Asian Pacific Journal of Cancer Care

Evaluating Tumour Marker Utilization in a Rural Tertiary Care Teaching Hospital: Insights from a Clinical Laboratory Audit in the Konkan Region

Jayshri Sadashiv Jankar — 2026-02-13

Introduction: Tumour markers are biochemical entities used to aid in diagnosis, prognostication, and therapeutic monitoring of malignancies. However, their utility in rural healthcare settings remains underexplored. This study aimed to audit the utilization patterns of tumour marker assays in a rural tertiary care hospital, evaluate their appropriateness in clinical context, identify potential misuse, and propose actionable recommendations for rational test ordering.

Materials and Methods: A retrospective audit was conducted on 477 patients over two years (June 2021–June 2023) in the Central Clinical Laboratory of BKL Walawalkar Hospital. Data were analyzed by sex, departmental origin (IPD/OPD), type of tumour marker ordered, and clinical relevance as per established guidelines. Tumour markers included PSA, CEA, CA-125, CA 19-9, AFP, and B-HCG.

Results: Females constituted 54.1% of the cohort. PSA (21.3%) and CEA (21%) were the most commonly ordered tests. CA-125 and B-HCG were largely requisitioned by OB-GYN departments. A mismatch was observed between test ordering patterns and guideline-based indications in several instances, particularly for PSA and CEA, with evidence of redundant or non-indicated requisitions from departments with low oncology involvement.

Conclusions: While tumour markers are indispensable tools in oncology, this audit reveals significant gaps in their utilization, especially in departments lacking direct oncologic focus. The findings underscore the need for institutional guidelines, education on appropriate test use, and periodic audits to promote diagnostic stewardship in resource-limited rural settings.

FDG PET/CT vs Staging Laparoscopy for Occult Metastases in Locally Advanced Gastric Adenocarcinoma: A Prospective Comparative Diagnostic Study

Jubaraj Kalita — 2026-02-13

Introduction: Gastric cancer is an aggressive malignancy with a high risk of peritoneal spread. Accurate staging is critical to optimize treatment strategies and avoid unnecessary laparotomies. While PET-CT provides information on nodal and distant disease, staging laparoscopy allows direct visualization of peritoneal and liver involvement.

Materials and Methods: This was a prospective; single-centre diagnostic study conducted at IMS & SUM Hospital, Bhubaneswar, including 42 consecutive patients with newly diagnosed, locally advanced, non-metastatic gastric adenocarcinoma (cT3–4a, N0–3, M0). All patients underwent baseline contrast-enhanced CT, followed by both PET-CT and staging laparoscopy with peritoneal wash cytology. The primary endpoint was paired sensitivity of PET-CT versus staging laparoscopy in detecting peritoneal disease. Diagnostic yield and detection rates were compared.

Results: Among 42 patients (73.8% male; median age 57 years), staging laparoscopy identified peritoneal disease in 9/42 (21.4%, 95% CI 10.9–36.9), whereas PET-CT detected none (0/42; McNemar p < 0.001). PET-CT demonstrated perigastric nodal uptake in 37/42 (88.1%, 95% CI 74.4–95.6), but nodal status could not be confirmed pathologically. Staging laparoscopy detected liver metastases in 2/42 (4.7%) and omental deposits in 6/42 (14.2%), all of which were missed on PET-CT. Histopathology of M1 cases revealed poorly differentiated variants, predominantly signet ring and mucinous adenocarcinoma. Overall, staging laparoscopy altered management in 16/42 (43%) patients by redirecting them to neoadjuvant chemotherapy or palliative care.

Conclusions: PET-CT alone is inadequate for detecting peritoneal disease in locally advanced gastric cancer. Staging laparoscopy remains indispensable, especially in poorly differentiated tumors, and significantly impacts treatment planning. Integration of PET-CT with staging laparoscopy provides the most reliable approach for accurate staging and optimal patient management.

Sigmoid Point Validation for Dosimetric Evaluation and Reporting of Accumulated Sigmoid Dose in Multifractionated Brachytherapy for Carcinoma Cervix

Ayesha Iqbal Maniyar — 2026-02-13

Introduction: Carcinoma of the uterine cervix is the most common cancer in females. The mainstay of treatment is combined external beam radiotherapy (EBRT) and intracavitary brachytherapy (ICBT), especially in the advanced stages. Brachytherapy forms an integral part of radiation therapy and cornerstone for both the local control rates and toxicities. The doses received by organ at risks (OARs) are significantly associated with radiation-related toxicities. An accurate estimation of the cumulative irradiation dose for OARs is crucial. The sigmoid is an important organ at risk for gynecological brachytherapy (BT). However, the reliability of localization of high-dose regions during multi-fractionated treatment is limited. This work reports the methodological development of sigmoid points to summate multi-fractionated doses.

Materials and Methods: Fifty patients who were treated for locally advanced cervical cancer with radical chemoradiation and multifractionated high-dose rate (HDR) brachytherapy from April 2023 to December 2024 were evaluated. Sigmoid points 1 (SP1) and 2 (SP2) were assigned on the treated brachytherapy plans retrospectively. The correlation between SP1 and SP2 with sigmoid D0.1cc and D2cc doses were analyzed.

Results: The study involved 50 patients with a median age of 50 years, ranging from 35 to 70, all diagnosed with squamous cell carcinoma. The FIGO stages were: 6% in IIA, 40% in IIB, 12% in IIIB, 18% in IIICr1, 14% in IIICr2, and 10% in IVA. Treatment doses varied from 6 – 7.5Gy HDR in 2-4 fractions and inter-fraction time was 6-12 hours. The mean values for D0.1cc, D2cc, SP1, and SP2 were 4.12, 3.18, 3.82, and 15.20, respectively. Significant correlations were observed between D0.1cc and D2cc (P = 0.000), SP1 and SP2 (P = 0.002), D0.1cc and SP2 (P = 0.003), D2cc and SP1 (P = 0.004), and D2cc and SP2 (P = 0.001).

Conclusion: SP2 showed significant correlation with D0.1cc and D2cc sigmoid doses, suggesting preliminary utility as a surrogate for volumetric parameters in inter-fraction dose summation. However, further validation with clinical outcome correlation is warranted.

Knowledge and Practice Regarding Breast Self-Examination among Reproductive Aged Women Attending at TMSS Medical College, Bogura, Bangladesh

Shormily Akter — 2026-02-13

Introduction: Female breast cancer is the second most common cancer globally, and in Bangladesh, it is the leading cause of cancer-related deaths among women. BSE may increase women’s awareness of their own breast health; however, evidence for its impact on mortality reduction is limited, that every woman should practice for early detection. To assess the knowledge and practice of BSE among reproductive aged women attending in the outpatient department of a tertiary care hospital in Bogura, Bangladesh.

Materials and Methods: A descriptive cross-sectional study was conducted among 207 women with the age bracket of 15-49 years of age, attending the outpatient department of TMSS Medical College and RCH, Bogura, Bangladesh. Data was collected by interviewer provided with pre-tested structured questionnaire by face to face interview. The knowledge level was measured by five point Likert scale. Data entry was performed in Excel, and descriptive analyses were conducted using SPSS.

Results: Total number of respondents was 207. Among them, the overall knowledge level about BSE where individuals regularly check their own breasts to detect any unusual changes was 71% and 21.8% participants did not perform BSE correctly or regularly in relation to their knowledge of BSE. Regarding practice, 63.8% reported performing BSE at least once a month, whereas 21.7% did not practice BSE correctly or regularly.

Conclusion: Result suggested that while a majority of women had an average level of knowledge regarding BSE, gaps remain in correct and regular practice. Therefore, targeted health education initiatives are crucial to improve the scenario.

Association of Nuclear Factor-κB Expression with Hormone Receptor Status, HER2, and Histopathological Grade in Advanced Breast Cancer

Martua Arpollos — 2026-02-13

Introduction: Breast cancer is a leading cause of cancer-related mortality in women. Nuclear Factor-κB (NF-κB) pathway, is a key driver of carcinogenesis and tumor progression. This study evaluates the association between NF-κB expression and established biomarkers in advanced breast cancer.

Materials and Methods: This prospective, cross-sectional study was conducted at Dr. Wahidin Sudirohusodo Hospital and its network hospitals in Makassar, Indonesia, from April to September 2024. We assessed the association between NF-κB expression (determined by immunohistochemistry) and clinicopathological features in 41 patients with advanced (Stage III and IV) breast cancer. Immunohistochemistry was used to determine the expression of NF-κB, ER, PR, and HER2. Associations were analyzed using Fisher’s Exact Test and multivariable logistic regression to calculate odds ratios (OR) with 95% confidence intervals (CI).

Results: A majority of tumors were estrogen receptor (ER)-negative (56.1%), progesterone receptor (PR)-negative (61.0%), and HER2-positive (53.7%). NF-κB positivity was observed in 33/41 patients (80.5%). HER2 positivity was strongly associated with NF-κB positivity (OR = 24.5, 95% CI [2.5, 238.9]; p = 0.012, Fisher’s Exact Test). No significant associations were observed with ER, PR, or histopathological grade.

Conclusion: This study identifies a strong and independent association between nuclear NF-κB p65 expression and HER2 positivity in a cohort of patients with advanced (Stage III/IV) breast cancer. Further large-scale, prospective studies are warranted to validate the role of NF-κB as a candidate prognostic biomarker and to explore its utility as a therapeutic target in HER2-positive breast cancer.

Chemotherapy-Induced Musculoskeletal Pain Syndrome in Breast Cancer: A Cross-Sectional Analysis of Prevalence, Predictors, and Impact on Quality of Life

Hamid Reza Farpour — 2026-02-13

Introduction: Taxane-based chemotherapy is an effective treatment for breast cancer but frequently causes chemotherapy-induced musculoskeletal pain syndrome, a toxicity that significantly impairs patients’ quality of life. Despite its clinical importance, epidemiological data on this syndrome from Middle Eastern populations are limited. This study aimed to assess the prevalence, predictors, and quality-of-life impact of chemotherapy-induced musculoskeletal pain syndrome among breast cancer patients in Iran.

Materials and Methods: In this cross-sectional study, 151 Iranian women with breast cancer receiving chemotherapy were enrolled. Patients were stratified by regimen: paclitaxel (n=119), docetaxel (n=9), or non-taxane controls (n=23). CHIMPS was evaluated using the validated Persian version of the McGill Pain Questionnaire (MPQ). Multivariable logistic regression was employed to identify independent predictors of severe pain (defined as a numerical rating scale score ≥8).

Results: The overall prevalence of CHIMPS was 72.2% (109/151), with significant variation across regimens: 80.7% for paclitaxel, 66.7% for docetaxel, and 30.4% for non-taxane controls (χ²=29.4, p<0.001). Severe pain was more common in taxane recipients (paclitaxel: 52.1%; docetaxel: 66.7%) versus controls (28.6%; p=0.007). Key independent predictors of severe CHIMPS included docetaxel regimen (adjusted odds ratio [OR]=4.92, 95% CI: 1.87–12.93; p=0.001), pain onset within ≤2 days post-infusion (OR=3.21, 95% CI: 1.65–6.24; p=0.008), and nocturnal pain (OR=2.97, 95% CI: 1.42–6.18; p=0.004). The syndrome profoundly disrupted QOL, most notably in daily activities (95.4%), sleep (85.3%), and mobility (80.7%). Chemotherapy delays due to pain were uncommon (4.6%).

Conclusions: This study identifies a high burden of CHIMPS among breast cancer patients receiving taxane-based chemotherapy. The predictors identified specific taxane agent, early pain onset, and nocturnal pain provide a clinical framework for early risk stratification and proactive management to preserve treatment adherence and quality of life.

Comparison of Efficacy and Toxicity of Gemcitabine-Cisplatin Regimen VS Gemcitabine-Capecitabine Regimen as First Line Chemotherapy in Advanced Gallbladder Carcinoma

Nithin R. Daniel — 2026-02-13

Introduction: Gallbladder cancer (GBC) is the commonest malignancy of the biliary tract, and majority of patients with GBC in India has advanced unresectable disease. This study was undertaken to address the efficacy, the toxicity profile and the compliance of the two different gemcitabine-based chemotherapy regimens in advanced unresectable GBC.

Materials and Methods: A prospective randomized study was undertaken to compare the efficacy and toxicity profiles of two gemcitabine-based doublet chemotherapy regimens, gemcitabine-cisplatin and gemcitabine-capecitabine in patients with advanced GBC. All eligible patients were recruited from Dr. B Borooah Cancer Institute, Guwahati from 20.11.2020 – 20.08.2021 and randomly assigned to one of the groups of chemotherapy in 1:1 ratio.

Results: Among 250 patients with locoregionally advanced, inoperable and metastatic GBC registered at Dr B Borooah Cancer Institute, 50 patients fulfilled the criteria and were planned for recruitment for our study. After randomization, 23 patients were allotted among each of the gemcitabine-cisplatin and gemcitabine-capecitabine arms. With the median follow up time of 8 months, the median PFS (progression-free survival) and median OS (overall survival) for the entire cohort was 6 months and 8 months, respectively. Median PFS was marginally higher in the gemcitabine-cisplatin arm, in comparison to gemcitabine-capecitabine arm, but not statistically significant (6.5 months vs. 5.4 months; p = 0.793). Median OS was marginally higher in the gemcitabine-cisplatin arm, in comparison to gemcitabine-capecitabine arm, but was not statistically significant (8.5 months vs. 7.6 months; p = 0.879). The overall response rate (ORR - includes partial response [PR] and complete responses [CR]) were similar (26%) in both the arms. Non-hematological toxicities were similar with both the regimen. Hematological toxicities were found to be non-significantly higher with gemcitabine-cisplatin as compared to gemcitabine-capecitabine.

Conclusion: Gemcitabine with capecitabine in advanced GBC can alternatively be considered in first line treatment with similar OS, PFS, ORR and with acceptable toxicity profile compared to gemcitabine-cisplatin, thereby avoiding cisplatin-induced long-term toxicities

Stereotactic Radiosurgery and Stereotactic Radiotherapy for Brain Metastasis: Experience from a Tertiary Cancer Centre

Nabeel Yahiya EK — 2026-02-13

Introduction: Brain metastases are a common and serious complication in cancer patients, significantly impacting neurological function and quality of life. Stereotactic radiosurgery (SRS) and fractionated stereotactic radiotherapy (FSRT) offer focal, precise treatment options with potentially lower toxicity compared to whole brain radiotherapy. This study aims to evaluate the clinical outcomes and dosimetric parameters of SRS and FSRT in patients with brain metastases treated at a tertiary cancer center.

Materials and Methods: A retrospective observational study was conducted on 13 patients with solitary brain metastases treated with SRS or FSRT from 2014 to 2022. Patient data, treatment details, and dosimetric parameters were collected. Overall survival (OS) and local progression-free survival (LPFS) were estimated using the Kaplan–Meier method.

Results: The median age of patients was 56 years, with lung (62%) and breast (38%) as the most common primary tumors. The median OS was 12 months, with 1- and 2-year OS rates of 48% and 29%, respectively. LPFS at 1 and 2 years was 47% and 19%. Dosimetric parameters, including target volumes and plan quality indices, adhered to established stereotactic radiotherapy standards. No symptomatic radionecrosis was reported. Systemic therapy use was limited due to resource constraints.

Conclusion: SRS and FSRT can be delivered with high dosimetric precision and acceptable toxicity in patients with brain metastases, even in settings with limited access to advanced systemic therapies. These findings support the continued use of focal radiotherapy modalities and underscore the need for larger prospective studies incorporating modern systemic treatments to optimize management and outcomes.

Burden of Childhood Cancer in Nepal: An Analysis of GLOBOCAN Data 2022

Gambhir Shrestha — 2026-02-13

Introduction: Childhood cancer poses a significant public health challenge in low-middle-income countries, such as Nepal. This study reports the burden of childhood cancer in Nepal.

Materials and Methods: This study utilized the data from the latest GLOBOCAN 2022 database to present estimates of childhood cancer in Nepal. The data were described as incidence, prevalence, and mortality stratified by age, gender, and cancer type. The projected trend of childhood cancer was also analyzed until the year 2050.

Results: In 2022, there were an estimated 936 childhood cancer cases in Nepal, including 330 new cases with an age-standardized rate (ASR) of 4.1 per 100,000 and 121 deaths with an ASR of 1.5 per 100,000. The most common cancers were leukemia, non-Hodgkin lymphoma, and brain and central nervous system. The projected trend in 2050 indicated a decrease in childhood cancer cases and mortality by 10.6% and 10.7%, respectively.

Conclusion: This study highlighted the burden of childhood cancer in Nepal, aligning with global and Asian trends. Urgent action is required, emphasizing a comprehensive approach that includes raising awareness, early diagnosis, treatment, resource allocation, and policy integration to effectively alleviate the burden of childhood cancer.

Hexokinase 2 (HK2) Expression Pattern Comparison in Prostate Neoplasms

Jamilah Lestari — 2026-02-13

Introduction: This study aims to assess the differences in HK2 expression patterns in Benign Prostatic Hyperplasia (BPH), Prostatic Intraepithelial Neoplasia (PIN), Low Grade Prostate Adenocarcinoma (LGPAC) and High Grade Prostate Adenocarcinoma (HGPAC).

Materials and Methods: A cross-sectional observational study was conducted on 80 samples of prostate tissue embedded in paraffin, diagnosed from January 2020 to December 2022. Samples were divided into categories: Benign Prostatic Hyperplasia (BPH, n=37), Prostatic Intraepithelial Neoplasia (PIN, n=10), Low Grade Prostate Adenocarcinoma (LGPAC, n=9), and High Grade Prostate Adenocarcinoma (HGPAC, n=24). Immunohistochemistry was employed to evaluate HK2 expression Intensity, Proportion, and the Immunoreactive Score (IR-Score) approach was utilized to assign a score.

Result: There were significant differences in HK2 expression patterns among the groups (p=0.001). Regarding intensity, Benign Prostatic Hyperplasia (BPH) predominantly showed weak to moderate expression (32.4% weak, 67.6% moderate), while Prostatic Intraepithelial Neoplasia (PIN) demonstrated 90.0% moderate and 10.0% strong expression. Low Grade Prostate Adenocarcinoma (LGPAC) was also mostly moderate (88.9%), with 11.1% showing strong intensity, whereas High Grade Prostate Adenocarcinoma (HGPAC) was predominantly strong (75.0%). The percentage of stained area differed significantly (p=0.001), with Benign Prostatic Hyperplasia (BPH) showing 29.7% in ≤10%, 10.0% in 10–50%, and 67.6% in >50%. Prostatic Intraepithelial Neoplasia (PIN) and Low Grade Prostate Adenocarcinoma (LGPAC) demonstrated 100.0% staining in 10–50%, while High Grade Prostate Adenocarcinoma (HGPAC) showed 25.0% in 10–50% and 75.0% in >50%. Immunoreactive Score (IR-Score) analysis further revealed significant differences(p=0.001), with weak scores in 32.4% and strong scores in 67.6% of Benign Prostatic Hyperplasia (BPH) cases, while all Prostatic Intraepithelial Neoplasia (PIN), Low Grade Prostate Adenocarcinoma (LGPAC), and High Grade Prostate Adenocarcinoma (HGPAC) cases showed strong scores.

Conclusion: HK2 expression rises progressively from benign to malignant prostate lesions, with high-grade prostate adenocarcinoma exhibiting the strongest intensity and the largest stained area. Elevated HK2 expression is reliably noted in malignant cases compared to benign lesions. These results suggest that HK2 overexpression correlates with increased malignancy, reinforcing its possible function as a prognostic biomarker in prostate cancer.

Innovative Practice Report on Nurse-led Interfaith Symbol Translation and Adaptive Clinical Nursing Technology: A Qualitative Interview-based Study

Zhenyu Zou — 2026-02-13

Introduction: To summarize and analyze the innovative, culturally adaptive interventions developed and implemented by frontline oncology nurses to resolve conflicts between patients’ religious practices and clinical care protocols.

Materials and Methods: Semi-structured interviews were conducted with nurses working in a hospital oncology department. The interviews focused on documenting real-world challenges and the practical solutions nurses created in response to patients’ religious needs. Through thematic analysis of the interview data, three representative cases were summarized, detailing the nurses’ interventions for Buddhist chanting, Muslim Ramadan fasting, and Christian cross-holding.

Results: The analysis documented several nurse-led interventions that successfully resolved clinical conflicts. To manage chanting-induced blood pressure fluctuations, nurses developed and introduced a “mantra counting breathing card” to guide rhythmic breathing. For a fasting Muslim patient at risk of hypoglycemia, nurses designed and implemented a sunset-centered, time-phased intravenous infusion schedule. In the case of ECG interference from a metal cross, nurses innovated by applying a medicalgrade silicone pad to shield the object, which eliminated the artifact. These nurse-initiated solutions were reported to enhance patient compliance and psychological comfort.

Conclusion: This study summarizes a transferable framework for faith-sensitive care derived directly from the clinical innovations of frontline nurses. It demonstrates that nurses are pivotal agents in culturally adaptive care, capable of creatively translating religious symbols into safe clinical practices. By documenting and systematizing these grassroots innovations, this research provides a model for leveraging existing nursing expertise to reconcile cultural needs with medical requirements, promising improved patient-centered outcomes in multi-faith settings.

The Association of Chronic Oral Mucositis with Quality of Life in Head and Neck Cancer Patients Undergoing Radiotherapy

Hamid-Reza Sadoughi — 2026-02-13

Introduction: Oral mucositis is a common and debilitating side effect of radiotherapy in patients with head and neck cancer, significantly impacting their quality of life. This study aimed to investigate the prevalence of chronic oral mucositis and its association with the quality of life in patients undergoing head and neck radiotherapy.

Materials and Methods: This descriptive-analytical study was conducted on patients with head and neck cancer receiving radiotherapy at Radiotherapy department of Vasei hospital, Sabzevar. Demographic data (age, gender, comorbidities, tobacco use, and medications) and clinical data (cancer type, radiation dose, and radiotherapy duration) were collected. Quality of life was assessed using the WHOQOL-BREF questionnaire, and the severity of oral mucositis was evaluated based on WHO criteria. Data were analyzed using descriptive and analytical statistical methods, including chi-square, independent t-tests, and Mann-Whitney tests.

Results: Oral mucositis was observed in 90% of patients undergoing head and neck radiotherapy, with its severity significantly correlated with radiation dose (p < 0.001), radiotherapy duration (p = 0.02), and the presence of comorbidities (p = 0.03). Patients with chronic mucositis reported significantly different quality of life scores across physical, psychological, and social domains, with notable reductions in mental (p < 0.001), social (p < 0.001), and environmental health (p < 0.001). Additionally, tobacco use (CI: 1.3–6.1, p < 0.001) and a history of chemotherapy (CI: 1.1–5.2, p = 0.02) were associated with increased symptom severity. A significant correlation was observed between younger patient age and the occurrence of dysphagia and chronic mucositis (p < 0.001).

Conclusion: Chronic oral mucositis is a prevalent complication in head and neck radiotherapy patients, adversely affecting their quality of life. Effective management through preventive and therapeutic strategies can enhance patient outcomes. Future studies with larger sample sizes and a focus on novel therapeutic interventions for mucositis are recommended.

A Comparative Study of Cervicography and Histopathology Reports from Colposcopic-Directed Biopsies at a Tertiary Care Hospital in Pathum Thani, Thailand

Pitchapong Kittiniyom — 2026-02-13

Introduction: This study aimed to evaluate the diagnostic performance of cervicography (CG) in detecting cervical intraepithelial neoplasia (CIN) grade 2 or higher (CIN2+) and to compare the diagnostic performance among examiners with different levels of clinical experience.

Materials and Methods: We conducted a retrospective descriptive study at Thammasat University Hospital in Pathum Thani, Thailand, from October 2023 to November 2024. Participants included women who underwent colposcopy and colposcopy-directed biopsy. CG images were independently interpreted by a gynecologic oncologist (expert) and two Obstetrics and Gynecology residents (R1, R2), all of whom were blinded to clinical and histopathologic data. The interpretations from the expert, R1, and R2 were compared to the histopathologic reports of cervical biopsy.

Results: A total of 160 participants were recruited for the study. The mean age of participants was 42.5 years. High-risk HPV was detected in 96.3% (104/108) of participants. Histopathology confirmed CIN2/3 in 24.4% (39/160) and cancer in 0.6% (1/160) of participants. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) for detecting CIN2+ among expert, R1, and R2 were 47.5/45.0/47.5, 95.0/85.8/78.3, 76.0/51.4/42.2, and 84.4/82.4/81.7 percent, respectively. Specificity and PPV were significantly higher for the expert, while sensitivity and NPV were similar across examiners.

Conclusion: CG demonstrated acceptable diagnostic performance in detecting CIN2+. While specificity and PPV increased with examiner experience, sensitivity stayed consistent across different training levels.

Comparative Diagnostic Accuracy of Fecal Occult Blood Test and Fecal Matrix Metalloproteinase-9 for Noninvasive Detection of Colorectal Cancer: A Cross-Sectional Study

Agus Hariyanto — 2026-02-13

Introduction: Colorectal cancer (CRC) ranks as the third most common malignancy and the second leading cause of cancer-related mortality globally. Early detection is vital to improving outcomes. The fecal occult blood test (FOBT) is widely used as a noninvasive screening tool but has limited diagnostic precision. Fecal matrix metalloproteinase-9 (MMP-9) has emerged as a promising biomarker, with limited regional validation in Southeast Asia. This study compared the diagnostic performance of FOBT and fecal MMP-9 against colonoscopy in detecting CRC.

Materials and Methods: A cross-sectional diagnostic accuracy study was conducted from July to September 2024 among 90 patients undergoing colonoscopy at Wahidin Sudirohusodo Hospital, Indonesia. All participants provided stool samples for FOBT and fecal MMP-9 quantification via enzyme-linked immunosorbent assay (ELISA). Colonoscopy with histopathology served as the reference standard. Sensitivity, specificity, predictive values, area under the ROC curve (AUC), Youden’s index, and 95% confidence intervals (CIs) were calculated.

Results: The mean participant age was 50.9 ± 15.6 years, with 51.1 % male. CRC was diagnosed in 37.8 % of cases. FOBT showed high sensitivity but low specificity (97.1 %, 95% CI 85.1–99.9; 32.7 %, 95% CI 20.6–46.7; AUC = 0.646 [95% CI 0.534–0.758]; Youden = 0.298). Fecal MMP-9, using an empirically derived ROC cut-off 0.153 ng/mL, yielded balanced performance (sensitivity 76.5 %, 95% CI 58.8–89.3; specificity 76.8 %, 95% CI 63.6–87.0; AUC = 0.835 [95% CI 0.751–0.918]; Youden = 0.533).

Conclusion: Fecal MMP-9 demonstrated greater overall accuracy compared with FOBT and may serve as a promising noninvasive biomarker to enhance colorectal cancer screening efficiency, particularly in resource-limited settings.

Molecular Interplay Between Cancer and Neurodegeneration: Shared Pathways and Emerging Biomarkers and a Narrative Review

Maryam Rostami — 2026-02-13

Overview: Neurodegenerative diseases (NDs), including Alzheimer’s disease (AD), Parkinson’s disease (PD), Huntington’s disease (HD), and amyotrophic lateral sclerosis (ALS), are characterized by progressive neuronal loss, protein aggregation, oxidative stress, mitochondrial dysfunction, and impaired proteostasis. In contrast, cancer arises from uncontrolled cell proliferation, invasion, and metastasis.

Methods: Despite their opposing clinical outcomes, mounting evidence highlights a complex interplay between these conditions, with epidemiological studies consistently revealing an inverse relationship: patients with NDs exhibit reduced risk of many cancers, while certain malignancies, such as melanoma in PD, occur at increased frequency. Shared molecular pathways including DNA damage response, unfolded protein response, mitophagy, redox imbalance, and chronic inflammation underpin this reciprocal association, where the same regulators can promote degeneration in neurons but survival in cancer cells.

Results: Proteins central to neurodegeneration, such as tau, amyloid-β (Aβ), α-synuclein, SOD1, and TDP-43, also contribute to tumor biology by modulating apoptosis, proliferation, chemoresistance, and metastasis. For instance, tau influences microtubule stability in both AD and cancers, while Aβ and APP drive invasion in gliomas and breast cancer. Similarly, α-synuclein promotes melanoma progression, SOD1 enhances oxidative stress resistance in tumors, and TDP-43 regulates oncogenic splicing events. These dual roles position ND-associated proteins as promising biomarkers and therapeutic targets across oncology and neurology. Blood-based biomarkers derived from these proteins further expand their clinical potential, offering minimally invasive tools for early cancer detection, prognosis, and therapy monitoring. Standardized detection protocols and multimodal diagnostic strategies integrating ND-related proteins could improve patient outcomes by enabling timely intervention and personalized treatment.

Conclusion: The shared yet divergent molecular networks of cancer and neurodegeneration highlight opportunities to uncover novel biomarkers and design targeted therapies that exploit common mechanisms while minimizing adverse effects, thereby bridging insights across two seemingly opposing disease domains.

Immune Thrombocytopenia as the Initial Presentation of Metastatic High-Grade Serous Ovarian Cancer: A Case Report

Ali Mohammad Esfandiary Rad — 2026-02-13

Introduction: Immune thrombocytopenia (ITP) is an immune-mediated multifactorial disorder characterized by isolated thrombocytopenia which is divided in primary (without an underlying known cause) and secondary (that an underlying cause can be detected). Secondary ITP can be a type of paraneoplastic syndromes (PNS) that occurs in setting of a malignancy.

Case Presentation: Here, we describe a 63-year-old female with newly diagnosed ITP and chief complaint of lower limb ecchymosis which further workups revealed a metastatic highgrade papillary serous ovarian carcinoma (HGSOC) and also after treatment, clinical and laboratory parameters (CA-125) indicated a successful therapeutic response.

Conclusion: This case highlights the importance of evaluating secondary causes, including underlying malignancies, in patients with newly diagnosed ITP, particularly in older individuals. Recognition of ITP as a potential paraneoplastic manifestation may facilitate earlier cancer detection and appropriate management, ultimately improving clinical outcomes.

Non-Hodgkin Lymphoma Mimicking Lymphadenitis Tuberculosis: Don’t Miss It in Tuberculosis Endemic Area

Haryati Haryati — 2026-02-13

Introduction: In TB-endemic areas, lymphadenopathy may be misdiagnosed as TB and disguise lymphoma. Specialized professionals or multidisciplinary teams (MDT) must collaborate to solve the diagnostic challenge.

Case Presentation: We present a case of a 27-year-old woman who was initially diagnosed with TB cervical lymphadenitis by open biopsy. After 4 months of anti-tuberculous drugs, the neck wound after surgery worsened, and frequently, air bubbles and food emerged. TB medication was discontinued, and the following chest and head-neck CT scan revealed a soft tissue mass 5.7 x 9.5 cm infiltrating cutis in the pre-sternal region with the destruction of the sternum and multiple lymph nodes in the thorax, axilla, and cervical area, as well as anaplastic large cell lymphoma, a rare type of non-Hodgkin lymphoma with positive Ki67, CD45, and CD3, and negative CD20 and CK from re-biopsy. An MDT meeting concluded non-Hodgkin’s lymphoma, Ann Arbor stage IVB. Cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP) treatment was given. After six cycles of chemotherapy, symptoms improved, and the wound healed.

Conclusion: It highlights, misdiagnosis of lymphoma as tuberculosis delays treatment and affects prognosis. Thus, repeated investigations after anti-TB treatment failed, and the MDT meeting helped clinicians diagnose and treat patients.