The Indonesian Journal of Cancer Control
The Indonesian Journal of Cancer Control (InaJCC) is a quadrimester electronic journal, publishing papers in a wide spectrum of cancer control. The journal was launched in 2021 as the official publication of The Indonesian Society of Oncology.
Bridging the complexity of triple negative breast cancer care through multidisciplinary team approach
Triple-negative breast cancer (TNBC) is still associated with a grave prognosis, especially compared to other breast cancer subtypes. TNBC carries a high risk of recurrence and distant metastasis, resulting in lower survival rates. Additionally, TNBC exhibits significant heterogeneity at the histopathological and multiomics levels, further complicating the development of effective treatments. While some TNBC subtypes may initially respond to chemotherapy, resistance frequently develops, increasing the risk of aggressive recurrence. The approach to TNBC management has undergone significant transformations in recent years, recognizing it as a heterogeneous disease with diverse biology and behavior. Chemotherapy remains the cornerstone of treatment for most TNBC cases, with the incorporation of PD-L1 CPS or immune cell (IC) scores and BRCA status being crucial for optimizing patient management. Besides the advancement of TNBC treatment, the multidisciplinary team also plays a key role in TNBC management, enabling improved diagnosis, treatment outcomes, disease monitoring, and management of adverse events.
Copyright (c) 2025 Prof. Dr. dr. Ibnu Purwanto, Sp.PD-KHOM https://creativecommons.org/licenses/by-nc/4.0
Mechanisms of target therapy resistance in non-small cell lung cancer
In the past two decades, research on driver mutations has revolutionized lung cancer treatment with the emergence of targeted therapies as a new therapeutic strategy that significantly improves the prognosis of lung cancer. Targeted therapies are designed to recognize and disrupt specific proteins or pathways involved in the growth, spread and survival of cancer cells with high effectiveness. The use of targeted therapies has been shown to provide better progression-free survival and overall survival compared to traditional chemotherapy in NSCLC patients with targeted mutations. However, most patients eventually develop resistance regardless of the type and line of targeted therapy used. Resistance can occur in patients who initially respond targeted therapy. This is due to adaptive changes in tumor cells and the tumor microenvironment during drug exposure, through genetic and epigenetic processes forming secondary resistance. Understanding targeted therapies and their resistance mechanisms is essential to manage effective treatment for patients.
Copyright (c) 2025 Nadia Amalia Haq https://creativecommons.org/licenses/by-nc/4.0
Misdiagnosis of Lung Adenocarcinoma Mimicking of Pulmonary Tuberculosis: A Case Report
Background: Pulmonary abnormalities caused by lung cancer can be clinically and radiologically similar to pulmonary tuberculosis (TB). Pulmonary symptom of TB and lung cancer overlap each other such as chronical dyspnea, coughing, hemoptysis, chronic pain and weight loss. Radiologically such as cavities, infiltrates, nodules and miliary. These similarities make it challenging for clinicians and causes misdiagnosis with incidence between 0,03% and 30,4% worldwide. Case Presentation: A 65-year-old male with chief complaint of shortness of breath and chronic cough for three months, accompanied by symptoms of atypical chest pain, weight loss and indigestion. Chest physical examination found dullness of percussion and decrease breath sound on left side hemithorax. Chest X-ray showed cavity in the left lung. The bronchoscopy result showed mass in the left bronchial and left upper lobe. Biopsy results were obtained adenocarcinoma. Discussion: Pulmonary tuberculosis and lung cancer often mimic each other on imaging, sharing features such as irregular consolidations and thick-walled cavities. This similarity frequently leads to diagnostic confusion and potential misclassification, especially in regions with high tuberculosis prevalence. Accurate distinction requires thorough pathological and microbiological confirmation to ensure proper management. Conclusions: Diagnosing pulmonary tuberculosis and lung adenocarcinoma is challenging especially based on similarity of clinical and radiological findings, resulting in significant misdiagnosis. Further examinations and clinician expertise are essential to differentiate.
Copyright (c) 2025 Tria Meirissa https://creativecommons.org/licenses/by-nc/4.0
The Comprehensive cancer management as an effort to improve the quality of cancer care in Indonesia towards a Golden Indonesia 2045
Cancer remains a major public health challenge in Indonesia, with increasing incidence and mortality rates. GLOBOCAN 2020 data highlights a growing cancer burden, particularly in developing countries, where late-stage diagnoses and treatment delays contribute to poor outcomes. Breast cancer is the most prevalent cancer in Indonesia, followed by cervical cancer, leukemia, and colorectal cancer. Despite national efforts, a high proportion of patients present at advanced stages, leading to decreased survival rates and increased healthcare costs. This study examines the factors influencing cancer diagnosis and treatment delays in Indonesia. A comprehensive literature review was conducted, analyzing hospital-based cancer registry data, epidemiological trends, and healthcare system challenges. Key barriers include limited screening coverage, inadequate public awareness, reliance on alternative therapies, and systemic delays in referrals, diagnostics, and treatment initiation. Additionally, disparities in access to advanced cancer care exacerbate the issue. Findings emphasize the need for a comprehensive cancer management approach, integrating early detection programs, precision medicine, and multidisciplinary care. Strengthening primary healthcare services, enhancing oncology education for healthcare professionals, and developing comprehensive cancer centers are crucial steps. National cancer control policies must align with global strategies to improve patient outcomes. As Indonesia approaches its “Golden Indonesia 2045” vision, it is essential to prioritize cancer prevention and treatment. Addressing healthcare system inefficiencies, fostering collaborations between government, academia, and private sectors, and ensuring equitable access to quality cancer care will be pivotal in reducing the cancer burden and improving survival rates.
Copyright (c) 2025 Ikhwan Rinaldi https://creativecommons.org/licenses/by-nc/4.0
5 Years, layer by layer: mohs micrographic surgery insights from Indonesia cancer center dharmais cancer hospital
Abstract: Background: Mohs micrographic surgery (MMS) is the gold standard for treating high-risk non-melanoma skin cancer (NMSC). However, epidemiological data on MMS in Indonesia remain limited. This study aims to evaluate MMS use, tumor characteristics, and surgical outcomes at a single center in Indonesia. Methods: A retrospective review of 83 MMS cases at Dharmais Cancer Hospital (2020–2024) was conducted. Data on demographics, tumor characteristics, and surgical outcomes were analyzed. Tumor locations were classified into high-risk (H area), moderate-risk (M area), and low-risk (L area) anatomical zones. Results: Most tumors were located in the H area (57.8%). Basal cell carcinoma (BCC) was the most common diagnosis (79.5%), with infiltrative BCC as the predominant subtype (41.0%). A surgical margin of ≥3 mm was significantly associated with achieving tumor clearance in a single stage (p = 0.018). Multiple-stage MMS was required in 15.0% of cases. Defect closure was primarily performed using grafts or flaps (69.9%), with dermatologists performing most reconstructions (83.1%). Conclusion: MMS is effective for treating high-risk NMSC in Indonesia, with findings comparable to global data. The study highlights the importance of appropriate surgical margins and the need for further research, particularly in Asian countries. Establishing a national skin cancer registry would enhance future epidemiological studies. Keywords: Mohs micrographic surgery, basal cell carcinoma, surgical margin, H area, Indonesia
Copyright (c) 2025 Raissa Putri Raspati, Adeline Jaclyn, Danang Tri Wahyudi, Aida Sofiati Dahlan, Agassi Suseno Sutarjo, Fadhli Aulia Mughni, Inadia Putri Chairista, Nuril Ilmi https://creativecommons.org/licenses/by-nc/4.0
Knowledge, attitude, and practices of Islamic scholars on cancer care and preventive measures in Ile-Ife, Nigeria
Abstract Background: Cancer is currently one of the leading causes of morbidity and mortality, especially among adults globally. It is important to understand the perspectives of religious leaders on cancer prevention and care since their doctrines have tremendous impacts on the behaviour of their followers. Aim: This study assessed the knowledge, attitudes, and practices of Islamic scholars/clerics on cancer care and prevention. Methods: A cross-sectional design using a mixed-method approach and a two-stage sampling technique was used to recruit 128 consenting Islamic scholars. An interviewer-administered questionnaire and focus group discussion guide were used for data collection. Quantitative data were analysed using the SPSS software version 20 with p ≤ 0.05 taken as significant. Qualitative data from 36 participants with the results analysed using thematic content analysis. Results: The majority of the respondents had heard of cancer, and 60% of them had poor knowledge of cancer care and prevention. The statistically significant predictors of good practice among the respondents include being not married (AOR 3.64; 95%CI 1.26-10.47; p=0.017), being new members of an Islamic congregation (AOR 6.00; 95%CI 2.22-16.19; p=0.0001) and having good knowledge (AOR 4.85; 95%CI 1.66-14.11; p=0.004). The FGD sessions revealed several myths and misconceptions about cancer. Conclusion: This study revealed predominantly poor cancer knowledge, negative preventive attitude, and poor cancer care/preventive practices. It underscores the need for an educational intervention targeting Islamic scholars to equip them with the right cancer-related information, which can be passed down to their followers. Keywords: Knowledge; Attitude; Practice; Cancer Awareness; Islamic scholars.
Copyright (c) 2025 Abdulakeem Ahmed https://creativecommons.org/licenses/by-nc/4.0
Rare Delayed Tracheal Perforation after Total Thyroidectomy Repaired With Autologous Pericardial Pacth
Background: Thyroidectomy is a general surgical procedure that is very common with 3–5% complication rate. Tracheal perforation after thyroidectomy is rare at 0.06%, and is usually identified and repaired intraoperatively. Delayed tracheal perforation is even rarer, with only few cases reports with different management.1–3 Case illustration: We report a case of a 57-year-old female who underwent total thyroidectomy for infiltrating bilateral thyroid cancer. Tumor infiltration to the trachea was shaved, followed by tracheostomy to secure the airway. Perforation symptoms appear on day 4 after the patient experienced choking in the form of progressive slem production. Perforation was found in the shaven area fused to the tracheostomy hole sized 2x3 cm. The patient was managed in stages, initially with debridement and antibiotics followed by surgical repair. Tracheal repair surgery performed an autologous pericardial pacth combined with a PTFE vascular implant. The patient was extubated 1 week after repair and discharged alive. No further complications on follow-up. Discussion: In this case, perforation happened due to mechanical force on the remaining thin shaved tracheal wall during choking. Autologous pericardial patch was used due to its several advantages combined with PTFE vascular implant as rigid stenting that prevent colaps when breathing. Conclusion: Autologous pericardial patch combined with PTFE was sufficient to close delayed perforated trachea after thyroidectomy.
Copyright (c) 2025 Daan Khambri, Ramadanus https://creativecommons.org/licenses/by-nc/4.0
Recurrent Buccal Kimura’s Disease with Contralateral Parotid Gland, Lymph Nodes, and Subcutaneous Involvement: A Rare Case
Kimura's disease (KD) is a rare chronic inflammatory condition predilected in the head-neck region as a painless lump that may mimic malignancy. No previously recurrent KD has been reported in Indonesian males, especially with contralateral involvement. We report a 30-year-old male who had a progressive buccal lump with a history of biopsy-proven KD. Neck US and MRI imaging and histopathology confirmed a recurrence of buccal KD with involvement of the contralateral right parotid gland, bilateral lymph nodes, and subcutaneous buccal region. After superficial right parotidectomy, steroid, and further chemoradiotherapy, postoperative residuals were shown in follow-up CT. Combined neck US and MRI/CT can demonstrate mass extension. Follow-up imaging is important to evaluate mass extensions and residuals.
Copyright (c) 2025 Rahmad Mulyadi, Noprianty Eka Pratiwi, Ening Krisnuhoni https://creativecommons.org/licenses/by-nc/4.0
Multidisciplinary Approach in Prostate Cancer Management: Harmonizing the Role of Surgery, Radiation, and Systemic Therapy
Prostate cancer management necessitates a comprehensive multidisciplinary approach, involving specialists such as medical oncologists, urologists, pathologists, radiologist, and radiation oncologists. A 68-year-old male underwent interventions for metastatic prostate cancer. Initially diagnosed with localized disease, he received a radical prostatectomy (RP) and subsequently underwent radiation therapy (RT) along with androgen deprivation therapy (ADT). His initial diagnosis categorized him as high-risk localized prostate cancer (stage cT2cN0M0), guided by screening recommendations, leading to a histopathological diagnosis of pT2N0M0. Prognostic factors like Gleason score and PSA level informed treatment decisions. Although PSA levels initially decreased post-prostatectomy, subsequent rises necessitated further intervention. Early postoperative radiotherapy and adjuvant ADT demonstrated efficacy in improving patient outcomes. Metastatic screening and subsequent therapy were guided by evidence-based protocols. Despite the patient's response to treatment, bone metastasis occurred, prompting palliative external radiation and zoledronic acid therapy. After RP, RT, ADT, palliative external RT, and bisphosphonate therapy, imaging revealed no residual lesions or signs of metastasis, with a significantly decreased PSA level. This case serves as a compelling example of a multidisciplinary team's involvement in maximizing patient care and treatment effectiveness for metastatic prostate cancer.
Copyright (c) 2025 Dimas Priantono, Wulyo Rajabto, Rahmat Cahyanur, Albertus Raditya Danendra, Edo Aditya Dwi Susanto, Manika Putri Kunigara https://creativecommons.org/licenses/by-nc/4.0
The Impact of omega-3 supplementation on body weight in cancer patients
Introduction: Cancer-related malnutrition affects 20-70% of patients, causing anorexia and increased energy expenditure, leading to muscle and adipose tissue decline. Omega-3 PUFA supplementation is believed to reduce inflammation and maintain muscle strength and weight, improving the quality of life. This study aims to examine its effectiveness in aiding weight maintenance in cancer patients. Case Illustration: A 23-year-old man was admitted to the hospital with a worsening headache. He had a history of craniotomy, maxillectomy, and tracheostomy due to a tumor obstructing his airway, followed by chemotherapy. Despite normal bowel and urination, he reported decreased appetite and weight loss. Physical examination revealed severe malnutrition and a left facial mass with temporal hollowing. Anemia, hyponatremia, and hypokalemia were noted. The patient was scheduled for surgery and advised dietary adjustments and omega-3 supplementation to manage inflammation and prevent further weight loss. He questioned its efficacy beyond cardiovascular health. Discussion: A critical review revealed significant outcomes of omega-3 supplementation on cancer patients' weight. Cancer induces inflammation and metabolic changes, leading to anorexia and muscle decline. Omega-3 suppresses inflammation, improves appetite, and promotes weight gain. Studies support its efficacy in various cancer types. Concerns over chemoresistance and gastrointestinal effects exist. Nonetheless, omega-3 can be safely integrated into cancer patient management to improve treatment response and quality of life. Supplementation with at least 1g of EPA is recommended for its anti-inflammatory benefits. Conclusion: Omega-3 supplementation can help maintain weight in cancer patients.
Copyright (c) 2024 Retno Wijayanti, Krisadelfa Sutanto https://creativecommons.org/licenses/by-nc/4.0
Diagnosis and treatment post chemoradiation: A case report on recurrent nasopharyngeal carcinoma
Background: Nasopharyngeal carcinoma (NPC) is a common malignant disease in Southeast Asia and radiotherapy is the preferred treatment. Approximately 10% of patients show local recurrence after radiotherapy. Following radiotherapy, fibrous hyperplasia of the nasopharynx and poor local circulation due to local vascular occlusion often occur, leading to low treatment efficacy and many side effects from re-irradiation. Residual tumor after the first treatment may mutate and other mechanisms can cause the tumor to be resistant to the same treatment. Surgical treatment of residual and recurrent NPC has been advocated. Thus, early detection and accurate residual/recurrent NPC staging are essential for treatment and prognosis. Fluorodeoxyglucose-positron emission tomography-computed tomography (FDG PET-CT) is the most accurate imaging modality for assessing local residual or recurrent NPC but has several limitations. Diffusion weighted imaging-magnetic resonance imaging (DWI-MRI) is an imaging technique that can detect distant metastases of NPC and postradiotherapy biological changes and has a lower cost than FDG PET-CT. Objective: To determine the right choice in the diagnosis and management of patients with residual/recurrence NPC. Methods: Literature searching was done in Pubmed and Cochrane for managing residual/ recurrent NPC with seven literature results and one relevant literature. Conclusion: The combination treatment preceded by surgery is superior to conventional conformal radiotherapy (CRT) alone. For diagnosis, DWI-MRI can provide qualitative and quantitative information about tumor cell levels and identify residues, local fibrosis, and post-radiotherapy recurrence in NPC.
Copyright (c) 2024 Marlinda Adham , Febby Shabrina, Rayhan Eddy Yunus https://creativecommons.org/licenses/by-nc/4.0
Efficacy of gefitinib versus erlotinib as first-line treatment in EGFR mutant advanced lung adenocarcinoma at RSP Dr. H. A. Rotinsulu
Background: Gefitinib and erlotinib are superior to chemotherapy, and are considered first-line therapies in adenocarcinoma with epidermal growth factor receptor (EGFR) mutation patients. However, the determination of the choice of gefitinib or erlotinib is not yet clear. Aim: To compare the progression-free survival (PFS), overall survival (OS) and time on treatment (TOT) of adenocarcinoma with EGFR mutation patients who receiving first-line gefitinib versus erlotinib. Methods: This is a retrospective study used medical record of patients who were treated with first-line gefitinib 250 mg once daily versus erlotinib 150 mg once daily at Dr. H.A. Rotinsulu Lung Hospital from 1st January 2019 to 31th December 2021. Results: There are 103 patients (74,1%) who received gefitinib and 36 patients (25,9%) who received erlotinib as first-line treatment. Median PFS in gefitinib and erlotinib group was 26 months and 17 months (P=0,184), respectively. Median overall survival time of the gefitinib group was the 46,78 months but in erlotinib group cannot be analysed. Median time-of-treatment was 12 months in gefitinib group and 11 months in erlotinib group (P=0,172). The incidence rate ratio in the TKI group did not show a causal relationship with death due to IRR values of 0,74 and 95% CI IRR of 0,21;3,24. Based on univariate analysis, gender affects PFS (HR1,7;CI95%;1,0-3,4;P=0,049) and TOT (HR1,6;CI95%;1,1-2,6;P=0,020). The data also showed that age affects TOT (HR1,5;CI95%;1,0-2,4;P=0,037). Conclusion: There was no difference in efficacy between gefitinib and erlotinib in the treatment of pulmonary adenocarcinoma patients with EGFR gene mutations at Dr. H.A. Rotinsulu Lung Hospital.
Copyright (c) 2025 Elisna Syahruddin, Uun Unaedi, Edi Sampurno, Herudian Ahmadin, Reza Kurniawan Tanuwihardja, Dyah Panji https://creativecommons.org/licenses/by-nc/4.0
Unusual site of skin metastasis from lung adenocarcinoma
Background: Skin metastasis incidence is approximately 3,4% of lung cancer with highest incidence in man. It arises mostly in man from primary cancer of the lung (24%), colon (19%), melanoma (13%) and oral cavity (12%). In woman, it arises from breast (69%), colon (9%), melanoma (5%), ovaries (4%) and lung (4%) primary cancer. It may occur at the same time or before the primary cancer detected. Case Illustration: Forty-sixth years old male referred with lesion found in chest x-ray during the medical check-up procedure. Nodules arose at parietal and abdomen region since three months prior. Chest CT scan revealed a solid 6,4 cm mass in long axis at the medial of left lung lobe. Head CT scan revealed subsolid nodule at cutaneous-subcutaneous of the left occipital attached to the periosteum without bone destruction and solid nodule at cortex-subcortex of right frontoparietal accompanied by perifocal edema. Bronchoscopy procedure found edematous mucosa of left B1 to B3 orificium. Histopathology and cytology examination confirmed adenocarcinoma with wild-type EGFR mutation. Discussion: Preference site of lung cancer skin metastasis is at supra-diaphragm region. Nodules are usually firm, painless and appear as oval or round form. Ulceration may be seen. In our case, the lesion were ulcerate with granulation tissue at the edge and black scars form containing necrotic tissue. Adenocarcinoma is the most common type of lung cancer with skin metastases. Conclusion: It is essential to consider any skin pathological form in patient with lung adenocarcinoma as skin metastases.
Copyright (c) 2025 Isti Mardiana Soetartio, Dina Faizah, Amira Ismi Noor, Semba Anggen Rachmani https://creativecommons.org/licenses/by-nc/4.0
The influence of GCB and Non-GCB subtypes based on the Hans algorithm on 2 Year event free survival in diffuse large B-cell lymphoma patients who received RCHOP therapy
Background: Diffuse large B cell lymphoma (DLBCL) is the most common subtype of non-Hodgkin's lymphoma. Based on the Hans algorithm, DLBCL is divided into two main subtypes, namely Germinal Center B-Cell-like (GCB) and non-GCB. GCB has a better prognosis than non-GCB subtypes. Research Objective: To compare the effect of subtypes on the 2-year event-free survival (EFS) of DLBCL patients who received RCHOP therapy. Methods: This research is a retrospective cohort study sourced from patient medical record data RSCM who registered from January 2014-March 2021. We collected demographic data, clinical examination results, hematology parameter, LDH, radiological examinations and events for 2 years. Survival analysis was performed using the Kaplan-Meier curve, cox-regression test was performed to assess the hazard ratio (HR). Nominal variables compared using the Chi-Square test, while numerical variables analyzed using independent T-Test. Results: Our study found 108 DLBCL patients with 33 GCB subtype patients (30.6%), median age 53 years (range 18—88 years), 60 (55.6%) were at stage I or II, and 89 (82%) patients had extranodal lesions 0-1. Event free survival in the GCB subtype was 54.5% and in the non GCB subtype group was 42.7%. The mean EFS for the GCB subtype was 19.6 months (95% CI, 17.38-21.82) and for the non-GCB subtype 18.6 months (95% CI, 17.21-20.01). The HR for GCB subtype was 0.749 (95% CI: 0.416-1.349, p=0.336). Conclusion: DLBCL patients with the GCB subtype have better 2-year EFS and a longer mean EFS time compared to non-GCB. The GCB subtype protective against event (p>0,05).
Copyright (c) 2025 Faisal Syarifuddin https://creativecommons.org/licenses/by-nc/4.0
Background: Marjolin’s ulcer (MU) is a rare but aggressive malignant transformation of long-standing scars or chronic wounds. Case Illustration: we present three cases of MU that arise from post-traumatic scar. Two of the cases were found on the lower extremity and one on the scalp. Two lesions of lower extremities were preceded by burn injury from various causes. One lesion on the scalp was caused by non-burn trauma. Diagnosis was confirmed after tissue biopsy which revealed well-differentiated squamous cell carcinomas. Two patients underwent surgical intervention (wide excision and Mohs micrographic surgery) followed by split-thickness skin graft (STSG). In one patient, a wide excision was planned to be performed but the patient died before the surgery. Discussion: the most frequent type of MU is squamous cell carcinoma (SCC). Extremity is the most common sites of predilection followed by the head and neck region. Marjolin’s ulcer with histopathological features of SCC is more aggressive and carries a poor prognosis with a high rate of recurrence. Conclusion: early recognition of malignant conversion followed by comprehensive staging and early treatment, are of the utmost importance. Surgery remains the optimal treatment for MU, frequent and intense follow-up after surgery is required.
Copyright (c) 2025 Dina Kusumawardhani, Melody Febriana Andardewi, Adhika Ayu Lestari, Larisa Paramitha Wibawa, Roro Inge Ade Krisanti https://creativecommons.org/licenses/by-nc/4.0
Overall survival of non-small cell lung cancer who treated with systemic therapy: The experience at a regional hospital, Bandar Lampung
Background: The benchmark for the success of cancer treatment is the survival rate. Although the hope for survival is increasing, there are still concerns regarding the cost of treating lung cancer with targeted therapy which is very expensive and has not yet been included in the national formulary for third generation EGFR-TKI target therapy (osimertinib). Method: Analytic descriptive with retrospective cohort design processed with SPSS 25 with log rank test and shown with Kaplan Meier product limit curve. Data was taken at Dr.Hi.Abdul Moeloek Hospital from January 2020 to December 2022 during the Covid 19 pandemic. Results: Group of Lung adenocarcinoma treated by EGFR-TKI 39 subjects. The lung adenocarcinoma group was treated with paclitaxel-carboplatin 53 subjects.The median survival time of the group treated with EGFR-TKI was 7 (95% CI: 3.805-10.195) months, while the group receiving paclitaxel carboplatin was 5 months (95% CI: 3.788- while the overall median survival was 6 months (95% CI: 4.836- 7.164) there is no significant difference with the p value: 0.209. Conclusion: The median survival rate of two groups at 6 months was not significantly different.
Copyright (c) 2025 Sukarti Sukarti, Andreas Infianto, Syazili Mustofa https://creativecommons.org/licenses/by-nc/4.0
Expression of thyroid transcription factor-1, P40, and cytokeratin 5/6 in non-small cell lung carcinoma at Persahabatan Hospital in 2021
Background: Non-small cell Lung carcinoma (NSCLC) comprises 80% of lung cancer and mainly consists of adenocarcinoma and squamous cell carcinoma. Immunohistochemistry plays an important role in accurately diagnosis of different types of lung cancer. Aim: To determine the expression of thyroid transcription factor-1 (TTF-1), P40, and cytokeratin 5/6 (CK 5/6) in lung cancer and to determine the differences in the expression of TTF-1, P40, and CK 5/6 in adenocarcinoma and squamous cell carcinoma. Method: This study is a cross-sectional study with 47 samples, 35 adenocarcinoma and 12 squamous cell carcinoma for immunohistochemistry examination. Immunohistochemistry examination on TTF-1 expression using monoclonal mouse antibody 8G7G3/1, P40 expression using polyclonal rabbit antibody, and CK 5/6 expression using CK5/6.007 monoclonal mouse antibody. Results: Expression of TTF-1 was found in 25 cases of adenocarcinoma (71.4%) and in four cases of squamous cell carcinoma (33.3%). P40 was expressed in eight cases of squamous cell carcinoma (66.7%) and in six cases of adenocarcinoma (17.1%). Cytokeratin 5/6 was expressed in eight cases of squamous cell carcinoma (66.7%) and in four cases of adenocarcinoma (11.4%). Thyroid transcription factor-1 had a positive correlation with adenocarcinoma, whereas P40 and CK 5/6 negatively correlated with adenocarcinoma, but were more associated with squamous cell carcinoma. Conclusions: There were significant differences in TTF-1, P40, and CK 5/6 expressions between adenocarcinoma and squamous cell carcinoma, but the three expressions could not be used simultaneously. Thyroid transcription factor-1 expression was more accurate than P40 and CK 5/6 for differentiating adenocarcinoma with squamous cell carcinoma.
Copyright (c) 2025 Elisna Syahruddin, Linda Masniari, Jamal Zaini, Romi Beginta, Eylin Raharjo, Ruth E Sembiring https://creativecommons.org/licenses/by-nc/4.0
Comprehensive treatment of lung malignancy for meaningful survival
The American Cancer Society estimates, in 2023 there will be an estimated 238,340 new cases of lung cancer in which 117,550 cases in men and 120,790 cases in women. Non-Small-Cell Lung Cancer (NSCLC) is a prevalent type of lung cancer, accounting for approximately 80% of all reported lung malignancy cases and characterized by a poor 5-year survival rate. Lung cancer detected in early stages with prompt diagnosis and appropriate treatment will improve the patient's life expectancy. According to current data, patients admitted to the hospital with lung cancer in an advanced stage. Platinum-based chemotherapy is widely regarded as the gold standard of therapy for patients with advanced lung cancer across the world. Chemotherapy not only eliminates cancer cells, but also affects actively proliferating normal cells, such as hematopoietic cells in the bone marrow. Stem cells that secrete granulocytes, erythrocytes and platelets in the peripheral circulation will be harmed as well. Further research and new discoveries are required for treatment approaches that are projected to reduce the problem of adverse survivorship bias and improve the quality of life for lung cancer patients. Several targeted therapies, such as EGFR tyrosine kinase inhibitors and ALK inhibitors, have demonstrated significant clinical success in treating NSCLC patients with the corresponding gene mutations.
Copyright (c) 2025 Laksmi Wulandari https://creativecommons.org/licenses/by-nc/4.0
Liquid biopsy and tissue biopsy for epidermal growth factor receptor (EGFR) mutation analysis in lung adenocarcinoma
Background: Epidermal growth factor receptor (EGFR) mutations in non-small cell lung cancer (NSCLC), especially the type of adenocarcinoma, have emerged as a significant therapeutic target. Obtaining tissue samples from patients with advanced lung cancer has been challenging and the tissue samples often exhibit tumour heterogeneity depending on the location in the lungs. Notably, peripheral blood liquid biopsy exhibits better specificity in detecting EGFR mutations in NSCLC patients, yet tissue biopsy remains necessary for those with negative blood biopsy results due to its lower sensitivity. Methods: We compared EGFR test from histo/cytopathological samples versus blood of naïve adenocarcinoma NSCLC at Persahabatan Hospital, Jakarta. EGFR mutation test from pathological sample was done using PCR HRM, Fragment Analysis, Direct Sequencing and AmoyDx, whereas EGFR mutation testing from blood was using Therascreen EGFR Plasma RGQ PCR Kit. Results: Among 100 subject recruited, 89 matched samples were eligible for evaluation. EGFR mutation were detected positive from 39.3% tissue biopsy compare with only 22.5% positive EGFR mutation from blood. Using the tissue biopsy as standard, the sensitivity and positivity of liquid biopsy was 54.29% and 98.15%, with positive predictive value of 95% and negative predictive value of 76.81%. Conclusion: Liquid biospy has high specificity in detecting EGFR mutation in naive adenocarcinoma NSCLC. However, its use in the clinic cannot replace the role of the PA examination to determine the type of cancer cells.
Copyright (c) 2024 Elisna Syahruddin, Fanny Fachrucha, Jamal Zaini, Andika C. Putra, Erlang Samoedro, Sita L. Andarini https://creativecommons.org/licenses/by-nc/4.0
Microbial allies and enemies: How the skin microbiome influences skin cancer
The microbiota is a population of bacteria that inhabit the human body, whereas the microbiome is the set of genes they encode. The microbiota can affect skin cancer risk and treatment response. Cancer is defined as uncontrolled or abnormal cell proliferation. The pathogenesis of skin cancer is multifactorial which includes disruption of the skin barrier, the immune system, metabolites and toxins from microbes, and ultraviolet radiation. The microbiome is an important component of the tumor microenvironments, both in the skin and gut. Microbial dysbiosis is associated with chronic inflammation which may further mediate carcinogenesis. The polymorphic microbiome is consider one of the enabling characteristics of the hallmarks of cancer. Abnormal skin microbiota will produce cytokines and chemokines that contribute to tumor growth. Various microbiota has tumorigenesis effects such as Staphylococcus aureus, beta-HPV, Corynebacterium, and Fusobacterium, but there are also protective microbiota namely Cutibacterium, Malassezia, and Staphylococcus epidermidis. Studies showed that the presence of microbiome polymorphic variability between individuals has a profound impact on cancer phenotypes
Copyright (c) 2024 Nabila Zaneta Soebijanto https://creativecommons.org/licenses/by-nc/4.0
Anticancer potential of Panduratin A against non-small cell lung cancer
Lung cancer is one of the leading causes of cancer death worldwide and ranks first in the number of cancer cases that occur in men and fourth in women in Jakarta. Small cell lung cancer (SCLC) accounts for 15% of lung cancer cases, whereas non-small cell lung cancer (NSCLC) accounts for 85% of instances. Exposure to carcinogens, heavy metals, and polycyclic aromatic hydrocarbons (PAHs) increases lung cancer risk. Repeated exposure to carcinogens can cause genetic mutations by forming DNA adducts. Genetic mutations commonly occur in EGFR, the p53 tumor suppressor gene, and failure in apoptosis. Conventional therapy has limitations such as severe side effects, drug resistance, and treatment costs. Therefore, a new strategy is needed to use natural plant compounds as chemopreventive agents or to slow cancer growth. Panduratin A is a natural chalcone-derived compound isolated from fingerroot or Temu Kunci (Boesenbergia pandurata). This compound exerted various antibacterial, anti-inflammatory, antioxidant, and anticancer activities. Panduratin A's anticancer mechanisms included cell cycle arrest, induction of apoptosis, and anti-angiogenesis in several cancer cell lines. Panduratin A was also selectively cytotoxic and inhibited the PI3K/Akt signaling pathway.
Copyright (c) 2025 Silmi Hanifah, Melva Louisa, Wawaimuli Arozal https://creativecommons.org/licenses/by-nc/4.0
Palliative management of advanced stage head and neck cancer
Background: Head and neck cancer is one type of cancer with high prevalence in Indonesia. So far, the therapeutic approach for patients with head and neck cancer has focused a lot on the curative approach. In patients with advanced conditions, unable to undergo curative therapy, the palliative approach plays an important role to improve the quality of life. This paper aims to better understand about palliative care in advanced head and neck cancer. Case Illustration: Male, 43 years old, with adenocystic carcinoma of the salivary gland. The tumor has already spread to the spinal cord. The team decided to put the patient into palliative care. Treatment goals for this patient were to reduce pain. Discussion: Therapeutic choices for head and neck cancer include surgery, radiotherapy, and chemotherapy. The palliative approach plays a role at the point where the patient’s condition determines the shift in the treatment plan from curative to palliative therapy. Early palliative therapy provided a statistically greater effect on the overall quality of life, overall survival, incidence of depression and severity of symptoms. Conclusion: In advanced head and neck cancer, early palliative intent treatment leads to improvements in quality of life.
Copyright (c) 2023 Marlinda Adham , Anita Amalia Sari, Rudi Putranto, Indrati Suroyo, Eka Dian Safitri https://creativecommons.org/licenses/by-nc/4.0
See and treat: Cervical cancer prevention strategy in Indonesia with VIA-DoVIA screening and prompt treatment
Cervical cancer, as the second most common type of cancer in Indonesia after breast cancer, is a major problem for Indonesian women. Cervical cancer can be prevented with HPV vaccination and various screening/early detection methods, such as Pap smear, VIA (visual inspection with acetic acid) test, and HPV-DNA test. Currently, VIA test is the chosen screening method for cervical cancer in Indonesia, as it is easy, cheap, accurate, and can be implemented in all regions of the country. The VIA method was developed using VIA documentation (DoVIA) and VIA documentation telemedicine (TeleDoVIA). It is established that positive findings should be treated with cryotherapy. This serial of diagnosis using VIA screening and treatment with cryotherapy is termed See and Treat. Subsequently, it is developed into Screen and Treat. The gas supply for cryotherapy may become a challenge, which drive the search for an alternative therapeutic method, such as using TCA (trichloroacetic acid). Strategies for the prevention of cervical cancer includes implementation of HPV vaccination (90%), 70% coverage of screening, and treatment after positive findings (90%). The involvement of the authorities is crucial for the achievement of strategical target and its public implementation, by setting regulations for the success of screening coverage.
Copyright (c) 2023 Laila Nuranna https://creativecommons.org/licenses/by-nc/4.0
Prognostic value of tumor-infiltrating lymphocytes among HER-2+ breast cancer patients receiving trastuzumab-based adjuvant therapy
Background: Tumor-infiltrating Lymphocytes (TILs) have prognostic value on HER2 positive breast cancer (BC). The absence of standardized method for evaluating TILs causes variations in results of previous studies. This study is performed to evaluate the prognostic value of TILs in HER2 positive BC treated with trastuzumab-based adjuvant therapy using standardized method recommended by the International TILs Working Group. Aim: To analyze the prognostic value of TILs in HER2 positive BC patients receiving trastuzumab-based adjuvant therapy at Dr. Sardjito General Hospital, Yogyakarta and to analyze proportion differences between high TILs (≥30%) and low TILs (<30%). Methods: This is a retrospective cohort study on HER2 positive, stage 1-3 BC patients who received trastuzumab-based adjuvant therapy. Histopathology slides from 6 hospitals/laboratories were analyzed by two pathologists. Results: 73 data were available for analysis. TILs stroma <30% was 65,8% and most patients received combination of anthracyclines, taxanes and trastuzumab (67,1%). There was no difference of overall survival between high and low TILs (p log rank: 0,331). Conclusion: The proportion of HER2 positive breast cancer with high TILs was lower than those with low TILs. HER2 positive BC with high TILs did not show better overall survival compared to those with low TILs. Our study did not support the theory that different TILs score has prognostic value in HER2 positive breast cancer. Since no formal recommendation for a clinically relevant TIL threshold has been given, further study with bigger samples and better concordance rate among pathologists should be done.
Copyright (c) 2021 dr. Diah Ari Safitri, Sp.PD-KHOM, Dr. dr. Ahmad Ghozali, Sp.PA(K), dr. Johan Kurnianda, Sp.PD-KHOM https://creativecommons.org/licenses/by-nc/4.0
A rare case of falcotentorial meningioma type II of the pineal region
Background: Pineal region meningiomas are incredibly uncommon causes of pineal mass. Diagnosis is usually made when the tumours already reach huge diameters and cause mass effects, obstructing the ventricles and aquaducts. Case Illustration: We present a case of a 32-year-old man complaining of worsening blurred visions and headaches. Brain Magnetic Resonance Imaging (MRI) disclosed a well-defined, lobulated pineal region mass that homogenously enhanced after contrast injection, with a dural adherence, close to the junction of the Vein of Galen and the straight sinus and inferior to the anterior edge of the tentorium, suggestive of a diagnosis of falcotentorial meningioma type II from the pineal region. The tumour compressed the mesencephalon and caused non-communicant hydrocephalus. The patient underwent tumour removal. Histological analysis of the tumour was consistent with meningioma WHO grade I. Discussion : Pineal region meningioma, the falcotentorial type, can also be classified into four different types based on the tumour’s adherence to the dura and the extension to its surrounding structures. Although rare, pineal region meningioma should be included as a differential diagnosis in a patient presenting with a pineal mass. MRI, both conventional and multimodal, still holds a crucial role in aiding clinicians and surgeons to make the correct diagnosis and deliver the best treatment option for the patients. Conclusion : MRI can help differentiate pineal region meningiomas from intracranial and other pineal region tumours and aid the neurosurgeons in deciding the appropriate management approach for this rare intracranial neoplasm.
Copyright (c) 2023 Rahmad Mulyadi, Prijo Sidipratomo, Taufik Budianto, Eka Susanto https://creativecommons.org/licenses/by-nc/4.0
Perianal infections in acute leukemia patients who received induction and consolidation chemotherapy
Perianal infection (PI) is one of the complications often found in acute leukemia patients who received induction and consolidation chemotherapy. Perianal mucosal damage in these patients can be a port of entry of pathogenic microorganism. Clinical manifestations of PI can range from abscess and fistula to life-threatening complications of tissue necrosis and sepsis. Patients with neutropenia sometimes do not show profound signs of inflammation so that diagnosis sometimes requires imaging studies. These conditions not only cause death, but also decreases the patient's quality of life. Management of PI includes surgical and nonsurgical procedures, both of which show good results in most patients, however complications such as sepsis and necrosis can still be found. Prevention and early diagnosis of PI in leukemia patients are important and need to be developed.
Copyright (c) 2023 Diah Pitaloka, Adhimukti T. Sampurna, Tubagus Djumhana Atmakusuma, Aida SD Hoemardani, Nandita Melati https://creativecommons.org/licenses/by-nc/4.0
Frozen Section Tissue Staining For Non-Melanoma Skin Cancer in Mohs Micrographic Surgery
Non-melanoma skin cancer has the highest incidence globally. The most common types of non-melanoma skin cancer are basal cell carcinoma and squamous cell carcinoma. Currently, Mohs micrographic surgery is the gold standard in the management of non-melanoma skin cancer because of its higher success rate, lower recurrence rate, and better cosmetic outcome compared to conventional surgery. Hematoxylin and eosin are commonly used for tissue staining of frozen sections in Mohs micrographic surgery. In some cases, other staining such as toluidine blue, hematoxylin and safranin O, periodic acid-Schiff, and oil red O are required to identify the characteristic features of various types of cancer. The use of properly frozen section tissue staining facilitates Mohs micrographic surgeon in determining the boundary of a cancer-free incision.
Copyright (c) 2024 Irwan Saputra Batubara, Larisa Paramitha Wibawa, Adhimukti T Sampurna, Lis Surachmiati Suseno, Riesye Arisanty https://creativecommons.org/licenses/by-nc/4.0
Prognostic factors in lung cancer patients with lung adenocarcinoma who received chemotherapy and EGFR TKI at H. Adam Malik Hospital Medan
Background: Lung cancer has a poor prognosis compared to other types of cancer because of its low survival rate. The management of lung adenocarcinoma includes a chemotherapy approach and targeted therapy with EGFR-TKI, but the patient is still not optimal. This study aims to determine the prognostic factors in lung cancer patients with lung adenocarcinoma who received chemotherapy and EGFR-TKI at H. Adam Malik Hospital, Medan. Method: This is an analytic study with a retrospective cohort design conducted at the Oncology Polyclinic, H. Adam Malik Hospital from January 2017 to December 2019. The subjects were all patients with lung adenocarcinoma who received chemotherapy and EGFR-TKI treatment. Demographic and clinical evaluation data of patients tested with statistics to assess prognostic factors of adenocarcinoma patients who have been treated. Results: The median length of life for patients receiving EFGR-TKI was 9 months (95% CI: 6,866 – 11,134 months). The median length of life of subjects receiving chemotherapy was 10 months (95% CI: 8,923 – 11,077 months) The median PFS of patients receiving chemotherapy was 6 months (95% CI: 4,841 – 7,159 months) and patients receiving EGFR therapy for TKI was 6 months (CI 95%: 4,720 – 7,280 months). A log-rank test showed that there was a significant difference in median PFS between adenocarcinoma patients receiving EGFR TKI and chemotherapy (p = 0.013). Conclusion: A significant difference was found in the median PFS between patients with lung adenocarcinoma who received EGFR-TKI and chemotherapy.
Copyright (c) 2024 Muhammad Redha, Noni Novisari Soeroso, Setia Putra Tarigan, Taufik Ashar https://creativecommons.org/licenses/by-nc/4.0
Screening Approach and Early Detection Of Lung Cancer In Non-Smoking Female
The prevalence of lung cancer is generally dominant in men as cancer with the highest mortality rate. However, the mortality rate for lung cancer in women has increased, which placed lung cancer as the first deadliest cancer based on mortality rate followed by breast cancer. In Indonesia, lung cancer ranks third in the incidence of lung cancer in both gender and ranks first in the incidence in men. For women, lung cancer is not in the top 5 of the highest cancer’s incidence. There are several risk factors in women, such as passive smoking, exposure to pesticides, exposure to biomass, and others. Exposure to biomass includes exposure to wood smoke, mosquito coils, and lime dust. Therefore, early detection of those who have been exposed to the above risk factors is needed. Two components of cancer detection include early detection and screening. Early detection focuses on detecting symptomatic patients as early as possible, whereas screening consists of screening healthy individuals to identify those with cancer before symptoms appear. A global study by The National Lung Screening Trial (NLST) showed a 20% reduction in mortality from lung cancer by screening using Low Dose CT-Scan (LDCT), thus making LDCT the modality of choice for screening lung cancer patients.
Copyright (c) 2024 Noni Novisari Soeroso https://creativecommons.org/licenses/by-nc/4.0
Correlation between chemotherapy cycles and performance status based on ECOG in non-small cell lung cancer patients
Background: The prevalence of lung cancer incidence is 14.3% in men and 8.4% in women. Smoking is one of the causes of lung cancer. Chemotherapy is a treatment for NSCLC and affects to the performance status patients. Aim: This study is to determine the relationship between chemotherapy cycles and performance status based on ECOG in non-small cell carcinoma (NSCLC) lung cancer patients at dr. Zainoel Abidin Banda Aceh in 2017-2020. Method: This is an observational analytic study with cross sectional design with total sampling method and data sourced from medical records as many as 164 subjects. Result: The results showed that 57% of NSCLC patients after chemotherapy had a stable performance status while the other 41% decreased. The carboplatin + paclitaxel regimen is the most widely used regimen (43%) and shows average PFS < 1 year dan OS < 2 years. Conclusion: Based on bivariate analysis using the Spearman method, obtained p-value <0.05 with an R value of 0.367 which indicates there is a relationship between chemotherapy cycles and performance status based on ECOG in NSCLC patients at RSUD dr. Zainoel Abidin with a low correlation coefficient.
Copyright (c) 2023 NOVITA ANDAYANI, Diana F Syafni, Mirfandi Amirsyah, Yunita Arliny, Rima Novirianthy, Murtaza https://creativecommons.org/licenses/by-nc/4.0