Indonesian Journal of Cancer

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ISSN / EISSN : 1978-3744 / 2355-6811
Total articles ≅ 141
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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.
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.
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.
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
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.
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...
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
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
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.
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.
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