Patterns of Care of Childhood Cancers in India

Management of childhood cancers in India has seen a new high in last few decades due to collaborative efforts of Physicians and organizations- both governmental and non-governmental. However, care is still heterogenous in this vast country. The problems span from a lack of data to programs for tackling cancers at the community level and lack of awareness among parents and physicians on childhood cancers, along with a nihilistic attitude and stigma attached to cancers even in this digital era. In this article, we describe the milestones in the development of Pediatric Oncology as a specialty, of cancer registries, of diagnostic armamentarium, access to affordable drugs, and, palliative care for children with cancers in India, that perhaps reflects care in other developing countries

Clinical Profile, Patterns of Care and Outcomes of Childhood CNS Tumours in India

Paediatric CNS tumours are the third most common childhood malignancy in India. They account for 14% of all cancers in the 1–14 years age group. There is dearth of adequate prospective or retrospective studies about patterns of care and outcomes. There is male preponderance. Primitive Neuro-ectodermal tumours (PNET) are the most common histology followed by astrocytoma and other gliomas among children from 0 to 19 years. Surgery, radiotherapy, and chemotherapy are the main modalities of treatment. Available data points to underutilisation of radiotherapy in clinical practice due to the fear of non-compliance. Paediatric CNS tumours outcomes are different from adult brain tumours due to their aggressive histology, variable clinical presentations, delay in diagnosis, etc. There is also shortage of adequate multidisciplinary paediatric neuro-oncology units in the country. Future directions include setting up more dedicated paediatric neuro-oncology units, implementation of new 2022 WHO classification by adopting molecular testing across different histology’s, use of better radiation technology to prevent long term neurocognitive and other late effects and survivorship clinics to monitor for late effects and rehabilitate the childhood cancer survivors and, perhaps a registry. These issues are discussed in detail in this chapter

Targeted Therapy for Medullary Thyroid Cancer: A Review

Medullary thyroid cancers (MTCs) constitute between 2 and 5% of all thyroid cancers. The 10-year overall survival (OS) rate of patients with localized disease is around 95% while that of patients with regional stage disease is about 75%. Only 20% of patients with distant metastases at diagnosis survive 10 years which is significantly lower than for differentiated thyroid cancers. Cases with regional metastases at presentation have high recurrence rates. Adjuvant external radiation confers local control but not improved OS. The management of residual, recurrent, or metastatic disease till a few years ago was re-surgery with local measures such as radiation. Chemotherapy was used with marginal benefit. The development of targeted therapy has brought in a major advantage in management of such patients. Two drugs—vandetanib and cabozantinib—have been approved for use in progressive or metastatic MTC. In addition, several drugs acting on other steps of the molecular pathway are being investigated with promising results. Targeted radionuclide therapy also provides an effective treatment option with good quality of life. This review covers the rationale of targeted therapy for MTC, present treatment options, drugs and methods under investigation, as well as an outline of the adverse effects and their management

Metastatic adenocarcinoma in a young male, 12 years after treatment of primary non seminomatous germ cell tumor

A man aged 32 years presented with metastatic adenocarcinomatous deposits, 12 years after his initial diagnosis and treatment of immature teratoma of the testis. He was treated for his metastasis with local radiotherapy, failing which he underwent excision of the tumor and palliative chemotherapy. This case is presented for its rarity of occurrence, unique presenting features and difficulty in management