Asian Pacific Journal of Cancer Care

A Qualitative Exploration of Survivorship Experiences of Breast Cancer Patients from Northern Kerala, India

Neethu Ambali Parambil — 2026-03-07

Introduction: Early detection and advancements in treatment have led to an increasing number of women living with breast cancer globally. The issues and challenges faced by these women post-treatment was varied, and this study aims at looking into the survivorship experiences of women who have completed six years of treatment.

Materials and Methods: Survivors diagnosed in 2016 were taken from the Hospital Based Cancer Registry of a Tertiary Cancer Centre (TCC). From those under follow-up and traceable in 2022, in-depth interviews were conducted among 15 long-term survivors, selected purposefully, to understand their survivorship experiences. The interviews followed the principle of saturation. The transcribed interviews were analyzed manually. The codes were clustered into themes as per the emerging patterns. The Consolidated Criteria for Reporting Qualitative Research was used for study reporting (COREQ).

Results: The analysis followed a deductive coding approach. The themes that emerged from the interviews are the following 1) survivor identity 2) The survivor and stigma 3) The socioeconomic support 4) Social expectations 5) Service provision-related experiences 6) Survivor’s role as ambassadors.

Conclusion: Even after successful treatment completion, breast cancer survivors were experiencing challenges and issues both personally and from society even after 6 years. The needs and expectations of these survivors during their post-follow-up period also cannot be ignored. The survivors can be effectively utilized as ambassadors for promoting early detection and reducing apprehensions among newly detected patients. Implications for Cancer Survivors: A deeper understanding of the survivorship experiences will help formulate policies for improving the quality of survivorship, as such guidelines are non-existent in most low-middle-income countries.

Evaluating the Relationship Between CA15.3 Levels and Key Clinical Factors in Breast Cancer Patients of North East India

Sawmik Das — 2026-03-07

Introduction: Breast cancer is the most common malignancy in women worldwide, with early detection crucial for improving prognosis and survival rates. Aims and objectives: This study aims to evaluate the association between serum CA15.3 levels and the expression of estrogen receptor (ER), progesterone receptor (PR), and human epidermal growth factor receptor 2 (Her2/neu) in breast cancer patients.

Materials and Methods: Venous blood samples from 302 histologically confirmed breast cancer patients were analyzed. Serum CA15.3 levels were measured using an automatic chemiluminescence immunoassay system. Statistical analyses were conducted to assess the correlation between CA15.3 levels and hormone receptors in both bivariate and multivariate setups.

Results: Results showed that older patients (age > 48) were over three times more likely to have elevated CA15.3 levels (OR: 3.27, 95% CI: 1.18 to 9.63). A significant association was also found between Her2/neu status and CA15.3 levels, with positive Her2/neu patients more likely to have elevated CA15.3. ER and PR statuses were similarly associated with higher CA15.3 levels, highlighting the role of hormonal factors in breast cancer. However, tumour grade did not significantly impact CA15.3 levels. The ROC curve analysis revealed moderate discriminatory power with an AUC of 0.679, indicating that the model correctly classifies approximately 67.9% of cases. The optimal threshold for predicting elevated CA15.3 levels was 0.507, yielding a sensitivity of 0.479 and specificity of 0.859.

Conclusion: In conclusion, CA15.3 levels in breast cancer patients are significantly influenced by ER, PR, and Her2/neu status, as well as age.

Precision in Motion: The Dosimetric Edge of Adaptive Radiotherapy for Non-Small Cell Lung Cancer (NSCLC)

Vandana Thakur — 2026-03-07

Introduction: To evaluate the dosimetric advantages of adaptive radiotherapy (ART) in patients with inoperable Stage II–III non-small cell lung cancer (NSCLC), focusing on changes in target volumes and sparing of organs at risk (OARs) after mid-treatment re-planning. Settings and Design: This prospective, single-institution dosimetric study included patients treated with intensity-modulated radiotherapy (IMRT) between December 2023 and January 2025.

Materials and Methods: Twenty-five patients with histologically confirmed NSCLC unsuitable for surgery underwent initial and mid-treatment planning using 4D-CT. IMRT plans were generated using Monaco® TPS, and re-planning was performed after 40 Gy based on updated tumor and OAR contours. Adaptive plans were implemented for treatment continuation. Paired t-tests evaluated changes in gross tumor volume (GTV) and planning target volume (PTV). Wilcoxon signed-rank tests assessed differences in dose–volume histogram (DVH) parameters between initial and adaptive plans. A p-value <0.05 was considered statistically significant.

Results: Significant reductions in tumor volumes were observed post 40 Gy. Median primary GTV decreased by 40% (p = 0.001), nodal GTV by 52.3% (p = 0.001), and PTV by 36.2% (p = 0.001). ART led to substantial OAR sparing: ipsilateral lung V20 decreased by 49.6%, heart V5 by 45.5%, and mean esophageal dose by 24.5% (all p = 0.001).

Conclusion: Adaptive radiotherapy offers significant dosimetric benefits in NSCLC by reducing radiation exposure to critical structures without compromising target coverage. These findings support broader clinical adoption of ART in medically inoperable NSCLC patients.

Development of a Brachytherapy Applicator with In-Vivo Dosimetry Using 3d Printing Technology for the Treatment of Gynaecological Cancers

Jayapalan Krishnan — 2026-03-07

Introduction: This study aimed to create a 3D-printed brachytherapy applicator with integrated in-vivo dosimetry and to find an optimal distance for the placement of peripheral catheters with a central tandem for treating gynaecological carcinoma.

Material and Methods: A 3D-printed applicator made of polylactic acid (PLA) with detachable components for in-vivo dosimetry was created and tested on a customized water phantom using TG-43 and model based algorithm. The developed sorbo applicator was used to build a strategy for analyzing Ir-192 brachytherapy source dose distribution using a virtual water phantom. Three sets of plans were investigated, one with a central source and the others with peripheral sources, utilizing needles and flexible catheters positioned at varied radial distances from the central source.

Results: The applicator was validated and found to have no significant changes in dosimetric and geometric features. The dose distribution with only the central source showed a rapid falloff near the source and a progressive falloff as distance increased. Peripheral sources loaded at the distance from 1.2 to 1.3 cm from the central source, resulted in improved dose asymmetry as well as reduced the dose to the organ at risk. Flexible catheters provide superior coverage. In-vivo dosimetry demonstrated optimized agreement with estimated dose.

Conclusion: The newly developed brachytherapy applicator, made with sophisticated 3D printing technology and incorporated in-vivo dosimetry, effectively optimizes dose distribution to both the vaginal walls and the vault apex. This novel design may be a dosage-guided therapy that improves dose delivery by changing the source position and dwell time.

Clinical Characteristics, Treatment Outcomes, and Prognostic Factors in Hodgkin Lymphoma: A Retrospective Cohort Study at King Khalid Hospital, Najran

Ahmed M. Badheeb — 2026-03-07

Introduction: Hodgkin lymphoma (HL) is characterized by heterogeneous clinical outcomes influenced by a complex interplay of biological and clinical factors. This study aims to delineate presentation patterns, treatment responses, and prognostic indicators within a Saudi Arabian cohort, with consideration of regional epidemiological variations.

Materials and Methods: A retrospective cohort study was conducted involving 23 patients diagnosed with HL at King Khalid Hospital, Najran, between 2014 and 2021. Diagnoses were established according to the World Health Organization (WHO) 2017 classification. Treatment responses were assessed after every two chemotherapy cycles using RECIST version 1.1, due to limited availability of PET imaging modalities. Progression-free survival (PFS) predictors were analyzed using univariate Cox proportional hazards regression, with explicit acknowledgment of the limited statistical precision stemming from the small sample size.

Results: The mean age was 36.3 ± 16.3 years, with males constituting 60.9% of the cohort. Nodular sclerosis was the most common histological subtype (65.2%), and stage III was the most frequent at diagnosis (43.5%). The ABVD chemotherapy regimen yielded an objective response rate of 78.3%, with a complete response observed in 43.5% of patients. At a median follow-up of 33 months, univariate analysis identified significant associations between reduced PFS and advanced disease stage (III/IV vs. I/II; hazard ratio [HR] 3.26, 95% confidence interval [CI] 0.34–31.35; p=0.001), high International Prognostic Score (IPS ≥3 vs. 0–2; HR 17.93, 95% CI 1.85–173.94; p=0.013), and increasing age (per year; HR 1.21, 95% CI 1.10–1.34; p<0.001).

Conclusions: In this cohort, advanced disease stage, elevated IPS, and increasing age were associated with inferior PFS, consistent with established prognostic models despite regional epidemiological differences. These findings underscore the necessity for larger, prospective studies to validate risk stratification tools and optimize management strategies in similar healthcare settings.

Development of Standard Operating Procedures in Palliative Care: A Qualitative Approach

Siti Zahara Nasution — 2026-03-07

Introduction: Cancer remains a leading cause of death globally and in Indonesia. In advanced stages where curative treatment is limited, palliative care becomes essential for reducing suffering and improving quality of life. However, standardized protocols for palliative care delivery remain limited, particularly in resource-constrained settings like North Sumatra. Objective: This study addresses the critical gap in contextualized Standard Operating Procedures (SOPs) for palliative care in Indonesia.

Materials and Methods: A qualitative approach employing the initial stages of the Borg & Gall Research and Development model was utilized. Data were collected through semi-structured in-depth interviews with eight purposively selected informants (four advanced cancer patients and four healthcare professionals) and direct observations in four referral hospitals in North Sumatra. Data saturation was achieved after six interviews, confirmed by two additional interviews. Thematic analysis followed Braun and Clarke’s six-stage framework, with triangulation, member checking, and peer debriefing ensuring trustworthiness.

Results: Six main themes emerged: (1) family and environmental support, (2) pain management, (3) improving quality of life, (4) role of healthcare professionals, (5) access to health services, and (6) hope in palliative care. Observations revealed significant limitations in trained personnel, medication availability, and service standardization, particularly in rural areas. Findings align with international frameworks (WHO, ASCO, ESMO) while highlighting unique cultural and systemic challenges in Indonesia.

Conclusion: SOPs for palliative care must be contextually designed, incorporating local cultural values, healthcare infrastructure realities, and international best practices. Specific recommendations include standardized pain assessment protocols, structured family involvement frameworks, multidisciplinary care pathways, and strategies for resource-limited settings. Continuous training and policy support are essential for sustainable implementation.

Spatial Distribution and Clinicopathological Factors Associated with Late-Stage Breast Cancer in Kelantan, Malaysia: A Geographic Information Systems (GIS)-Based Analysis

Aishah Md Salleh — 2026-03-07

Introduction: Breast cancer remains the most common cancer in Malaysia, with 47.9% of cases diagnosed at late stages (stage III and IV). Geographic Information Systems (GIS) are used to analyse spatial data and understand the distribution of diseases. This study aimed to assess the spatial distribution of breast cancer and identify clinicopathological factors associated with metastatic disease (stage IV) among late-stage patients.

Materials and Methods: This retrospective study included female patients with histopathologically confirmed breast cancer. A total of 224 patients from Hospital Pakar Universiti Sains Malaysia (HPUSM), Kelantan, Malaysia were analysed. This study used GIS to assess spatial distribution patterns of breast cancer cases and logistic regression to determine clinicopathological factors associated with metastatic versus locally advanced (stage III) disease.

Results: Spatial analysis revealed significant clustering of late-stage breast cancer cases (NNR: 0.44, Z-score: − 13.18, P < 0.001). Late-stage patients were more likely to reside within 10 km of the nearest available hospitals (75.2%) compared to early-stage patients (45.1%) (χ² (1, N = 224) = 19.47, P < 0.001). Progesterone receptor (PR)-positive status was associated with 90% lower odds to present with stage IV disease rather than stage III compared to PR-negative patients (Adjusted odds ratio (AOR): 0.10, 95% CI: 0.01–0.89, P = 0.039).

Conclusions: Results from our study highlighted areas with a higher concentration of advanced disease and suggested that patients living closer to healthcare facilities may present with more advanced disease. Furthermore, PR positivity was identified as a significant predictor of metastatic disease among late-stage patients. These findings underscore the potential of GIS to guide hotspot-targeted screening initiatives, such as mobile mammography in high-risk areas, and highlight the value of PR status as a marker for risk stratification in late-stage patients, informing both clinical decision-making and targeted public health interventions.

Prevalence of Endometrial Cancer and Correlation between Body Mass Index and Histopathological Finding of Endometrial Tissue for Prediction of Endometrial Cancer: Retrospective Analysis of Electronic Medical Records

Chatpisit Petcharoen — 2026-03-07

Introduction: Aim of the study was to investigate the prevalence and correlation of body mass index (BMI) and histopathological finding of the endometrium for prediction of endometrial hyperplasia/ endometrial cancer (EH/EC) in women with abnormal uterine bleeding (AUB).

Materials and methods: This retrospective cohort study was conducted at the outpatient clinic, department of obstetrics and gynecology, Bhumibol Adulyadej Hospital, Royal Thai Airforce, Thailand from January 2021 through December 2024. The subjects were female who presented with AUB and underwent endometrial biopsy (EB). Demographic data was collected and analyzed.

Results: A total of 1,408 cases were recruited. Mean age of participants were 49.9 years old. There were 430 and 978 cases of age less (A1) and more than (A2) 45 years old. Subjects A2 group had significantly more parity (74.9% vs 59.3%), diabetes mellitus (10.2% vs 0.9%), hypertension (20.6% vs 3.5%) and dyslipidemia (13.1% vs 1.6%) than those in A1 group. Polycystic ovarian syndrome was commonly found among subjects in A1 group than A2 group (2.8% vs 0.2%, p-value < 0.001). Prevalence of EC was 3.5 (54/1, 540) percent. Percentage of EH/EC was 14.2 (200/1,408). Among subjects in A1 group, the cut point of BMI for predicting EH/EC was 32 kg/m². Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy were 48.9, 85.7, 28.6, 93.5, and 81.9 percent, respectively.

Conclusions: BMI ≥ 32kg/m² was significantly associated with EH/EC among women age less than 45 years old with abnormal uterine bleeding.

Analysis of Quality of Life Among Cervical Cancer Patients Following-Chemoradiotherapy in Tripura, India

Sarada Sutradhar — 2026-03-07

Introduction: This study aimed to comprehensively evaluate the quality of life (QoL) of cervical cancer survivors, examining the influence of demographic, clinical, and treatment-related factors, and to contextualise these findings with existing national and international literature.

Materials and Methods: A cross-sectional study was conducted among cervical cancer survivors using the EORTC QLQ-C30 and QLQ-CX24 questionnaires. Sociodemographic and clinical data, including age, education, marital status, reproductive history, treatment modality, and FIGO stage, were analyzed to assess associations with QoL domains.

Results: Global health status and functional scores were generally favourable, with physical, cognitive, and role functioning relatively preserved. Sexual activity was the lowest-scoring functional domain. Younger and more educated patients demonstrated better cognitive and social functioning but reported higher sexual anxiety. Chemo-radiotherapy recipients reported improved global health but higher gastrointestinal symptoms. Early-stage disease correlated with superior functional scores and fewer symptoms. Socioeconomic disadvantage was linked to delayed presentation and poorer QoL outcomes. Overall, the quality of life was good for 53% of cervical cancer patients. Education, socioeconomic position, risk variables, cancer stage, and treatment mode were all significantly related to global QOL. Insomnia, loss of appetite, dyspepsia, constipation, financial problems, lymphoedema, peripheral neuropathy, and other symptoms were commonly reported. When compared to stage IV, FIGO stages I–III demonstrated better physical (p = 0.023), cognitive (p = 0.005), and social functioning (p = 0.014) and overall quality of life (QOL).

Conclusions: Cervical cancer survivorship is shaped by treatment type, disease stage, sociodemographic factors, and time since diagnosis. Early detection, education, and targeted interventions addressing physical, sexual, and psychosocial issues are essential. Implications for Cancer Survivors: Integrating survivorship care planning, sexual health counselling, and community awareness programs into routine follow-up can improve long-term QoL, especially for younger, educated, and early-stage survivors. Clinically, supportive measures such as intensitymodulated radiotherapy (IMRT) and standardized supportive care protocols are recommended to reduce long-term gastrointestinal toxicity. Recent studies demonstrate the benefits of modernized chemoradiotherapy regimens in improving both survival and QoL outcomes.

Comparative Efficacy of Induction Chemotherapy Followed by Concurrent Chemoradiotherapy versus Chemoradiotherapy Alone in Inoperable Locally Advanced Head and Neck Cancer: A Quasi-Experimental Study

Sajib Kumar Talukdhar — 2026-03-07

Introduction: Head and neck cancer is a common oncological problem in Bangladesh. Most of the head and neck cancers present with a locally advanced stage. Concurrent chemoradiotherapy (CCRT) is the current standard for inoperable locally advanced head and neck cancer (LAHNC). Several studies explored the induction chemotherapy (ICT) option before CCRT and found promising outcomes. Objective: The study aimed at assessing the complete response rate and toxicity of CCRT with or without ICT in inoperable LAHNC.

Materials and Methods: This quasi-experimental study enrolled 140 patients from June 2018 to July 2019. Participants were included based on the inclusion and exclusion criteria and equally divided between the two arms: 70 patients in Arm A (ICT plus CCRT) and 70 patients in Arm B (CCRT). ICT and CCRT were given to Arm A, while CCRT alone was given to Arm B. Three months following completion of the treatment, the final outcomes were assessed.

Results: At the final follow-up, Arm A showed a statistically higher complete response rate compared to Arm B (58.57% versus 32.85%, p-value = 0.002). Treatment-related toxicities, such as mucositis, xerostomia, dermatitis, anemia, neutropenia and renal toxicity, were similar in both arms.

Conclusion: Patients who received ICT before CCRT had a significantly higher complete response rate compared to those who received CCRT alone with comparable toxicities. Therefore, ICT may improve locoregional control when added before CCRT in inoperable LAHNC.

Prevalence, Histopathology, and Predictors of Malignancy in Breast Lesions from Yemen: A Retrospective Cross-Sectional Analysis (2011–2024)

Fayed Al-Yousofy — 2026-03-07

Introduction: Breast cancer represents an escalating public health challenge in Yemen, a country experiencing a prolonged humanitarian crisis. The prevalence of advanced-stage diagnoses, poor clinical outcomes, and a lack of detailed, population-specific data impede the development of effective early detection strategies. This study aims to characterize the prevalence and predictors of breast lesions in the Yemeni population, providing evidence to guide risk-adapted screening approaches.

Materials and Methods: A retrospective cross-sectional analysis was conducted on 2,288 histopathologically confirmed cases of breast lesions between January 2011 and March 2024, sourced from a major diagnostic laboratory network in the Ibb and Taiz governorates. Multivariate logistic regression was used to identify independent predictors of malignancy, reported as adjusted odds ratios (AORs) with 95% confidence intervals (CIs). Comparative analyses were performed using chi-square and McNemar’s tests.

Results: Our results indicated that benign lesions predominated, accounting for 66.6% of cases (95% CI: 64.7–68.5), with fibroadenoma being the most common subtype (32.2%). Malignant lesions comprised 33.4% of cases, with invasive ductal carcinoma (IDC) as the predominant malignancy (63.5%). Significant predictors of malignancy included age over 60 years (adjusted odds ratio [AOR] = 3.2; 95% CI: 2.1–4.9), female gender (AOR = 5.0; 95% CI: 3.3–7.6), and lesion size greater than 5 cm (AOR = 3.2; 95% CI: 2.1–4.9). A concerning trend of cancer presenting at younger ages was observed. Age-stratified analysis revealed substantial variation: 72.8% malignancy in patients over 60 years compared to 7.9% in those under 30 years. A recent regional awareness campaign (2021–2022) showed no significant immediate effect on detection rates (p = 0.23).

Conclusion: Benign breast lesions are significantly more prevalent in this Yemeni cohort. These findings underscore the necessity of risk-adapted screening targeting females aged 30–60 and patients presenting with larger lesions. The younger age at onset and high rates of consanguinity suggest a probable genetic component, highlighting the urgent need for genetic counseling and sustained, culturally informed public health interventions in Yemen’s resource-limited context.

An Ex-Vivo Study of Photobiomodulation Effects on Hematological and Inflammatory Markers in Breast Cancer Patients

Bushra Radhi Hussein — 2026-03-07

Introduction: Photobiomodulation with low-level laser therapy has been demonstrated immunomodulatory and anti-inflammatory effects in various clinical settings. However, its systemic effects on hematological parameters in breast carcinoma patients remain underexplored. Objective: To evaluate the impact of LLLT on immune and inflammatory blood markers in breast carcinoma patients, with a focus on fluence-dependent responses based on varying exposure durations.

Materials and Methods: One hundred samples of venous blood from breast carcinoma patients were randomly assigned to either a non-irradiated control group or one of the experimental groups that were treated with a laser. Experimental group samples were subjected ex vivo to an 810 nm, 500 mW near-infrared laser for 1, 1.5, 2, and 2.5 minutes, corresponding to energy densities of 30, 45, 60, and 75 J/cm². We compared important hematological measurements total white blood cell (WBC), lymphocyte (LYM), granulocyte percentage (GRA %), hemoglobin content (HGB), and platelet (PLT) and assessed means between groups by one-way ANOVA and suitable post hoc tests.

Results: LLLT resulted in a significant decrease in WBC, LYM, HGB, and PLT values across all irradiated samples compared to controls. In contrast, GRA% showed a consistent and significant increase in all laser-treated groups. No dose-response trend was observed among the laser durations, suggesting a threshold biological effect.

Conclusion: Ex vivo LLLT alters key hematological indices in blood from breast carcinoma patients, marked by immune cell redistribution and mild erythrocyte suppression. These outcomes support the potential of LLLT to moderate inflammatory in addition to immune responses, warranting further investigation in in vivo and clinical settings.

Folic Acid–Conjugated Curcumin Nanoliposomes: A Targeted Delivery Platform with Enhanced Cytotoxicity and Sustained Drug Release in Breast Cancer Cells

Mohammad Kazem Molavi Rahbar — 2026-03-07

Introduction: Breast cancer remains one of the most prevalent and fatal malignancies among women, emphasizing the need for safer and more effective therapeutic approaches. Curcumin is a multifunctional natural compound with proven anticancer activity; however, its low solubility and rapid systemic elimination restrict its clinical application. In this study, folic acid–linked PEGylated nanoliposomes (FA-Lipo-Cur) were developed to enhance curcumin delivery and cellular uptake in folate receptor–overexpressing MDA-MB-231 breast cancer cells.

Materials and Methods: Curcumin-loaded, folate-conjugated nanoliposomes were fabricated via the thin-film hydration method followed by post-insertion of DSPE-PEG (3350)-FA. The formulations were characterized for particle size, ζ-potential, polydispersity index (PDI), morphology (SEM/TEM), encapsulation efficiency (EE%), and in-vitro drug release kinetics. Cytotoxicity was assessed using the MTT assay after 48 h exposure to FA-Lipo-Cur, non-targeted Lipo-Cur, and free curcumin.

Results: Both formulations produced spherical vesicles with uniform morphology and high encapsulation efficiency (>75%). The mean particle size of FA-Lipo-Cur was 250 ± 7.7 nm, with a ζ-potential of −25.1 ± 2.1 mV and PDI of 0.16 ± 0.02, indicating excellent colloidal stability and homogeneity. In-vitro release studies demonstrated sustained curcumin release over 48 h, with a slower release rate for FA-Lipo-Cur compared to Lipo-Cur, attributed to steric stabilization by the PEG–folate corona. In cytotoxicity assays, FA-Lipo-Cur exhibited the lowest IC₅₀ (33 ± 3.3 µg/mL) compared with Lipo-Cur (45 ± 3.9 µg/mL) and free curcumin (55 ± 4.1 µg/mL) (p < 0.05). When folate receptors were pre-saturated with free folic acid, the IC₅₀ of FA-Lipo-Cur increased to 47.5 ± 3.2 µg/mL, confirming that enhanced cytotoxicity arose primarily from receptor-specific targeting rather than non-specific uptake.

Conclusion: The FA-Lipo-Cur system therefore represents a promising, biocompatible nanocarrier platform for targeted breast cancer therapy, warranting further pharmacokinetic and in-vivo tumor model evaluation.

Molecular Foundations of Cancer: A Narrative Review of Hallmarks, Microenvironment, and Precision Therapeutic Advances

Sathyananth M — 2026-03-07

Background: Cancer represents a devastating global health challenge characterized by intricate molecular mechanisms that defy conventional therapeutic approaches. This review integrates contemporary scientific understanding of the biological processes underlying cancer, exploring the complex interplay among genetic, cellular, and microenvironmental factors that drive tumor development. It critically examines pivotal hallmarks such as dysregulated cellular proliferation, metastatic potential, and immune system interactions. Central molecular signaling pathways, including MAPK and PI3K-AKT, are analyzed to reveal the dynamics of malignant transformation. Furthermore, the exploration of the tumor microenvironment and cellular metabolic adaptations illustrates the resilience of cancer cells. The aim of this narrative review is to synthesize foundational molecular mechanisms and emerging precision therapeutic strategies to provide a comprehensive perspective on the molecular complexity of cancer.

Conclusion: Emerging therapeutic strategies represent a paradigm shift towards precision medicine, leveraging targeted molecular interventions, immunotherapy, and advanced nanotechnology. This review provides a unique synthesis by specifically linking foundational mechanisms, such as epigenetic modifications, to the pathological heterogeneity observed in tumors. By integrating current scientific knowledge and technological innovations like CAR-T therapies, this work provides a comprehensive perspective on the future of personalized cancer management.

Denosumab in Giant Cell Tumour of Bone - A Case Series with Review of Literature

Abin Roy — 2026-03-07

Introduction: Giant Cell Tumour of Bone (GCTB) is an uncommon, locally aggressive primary bone neoplasm that may result in significant morbidity owing to its destructive growth pattern. Although intralesional curettage combined with local adjuvant therapy represents the current standard of care, this technique is associated with a relatively high incidence of local recurrence. Denosumab, a monoclonal antibody targeting RANKL (Receptor Activator of Nuclear Factor Kappa-B Ligand), has been shown to reduce tumor size, alleviate pain, and enable less extensive surgical procedures. It may also decrease the risk of recurrence and provide significant palliation in cases of metastatic or locally recurrent giant cell tumor of bone (GCTB).The series highlights the diverse clinical presentations, discusses evolving treatment strategies, and emphasizes the practical challenges faced by surgeons and oncologists in incorporating novel agents such as Denosumab into everyday practice.

Methods: This retrospective analysis focuses on patients diagnosed with GCTB and received Denosumab at the Department of Medical Oncology, Government medical College Kozhikode between November 2022 and December 2024. Data collection included demographics, clinical presentations, diagnostic findings, treatment modalities, and follow-up outcomes.

Results: The case series comprised various presentations, ranging from first presentation, recurrence to metastasis. 3 patients with localised disease underwent curettage with liquid nitrogen application and one patient underwent wide excision with reconstruction. Two patients who declined surgery continued on Denosumab with durable disease control. Two patients with symptomatic distant metastasis achieved symptomatic benefit and radiologic response with Denosumab therapy.

Conclusion: This case series confirms the findings of previous studies which shows that Denosumab reduces tumor size, alleviate pain, and enables less extensive surgical procedures in GCTB. It also helps to control disease in cases of metastatic and recurrent disease. This study highlights the real word challenges faced by clinicians and highlights the need for multidisciplinary team approach in the management of GCTB.

Diffuse Large B-Cell Lymphoma Beyond the Nodes: A Case Series of Rare Extranodal Presentations in the Nasopharynx, Breast and Central Nervous System

Neha Yadav — 2026-03-07

Background: Lymphomas may originate from nodal or extranodal sites, with an increasing proportion of patients presenting with extranodal non-Hodgkin Lymphoma (NHL). Diffuse large B-cell lymphoma (DLBCL) is the most common subtype of NHL, seldom involves the nasopharynx, breast or central nervous system (CNS).

Objectives: In this study we described three rare primary extranodal presentations of DLBCL.

Methods: One case was nasopharyngeal DLBCL in a 13 years old boy who presented with recurrent nasal bleeding, obstruction, and discharge. Second case was breast DLBCL in a 72 years old female patient who had chief complaint of right breast lump for last 1 month without axillary lymphadenopathies. We had third case of DLBCL involving brain in a 50 years old male patient who had persistent headache and dizziness.

Case presentation: All the three cases had clinical suspicion of malignancy which was most common in that site.

Conclusion: Hence these cases emphasized the diagnostic importance of histopathology and immunohistochemistry in arriving at the correct diagnosis.

Combination Therapy with Hyperthermia, Low-dose Anti-cancer Drug Therapy, and Intravesical Bacillus Calmette–Guérin Instillation for High-risk Non-muscular Invasive Bladder Cancer: A Case of Long-term Survival

Akihito Yoshida — 2026-03-07

Introduction: We report a case of long-term survival in a patient with high-risk non-muscular invasive bladder cancer(NMIBC) treated with hyperthermia and low-dose anti-cancer drug therapy combined with intravesical bacillus Calmette–Guérin (BCG) instillation.

Methods:The patient was a male in his 70s. He underwent a left nephroureterectomy for left renal pelvic cancer. Six months later, right renal pelvic cancer was detected. The patient was treated with hyperthermia, radiation therapy, and low-dose anti-cancer drug therapy because he declined surgical treatment. Four years later, he underwent transurethral resection (TUR) of bladder cancer (pathology: urothelial carcinoma (UC) pT1 grade (G) 3) due to recurrence in the bladder. Intravesical instillation of anti-cancer drugs. Next, TUR for urethral recurrence and random bladder biopsy were performed. The pathological diagnosis was UC pT1 G3, and extensive in situ was detected in the bladder. The intravesical instillation of BCG and TUR was conducted four times for urethral recurrence.

Result: During these episodes, the patient refused surgery, and he has been aliving without disturbing his quality of life.

Conclusion: Hyperthermia and low-dose anti-cancer drug treatment combing with intravesical BCG instillation for high-risk non-muscular invasive bladder cancer is effective for the patient refusing standard treatment.