Asian Pacific Journal of Cancer Biology

Accuracy of the Combination of TI-RADS and BETHESDA Regarding Histopathology of Thyroid Malignancy

Efrem Hoesman Ciputra — 2025-04-16

Background and aim of the work: Thyroid carcinoma is a common type of cancer, making up 2.1% of all new cancers. Ultrasonography (USG) is used to check thyroid nodules. TI-RADS is a system that classifies thyroid nodules based on USG. High-risk nodules undergo fine-needle aspiration biopsy (FNAB), and the results are reported using the BETHESDA classification. This study aimed to determine how accurate TI-RADS and BETHESDA are together for diagnosing thyroid cancer.

Research design and methods: This observational study examined data from thyroid cancer patients. We assessed characteristic data comprising age, gender, TI-RADS, BETHESDA, and thyroid malignancy histopathology. An independent t-test and Fisher exact test assessed the relationships between TI-RADS, BETHESDA, and thyroid malignancy histopathology. Diagnostic tests were based on ROC curve analysis of FNAB (BETHESDA), USG (TI-RADS), and a combination of both in establishing a diagnosis of malignancy based on the results of histopathological examination.

Results: This study included 47 patients. FNAB (BETHESDA) was more accurate at 80.85% compared to USG (TI-RADS) and their combination. Similarly, FNAB (BETHESDA) had a higher sensitivity at 80.48% compared to USG (TI-RADS) and their combination. However, when FNAB (BETHESDA) and USG (TI-RADS) were combined, they had the highest specificity values, reaching 100.0%, compared to each examination alone.

Conclusions: The study found that while FNAB (BETHESDA) is accurate and sensitive, combining it with USG (TI-RADS) improves specificity, making it a valuable approach for clinical decision-making. This integration could lead to better diagnostic accuracy and patient outcomes by providing a more comprehensive assessment of thyroid nodules.

Breast Cancer Awareness, Screening Practices, Barriers, and Educational Interventions in Middle Eastern Countries: Challenges and Successes

Omar Ayaad — 2025-04-16

Objective: This review explores breast cancer awareness, knowledge, and screening practices among women in Gulf andMiddle Eastern countries, highlighting disparities and challenges within the region.

Methods: A systematic literature review was conducted using databases like PubMed, Scopus, and Google Scholar to identify English-language studies (2015 onward) on breast cancer awareness, knowledge, and screening practices among women in Gulf and Middle Eastern countries. Data from eligible studies were independently extracted by two reviewers, and a weighted average formula was applied to synthesize findings, ensuring greater influence from larger sample sizes while minimizing redundancy across countries.

Results: By synthesizing findings from 25 studies, the review identifies significant variations in breast cancer awareness levels, with 30% of populations exhibiting high awareness, 45% moderate awareness, and 25% low awareness. A weighted average analysis reveals gaps between awareness and practices of screening methods: while 75% of women were aware of breast self-examination (BSE), only 45% practiced it; similarly, awareness of mammography stood at 60%, but practice levels were as low as 35%. Key barriers to timely medical help-seeking include emotional (65%), informational (50%), and financial (40%) factors, underscoring the role of cultural stigmas, logistical challenges, and limited healthcare access. Educational interventions demonstrated success in bridging awareness gaps, increasing awareness by 85% and improving help-seeking behavior by 70%. Effective initiatives include school-based health education, digital platforms, and community outreach. However, challenges persist in addressing cultural and psychological barriers and ensuring equitable healthcare access.

Conclusion: Lessons from developed countries emphasize the value of integrated public health campaigns, proactive healthcare engagement, and advanced technology in improving breast cancer outcomes. The review concludes with actionable recommendations to enhance awareness, screening practices, and healthcare systems across the Gulf and Middle East, paving the way for earlier detection and better survival rates.

Exploring the Immunological and Physiological Effects of Zingiber Officinale on Women with Ovarian Cancer in Iraq

Maytham T. Qasim — 2025-04-16

Objective: Ovarian cancer is a major global health issue and ranks as the sixth most common cancer among women worldwide. Unfortunately, it is often diagnosed at an advanced stage, making treatment outcomes less favorable. This study examines the role of Zingiber officinale, commonly known as ginger, as a complementary therapy for women in Iraq battling ovarian cancer. It highlights ginger’s potential to improve the effectiveness of treatments and enhance patients’ quality of life.

Methodology: The research used a mixed-methods approach, involving 57 participants over a 42-week period. It focused on the bioactive components of ginger such as gingerol, shogaol, paradol, and zingerone which are well-known for their anti-inflammatory, antioxidant, and immune-boosting properties. These compounds may work in tandem with traditional cancer treatments. Participants, categorized based on the stage of their cancer and their treatment regimens, were given ginger supplements alongside standard chemotherapy. The study carefully tracked and analyzed immune responses, physiological changes, and clinical outcomes.

Results: The findings were notable. Ginger supplementation significantly boosted T-helper cell activity, improved CD4/CD8 ratios, and lowered inflammatory cytokine levels. Physiologically, participants experienced better antioxidant activity, reduced chemotherapy-induced nausea, and better fatigue management. Perhaps most strikingly, those taking ginger required fewer secondary surgeries and additional chemotherapy sessions. Their biochemical markers, including CA-125 levels, lipid profiles, and oxidative stress markers, also showed improvement. The research highlights ginger’s potential as a valuable addition to traditional cancer treatments, helping to strengthen the immune system and body while reducing the side effects of therapy. However, the study did face some limitations, such as a relatively small sample size, a lack of diverse participants, and limited resources. Further research is needed to confirm these findings. Future studies should involve larger and more diverse groups of participants, extend the duration of observation, and explore ginger’s effects on other types of cancer to broaden the scope of its benefits.

Conclusion: Ultimately, this study advocates for incorporating ginger into cancer care protocols due to its affordability, accessibility, and minimal side effects. By integrating ginger into oncology practices, healthcare providers can potentially revolutionize supportive care for ovarian cancer patients, paving the way for holistic well-being and better treatment outcomes.

Niosome-Encapsulated Selenium Nanoparticles: A Novel Paradigm for Cancer Therapy

Hora Amoozegar — 2025-04-16

Overview: This study explores a novel therapeutic method for oral squamous cell carcinoma using selenium nanoparticles encapsulated within niosomal carriers, targeting enhanced stability, cellular uptake, and controlled drug release.

Methods: Selenium nanoparticles were encapsulated into niosomes via thin-film hydration and characterized by dynamic light scattering (DLS) for particle size, zeta potential, and polydispersity index (PDI). Cytotoxicity was assessed using the MTT assay on CAL27 cells after 24 hours, alongside a drug release study conducted under simulated physiological conditions.

Results: The formulated nanoparticles showed an average size of ~180 nm, zeta potential of –25 mV, and low PDI (~0.15), indicating high stability and uniformity. MTT results indicated a 60% decrease in cell viability compared to controls after 24 hours. The drug release exhibited an initial burst (35% release in 6 hours), followed by sustained release reaching ~90% over 48 hours.

Conclusion: Niosome-encapsulated selenium nanoparticles display promising physicochemical characteristics, significant cytotoxic activity, and a controlled release profile, underscoring their potential as an effective therapeutic approach for oral squamous cell carcinoma. Further in vivo studies are recommended to validate clinical applicability.

Minimizing the Risk of Biological Specimen Mix-Up in the Mammography Unit: A Failure Mode and Effect Analysis (FMEA) Methodology in Oncology Setting

Rawan Ibrahim — 2025-05-04

Background: Effective cancer management relies heavily on early diagnosis, which significantly improves patient outcomes by enabling timely and accurate treatment decisions. Despite advancements in diagnostic tools, the risk of specimen mix-ups remains a critical challenge, particularly in the pre-analytic phase of specimen collection.Purpose: This study aimed to minimize the risk of biological specimen mix-ups in the mammography unit in Oncology center through the implementation of the Failure Mode and Effect Analysis (FMEA) methodology.

Methods: A proactive FMEA was conducted in the mammography unit, targeting the pre-analytic phase of specimen collection. A multidisciplinary team identified potential failure modes, assessed their severity, occurrence, and detection, and calculated the Risk Priority Numbers (RPNs). Interventions were developed and implemented to address high-risk areas, with post-intervention RPNs evaluated to measure the effectiveness of the changes.

Results: The analysis revealed high-risk failure modes, including patient misidentification, labeling errors, and inadequate specimen tracking, with initial RPNs ranging from 280 to 360. Interventions such as standardizing patient identification, improving consent processes, and enhancing specimen labeling systems led to significant RPN reductions across all categories, with the most notable improvement observed in site marking (67% reduction).

Conclusion: The proactive use of FMEA effectively identified, mitigated the risks, and enhanced the safety and reliability of specimen collection in the mammography unit. This approach highlights the importance of applying systematic risk management processes in improving diagnostic accuracy and patient safety, providing a model for other healthcare settings.

Production, Purification, and Characterization of L-Methioninase Produced by Escherichia coli Isolates: Potential Application in Cancer Treatment

Zahraa Mohammed Wahib — 2025-05-04

Background: L-methioninase is one of the fascinating enzymes, and it has recently been the subject of intensive research due to its several potential medical uses, L-methionine plays a crucial role in the growth and proliferation of many cancer cells, particularly those seen in specific tumor types. L-methioninase’s ability to lower the body’s levels of L-methionine is the main reason for its strong anti-cancer effects.

Objective: To purify and characterize L-methioninase produced by Escherichia coli.

Methods: Twenty-one E. coli isolates were screened for L-methioninase production by semi-quantitative and quantitative methods, and then L-methioninase was purified using ammonium sulfate, ion exchange, and gel filtration chromatography.

Results: Out of all isolates, 16/21 (76.19%) were L-methioninase producers by semi-quantitative, while by quantitative screening, only six isolates out of these 21 isolates revealed specific activity ranged from 0.89 to 1.15 U/mg, and the maximum specific activity was for E. coli U8. The L-methioninase was purified using ammonium sulfate, ion exchange, and gel filtration chromatography. The best saturation ratio for L-methioninase precipitation was at 70% ammonium sulfate, considered a partial purification where L-methioninase specific activity was 2.52 U/mg. while L-methioninase-specific activity reached 4.11 U/mg when ion exchange chromatography was used with 3.2-fold purification and a yield of 46.2%. Finally, a pure L-methioninase-specific activity of 6.48 U/mg was gained using gel filtration with 5.1-fold purification and a yield of 42.9%. Determining molecular weight characterized the purified L-methioninase; the result showed that the purified L-methioninase had a molecular 50 kDa.

Conclusions: L-methioninase was purified from E. coli by many steps, including ammonium sulfate precipitation, DEAE-cellulose, and Sephedex G-150, in addition, SDS-PAGE electrophoresis supports the success of the purification process.

Enhanced Anticancer Potential of Curcumin-Loaded Liposomal Nanoparticles in Oral Cancer Treatment

Ramin Moravedeh — 2025-05-07

Objective: Curcumin, a naturally occurring polyphenol derived from turmeric, has demonstrated notable anticancer properties in various malignancies, including oral squamous cell carcinoma. However, its clinical application has been hampered by poor aqueous solubility and limited bioavailability. To address these challenges, we developed curcumin-loaded liposomal nanoparticles aimed at improving drug stability, enhancing solubility, and increasing cellular uptake in oral cancer cells.

Methods: Liposomal nanoparticles were prepared using the thin-film hydration method, followed by characterization of particle size, zeta potential, and drug encapsulation efficiency. The anticancer potential of free curcumin versus liposomal curcumin was evaluated in oral cancer cell lines (e.g., SCC-9 and HN-5) through cell viability and cytotoxicity assays (3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide, MTT). For in vitro drug release testing, the liposomal formulation containing curcumin was placed in a dialysis bag (molecular weight cutoff ~14 kDa) and immersed in phosphate-buffered saline (PBS) under continuous stirring at 37°C.

Results: Characterization revealed an average particle size of approximately 220 nm, a zeta potential of around -28 mV, and an encapsulation efficiency of about 82%. Compared to free curcumin, curcumin-loaded liposomes exhibited significantly enhanced antiproliferative effects in oral cancer cells, reflected by a 20% to 30% greater reduction in cell viability. Furthermore, the IC50 value for liposomal curcumin was substantially lower, highlighting its superior potency. In vitro drug release studies demonstrated a sustained release profile, with a moderate burst release observed in the initial hours, followed by a gradual release over 48 hours.

Conclusion: Curcumin-loaded liposomal nanoparticles offer a promising strategy to overcome the limitations of free curcumin by increasing its aqueous solubility, stability, and targeted delivery to cancer cells. The improved therapeutic efficacy and reduced off-target toxicity underscore the potential of this nanocarrier system as an effective treatment modality for oral cancer.

Identification of Extra Cellular Matrix (ECM) Genes in Triple Negative Breast Cancer

Hemangini Hasit Vora — 2025-05-10

Introduction: Extracellular Matrix (ECM) is often abnormally produced, degraded, and remodelled, which creates a pro-tumorigenic environment in cancer and leads to tumor growth, angiogenesis, invasion and metastasis. This study aimed to investigate ECM genes by microarray-based transcriptome analysis and miRNA that target ECM genes in triple-negative breast cancer (TNBC).

Materials and Methods: The current study evaluated 682 TME-related genes using Array Comparative Genomic Hybridization (aCGH) in 55 patients with TNBC.

Results: 266 ECM genes were studied by transcriptome analysis, and it was observed that 132 ECM genes were up-regulated and 25 ECM genes were down-regulated in TNBC. Regarding upregulated genes, the majority of the genes were of Collagen family genes. Regarding downregulated genes, 14 genes were of Integrin family genes. PPI network analysis of upregulated genes using the STRING database, five hub genes identified were FN1, COL3A1, COL1A2, COL1A1, and COL6A2. Five of eight ranking methods identified FN1 and COL1A1 as the top most upregulated hub genes. The top 5 significant down-regulated hub genes were ITGB2, ITGAM, ITGAX, ITGB3, and ITGA4. Of 8 ranking methods, 7 ranking methods identified ITGB2, ITGAM and ITGAX as the most significant down-regulated hub genes. Further, target gene - miRNA regulatory networks using the miRTargetLink 2.0 tool.

Conclusion: ECM genes FN1, COL1A1, ITGB2, ITGAM and ITGAX may be involved in disease progression in TNBC and, after validation, may be considered therapeutic targets for TNBC

Effect of Minimum Segment Width on SRT/SBRT Volumetric Arc Therapy Plans for Flattening Filter Free Beams

Satinder Pal Kaur — 2025-05-10

Background: Volumetric arc therapy (VMAT) based stereotactic radiotherapy (SRT) or stereotactic body radiation therapy (SBRT) is a highly advanced radiation therapy technique that uses intensity-modulated radiation beams delivered in multiple arcs. After optimization, different segments of small sizes and shapes are created in an arc that will influence the indices like homogeneity index (HI), conformity index (CI), gradient index (GI), number of segments (NOS) which in turn will increase or decrease the total treatment time in terms of monitor units (MUs). The dose calculation algorithm faces difficulty in predicting the accurate dose for these small segments because of the lack of charged particle equilibrium (CPE) and requires precise modeling of lateral electron scatter. The segmentation parameter minimum segment width (MSW) can control the generation of these small-sized segments. It can also affect the quality and deliverability of a VMAT plan.

Methods: This retrospective study includes 33 patients with lung, liver, and brain tumors (11 patients for each site) treated with the SRT/SBRT technique using a 6 MV flattening filter-free (FFF) beam. Four different plans with MSW 0.5 cm, 1 cm, 1.5 cm, and 2 cm were created by medical physicist using the Monaco treatment planning system (TPS) version 5.11.03.

Results: A statistically significant reduction in MU (P= 0.01 for brain, P= 0.005 for lung) and NOS (P=0.034 for brain, P=0.011 for lung) was observed for brain and lung cases in plans with MSW 1 cm. For liver cases, along with MU and NOS (P= 0.029 & 0.013 respectively), the paired t-test shows a statistically significant difference (P= 0,046, 0.019 & 0.009) in the GI for intergroup comparison between two plans at different MSW. Improved GI in the case of plans with narrower segments (MSW 0.5 cm and 1 cm) corresponding to sharp dose fall-off compared to plans with broader segments (MSW 1.5 cm and 2 cm). There is no statistical difference in other parameters including global maximum dose and target coverage for plans at different MSW for all cases.

Conclusion: VMAT plans for SRT/SBRT generated with an MSW of 1.0 cm demonstrated comparable dose distributions to plans with MSWs of 0.5 cm with fewer MUs for brain, liver, and lung cases treated with 6 MV FFF beams.

The Relationship between Microsatellite Instability and KRAS Mutations in Liver-metastatic Colorectal Cancer: A Preliminary Cross-sectional Study

Adrian Pardomuan Purba — 2025-05-10

Background: Colorectal cancer (CRC) has a high mortality rate due to the development of liver metastases. Mutations in RAS and mismatch repair (MMR) genes are common in CRC, with Kirsten rat sarcoma viral oncogene (KRAS) mutations occurring in approximately 44% of cases and MSI in 15%. Both mutations are associated with poor prognosis. The study aims to identify MSI status and KRAS mutations in liver-metastatic CRC at a hospital in eastern Indonesia.

Methods: In this cross-sectional study, 57 patients with liver-metastatic CRC were included. We evaluated KRAS mutations and microsatellite instability (MSI) status in patients’ DNA extracted from paraffin blocks. The procedures involved included specimen examination, DNA extraction, and genetic sequencing. The data were analyzed using SPSS version 25.0. Fisher’s exact test was utilized to evaluate the relationship between MSI status and KRAS mutations. A significance level of p<0.05 was considered statistically significant.

Results: This study included patients aged 16–80 years with liver-metastatic colon cancer. Patients were primarily male with left-sided tumors of adenocarcinomatous histopathology and high histopathological grade. Of the 57 subjects, 31.6% had MSI-high (MSI-H) tumors and 21.1% expressed mutant KRAS. The majority of MSI-H tumors (82% of patients) expressed mutant KRAS, while most MSI-low (MSI-L) tumors (60% of patients) expressed wild-type KRAS. However, Fisher’s exact test indicated no significant relationship between MSI status and KRAS mutation status in liver-metastatic colon cancer (p = 0.489).

Conclusions: This study found no significant relationship between MSI status and KRAS mutation status in patients with liver-metastatic colon cancer.

Epidemiological Analysis of Prostatic Cancer: Incidence, Prevalence, Mortality, and Disability Burden in Middle Eastern Countries

Malik Ayyad — 2025-05-04

Prostatic cancer is considered the second most common cancer among men worldwide. It has significant geographical variability in its burden. Using data from the Global Burden of Disease (GBD) 2021 database, this review aimed to analyze the epidemiological burden of prostatic cancer in 14 Middle Eastern countries. The data of incidence, prevalence, mortality, and age-standardized disability-adjusted life years (DALYs) were analyzed. Compared to the global average rate of 33.449 per 100,000, our results showed that the Middle East reports a lower average incidence rate of 17.297 per 100,000 population. However, outliers such as Lebanon (64.381 per 100,000) and Turkey (52.166 per 100,000) exhibit a significantly higher burden. Mortality and age-standardized DALYs also highlight disparities, with Lebanon and Turkey recorded a higher values compared to other regional counterparts. Conversely, countries like Oman and Yemen reported the lowest rates, potentially reflecting underdiagnosis or limited healthcare access. The results underscore the importance of enhancing early detection programs, such as prostate-specific antigen (PSA) testing, and addressing modifiable risk factors, including smoking and obesity. By bridging gaps in data and healthcare access, this research highlights critical areas for policy interventions and targeted public health strategies to reduce the burden of prostatic cancer in the region. The findings provide valuable insights to inform regional healthcare planning and resource allocation, contributing to a broader understanding of global prostatic cancer epidemiology.

The Significant of the Oncoviruses in Saliva Patients in Dental Clinics

Nasrin Mohamadi — 2025-05-04

Saliva possesses the potential to contain numerous pathogenic viruses, which constitutes a significant concern, particularly within dental clinics. The viruses identified encompass both low-risk and high-risk human papillomavirus, herpes viruses such as HSV1 and HSV2, human varicella zoster virus, Epstein-Barr virus, human cytomegalovirus, HHV6, HHV7, HHV8, hepatitis A virus, hepatitis B virus, hepatitis E virus, rabies virus, JC virus, BK virus, and influenza A and B viruses, alongside coronaviruses. These viral entities are responsible for a substantial incidence of morbidity and mortality on a global scale. Despite the absence of definitive therapeutic interventions for the majority of these infectious viruses, there exist limited vaccination programs targeting several of them, including both low-risk and high-risk human papillomavirus, hepatitis B vaccine, influenza A and B vaccines, and the COVID-19 vaccine. It appears imperative that enhanced attention and preventive strategies be instituted in dental clinics to mitigate the transmission of infectious diseases propagated through saliva.

Preventable Risk Factors: Retrospective Analysis of a Cohort of 21 Cases of Cervical Low-Grade Squamous Intraepithelial Lesions

Prajakta Paradkar Hemant — 2025-05-04

Objective: In 2020 we had reported that with non-invasive integrative management, 20 out of 21 cases of Low-grade Intraepithelial Squamous Lesions (LSIL) of cervix responded, whilst one case discontinued early. Subsequent to the analysis by Global Collaborative Group on Cancer Risk Factors in 2022, we report retrospective analysis of Preventable Risk Factors (PRFs) in this cohort.

Materials and Methods: We graded each PRF from 0 to 3 scores as per the severity with grade 0=no risk, 1=minor risk, 2= moderate risk and 3= definite risk. Sixteen PRFs for cervical cancer were scored in all cases into 4 grades. The treated 20 cases were classified in 3 groups according to Pap smear changes- Group 1: persistent LSIL/non-responders (n=2); Group 2: regression to Atypia (n=9); Group 3: responders/regression to negative smears (n=9).

Results: Single or multiple PRFs, other than LSIL in Pap smear at enrolment, were present in every case. Some common PRFs in this cohort were cervico-vaginal infection (21/21), overweight/obesity (11/21), Unhealthy diet (3/21), raised serum IL-6 (3/21) etc. The mean±SD total risk score after grading in Group 1 was 14.5±3.53 vs 10.44±4.66 in Group 2 vs 10.62±1.22 in Group 3.

Mann Whitney U test: p value = 0.051 indicated a nonsignificant trend towards higher risk scores in Group 1 vs Group 3.

Conclusion: All LSIL cases had single or multiple risk factors at initial examination. The total scores of graded PRFs were slightly higher in the persistent LSIL group than in treatment responders, just short of statistical significance. It may be difficult to screen and advise all women to reduce PRFs due to unmanageable numbers. Therefore, at least all screen positive cases should be advised on possible consequences of PRFs. Downgrading PRFs may reduce recurrences and progression to invasive cancer. Some PRFs are common to other cancers and non-communicable diseases hence there are multiple health benefits of such a policy.

Surface Mould Brachytherapy in Superficial Tumors, Case Series from a Tertiary Cancer Centre in North India with Review of Literature

Mohd Waseem Raza — 2025-05-04

Purpose: To evaluate the efficacy of surface mould brachytherapy (SMB) in the management of superficial tumors, particularly in anatomically challenging locations, in the era of advanced radiotherapy technologies.

Methods: Present study is a retrospective review of case series of ten patients with early stage and recurrent diseases of various sites that were treated with surface mould brachytherapy. Three patients of different disease sites were selected for reporting. All patients underwent individualized CT-based planning. All of them were treated using Ir-192 high dose rate (HDR) SMB at our center.

Results: We followed up the patients at 1^st, 3^rd, 6thmonth and then yearly thereafter. Among all the ten cases there were two local recurrences, three cases died of metastatic disease and five were disease free till last follow up at two years. Skin reactions of grade 2 and 3 were reported during treatment which subsided after 2 to 3 weeks of treatment.

Conclusion: SMB is a very effective treatment for early-stage disease and treating carcinoma of skin where difficult curve surfaces are involved. It is effective in treatment of solitary recurrences of disease and also helpful in organ preservation.