Hepatocellular Carcinoma in Oman: An analysis of 284 cases

Objectives: Hepatocellular carcinoma (HCC) is the most common type of primary liver tumour worldwide and is increasing in incidence. This study aimed to describe the clinical characteristics of HCC among Omani patients, along with its major risk factors, outcomes and the role of surveillance. Methods: This retrospective case-series study was conducted between January 2008 and December 2015 at the three main tertiary care hospitals in Oman. All adult Omani patients diagnosed with HCC and visited these hospitals during the study period were included. Relevant data were collected from the patients’ electronic medical records. Results: A total of 284 HCC patients were included in the analysis. The mean age was 61.02 ± 11.41 years and 67.6% were male. The majority had liver cirrhosis (79.9%), with the most common aetiologies being chronic hepatitis C (46.5%) and B (43.2%). Only 13.7% of cases were detected by the HCC surveillance programme. Approximately half of the patients (48.5%) had a single liver lesion and 31.9% had a liver tumour of >5 cm in size. Approximately half (49.2%) had alpha-fetoprotein levels of ≥200 ng/mL. The majority (72.5%) were diagnosed using multiphase computed tomography alone. Less than half of the patients (48.9%) were offered one or more HCC treatment modalities. Conclusion: The majority of Omani HCC patients were male and had cirrhosis due to viral hepatitis. In addition, few patients were identified by the national surveillance programme and presented with advanced disease precluding therapeutic or even palliative treatment.Keywords: Hepatocellular Carcinoma; Liver Cirrhosis; Human Viral Hepatitis; Public Health Surveillance; Early Detection of Cancer; Alpha-Fetoprotein; Oman

Minocycline Improves the Efficacy of EGFR Inhibitor Therapy: A Hypothesis

Skin rash is a side effect of drugs that inhibit Epithelial Growth Factor Receptor (EGFR) as a part of targeted therapy of cancer. It’s appearance and severity correlates with survival. Minocycline, an oral tetracycline antibiotic, is recommended as treatment (and increasingly, for prevention) of the rash, though infection is seen in only one-third of the patients. Minocycline has additional anti-cancer properties such as poly (ADP-ribose) polymerase (PARP) inhibition. It is proposed that such properties contribute to the efficacy of EGFR-inhibitors, and can also explain the positive correlation between grade of rash and survival as patients with higher grades of rash are more likely to receive minocycline. Early concurrent administration of minocycline is recommended in patients planned for EGFR therapy while awaiting trials proving this hypothesis

Be a true listener, rather than a good conversationalist

Oncology patient care is an ever evolving field both as a science and a clinical art. We evaluate, diagnose, and treat cancer patients daily. We break the bad and the good news to them. We are the hope on which their life and dreams hang on. We, as practitioners, have to assess each patient as an intelligent observer. We have to devise our strategy to break heartbreaking news to them in a tailored and personalized fashion according to the physical, psychological, emotional, and social status of the patient. The process has to be gentle, perceptive, pragmatic, yet truthful. These need to be reasonably good observational, listening, comprehending, and delivering potentials; which are sharpened by experience and skills

Primary Gastric Chorioadenocarcinoma

Primary gastric chorioadenocarcinoma (PGC) is a rare and rapidly invasive tumor. Choriocarcinoma is usually known to be of endometrial origin and gestational; however, it has been reported in other extragenital organs, such as the gall bladder, prostate, lung, liver, and the gastrointestinal tract. Human chorionic gonadotropin related neoplasms of the stomach are seldom discussed in the literature. We report a case of PGC in a 56-year-old man treated with a standard non-gestational choriocarcinoma chemotherapy regimen, EMA/CO (etoposide, methotrexate, actinomycin D, cyclophosphamide, vincristine), with a complete response and good tolerability

COVID-19 amongst cancer patients: an experience from Oman

Introduction: The pandemic of coronavirus has no parallel in recent history. Human Life has completely transformed. There are no approved standard therapies. Patients with comorbidities, old age, immunocompromised, and cancer are at higher risk of complicated course and higher mortality. Patients and Methods: This study is an analysis of Cancer patients who got COVID-19 infection to assess the rate, demographics, laboratory data, and mortality. The data was compared, with normal non-cancer COVID-19 infected patients.  Results: The overall number of COVID-19 positive cancer patients was low (0.47%) compared to normal population (2.17%). The mortality in COVID-19 Positive cancer patients was 35.1% vs 1.03%. Diabetic, hypertensive and cardiac patients are more likely to get COVID-19.  Among Normal subjects, ratio of expatriate patients was higher.  Septicemia was more frequent in cancer patients. Non-cancerous patients were more commonly ventilated.  Leucocytosis, renal impairment, Hypocalcemia, high Troponin, high D-dimer, and high transaminases were seen more in non-cancerous patients. A high Lactate dehydrogenase was more common in cancer patients. The mortality from COVID-19 was higher in cancer patients 25% vs 15.7%. Around 72.8% cancer patients received active treatment with in past 4 weeks before COVID-19 infection. Discussion and Conclusions: There are very few reports of COVID-19 infection in cancer patients. The number of patients is small with limited information and capacity of the healthcare system. Oncologists should consider to tailor cancer clinical management. The cancer patients must practice social distancing, and seek early evaluation for symptoms suspicious for COVID-19, testing for virus and chest radiography. Contintuous..

Age at diagnosis of female breast cancer in Oman: Issues and implications

Introduction: Female breast cancer (BC) is the most frequent malignancy diagnosed globally, about 23% of the diagnosed cancers. BC incidence varies geographically, highest in Western Europe and lowest in Africa. BC in females is strongly correlated to age, the highest incidence rate amongst older women reinforcing the importance of hormonal status. BC in young females has an aggressive phenotype. There is a shared observation amongst practicing oncologists that BC in Middle East and the developing world presents at an earlier age. Aim and Objective: The aims of this study are to evaluate the age at presentation of female BC in Oman, and to compare our data with international and regional published data. It discusses the impact of young age Breast Cancer. Materials and Methods: All diagnosed female BC cases registered from 1996-2010 all over the country, were retrieved from the National Cancer Registry, Ministry of Health. BC cases were analyzed with respect to age at presentation. The data were compared with regional and international data. Results: A total of 14,109 cancer cases were recorded during the period of study. BC was the leading malignancy as 1,294 cases (9.1%). Female BC patients were 1,230; denoting 19.2% of all female cancers. 53.5% of female BC presented below 50 years of age. Male BC constituted 5% of total, with 67% of male BC occurring over 50 years of age. Compared with data from Oman, the highest rates in UK and other Western countries are above 50 years of age. These rates are four to 10 times higher than local in different age groups. Interestingly, these rates increase with increasing age in UK from 40-45 to up to 85+, keep on increasing and go up to four times higher with higher age. This phenomenon, of increasing incidence rates with age, is not observed in our local population. Discussion: BC is significantly correlated to age as reported from Western population. BC is reported at a younger age from developing and Arab World, which need to be further studied and validated. This phenomenon of BC in younger age may have significant implications and effects ranging from screening, diagnosis, management, prognosis, and cost of treatment. Conclusion: The impact on young women diagnosed with BC is enormous, ranging from psychosocial to healthcare services and economics. There is a need to study it further in depth in developing World