headache with associated projectile vomiting, which persisted for a month and was accompanied with diplopia and ataxia. MRI was done revealing a mass on the left temporal lobe, which was compatible with diffuse meningitis and an alternative diagnosis of a high-grade neoplasm with leptomeningeal metastasis. She underwent left temporal parietal craniotomy with excision of the tumor and revealed a histopathologic diagnosis of high-grade gliomas consistent with glioblastoma. Patient underwent adjuvant Craniospinal Irradiation (CSI). Additional chemotherapy was then initiated with Temozolamide for 6 cycles due to the residual glioblastoma with leptomeningeal metastasis. A repeat craniospinal MRI was done after the last cycle of chemotherapy, which revealed an apparent complete resolution of the previously noted contrast-enhancing residual mass. Leptomeningeal metastasis from GBM in the pediatric age group is not a common occurrence. The evaluation of leptomeningeal dissemination of tumor is based on the several criteria: presence of clinical signs and/or symptoms, evaluation of lumbar CFS cytology and craniospinal CT scan or MRI. Current treatment for pediatric GBM typically includes initial surgery followed by radiation and chemotherapy. There is no specific recommendation for CSI for primary disseminated GBM. The efficacy of Temozolamide remains controversial but a beneficial effect is not disproven.
Shreya Kar
National University of Singapore, Singapore
Title: Role of annexin A1 in the dynamics of macrophage polarization in the breast tumor microenvironment
Biography:
Abstract:
Tumor-associated Macrophages (TAMs) choreograph various aspects of the tumor microenvironment. Annexin A1 (ANXA1) is an anti-inflammatory protein is highly expressed in metastatic breast cancer. Gene Expression Omnibus (GEO) and array express was used to assess the association between TAMs and breast cancer in the patients. MMTV-Wnt1 mouse model was used for in vivo study. Microarray Affymetrix was done to find the signaling mechanism involved. LC-MS was done to find the array of secreted protein by the breast cancer cells. Clinically, we found that M2 TAMs were highly enriched in Claudin-low breast cancer subtype and was strongly associated with ANXA1 gene expression, which was validated in our mouse model. Additionally, macrophages were skewed to a more M2 TAM-like phenotype upon co-culture with breast cancer cells, with enhanced migratory and invasive properties and phagocytic potential, which was reduced in the ANXAI-/- macrophages. TAMs isolated from the breast tumors of wild type and ANXA1 knockout mice wherein 4T1 had been injected orthotopically, showed higher percentage of M2 macrophages in the wild type as compared to the ANXA1 KO. We have found a novel signaling loop connecting RANTES-Annexin A1-stat3-Arginase 1 using our Affymetrix and LC-MS data, which has been also validated in our ex vivo and in vivo model. This study demonstrates a novel role of ANXA1 in regulating the dynamic process of macrophage polarization in the breast tumor microenvironment and future studies include abrogating this process using a novel stat3 inhibitor.
Aldrin John S Almario
Bulacan Medical Center, Philippines
Title: A case report of neuroendocrine tumor presenting as rectal polyp
Biography:
Abstract:
Introduction: Rectal Neuroendocrine Tumors (NETs) are hindgut carcinoid tumors that originated from the neuroendocrine system of the gastrointestinal tract. This report presents a case of an adult Filipino with recurrent episodes of hematochezia.
Case Presentation: A 33 year old Filipino presented with recurrent hematochezia. On the recent hospital admission, lower endoscopy was employed which revealed a small sessile rectal polyp. Endoscopic polypectomy was done. Histopathologic study revealed findings suggestive of a neuroendocrine tumor. Diagnosis was confirmed using immunohistochemistry study which was consistent with a neuroendocrine lesion with positive expression of synaptophysin antibody marker and weakly reactive chromogranin antibody marker.
Conclusion: Rectal NETs are benign tumor of the gastrointestinal tract. Most patients are asymptomatic and diagnosis is mainly done during endoscopic examination. Immunohistochemistry study is needed for confirmation of diagnosis. Treatment modalities are mainly based on the tumor grade and stage. Endoscopic resection is usually done for low grade tumors whereas surgical intervention such as anterior resection or abdominoperineal extirpation and medical therapy using Interferon-alfa and platinum based chemotherapy are recommended for high grade tumors.
Dawn Lynn Guardiario
Philippine College of Physicians, Philippines
Title: Achievement of pathologic complete response of patients with locally advanced rectal adenocarcinoma: A 5-year single institution experience in Cebu, Philippines
Biography:
Dawn Lynn Guardiario has completed his Diplomate in the College of Physicians, Philippine.
Abstract:
Introduction: Rectal Neuroendocrine Tumors (NETs) are hindgut carcinoid tumors that originated from the neuroendocrine system of the gastrointestinal tract. This report presents a case of an adult Filipino with recurrent episodes of hematochezia.
Case Presentation: A 33 year old Filipino presented with recurrent hematochezia. On the recent hospital admission, lower endoscopy was employed which revealed a small sessile rectal polyp. Endoscopic polypectomy was done. Histopathologic study revealed findings suggestive of a neuroendocrine tumor. Diagnosis was confirmed using immunohistochemistry study which was consistent with a neuroendocrine lesion with positive expression of synaptophysin antibody marker and weakly reactive chromogranin antibody marker.
Conclusion: Rectal NETs are benign tumor of the gastrointestinal tract. Most patients are asymptomatic and diagnosis is mainly done during endoscopic examination. Immunohistochemistry study is needed for confirmation of diagnosis. Treatment modalities are mainly based on the tumor grade and stage. Endoscopic resection is usually done for low grade tumors whereas surgical intervention such as anterior resection or abdominoperineal extirpation and medical therapy using Interferon-alfa and platinum based chemotherapy are recommended for high grade tumors.
- Breast Oncology | Reproductive Cancer | Cancer Therapy
Location: Singapore
Session Introduction
A Guillaume Pollet
European Institute of Business Administration (INSEAD), Singapore
Title: Quality of life management after breast surgery: The standard use of fat grafting
Biography:
A Guillaume Pollet is a Specialized Breast Cancer Surgeon with Expertise in Oncoplasty and Global Care (Oncofertility) and Former G&O. His professional activity disrupts the conventional treatment after being educated in the Institut Curie, Paris, one of the most prestigious, innovative and precursor Cancer Center in the world. He is currently an Executive MBA at INSEAD Business School, Singapore.
Abstract:
Surgical treatment is part of the gold standard for early breast cancer, but sequelae may be associated (30% of cases), with negative impact on social, physical, personal and sexual life. Supportive care and awareness of Quality Of Life (QOL) have modified the conventional care. The emergence and generalization of new techniques and technologies go in that direction. Methodology includes day surgery under general anesthesia, percutaneous without incision, iterative procedures following the volume targeted association of liposuccion-fat treatment and reinjection (fat grafting). The direct benefit is a volume gain; the indirect benefits are tissue rejuvenation with new vascularization, innervation and a better trophicity. The indications are for cosmetic sequelae and breast reconstruction (exclusive or combined). Beyond the former description, the Pros go for a low invasive surgery (low risk) with the benefit of liposuccion and an increase in mammogram transparency. On the other side, a lack of consistency in the results, the side effect of liposuccion (waves), the fear about stem cells and growth factors and benign modification in mammograms (calcifications, fat cysts). Results are mostly sustainable, and the main effect is the change in mentalities: cancer patients transform into aesthetic patients, without sickness. The impact is highly positive. It is concluded that the controlled and risk-free technique, the consistency of the results depends on the patient (comorbidities, past tarts, compliance, the experiment of the surgeon (learning curve, choice of the technic and devices used). Prediction of results using 3D is possible but not yet in reconstruction. The holistic allows strong relationship, confidence, trust and early adoption of the protocols proposed to the patient. Tailor-made treatment is a motto that should not be ignored, so as not to forget the main objective to treat a patient and not just a disease.
Hemish Kania
Dr. B. Borooah Cancer Institute, India
Title: Hand sewn v/s stapled cervical esophagogastric anastomosis in esophageal carcinoma: A study of postoperative clinical outcomes
Biography:
Hemish Kania is working as surgical Oncology Fellow at Dr. B. Borooah Cancer Institute, India.
Abstract:
Introduction & Aim: Esophageal carcinoma is a multifaceted and complex disease of rapidly rising incidence that exerts an increasing social and financial burden on global healthcare systems. Esophagogastrectomy is the standard treatment for esophageal carcinoma and end-stage benign esophageal disease; however, the techniques of esophagogastric anastomosis after esophagectomy are complex and associated with postoperative complications, such as anastomotic leakage and stricture.
Methods: All patients who underwent esophagectomy with cervical esophagogastric anastomosis at a single academic center from 2013 to 2018 were included in the study. Both early and late complications were analyzed.
Results: 60 patients underwent resection for carcinoma of the esophagus and gastroesophageal junction. Of these 45 patients had esophagectomy with cervical esophagogastric anastomosis. Hand sewn and 15 patients underwent a linear stapled anastomosis Both groups were comparable with respect to preoperative characteristics. There was no difference in T and N stage of the disease. There was statistically significant difference in the mean anastomotic time( 34.3 min in hand sewn group v/s 15.4 min in linear stapled group , p< 0.001,), anastomotic leak ( 6 major leak and two minor leak in hand sewn group v/s 0 leaks in linear stapled),anastomotic stricture ( 8 in hand sewn group v/s 1 in linear stapled group). Similarly there was significant difference in the mean operative time , mean ICU stay ,mean hospital stay , ICD removal time, time of ambulation of oral feeds and time of ambulation of patients in linear stapled anastomosis compared to hand sewn anastomosis
Conclusion: LS anastomotic technique for esophagogastric anastomoses in esophagectomy for cancer indicates that the new technique lowers anastomotic leakage and stricture rates compared to traditionally used HS techniques. Furthermore, the application of the LS technique is usually easy and standardized such that the incidence of technical errors is minimized. Use of staplers decreased the mean anastomotic time. The incidence of anastomotic leakage and stricture decreased which indirectly reduced the mean ICU stay, hospital stay and early supplementation of feeding to the patient which decreased the overall morbidity to the patient. The use of stapler however has shown no decrease or increase blood loss and surgical time, but decreased the anastomotic, pulmonary complications and mortality. The linear-stapled esophagogastric anastomosis is a safe and effective anastomotic technique, which can decrease the rate of leak, postoperative dysphagia. In contrast, the HS method requires surgical expertise and might not be practical everywhere; therefore, we should preferentially use LS over the HS method.
Aalapti Singh
Institute of Medical Sciences & SUM Hospital, India
Title: Screening of distress in cancer patients: Its needs, importance and tool of examination
Biography:
Abstract:
Cancer continues to be a majorly significant threat to our society despite advancements in its diagnosis and treatment. It is the second largest cause for mortality around the world after cardiovascular diseases. Cancer patients have to cope with a great deal of distress. Individuals facing a possible diagnosis of cancer are confronted with multiple physical, psychological and educational challenges. A diagnosis of cancer increases susceptibility to stress; indeed, cancer patients are at high risk for a variety of emotional disorders including anxiety, traumatic stress and depression. Patients’ stress can be amplified by long waiting room times, lack of information, poor communication between clinic staff and patients and inadequate psychosocial care. This calls for an immediate need to begin screening of distress in cancer patients. Examination of distress not only helps in capturing it’s prevalence but also guides in identifying the common areas of distress among patients, as well as relevant solutions to their problems. Most importantly, screening of distress alone is not solely useful in itself. After screening, patients must be given adequate interventions and be followed up regularly to monitor changes in their levels of distress over time. There are several tools available for screening of distress in cancer patients. Some are traditional and most commonly used, as well as, recently, experts through research have come up with cancer-tailored tools for examination of distress. The long established tools include- DASS (42), DASS (21), ESAS, HADS, Beck’s Depression Inventory (BDI) and many more. On the other hand, we now have tools more suited towards cancer patients’ interests such as the National Comprehensive Cancer Network Distress Thermometer (NCCN-DT), Emotional Thermometer (ET), Mental Adjustment to Cancer (MAC) scale and so on. This study encompasses the silent features of each of these tools, methodology of use and application in daily routine.
Amabelle Trina Gerona
St. Luke’s Medical Center, Philippines
Title: Factors affecting sleep quality and its association to quality of life in adult Filipinos with cancer
Biography:
Amabelle Trina Gerona is working as Medical Oncology Fellow at St. Luke’s Medical Center, Philippines.
Abstract:
Introduction & Aim: Sleep disturbances are highly prevalent in cancer patients and may be attributable to factors including pain, treatment side effects and psychological factors. However, the relationship between sleep and cancer is bidirectional. There is substantial evidence that sleep disturbance is associated with many aspects of cancer treatment, morbidity, mortality and quality of life. This study evaluated sleep quality in adult Filipinos with cancer and determined the association of demographic characteristics and clinical features to sleep quality.
Methods: This was a cross-sectional surveillance study conducted among adult Filipinos with cancer seen at the Ambulatory Care Unit of a tertiary hospital. Questionnaires were answered to assess subjective sleep quality, pain score and quality of life. Frequency and percentages were determined. Determination of factors affecting sleep quality was analyzed using univariate and multivariate statistics.
Results: 406 cancer patients studied, 80% were women and the mean age was 53 years old. Majority (62%) had breast cancer. Seventy-nine percent (79%) of the patients had a PSQI score of 5 or greater, indicating poor sleep quality. Sleep among participants was characterized by prolonged time to fall asleep and shortened sleep duration. Majority reported some degree of daytime dysfunction due to poor sleep. Age, gender and marital status did not appear to affect the quality of sleep. Among disease-related factors, presence of more advanced disease, increasing pain severity and treatment with chemotherapy and/or radiotherapy were demonstrated to lead to poorer sleep quality. Surprisingly, even patients who were not receiving any active therapies (on-going surveillance) complained of sleep disturbance. Upon further investigation, poor sleep quality was shown to predict a worse quality of life among the study participants.
Conclusion: Overall, the quality of sleep among adult Filipinos with cancer is significantly impaired. In particular, presence of more advanced disease, treatment with chemotherapy and radiotherapy and moderate to severe pain significantly increase the risk of having poor sleep. In turn, disturbed sleep predicted a poorer quality of life. These findings support the need to include assessment of sleep quality for a more holistic approach to cancer care.
Shelton Tacang
Jose R. Reyes Memorial Medical Center, Philippines
Title: Recurrent and metastatic papillary thyroid microcarcinoma presenting as toxic multinodular goiter
Biography:
Abstract:
Background: Hyperthyroidism does not safeguard individuals from developing thyroid cancer. Papillary thyroid microcarcinoma, notwithstanding its torpid course and low risk, classification has a propensity to induce significant morbidity despite radioactive iodine treatment.
Clinical Case: We present the unusual case of a 37-year old, Filipino male who demonstrated typical signs and symptoms of toxic Multinodular Goiter (TMG) including anterior neck mass, tremors, weight loss, excessive sweating, palpitations, easy fatigability and bilateral proptosis. The patient upon follow up was found to have agranulocytosis attributed to being on anti-thyroid medication for two years. The patient was then subjected to total thyroidectomy with a histopathology report showing colloid goiter with concomitant papillary thyroid microcarcinoma (0.9 cm in widest diameter). Initial Radioactive Iodine (RAI) therapy was initiated following surgery and subsequent 131I Whole Body Survey (WBS 131I) a year after, showing a negative result; however, after two months of WBS 131I, there was locoregional recurrence detected by neck ultrasound and CT scan and eventually confirmed on lymph node biopsy after Modified Radical Neck Dissection (MRND). In an attempt to ablate the probable micrometastases, a second RAI therapy with a higher dose was administered and subsequent post-therapy scan revealed recurrence of cancer on the thyroid bed and distant metastasis on the right lower quadrant of the abdomen. Currently, the patient is on suppression therapy and constantly monitored for progression of the disease.
Conclusion: Even when aided with strict protocols, clinicians must recognize that guidelines are not surrogate to clinical judgment and that prompt institution of treatment is critical to circumvent potential pitfalls. This case further illustrates the avenue of championing the use of Radioactive Iodine (RAI) therapy just as in the low risk stratification.