role of the multidisciplinary cancer team in reducing cancer morbidity and mortality rate in Indonesia with colorectal cancer as a model

In Indonesia, the incidence of colorectal cancer (CRC) has risen from obscurity (outside the top 10) to its present high – number two for males and number three for females (Globocan 2012). These figures are not without reason. Globally, about 25% of patients are at stage IV CRC when they visit their doctors – more than 34% in a report from Indonesia - and it is assumed that 85% of patients with stage IV CRC have unresectable liver disease with a 5-year survival rate of less than 5%. The concept of an integrated team concept or multidisciplinary care team (MDT) has open the chance for a more aggressive management with better outcome, in which unresectable cases may become resectable and the survival rate of less 5% can be improved to more than 30%. Therefore, the purpose of treatment can be shifted from palliative to curative care. Various studies have demonstrated that MDT can improve survival rate of CRC patients and it is also beneficial for its members. MDT can reduce cancer morbidity and mortality rate in Indonesia.

Prognostication in patient with terminal stage of cancer

Prognosis is one of the most critical factors affecting clinical decision in medical practice. In terminal illness where patients are only less than months to live, prognostication is essential to provide an appropriate plan, particularly to avoid futile treatment and to arrange palliative care referral. Prognostication is a process of foreseeing and foretelling, which enable the health care team, patients and family to be involved in the decision making. Determining prognosis is a challenge for doctors as lack of knowledge and skills and fear of the response of the patients and their families. Prognostication is essential in decision making among terminally ill patients, as the risks of adverse effects, energy, time and cost potentially outweighs the benefit of survival, quality of life, functional gain and hope. The benefit of prognostication is not only for the doctors, but particularly to the patients, their families, as well as to institution and health care system. In daily practice a subjective judgment made by doctor based on clinical assessment is usually overoptimistic. A tool is needed to make a better prognostication. Palliative Prognostic Index (PPI) and Palliative Prognostic Score (PaP score) are the most common tools used in palliative care setting.

Characteristics of primary cutaneous metastasis in Department of Dermatology and Venereology, Dr. Hasan Sadikin General Hospital Bandung, Indonesia, in ten years

Background: Cutaneous metastasis (CM) is a rare condition characterized by skin infiltration and cell proliferation from malignant tumor. Breast cancer is the most common primary malignancy causing CM. This retrospective study aimed to recognize the characteristics of CM from internal organ malignancies, based on the medical records from the Tumor and Dermatology Surgery Division, Department of Dermatology and Venereology, Dr. Hasan Sadikin General Hospital Bandung, Indonesia during October 2008-September 2018. Methods: The diagnosis of CM referred to clinical manifestations, histopathological, and immunohistochemical examinations. All medical records of patients contained gender and age, primary malignancy, clinical manifestations and location of skin disorders, time interval between diagnosis of primary malignancy and occurrence of CM, and mortality. Data were collected and evaluated descriptively. Results: A total of five subjects consisted of 3 patients with breast cancer, 1 patient with lung cancer, and 1 patient with prostate cancer. The subjects' age ranged from 40 to 49 years old (40%) and above 60 years old (40%) with the male to female ratio of 2:3. Breast cancer is found to be the most common malignancy (60%). All of the subjects had a skin lesion on the chest wall, abdomen, and back, and 60% of subjects had a nodule as a clinical manifestation. As much as 60% of subjects have died within four months after CM diagnosis was established. Conclusion: Breast cancer is the most common cause of CM. The CM's primary malignancies are affected by sex, age, clinical manifestations, predilection, and mortality characteristics.

Pelvic ultrasound scanning in asymptomatic adult-type granulosa cell tumor: A case report and review

Background: Ovarian cancer is common amongst women worldwide. In Indonesia, it is the fourth most common female cancer with a 5-year survival rate of 45%, but can reach up to 92% if treated early. Granulosa cell tumors (GCT) arise from the sex-cord and are considered malignant. This study presents a rare case of asymptomatic adult-type granulosa cell tumor in an elderly lady diagnosed during routine pelvic ultrasound scanning. Case Illustration: A 65-year-old lady, P2A0, was referred due to left ovarian mass three years before admission. A left adnexal mass was palpated with no sign of internal genital adhesion. Transvaginal ultrasound showed atrophy of uterus and thin endometrial layer. One solid adnexal mass with a cystic part was found on the left adnexal with papillary projection and low resistance index. Histopathological examination revealed adult type-granulosa cell tumor and classical Call-Exner body with grooved nuclei (coffee bean nuclei). Diagnosis of GCT was made by histological findings. Discussion: Histologically, granulosa cells of adult subtype appear round, pale, with scant cytoplasm, classic coffee bean nuclei and Call-Exner bodies. In contrast, the juvenile subtype has eosinophilic and/or vacuolated cytoplasm with macrofollicular or cystic patterns, composed of immature granulosa cells with frequent mitoses. Call-Exner bodies and coffee bean grooved nuclei are not commonly found. Conclusion: The diagnosis of GCT was made through histological findings which were consistent with previous findings. Therefore, a laparotomy frozen section can be considered in menopausal women with suspected ovarian neoplasms.

Potential of herbal medicines in cancer therapy

Herbal medicines have long been used for traditional treatment of diseases. Our ancestors used plants empirically as treatment and for the maintenance of health inherited from generation to generation. At present, most of the research and development of drugs is still focused on a single compound as the main compound against the treatment target. It is difficult to get a single compound chemical with high selectivity and potential but low toxicity to the target of the disease. Empiric treatment with medicinal plants is particularly a concern in cancer treatment, where treatment is currently done with chemotherapy, radiotherapy, and surgery. The active compound of herbal plants is one alternative in searching for a new anti-cancer because it is believed to have minimal side effects. Therefore, the design and development of anti-cancer drug candidate from herbal plants are increasingly in demand.