We conducted 2 case-control studies with Malaysian and Hong Kong Chinese and investigated the association between salted fish intake and nasopharyngeal carcinoma (NPC). Both studies show a highly significant association between salted fish intake, especially during childhood, and NPC. Furthermore, from our results we estimate that the majority of NPC cases occurring in the southern Chinese can be attributed to their consumption of this food early in life.
One thousand consecutive cases of carcinoma of the uterine cervix treated in the General Hospital Kuala Lumpur between January 1977 to December 1979 were studied. Epidemiological breakdown by race, age, parity, occupation, stage and histology of the disease were obtained. Treatment complications in survivors available for follow-up were analysed. The Chinese had the highest incidence, followed by the Indians and the Malays. Ninety six percent were squamous cell cancers, the remaining were adenocarcinomas. Eighty percent of patients were seen at an advanced stage (Stage IIB-IV). Late radiation complications were mainly proctitis, cystitis and fistula; (5%, 7.2% and 1.4% respectively). These figures are comparable to many centres but the incidence of cystitis is relatively higher. This is believed to be related to irradiation techniques in these cases.
One hundred patients with carcinoma of the cervix stages 1B to 4A were treated with intracavitary high dose rate radiation using a linear cobalt source. All cases have received external beam pelvic irradiation to 4500cGy mid plane in twenty fractions over four weeks. The results in terms of patient compliance and convenience were good while acute and late morbidities were comparable to standard Manchester technique of low dose rate intracavitary therapy as practised in the Institute of Radiotherapy and Oncology General Hospital Kuala Lumpur. The four year actuarial survival rate is 76% for stage II and 48% for stage III. All three stage IV patients died within 1 year. Four out of seven stage I patients are alive (minimum follow-up 18 months, longest 43 months). One died of systemic spread at 33 months while one is lost to follow up.
The clinical, biochemical and pathological features of 31 patients with thyroid carcinoma managed at Hospital Universiti Sains Málaysia, Kubang Kerian from 1985 to 1989 were analyzed. There were 25 females and 6 males. The types of carcinoma were: papillary-17 cases; follicular-10 cases; medullary-2 cases and anaplastic-2 cases. For papillary carcinoma the mean age of the patients was 52.9 years. For follicular carcinoma the mean age was 48.3 years, for medullary carcinoma, 48.5 years and for anaplastic, 74.5 years. All patients had pre-existing goitre except for 2 and most presented with advanced disease. The mean duration of symptoms for papillary carcinoma was 3.7 years, follicular carcinoma 1.6 years, medullary carcinoma 13.5 years and anaplastic carcinoma 6 months. 12 patients presented with goitre of increasing size; 9 had compression symptoms; 4 presented with cervical lymph node enlargement and 6 presented with bony pains of whom 2 had paraplegia. None of the patients were ever thyrotoxic or hypothyroid. Treatment in general was unsatisfactory because of patients' non-acceptance of surgery and/or radioactive iodine.
A case of sphenoid sinus mucocoele following radiotherapy in a patient with nasopharyngeal carcinoma is reported. Diagnosis was made by radiological investigation and confirmed at surgery performed via a sublabial transeptal approach. Its content was completely removed and continuous drainage of the sinus was maintained by an indwelling tube. It is felt that the sphenoid mucocoele developed as a result of occlusion of the sinus ostium by scarred mucosa following radiotherapy.
Cancer radiotherapy to the head and neck region results in short- and long-term radiation tissue injuries. Radiation bone injury is a long-term manifestation which could progress to osteoradionecrosis. A case of radiation tissue injury to the periodontium is presented. The possible pathogenesis of these events is described as they relate to the sequential radiographic changes observed over a period of 6 years until the involved teeth were exfoliated. The post-irradiation management of the teeth with advancing periodontal disease in the path of irradiation was by conservative means, including good personal oral hygiene care, scaling and root planing, periodic chlorhexidine irrigation, and topical fluoride application.
Matched MeSH terms: Head and Neck Neoplasms/radiotherapy
The frustration and disappointment in managing advanced cancers of the nose and paranasal sinuses are well known. We report a case of a successful treatment of such a tumour in a 37-year-old soldier, using a combination of therapy including surgery, chemotherapy and radiation. Each mode of treatment is discussed.
Matched MeSH terms: Nose Neoplasms/radiotherapy; Paranasal Sinus Neoplasms/radiotherapy
A total of 10 volunteers were monitored for radiation doses, whose spouses were given radio-iodine (131I) orally. Nine of the spouses were given radio-iodine for Graves' disease and one for thyroid carcinoma. It was found that the highest radiation dose received by the volunteer was only 13.5% of the annual dose limit for individual members of the public. Hence, patients treated with radio-iodine do not pose a significant radiation hazard to the public.
Primary germinomas of the central nervous system carry a good prognosis because of their radiosensitivity. Recurrences are rare and extraneural metastases are even more unusual. One of the possible routes of extraneural spread is via ventriculo-peritoneal shunts which may be required to reduce intracranial pressure. One such case of germinoma metastasizing via a ventriculo-peritoneal shunt is reported. Patients with intracranial germinomas and ventriculo-peritoneal shunts should have close surveillance of their abdomens and may require systemic chemotherapy.
This retrospective study of radioactive needle implants at the Institute of Radiotherapy and Oncology, Kuala Lumpur Hospital serves as an audit of our practice as well as a demonstration of the usefulness of this technique of brachytherapy. A variety of tumour sites were implanted, of which over two-thirds involved the tongue and buccal mucosa. Although most of the implants were carried out with radical intent, one-tenth of these implants were performed for palliation. Radiotherapy techniques employed are described. The crude survival ranged from 1 month to 109 months while the disease free interval ranged from 0 months to 102 months.
We report a rare tumour of the nasopharynx- papillary adenocarcinoma. This is usually of low grade and certainly in out patient it behaved so. It is even rarer to have this tumour in a patient with Turner's syndrome in whom there is a high incidence of gynaecological malignancy. It has not previously been documented and the occurrence in this patient is probably coincidental.
Radical radiotherapy is considered as the treatment of choice in locally advanced cancer cervix. In late stages radiotherapy produce optimum palliation and to some extent cure. Three hundred cases of cancer cervix (stage I-IV) comprising stage-I (7), stage-II (144), stage-III (145) and stage IV (4) were evaluated and treated with radiotherapy between April 1990 to July 1994. FIGO stage IB, IIA and IIB (early), were treated with predominant intracavitary radiotherapy (34 Gy X 2 fractions; within one week) followed by external pelvic radiotherapy to a dose of 36 Gy in 18 fractions; treating 200 cGy per fraction, 5 days a week. The late stage (stage-IIB, IIIA and IIIB, IVA) of disease were managed with initial external radiotherapy to a dose of 50 Gy, followed by a single intracavitary dose of 30 Gy to point-A. The median follow up was 33 months (range 12-72 months). The tumor volume less than 100 cc were associated with better survival than volume more than 100 cc (p < 0.05). The five year actuarial survival was 83%, 68% and 58% respectively in FIGO stage I-III disease. There were 0.33% and 2.6% late grade-III bladder and rectal complications. Our experience shows effectiveness of radiotherapy in the management of locally advanced cancer of the cervix.
From June 1993 to September 1995, 132 case files of patients who received palliative radiotherapy (RT) for skeletal metastases were reviewed. Majority of the patients (75/132) was in the age range of 41-60 years. Common sites of metastases were the vertebrae (86 patients) and the pelvic bones (40 patients). The major primary tumors encountered were as follows: multiple myeloma (30), breast cancer (25) and prostate cancer (20). Pain was the commonest symptom of presentation. Doses of palliative RT ranged from 8-40 Gy in different fractionation schedules. Ninety-four patients showed more than 50% symptomatic response, 26 had no response and 12 were lost to follow up immediately after the treatment. Single fraction treatments resulted in almost similar responses compared to various multiple fraction treatments. To conclude, short course radiation therapy regimes are optimum in our local circumstances where RT resources are limited and patients have to travel long distances to attend hospital.
A 14 year old girl presented in 1986 with a huge perineal swelling which was progressively increasing in size and associated with loss of weight and loss of appetite. Biopsy from the mass revealed rhabdomyosarcoma of the vulva. She was treated with chemotherapy and radium implant. She responded well to the regime. Fibrosis of the vulva and vagina caused difficulty in consummation. Once it was corrected, she conceived easily and proceeded to a normal pregnancy and delivery.