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Theme 8:
Oncology


Efficacy and Safety of Piperacillin-Tazobactam and Cefepime as Empirical Therapy for Febrile Neutropenic Children with Acute Lymphoblastic Leukaemia

Mehnaz Akter, Afiqul Islam, Chowdhury Yakub Jamal1, Momena Begum1,
     ATM Atikur Rahman, Zannat Ara, Md. Bani Yeamin, S. M Rezanur Rahman, 
     Muhammad Tanvir Ahammed, Farida Yasmin

Department of Haematology and Oncology, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh

Objective: The aim of the study is to compare the efficacy and safety between Piperacillin-tazobactam with Cefepime in febrile neutropenic children with acute lymphoblastic leukemia. Methodology: This randomized clinical study was conducted from August 2015 to August 2016 in the department of Paediatric Haematology and Oncology, BSMMU. Sixty one( 61) episodes of febrile neutropenia in children with ALL, aged 0 to18 years included in this study. Patients were randomized into two groups by lottery and blinding was open. One group received Piperacilln/Tazobactam and another group received Cefepime. Informed consent from respective parents and legal guardian obtained prior to inclusion of any child. History and physical findings recorded in preformed data instrument. Complete blood count (CBC) was done in every alternate day, blood culture and sensitivity, urine  microscopic examination and culture and sensitivity, X-ray of the chest, metabolic work up (serum glutamic pyruvic transaminase, serum electrolytes, serum calcium, and serum creatinine) were done in every patient. Microscopy and culture/sensitivity of stool specimen, pus, wound swab and CSF study was done in selected cases. Duration of fever, duration of neutropenia, hospital stay and all adverse drug reactions were recorded in each of the febrile neutropenia episodes. Efficacy of the drug were assessed based on whether the symptoms of febrile neutropenia resolved by the initial empiric therapy or the patient were switched to other antimicrobial agents and failure were recognized if patient needs change of therapy.  Result: Sixty-one (61) febrile neutropenic episodes from 59 acute lymphoblastic leukaemia children were included. But 1 patient lost to follow up and finally 60 febrile neutropenic episodes were analyzed. Among them, febrile neutropenic episodes in the Piperacillin/Tazobactam group were 28 and in Cefepime group was 32 episodes. In the study 34(57.63%) were male and 25 (42.37%) were female and median age was 5 years and 38 (62.3%) neutropenic episodes were in induction phase. Majority of the febrile neutropenic episodes had fever without focus 21(35%). Microorganisms isolated in 13 (21.66%) patients and majority 6 (46.15%) had blood infection. Most of the isolated organisms were gram negative 11(84.61%). Piperacillin/Tazobactam was 100% sensitive to Klebsiella spp, Acinetobactor spp and Enterococcus spp and 100% resistant to E. coli spp and  Cefepime was 67% sensitive to Klebsiella spp, 50% sensitive to Pseudomonas spp and 100% resistant to E. coli spp. In this study overall treatment success without modification in the Piperacillin/Tazobactam group was 17(60.7%) and in Cefepime group was 18 (56.3%), P value was (0.732) that was not significant. Regarding the other parameters the mean duration of fever, median duration of neutropenia and duration of hospital  stay, there were no statistically significant difference. No serious adverse effects occurred in either of the groups. Both Piperacillin/Tazobactam and Cefepime were effective and safe as an empirical therapy for febrile neutropenic children with acute lymphoblastic leukaemiaConclusion:The present study shows that efficacy and safety of Piperacillin/Tazobactam as initial empirical therapy for febrile neutropenic children with Acute Lymphoblastic Leukaemia is as effective and safe as Cefepime monotherapy.




Role of Fluconazole as Antifungal Prophylaxis during Induction Phase of Chemotherapy in Paediatric Acute Leukaemia

Islam F1, Jamal Cy2, Nigar I3, Islam A4,  Karim Ma5, Siddique R6, Rahman Atm A7,
Sdm Taimur8,  Ali My9, Shaheen Ma10

Paediatric Haematology and Oncology, Department of Microbiology, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh. Ibrahim Cardiac Centre and Research Institute, Dhaka Bangladesh.


Background: Patients with haematological malignancies often develop febrile neutropenia (FN) as a complication of cancer chemotherapy. Opportunistic infections, especially invasive fungal infections (IFI), are often observed during the neutropenic phase. Though the control of bacterial infections has markedly improved with the use of antibiotics in the past decades, treatment of IFI is still a major problem. Antifungal prophylaxis is recommended for patients with haematological malignancies to reduce the risk of IFI. Hence, the aim of this study was to evaluate the role of fluconazole as antifungal prophylaxis in children with acute leukaemia during induction chemotherapy. Method: This was a randomized, double-blinded, placebo-controlled prospective study carried out in the Department of Paediatric Haematology and Oncology, BSMMU, from September 2016 to August 2017. There were 60 patients (30 in fluconazole and 30 in placebo group), with age ranging from 1 to 18 years old. Computer-generated randomisation tables were used to select the cases and controls. Fluconazole prophylaxis was given at 6 mg/kg PO daily, from 1 day prior to chemotherapy initiation till completion of induction therapy. Evaluation of the patient was done at baseline, and twice weekly until after one week of completion of antifungal prophylaxis. Data regarding evidence of fungal infection, side effects of fluconazole and requirement of empirical antifungal agent were recorded by using semi-structured questionnaires. At the end of study, drugs were uncoded. Written informed consent was taken from each patient’s parent/guardian. Result: Mean age of the patients was 7.08±3.33 years in the fluconazole group, and 6.29±2.79 years in the placebo group. Male:female ratio was 1.14:1. Out of the 60 patients, 44 had ALL and 16 had AML. Mean duration of neutropenia in fluconazole and placebo groups were 13.40±5.75 days and 16.83±5.77 days respectively. Duration of empirical antifungal therapy in fluconazole and placebo groups differed significantly (p=0.008). The difference in neutrophil recovery in the two groups was also significant (p=0.015). Success rate of fluconazole prophylaxis in preventing IFI was 83.3% (n=25). There was 1 proven case of IFI each in both groups. There were 2 probable cases of IFI in the fluconazole group and 4 in the placebo group, while there were 14 suspected cases of IFI in the fluconazole group and 17 in the placebo group. Amphotericin B was administered in 27.2% of ALL patients in the placebo group, and 54.5% of AML patients in the fluconazole group. There was no significant difference in the concentration level of galactomannan (GM) in the two groups. Considering GM index >1, 2 patients in the fluconazole group and 4 patients in the placebo group had positive cultures. There were 2 PCR-positive patients in the fluconazole group out of a total of 6 PCR-positive cases. Hypokalaemia was observed most frequently in 36.66% of cases in the fluconazole group. Conclusion: Prophylactic fluconazole can be used to decrease fungal infection as well as the duration of febrile neutropenia during induction chemotherapy of leukaemic children.








Staging of Cervical Cancer at the Colposcopy Clinic of Bangabandhu Sheikh Mujib Medical University, Shahbag, Dhaka, Bangladesh

 Ashrafun Nessa, Noor-E-Ferdousi, Afroza Chowdhury, Trina Islam, Kamrul Hasan Khan, Harun Ur Rashid

Professor, Department of Gynaecological Oncology, Bangabandhu Sheikh Mujib Medical University, Shahbag, Dhaka, Bangladesh, Assistant Professor, Department of  Gynaecological Oncology, Bangabandhu Sheikh Mujib Medical University, Shahbag, Dhaka, Bangladesh ,Colposcopist, Department of Obstetrics and Gynaecology, Bangabandhu Sheikh Mujib Medical University, Shahbag, Dhaka, Bangladesh , Research assistant, National Centre of Cervical and Breast Cancer Screening and Training at Bangabandhu Sheikh Mujib Medical University, Shahbag, Dhaka, Banglades, Professor, Department of Pathology, Bangabandhu Sheikh Mujib Medical University, Shahbag, Dhaka, Bangladesh, 6Medical officer, Directorate General of Health Services, Mohakhali, Dhaka, Bangladesh.

Background: Cervical cancer (CC) is the second most cancer death among women of reproductive age group in Bangladesh. It is a slowly progressing disease and early detection and treatment of this condition reduces the mortality and morbidity.  Objectives: To find out the staging of CC during presentation at the colposcopy clinic of Bangabandhu Sheikh Mujib Medical University (BSMMU) and to find out the pattern of management of these women. Material and Method: This retrospective cross-sectional study was carried out at the colposcopy clinic of BSMMU from January 2016 to June 2019. Data was collected from the colposcopy registry book at BSMMU, through telephone call to women and follow-up appointments. Incidentally diagnosed CC cases at the colposcopy clinic with known staging were recruited in this study. Result: Among 575 women with CC, clinical staging was available among 523 (90.96%) women. The mean age of women with CC was 48.59 ±2SD, about four fifths of them were from 31-60 years age group. Among 523 women with CC, 107(20.5%) had stage I disease, 124 (23.7) had stage IIA, 240 (45.9) had stage IIB and remaining 52 (9.90%) had Stage III and IV disease.  Majority them  (N=422) had squamous cell carcinoma and  32(6.3%) had adenocarcinoma. Among 523, 39 (7.5%) women underwent radical hysterectomy only, 111 (21.2%) underwent radical hysterectomy followed by adjuvant therapy, 29 (5.5%) received primary radiotherapy,  153 (29.3%) received  concurrent chemo-radiation, 11 (2.1%) received palliative care, 25 (4.8%) refused treatment and 152 (29.1%) women could not followed-up.Conclusion: In Bangladesh, women with CC presents at relatively higher age. Due to existing screening programme, good proportion of them started to attend in early stage disease. Government should take necessary steps to improve management of women with CC to reduce mortality and morbidity related to CC. 



Mixed-Phenotype Acute Leukemia : Flow Cytometric Analysis in A Tertiary Care Center Of Bangladesh

Shirin Tarafder

Professor, Microbiology and Immunology, Bangabandhu Sheikh Mujib Medical University, Dhaka Bangladesh.

Introduction: Mixed-phenotype acute leukemia (MPAL) is a rare but difficult to treat hematologic malignancy with immunophenotypic co-expression of at least two cell lineages, or with only rare cases involving all three lineages, e.g. myeloid with B-or T-lymphoid or all three of myeloid, B- and T-lymphoid altogether. Advancement in multiparametric flow cytometry has made its identification easier. The aim of this prospective study was to identify cases of  MPAL and to study the incidence, clinical features, hematological profile and immunophenotypic expression profile of MPAL atour center. Method: All consecutive cases of acute leukemia (AL) from November 2015 to August 2019, diagnosed on the basis of bone marrow and/or peripheral blood morphology were utilized for immunophenotyping. A panel of fluorochrome-labelled monoclonal antibodies against myeloid, B-cell, T-cell and immaturity markers were used.  These cases were diagnosed based on immunophenotyping of  EDTA peripheral blood or bone marrow aspirates to have MPAL as per the World Health Organization (WHO) 2008 guideline. Result:Among 532 consecutive AL cases diagnosed and evaluated during this period, 12(2.25%) patients with MPAL were identified fulfilling WHO 2008/ EGIL criteria for immunophenotypic characteristics of AL. Nine were adults, male : female = 3.5:1. Three were children , all of them were male. Median age of this cohort (n=12) was 26.5 years( range: 2-70 years ). Seven (58.4%) cases were diagnosed as B/myeloid , 4(33.3%) as T/myeloid and one (8.3%) as B/T  MPAL.Morphologically MPAL cases were diagnosed as 9 acute myeloid  leukemia (AML) and 3 acute lymphoid leukemia (ALL) whereas blast morphology was not predictive of a MPAL. Conclusion:Multiparametric flow cytometry by using comprehensive panel of monoclonal antibodies is a valuable tool to diagnose MPAL as it is a rare subset of acute leukemia known to have a poor outcome.




Geriatric Oncology and Bangladesh: A Clinical Jeopardy of Cancer Patient Management in Near Future

Muhammad Rafiqul islam, Abdullah Al mamun, ATM kamrul Hasan, Syed Mohammad Ariful Islam

National Institute of Cancer Research and Hospital

Background: Geriatric health problem is a burning issue in developing country like Bangladesh. By 2050 one in 5 will be elderly in Bangladesh. In elderly, Cancer is becoming the second cause of death of non-communicable disease in Bangladesh (11%). Common features of cancer in elderly patient are different than relatively younger patient. Many of Elderly patient having other commodities than cancer before the diagnosis. Method: This descriptive observational study was carried out to identify common presenting features of elderly cancer patient among 1730 cases cancer at department of Medical Oncology of National Institute of Cancer Research and Hospital, Dhaka from September 2017 to February 2108 for period of 6 month. Result: Among 1730 cancer patient, 505 patients age were 60 and above 60 years (29.19%). 326 patients (64.55%) were male, 179 (35.44%) were female.0ut of 505 elder cancer patient,421 (83.37%) patient having one or more than one type of habitual problem like smoking, betel nut, Gul or alcohol. male patient were more (88.03%) common with this problem, whereas female patient (71.51%) having habitual problem. 34.15 % male and 10.16% female  patient having more than one type of habitual problem. At time of presenting of OPD, most of the patients performance status (ECOG) were 2 and 3 (59.40%). elderly male (33.74%) having worse performance status (ECOG) than female patient (15.08%).275(54.46%) patient having known comorbidities like hypertension(HTN), Diabetes Mellitus(DM), chronic obstructive Pulmonary disease(COPD), ischemic heart Disease (IHD) etc. COPD is most common in male and HTN was the most common in female. Conclusion: Geriatric health is becoming a big concern for Bangladesh within 2030. In this study, we tried to figure out the socio-demographic and clinical perspective of cancer in geriatric group people in Bangladesh. Management of cancer in elderly is more sophisticated than others.




Children Treated with Metronomic Chemotherapy in A Low and Middle Income Country; is A New Concept in Oncology

Momena Begum, Chowdhury Yakub Jamal, Md. Anwarul Karim, Afiqul Islam, ATM Atikur Rahman

Department of Pediatric Hematology and Oncology, Bangabandhu Sheikh Mujib Medical University Dhaka, Bangladesh

BACKGROUND: Metronomic chemotherapy (MC) is defined as the frequent administration of chemotherapy at doses below the maximal tolerated dose (MTD) and with no prolonged drug-free break or simply “lower doses, longer times”. MC well adapted to low and middle income countries. OBJECTIVE: The aim of this study was to assess the safety of MC drugs given to children with refractory and advance cancer of various tumor types.METHOD: This prospective observational study was conducted in the Department of Pediatric Hematology and Oncology, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh from January 2016 to January 2018. This study evaluated the outcome and safety of MC with  orally available cytotoxic drugs, Cyclophosphamide (50mg/m2/dose) and Etoposide (50mg/m2/dose) daily for 21days followed by 1-week break, Sodium Valproate (Valproic acid)- 10-15mg/kg/day for 21 days followed by 1-week break. This treatment was given to children with advance stage diseases (stage-IV), refractory cancer following treatments with the standard protocols available in our institution and to patients who were eligible for the protocol but unable to took treatment due to financial constrain.  Adverse events were determined through laboratory analyses and investigator observations.RESULT: Total 21 children (median age- 4y ; range, 6 m to14y) were included. Among 21 patients 2 patients lost to follow-up. 19 patients included in this study. The most frequent diagnoses were Neuroblastoma (14). At 8 weeks 13(68.42%) patients experienced disease stabilization and progressive disease 06(31.57%). 11(57.89%) patients achieved partial remission. Complete remission achieved 9(47.36%) patients at 28 weeks and 2(10.52%) patients up to last follow-up at 150weeks and continued their treatment for 37.5 months. After a median follow-up of 24 weeks (range:2-96wk) 8 patients (42%) were alive. During treatment period there was no significant complication only one patient developed mild neutropenia. No other moderate to severe toxicities were noted.CONCLUSION: The MC that we used were safe, well tolerated and represents good value for patients with advance diseases that are eligible for palliative care. Children achieved disease stabilization, partial and complete remission without any complication. The use of MC in children in low-income countries warrants further studies.

SL 181

Frequency, Risk Factors, Severity and Clinical Manifestations of Vincristine Induced Peripheral Neuropathy in Children Undergoing Chemotherapy for Acute Lymphoblastic Leukemia During Induction

Nazneen Sultana

Department of Paediatric Haematology and Oncology, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh

Background: As cure rates of childhood Acute Lymphoblastic Leukemia (ALL) is exceeding 80%, there is compelling need to alleviate treatment related toxicities that can compromise quality of life. Vincristine is an anticancer agent which is given to every child with ALL and peripheral neuropathy is the major dose-limiting toxicity of this microtubule inhibitor. But there is limited data documenting true incidence, risk factors, severity and clinical manifestations of vincristine induced peripheral neuropathy from Bangladeshi population. Methodology: It was a prospective observational study which was conducted from September 2017 to August 2018 in the Department of Paediatric Haematology and Oncology, BSMMU, Dhaka. All newly diagnosed cases of ALL and AML between the age of 5- 17.9 years with no pre-existing neurological abnormality were included. Relevant data regarding assessments of peripheral neuropathy using pediatric modified -Total neuropathy score (pm-TNS) and NCI-CTCAE grade were collected  prospectively and analyzed. Result: Among seventy two diagnosed ALL patients, 29.2% (21) developed peripheral neuropathy (PN) (p-value 0.038) compared to thirty AML patients only 10% (3) developed PN which was taken as control group. Higher frequency of peripheral neuropathy 57.1% was found in age below 10 yrs patients (p-value <0.001). Higher frequency of peripheral neuropathy was found in female patients (57.1%). Highest frequency of peripheral neuropathy was observed in week 4 of induction chemotherapy (66.7%).  In this study, NCI-CTCAE grade 1 peripheral neuropathy was observed during induction period. Major clinical manifestations observed were decreased distal muscle strength (58.3%), difficulty in walking (58.3%) and constipation (54.2%). There was no association of peripheral neuropathy with demographic characteristics (sex, weight, height, BMI of patients), initial WBC count. Conclusion: In this study, the frequency of vincristine induced peripheral neuropathy(VIPN) was found to be 29.2% during induction period. VIPN was found singnificantly higher in age below 10 years which was milder in severity. 




Cervical Carcinoma Patterns of Presentation and Management: Recent Experience in National Cancer Research Institute and Hospital, Bangladesh

Suriana Sultana1, Sirajum Monira2, Sarowat Sultana, MSI Jony4, Mahmudur Rahman, Mohibur Hossain Nirob

1FCPS Part 2 Trainee, National Institute of Cancer Research and Hospital; 2IMO, National Institute of Cancer Research and Hospital Dhaka, Bangladesh, Associate Professor, National Institute of Cancer Research and Hospital Dhaka, Bangladesh Register, National Institute of Cancer Research and Hospital Dhaka, Bangladesh Medical Officer, National Institute of Cancer Research and Hospital Dhaka, Bangladesh Resident, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh

Introducion: Carcinoma cervix is the second most common types of cancer in Bangladesh, with approximately 12,000 new cases detected every year and around 6,000 deaths due to the severity of the disease according to UN population agency UNFPA. Prognosis and outcome of the disease depends on staging of the disease, histological grade and patient related factors. Surgery and chemoradiotherapy are the main modalities of treatment in early and advanced cervical carcinoma. In case of undermined stage and grade, upgraded treatment modality is recommended. In this study we explored patterns of disease presentation and treatment modalities in a tertiary level hospital.Method: This retrospective observational  study carried out in the department of radiation oncology, National institute Cancer Research and Hospital, Mohakhali, Dhaka from January 2019 to june 2019. Data collection was done from hospital based cancer registry. Result:Total 128 Cervical carcinoma patients were analyzed.  Most of the patients (61.78%) presented with advanced stage of disease. About 28% patients presented as unstaged disease due to incomplete surgical evaluation that resulted in patients receiving higher treatment modality (Concurrent Chemoradiotherapy). Common histologic pattern was Invasive Squamous cell carcinoma (89%) but histopathological grading was absent in 36% cases. 62.5% of the patients had incomplete surgery before presenting to radiotherapy department for further management, all of which were  done outside of the institute. Conclusion: This study highlights the importance of multidisciplinary approach in the management of cervical carcinoma patients as improper diagnosis and staging results in advanced disease presentation with treatment related morbidity and poor treatment outcome. We also suggest for strengthening screening program and proper referral for early management,  establishing standard treatment protocol with multidisciplinary approach to minimise cervical cancer mortality and morbidity in Bangladesh.



Quality of Life Of Cervical Cancer Patients After Completion of Treatment-A Study in Bangladesh

Nasrin Hossain

National institute of cancer research and hospital, Dhaka

Introduction:Cervical cancer is the main cause of malignancy related death among women living in developing countries. The aim of study is to evaluate the quality of life (QOL) among Bangladeshi cervical cancer survivors and its relationships with demographic and disease related factors. Method: A cross sectional study was carried out on one hundred nine consecutive cervical cancer survivors in National Institute of cancer research and hospital, Dhaka. Study period was 6 months and using European organisation for research and treatment of cancer core questionnaires( QOL C-30 and QOL CX24). Demographic condition like education level, occupation and disease related factors against functional scales. Cronbach’s alpha was calculated to asses internal consistency among items. Result: cervical cancer survivors stated a moderate QOL. Sub- domains of QOL score and global health status were significantly associated with physical function (PF) scales ( p=.000), fatigue (p=.045), nausea and vomiting (p=.000), appetite loss( p=.001), constipation ( p=.005), symptom experience ((p=.005) and menopausal symptoms ( p=.015). QOL mean score were negatively associated with emotional function ( EF)scales , pain, fatigue, nausea, appetite loss and financial problems. Education level showed significant association with physical function (PF)(p=.001), emotional (EF)(p=.027), cognitive function (CF)( p=.000) and sexual function (p=.001). Duration ( fellow up) time was significantly associated with PF(p=.005), EF(p=.012), symptoms expr(p=.001). Conclusion: QOL in cervical cancer survivors was moderate, treatment of related symptoms and improvement of demographic condition can influence the QOL and survivors improve the care of cervical cancer. So , improve the QOL among cervical cancer survivors.




Female Lung Cancer: an Emerging Issue in Bangladesh

Muhammad Rafiqul islam, Jahangir alam, Abdullah Al mamun, ATM Kamrul Hasan, Syed Mohammad Ariful Islam

National Institute of Cancer Research and Hospital, Dhaka Bangladesh

Introduction: Breast cancer is the leading killer of female cancer patient. Lung cancer became the second affecting cancer (12%) but the main killer (25%). We tried to find out the socio-demographic status and some characteristic of lung cancer of female in Bangladesh.Method:This was a descriptive observational study on 1549 female cancer patients reached at Outpatient of Medical oncology department of National Institute of cancer Research and Hospital, Mohakhali, Bangladesh from January 2018 to June 2018. Result: Total number of 1549 female patients were included in this study. The average age of the study population was 46.87 where is the average age of female lung cancer patient was 55.25 years and average weight was 50.54kg  but the female lung cancer patients average weight was 45.09kg. We had found 215 lung cancer patient (12%) among the 1549 female cancer patient.  92% were NSCLC, 7% were Small Cell Variety with 1% others like Sarcoma, mesothelioma etc. In the non-small cell carcinoma, 59% were adenocarcinoma, 28% were squamous cell carcinoma and not-identified 5%.  133 patient (62%) had right sided lung cancer. most of the patients were illiterate (72%) and 82% patient were poor or below average economically. only 28% female patient didn’t have any habitual problem. 39% patients had the battle nut/ Jarda , 15%were smoker, 5% were Gul user and 13% had more than one habitual issues. most frequent comorbidity was Hypertension which was 43% and second was DM (28%) and 26% patient having more than one comorbidity. Conclusion: The percentage of female lung cancer in Bangladesh and United State of America is same (12%). The socio-demographic status of USA and Bangladesh is different. So, what are the factors that responsible for female lung cancer, may be a good research point. Cancer with other comorbidities makes the treatment more complicated for the cancer physician as well as brings the worst outcome. So, cancer management should be personalized. 




 Hormone Receptor Status of Female Breast Cancer Patient: Perception at A Tertiary Level Cancer Hospital in Bangladesh.

Muhammad Rafiqul Islam, Abdullah Al mamun, ATM kamrul Hasan, Syed Mohammad Ariful Islam, Anwar Hossen

National Institute of Cancer Research and Hospital, Dhaka, Bangladesh

Background:   In Bangladesh, breast cancer is most common cancer in female patient. Hormonal status and Her-2 status investigation is not available throughout the country and a little bit expensive. In Bangladesh, not yet any cancer registry, so the real picture of breast cancer hormonal status and Her-2 status patterns are unknown. The aim of the study to determine the hormonal and Her-2 status of female breast cancer of Bangladesh. Method: This was a descriptive observational study on 745 female breast cancer patients reached at Outpatient of Medical Oncology department of National Institute of cancer Research and Hospital from July 2017 to march 2018. Patients were selected purposive sampling method. Result: Total number of 784 patients were included in this study. The mean age of the study population was 43.85 years (SD 10.76 years). Among them 463 (59.06%) patients ER/PR/Her-2 status report were unavailable. We had found 12 type of presentation of HR/PR/Her-2 status. Among them most common variety was triple negative 105 (32.60%) and ER+PR+Her-2-Ve variety was second most common 91(28.26%). the total population was divided in to two groups 20-49 years and above 50 years. 544(69.39%) patients were in 20-49 years group and 240(30.61%) were in above 50 years.  In first group, 119 (52.89%) were ER+ve, 91(40.44%) were PR+ve, Her-2 +ve 39(17.33%), 151 (67.11%) were Her-2-Ve, 33(14.67%) patient did not advise to do the her-2status and 1 patient found Her-2 equivocal. all ER,PR,Her-2 positive were 14 patient (6.22%) and 66 (29.33%) were triple negative in this group.  R, PR, Her-2 all were positive in 6(6.25%) patient and triple negative were 39(40.63%) and I patient were equivocal. Conclusion:  The socio-economic condition of female breast cancer patient is very poor. More over the maximum female breast cancer patient did not do the ER/PR/Her-2 investigation, why? Finding the factors that can modify this situation, may be a good research area in Bangladesh.




Knowledge and Practice Towards Smoking in Lung Cancer Patients

Md. Golam Zel Asmaul Husna

National Institute of Cancer Research and Hospital Dhaka, Bangladesh

Introduction:Tobacco in any form, is injurious to human body. It is estimated that about 40% of all cancers diagnosed in the United States are associated with smoking tobacco. In USA, one third patients smoke at or around the time of malignancy diagnosis.  In Bangladesh, according to WHO, 43.3% adults use tobacco products (men 58.0% women 28.7%), among them, 23.0% smoke tobacco (men 44.7%; women 1.5%). In addition, about one-fourth of the deaths in Bangladeshi men between 25-69 years are due to smoking related illness. Studies showed that those who continue to smoke after diagnosis of lung cancer are at higher risk for poorer prognosis, as compared with cancer patients who quit. The risk can be minimized by educating the patients and caregivers regarding the benefit of cessation of smoking. Methodology: We conduct an observational cross sectional study to assess the knowledge and practice towards smoking as a risk factor, among lung malignancy patients in NICRH, by convenient sampling. N= 43. Result: Result revealed that, the 57%  of our respondants are recent smoker and, 43% are ex smoker mean age is 60 years. The mean pack year is 47 years, more than two third of the participants agree that tobacco smoking causes cancer and about 48% of respondents know smoking is the leading cause of lung or head-neck malignancies.  62% patient blames smoking as a risk factor for their current condition. Conclusion: Smokers underestimate their risk of lung cancer. Smokers show optimism by claiming that they are less at risk. Cancer patients still smoke despite their grave diagnosis. It is very disappointing that, being aware about the risk, lung malignancy patient doesn’t quit smoking or they are very reluctant to quit. It’s very necessary to make a clear perception about smoking as a risk factor for lung malignancy and CVDs.




Patient Attitude Toward Treatment Decision in Advanced Non-Small Cell Lung Cancer

Rahmat Ullah Bhuiyan

National Institute of Cancer Research Hospital, Dhaka, Bangladesh

Introduction: Lung cancer is the leading cause of cancer death, 18% cancer related death in worldwide and two third in United States. There is no clear data in our country.The goal of therapy in advanced non-small cell lung cancer is to improve QOL and prolong survival. Recent study suggests that cytotoxic chemotherapy improve median survival approximately 9 to 12 month vs 5 to 8 month with best supportive care but profound toxicity. However the benefit of chemotherapy should be weighted with patient perception and preference. Methodology: An observational and cross sectional study was conducted aiming to see the variability of the patient preference regarding platinum based chemotherapy in advanced non-small cell lung cancer.60 patient were included in this study and clearly explained the chemotherapeutic agent response, median survival with all possible toxicities and treatment cost. A pretested questionnaire was used to record patient’s willingness to accept chemotherapy or not in a tertiary level hospital in Bangladesh. Result: Result reveals wide variability in perception of chemotherapy in advanced non-small cell lung cancer. Most of the patients were male and two third of respondents received at least primary education. About one fourth patient were critically ill ( ECOG p/s is 3 and 4).68% of them were interested to receive chemotherapy despite knowing limited survival benefits. Surprisingly 24% patients believe that chemotherapy may cure them completely and 34% patient refuses chemotherapy due to toxicity, cost and not interested to take any treatment.Conclusion: Our study suggests that patient with advanced non-small cell lung cancer differ in acceptance of chemotherapy according to their level of education, knowledge, belief, economic and social value.so they should offer more than one treatment option instead of chemotherapy for all patients. More study is needed to identify various factors which are hidden behind this attitude.




Clinical Characteristics and Demographic Features of Chronic Phase of CML Patients In Bangladesh

Bikash Chandra Chand, Anamul Hasan, Raisa Akther, Jigishu Ahmed, Maisha Aniqua, Palash Kanti Dhar, Sharmine Zaman Urmee, Hafizur Rahman

Clinical Hematology and Cancer Biology Laboratory, Laboratory Sciences  Services Division, icddr,b, Mohakhali, Dhaka, Bangladesh

Introduction: Chronic myeloid leukemia (CML) in Asia has an incidence rate lower than Western countries yet tends to affect a younger population. In Bangladesh, there is no complete CML cancer registry hence a lack of appropriate information regarding the onset of age as well as basic demographical characteristics of the CML patients existing in Bangladesh. This study objective was to assess CML patient’s demography  (age, sex, regional variation), clinical and hematological, and molecular characteristic to explore the pattern of Bangladeshi CML patients. Method: The study’s population consisted of 290 patients with CML between August 2013 to November 2018 attending the outpatients department of icddr,b. Demographic information were collected prior to sample collection. Patients suspected as CML by previous CBC, peripheral blood film and bone marrow aspiration were confirmed by RT-PCR (BCR-ABL qualitative and quantitative) test.Result: The patients cohort had the age range of 10-80 years and mostly coming from Dhaka (108, 37.2%) and Chattagram (72, 24.8%). The median age at diagnosis was 36.0 (IQR: 28, 48). Most of the patients (45, 15.5%) were present in age group of 35-39 years. The median age of male and female was 36 years and 35 years respectively and male to female ratio was 2.29:1. The mean total leucocyte counts, platelet counts, and hemoglobin level were 195 x 109/L, 437 x 109/L and 9.81 g/dL during disease presentation. Females were more anemic than male (M Vs F: 9.96 Vs 9.46 g/dL) and also carried more platelet (M Vs F: 406 Vs 511 x 109/L). 287 patients were found to be as BCR-ABL subtype major (e13a2/e14a2) and 3 patients were BCR-ABL subtype minor (e1a2).Conclusion: Bangladeshi CML patients seem to be a population of younger people with a pattern of male-predomination. Further large scale study is therefore warranted.




Emergency Radiotherapy in Management of Cancer Patient: Tertiary Centre Review

Sarowat Sultana, Golam Zel Asmaul Husna, Arowa Binte Matin

Radiation Oncology, National Institute of Cancer Research Hospital, Dhaka, Bangladesh

Introduction: An unexpected situation that endangers life and requires an immediate action is an emergency of a cancer patient. Emergency radiotherapy is an important option for treating cancer patient in both early and late stages of the diseases. The purpose of the study was to investigate the role of urgent radiotherapy in management of cancer for improving the quality of life (QOL). Radiotherapy is one of the vital wings of treatment options in emergencies of oncology as well as primary malignancy. Methodology: Retrospective crosssectional study aiming to determine the number of patient getting urgent radiotherapy and see the patient burden, to have a view about the incidence of specific site of disease requires urgent radiotherapy and make plan to handle the emergency RT patient load. All patients who got urgent radiotherapy in radiation oncology department of NICRH during January to June 2019 were included in this study. Both radical and palliative intent patients were included in this study. Secondary data from registry collected and analyzed.Result: Total number of patient was 434. Among them 37% were female and 63% male. Mean age was 50.6 years, ranging 10-80 years. About 93% patient was given RT as palliative intent and rest 7% was given as curative intent. The highest incident disease was Ca lung (41%), followed by Ca Breast (14%) and CUP (8%). In terms of irradiated sites, the most irradiated site is bone 52% followed by brain 29%.Conclusion: Radiation treatment is fast, time sparing and effective treatment option for oncological emergencies. The delivery of radiation is accomplished by a variety of techniques and fractionation schedules. If there is no delay, urgent Radiation therapy can save life, reduces morbidity sometimes curative too. Provision of urgent RT as one stop basis is a basic need for a multi-disciplinary cancer care center.




Experience of Tc-99m MDP Bone Scan in Newly Diagnosed Carcinoma Prostate

Samira Sharmin

Institute of Nuclear Medicine and Allied Sciences, Sir Salimullah Medical College Hospital

Background: Carcinoma prostate is very common malignancy in men worldwide. Whole body bone scan is very popular imaging modality for the diagnosis of metastatic lesion in bone in carcinoma prostate patients. This study was designed to evaluate the bone scan findings along with other biochemical and histopathologial   reports in newly diagnosed carcinoma prostate patients who were referred for bone scan in Institute of Nuclear Medicine and Allied Sciences (INMAS) Mitford, Dhaka. Method: This study was carried out in the INMAS, Mitford, and Dhaka over a period of 02 year from January 2017 to December 2018.   About 101 newly diagnosed carcinoma patients were included in this study.  Bone scan was done by Dual Head Gamma Camera after injection of 20 mci Tc-99m MDP. Images were both anterior and posterior views along with SPECT in needed. Result: Mean Age 67.63±8.6, mean PSA 58.29± 52.38 with range of 14- 345 ng/ml and Gleason score ranges from 04-09. In this study 12 patients had PSA <20ng/ml had, among them   only 1 patient had multiple metastases but 07 had no metastasis in bone scan. 5 patients with PSA level 20-50 ng/ml   had multiple metastases in bone scan and 21 patients with PSA level >100 ng/ml had multiple metastases in bone. Regarding Gleason score, only 1 patient had multiple metastases   having Gleason score <4 among 33 patients. 14 patients with Gleason score 4-7  had multiple  metastases while  12 patients    among  26  who had  Gleason score >7 were found  to have  multiple skeletal metastases. Conclusion:  This study revealed that low PSA level  or lower Gleason score could not exclude the  bone metastases in  carcinoma prostate patients.




Association Between Human Papillomavirus (HPV) and The Oral and Oropharyngeal Cancer: A Systematic Review and Meta-Analysis

Shakil Ahmed1, Abrar Wahab2, Ahmed Hossain3

1Research Assistant, Department of Public Health, North South University, Dhaka, Bangladesh 2Monitoring Evaluation and Research Officer, Shornokishoree Network Foundation, 3Professor, Department of Public Health, North South University, Dhaka, Bangladesh

Background: Oral and Oro-pharyngeal cancer is a disease with multifactorial etiology. Smoking, alcohol, betel-quid, genetic vulnerability and some DNA viruses could also be associated with the causation of the oral and oropharyngeal cancer. Human papillomavirus (HPV), is well known as the causative agent of cervical cancer, apparently it is also responsible for the causation of the cancer of the oral cavity and oropharynx. The association of the HPV with the oral and oropharyngeal cancer remained obscure, referring mainly to the inconsistent data, although some research suggested their positive correlation. So, to investigate the association between human papillomavirus (HPV) and the oral and oropharyngeal cancer and to provide evidence based analysis of articles related with oral and oropharyngeal cancer and HPV we carried out this systematic review and meta-analysis. Methodology: A systematic review was conducted using PubMed, Medline, Chochrane, Google Scholar and the Internet search. Reviewed literature included the case-control and comparative cross-sectional studies. Consolidated data were analyzed by calculating the relative risk and odds ratios using binary random-effects model. Result: Out of 10,770 participants, 6,750 were cases and among the cases 26.09% of them were positive for HPV DNA. The estimated OR was 1.82 and 95% confidence interval which showed significant increased risk of human papillomavirus among the case group on the contrary to control group. Conclusion: The present meta-analysis indicated a significant causal relation among the human papilloma virus and oral and oropharyngeal cancers.




Carcinogenicity of Red Meat Consumption and Lung Cancer Risk Among Never and Non-Smokers: A Multicenter Case-Control Study in Bangladesh

Md. Shahjala, Ahmed Hossain

Student, Department of Public Health, North South University, Professor, Department of Public Health, North South University

Objectives: Red meat has been associated with carcinogenesis at several anatomic sites, but no study has examined red meat intake in relation to a range of malignancies in Bangladesh. Some epidemiologic studies suggest that diets high in red meat consumption are lung cancer risk factors. In Bangladesh, we investigated the red meat intake increases lung cancer risk at a variety of sites. Methods: A multicenter case-control study was conducted among never and non-smokers. Red meat intake was estimated from the frequency of consumption. We estimated a mixed effect logistic model with the sociodemographic and dietary factors and a random intercept by center. Confounding variables were investigated before applying the models. Data were entered by Epi Info and analyzed using R software. A p-value of < 0.05 at 95% confidence interval was considered to be statistically significant. Result: Red meat was positively associated with lung cancer risk (highest-versus-lowest tertile: OR, 1.8; 95% CI, 1.5–2.2; P trend < 0.001); the risks were strongest among never smokers (OR, 2.4; 95% CI, 1.4–4.0; P trend = 0.001). Conclusion: Consumption of red meat, was associated with an increased risk of lung cancer.




Status of Lipid Profile in Children with Acute Lymphoblastic Leukaemia During Induction Chemotherapy

SIDDIQUE R, JAMAL CY  NIGAR I, KARIM MA

Paediatric Haematology and Oncology, Department of Microbiology, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh

Background: The two main components of acute lymphoblastic leukaemia (ALL) treatment, steroids and L-asparaginase, cause lipid abnormalities and hyperglycaemia, leading to various forms of morbidity and mortality. If lipid abnormalities are not predicted timely, this might lead to pancreatitis and thromboembolism in acute conditions. Survivors of ALL may also develop hypertension and ultimately increased risk of coronary heart disease in the long run. Hence, this study would give an insight to the spectrum of the problems in our population and might help in planning treatment. Method: This was a prospective, observational study carried out from March to November 2013 in the Department of Paediatric Haematology and Oncology, BSMMU, with an aim to evaluate the changes in lipid profile due to induction chemotherapy. Thirty-five newly diagnosed children with ALL, aged 3 to 15 years old, were included in the study after obtaining written consent from their parent/guardian. Two patients were lost to follow-up while three died before completing asparaginase (E. coli) therapy. Fasting (8-12 hours) serum total cholesterol, TG, HDL, LDL, fasting blood glucose, ALT and creatinine levels, as well as PT and APTT were done before treatment, after completion of asparaginase according to protocol, and after induction. All the biochemical tests were done by photometric method, while PT and APTT were done by photo-optical method. Risk stratification of the patients was done by age, CBC and bone marrow examination. All data were recorded in a semi-structured questionnaire. Final analysis was done with the data of 30 children by SPSS version 15. Result: The mean (±SD) age of the study cohort was 6.07±2.95 years. Among them, 66.7% were ≤6 years old and 66.7% were male. Pre-treatment mean total cholesterol, TG, HDL and LDL levels were 158.40±42.70, 184.47±65.32, 19.93±10.85 and 101.20±35.01 mg/dl respectively. After completion of L-asparaginase, TG and LDL declined significantly, while HDL increased significantly. After completion of induction chemotherapy, the mean values of total cholesterol, HDL and LDL levels increased to 195.43±36.58 (p=0.003), 50.20±19.59 (p=0.001) and 116.70±27.59 mg/dl (p=0.186) respectively, but TG decreased to 140.93±62.80 mg/dl (p=0.060). Conclusion: Total cholesterol, HDL and LDL levels were found to be increased, while TG levels decreased in patients with acute lymphoblastic leukaemia after induction chemotherapy.

 

An Overview of Vulvar Cancer -Women"S Health Issue in Bangladesh

Farhana Kalam1, Shahana Pervin2

1National Institute of Cancer Research and Hospital,  Obstetrical and Gynaecological Society of Bangladesh, International Gynecologic Cancer Society, Association of Gynaecologic Oncologist of India, Asian Society of Gynaecologic Oncology

Background: Vulvar cancer represents about 5% of malignancies of the female genital organ and 0.6% of all female cancer. It is sometimes very challenging to manage properly the patients suffering from vulvar cancer who presents lately.Objective: The aim of this study is to evaluate the risk factors, clinical presentation and different modalities of treatment received the patients of vulvar cancer.Method: Prospective observational study was conducted in the department of Gynecological Oncology, National institute of cancer research and hospital, Mohakhali, Dhaka, Bangladesh from July 2015 to July 2019.Total 76 Patients with vulvar cancer attending gynae oncology unit 2 of NICRH were included in this study. All necessary information, clinical findings, and standard biochemical tests with the aid of some ancillary aid, imaging features of the tumors, histopathological finding were recorded in a pre-designed data collection sheet. Data was analyzed by SPSS. Result: Among 76 patients 34.21% patients were in < 50 years of age and 65.78% were in > 50 years of age and peak incidence was seen in the age group of 60-70 years. Incidence was significantly more in multiparous (p = .001) and post-menopausal women. HPV +ve cases about 35% and 16% HPV -ve among 51 % of cases  and no record of HPV test  in 49% of cases.77.63% of the cases were squamous cell carcinomas (G-I). 25% cases are lymph node positive. Eighty four percent of the cases were primarily treated with surgery with or without adjuvant therapy and about fifteen percent of the cases were treated by radiotherapy or CCRT. Sixty six percentage of the patients were in regular follow up.Conclusion: Conservative surgical treatment is the best option in early stage vulvar cancer and gives high survival rates .The outlook is normally good if diagnosis happens in the early stages, before the cancer spreads, and if the women receives prompt and appropriate treatment.




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 Knowledge and Awareness About Cervical Cancer and Prevalence of HPV Vaccination Among University Students Of Bangladesh

Md. Abdur Rafi1, Md. Rezwanul Haque Choudhury2, Kazi Abdul Mubin3, 

1Rajshahi Medical College Hospital, 2Rangpur Medical College Hospital, 3Department of Pharmacy, University of Rajshahi

Introduction: The incidence and mortality rate of cervical cancer in developing countries remain high despite being a preventable gynecological cancer by vaccination and early treatment due to poor awareness level. The present study aimed at assessing the knowledge of cervical cancer and identifying the HPV vaccination coverage among the young university students of Bangladesh.Method: The cross sectional study was conducted among the students of University of Rajshahi during February, 2019 using a pretested self-administered structured questionnaire. Chi square test was used to identify the predictors of knowledge level and binary logistic regression was used to identify the association between knowledge and taking HPV vaccine. Result: Among 412 participants 60.4% was female and their mean age was 19.75 years. Most of the respondents believed cervical cancer preventable but they had very little idea about the procedures of prevention or screening. Half of them were aware about HPV vaccine though most of them had no idea about the perfect age of vaccination. Almost one third of the respondents could not identify any risk factor and two third could not identify any symptoms of cervical cancer. HPV infection was most commonly identified risk factor followed by poor personal hygiene and multiple sexual partners. Older age, urban residence and higher socioeconomic condition were significantly associated with better knowledge. Internet and social media was most popular source of information. About 15.3% female respondents had taken HPV vaccine. Lack of knowledge, opportunity and higher price were claimed as the commonest cause of not taking the vaccine. In regression analysis higher knowledge about cervical cancer was significantly associated with taking vaccine.Conclusion: Mass awareness programs should be launched to raise awareness about cervical cancer and HPV vaccination and the vaccine should be included national EPI schedule.




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 Delayed Diagnosis and Difficulties in Treatment of  Ewings  Sarcoma in Children

Farida Yasmin, Mamtaz  Begum, M. Rashed  Z. Kabir, Ferdousi  Begum, Ashis kumar Ghosh

National Institute of Cancer Research and Hospital


Introduction : Ewings sarcoma  are high-grade sarcomas with a high metastasis rate occurring mainly in children and young adults .  A significant increase in survival rates has been observed in the last few decades with the use of a multimodal therapeutic approach that includes chemotherapy, surgery and radiotherapy  for patients with localized disease but not significantly improved for patients with metastatic disease. Objective : To evaluate the  demographic characteristics , delayed diagnosis and the difficulties in management of Ewings sarcoma in children  in a tertiary care hospital, Bangladesh . Materials and  Method :  In this retrospective  study ,  data regarding  age and sex distribution, location of tumors, management  of Ewings sarcoma  in children  were retrieved from the medical records of pediatric oncology department  in national institute of cancer research and hospital , Dhaka from january,  2017 to  december ,2018 . Result:  Total  97 cases of Ewings sarcoma  patients were collected including 32 boys  , 19 girls . Most of the patients were between  10 years to 18 years of age . The most commonest site were lower extremity (54%), followed by pelvis (19.6%) and upper extremity (17.6 ) , 64.7% patients presented with localized disease and 35.3% with metastatic disease at diagnosis , 58.8% patients had symptoms more than 6 months . Out of 97 patients only 42 (41%) patients started treatment. Of those patients who started treatment 19 patients continued with multimodalities of treatment, 8 patients discontinued, 10 developed metastatic disease during treatment 5 patients were dead . Conclusion :  A significant portion of patient  had delayed diagnosis and metastatic disease at diagnosis. Most of the Ewings sarcoma patients did not received treatment. The obstacles and difficulties of treatment are delayed diagnosis 58.8%, financial  inability 83% , lack of accessing to care 78%, abandonment of treatment and death from toxicity .




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Health Seeking Behavior of Hepatocellular Carcinoma Patients: From Symptoms to Treatment

Preyanka Nath1, Puspita Hossain2, Shamim Iqbal3

1Department of Biochemistry and Microbiology, North South University Dhaka, Bangladesh, 2James P. Grant School of Public Health, BRAC University; 3Department of Public Health, Independent University

Background:  Hepatocellular carcinoma (HCC) stands as the fifth prevalent cancer and third for cancer mortality. Health seeking bahviour (HSB) is directly related to disease incidence, prevalence, early diagnosis of symptoms, presentation to health care facility and thus reflect on reducing morbidity and mortality. This HSB is a necessary action for patients seeking treatment and there are many factors influencing this treatment-seeking behavior. Aim: To explore influencing factors shaping the treatment seeking pathway of the HCC patients from the emergence of symptoms to final treatment at a tertiary hospital and illustrate this pathway. Method: This qualitative study included fourteen (11 male and 4 female) in-depth interviews from patients and four key informant interview from service provider were collected using a semi-structured guideline through purposive sampling. All interviews transcribed verbatim, clustered in data matrix and sorted. Sorted data were analyzed according to the theme and pattern by using a priori and inductive codes. Result and discussion: Patient’s treatment started from their near vicinity and gradually reached BSMMU changing a number of treatment modalities and this process is influences by barriers and motivational factors. Lack of finance and wrong treatment delayed their treatment while support from the family and financial stability acted as a motivational factor. Diagnostic cost captured the major portion of the treatment cost and the total treatment cost itself was a big number to count. Majority patients followed a multistage treatment seeking pathway with a view of achieving better treatment and finally they stopped at BSMMU for reliable treatment. The length of such pathway was also differed among patients. Conclusion: Recognizing the factors playing role in treatment seeking pathway and addressing those in pragmatic way are expected to make an impact on HCC management.




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Practises of Cancer Screening in Abroad and Bangladesh

Julfikar Saif

Phase A resident, Department of Oncology, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh

Screening is the presumptive identification of unrecognized disease or defects by means of tests, examinations, or other procedures that can be applied rapidly. It has to be acceptable to the population, economically feasible for the society and country. Also screening programmes need to have sufficient sensitivity, specificity, positive and negative predictive value. There has to be facility for further confirmatory tests, effective interventions and follow-up available for detected conditions to justify mobilisation of manpower and resources for implementation of screening. Malignancy is the second largest contributor to non-communicable disease related mortality with about 9.6 million deaths globally in 2018. Chances of achieving cure are very much dependent on detecting the disease in early stages before it has spread locally or throughout body. High income developed countries already have screening programmes for different cancers on going and reaping benefits at the expense of increased health expenditure. With the changes of socioeconomic landscape in Bangladesh non communicable disease mortality has crept to as much as 59%. Due to lack of widespread awareness and availability of screening programmes most patients present with incurable advanced stage cancers which is a barrier to improving national life expectancy further. It is high time to adopt nationwide cancer screening programmes which are realistic and suitable for Bangladesh to meet the challenge.




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Cancer Care in A Tertiary Care Hospital in Bangladesh: A Descriptive Type of Cross-Sectional Study

Md. Ekram bin Faruq

Resident (Phase B), Department of Oncology, Bangabandhu Sheikh Mujib Medical University

Over the timeline of last century noncommunicable diseases held the steering over communicable diseases and are now responsible for the majority of global deaths. NCDs are projected to increase from 38 million in 2012 to 52 million by 2030. Four major NCDs (cardiovascular diseases, cancer, chronic respiratory diseases and diabetes) are responsible for 82% of NCD deaths. As an emerging killer of mankind, cancer incidence and mortality are growing rapidly and is expected to rank as the leading cause of death in every country of the world in the 21st century. The reasons are complex and are thought to be contributed from causal relationship between multiple factors including aging, increase life expectancy, socio- economic developments as well as various risk factors like smoking, alcohol, sedentary life style etc. The World Health Organization (WHO) reported the cancer disease accounting for 8.2 million deaths in 2012 and also predicted that 12 million of all deaths by 2030 worldwide will be due to cancer. There are 1.3 to 1.5 million cancer patients in Bangladesh, with about 0.2 million patients newly diagnosed with cancer each year. According to GLOBOCAN 2018, the most prevalent cancers in Bangladesh are Oesophagus, Lip and oral cavity cancer, Breast, Lung and Cervix. However, data from NICRH in 2014 tends to differ slightly than this and top 5 malignancies reported there are Lung, Breast, Lymphoma, Cervix and Oesophagus. Being the only medical university in the country and the lighthouse of medical research in Bangladesh, BSMMU is still lacking an effective cancer registry system. There are no data published from BSMMU about the cancer scenario in its Oncology department. This study aims to portray a snapshot of patient care in Department of Oncology, BSMMU. This study will help to demonstrate a complete picture and thus helps to offer effective measures to improve the quality of treatment one step forward.




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Perspective of Global Cancer Incidence and Mortality

Syed Md. Asadul Hoque

Phase-A Resident, Department of Oncology, Bangabandhu Sheikh Mujib Medical University

Non-communicable diseases (NCDs) are now responsible for the majority of global deaths and cancer is the second leading cause of death all over the world. Cancer is also one of the most important barriers to increase life expectancy in every country of the world in the 21st century.  The global cancer burden is estimated to have risen to 18.1 million new cases and 9.6 million deaths in 2018. In both sexes combined, lung cancer is the most commonly diagnosed cancer (11.6% of the total cases), closely followed by female breast cancer (11.6%), prostate cancer (7.1%), and colorectal cancer (6.1%). The increasing cancer burden is due to several factors, including population growth and ageing as well as the changing prevalence of certain factors, linked to social and economic development. Cancer transitions are most striking in emerging economies, where an increasing magnitude of the disease is paralleled by a changing profile of common cancer types. Although, approximately 70% of global deaths from cancer occur in low and middle income countries (like Bangladesh), a high quality cancer registry data, the basis for planning and implementing evidence based cancer control programs, are not available. Late stage presentation due to lack of public awareness, inaccessible diagnosis and unavailability of treatment put a significant impact on growing economy of these countries also. This presentation provides a status report on the global burden of cancer worldwide using the GLOBOCAN 2018 estimates of cancer incidence and mortality produced by the International Agency for Research on Cancer (IARC).




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Challenges in The Management of Preinvasive Diseases of Cervix

Begum Rokeya Anwar

National Institute of Cancer Research and Hospital

Recently the terminology and classification of pre invasive diseases have undergone a tremendous change. Recent understanding of the role of HPV DNA in the causation of cervical neoplasia ends up with the ‘LAST’ (Lower Anogenital  Squamous  Terminology) project. Aim of this project or classification is to develop an optimum diagnosis and management of precancerous lesion.The transit time from carcinoma in situ (CIS) to invasive cancer is said to require 8, 10 or 20 years. CIN does not necessarily progress in an orderly fashion to invasive cancer. Inadequate evaluation by physicians, cytopathologists and colposcopists may lead to improper management of pre invasive disease.CIN 1 is amarker of HPV infection, usually not representing a pre cancerous lesion. Some CIN 2 lesion represents acute HPV infection with more severe microscopic lesion; destined to regress. Others are precursor of CIN 3, which will persist and progress to future invasion; if left untreated. Dual immunohistochemical staining for ki-67 and p16 can improve histological classification.  In cases of professional disagreements in histological interpretation p16 is an adjunct tool.CIN 3 is clearly established as a cancer precursor. CIN lesion and invasive cancer may coexist in same patient. Early invasive cancers may be clinically occult. Without excision or proper evaluation of the lesion, TAH is an old challenge.Each method of cervical cancer screening needs adequate evaluation by clinicians, cytopathologists and colposcopists. HPV DNA test with high negative predictive value is the choice of screening as it reduces colposcopical burden, prolong interval of screening and reduce follow up visits of the patients.