Koirala Memorial Cancer Hospital Research Articles

Bacterial Etiology of Wound Exudates in Tertiary Care Cancer Patients and Antibiogram of the Isolates.

Introduction:Patients with malignancies frequently develop infections as a result of surgical procedures and fungating wounds leading to pus formation. This cross-sectional study was conducted to explore the bacteriological spectra of infections of various cancer sites and their antibiotic sensitivity patterns among the patients visiting minor operation theatre (OT) of B.P. Koirala Memorial Cancer Hospital (BPKMCH), Chitwan, Nepal.Methods:Over a period of 3 months from September to November 2018, a total of 183 wound exudates and pus samples were collected and analyzed by standard microbiological procedures. Isolates were identified based on the colony characters, Gram staining and an array of biochemical tests. Antibiotic susceptibility testing was performed by Kirby-Bauer disc diffusion technique according to criteria set by CLSI, 2016. Methicillin resistance in Staphylococcus aureus was tested with the help of cefoxitin using disc diffusion method.Results:Out of the 183 samples, 149 (81.4%) were culture positive. Among 13 different isolates identified, S. aureus (43.0%) was predominant followed by E. coli (14.0%). Higher incidence of bacteria was seen among the males (52.3%), in the age group 51 to 60 years (26.8%) and among the patients undergoing surgical intervention to deal with cancer (34.2%). The prevalence of wound infection was significantly affected by gender, age, and treatment regimen (P < .01). Out of the total 68 S. aureus isolates, 38 (44.1%) were deemed as Methicillin-resistant Staphylococcus aureus (MRSA). Among the 158 isolates, 85 (53.8%) were multi-drug resistant (MDR). Cefepime was the most effective antibiotic for Gram positive isolates whereas both imipenem and meropenem were found to be equally more effective for Gram negative isolates.Conclusion:This study suggests that patients with malignancies harbor pathogenic bacteria; therefore, prudent use of antibiotics is essential to prevent the emergence of MDR pathogens.

Complications and predictors of diagnostic yield of endobronchial forceps biopsy in visible lesions

Background: Fiberoptic bronchoscopy is an important and relatively safe procedure for evaluation of various pulmonary diseases. Endobronchial forceps biopsy is commonly performed sampling technique for visible lesions in tracheobronchial tree. Diagnostic yield of biopsy depends upon lesion type and the number of biopsy samples taken. This study aimed to evaluate the complications and diagnostic yield of endobronchial forceps biopsy in visible lesions and correlate the number of biopsy samples taken with the yield.&#x0D; Methods: This was an observational study conducted at two tertiary care hospitals in Chitwan; Chitwan Medical College Teaching Hospital and B P Koirala Memorial Cancer Hospital. One hundred and forty patients who underwent endobronchial forceps biopsy of bronchoscopically visible lesions were included. Complications and diagnostic yield of the biopsy samples and its correlation with number of biopsies taken were evaluated.&#x0D; Results: The common complications observed were transient drop in saturation &gt; 4% (22%) and mild bleeding (9.9%). The net diagnostic yield was 67.4% that significantly improved with an increase in the number of biopsies taken. The yield was better for exophytic growths compared to submucosal/ mucosal lesions (83.7% vs. 57%, OR = 8.1 (2.2 – 29.9), P&lt;0.001). The association of improved yield with increased number of biopsy was more pronounced in exophytic growths compared to submucosal/mucosal lesions.&#x0D; Conclusion: Endobronchial forceps biopsy is a safe procedure that gives a good diagnostic yield in bronchoscopically visible lesions, provided adequate number of biopsy sample are taken. The probability of getting a positive yield is high in exophytic growths.

Penile squamous cell carcinoma :a three-year study at BP Koirala Memorial Cancer Hospital

Background: Penile cancer is an aggressive and mutilating disease which deeply affects self-esteem and daily life of the patient. Penile cancer mostly affects the elderly, seen in people in their sixties and seventies. Occurrence in younger age is a need of research of penile neoplasia in young non-circumcised patients.&#x0D; Materials and Method: This is a three-year retrospective study. Data was extracted from the Department of Pathology and Medical Record section of B.P. Koirala Memorial Cancer Hospital. All histologically proven cases were included. The objective of this study was to assess clinical histopathological profile of penile carcinoma.&#x0D; Results. A total of 114 malignant cases were included out of which most common age group involved was 50-60 years with mean age of presentation being 51.6 years. Glans was the commonest site of involvement in 59 cases (51.7%). Well-differentiated squamous cell carcinoma was the most common type (71%). Forty nine patients (43%) presented when the mass size was 4-6 cm and 44 (39%) came with 2-4cm and rest less than 2 cm. Lymphvascular invasion was seen in 15 (13%) out of 114 cases and perineural invasion was seen only in 5 (4.3%) cases. 20 cases (17.5%) had lymphnodes positive which are less than 5 lymphnode positive and five (4.3%) had more than 5 lymphnodes positive.&#x0D; Conclusion. Early diagnosis and intervention of the patient ensure high probability of getting cured because the stage at presentation appears to be the most vital prognostic indicator for survival.

Carcinoma of Vulva in Nepalese Women Managed at B. P. Koirala Memorial Cancer Hospital

Introduction: This study aims to analyze the clinical presentation and management outcomes carcinoma of vulva managed B. P. Koirala Memorial Cancer Hospital.&#x0D; Methods: A descriptive study was conducted of all carcinoma of vulva cases managed at B. P. Koirala Memorial Cancer Hospital from 1999 to 2009. The case record of all women diagnosed to have carcinoma of vulva were retrieved and socio-demographic characteristics, clinical presentations, histological type, treatment modalities and outcome were obtained and analyzed.&#x0D; Results: There were 5152 gynecological malignancies and vulvar cancer accounted for 87, giving a prevalence of 1.7%. The ages ranged from 17 to 86 years (mean of 48.6 years). Parity was 0-10. Vulva wound and pruritus were the most frequent clinical features with presentations in stage I -8%, stage II- 28%, stage III – 52 % and stage IV -12%. Squamous cell carcinoma (93%) predominated and 62% were grade I. Among the 87 cases, 32% were treated primarily with surgery, 34% primarily with concurrent chemo-radiation and 28% with combined modality. Clinical follow-up of one to five years showed that 26 (30%) cases had local recurrence and 22 (25%) died of disease.&#x0D; Conclusion: Carcinoma of the vulva is a rare gynecological malignancy in Nepal. Surgery and radiotherapy remain to be the mainstay of treatment. Delayed presentation still results in greater morbidity and mortality rates.

An Overview of Ovarian Tumours at B.P. Koirala Memorial Cancer Hospital, Nepal

Introduction: Ovarian cancer is the seventh most commonly diagnosed cancer among women in the world. This study was conducted with the aim to find out different histological types of ovarian tumours reported at B.P. Koirala Memorial Cancer Hospital (BPKMCH), Chitwan, Nepal.&#x0D; Methods: This was a retrospective study carried out at the Department of Pathology of BPKMCH from January 1, 2018 to December 31, 2018. This study included the patients who were operated at BPKMCH or referred cases from elsewhere, but the specimen was processed and reported at BPKMCH. All the data were retrieved and analyzed from the records of Pathology Department.&#x0D; Results: Altogether 87 cases of ovarian tumours were reported during the study period. Out of which, 31 cases were benign ovarian tumours whereas 56 cases were malignant ovarian tumours. Both benign and malignant ovarian tumours were most common in age group 41 to 50 years of age. Among benign ovarian tumours, 12 cases were serous cystadenoma, 7 cases mucinous cystadenoma, 6 cases mature cystic teratoma, 2 cases serous cyst adenofibroma, 2 cases benign Brenner tumour and 2 endometroid cystadenoma. Among malignant ovarian tumours, 33 cases were serous cystadenocarcinoma, 11 cases mucinous cystadenocarcinoma, 2 cases immature teratoma, 3 cases were malignant sex cord stromal tumours (granulosa cell tumour), 2 cases dysgerminoma, 1 case yolk sac tumour, 1 case endometroid carcinoma and 3 cases were metastatic adenocarcinoma.&#x0D; Conclusion: Surface epithelial tumours were most common ovarian tumours in this study. Serous cystadenomas were most common benign ovarian tumours whereas serous cystadenocarcinomas were the most common malignant ovarian tumours.

Enterostomal Therapy Service: Ten-year Experience at B.P. Koirala Memorial Cancer Hospital

Introduction: Enterostomal therapy (ET) is the newly evolving subspecialty area of nursing. None of the university started the ET courses in Nepal. Very few ET nurses catering the needs of osteomates in different hospital. Increasing burden of colorectal and urinary bladder cancer increases the ostomy population. There are no definite data regarding the ostomy population in national context. So, this is the neglected area of care in most cancer hospital of Nepal. The objective of this study is to find out the total number of ostomy population in terms of types of ostomies, age, sex, geographical distribution, complications and stoma service availability at BP Koirala Memorial Cancer Hospital.&#x0D; Methods: A descriptive study was carried out retrospectively at, BP Koirala Memorial Cancer Hospital, Bharatpur Nepal and approved by nursing department. All available data were abstracted from stoma clinic from 2008 to 2018.&#x0D; Results: There were total 659 ostomates registered in the stoma clinic. Among them majority 63% were male. There were main three categories of ostomate namely colostomies (66.7%) 440, Ileostomies (9.8%) 65 and urostomies (23.3%) 154. Ostomate represented from 56 districts. International osteomate also took services from the clinic. Peristomal skin excoriation, Parastomal hernia, stoma prolapsed were complications reported by the osteomates.&#x0D; Conclusion. This aspect of ostomy care and management deserves an investment of research to find out the reliable data.

Trend in Incidence of Cervical Cancer in a National Tertiary Cancer Hospital of Nepal, 2012-2017

Introduction: Cervical cancer is the first common cancer and a leading cause of mortality among Nepalese women. The trend of cervical cancer can be useful for effective planning and policymaking to reduce the burden of the disease. This study aims to determine the incidence of cervical cancer and assess its trend in over 6 years in a national tertiary cancer hospital.&#x0D; Methods: This was a descriptive study with secondary data analysis of new cervical cancer that were registered from 2012 to 2017 in the registry of B.P. Koirala Memorial Cancer Hospital, Chitwan, Nepal. Descriptive statistics along with the trend of cervical cancer were analyzed.&#x0D; Results: A total of 3,254 cervical cancer cases were registered during 2012 to 2017. It contributed to 11.7% of total cancer and 21.2% of total female cancer cases. The trend of cervical cancer was relatively constant with highest of 605 cases in the year 2016 and lowest of 459 in the year 2014. The most common age group was 45-59 years (44.6%) followed by 60-74 years (29.4%) and 30- 44 years (21.1%).&#x0D; Conclusions: The trend of cervical cancer is relatively constant over the study period. Organized awareness activities, HPV vaccination, and screening programs are recommended to prevent and control the burden of cervical cancer in the country.

A Retrospective Analysis of Carcinoma Penis Patients Treated at a Cancer Center in Nepal in a Period of Five Years

Introduction: Carcinoma Penis is not an uncommon condition in a developing country like Nepal and comprises 1-10% of all the malignancies in males. In this study we analyzed the demographic and clinicopathological profile of penile cancer patients who visited our cancer center during specified period.&#x0D; Methods: This is a descriptive cross-sectional study, that altogether included 218 patients from January 2012 to December 2016 with penile cancer conducted at B P Koirala Memorial Cancer Hospital, Nepal. All the demographic and clinico-pathological data were collected and analyzed using SPSS 16.0 software. Tumor staging was standardized according to the American Joint Committee on Cancer system. Quantitative data were represented as mean and standard deviation whereas categorical variables were expressed as frequencies and percentages of an appropriate denominator.&#x0D; Results: Among 218 patients, the mean ± SD age was 53.94 ± 13.69 years. Most were married (88.07%), smokers (67.88%), had poor personal hygiene (70.64%) and had not completed primary school (71.64%). The predominant profession was agriculture (81.65%). Most of the patients (56.88%) were diagnosed in clinical stage III b (T1-3, N2). Management was circumcision alone in 5.5%, Wide local excision in 6.88%, partial penectomy in 66.97% patients, total penectomy with perineal urethrostomy in 11% of patients and 9.63% patients were sent for chemotherapy after initial biopsy for fixed and fungating inguinal nodes. Bilateral inguinal lymph node dissection was performed in 87.15% patients. Most of our patients were uncircumcised (90.82%) Squamous cell carcinoma was the commonest histopathology (98.6%).&#x0D; Conclusion: Penile cancer is more common among farmer with low socioeconomic status. The disease is already locally advanced and at the time of diagnosis. Surgery is the main modality of treatment.

Pattern of Major Salivary Gland Malignancy in B.P. Koirala Memorial Cancer Hospital

Background: Salivary gland tumors represent a different variety of histological types. The definite diagnosis of type of salivary gland tumor is required for proper treatment planning. The aim of this study was to evaluate the pattern of salivary gland malignancy in B.P. Koirala Memorial Cancer Hospital, Bharatpur, Chitwan.&#x0D; Methods: This cross-sectional study was carried out in patients of malignant salivary gland tumor registered in B.P. Koirala Memorial Cancer hospital retrospectively from September 2009 to August 2012.&#x0D; Results: Parotid gland was the most common sites for malignant salivary gland tumor (80%) followed by submandibular gland (20%). Mucoepidermoid carcinoma is the most common malignant salivary gland tumor of parotid gland and Adenoid cystic carcinoma was the most common malignant tumor of submandibu-lar gland. Male: Female ratio was 1.5:1 with age range from 12 years to 71 years. Common age group for malignant salivary gland tumor was from 50 to 60 years.&#x0D; Conclusions: Parotid was the most common site whereas Mucoepidermoid carcinoma was the most common malignant tumor of major salivary gland.

Psychosocial and Functional Distress of Cancer Patients in A Tertiary Care Hospital: A Descriptive Cross-sectional Study

Global burden of cancer is witnessing an exponential increase. Nepal is no exception. In the recent years, cancer care has seen a focus shift towards holistic healing. This includes screening and assessing for psychosocial distress, allowing health care providers to deliver timely psychological interventions. The goal of this study was to find the prevalence of psychosocial and functional impact of cancer diagnoses in Nepal. A descriptive cross-sectional study was carried out on 169 cancer patients attending out-patient department, day-care and in-patient department at B.P. Koirala Memorial Cancer Hospital, Nepal. National Comprehensive Cancer Network Distress Thermometer was used to evaluate spiritual/religious concerns, practical, family, emotional and physical issues and the distress score of these patients. One-hundred and thirty eight (81.7%) of respondents had a Distress Thermometer score of ≥4. Distress Thermometer score of 7 was reported by the largest number of patients. Highest average Distress Thermometer scores were found in patients with hepatobiliary, head & neck and lung cancers. More than 50% of the patients reported to experience spiritual or religious concerns, fatigue, pain, worry and insurance or financial related concerns. Pain, sadness, worry and spiritual/religious concerns were significantly associated with distress levels. Sixty-two (36.7%) of respondents were in stage IV of cancer. Average Distress Thermometer score for patients in stage IV cancer was 5.69, the highest among all cancer stages. Ninety-six (56.8%) of the respondents were females, 73 (43.2%) were males. Gynaecological, haematological, gastrointestinal, head & neck and breast cancers were the top 5 cancer types. Cancer patients in Nepal have clinically significant psychosocial issues that directly impact on their distress.

Reproductive and Hormonal Factors in Relation to Lung Cancer Among Nepali Women.

Background: Of the 1.8 million global incident lung cancer cases estimated in 2012, approximately 60% occurred in less developed regions. Prior studies suggest sex differences in lung cancer risk and a potential role for reproductive and hormonal factors in lung cancer among women. However, the majority of these studies were conducted in developed regions. No prior study has assessed these relationships among Nepali women.Methods: Using data from a hospital-based case-control study conducted in B. P. Koirala Memorial Cancer Hospital (Nepal, 2009–2012), relationships between reproductive and hormonal factors and lung cancer were examined among women aged 23–85 years. Lung cancer cases (n = 268) were frequency-matched to controls (n = 226) based on age (±5 years), ethnicity and residential area. The main exposures in this analysis included menopausal status, age at menarche, age at menopause, menstrual duration, gravidity, and age at first live-birth. Odds ratios (ORs) and 95% confidence intervals (CIs) were estimated using multivariable logistic regression.Results: Among postmenopausal women, those with a younger age at menopause (<45 years; 45–49 years) had an increased odds of lung cancer compared to those with an older (≥50 years) age at menopause [OR (95%CI): 2.14 (1.09, 4.17); OR (95% CI): 1.93 (1.07, 3.51)], after adjusting for age and cumulative active smoking years. No statistically significant associations were observed with the other reproductive and hormonal factors examined.Conclusion: These results suggest that Nepali women with prolonged exposure to endogenous ovarian hormones, via later age at menopause, may have a lower odds of lung cancer.

Cancer Registration in Nepal: Current Status and Way Forward

Cancer registration is an organization for the systematic collection, storage, analysis, interpretation and reporting of data on subjects with cancer. Cancer Registry was initiated in 1995 and expanded as National Cancer Registry Program since 2003 by B.P. Koirala Memorial Cancer Hospital with the support of World Health Organization. National cancer registry program currently includes 12 hospital-based registries. First time in Nepal, B.P. Koirala Memorial Cancer Hospital piloted population-based cancer registry in 2013, which included 15 districts covering 25.8% of total population of Nepal. National cancer registry program is important to assure the quality of data from all the registries to ensure the availability of reliable and valid data of cancer cases. This will further help policymakers to develop preventive and control strategies against cancer. This paper reviews the current status of cancer registries in Nepal and discusses challenges and future perspectives related to national cancer registry program. National cancer registry should further include major hospitals in Nepal to give scientific information on cancer trends by community, provinces and regions and to analyze on survival of cancer cases. Keywords: cancer; national cancer registry program; Nepal.

Fatigue Experience and Coping Strategies among Cancer Patients Receiving Chemotherapy

Cancer is considered one of the foremost common causes of death. Fatigue is among the distressing symptoms for cancer patients receiving chemotherapy. Adequate coping is essential for individual to deal with the effects of cancer related treatment. The objective of the study was to find out the fatigue experience and coping strategies among cancer patients receiving chemotherapy. A descriptive, cross-sectional research design was used for the study. The samples was taken from day care and medical oncology ward of BP Koirala Memorial Cancer Hospital, Bharatpur. A total of 120 cancer patients receiving chemotherapy of 18 years and above were selected by using non probability consecutive sampling technique. Data was collected by using standard tool, Fatigue Symptom Inventory and Brief Cope. Data analysis was done by descriptive and inferential statistics. The study revealed that 82.5% of respondents had experienced fatigue and 50.8% respondents had used adequate coping strategies where "self distraction"(2.76±1.02) was the most used coping strategy by the respondents. Fatigue experience and coping strategies had negative correlation (r=-0.490, p=<0.001). Majority of the respondents had experienced fatigue, and half of the respondents used adequate coping strategies. The different methods of coping strategies for fatigue and chemotherapy related effects should be expanded as per the best available evidence to lower fatigue and other adverse effects.

Fatigue Experience and Coping Strategies among Cancer Patients Receiving Chemotherapy

Background: Cancer is considered one of the foremost common causes of death. Fatigue is among the distressing symptoms for cancer patients receiving chemotherapy. Adequate coping is essential for individual to deal with the effects of cancer related treatment. The objective of the study was to find out the fatigue experience and coping strategies among cancer patients receiving chemotherapy.Methods: A descriptive, cross-sectional research design was used for the study. The samples was taken from day care and medical oncology ward of BP Koirala Memorial Cancer Hospital, Bharatpur. A total of 120 cancer patients receiving chemotherapy of 18 years and above were selected by using non probability consecutive sampling technique. Data was collected by using standard tool, Fatigue Symptom Inventory and Brief Cope. Data analysis was done by descriptive and inferential statistics.Results: The study revealed that 82.5% of respondents had experienced fatigue and 50.8% respondents had used adequate coping strategies where “self distraction”(2.76±1.02) was the most used coping strategy by the respondents. Fatigue experience and coping strategies had negative correlation (r=-0.490, p=&lt;0.001).Conclusions: Majority of the respondents had experienced fatigue, and half of the respondents used adequate coping strategies. The different methods of coping strategies for fatigue and chemotherapy related effects should be expanded as per the best available evidence to lower fatigue and other adverse effects.Keywords: Cancer; chemotherapy; coping strategies; fatigue.

Cancer Incidence in 12 Major Hospitals of Nepal

Background and context: In Nepal, no population based cancer registry program exists to know the incidence, prevalence, morbidity and mortality of cancer. Since 2003 AD we have been conducting hospital based cancer registry program in 7 major hospitals and now we include 12 hospitals in 2014 in the initiation of BP Koirala Memorial Cancer Hospital. Aim: To find out about the burden across a greater proportion of cancer from 12 major hospitals of Nepal. Strategy/Tactics: Coordination with 12 hospitals´ medical record section to abstract the cancer data. The cases were verified by name, age, sex, address, topography and morphology. Repeated cancer cases were excluded from database. Program/Policy process: The total 9036 cancer cases were included in this study to know the cancer incidence in 12 major hospitals in 2014. This was descriptive type of study and all cases were collected from medical record section for data analysis. Outcomes: Among case the mean age of the patients was 53.6 years. The common form of cancer for both sex was bronchus and lung (13.7%) followed by cervix uteri (9.4%) and breast (9.4%). Cancer of the cervix (17.0%) was the top ranking cancer site for female followed by breast (16.4%) and bronchus and lung (10.9%). Similarly, cancer of the bronchus and lung (17.2%) was the commonest cancer for male followed by stomach (7.6%) and larynx (6.2%). Female cases (54.0%) were frequently high than in male (46.0%). What was learned: This type of study shows burden across a greater proportion of cancer from 12 major hospitals, but the coverage may not represent the whole country.

Quality of Life of Ostomy Patients Attending BP Koirala Memorial Cancer Hospital Chitwan

Background: The global scenario shows an increase trend of ostomy surgery. And, quality of life of ostomy patients has become a common concern. Understandings of factors that can have an impact on QoL should be assessed which will provide a guideline for improving QoL of ostomy patients. Aim: The aim of the study are to assess quality of life of ostomy patients and to find out the association between quality of life with selected demographic variables. Methods: A descriptive cross-sectional study was conducted to assess quality of life of ostomy patient. Ninety-four patients were selected by purposive sampling technique. COH-QOL-Ostomy questionnaire tool was used for data collection. Data were collected from descriptive and inferential statistics were used for data analysis. The P value was estimated at 95% confidence interval with 5% permissible error. Results: The study demonstrated that mean age of respondents was 51.10 ± 16.14 years. Permanent colostomy was common. The mean score for overall QoL was 6.50 ± 1.69. The physical domain (7.14 ± 2.32) had the highest score and spiritual (5.87 ± 1.56) had lowest. The major problems related to ostomy bag were leakage (68.90%), followed by itching around the stoma (52.70%), redness (32.40%), burning sensation (16.2%) and rashes (16.2%) respectively. Age, education, residence, occupation, duration of ostomy, reason and kind of ostomy, isolation of self from social gatherings and change in clothing style had significant effects on quality of life ( P &lt; 0.05). Conclusion: The findings revealed that presence of ostomy influences QoL of ostomy patients. Hence, adequate stoma care services, health education and counseling are important for having a positive impact on patients living with ostomy.

Comparative analysis between Liquid Based Cytology and Conventional Pap Smears at B P Koirala Memorial Cancer Hospital in Bharatpur, Chitwan, Nepal

Background and Objective: Liquid based cytology was introduced at B P Koirala Memorial Cancer Hospital in Bharatpur, Chitwan, Nepal, on 29th November 2017. The objective of this study was to compare the results of conventional pap smears over six (6) months periods from 29th May 2017 to 28th November 2017 with the results of liquid based cytology smears over six (6) months periods from 29th November 2017 to 28th May 2018.&#x0D; Methods: This is retrospective study. The results of conventional pap smears over 6 months and the results of liquid based cytology smears over 6 months periods were retrieved and analysed to give overall reporting profiles and compared between the two methods.&#x0D; Results: The percentage of unsatisfactory smears fell 3.9% by conventional pap smears methods where as the percentage of unsatisfactory smears fell 1.2% by liquid based cytology smears. There was an increase in the number of smears reported as dyskaryosis of any grade by liquid based cytology methods.&#x0D; Conclusion: The introduction of liquid based cytology led to improvements in unsatisfactory smear rates and also with significant pick up rates of dyskaryosis were maintained and improved.

Leukaemia with pregnancy managed at B. P. Koirala Memorial Cancer Hospital

Abstract: Leukaemia during pregnancy is rare, occurring approximately one in every 75,000 to 100,000 pregnancies annually. Chemotherapeutic agents may have harmful effects to the developing baby though leukaemia itself rarely harms the baby. There is no evidence that pregnancy accelerates the progression of disease or affects the outcome. However, treatment dilemmas often occur.&#x0D; Aims: To study the clinical presentation, treatment and outcome of leukaemia with pregnancy managed at B. P. Koirala Memorial Cancer Hospital (BPKMCH).&#x0D; Methods: Descriptive study was conducted at BPKMCH. Case records of women with cancer and pregnancy from January 2006 to February 2013 were analyzed regarding their clinical details, treatment, follow-up and feto-maternal outcome.&#x0D; Results: Six women, of 20 to 28 years had leukaemia with pregnancy among which four were chronic myeloid leukaemia (CML), one was acute lymphocytic leukaemia (ALL) and acute myeloid leukaemia (AML) each. All four cases of CML had conceived while on oral Imatinib; the three case diagnosed in the first trimester opted for immediate termination of pregnancy while the fourth one diagnosed at 22 weeks of pregnancy continued pregnancy and delivered at 34 weeks by emergency caesarean section for severe oligohydramnios. The ALL case diagnosed at 26 weeks of pregnancy wanted termination of pregnancy and immediate induction chemotherapy. The AML case diagnosed at 32 weeks of pregnancy desired to undergo induction chemotherapy with pregnancy but she defaulted treatment and had intrauterine fetal death and died due to postpartum haemorrhage. The baby, delivered to a mother exposed to Imatinib throughout pregnancy, till date has normal growth and development. Five mothers are in remission.&#x0D; Conclusions: Leukaemia with pregnancy, more common in younger women is rare and posed treatment challenges. Definitive treatment should be individualized according to the desire of the pregnant woman and should include a multi- disciplinary team. Termination of pregnancy in favour of definitive chemotherapy to mother is better and easier during the first trimester of pregnancy. Because of teratogenic effects of chemotherapy, effective contraception be used during therapy to prevent pregnancy.

Gynecological malignancies in pediatric and adolescent group: a ten year experience in a national cancer center of Nepal

Introduction: Gynecological malignancies in pediatric and adolescent group are common. Germ cell tumors and gestational trophoblastic neoplasia are the most frequently found malignancies which are highly chemosensitive. With prompt and appropriate treatment higher cure rate is attainable in such malignancies even in resource constraints country like Nepal.&#x0D; Objective: To study the clinicopathological profile and treatment outcome of gynecological malignancies among pediatric and adolescent group seeking treatment at B.P. Koirala Memorial Cancer Hospital (BPKMCH), Nepal.&#x0D; Methodology: Descriptive study was done at BPKMCH Nepal. All available case records of pediatric and adolescent girls diagnosed to have gynecological malignancies from 2002 to 2011 were collected and analyzed in terms of age, clinical features, malignancy types, treatment modalities and outcome.&#x0D; Results: Total 60 girls were eligible for the study. There were five patients (8.3%) below five years, 14 (23.3%) between 6-12 years and 41 (68.4%) patients between 13-19 years. Gynecological malignancies observed among the study group were: ovarian cancer in 46 (76.66%), gestational trophoblastic disease in 11 (18.33%), uterine cancer in two (3.33%) and vaginal cancer in one (1.66%). Among the ovarian cancers, 42 had malignant germ cell cancer (91.3%), three had epithelial ovarian cancer (6.5%) and one had juvenile granulose cell tumor. The commonest presentation was abdominal distension and pain in 70%. Onset of symptoms ranged from three days to 730 days (mean 95 days). Early stage disease was noted in 18 (30%) and advanced disease in 42 (70%). Eight (13.33%) underwent fertility sparing surgery only, 21(35%) underwent chemotherapy only and 31(51.66%) underwent multimodality treatment. Twenty (33.33%) defaulted and 40 (66.66%) completed treatment among which progressive disease and mortality was recorded in seven (17.5%) patients and 33 (82.5%) attended cure.&#x0D; Conclusion: Malignant germ cell cancer is the commonest gynecologic malignancy among pediatric and adolescent girls. In country where childhood marriage is still prevalent, GTT is also more common among adolescent girls. Early presentation and prompt appropriate treatment would offer chances of cure even with preservation of fertility.

Burden of GB Carcinoma among people from Terai, and Hill/ Himalayan regions of Nepal

Background: GB carcinoma is rare cancer worldwide, but is sixth most common cancer among females in Nepal. Burden of GB carcinoma has geographical and ethnic variation. This study mainly focuses on geographical distribution of GB carcinoma, among Nepalese patients visiting BPKMCH.&#x0D; Methods and materials: We conducted a retrospective study approved by Department of GI Surgery, BP Koirala Memorial Cancer Hospital, Bharatpur, Nepal. Datas were collected from Jan 1,2107 to 31st Dec 2017 from medical record sections. Analysis was completed using SPSS.&#x0D; Results: A total number of 340 patients were recorded, comprising 220 patients with malignancy and 115 patients with benign lesions, and remaining 5 patients files could not be traced. Among malignant patients 158 were female, and 62 were male, with male to female ratio (M: F) of 1:2.5. In malignant group, patients from terai were 70%, hilly and Himalayan region were 30%.&#x0D; Conclusion: The data provides clue on burden of GB carcinoma being relatively high in female, and terai region of Nepal.