Nepalese Journal of Cancer (NJC) is the official journal of the B.P. Koirala Memorial Cancer Hospital, Bharatpur, Chitwan, Nepal. The journal is internationally peer reviewed, covering biomedical topics relating to cancer care and research in Nepal and in the Region.
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Pushing the limits of pancreatic surgery; the quest for R0 resection through mesenteric principle and evolving vascular strategies
Background: Local recurrence is a major factor contributing to poor prognosis in pancreatic carcinoma, often driven by perineural invasion in the retro-pancreatic region. To improve R0 resection rates, surgical strategies have evolved toward more radical techniques, including total mesopancreatic excision, “triangle surgery,” and routine consideration of vascular resection and reconstruction. Objective: This review aims to elucidate the anatomical basis of mesopancreatic excision and to outline a comprehensive approach for incorporating vascular strategies into pancreatic cancer surgery, ensuring a balance between oncologic radicality and perioperative safety. Methods: An extensive review of current anatomical data, recent clinical literature, and institutional surgical experience was performed. The analysis focuses on the role of the three fusion fascias (Treitz, Fredet, and Toldt), the concept of the mesopancreatic triangle, and the application of triangle surgery for complete mesopancreatic excision. It also examines the evolution of vascular resection and reconstruction from a previous contraindication to an essential component of modern oncologic surgery. Results: Total mesopancreatic excision was found to be effective in removing retroperitoneal tissue containing potential microscopic disease. The planned use of vascular resection and reconstruction, supported by improved perioperative care, is now considered crucial in patients with venous or arterial involvement. Proper understanding and handling of fusion fascias during kocherization are vital to prevent tumor exposure, maintain oncologic planes, and define clear dissection boundaries. Advances in technique have also refined indications and execution of vascular reconstruction. Conclusion: Expanding the limits of resectability in pancreatic cancer requires a shift from conventional methods to advanced mesopancreatic and vascular approaches. By integrating evidence-based knowledge with practical surgical expertise, this review offers a structured guide for residents and surgeons to manage the complexities of pancreatic oncology and achieve optimal R0 resection outcomes.
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It is with profound sorrow that we announce the passing of Dr. Prakash Raj Neupane, an eminent surgical oncologist and a towering figure in the field of cancer care in Nepal. His demise marks an irreparable loss not only to the medical fraternity but also to the countless patients and families whose lives he touched with compassion, skill, and dedication.
Surgical Robotics in Modern Oncology: Precision, Promise, and Pragmatism
The field of surgical oncology has undergone a profound transformation with the advent of minimally invasive techniques, and more recently, robotic-assisted surgery. Building upon the foundations of laparoscopy, robotic platforms such as the da Vinci Surgical System have introduced enhanced dexterity, three-dimensional visualization, and improved ergonomics, redefining surgical precision in oncologic care¹. Robotic surgery has rapidly gained acceptance across multiple oncologic disciplines, particularly in urologic, gynecologic, and colorectal malignancies. Its technological advantages—including tremor filtration, wristed instrumentation, and superior visualization—enable meticulous dissection in anatomically constrained regions such as the pelvis and mediastinum². These features are especially relevant in cancer surgery, where achieving negative margins and preserving critical structures are paramount.
Early Experience with Chemo port Placement in Children with Cancer: An Integrated Activity in the Surgical Oncology Unit of a Cancer Hospital in Nepal
Introduction: Cancer patients require prolonged venous access for treatments, but repeated punctures can cause complications and distress, especially in children with fragile veins. Peripherally inserted central catheters like Broviac or Hickman pose infection risks and discomfort. Chemoports or sometimes also called vascular access port ( VAP) being subcutaneous in placement, offer fewer complications and greater comfort, making them preferable in paediatric population. Although chemoports have long been used for adults in our hospital, their application in children is recent. This study shares our experience with paediatric chemoports placement and its application, focusing on indications, insertion techniques, efficacy, safety, and early outcomes to assess their feasibility and benefits. Methods: This study included consecutive paediatric patients who underwent chemoport insertion between June 2023 and May 2025. The procedure was done under general anaesthesia with ultrasound-guided right IJV puncture. Catheter length was estimated between 8–11 cm, due to lack of intraoperative imaging. Postinsertion, patency was confirmed via aspiration/flushing, and placement verified by chest X-ray. Patients were monitored in the ICU before ward transfer. Nursing staff received regular training on port care. Followup data were prospectively recorded until port removal, death, or study end. Results: Fifty chemoports were inserted in 49 patients (32 males, 17 females), with a median age of 9 years, (IQR: 7.7–12). Acute leukaemia (ALL: 9, AML: 4) and osteosarcoma (8) were the most common diagnoses. Most (44/49) received ports before chemotherapy initiation. The right IJV (43/50) was the preferred access site. Nine patients completed treatment, with a median port duration of 354 days (IQR: 257–501); overall median duration was 215 days (IQR: 129–451). Disease outcome wise, 16 completed therapy, 22 remain on treatment and 11 patients even already died. Complications included intraoperative arrhythmia (38), ICD insertion (2), infections (3), premature removal (1), and reinsertion (1). Most issues were minor, with only one port removed due to recurrent sepsis. Conclusion: Chemoport insertion in paediatric oncology patients is safe and effective, with minimal complications. Standardized techniques and proper nursing care ensure successful outcomes. By improving patient comfort and treatment efficiency, chemoports serve as an excellent venous access option for paediatric cancer therapy, even in resource-limited settings like Nepal.
Correlation of CA-125 value and histological finding of adnexal mass in a Cancer Hospital
Background: To predict the nature of the adnexal mass, CA-125 is commonly used as a tumor marker. The diagnostic and prognostic value depends on the serum value of CA-125 and the histological variant. This study aims to determine the correlation between serum CA-125 levels and histopathological findings in adnexal masses. Methods: This retrospective study was conducted at a tertiary care cancer hospital. Medical records of patients who underwent surgery for adnexal masses were reviewed. Preoperative serum CA-125 values were categorized into five ranges: <35, 35–135, 136–235, 236–335, and ≥336 U/ml. Histopathological diagnoses were recorded, and the correlation between CA-125 levels and histological types was assessed using Pearson’s correlation coefficient (r). Results: For CA-125 levels <35 U/mL, a very weak positive correlation was noted (r = 0.12), while a moderate negative correlation was found in the 35–135 U/mL group (r = -0.45), indicating malignancy may be present even at lower CA-125 levels. A strong positive correlation (r = 0.60) was observed for CA-125 levels between 136–235 U/mL, mostly associated with serous and mucinous carcinomas. The 236–335 U/mL range showed negligible correlation (r = 0.05), possibly due to histological heterogeneity or small sample size. A very strong positive correlation (r = 0.75) was observed for CA-125 levels ≥336 U/mL, especially with high-grade serous carcinoma. Conclusion: Serum CA-125 levels are variably correlated with histological findings in adnexal masses. Higher CA-125 levels are more predictive of specific malignant subtypes, particularly serous carcinoma, but should be interpreted alongside clinical and radiological findings.
Complications of Thyroid Surgery and their risk factors in Malignant Thyroid disease: A Retrospective Study at a Tertiary Care Cancer Center of Nepal
Background: For the last few decades, the increase in the incidence of thyroid diseases including malignancies resulted in the increase in the number of thyroid surgeries as well. Thyroidectomy represents one of the commonest surgery performed by otolaryngologists. Thyroidectomy has potential complications like Hematoma, wound infections, hypocalcemia, hoarseness etc. These surgery related complications depends on the type and severity of disease, lack of identification of Recurrent Laryngeal Nerve and parathyroid glands, extent of surgery, neck dissection, previous surgery and size of tumor. Aims: The aim of this study is to evaluate the complications of thyroid surgery for malignant thyroid disease and to analyze the risk factors of the complications. Methods: A retrospective study was done from August 2024 to July 2025 in 153 patients with malignant thyroid disease who underwent surgical treatment in ENT-Head and Neck Oncosurgery unit, BP Koirala Memorial Cancer Hospital by reviewing the medical records of all these patients. The postoperative complications and the risk factors associated with these complications were evaluated. Results: Out of 153 patients with malignant thyroid disease, total thyroidectomy was done in 103 (67.3%) patients, hemithyroidectomy in 33 (21.6%) patients and completion thyroidectomy in 17 (11.1%) patients. 62 (40.5%) patients develop complications after thyroid surgery. Most common complication was hypocalcemia alone in 39 (25.5%) followed by recurrent laryngeal nerve (RLN) palsy alone 5 (3.3%), hematoma 3 (2%), Chyle leak alone 3 (2%), hypocalcemia with chyle leak in 6 (3.9%) & hypocalcemia with hoarseness in 3 (2%). Other less common complications were tracheal injury, oesophageal injury & injury to right pyriform sinus (PFS) & pre-vertebral muscles. Conclusion: Hypocalcaemia was the most frequent post-thyroidectomy complication, while voice change, hematoma, chyle leak are additional complications. Surgeons have to pay attention to curtail the complications during thyroid surgery.
Clinico-Pathological Profile of Relapsed Multiple Myeloma in Low-Resource Setting: A Single-Center Study from Nepal
Introduction: Multiple myeloma is a plasma cell malignancy with improved survival in the modern era; however, relapse remains inevitable in most patients. Data on relapsed multiple myeloma from Nepal are limited. Objective: To study the clinico-pathological profile, treatment patterns, and outcomes of relapsed multiple myeloma. Methods: A descriptive case series study was conducted at a tertiary care center in Nepal from January 2023 to August 2025. Patients with relapsed multiple myeloma were analyzed for clinical, laboratory, radiological, and treatment-related parameters. Results: Twelve patients were included in the study. Mean age of presentation was 61.8 years (range: 44 – 74 years) with a male predominance (75%). Bone pain was the most common symptom (83%). Raised beta-2 microglobulin was seen in 78%, and lytic bone lesions in 75%. IgG kappa was the predominant subtype (67%). PET-CT and cytogenetics was done in 17%. All patients received bortezomib-based therapy initially, however Carfilzomib based triplet regimen was restricted to 17% only after relapse. Total duration of follow up since first diagnosis was 110 months and survival at last follow-up was 83%. Conclusion: Relapsed multiple myeloma poses significant challenges in resource-limited settings due to restricted diagnostic and therapeutic options.
Knowledge and Attitude regarding Oral Cancer among Proficiency Certificate Level General Medicine Students in Bharatpur, Chitwan, Nepal
Introduction: Oral cancer is one of the most common cancer worldwide. Medical students can play a major role in recognizing oral mucosal changes that may lead to cancer. The objective of the study is to find out the knowledge and attitude among General Medicine (GM) students in Bharatpur, Chitwan, Nepal. Methods: A descriptive cross-sectional study was conducted among General Medicine (GM) students in Bharatpur, Chitwan. Nepal. was used. A self-administered structured questionnaire was distributed to collect data among 114 students. Data were analyzed by using SPSS version 22. Descriptive and inferential statistics were calculated. Results: The age of respondents ranged from 17 to 35 years, with a mean and standard deviation 20.01+2.455. Most of the respondents were male 58.8%, from Madhesh province 62.3%, unmarried 95.6%, followed by Hindu religion 91.2% and of Madhesi ethnicity 69.3%. The majority (83.3%) of respondents know the meaning of oral cancer. The overall level of knowledge towards oral cancer was good among 56.1% and a positive attitude was 57.9%. There is no association between level of knowledge and level of attitude (p=0.526). Respondents with a low level of knowledge demonstrated an equal distribution of positive and negative attitudes toward oral cancer. However, a majority of respondents with high and moderate levels of knowledge exhibited a positive attitude, accounting for 62.5% and 52.4% respondents, respectively. Conclusion: knowledge and attitude of General Medicine students towards oral cancer is just over the half, so, it needs to be improved and the concerned authority needs to pay more attention on education of students who are considered to be the future primary health care providers.
Care Burden among Family Caregivers of Children with Cancer at Pediatric Oncology Unit of Tertiary Cancer Hospital of Nepal
Background: Cancer is one of the most common diseases in children, leading to major challenges for caregivers and imposing a substantial caregiving burden. This burden can lead to negative health outcomes for the parents. The chronic nature of pediatric cancer places considerable demands on caregivers, severely impacting their well-being. Materials and Methods: A descriptive cross-sectional study design was used to assess the level of care burden among 100 family caregivers of children with cancer at pediatric oncology unit of B.P. Koirala Memorial Cancer Hospital, Chitwan, Nepal. Sample was selected through non-probability purposive sampling method and data were collected through modified Zarit Care Burden Interview Scale. Both descriptive and inferential statistics were used for data analysis with SPSS 22 version. Findings: Findings of the study revealed that 41% of the respondents had moderate level of care burden whereas 30% had low care burden, 28% had high care burden and only 1% had no care burden. There was significant association between level of care burden with the relationship with patient (p-value= 0.031) and the economic status of the family (p-value= 0.01). Conclusion: This study concludes that almost all of the family caregivers of children with cancer at BPKMCH had care burden. So, concerned health authorities need to provide family-centered measures and services to address caregiver burden ultimately improving their well-being and reduce the burden of caregivers.
Neo-adjuvant Chemotherapy in Malignant Ovarian Germ Cell Tumor
Introduction: Malignant ovarian germ cell tumors (MOGCT) are common in young females, management of which is associated with fertility and reproductive concerns. Being highly chemo-sensitive, neo-adjuvant chemotherapy (NACT) prior to definitive surgery could help reduce disease burden and increase the possibility of organ preservation. Methods: A descriptive study was done on ovarian cancer patients with fertility concerns attending Civil Service Hospital of Nepal from 2015 to 2021. Clinical data were collected from hospital registry and telephonic inquiries followed by in-person interviews in all the participants regarding their treatment, present status, oncologic and fertility outcome. Results: Eighteen MOGCT fertility needs were identified, among which seven underwent NACT (39%) with fertility preserving surgery and were enrolled in the study. Mean age was 16.8 years (range: 15-19 years). Histologically, of total seven cases, three (43%) were Dysgerminoma in stage IC, three (43%) were yolk sac tumor (2 in stage IC and 1 in stage IIIC), and one (14%) were of mixed germ cell tumor at stage IIIC. All 7 patients underwent fertility preserving surgery after NACT. At the time of presentation, three were married and four were unmarried. Two (28%) patients had recurrence as they defaulted during treatment among which one patient died and the other came after 1 year and completed chemotherapy. Thus 85% (six in seven) of the cases are in complete remission, among which three conceived and had successful delivery. Conclusion: The present study supports NACT to be beneficial in offering fertility sparing surgery even in advanced stage MOGCT.
Intraoperative Disasters During Minimally Invasive Esophagectomy
Background: Intraoperative disasters remain a serious concern during Minimally Invasive Esophagectomy (MIE), however, it has never been properly reported. The aim of the study was to analyze the incidence, types, and management of intraoperative disasters encountered during MIE in a Tertiary Cancer Hospital in Nepal. Methods: A retrospective review of prospectively maintained database of 303 consecutive MIE cases for esophageal and gastroesophageal junction cancer performed at BP Koirala Memorial Cancer Hospital was conducted. Patients who underwent McKewon’s MIE (n=260), Ivor-Lewis (n=4) MIE and Transhiatal MIE (n=39) were included in the study. Intraoperative disasters were defined as catastrophic events leading to major bleeding or injury to vital structures during surgery. Results: Major intraoperative complications were observerved in 9 patinets (2.9%). Tracheo-bronchial (n=2), Thoracic duct (n=2), pulmonary parenchymal (n=2), SVC (n=1), and aortic (n=1) were detected intraoperatively and were managed with suture repair. One splenic injury was controlled with electrocauterization. None of the patients required conversion to open surgery. There was one 90-day mortality (1/9; 11%) among patients with intraoperative complications. Conclusion: Identification and prompt management of intraoperative complications are critical in minimizing post operative mortality. Our study may serve as a reference to compare and evaluate performance of MIE for cancer in Nepalese context.
Comparative efficacy of Doxycycline vs Povidone-iodine for pleurodesis: A Prospective analytical study
Background: Chemical pleurodesis is an effective intervention for managing malignant or recurrent pleural effusions. Both doxycycline and povidoneiodine are widely available, cheaper, but comparative data on pain and efficacy outcomes remain limited. Methodology: A total of 100 patients with symptomatic pleural effusion requiring pleurodesis were included in the study either doxycycline (n=49) or povidoneiodine (n=51) through an intercostal drain. Pain scores were assessed using a visual analog scale (VAS) at preprocedure, 24 hours, and 48 hours postprocedure. Pleurodesis success, time to chesttube removal, complication rates, and followup outcomes were recorded. Results: Baseline characteristics were well balanced between groups. Pain scores at 48 hours were significantly lower in the povidoneiodine group (median 4, IQR 4–5) compared to doxycycline (median 5, IQR 4–6; p=0.006), with a similar trend at 24 hours (p=0.039). Pleurodesis success rates were comparable (doxycycline 89.8% vs. povidoneiodine 84.3%; p=0.415). Median time to chesttube removal was 2 days in both groups (p=0.344). Complication rates and 1 month followup reeffusion outcomes did not differ significantly between groups (all p>0.05). Conclusion: Povidoneiodine pleurodesis achieves comparable efficacy and safety to doxycycline while offering significantly better pain control at 48 hours postprocedure.
Sleep Quality and Sleep Disturbances among Breast Cancer Patients Attending a Tertiary Cancer Center in Nepal: A Descriptive Cross-sectional Study
Introduction: Sleep problems are common in people with cancer and can affect quality of life. This study aimed to find the prevalence of poor sleep quality and describe common sleep disturbances among breast cancer patients attending a tertiary cancer care center in Nepal. Methods: This descriptive cross-sectional study was conducted at B. P. Koirala Memorial Cancer Hospital (BPKMCH), Nepal, from July 2025 to December 2025. A non-probability convenient sampling method was used to recruit 391 breast cancer patients attending inpatient and outpatient services. Sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI). Data was entered in Microsoft Excel 2016 and analyzed using STATA version 17. Results: Among 391 participants, the prevalence of poor sleep quality (PSQI global score >5) was 92 (23.53%). The mean global PSQI score was 4.82±3.12. Difficulty initiating sleep at least once per week was reported by 115 (29.41%) participants, and 156 (39.90%) reported waking in the middle of the night at least once per week. A total of 92 (23.53%) participants reported using sleep medication at least once per week. Conclusion: About one-fourth of breast cancer patients had poor sleep quality by PSQI. Many others reported specific sleep problems, suggesting that sleep issues may be present even when overall sleep is not described as very poor. Routine screening and simple supportive measures may help improve patient well-being.
Knowledge, Attitude, and Practice Regarding Chemotherapy among Cancer Patients in a Tertiary Care Centre: A Descriptive Cross-Sectional Study
Introduction: Cancer is a leading cause of morbidity, and chemotherapy remains a principal treatment. Its effectiveness depends on patients’ understanding of the treatment and self-care practices. The study aimed to find out the level of knowledge, attitude, and practice regarding chemotherapy among cancer patients attending a tertiary care center. Methods: A descriptive cross-sectional study was conducted at a tertiary care hospital in Chitwan, Nepal, from January 2024 to June 2024. Ethical clearance was obtained from the Institutional Review Committee. A convenience sampling method was used to select 110 participants. Data was entered into Microsoft Excel 2016 and analyzed using the Statistical Package for the Social Sciences version 20.0. Point estimate at 95% Confidence Interval was calculated along with frequency and percentages for binary data and mean and standard deviation for continuous data. Results: Out of 110 participants, 90 (81.82%) had a poor level of knowledge regarding chemotherapy. The mean ± SD was 44.49 ± 14.39 years. Regarding attitude, 74 (67.27%) maintained a neutral attitude, while 58 (52.73%) completely agreed with the need for health education. For practice, 67 (60.91%) demonstrated poor self-care practices, and follow-up to the hospital on time was observed in 109 (99.09%). Conclusions: Patients receiving chemotherapy demonstrated low knowledge and poor self-care practices, despite maintaining a neutral attitude and expressing a strong willingness to receive health education.
The modeled CA 125 ELIMination rate constant K (KELIM) scores in predicting outcomes in advanced ovarian cancer undergoing neo-adjuvant chemotherapy and interval debulking surgery
Objectives: To evaluate the prognostic utility of standardized KELIM score (derived from CA-125 kinetics) in predicting complete cytoreduction at interval debulking surgery (IDS) following neoadjuvant chemotherapy (NACT) in stage III-IV epithelial ovarian cancer patients at BPKMCH Chitwan. Methodology: Observational study of 46 eligible patients (from 58 total) treated January-December 2025 with carboplatin AUC6 + paclitaxel 175 mg/m² q3w (median 3 cycles). Standardized KELIM calculated using biomarkerkinetics. org calculator (≥1.0 favorable) from serial CA-125 measurements. RECIST 1.1 response assessment, surgical complexity, completeness of cytoreduction (CC0: no gross residual; CC1: <2.5 mm), and postoperative hospital stay was analyzed. Results: Mean age 59 years (range 29-78); 76% favorable KELIM (mean 1.28, median 1.31, range 0.47-2.22). CA-125 declined from 1498 IU/mL (pre-NACT) to 48 IU/mL (pre-IDS). RECIST: 26% complete response, 70% partial response, 4% stable disease. IDS achieved CC0 in 83% (38/46) and CC1 in 17%—superior to CHORUS (39%), EORTC (81%), SCORPION (77%) trials. Favorable KELIM predicted CC0 with 91% rate (OR 6.1, PPV 94%), simpler surgery (1.35 vs 1.09, p=0.059), and shorter stays (11.9 vs 13.9 days). Conclusion: KELIM ≥1.0 robustly predicts chemosensitivity and IDS success in advanced ovarian cancer. Favorable scores guide optimal patient selection while unfavorable KELIM identifies candidates for complex surgery, bevacizumab (ICON7/GOG-0218), or HIPEC (Cho et al.). NACT-IDS proves highly effective in highburden Nepali patients; larger prospective validation needed.
Quality of Life among Breast Cancer Women in a Tertiary Cancer Hospital in Nepal: A Descriptive Cross-sectional Study
Introduction: Breast cancer is the most commonly diagnosed cancer in women worldwide, and improved survival has elevated health-related quality of life as a critical patient-centered outcome. This study was conducted to determine the mean health-related quality of life among breast cancer patients receiving treatment at a tertiary care hospital in Nepal. Methods: A descriptive cross-sectional study was conducted among 230 breast cancer patients attending the outpatient department of medical oncology, enrolled by non-probability convenience sampling. The Quality of Life Instrument; Breast Cancer Patient Version (QoL-BC), a validated 46-item tool across four domains, was used for data collection. Ethical clearance was obtained from the Institutional Review Committee. Point estimate at 95% Confidence Interval was calculated along with mean and standard deviation for continuous data, and frequency and percentages for binary data. Results: The median age of participants was 50 years. Half of the respondents (50.0%) had fair quality of life while the remaining half (50.0%) had poor quality of life (median score: 226.5; possible score: 46–446). Spiritual well-being recorded the highest median percentage score (65.71%), while psychological well-being recorded the lowest (44.09%). Patients in stages III and IV demonstrated poorer quality of life (50.5%) compared to those in stages I and II (47.5%). Conclusions: Half of the breast cancer patients had poor overall quality of life. Psychological well-being was the most severely impaired domain, while spiritual well-being was relatively preserved, suggesting an important role of spiritual belief in coping. Holistic care addressing all dimensions of quality of life is essential for this population.
Diagnostic Accuracy of Surgeon-Led Ultrasound Guided Lung Biopsy In Suspected Thoracic Malignancy
Background: Lung cancer is the leading solid organ malignancy in the world, having the highest share of financial burden in the world population. Increasing lung cancer patients can result in increase in waiting time for early diagnosis and treatment resulting in adverse outcome. Ultrasound guided lung and thoracic core needle biopsies done by non-radiologist clinicians are shown to reduce the waiting time for early diagnosis making the patient care efficient and safe. This study aimed to evaluate the diagnostic accuracy of surgeon led point-of-care ultrasound (POCUS) guided thoracic core needle biopsies for suspected thoracic malignancies in Nepal. Methodology: This study evaluated 226 patients retrospectively, who underwent POCUS guided thoracic core-needle biopsy at our institution from September 2023 to January 2025. All the biopsy reports available were collected retrospectively and descriptive analysis done. Results: The diagnostic yield of the surgeon led POCUS thoracic biopsy was 94.7%, 4.4% required repeat biopsy and radiological correlation was advised in 0.9%. Squamous cell carcinoma of the lung (28.3%) was the most common histological diagnosis made in the biopsies. Five cases (2.21%) developed pneumothorax after the core needle biopsy among which two required pigtail chest drain. Conclusion: Surgeon-led POCUS thoracic biopsies can be done safely increasing the diagnostic efficiency of the institution resulting in reduction in waiting time and reducing the patient load in radiology suit for the same procedure.
Clinico-Pathological Profile of Hodgkin’s Lymphoma: A Single-Center Study from Nepal
Background: Hodgkin’s lymphoma (HL) is a highly curable lymphoid malignancy with excellent outcomes when diagnosed early and treated with standardized multimodal therapy. However, data from low- and middle-income countries (LMICs) remain limited and are largely derived from single-center experiences. Objective: To describe the clinico-pathological characteristics, staging, treatment patterns, and outcomes of patients diagnosed with Hodgkin’s lymphoma at a tertiary care center in Nepal. Methods: This retrospective observational study included consecutive patients diagnosed with Hodgkin’s lymphoma at Vayodha Hospital, Nepal, between July 2022 and June 2025. Diagnosis was established using histomorphology and confirmed by immunohistochemistry. Disease staging was performed using contrast enhanced computed tomography (CECT) according to the Ann Arbor staging system. Clinical, pathological, treatment, and outcome data were analyzed descriptively. Results: A total of 35 patients were included. The mean age at diagnosis was 33.3 years (range: 4–74 years), with a predominance of young patients aged 10–30 years (46%). The male-to-female ratio was 1.3:1. Cervical lymphadenopathy was the most common presentation (57%). Mixed cellularity was the predominant histological subtype (68%). Advanced-stage disease (Stage III–IV) was observed in 54% of patients. Majority (89%) patients received chemotherapy, predominantly ABVD. One treatment-related mortality and one relapse were observed during a median follow-up of 36 months. Conclusion: Patients with Hodgkin’s lymphoma in Nepal commonly present at a younger age and with advanced-stage disease. Despite resource limitations, outcomes remain favorable with standard chemotherapy regimens. Strengthening early diagnosis and referral systems may further improve survival outcomes in LMIC settings.
Evaluation of Diagnostic Accuracy of Nuclear Medicine Imaging in Detecting Thyroid Disorders at Birat Medical College Teaching Hospital
Objective: To evaluate the diagnostic accuracy of nuclear medicine imaging in detecting thyroid disorders at a tertiary care center. Methods: This observational study included 120 patients suspected of thyroid dysfunction who underwent nuclear medicine imaging from January 2025 to December 2025. Thyroid scans were performed using Technetium-99m pertechnetate. Imaging findings were correlated with clinical assessment and laboratory investigations including T3, T4, and TSH levels. Results: Among the 120 patients, 72 (60%) were diagnosed with hyperthyroidism, 36 (30%) with hypothyroidism, and 12 (10%) were euthyroid with nodular lesions. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of nuclear imaging were 95%, 92%, 93%, and 94%, respectively. Conclusion: Nuclear medicine imaging is a highly sensitive and specific modality for diagnosing thyroid disorders and plays a crucial role in clinical decision-making.
Awareness and Practice regarding Breast Cancer Screening among Women Residing at Bharatpur-7, Chitwan
Background: Breast cancer is one of the leading causes of death among women worldwide. Early detection through screening techniques, increasing awareness related to breast cancer and implementing preventive practices can reduce its impact. The objective of the study was to find out awareness and evaluate the practice of breast cancer screening among women residing at Bharatpur Metropolitan City. Materials and Methods: A descriptive cross- sectional study design was carried out among 103 women by using non-probability purposive sampling technique from 5 toles of ward no. 7 of Bharatpur Metropolitan. Data were collected by using a structured interview schedule. Collected data was interpreted by using descriptive and inferential statistics and analysed by using SPSS version 22. Findings: Mean age of the respondents was 38.95 year. Nearly one third (29.1%) were of age group of 30- 39 years and majority (92.2%) respondents followed Hindu religion while (72.82%) belongs to Brahmin/ Chhetri. Likewise, only (6.8%) respondents had family history of cancer. The study findings further summarized the level of awareness into three categories where more than half (68.0% ) of the respondents had moderate, only (9.7%) had poor level, whereas (22.3%) had good level of awareness regarding breast cancer screening whereas nearly half (45.6 %) had poor practice and more than half (54.4%) had good practice of breast self-examination. Likewise, Educational level (0.039) of respondent was significantly associated with level of awareness at p ≤0.05. Conclusions: In conclusion, most of the respondents had moderate level of awareness and good level of practice regarding breast cancer screening however the concerned authorities should plan and conduct awareness programs to further minimize risks and enhance the existing awareness regarding breast cancer screening.
Knowledge and Practice Regarding Use of Biosafety Cabinet Among Nurses at Tertiary Cancer
Background: A Biosafety Cabinet (BSC) is a primary containment device that protects healthcare workers, patients, and the environment from exposure to infectious and hazardous agents such as chemotherapy drugs. Proper knowledge and practice of Biosafety Cabinet use are essential in oncology settings where nurses frequently prepare cytotoxic drugs. In Nepal, however, nurses often undertake chemotherapy preparation without sufficient theoretical or practical training, increasing occupational risks. The aim of this study was to assess the knowledge and practices of nurses regarding the use of BSCs at B.P. Koirala Memorial Cancer Hospital. Methodology: A descriptive cross-sectional study was conducted among nurses of B.P. Koirala Memorial Cancer Hospital, Bharatpur, Chitwan. A total of 100 nurses were selected using non-probability purposive sampling technique. Semi structured questionnaire was used to collect data within 2 weeks. The data collected was entered in SPSS version 22. Descriptive statistics (mean, standard deviation, frequency, percentage, etc.) and inferential statistics (chi square test) were calculated in the evaluation of the data. Results: Findings of this study showed that 14.0% of respondents had poor knowledge, 54.0% had moderate knowledge, and 32.0% had good knowledge of BSCs. In practice, 2.1% had poor practice, 17.0% had moderate practice, and 80.9% demonstrated good practice. Knowledge was not significantly associated with socio-demographic variables (p >0.05), while practice was significantly associated with department where they work (p = 0.039), but not with age, education, or years of experience. Conclusion: The study highlights satisfactory levels of practice but moderate gaps in knowledge regarding the use of BSC among oncology nurses. The findings call for structured training, curriculum enhancement, and standardized institutional protocols to strengthen biosafety practices and ensure protection of healthcare workers and patients in tertiary cancer care settings.
Granulosa Cell Tumor of Ovary with Anterior Abdominal Wall and Colonic Metastasis– A Case Report
Among the various sex cord-stromal tumors, granulosa cell malignancy is the most common, representing approximately 2-5% of primary ovarian tumors. There are adult-type and juvenile-type histological variants of granulosa cell tumor. These lesions are mostly asymptomatic, and inhibin is an important tumor marker. A 29-year-old female with irregular bleeding for 3 months. She had a right salpingo-oophorectomy for an adnexal cyst, and histology had revealed an adult granulosa cell tumor. Abdominal wall and pelvic metastasis occurred at the time of the first visit to our hospital. She presented late and underwent chemotherapy and then debulking surgery. Regular follow-up is required to monitor recurrence.
Proximal Tibial Bone Metastases in Patient with Breast Carcinoma: A Rare Case Report
Background: Bone metastases from any carcinoma below elbow and knee are rare, those to tibia are even rarer. Diagnosis sometimes may defer and often confused with primary bone carcinoma, osteomyelitis or arthritis. Management depends on extent of disease and severity of symptoms. Both radical and palliative treatment are possible, depending on the overall clinical severity. Case Presentation: We present a case of a 41-year female patient with a history of right breast carcinoma. Previously, the patient was misdiagnosed as right breast fibroadenoma with sebaceous cyst, a mass measuring 13.1x9.5x6.7 mm3. The patient was then advised to have an excisional biopsy of whole solid mass and mass was sent for histopathology examination to get clear opinion. The histopathology report revealed that there was cribriform ductal carcinoma in situ intermediate nuclear grade. Before starting any treatment, the patient is advised to have all the required laboratory examinations, CECT chest abdomen and 99mTc-MDP whole body bone scan. Whole body bone scan revealed that there is osteoblastic lesion in shaft of right proximal tibia suggestive of bone metastases. Later it was confirmed with histopathology report. Conclusion: Proximal tibial bone metastasis in a patient with breast carcinoma is a relatively very uncommon, but challenging, site for bone metastasis.
Favourable pregnancy outcome following inadvertent exposure to trastuzumab, tamoxifen and radiotherapy in a patient with breast cancer: a case report
Breast cancer is the most common malignancy among women worldwide and often affects those of reproductive age. Treatment typically involves surgery, chemotherapy, radiotherapy, targeted therapy, and endocrine therapy, several of which are contraindicated during pregnancy due to fetal toxicity. We report a rare case of unrecognized pregnancy in a 28-year-old woman receiving adjuvant therapy for breast cancer. Following excisional biopsy showing infiltrating ductal carcinoma, she underwent neoadjuvant chemotherapy, modified radical mastectomy, radiotherapy, and was receiving trastuzumab with tamoxifen. An ultrasound performed for abdominal discomfort revealed a 32-week viable pregnancy. At the time of diagnosis of pregnancy she was taking daily tamoxifen, on maintenance trastuzumab and in retrospect she had received radiotherapy after conception. She later delivered a healthy baby by caesarean section, and both mother and child remain well at two-year follow-up.
Non-Intubated Uniportal Subxiphoid VATS Thymectomy for Myasthenia Gravis: A Case Report with review of literature
Background: Myasthenia gravis (MG) is an autoimmune neuromuscular disorder characterized by fluctuating skeletal muscle weakness caused by antibodies against components of the neuromuscular junction, most commonly the acetylcholine receptor (AChR). Thymectomy is an established treatment for patients with MG, particularly those with AChR antibodies. Recently, uniportal subxiphoid has become the approach of choice offering improved postoperative recovery and reduced complications. Non-intubated thoracic surgery has also gained attention for minimizing anesthetic-related complications in MG patients. Case: Twenty two year old female diagnosed with AChR-positive, muscle specific tyrosine kinase (MuSK) negative MG receiving pyridostigmine who underwent uniportal subxiphoid VATS (Video assisted thoracoscopic surgery) thymectomy using local anesthesia and laryngeal mask airway (LMA) without muscle relaxant at B.P. Koirala Memorial Cancer Hospital (BPKMCH), Nepal. Preoperative evaluation included neurological assessment, serological testing, and radiologic imaging. The procedure was successfully completed without conversion to open surgery or endotracheal intubation. Postoperatively, the patient experienced an uneventful recovery and at 6 months follow up she was symptom free with reduced dose of pyridostigmine. Conclusion: Non-intubated uniportal subxiphoid VATS thymectomy is a safe and effective surgical option for MG patients. This technique may reduce postoperative complications and facilitate faster recovery compared with conventional intubated approaches. Our case highlights the potential benefits of minimally invasive thymectomy combined with non-intubated anesthesia in the management of myasthenia gravis.