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Kardinah Kardinah, Sutjipto Sutjipto, Evlina Suzzana
Indonesian Journal of Cancer, Volume 1; https://doi.org/10.33371/ijoc.v1i2.10

Abstract:
Indonesia mempunyai masalah yang sama dengan negara berkembang lainnya yaitu pasien kanker payudara yang datang ke rumah sakit dalam stadium lanjut. Oleh karena itu diperlukan upaya peningkatan kepedulian khususnya di lingkup tenaga medis terhadap kanker payudara melalui penyuluhan dan ketrampilan pemeriksaan payudara. Tujuan penelitian ini adalah mengumpulkan data awal untuk menentukan metode yang tepat untuk pelatihan pemeriksaan payudara bagi tenaga medis khususnya perawat, bidan dan dokter umum.Dilakukan penyuluhan bagi staf medis yang berminat dan pelatihan pemeriksaan payudara pada tenaga medis (perawat dan bidan) di RS.Kanker Dharmais periode April - Desember 2005. Untuk meningkatkan kepedulian dan kemampuan ketrampilan pemeriksaan payudara para peserta kemudian diminta untuk memberikan penyuluhan di lingkungannya dan mengajak wanita yang bersedia dilakukan pemeriksaan payudara dan USG payudara di RS. Kanker Dharmais.Sebanyak 25 orang perawat dan bidan serta 1 orang dokter umum yang berpartisipasi aktif, 856 wanita bersedia dilakukan pemeriksaan payudara dan USG payudara. Pemeriksaan payudara oleh tenaga medis yang telah dikonfirmasi dengan USG payudara ditemukan hasil normal 783 ( 91.5 %) dan 73 (8.5%) abnormal. Adapun dari hasil abnormal tersebut adalah 39 (53.4%) kista, 17 (23.3%) lesi solid benigna dan 8 (10.9%) dicurigai maligna. Sedangkan kelainan payudara lain yang ditemukan adalah mastitis, galactocele, duktal ektasis serta mamaria aberans.Pelatihan pemeriksaan payudara membutuhkan tidak hanya pengetahuan dan ketrampilan pemeriksaan payudara tetapi juga ketrampilan berkomunikasi dan menjalin kerjasama dengan para wanita di lingkungannya sehingga partisipasi masyarakat dapat ditingkatkan.Kata kunci: kanker payudara, deteksi dini, pemeriksaan payudara, USG payudara.
Achmad Hardiman, Mugi Wahidin, Drg Rini Noviani
Indonesian Journal of Cancer, Volume 1; https://doi.org/10.33371/ijoc.v1i2.9

Abstract:
Pengendalian penyakit kanker di Indonesia telah banyak dilakukan oleh berbagai pihak baik pemerintah maupun non pemerintah, namun belum berjalan secara terpadu, komprehensif, dan berkesinambungan. Berdasarkan Keputusan Menteri Kesehatan RI Nomor 1575/Menkes/Per/XI/ 2005 Tentang Organisasi dan Tata Kerja Departemen Kesehatan, dibentuklan Direktorat Pengendalian Penyakit Tidak Menular (PPTM) yang termasuk di dalamnya Sub Direktorat Penyakit Kanker yang bertugas mengkoodinasikan upaya pengendalian penyakit kanker di Indonesia.Upaya pengendalian penyakit kanker bertujuan menurunkan angka kesakitan dan kematian akibat penyakit kanker, memperpanjang umur harapan hidup serta meningkatkan kualitas hidup penderita. Kebijakan yang diambil adalah partisipasi dan pemberdayaan masyarakat, pengembangan kemitraan & jejaring kerja, pelaksanaan secara terpadu (pencegahan primer, sekunder dan tersier), pengelolaan secara profesional, berkualitas, merata dan terjangkau oleh masyarakat, penguatan penyelenggaraan surveilans faktor risiko dan rigistri penyakit kanker, pelaksanaan secara efektif dan efisien melalu pengawasan yang terus ditingkatkan.Strategi yang dijalankan adalah menggerakkan dan memberdayakan masyarakat, mendorong pelaksanaan pembangunan berwawasan kesehatan, pengembangan potensi dan peran serta masyarakat untuk penyebarluasan informasi, mengembangkan kegiatan deteksi dini penyakit kanker yang efektif dan efisien, meningkatkan akses masyarakat terhadap pelayanan kesehatan yang berkualitas, mendorong sistem pembiayaan kesehatan yang terjangkau, meningkatkan penyelenggaraan surveilans faktor risiko dan surveilans penyakit dengan registrasi kanker, dan mendorong dan memfasilitasi pengembangan vaksin pencegahan kanker.Kegiatan pengendalian penyakit kanker dilakukan secara komprehensif dari pencegahan primer, sekunder, dan tersier. Pokok-pokok kegiatan pengendalian penyakit kanker adalah pencegahan dan penanggulangan faktor risiko kanker, peningkatan imunisasi, penemuan dan tatalaksana penderita, surveilans epidemiologi, dan peningkatan komunikasi informasi dan edukasi (KIK).Pengorganisasian dalam upaya pengendalian penyakit kanker dilakukan secara berjenjang dari tingkat pusat sampai unit pelayanan kesehatan. Di tingkat pusat di bentuk Kelompok Penanggulangan Kanker Nasional Terpadu dan yang diikuti dengan pembentukan kelompok kerja (POKJA) pengendalian penyakit kanker di provinsi dan kabupaten/kota. Penanggung jawab di tingkat pusat adalah Direktorat Jenderal Pengendalian Penyakit dan Penyehatan Lingkuangan (PPdanPL), di tingkat provinsi adalah Dinas Kesehatan Provinsi, dan di tingkat kabupaten/kota adalah Dinas Kesehatan Kabupaten/Kota.Kata kunci: Kebijakan, Pengendalian Penyakit Kanker.
I Gusti Ayu Sri Mahendra Dewi, Desak Putu Gayatri Saraswati Seputra
Indonesian Journal of Cancer, Volume 16; https://doi.org/10.33371/ijoc.v16i1.813

Abstract:
Background: Thyroid Stimulating Hormone (TSH) and Free Thyroxin (FT4) concentration are currently highlighted in their relation to thyroid carcinoma development in thyroid nodule patients. This study aimed to identify the difference in the pre-operative mean serum concentration of TSH and FT4 in patients with benign thyroid nodules and thyroid carcinoma at Sanglah General Hospital Denpasar. Methods: : This study was a case-control study that involved 110 patients with thyroid nodules who underwent thyroidectomy at Sanglah General Hospital from January until December 2019, whose specimens were examined histopathologically at the Anatomical Pathology Laboratory of Sanglah General Hospital. Cases were patients with thyroid carcinoma. Controls were patients with benign thyroid nodules. The data were collected from medical records. Results: Most subjects in the thyroid carcinoma group were female (72.7%). The thyroid carcinoma group had a higher mean age at the time of thyroidectomy (47.33 ± 13.4) compared to the benign thyroid nodule group (46.07 ± 12.5) (p = 0.61). Significant difference was found regarding the nodule size between the two groups (p < 0.001). There were no significant differences in terms of nodule lateralization (p = 0.56) and the number of nodules (p = 0.58). Papillary thyroid carcinoma was the most common type of thyroid carcinoma (89.1%). A significantly higher pre-operative mean serum TSH concentration was found in cases (1.0 ± 0.23 IU/mL) compared to controls (0.8 ± 0.23 IU/mL) (p < 0.001). The pre-operative mean serum FT4 concentration was significantly lower in cases (1.1 ± 0.25 IU/mL) compared to controls (1.2 ± 0.22 IU/mL) (p = 0.006). The optimal TSH and FT4 cut-off values for thyroid carcinoma were > 1.0 IU/mL (61% sensitivity, 71% specificity) and < 1.1 IU/mL (61% sensitivity, 51% specificity), respectively Conclusions: : Higher pre-operative mean TSH concentration and lower mean FT4 concentration were found in patients with thyroid carcinoma. There were statistically significant differences between patients with thyroid carcinoma and benign thyroid nodules in terms of these two laboratory parameters.
Daan Khambri
Indonesian Journal of Cancer, Volume 16; https://doi.org/10.33371/ijoc.v16i1.861

Abstract:
Introduction: Trichilemmal carcinoma is a rare tumor derived from the outer hair sheath. It usually appears on the face, ears, neck, scalp, and sun-exposed areas. It generally occurs in patients older than 50 years old, and there is no sex predilection to this disease. Case Presentation: A 60-year-old woman came with a complaint of a lump in the head that often bled. The size of the lump was approximately like a bean seed and broke when she combed her hair. The lump was getting bigger within a year and easier to bleed. She often felt pain. Based on the history of surgery 2 months ago, the examination implies that the patient had trichilemmal carcinoma. Conclusions: Trichilemmal carcinoma generally occurs in the elderly category. Although trichilemmal carcinoma has a benign clinical course and local recurrence cases are uncommon, sufficient free margin and immediate reconstruction are challenging if the predilection is in the head and neck. Surgical excision is the recommended treatment for this disease
Indonesian Journal of Cancer, Volume 16; https://doi.org/10.33371/ijoc.v16i1.816

Abstract:
Background: In the community of Surabaya, the 2nd largest city of Indonesia, women living with cancer are mostly the long-term survivors of advanced-stage cervical cancer, but the number of women living with breast cancer cannot be ignored. There were various physical and psychological problems related to the total suffering and worsening phenomena. The limited resources available in the community have led to various levels of unmet needs in their perspective. This study aimed to analyze and describe the unmet needs of female cancer survivors in the community of Surabaya. Methods: This descriptive study involved five Public Health Centers (PHCs) among 63 PHCs in Surabaya (7.94%), Indonesia, which were selected by one-stage cluster random sampling. There were 41 and 40 women living with breast and cervical cancers, respectively, participating in this study (n = 81). The Supportive Care Needs Survey – Short Form 34 (SCNS-SF34) was used to collect the data of unmet needs (r = 0.234 – 0.821; Chronbach Alpha = 0.939). Descriptive statistic was used in data analysis (frequency, Mean, and Standard Deviation). Ethical clearance was issued. Results: Most respondents were late adult married women with low socioeconomic status. They were mostly short-term survivors and already had surgery. Most of them reported a moderate level of unmet needs (Mean ± SD = 109.30 ± 27.66). Health system and information needs became their top priorities (45.75), followed by patient care and support needs (37.89), physical and daily function needs (32.20), psychological needs (31.11), and sexuality needs (22.00). There were 9.88% of respondents who reported that there were no unmet needs. Conclusions: Female cancer survivors in the community reported a moderate level of unmet needs. Health system and information needs were the most reported unmet needs
Samuel Kelvin Ruslim, Selviant Selviant, Aviciena Bin Iskandar, Sielvyana Sie, Agustinus Darmadi Hariyanto, Monika Kencana Dewi
Indonesian Journal of Cancer, Volume 16; https://doi.org/10.33371/ijoc.v16i1.837

Abstract:
Introduction: Nasopharyngeal cancer (NPC) is a prevalent diagnosis of head and neck cancers (HNC) in Asia. In Indonesia, it is estimated that there are 12,000 new cases per year. Case Presentation: The author reports a 25-year-old male patient with recurrent NPC. This patient was first diagnosed with NPC stage IVB in 2013 and was treated by chemoradiation. In 2016, he found another mass in his neck. The biopsy result showed the recurrence of the NPC with histopathology of Undifferentiated carcinoma (WHO type III). Re-irradiation was planned, and the patient subsequently received 3D-Conformal Radiotherapy (3D-CRT) at our department. Four years after the completion of re-irradiation, the patient was alive and well with no signs of recurrence but still complained about late toxicities like trismus and fibrotic neck. Conclusions: In this study, we discuss the use of 3D-CRT in the re-irradiation of NPC with its limitation on obtaining optimum dose sculpture compared to more sophisticated and widely spread modalities like intensity-modulated radiotherapy (IMRT). However, with careful planning, we can still obtain optimum tumor dose, minimize organs at-risk (OAR) dose, and subsequently late toxicities that come after. We hope that this study can bring hope to centers with limited facilities, and we suggest further studies on re-irradiation, especially in OAR dose tolerance guidelines.
Antony Abel Adibrata, Marhendra Satria Utama, Adji Kusumadjati
Indonesian Journal of Cancer, Volume 16; https://doi.org/10.33371/ijoc.v16i1.856

Abstract:
Background: Soft Tissue Sarcoma is one of the rare cancers that increased in number in the last few years, but information about soft tissue sarcoma patients was still limited, especially in West Java, Indonesia. This study aimed to find out the patient profile and the histopathological cell distribution of soft tissue sarcoma patients who undergo radiotherapy. Methods: The study design was retrospective descriptive quantitative with the total sampling method. This study was done by observing all patients’ medical records registered from January 1, 2018, until December 31, 2019, in the Hospital-Based Cancer Registry of Radiology Department of Dr. Hasan Sadikin General Hospital Bandung, with the inclusion criterion of patients diagnosed with soft tissue sarcoma. Results: A total of 5% (n = 75) from 1,388 cases registered were soft tissue sarcoma. The most common patient profile was female (57.3%) and age group 45–54 years (21.3%). The chief complaint was dominated by a painless mass (56.0%) at the lower limb (37.8%) with the most frequent cell of fibrosarcoma (17.3%), the most intention of the radiotherapy of curative adjuvant (78.7%). Conclusions: The number of soft tissue sarcoma is small compared to other malignancies. It is more common in women, the most age group is from 45 to 54 years with the median of 47 years old, ranging from 9 to 90 years, it tends to occur in the lower limb with a chief complaint of a painless mass, and the most frequent cell is fibrosarcoma. The common treatment combination is surgery with radiotherapy
Walta Gautama
Indonesian Journal of Cancer, Volume 16; https://doi.org/10.33371/ijoc.v16i1.920

Abstract:
Breast cancer is the most prevalent cancer in Indonesia, 19.2% out of all cancers [1]. In 1992, most breast cancer patients (60-70%) sought medical treatment when the cancers were in late stages (stage III and IV) [2]. Thirty years later data collected from several teaching hospitals in Indonesia shows that 68- 73% of breast cancer patients come to medical centers in the late stages [3,4,5]. It is interesting to learn why the number of late-stage breast cancer patients in Indonesia remains the same despite the advancement in early detection and therapeutical measures. This editorial will mainly discuss one factor contributing to the diagnostic and treatment delay: patients’ accessibility to proper medical attention. Accessibility to proper medical attention for breast cancer patients in Indonesia depends on the number and distribution of trained oncologists, a concise referral system, and supportive regulation. Indonesia is a vast archipelago country with a population of more than 273 million people. In tertiary medical centers, breast cancer patients are attended by surgical oncologists since surgery is the main treatment. As per February 2002, there are only 233 surgical oncologists practicing. This number is far below the ratio proposed by the Indonesian Society of Surgical Oncologists (Perhimpunan Ahli Bedah Onkologi Indonesia/PERABOI) which is 0.2 per 100,000 population (546 surgical oncologists needed). This number is still below the ideal ratio which is twice as much. However, setting a goal too high would make the organization frustrated, hence the revised target. The role of oncologists is vital in breast cancer cases. A multinational analysis shows that being diagnosed with breast cancer by an oncologist correlates with shorter treatment delay [6]. It takes at least 6 years of general surgery training plus 2 more years of surgical oncology training to produce a surgical oncologist. This does not count the 2-5 years of working experience required before a general surgeon could apply for the surgical oncologist training. Acceleration is critical to producing more surgical oncologists, either by establishing more training centers or by modifying the training system. Establishing a surgical oncology training center is no simple procedure; especially since UU Pendidikan Kedokteran number 20/ 2013 mandates that medical specialist training must be university-based [7]. The government should consider the role of hospital-based training to accelerate the production of surgical oncologists. The revision of the law is underway that would recognize the role of professional society and collegium in medical specialist training. Acceleration can also be carried out through modifying the training system: from subspecialist training to specialist training. A general practitioner can enroll for the surgical oncology training without having to be a general surgeon first. The role of “collegium” is vital to ensure that the training curricula meet the requirement despite the cutting down of training time. Nevertheless, modification of the training system will take years unless there is government intervention to simplify the regulations. Another alternative to increase the number of competent surgeons attending breast cancer patients is by establishing a crash program in surgical oncology for general surgeons. The program would train general surgeons in early detection, proper treatment, and the vital knowledge of “when to refer” to tertiary medical centers so that the patients could have the best possible treatment. The lack in the number of surgical oncologists is worsened by the uneven distribution throughout the country. More than 50% practice in big cities in Java Island leaving some distant provinces with only one or two surgical oncologists. Distribution is vital so that expert medical advice is accessible throughout the country. The public health system and private insurance may cover the direct cost of breast cancer care but not the indirect costs such as traveling expenses to reach distant medical centers. The indirect cost is one factor contributing to patients’ delay to seek breast cancer care [8,9]. A study in Yogyakarta shows that various out-of-pocket expenses such as transportation and logistics linked to presentation, diagnosis, and subsequent breast cancer treatment remain a financial burden and hinder the patient from seeking early medical treatment [10]. The government needs to work closely together with the Society to regulate the distribution of surgical oncologists throughout the country. Indonesian Journal of Cancer, Vol 16(1), 1–2, March 2022 DOI: http://dx.doi.org/10.33371/ijoc.v16i1.920 www.indonesianjournalofcancer.or.id P-ISSN: 1978-3744 E-ISSN: 2355-6811 2 | A breast cancer referral system that concisely states “what and when” to refer to tertiary medical care is necessary to prevent referral delay. A study in a tertiary medical center in Surabaya shows that only 13,8% of the patient comes through the referral system [11]. This shows some dysfunctions in our country’s referral system. It is necessary to prepare a breast cancer referral guideline for physicians in primary and secondary medical centers. Lack of concise referral guidelines may result in some early breast cancer patients getting inadequate surgical oncology treatment in secondary medical centers and later coming to the tertiary medical center in a more advanced stage. Reformation of some regulations is imperative in ensuring patient access to proper medical attention. Laws that regulate medical specialist training need to be reformed in order to accelerate the production and national distribution of much demanded surgical oncologists. It is necessary to establish regulation on the breast cancer referral system to avoid referral delay in secondary medical centers. There is also an urgent need to re-evaluate the regulation of the national...
Trifonia Pingkan, Fitri Juniarta, Hartono Tjahjadi, Meliyana Lai
Indonesian Journal of Cancer, Volume 16; https://doi.org/10.33371/ijoc.v16i1.842

Abstract:
Introduction: Rhabdomyosarcoma (RMS) is a rare soft tissue tumor, mainly affecting children, adolescents, and adults younger than 15 years, representing 3% to 4% of all childhood malignancies. Genitourinary is the second-most-common location of RMS with around 25% of cases. We describe a rare case of vaginal rhabdomyosarcoma in adolescents with huge polypoid tumors. Case Presentation: A 15-year-old female presented with vaginal bleeding for seven months. Her medical story was unremarkable. The clinical examination showed a polypoid mass prolapsed from the vagina, and the laboratory result was anemia. The pelvic magnetic resonance imaging (MRI) showed a heterogenous bulky solid tumor in the vagina. The histopathological finding revealed a sarcoma, and the immunohistochemical staining result was rhabdomyosarcoma not otherwise specified (NOS). Conclusions: Vaginal RMS is a rare malignant tumor of mesenchymal origin with skeletal muscle differentiation. Vaginal RMS is the most common site of genitourinary RMS and presents as a rapidly growing and aggressive local mass. Imaging plays an important role in the initial diagnosis of vaginal RMS, regarding the presentation of the bulky protruding tumor on the vaginal region
Mujaddid Idulhaq, Pamudji Utomo, Denny Adriansyah
Indonesian Journal of Cancer, Volume 16; https://doi.org/10.33371/ijoc.v16i1.821

Abstract:
Background: Surgical interventions such as intralesional curettage until the complete excision and reconstruction require distal radius GCT treatment. However, to maintain the wrist function and reduce recurrent tendency, a more comprehensive understanding is needed to decide on the best therapeutic option as the standard strategy to achieve complete resection and functional outcomes. Therefore, this study aims to find the current treatment trends based on a literature study on distal radius GCT, emphasizing their potential outcomes. Methods: The search strategy using the PubMed search engine (https://pubmed.ncbi.nlm.nih. gov/) was conducted on September 21, 2020, with the keywords: “distal radius giant cell tumor”. The search resulted in 261 articles, and they were filtered by “published in the last five years,” which yielded 67 articles. These articles then underwent further screening, resulting in 40 articles for the analysis. Results: For article types, there were 27% (11/40) prospective studies, 32% (13/40) retrospective studies, 5% (2/40) systematic reviews, 27% (11/40) case reports, and 5% (2/40) case series. For the case series, more than ten cases were reported in both articles. There were 47 treatments in those total articles, and there were two types of GCT excision: intralesional curettage (extended and non-extended) (74.4%; 35/47) and en bloc (wide) resection (25.5%; 12/47). Conclusions: The total number of articles published in the last five years on the distal radius increased in 2020. Most types of articles were retrospective studies, followed by case reports and prospective studies. The most common treatment published in the last five years is intralesional curettage than en bloc resection, with excellent results in intralesional curettage’s functional outcome.
Yesiana Dwi Wahyu Werdani
Indonesian Journal of Cancer, Volume 16; https://doi.org/10.33371/ijoc.v16i1.819

Abstract:
Background: Cancer is a serious stressor that induces spiritual distress, loss of optimism, and dissatisfaction with subjective well-being. This study aims to determine that spiritual well-being (SWB) and optimism as factors that contribute to influencing the subjective well-being of cancer patients. Methods: This study had a cross-sectional design. A total of 88 cancer patients from public health centers in Surabaya and the Indonesian Cancer Foundation of East Java were selected to be sampled by consecutive sampling in 4 months. The Instruments used were valid and reliable throughout the test, comprising of the spiritual well-being scale, the 9-item version of the personal optimism scale, self-efficacy optimism scale, and satisfaction with life scale. The ethical feasibility was declared ethical. Data were analyzed using Pearson Product Moment Correlation Test and Linear Regression Test with p < 0.05. Results: The demographic data show that the mean age of 52.5 years, female gender (84%), being married (78.4%), having cervical cancer (52.3%), having stage-III cancer (55.7%), having cancer therapy (surgery, chemotherapy, and radiotherapy) (37.5%), and patients newly diagnosed from 6 months to 1 year (33%). The mean score of SWB was 99.67 (high SWB), optimism 20.03 (high optimism), and subjective well-being 24.18 (good subjective well-being). Pearson Product Moment Correlation Test between SWB and optimism showed p < 0.001, indicating that SWB had a significant relationship with optimism; patients with high SWB will have high optimism. From the Linear Regression Test, there was a significant effect of SWB on subjective well-being (r2 = 0.982 and p < 0.001) and optimism on subjective well-being as well (r2 = 0.988 and p < 0.001), meaning that patients with high SWB and high optimism tended to have good subjective well-being. Conclusions: Cancer patients who have high scores of SWB become more optimistic, which has a positive effect on the high score of subjective well-being as well.
Fitra Hardian Prisnamurti, Ahmad Zulfan Hendri, Aria Danurdoro
Indonesian Journal of Cancer, Volume 16; https://doi.org/10.33371/ijoc.v16i1.855

Abstract:
Background: Bladder cancer is the eleventh most common malignancy worldwide and the sixth cancer in men. Bladder cancer shows a male predominance with a sex ratio of 4:1. Most bladder cancers are transitional cell carcinoma, and the other tumors are squamous cell carcinoma, adenocarcinoma, and rare entities like small cell carcinoma. Clinical stage and grade are the most critical determinants of the prognosis of bladder cancer. Therefore, this study aims to evaluate the characteristics of bladder cancer in Dr. Sardjito General Hospital, Indonesia. Methods: We reviewed the medical records of patients with bladder cancer admitted to Dr. Sardjito General Hospital Yogyakarta from January 2015 until December 2020. The data were about demographic characteristics, clinical presentation and staging, grading and staging based on pathological examinations results, and cancer management. Results: This study found 282 patients with bladder tumors. Fifty patients did not meet the inclusion criteria so the remaining 232 patients consisted of 169 male patients (72.8%) and 62 female patients (27.2%). The stages of tumors when the patients first came in were T1 diagnosed in 46 patients (22.7%), T2 diagnosed in 81 patients (40%), T3 diagnosed in 11 patients (5.4%), and T4 diagnosed in 64 patients (31.6%). A total of 30 patients were found to have secondary bladder tumors. The pathological anatomy results showed that 177 patients (76.2%) had transitional cell carcinoma and 33 patients adenocarcinoma (14.2%). All patients had undergone Transurethral Resection of Bladder Tumor (TURBT) for diagnosis and staging, followed by definitive treatment. It consisted of TURBT and chemotherapy bladder instillation in 46 patients (19.8%), radical cystectomy in 84 patients (36.2%), partial cystectomy in 4 patients (1.7%), and multimodal therapy (en-bloc transurethral resection of bladder tumors (ERBT) and chemotherapy) in 26 patients (11.2%). There were 72 patients (31%) who underwent TURBT alone. Conclusions: From a 5-year study, we found similar results with previous studies that the most common bladder histopathological result is urothelial carcinoma. However, most patients presenting to our hospital have higher stages and grades, requiring radical treatment. These differences warrant a larger and more comprehensive, multi-center study in Indonesia.
Sari Eka Pratiwi, Heru Fajar Trianto, Nabilah Nurul Fatinah, Muhammad In’Am Ilmiawan, Iit Fitrianingrum, Desriani Lestari
Indonesian Journal of Cancer, Volume 16; https://doi.org/10.33371/ijoc.v16i1.845

Abstract:
Background: The prevalence and mortality rates of cervical cancer differ by region with the highest rates found in Latin America, Southeast Asia, and Africa. In Indonesia, cervical cancer is the second-largest contributor to the latest cases in 2020. In West Kalimantan, over 20,000 women were diagnosed with cervical cancer in 2014. This study aims to describe the characteristics of cervical cancer patients in West Kalimantan. Methods: A descriptive observational study was conducted on patients from 2017 to 2019 according to the Soedarso Hospital database. All medical records were reviewed and analyzed to obtain the variable data; they were age, ethnics, origin, stage of cervical cancer, histopathology types, and hemoglobin (Hb) level. Results: Cervical cancer patients for the 2017–2019 period totaled 147 people with 30 deaths. In this study, 97 patients from 2017 to 2019 met the inclusion criteria. Cervical cancer was found from the age of 27 years with a peak at the age of 41–60 years. Most patients came from Pontianak and Kubu Raya cities (45.4% and 14.4%, respectively) with the most ethnic groups being Malays (41.2%). A total of 43.3% of patients had a parity amount of more than five times. Most patients came at stage IIIb (45.4%). The patients present with moderate to severe anemia with the lowest Hb level of around 2.3 g/dL. Based on histopathology, the type of squamous cell carcinoma ranks the highest (70.1%). Conclusions: Cervical cancer incidence reaches the peak at adults to elderly. The amount of parity seems to contribute to the incidence of cervical cancer in West Kalimantan. Most patients came at an advanced stage and the type of squamous cell carcinoma with moderate to severe anemia
Christopher Kusumajaya, Ferry Safriadi
Indonesian Journal of Cancer, Volume 16; https://doi.org/10.33371/ijoc.v16i1.832

Abstract:
Background: Penile cancer is a rare and aggressive disease. The incidence in India, Africa, and South America ranges from 2.3 to 8.3 per 100,000. No data regarding incidence rates in Indonesia. The etiological factors include poor genital hygiene, phimosis, tobacco use, multiple sex partners, human papillomavirus (HPV) infection, and chronic inflammatory states. Squamous cell carcinoma (SCC) represents 95% of penile cancers. Progression and treatment of the disease cause devastating consequences and morbidity such as disfiguring penile amputation. This study aimed to assess the epidemiological characteristics of penile cancer in the city of Bandung, its associated risk factors, clinical manifestations, and compare the results with previous studies. Methods: This was a descriptive study conducted at Hasan Sadikin Hospital Bandung from January 2010 to 2019. The study included all penile cancer patients that came to Urology Department. Variables such as age, history of circumcision, phimosis, HPV infection, marital status, smoking habit, educational level, age of onset, operation, histopathological results, history of multiple sex partners, location of the tumor, comorbidities, and staging are collected from the medical record and analyzed. Results: A total of 13 penile cancer patients were involved with the age range from 28 to 67 years and 50.69 years on average. Most of them were smokers (69.2%) and uncircumcised (53.8%). All of the patients came at an advanced stage, and penectomy was done. Histopathologically, 84.6% were SCC. One of our patients was consulted by a haemato-oncologist for adjuvant chemotherapy (6 cycles of cisplatin and 5-fluorouracil). Conclusions: Penile cancer is a rare neoplasm in Bandung, West Java. The characteristics of penile cancer patients found in our hospitals were on average 50.7 years old, and the most risk factors found were smoking and uncircumcised. Histopathologically, most of them were SCC. All patients came to seek medical treatment at an advanced stage and had undergone surgical penectomy.
Andy Andy, Yacobda Sigumonrong
Indonesian Journal of Cancer, Volume 16; https://doi.org/10.33371/ijoc.v16i1.829

Abstract:
Background: Wilms Tumor (WT) or nephroblastoma is the most common primary malignant tumor of the kidney found in children (comprising about > 95% of all kidney tumors). The study of WT prognostic factors has not been elaborated enough in Indonesia. This study aimed to determine the prognostic factors of WT patients in Adam Malik Hospital, Medan. Methods: This study was conducted with a retrospective design due to the rarity of WT cases. A total of 21 WT patients diagnosed from 2003 to 2019 were taken from medical records at Adam Malik Hospital, Medan. Univariate and multivariate Cox regression analyses were performed to determine the independent prognostic factors of WT. The primary endpoint of this study was patients’ overall survival (OS) obtained by the Kaplan-Meier analysis on significant variables. Results: From the univariate Cox regression analysis, gender was found to be the sole significant factor (HR = 0.218, p = 0.005) where males have a lower hazard ratio. The multivariate Cox regression analysis yielded an age of diagnosis (HR = 13.860, p = 0.014) and complete tumor removals (HR = 0.056, p = 0.008). The Kaplan-Meier analysis was performed on three significant variables mentioned before. Only gender yielded a significant Mantel-Cox log-rank score (p = 0.002) with male patients found to have better survivability with a median survival of 476 days compared to that of females of 11 days. The three-year survival of males was 45.45% while all females did not survive until the cut-off. Conclusions: Three prognostic factors, including children’s gender, age of diagnosis, and tumor removal status, were confirmed to be prognostic factors for the overall survival of children with WT. Further studies covering broader demographic areas were suggested to confirm significant results.
Said Alfin Khalilullah, Ahmad Zulfan Hendri
Indonesian Journal of Cancer, Volume 15; https://doi.org/10.33371/ijoc.v15i4.827

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Background: Enhanced recovery after surgery (ERAS) protocol is multimodal perioperative care designed to achieve enhanced postoperative outcomes. Unfortunately, all these elements are not always fully applied due to each center’s limitations. In this study, the ERAS protocol was modified and implemented in patients with bladder cancer who underwent laparoscopic radical cystectomy (LRC). This study aimed to evaluate the outcomes of the modified ERAS protocol in LRC surgery. Methods: The retrospective study design was used to evaluate 35 patients (27 males and 8 females) who underwent LRC with the application of the perioperative modified ERAS protocol. All information relating to perioperative, intraoperative, and postoperative patient data was obtained from medical records. All complications that occurred were classified according to the Clavien-Dindo classification. Results: The mean age in this study was 58.3 ± 9.2, and the most common pathological finding was urothelial carcinoma. Intraoperative blood loss was 318.5 ± 112.5 cc with those requiring intraoperative blood transfusion of 4.8 ± 2.0 patients. The mean first diet was 2.1 ± 1.2 days. For bowel activities, the first flatulence was 1.6 ± 0.8 days. The mean mobilization with first sitting was 1.8 ± 0.9 days. Seventeen percent of patients experienced intraoperative complications and postoperative complications were encountered in 28.6% of patients. According to the ClavienDindo classification, most complications were grades 1-2 (17.1%). There was no incidence of mortality in this study. Conclusions: These promising results, including the postoperative recovery and complications rates, require validation with multi-center and randomized studies to confirm the benefits of the modified ERAS protocol in minimally invasive procedures, especially LRC surgery
Abdul Mughni, Vito Mahendra Ekasaputra, Siti Amarwati
Indonesian Journal of Cancer, Volume 15; https://doi.org/10.33371/ijoc.v15i4.831

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Introduction: Gastrointestinal stromal tumor (GIST) is a rare neoplasm representing 80% of gastrointestinal neoplasms. Laparoscopic resection is only recommended for GIST less than 2 cm and 5 cm for laparoscopic wedge resection. Thus, a large GIST is recommended to complete resection through laparotomy. A large GIST of the gastric fundus can be found in patients, which coincides with an upper right abdominal quadrant pain caused by cholecystolithiasis. A suggested laparotomy for tumor resection and cholecystectomy may result in poor recovery in the postoperative period. Therefore, one approach surgery with minimally invasive laparoscopic partial gastrectomy using Endoflex stapler and cholecystectomy was performed to achieve the optimal outcome. Case Presentation: A 43-year-old male had a major complaint of hematemesis and melena for one month and colicky pain in the right upper quadrant of the abdomen with increased intensity in the last two months. Contrast-enhanced abdominal MSCT revealed a solid 4.6 x 4 x 5.6 cm exophytic mass on the gastric fundus, added with 0.5 cm gall bladder stone. Laparoscopic partial gastrectomy and cholecystectomy were performed in a single minimal invasive surgical procedure. The post-operative period was uneventful. The patient experienced minimum pain, early mobilization, and better diet tolerance. He was discharged on day four after the surgery. Besides, the histopathologic result revealed a malignant mesenchymal tumor according to GIST with a tumor-free margin of resection. Conclusions: Single approach surgery with minimal laparoscopic partial gastrectomy and cholecystectomy has provided optimal outcomes for patients with large GIST and cholecystolithiasis.
Bima Taruna Sakti, Rosalina Rosalina, Jaka Pradipta
Indonesian Journal of Cancer, Volume 15; https://doi.org/10.33371/ijoc.v15i4.835

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Background: Conventional chest X-ray (chest X-ray) in Dharmais Cancer Hospital emergency room (ER) is still the primary modality to diagnose patients with cancer with dyspnoea complaints. Chest X-ray was also carried out to screen inpatients at the Dharmais Cancer Hospital ER at the beginning of the COVID-19 pandemic in Indonesia. It was essential because patients in the Dharmais Cancer Hospital ER were patients with cancer, with low immunity and a high risk of being exposed to various infections. Thus, the purpose of this study was to determine the characteristics of chest X-rays in patients with cancer at the Dharmais Cancer Hospital ER during the COVID-19 pandemic in February-May 2020. Methods: This was a descriptive study. The population involved was all patients at the Dharmais Cancer Hospital ER who received chest X-ray support, with the inclusion criteria for diagnosing lung cancer, breast cancer, cervical cancer, colorectal cancer, and blood cancer (Leukemia) from February to May 2020. Data analysis employed univariate analysis by utilizing tables and graphs in presenting the data. Results: 289 samples met the research criteria. The highest visits were patients with breast cancer (41.2%). The most common thoracic images were pleural effusion (34.3%), followed by bronchopneumonia (31.1%), normal lung (16.6%), lung mass (7.6%), pneumonia (5.2%), and others (5.2%), consisting of atelectasis, bronchitis, fibrosis/chronic pulmonary process, pulmonary emphysema, cardiomegaly, and specific process. Besides, the chest x-ray bronchopneumonia was 31.1% (90 samples), accompanied by pleural effusion of 44.4%. From the chest X-ray, pleural effusions were 34.3% (99 samples), with lung cancer being the most common with pleural effusions (48.4%). Conclusions: More than 80% of chest x-ray performed in the ER are abnormal. Also, breast cancer is the highest in the Dharmais Cancer Hospital ER cases, with the highest chest x-ray of pleural effusion.
Fatih Tay, Mustafa Büyükkör, Öztürk Ateş
Indonesian Journal of Cancer, Volume 15; https://doi.org/10.33371/ijoc.v15i4.833

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Introduction: Leiomyosarcoma (LMS) is a fatal tumor, though primary cardiac is very rarely encountered. In this report, we evaluated the surgical and medical management of primary cardiac LMS, which is a sporadic tumor. Case Presentation: A 60-year-old female patient was examined for pulmonary edema after penicillin allergy in May 2019, while transthoracic echocardiography (ECHO) revealed an appearance compatible with a 5x3.5 cm mass in the right atrium. In addition, transesophageal ECHO showed a 7x4.6 cm foreground mass compatible with a myxoma in the right atrium (RA). The patient was then operated on emergency. Besides, an adjuvant ifosfamide-mesna-doxorubicine (IMA) protocol was planned to be given to the patient after local radiotherapy. Conclusions: In this report presented, we made RT and chemotherapy treatment plans in the case of recurrence without R0 surgery. Recurrence rates of up to 50% can occur in LMS, and systemic chemotherapy can be applied after relapse
Brahmana Askandar Tjokroprawiro, Sonny Fadli, Budiono Budiono
Indonesian Journal of Cancer, Volume 15; https://doi.org/10.33371/ijoc.v15i4.815

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Background: This study was conducted to determine the association between clinical characteristics, progression-free survival (PFS), and 3-year survival in patients with epithelial ovarian cancer who underwent surgery in 2016-2017 at RSUD Dr. Soetomo. This study was carried out with the hope of contributing to services for patients with epithelial ovarian cancer to improve outcomes at RSUD Dr. Soetomo. Methods: This retrospective analytic study used medical record data. Survival analysis was done employing Kaplan-Meier and log-rank tests, while Cox regression was utilized to analyze characteristics, recurrence, and mortality. Results: In 2016-2017, 56 patients with epithelial ovarian cancer met the inclusion criteria. Clinical characteristics of residue, stage had significant associations with PFS (P-value of 0.007 and P-value of 0.005, respectively). Residue, stage, histopathology, and the number of chemotherapy cycles had significant associations with 3-year survival (P-value of 0.001, P-value of < 0.001, P-value of < 0.001, P-value of 0.031, respectively). Recurrence and stage had a significant association with the following hazard ratios: stage I HR: 1 (CI 95%, P-value 0.145), stage II HR: 6.5 (CI 95% 0.6–74.7, P-value 0.134), stage III HR: 12.2 (CI 95% 1.4–105.4, P-value 0.061), and stage IV HR: 10.4 (CI 95% 0.8–120.8, P-value 0.061). Mortality had significant associations with stage, histopathology, and the number of chemotherapy cycles, with hazard ratios as follows: stage IV HR: 43.6 (CI 95% 4.5–417.9, P-value 0.001), seromucinous histopathology HR: 20.1 (CI 95% 0.9–408.6, P-value 0.026), chemotherapy cycles < 3 HR: 3.6 (CI 95% 1.2–11.5, P-value 0.459), and > 3 HR: 1 (CI 95%, P-value 0.028). Conclusions: Residue and stage had statistically significant associations with PFS and can be predictors for disease recurrence. Residue, stage, histopathology, number of chemotherapy cycles had significant associations with 3-year survival, but only the latter three characteristics can be predictors for mortality
Harissa Husainy Hasbullah, Zulia Zulkiffli, Han Albert Dicken
Indonesian Journal of Cancer, Volume 15; https://doi.org/10.33371/ijoc.v15i4.857

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Introduction: Choroidal metastases are infrequent in breast cancer, but if they present, they usually signify the disseminated disease and poor prognosis. The challenges in treating choroidal metastases are not only to prolong survival but also to preserve vision, improving the quality of life. Case Presentation: Our patient was firstly diagnosed with stage-three triple-negative breast cancer at the age of 32 years. She had surgery, adjuvant chemotherapy with anthracycline regime, as well as adjuvant radiotherapy. Her disease firstly recurred two years later with pleural effusion, but it was controlled with six cycles of docetaxel. She was in remission until ten years later when she presented with a worsening dry cough and progressive blurring of vision in both eyes. CT restaging showed multiple sub-centimeter bilateral lung nodules, singular pleural metastases, and multiple bone metastases. Choroidal metastases were also confirmed with the ophthalmological assessment which includes CT of the orbit. She received short-course palliative radiotherapy followed immediately by eribulin. Then, she started monthly bisphosphonates. She was able to read again four months after radiotherapy, and her vision remains normal to date. The latest PET scans showed no FDG avid disease in the lungs with pleural metastases significantly reduced in size. Bone metastases remain stable and asymptomatic. It has been nearly four years since the diagnosis of choroidal metastases. She is still on eribulin at an adjusted dose and interval. She remains asymptomatic from her bone, lung, and choroidal metastases. Conclusions: Short-course radiotherapy to the orbit, followed by continuous administration of eribulin, can lead to prolonged survival with a good quality of life in triple-negative breast cancer with choroidal metastases
Hidayatul Hasni, Mayetti Mayetti, Dwi Novrianda
Indonesian Journal of Cancer, Volume 15; https://doi.org/10.33371/ijoc.v15i4.828

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Background: Mucositis is one of the side effects of chemotherapy, which can be a severe problem for children with cancer. Cryotherapy can cause vasoconstriction and decrease blood flow to the oral mucosa, resulting in lower concentrations of chemotherapy agents to prevent mucositis. This study aims at determining the effectiveness of oral cryotherapy as prophylaxis mucositis in children with cancer undergoing chemotherapy. Methods: This quasi-experiment study with a pretest-posttest control-group design involved 45 respondents (22 in the intervention group and 23 in the control group) selected using consecutive sampling. The data collection instrument was the WHO mucositis scale. Results: Of the 45 children undergoing chemotherapy, 24 (53.3%) were of school age, 25 (55.6%) were male, 33 (73.3%) had good nutritional status, and 17 (37.8%) had mild neutropenia before undergoing chemotherapy. All respondents (100%) did not experience mucositis, but after chemotherapy, 9 children (40.9%) in the intervention group had mucositis, and 19 children (82.6%) experienced mucositis in the control group. The data were analyzed using the Wilcoxon test to see the difference between the intervention group and the control group and the Chi-Square test with Yates’s correction to see the effect of cryotherapy on the prevention of mucositis. The results showed that there was a difference in the incidence of mucositis between before and after intervention in the intervention group (p = 0.003) and the control group (p = 0.000), and cryotherapy was effective in preventing mucositis (p = 0.01). Conclusions: Cryotherapy is effective against the prevention of mucositis. Nurses and families need to be able to apply oral cryotherapy and other evidence-based treatment as a method to prevent mucositis
Rian Fabian Sofyan, Bayu Brahma, Iskandar Iskandar, Putri Naura
Indonesian Journal of Cancer, Volume 15; https://doi.org/10.33371/ijoc.v15i4.830

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Background: Oncological reconstructive surgery is a new paradigm in which it combines oncologic principles with reconstruction techniques. This study aims to present patients’ characteristics who had undergone oncological reconstructive surgery at the Department of Surgical Oncology, Dharmais National Cancer Center. Methods: This descriptive study identified patients’ characteristics who underwent oncological reconstructive surgery, their cancer types, and their therapies. All data were obtained from surgery registration and medical records from January 2019 to January 2020. Data were then presented in number and percentage. Results: A total of 174 patients had undergone oncological reconstructive surgery within one year. The mean age of all patients was 48.2 ± 16.7 years old. Most patients were female (72.1%), with breast cancer making up most cases (43.7%). Most of the participants also underwent mastectomy (42.1%), which was later followed by various reconstruction types. Sixty patients received free tissue transfer with microsurgery (34.4%), of which head and neck cancer constituted most cases. In addition, the most common donor site for the free flap was the Anterolateral Thigh (41.7%). Of all 174 patients, 75.2% presented with locally advanced cancer, and 17.8% had metastatic cancer. Within one year of follow-up, the survival rate was 87.4%, while local recurrence was 3%. Conclusions: The oncological reconstructive surgery approach plays a therapeutic and reconstructive role, and such might be the preferred method of choice for patients presenting with advanced-stage cancer
Sondang Nora Harahap, Daan Khambri
Indonesian Journal of Cancer, Volume 15; https://doi.org/10.33371/ijoc.v15i4.805

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Introduction: Poorly differentiated neuroendocrine carcinomas (NECs) originating from the eye are rare and very highly malignant diseases with a poor prognosis. Small cell NEC of the head and neck is a rare disease and highly aggressive. Early recognition and treatment are crucial for reducing morbidity and mortality. Case Presentation: A 19-year-old male visited our oncology surgery outpatient department due to the progressive neck mass enlargement originating from the eye. The patient was previously diagnosed with invasive choroid malignant melanoma of the left eye which had metastasized to the lymph nodes of the left neck. He underwent a surgical removal/exenteration of the left eye. The result showed that the patient’s survival with poorly differentiated tumors was about 14% while patients with well-differentiated NEC had a survival rate of 34%. It also indicates that the prognosis of these tumors is very poor with a total of over 90% of patients having distant metastatic disease. Histopathological examination showed the tumor tissue and its immunohistochemistry with positive streaks of CD56, NSE, Synaptophysin, and Ki67 suggested small cell NEC. Conclusions: it is crucial to establish an early diagnosis of these tumors to reduce morbidity and mortality. No optimal treatment for such disease has yet been established.
Hafizar Hafizar, Etriyel Myh
Indonesian Journal of Cancer, Volume 15; https://doi.org/10.33371/ijoc.v15i4.804

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Background: Multiple advancements of endoscopic technology were designed to enhance the sensitivity and specificity of the diagnostic tools of bladder cancer; thus, we perform a meta-analysis to compare diagnostic performance between confocal laser endomicroscopy (CLE) and biopsy for detecting bladder cancer. Methods: We compared CLE’s accuracy in diagnosing bladder cancer reported by studies obtained from the electronic database MEDLINE, CENTRAL, and CINAHL, from May to June 2020. The pooled effect estimate was calculated employing the DerSimonian and Laird random-effects model. We only included moderate to high-quality studies, which had been assessed by the QUADAS-2 tool. Results: Eight studies were included in this review; five of those were good-quality studies. A total of 519 samples from 345 patients were included in the pooled effect estimate calculation. Pooled sensitivity and specificity of CLE in diagnosing bladder cancer were 90.2% (0.86, 0.93) and 78.1% (0.71, 0.85), respectively. The use of white-light cystoscopy (WLC) before CLE increased its specificity (56.8% versus 84.6%). Pooled sensitivity and specificity of CLE in predicting lowgrade lesion were 73% (0.66, 0.80) dan 83% (0.78, 0.87), respectively. Meanwhile, pooled sensitivity and specificity of CLE in predicting high-grade lesion were 73% (0.66, 0.78) and 79% (0.73, 0.83), respectively. Conclusions: CLE has good accuracy in distinguishing malignant and benign tumors. Grading tumors with this modality is also accurate. The use of probe CLE (pCLE), coupled with WLC, will increase its specificity.
Yohana Azhar, Ahmad Iffa Maududy, Nadjwa Zamalek Dalimoenthe
Indonesian Journal of Cancer, Volume 15; https://doi.org/10.33371/ijoc.v15i4.826

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Background: Seroma is arguably the most significant complication that can happen after mastectomy. Although seroma is not a life-threatening complication, this condition can lead to severe morbidities. This situation can cause prolonged hospital stays and delayed adjuvant therapy. In this regard, autologous fibrin glue is a hemostatic agent that can accelerate fibrin formation, stop vascular oozing, and decrease dead space. Therefore, this research was performed to evaluate autologous fibrin glue function in lowering seroma volume after mastectomy and shortening the length of hospital stay. Methods: This randomized control trial research was designed to compare the effect of autologous fibrin glue to a control group that did not receive autologous fibrin glue. Seroma volume was calculated every 24 hours. The drains were then removed after the production of seroma less than 30 mL/24 hours. Results: We recruited 20 patients for each of the two groups who met the inclusion criteria. Age, histopathology type, breast cancer stage, number of lymph nodes, and tumor size did not significantly differ. However, patients in the fibrin glue group had significantly lower cumulative drain production. The median seroma volume in the treatment group was 9.30 mL, while the median in the control group was 20.90 mL (p < 0.05). Conclusions: Autologous fibrin glue significantly decreased seroma formation and length of hospital stay.
Dedy Hermansyah, Fernando Silalahi, Albiner Simarmata, Denny Rifsal Siregar
Indonesian Journal of Cancer, Volume 15; https://doi.org/10.33371/ijoc.v15i4.797

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Introduction: Phyllodes tumors are fibroepithelial breast lesions that are uncommon in women and rare among children. Due to scarcity, there are only a few large pediatric phyllodes tumor series. Current guidelines do not differentiate treatment recommendations between children and adults. Case Presentation: A 12-year-old girl presented with a lump in her right breast which grew rapidly within a month. On physical examination, we found a mass on the right breast sized ± 10 x 10 cm; the lump was fragile and bled easily. The patient’s condition was getting worse and worse. Due to this deterioration, we performed a mastectomy immediately. Conclusions: The incidence of malignant phyllodes tumor in children is very rare and required prompt treatment in emergency cases.
I Gusti Ngurah Agung Trisnu Kamajaya, Bagus Ngurah Brahmantara, Aa Ngurah Agung Putra Wirawan
Indonesian Journal of Cancer, Volume 15; https://doi.org/10.33371/ijoc.v15i3.774

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Background: Ovarian cancer is still one of the neoplasms within the gynecology scope. Besides, World Health Organization (WHO) states that ovarian cancer ranks fourth cancer in women with the lowest five-year survival rate (43%). Thus, this research aims to recognize the risk factors in patients with ovarian cancer and the commonly found characteristic.Methods: This cross-sectional observational research on 29 women diagnosed with ovarian cancer observed the age, parity, body mass index (BMI), contraception, character, and stadium. The medical record samples based on patients’ registers were obtained from the Obstetrics and Gynecologic Polyclinic in Mangusada Badung Regional Public Hospital in the January–December 2019 period, and the result data were distributed using contingency tables. Results: The data dominantly diagnosed ovarian cancer, with age distribution 51-60 years (34.5%), 44.8% with obesity, 44.8% nullipara, without a history of contraceptive use, menarche within 12 years old (41.4%), diagnosed stage IIIC (42.3%), and with serous epithelial tumor subclassification (65.5%).Conclusions: Predominant ovarian cancer is found at a late stage. The most common risk factors of developing ovarian cancer, including the age of 51–60, obesity, menarche within 12 years old, and no history of hormonal contraceptive use, are consistent with this research hypothesis about risk factors dominantly found in patients with ovarian cancer
Rizka Annisa Harahap, Pimpin Utama Pohan, Sufitni Sufitni
Indonesian Journal of Cancer, Volume 15; https://doi.org/10.33371/ijoc.v15i3.744

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Background: Thyroid cancer is the most common endocrine cancer, and its incidence has continuously increased in the last three decades all over the world. The national prevalence of thyroid cancer has not been recorded. Sex, obesity, and the size of thyroid nodules are the risk factors for thyroid cancer. The aim of this study is to acknowledge the characteristics of thyroid cancer patients in Haji Adam Malik General Hospital. Methods: This is a cross-sectional study and carried out among 97 patients with thyroid cancer at Haji Adam Malik General Hospital from 2013 until 2015. Secondary data were obtained by consecutive sampling techniques using medical records. The inclusion criteria are all patients diagnosed with thyroid cancer based on histopathological analysis. Data were analyzed descriptively using SPSS in percentage.Results: From 97 patients with thyroid cancer, it could be concluded that thyroid cancer is the most frequently diagnosed in the age group of 55–64 years (32.0%). Females were predominant that attributed to 71.1% than males (28.9%). The majority of thyroid cancer was diagnosed at stage IV (39.2%) with the most common histopathological feature of papillary thyroid carcinoma (46,4%). Thyroid cancer patients are usually found with normal BMI (37.1%) and nodule thyroid found with the diameter of ≥4cm (47.4%).Conclusions: In the 55–64-year age female group, thyroid cancer is most diagnosed at stage IV with papillary thyroid carcinoma. Thyroid cancer patients are usually found with normal BMI and the nodule size of ≥4 cm.
Irma Savitri Rasjad, Brahmana Askandar Tjokroprawiro
Indonesian Journal of Cancer, Volume 15; https://doi.org/10.33371/ijoc.v15i3.718

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Background: Procalcitonin (PCT) is a pro-hormone calcitonin that is strongly associated with bacterial infections, especially bacteremia. High serum PCT levels have been correlated with Lung cancer, colorectal cancer, thyroid cancer, and tumors of neuroendocrine. Studies on the role of PCT in ovarian tumors are still limited. This study aims to evaluate the role of PCT as a prognostic variable to determine the effectiveness of diagnostics in predicting ovarian cancer progression and metastasis.Methods: This was a descriptive analytic study with a cross sectional design, conducted in Dr. Soetomo General Hospital Surabaya from July until October 2019. The subject selection used total quota sampling with inclusion criteria of female aged >12 or already menstruating, undergoing surgical removal of ovarian tumors either cystic or solid, with risk malignancy index (RMI) of >200, and with imaging results of suggestive ovarian malignancy. The data were analyzed descriptively using Chi-square test (α <0.05) and receiver operating characteristic (ROC) curve analysis.Results: There were 36 study subjects; 38.9% of them are 40-49 years old; 77.8% have malignant tumors; and 22.2% of them have benign tumors with epithelial histopathology of 78.5% and nonepithelial of 21.4%. The optimal cut-off for PCT levels in ovarian tumors is 0.07 ng/ml with a 57.1% sensitivity and 87.5% specificity. There was a significant correlation between levels of PCT and ovarian tumors based on tumor types, postoperative tumor residues, and stages (p <0.05). There was no significant correlation between PCT levels and histopathological types and tumor grade.Conclusions: Procalcitonin can be used as a prognostic variable to determine disease progression in ovarian tumors, especially in ovarian cancer.
Ayu Hutami Syarif
Indonesian Journal of Cancer, Volume 15; https://doi.org/10.33371/ijoc.v15i3.812

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Background: Pancreatic ductal adenocarcinoma (PDAC) has been deathly cancer arising from pancreatic cells. Despite the improvement in the standard of diagnosis, most patients seek medical care in the late stage. Due to the aggressiveness of the disease, it is therefore imperative to detect the early lesion for a better outcome.Methods: We identified 416 articles relevant to circulating tumor DNA (ctDNA) and PDAC using predefined keywords in PubMed, PubMed Central, and Cochrane Library from January 1, 2011, to January 1, 2021 (10 years). Firstly, we screened the titles and abstracts, and 63 articles were included. Then, we screened those articles for the full-text version and included only 8 articles fulfilling our inclusion criteria. All steps were reviewed by the author.Results: The presence of ctDNA in the blood reflects the occurrence of the pancreatic cancerspecific mutation in the primary tumor. The detection of KRAS mutation in ctDNA and tumor samples is highly consistent. The number of positive findings in early-stage patients is low, in line with the low ctDNA concentration measured. However, the combination of KRAS detected in ctDNA and other biomarkers showed prominent results with higher sensitivity and specificity.Conclusions: ctDNA is a promising tool for early detection of PDAC. Despite its low positivity rate in certain studies, it is considerably concordant with the primary tumor. Future improvement in the technique application is required to overcome the issue of low DNA concentration in circulation.
Dedy Hermansyah, Yolanda Rahayu, Arjumardi Azrah, Gracia Pricilia, Sufida Sufida, Denny Rifsal, Albiner Simarmata
Indonesian Journal of Cancer, Volume 15; https://doi.org/10.33371/ijoc.v15i3.791

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Background: Triple-negative breast cancer (TNBC) is a subtype of breast cancer that does not have estrogen receptors, progesterone receptors, and HER-2 receptors. This subtype is found in 15-20% of all types of breast cancer, and it is often associated with a high recurrence rate and mortality after getting definitive therapy. The aim of our study is to investigate the clinicopathology of breast cancer in our center, where the majority were Bataknese.Methods: We evaluated the clinical and pathological characteristics of TNBC retrospectively from medical records data, from January 2017 to December 2019 with a total of 105 patients but only 79 patients had complete clinicopathological and immunohistochemistry data. This study was conducted in Murni Teguh Memorial Hospital, Medan, Indonesia. Results: From 79 TNBC patients, the average age at clinical presentation was 41-50 years group about 35 samples (44.3%). All patients had an invasive type of ductal carcinoma (100%). The majority of tumor size was T2 in 51 patients (64,6%), 83.6% grade 3 tumors. Both angioinvasion and lymph invasion were found in 48 patients (60.8%) while tumor-infiltrating lymphocyte (TIL) was found in 58 patients (73.4%), and 44 patients (55.7%) had lymph node metastases.Conclusions: According to some existing literature, TNBC showed more aggressive characteristics which are the same as our study. TNBC was diagnosed at young age, grade 3 tumors, having TIL which is very likely to occur distant metastases to lymph nodes.
Widiastuti Widiastuti, Eri Rakhmawati, Yusuf Syaeful Nawawi, Ana Rima
Indonesian Journal of Cancer, Volume 15; https://doi.org/10.33371/ijoc.v15i3.817

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Introduction: Chylothorax is a rare condition originating from lymphatic system damage as an accumulation of chyle in the pleural space. It can be classified into spontaneous or non-traumatic, traumatic, and idiopathic. A spontaneous chylothorax is primarily caused by neoplasm, such as lymphoma.Case Presentation: Herein, we report two cases of chylothorax presenting as massive pleural effusion in two patients of a 23-year-old male with nodular sclerosis type Hodgkin’s lymphoma and a 31-year-old female with metastatic lymphadenopathy of undifferentiated carcinoma from non-Hodgkin’s lymphoma.Conclusion: A spontaneous chylothorax is a rare condition that may lead to a life-threatening event when it is not properly and promptly treated.
Sibel Sensu, Nusret Erdogan, Kayhan Basak, Egzona Qipa, Murat Buyukdogan
Indonesian Journal of Cancer, Volume 15; https://doi.org/10.33371/ijoc.v15i3.795

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Introduction: Ewing sarcoma breakpoint region 1- activating transcription factor 1 (EWSR1-ATF1) fusion is mentioned as a diagnostic marker in favor of clear cell carcinoma in the differential diagnosis of clear cell neoplasms of salivary glands. However, in literature, its positivity is reported between 82% and 93%. In salivary glands, various benign and malignant primary tumors, as well as odontogenic neoplasms and metastatic cases, present with a varied number of clear cells. Clear cell carcinoma of the salivary gland is a rare entity with distinct histochemistry and immunohistochemistry features.Case Presentation: We present a clear cell carcinoma of the salivary gland showing cytoplasmic Periodic acid–Schiff (PAS) (+), mucin (-) staining, cytokeratin (CK), CK7, and P63 immunoreactivity without EWSR1-ATF1 fusion. Conclusions: We conclude that clinical, morphological, and immunohistochemical analyses should be the guide for diagnosis even though molecular analysis does not support it.
Nisha Virginia, Maksum Radji, Lucia Rizka Andalucia
Indonesian Journal of Cancer, Volume 15; https://doi.org/10.33371/ijoc.v15i3.800

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Background: Quality of life and adherence to long-term imatinib mesylate (IM) therapy is a major factor in achieving therapeutic effects in patients with chronic myeloid leukemia (CML). However, the data of the quality of life and adherence level is inconsistent in various studies and is also not fully understood yet in Indonesia. Methods: This is an observational study (single-centered) using a cross-sectional design. CML patients older than 18 years old with National Health Insurance (JKN) at the Dharmais Cancer Hospital (RSKD) Jakarta who used IM for at least one month were tested using the Medication Adherence Questionnaire (MAQ) and the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire C30 (EORTC QLQ-C30) from March to April 2020.Result: A total of 50 CML patients were included in the study (male: female ratio = 1.08: 1), had a good median score of global health status/QoL, and had a good function and symptom scales, except for the fatigue symptom scale (median: 33.33; 25th percentile - 75th percentile: 11.11– 44.44). The patient adherence rate was dominated by adherent patients (20/50; 40.0%). Comparative analysis revealed that the scale of QoL (p = 0.028) and fatigue (p = 0.094) variables showed statistically significant differences between adherent and non-adherent subjects.Conclusions: This study showed that two-fifth of patients were considered to be non-adherent. Adherent patients were known to have higher QoL than non-adherent patients. Meanwhile, patients with severe symptoms of fatigue were found to be non-adherent to IM therapy.
Lia Sasmithae, Indra Perdana
Indonesian Journal of Cancer, Volume 15; https://doi.org/10.33371/ijoc.v15i3.803

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Introduction: Cutaneous T-Cell Lymphoma (CTCL) is a form of Non-Hodgkin Lymphoma involving T-cell neoplasms mainly concentrated in the skin. Primary Cutaneous Peripheral T-Cell Lymphoma is Not Otherwise Specified (PTL-NOS) is the rarest case of CTCL disease.Case Presentation: A female, 35 years old, complained of a lump on her face. In the last 3 months, the lump felt soft, contained a liquid that, when it ruptures, secretes Blood, and the crusty scar will blacken and easily bleed with pain. Physical examination of pale conjunctiva on the face, neck, chest, abdomen, back, and legs obtained nodules with a chewy consistency with erythema appearance in varying size. Some nodules that appear were covered in blackish crustae. The right lung has a decrease in the sound of breath, accompanied by swelling in both limbs. The conclusion of bilateral femur skin biopsy impresses cutaneous T lymphoma cells. Within three months, cancer developed into lesions spread almost throughout the body, and due to the rapid and progressive nature of cancer, its diagnosis developed into PTL-NOS.Conclusions: Patients with PTL-NOS may come with solitary nodules such as red tumors in any area of the body. However, most often, patients come with symptoms of multifocal or diffuse scattered nodules. In enforcing the diagnosis, it takes a high level of suspicion, and multiple rebiopsies are necessary to enforce the diagnosis of CTCL.
Metasebia Tegegen, Fatuma Hassen, Abdulaziz Abubeker, Fissehatsion Tadesse, Daniel Hailu, Ashenafi Alemu, Aster Tsegaye, Rawleigh Howe, Amha Gebremedhin
Indonesian Journal of Cancer, Volume 15; https://doi.org/10.33371/ijoc.v15i3.796

Abstract:
Background: Immunophenotypic characterization of acute leukemia is an important clinical application of flow cytometry and has become a powerful tool contributing to proper diagnosis and classification. The aim of this study is to phenotype and classify acute leukemias by flow cytometry using commonly used markers for leukemia diagnosis.Methods: A total of 40 pediatric and adult patients diagnosed with acute leukemia were evaluated by flow cytometry with 17 surface and cytoplasmic markers known to be useful in discriminating different types of acute leukemia. These results were compared with classification results using standard morphological criteria.Results: 21 of 40 patients (52.5%) were classified as acute myeloblastic leukemia (AML) while 19 (47.5%) were identified as acute lymphoblastic leukemia (ALL). Of all the ALL cases, 10 of the 19 (52.6%) were B-ALL and 47.4% (9/19) were T-ALL based on flow cytometry. Markers of immaturity HLA-DR and CD34 antigens were co-expressed in 61% of AML cases and 33% of T-ALL cases, whereas CD34 was expressed in 50% of the B-ALL cases. cMPO and CD13 were the most expressed markers of AML, CD19 and cCD79a were present in all cases of B-ALL, and cytoplasmic CD3 and CD7 were positive on most all T-ALL cases. Discrimination of AML from ALL patients by flow cytometry was 80% concordant with traditional morphology. Notable discrepancies occurred in cases where leukemia cells expressed markers for more than one lineage.Conclusions: In the Ethiopia setting, flow cytometry represents a feasible and promising adjunctive diagnostic approach for acute leukemia.
Iin Kurnia Hasan Basri
Indonesian Journal of Cancer, Volume 15; https://doi.org/10.33371/ijoc.v15i2.764

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Thyroid cancer is one of the most common endocrine malignancies. Although the 10-year survival rate of differentiated thyroid cancer (DTC) is about 90% after conventional treatments, a small proportion of patients still suffer from tumor recurrence or drug resistance. DNA doublestrand breaks (DSBs) are important cellular lesions that can result from ionizing radiation exposure. The biomarker for DSB formation is the phosphorylated form of the histone H2 variant H2AX (γ-H2AX). We propose the use of γ-H2AX as a DNA DSB biomarker in thyroid cancer patients receiving radioiodine treatment as a possibility to detect the potential of instability genome after receiving the treatment. Evaluating DNA DSB damage with γ-H2AX biomarker might be important in managing thyroid cancer.
Steven Octavianus, Henry Kodrat
Indonesian Journal of Cancer, Volume 15; https://doi.org/10.33371/ijoc.v15i2.784

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Introduction: Salivary gland cancer is an uncommon malignancy in the head and neck. The most common histopathologic type in salivary gland malignancies is mucoepidermoid carcinoma (MEC). Radiotherapy has a role in salivary gland malignancy, especially in inoperable cases and postoperative settings. Definitive or postoperative radiotherapy with or without chemotherapy can improve locoregional control (LRC) in patients with parotid mucoepidermoid carcinoma. Case Presentation: We report a case of a 77-year-old male with inoperable MEC of the right parotid, who received definitive radiotherapy. From the three-month evaluation after radiation therapy, we found a significant reduction in the tumor mass. Conclusions: Surgery remains the treatment of choice for patients with salivary gland malignancies. Definitive radiotherapy can be a treatment modality in inoperable cases or patients who refuse surgery. Although the result is not satisfactory, radiotherapy can still give clinical benefits to patients.
Cindy Angelina Limantara, Ario Djatmiko
Indonesian Journal of Cancer, Volume 15; https://doi.org/10.33371/ijoc.v15i2.766

Abstract:
Background: The quality of life (QoL) of breast cancer (BCa) patients is an outcome of therapy that is often overlooked. In real life, postoperative breast cancer patients experience deep trauma in view that breasts are a symbol of femininity, which are very valuable for any female. This study aims to compare the QoL in patients who received mastectomy only and mastectomy with reconstruction.Methods: A retrospective comparative study of 25 post-mastectomy to 25 post-mastectomy with reconstruction BCa patients in Onkologi Surabaya Hospital. The subjects are patients who visited between July 2019 until March 2020, as many as 50 samples in accord with the inclusion and exclusion criteria. The assessment was performed using 3 instruments, including the hospital anxiety and depression scale (HADS), body image scale (BIS), and female sexual function index (FSFI). The collected data were analyzed using SPSS 15.0 for Windows.Results: A significant difference in mean values was seen in body image and sexual function. Post-mastectomy BCa patients presented more body image disturbance (p < 0.05). Better sexual function is claimed by post-mastectomy with reconstruction BCa patients in Onkologi Surabaya Hospital (p < 0.05). Meanwhile, the depression and anxiety values did not differ significantly in both groups (p > 0.05).Conclusions: Patients who underwent mastectomy and breast reconstruction have a better QoL in comparison with patients who received mastectomy only, in the domains of body image and sexuality function.
Dery Wahyudi, Sari Eka Pratiwi
Indonesian Journal of Cancer, Volume 15; https://doi.org/10.33371/ijoc.v15i2.722

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Background: Pancreatic cancer has a poor prognosis, and the symptoms are difficult to be detected early in the early stages. Indonesia Statistics on 2004–2007 states that pancreatic cancer is not included in the 10 cancers with the highest incidence. In West Kalimantan. There are no published data related to pancreatic cancer cases. This is the reason for the researchers because this data is sufficiently needed to support other studies related to pancreatic cancer.Methods: Epidemiological studies were conducted in the form of data collection at Dr. Soedarso Hospital Pontianak. Data were retrieved from cases of pancreatic cancer regression in annual Morbidity Data of Pancreatic Cancer Patients in Dr. Soedarso Hospital Pontianak from 2018 until 2009 consisting of the frequency of new cases and deaths, as well as demographic data such as age and gender of patients. Data were processed using Microsoft Excel.Results: A total of 79 cases and 9 deaths caused by pancreatic cancer were recorded in Dr. Soedarso Hospital Pontianak from January 2009 to December 2018. The highest incidence rates occurred in 2014 with 17 out of 79 cases (21.5%). As many as 63.3% of pancreatic cancer cases are dominated by men. Most cases of pancreatic cancer in patients with the age range of 45-64 years (67.1%) and the average age is 53.8 years.Conclusions: Incidence of pancreatic cancer in Dr. Soedarso Hospital Pontianak each year of 7.9 cases. Men and elderly people dominate cases of pancreatic cancer. Further study of the clinical characteristics and analysis of risk factors in patients with pancreatic cancer needs to be done to support preventive strategy development.
Bagus Gilang Samudra, Aria Danurdoro, Danarto Danarto
Indonesian Journal of Cancer, Volume 15; https://doi.org/10.33371/ijoc.v15i2.789

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Background: Renal cell carcinoma (RCC) is one of the most common malignancies in the kidney and causes a mortality rate of more than 100,000 each year globally. The neutrophil-lymphocyte ratio (NLR) is one of the markers in the inflammatory response that also correlate with the alteration of any cancer cells. We investigated the correlation between the NLR on tumor stage, Fuhrman nuclear grade, length of stay (LOS), mortality, and recurrence rate in renal cell carcinoma.Methods: We investigated 52 patients with renal cell carcinoma retrospectively from the databases of the patients who underwent radical and partial nephrectomy in Sardjito Hospital Yogyakarta between 2012 and 2017. Patients were classified as lower stage (T1-T2) and higher stage (T3-T4). We also classified it as a group of Fuhrman nuclear grade (G1, G2, G3, and G4). Two sample t-test or one-way ANOVA was used for the continuous variables and a chi-square test or Fisher’s exact test for the categorical variables. Pearson test was used to do the correlation test.Results: Among a total of 52 patients analyzed in our study, there were 36 males (69%) and 16 females (31%). A normal distribution of datasets was verified. The mean of preoperative NLR in these 52 patients was 6.35 (+4.01), with a range of 1.48 - 21.0. The value of NLR was positively correlated with tumor pathologic stage (p = 0.020), length of stay of the patients (p = 0.00), and the mortality rate (p = 0.012). Neutrophil lymphocyte ratio was not significantly correlated with Fuhrman tumor grade (p = 0.357) and tumor recurrence (p = 0.670).Conclusions: We compared the relationship of preoperative NLR with renal cell carcinoma tumor stage (T), Fuhrman grade, length of stay, mortality, and tumor recurrence. NLR was found to have a statistically significant higher T stage, mortality, and length of stay of the patients. Further studies with more patients are needed to confirm our study.
Desak Putu Gayatri Saraswati Seputra, I Gusti Ayu Sri Mahendra Dewi
Indonesian Journal of Cancer, Volume 15; https://doi.org/10.33371/ijoc.v15i2.772

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Introduction: Thymoma is a neoplasm of the thymus gland which arises from the epithelial tissue. Thymoma is frequently related to various paraneoplastic syndromes, most commonly myasthenia gravis. Up to 50% of patients with thymoma are reported to develop myasthenia gravis, whereas 10–15% of patients with myasthenia gravis are found to have thymoma. Case Presentation: This case series reported 3 patients with myasthenia gravis which co-occurred with thymoma at Sanglah General Hospital from 2018 to 2019. The patients’ ages range from 33 to 61 years (mean age 46 ± 11 years) with a 2:1 male-to-female ratio. The diagnosis of myasthenia gravis was made by the presentation of typical myasthenia gravis appearances, the fluctuating intensity of ocular and bulbar muscle weakness (all three cases), and limbs and axial muscle weakness (one case); no respiratory muscle involvement was found. Physical and supporting examinations including electroneuromyography results were coherent with myasthenia gravis. The diagnosis of thymoma was made by highly suggestive appearance in Thorax Multi Sliced Computed Tomography (MSCT) scan examination and histopathologic findings. MSCT scan examination showed a well-circumscribed ovoid solid mass in the mediastinum (left anterosuperior, superior, and anterior to middle right mediastinum) sized from 1.8x1.5x2.9 cm to 8.1x9.9x9.7 cm, enhanced with contrast injection with areas of calcification and central necrotic (1 case) and no dissemination to regional lymph node and neighboring organs. All cases received acetylcholinesterase inhibitors and underwent extended thymectomy. Histopathological examination showed accordance with thymoma features of subtype A, AB, and B1.Conclusions: Clinicians should be aware of the thymoma and myasthenia gravis co-existence possibility to ensure early recognition and appropriate management.
Brahmana Askandar, Andika Adi Saputra
Indonesian Journal of Cancer, Volume 15; https://doi.org/10.33371/ijoc.v15i2.757

Abstract:
Background: Endometrial cancer is the sixth most common malignancy incidence in women worldwide. The surgical staging in endometrial cancer management such as bilateral salpingooophorectomy and lymphadenectomy is not a routine procedure for all endometrial cancer patients. Therefore, a biomarker to estimate the presence of endometrial cancer metastases to adnexa and lymph nodes is needed. This study aims to find out the level of cancer antigen 125 (CA-125) in endometrial cancer endometrioid type and the relationship between the level of CA-125 and the incidence of adnexal metastases, lymph node metastases, clinical stage, and myometrial invasion.Methods: This observational analytic study used a direct observational design. The in-vitro quantitative examination was performed to measure CA-125 levels using CA-125 Advia Centaur CA-125 Kit. Fischer exact test used to analyzed CA-125 levels with the subject characteristics. All the statistical analyses were performed using SPSS v. 21.0.Results: Of the 30 research subjects with the characteristics of the most age groups of 51–60 years (60%), with the most multiparous parity (73.3%), grade III (43.3%), myometrial invasion > 50% by 66.7%, early-stage (63.3%), the incidence of adnexal metastases (30%), and the incidence of lymph node (LN) metastases (10%), a significant relationship between CA-125 levels and lymph node (LN) metastases was found with a p = 0.041 and the phi association of 0.016 and between CA-125 levels and adnexal metastases with a p = 0.035 and the phi association of 0.026. There was also a significant relationship between CA-125 levels and the clinical stage (advanced stage) with p = 0.004 and the phi association of 0.002. There is no significant relationship with a p = 0.702 and a phi association value of -0.098.Conclusions: CA-125 can be used as a tumor marker to predict the presence of extrauterine metastases (adnexa & lymph nodes).
Harisa Mardiah, Radita Nur Anggaeni Ginting, Heru Rahmadhany, Esther Reny Deswani Sitorus
Indonesian Journal of Cancer, Volume 15; https://doi.org/10.33371/ijoc.v15i2.708

Abstract:
Background: Breast cancer is influenced by various risk factors, including age and obesity. Older women who are overweighted and obese have a higher risk of developing breast cancer. This study aims to find the correlation between age and body mass index (BMI) with histopathological features of breast cancer patients in RSUP Haji Adam Malik Medan.Methods: This research is an analytical study using a cross-sectional design with 103 samples obtained from medical record data by random sampling. The data obtained were then adjusted to the research criteria and grouped based on predetermined variables.Results: The majority of the age group was 41-50 years (36.9%), obesity BMI (40.8%), histopathological subtype of invasive carcinoma of no special type (NST) (85.4%), and grade II (46.6%). Kruskal-Wallis test result between histopathological subtypes and breast cancer grading based on age, respectively, obtained p=0.503, r=.325; (α>0.05), and p=0.207, r=0.393; (α>0.05), while based on BMI obtained p=0.017, r=0.021; (α<0.05), and p=0.018, r=0.018; (α<0.05). The OR value (95% CI) obtained on overweight-obese BMI with invasive carcinoma NST subtype was 7.63 (7.27–14.90) and other subtypes were 2.40 (1.14–13.75), and for grades II and III, they were respectively 3.57 (1.32–8.09) and 3.27 (1.17–9.91).Conclusions: There was a correlation between BMI with histopathological subtypes and breast cancer grading, but the correlation tended to be weak. Whereas, with age, there was no correlation. BMI overweight-obese were more likely to have invasive carcinoma NST subtype and higher-grade of breast cancer.
Fauzatun Hadiyati, Ratna Supriastuti, Arifah Mujiharti
Indonesian Journal of Cancer, Volume 15; https://doi.org/10.33371/ijoc.v15i2.768

Abstract:
Background: Cancer patients that are hospitalized often have problems with their nutrient intake. Low nutrient intake can be affected by malnutrition. In cancer patients, the intake of nutrients needs to be considered specifically in relation to the occurrence of metabolic changes that lead to decreased nutritional status. The objective of this study is to analyze the effect of dietary modification and nutritional education on nutrition care process (NCP) for increasing dietary intake, body weight, and nutritional status of malnourished cancer patients and cancer patients at risk of malnutrition.Methods: The study was a quasi-experiment with one-group pretest-posttest design. The population consisted of all new adult hospitalized cancer patients. The data were collected from July to September 2019. The statistical analysis used paired sample t-test. Dietary modification and nutritional education were given individually based on each nutrition problem of the patient and their nutritional needs.Results: There were 83 patients involved for the study. Most of the patients were female (61.4%), aged over 45 years (62.7%), graduated from high school (47%), were housewives (49.4%), and had clinical histories of no comorbidities (90.4%). Most of them had improvement in general condition (74.7%). The study showed significantly increasing dietary intake of energy (889.7 calorie), protein (36.4 gr), fat (49.3 gr), and carbohydrate (131.4 gr) (p = 0.000). The increasing percentage of nutrient intake to nutritional needs before and after intervention of NCP was 39.8 to 88.6% for energy, 44.4 to 104% for protein, 51 to 120% for fat, and 41.5 to 90.1% for carbohydrate. The average increase (but not significant related correlation) in body weight was 0.16 kg (p = 0.141) and body mass index 0.05 kg/m2 (p = 1.94). Conclusions: Dietary modification and nutritional education on NCP improve dietary intakes (energy, protein, fat, and carbohydrate) of cancer patients at risk of malnutrition and being malnourished.
Etty Hary Kusumastuti, Nurdhani Hi Djafar, Alphania Rahniayu
Indonesian Journal of Cancer, Volume 15; https://doi.org/10.33371/ijoc.v15i2.771

Abstract:
Background: Papillary thyroid carcinoma (PTC) that has metastasized has a higher risk because of the poor prognosis, ranging from decreased quality of life of the patient to death. There is a need for markers that can understand the image of the tumor so that it can predict earlier the level of aggressiveness and the ability of tumor cells to metastasize. Tumor cells that proliferate excessively will cause CXCR4 expression. Activation of CXCR4 will increase MMP-9 via the MAPK/ ERK line. MMP-9 will degrade the extracellular matrix causing tumor cell metastasis. This study is aimed to analyze the correlation of CXCR4 and MMP-9 expressions with lymph node metastasis (LNM) in PTC.Methods: This cross-sectional analytic observational study was conducted in 43 PTC samples taken from the Anatomical Pathology Laboratory of Dr. Soetomo Hospital from January 2011 to December 2018. The samples were divided into 2 groups based on the regional cervical LNM status. Immunohistochemical staining was used to assess the expression of CXCR4 and MMP-9. Spearman test was used to analyze the correlation of CXCR4 and MMP expression with cervical LNM status.Results: The expression of CXCR4 and MMP-9 was higher in the papillary thyroid carcinoma group with cervical regional LNM (p = 0.007 and p = 0.030). There was a significant positive relationship between CXCR4 and MMP-9 expressions with regional LNM status with rs = 0.468 and p = 0.001 (p < 0.05). Conclusions: Expression of CXCR4 and MMP-9 was proven to correlate with regional cervical LNM status in papillary thyroid carcinoma. Both can be used as predictive markers for metastasis in papillary thyroid carcinoma.
Mugi Wahidin, Rini Febrianti
Indonesian Journal of Cancer, Volume 15; https://doi.org/10.33371/ijoc.v15i1.783

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Background: Human Papilloma Virus (HPV) is the leading risk factor of cervical cancer. World Health Organization (WHO) has recommended including HPV vaccination in national immunization programs in all countries. Specifically, Jakarta Province has been implementing HPV vaccination since 2016. In this case, several factors influence vaccination coverage. However, there is limited evidence about determinants associated with HPV vaccination. Therefore, this study aimed to investigate the factors associated with HPV vaccination among elementary students in Central Jakarta.Methods: This was a cross-sectional study conducted from March until June 2020. The study population involved 167 female students of the 6th level of the elementary school in Central Jakarta. There were eight elementary schools in Kemayoran and Cempaka Putih Sub Districts selected purposively. Primary data was collected employing an online questionnaire, which was fulfilled by respondents (mothers and students). Data were analyzed utilizing statistic software for descriptive and bivariate analysis. For the bivariate analysis, Chi-Square Test was performed.Results: The HPV vaccination coverage was 80.84%. It was also showed that the last education level of the respondents’ father and mother was mainly senior high school (SMA) for 50.3% and 47.9%, respectively. The mothers’ knowledge was mainly in the middle (56.9%), and they had a positive attitude/support (67.1%). There were only 2.4% of the respondents with a family history of cervical cancer. In terms of family economic status, the main part of respondents had low expenditure for 2-3 million IDR (59.3%) a month. Meanwhile, human resources (vaccination providers) and HPV vaccine were 100% available in the vaccination service. Of the respondent, 47.9% of those said that the vaccine price was affordable. Children who had no support to get HPV vaccination from their father, mother, and siblings were 14.4%, 6.6%, and 21.6%, respectively. Besides, children who were not supported by their teachers was 3.6% and not supported by their peers was 23.4%. Meanwhile, father and mother’s supports were significantly associated with HPV vaccination.Conclusions: Factors associated with HPV vaccination were the support from the father and mother.
Irmanida Batubara, Arif Rakhman Hakim, Silmi Mariya, Suminar Setiati Achmadi, Valentina Sokoastri Valentina Sokoastri, Agustin Sri Mulyatni, Rohayati Suprihatini
Indonesian Journal of Cancer, Volume 15; https://doi.org/10.33371/ijoc.v15i1.780

Abstract:
Background: 9,10-Anthraquinone (9,10-AQ) is a contaminant on some agricultural products and considered as carcinogenic based on EU Regulation No. 1146/2014. Except for little evidence on experimental rats, there is no strong proof regarding the carcinogenicity in humans. Therefore, it is essential to find a safe dose of this compound since the difference in 9,10-AQ levels will affect cancer cell growth. This research aims to find the 9,10-AQ concentration that does not proliferate the human cancer cells under in vitro study.Methods: In determining the 9,10-AQ concentration that does not proliferate the cancer cells growth, 0.01 to 500 mg/L 9,10-AQ was directly tested on four human cancer cells (colorectal carcinoma HCT 116, colon adenocarcinoma WiDr, breast cancer MCF-7, and cervical cancer HeLa), and the viability of the cells was counted via (3-[4,5-dimethylthiazol-2-yl]-2,5-diphenyl tetrazolium bromide) assay. In the gene expression level, the effects on a selected cancer cell line were determined by qRT-PCR against BAX, BCL-2, PCNA, and P53.Results: The result indicates that 9,10-AQ up to 500 mg/L concentration does not proliferate the cell’s growth but instead inhibits those four cancer cells’ growths. The concentration of 9,10-AQ that inhibits 50% the cancer cells growth (IC50) value was 321.8 mg/L (1.55 mM) against HCT 116 and above 500 mg/L (above 2.40 mM) against WiDr, MCF-7, and HeLa. The 9,10-AQ at 500 mg/L (or 2.40 mM) increases BAX expression and acts as an apoptotic agent on HeLa cells.Conclusions: The investigation has shown that 9,10-AQ up to 500 mg/L concentration does not proliferate the cancer cell growth; instead, it inhibits the HCT 116 and HeLa cells growth. We have preliminary evidence regarding the apoptotic mechanism of 9,10-AQ by increasing BAX gene expression on HeLa cells.
, Cosphiadi Irawan
Indonesian Journal of Cancer, Volume 15; https://doi.org/10.33371/ijoc.v15i1.782

Abstract:
Cyclin D1 is a protein that plays a role in the transition from the G1 to S phase of the cell cycle. Cyclin D1 expression has been found to increase in various malignancies and, in many studies, was associated with tumor growth, stage, lymph node involvement, distant metastases, and poor prognosis. Until now, studies on the association of cyclin D1 expression level with chemotherapy response have shown different results. An in-depth understanding of the cell cycle will allow doctors to develop target therapies that work when specific interventions are carried out at certain stages. Some studies reported that cyclin D1 expression was inversely related to chemotherapy response, while others showed opposite results. A significant number of studies have attempted to elucidate this ambiguous effect of cyclin D1. The suggested mechanism involves the difference of cancer cell types, the effect of chromosome instability in a few malignancies, trigger to an excessive DNA repair protein expression stimulus, and the response to DNA damage severity. The ambiguous effect of cyclin D1 towards chemotherapy was thought to arise from the difference in tumor type, chemotherapy agents used, and cell damage severity caused by cytostatics as per different research works. More in-depth research with parallel evaluation of other possible mechanisms such as DNA repair should elucidate the reason behind the inconsistent findings.
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