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INDONESIA
Indonesian Journal of Cancer
Published by National Cancer Center-Dharmais Cancer Hospital
ISSN : 19783744     EISSN : 23556811     DOI : https://www.doi.org/ 10.33371
Core Subject : Health, Science,
Biochemistry, Genetics & Molecular Biology Immunology & microbiology Medicine & Pharmacology Public Health
Indonesian Journal of Cancer is a peer-reviewed and open-access journal. This journal is published quarterly (in March, June, September, and December) by Dharmais Cancer Hospital - National Cancer Center. Submissions are reviewed under a broad scope of topics relevant to experimental and clinical cancer research. Articles are original research that needs to be disseminated and written in English. All submitted manuscripts will go through the double-blind peer review and editorial review before being granted acceptance for publication. The journal publishes original research articles, case reports, and review articles under the following categories: cancer management, cancer prevention, cancer etiology, epidemiology, molecular oncology, cancer diagnosis and therapy, tumor pathology, surgical oncology, medical oncology, radiation oncology, interventional radiology, as well as early detection.
Arjuna Subject : Kedokteran - Onkologi
Articles 635 Documents
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Non-Down Syndrome Acute Megakaryoblastic Leukemia with KMT2Ar/MLL Rearrangement: A Case Report Veronika Juanita Maskito; Agus Susanto Kosasih; Dina Garniasih
Indonesian Journal of Cancer Vol. 20 No. 2 (2026): June
Publisher : http://dharmais.co.id/

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.33371/ijoc.v20i2.1453

Abstract

Introduction: Non-Down syndrome acute megakaryocytic leukemia (Non-DS-AMKL) is a rare leukemia. Pediatric acute myeloid leukemia (AML) accounts for only 4—15% of all leukemia cases, while AMKL accounts for only 3-10% of pediatric AML. Most AMKLs are Down syndrome (DS) (> 75%). Diagnostic criteria require a minimum of 20 % blasts in the bone marrow, of the megakaryocytic lineage, in a person without Down syndrome. Flow cytometry in blast cells must reveal expressions of one or more platelet markers (CD41a, CD42b, or CD61). Genetic test differentiates treatment and prognosis. This is the first AMKL report in Indonesia that approaches comprehensive genetic testing. Case Presentation: The patient was a 26-month-old boy who had bruises over his tummy, arm, and legs. He was anemic, having splenomegaly with Schuffner 2, hemoglobin level 9.1 g/dL, leucocyte 7,200/uL, platelet 12,000/uL, erythrocyte sedimentation rate 22 mm/hour. The bone marrow was hemodiluted with 53% blasts dominated by large cells with a high nucleus cytoplasmic ratio, nucleoli were found, irregular fine chromatin, basophilic cytoplasm with prominent cytoplasmic projection/blebs consistent with megakaryoblast. These blasts were expressing CD45 dim, CD36, CD41a, CD33, HLA-DR and CD13 dim. A genetic test using fluorescence in situ hybridization (FISH) and next-generation sequencing (NGS) revealed lysine methyltransferase 2A/KMT2A/MLL positive. Therefore, the patient was confirmed as the Non-DS AMKL with positive KMT2A, which confers a dismal outcome compared to the GATA-binding factor1/GATA1/Erythroid transcription factor mutation.Conclusions: Non-DS AMKL is a challenging diagnosis in terms of morphology, immunophenotypic, signs, symptoms, and genetics. Genetic profile will contribute important scientific understanding to decide and improve AMKL treatment and prognosis, particularly unsatisfactory prognosis AMKL, such as a patient with KMT2Ar/MLL
Statins and Survival in Castration-Resistant Prostate Cancer After Abiraterone or Enzalutamide: A Systematic Review Encep Ivan Setiawan; Raden Danarto
Indonesian Journal of Cancer Vol. 20 No. 2 (2026): June
Publisher : http://dharmais.co.id/

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.33371/ijoc.v20i2.1458

Abstract

Background: Prostate cancer is the second most commonly diagnosed cancer in men worldwide and a leading cause of cancer-related mortality. Castration-resistant prostate cancer (CRPC) develops despite androgen deprivation therapy (ADT), often after treatment with abiraterone or enzalutamide. Statins have shown potential anticancer effects through inhibition of HMG-CoA reductase and related signaling pathways. This systematic review evaluated whether statin use improves survival and disease outcomes in patients with CRPC previously treated with abiraterone or enzalutamide.Methods: A systematic search of PubMed, ProQuest, SAGE, and Europe PMC was conducted following PRISMA and Cochrane guidelines. Studies published within the last 10 years were included if they involved adults with CRPC receiving ADT or orchiectomy and compared statin users with non-users. Risk of bias was assessed using RoB 2.0 for randomized controlled trials (RCTs) and ROBINS-I for non-randomized studies. Primary outcomes were overall survival (OS), cancer-specific survival (CSS), and prostate-specific antigen (PSA) response.Results: Eight studies (two RCTs and six retrospective cohort studies) involving 35,401 patients were included. Most studies had a low to moderate risk of bias. Results were heterogeneous. Two of four studies reported significantly improved OS among statin users, while the remaining studies found no significant association. One study showed improved CSS, and two studies reported higher PSA response rates with statin use. However, these benefits were not consistently observed throughout all studies.Conclusion: Statin use may improve survival outcomes and PSA response in patients with CRPC. However, current evidence remains
Exploring the Key Factors Influencing Survival in Pediatric Acute Lymphoblastic Leukemia: A Literature Review Cindy Adityoputri; Olga Rasiyanti Siregar; Rini Savitri Daulay; Rina Amelia; Bidasari Lubis; Hendri Wijaya
Indonesian Journal of Cancer Vol. 20 No. 2 (2026): June
Publisher : http://dharmais.co.id/

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.33371/ijoc.v20i2.1464

Abstract

Acute lymphoblastic leukemia (ALL) is a hematologic malignancy characterized by the uncontrolled proliferation of immature B-cell or T-cell lymphoid progenitors. This malignancy predominantly affects children, with a peak incidence between the ages of 2 and 5 years. Data from Indonesia show an incidence of leukemia of around 4 per 100,000 children, with an estimated 2,000-3,200 new cases per year. The survival rate for childhood leukemia in Indonesia is only around 20-30%, while in developed countries, it is nearly 90%. This article aims to explore deeply the factors influencing survival in pediatric ALL through a systematic literature review of records from 1981 to 2024. Our findings suggest that low-middle-income countries, age < 1 year, male gender, malnutrition, splenomegaly, hepatomegaly, severe anemia, leukocytosis, thrombocytopenia, high-risk stratification, and poor quality of life are linked to lower survival rates.
The Effectiveness of Glacial Acetic Acid and 95% Alcohol in Lysing Blood-Contaminated Liquid-Based Cervical Cytology Specimens I Putu Sindhunata Upadhana; Fitria Diniah Janah Sayekti
Indonesian Journal of Cancer Vol. 20 No. 2 (2026): June
Publisher : http://dharmais.co.id/

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.33371/ijoc.v20i2.1475

Abstract

Background: Liquid-based cervical cytology is a monolayer slide preparation technique that enhances the accuracy of conventional Pap smears. Blood contamination (erythrocytes) is one of the most common causes of inadequate liquid-based cervical cytology samples. Therefore, alternative methods and materials are necessary to improve the adequacy of blood contaminated liquid-based cervical cytology samples. This study aims to evaluate the effectiveness of a 95% alcohol and glacial acetic acid combination in enhancing the adequacy of blood-contaminated liquid-based cervical cytology samples.Methods: A total of 30 samples were included in this study, with patients aged between 21 and 59 years. The samples were divided into two groups based on the ratio of 95% alcohol to glacial acetic acid, specifically 4:1 and 3:2. The study utilized an experimental design, wherein sample lysis was carried out using these two reagent combinations. The adequacy of the samples was evaluated microscopically both prior to and following the lysis process. Statistical analysis was performed using the Wilcoxon Signed-Rank Test and the Mann-Whitney U Test.Results: The results demonstrated that the 95% alcohol and glacial acetic acid combination effectively improved sample adequacy, with the 3:2 ratio yielding a more significant improvement (80%) compared to the 4:1 ratio (60%). The p-values from the Wilcoxon Signed Rank Test were 0.003 for the 4:1 ratio and < 0.001 for the 3:2 ratio, indicating a significant difference between pre-lysis and post-lysis adequacy. However, the Mann-Whitney U test showed no significant difference between the two concentration ratios (p = 0.240). Conclusions: The combination of 95% alcohol and glacial acetic acid is an effective alternative for enhancing the adequacy of blood-contaminated liquid-based cervical cytology samples, with the 3:2 ratio providing optimal results.
A Pediatric Case of Desmoplastic Nodular Medulloblastoma: A Case Report and Literature Review Daniel Antonio Encarnación-Santos; Gennady Chmutin; Egor Chmutin; Adam Mainer Romanovish; Ismail Bozkurt; Nazmin Ahmed; Kivanc Yangi; Dilerbek Nuriddinov; Bipin Chaurasia
Indonesian Journal of Cancer Vol. 20 No. 2 (2026): June
Publisher : http://dharmais.co.id/

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.33371/ijoc.v20i2.1480

Abstract

Background: Desmoplastic nodular medulloblastoma (DNMB) is an uncommon but malignant variant of medulloblastoma that typically occurs in children. Although it is malignant in nature, children with DNMB have a high 5-year overall survival rate. Here, we present a complex case of a DNMB in a 6-year-old pediatric patient. This study highlights the importance of early and effective treatment approaches in DNMB through a challenging pediatric case.Case Presentation: A 6-year-old boy with a genetic condition of delayed motor and mental development and ischemic-hypoxic brain damage was brought to our center. He was observed to have drowsiness, whims, and seizures. An initial non-contrast-enhanced head computed tomography (CT) scan revealed occlusive hydrocephalus. Subsequently, a contrast-enhanced brain magnetic resonance imaging (MRI) showed a lesion at the posterior fossa, growing towards the corpora quadrigemina, with areas of growth towards the right cerebellar hemisphere and vermis. After a subtotal resection was achieved in the initial surgical intervention, a second surgical procedure was performed, during which the residual lesion was grossly totally resected. The patient’s treatment process was complicated by hydrocephalus, which was initially managed with Ommaya reservoir implantation, followed by ventriculoperitoneal shunt placement. The patient then received radiotherapy and adjuvant chemotherapy with cyclophosphamide, vincristine, carboplatin, and intravenous methotrexate. Conclusions: Despite its malignant nature, early diagnosis and appropriate treatment strategies, including gross total resection followed by chemoradiotherapy, significantly improve overall survival rates. Managing complex cases requires timely intervention and close postoperative monitoring, particularly in cases with fourth ventricle involvement, where hydrocephalus management is critical.
High-Grade Polymorphous Adenocarcinoma Mimicking Salivary Duct Carcinoma: A Diagnostic Challenge Noviana Nugrohowati; Ade Saputri; Tania Kusuma; Irianiwati Widodo
Indonesian Journal of Cancer Vol. 20 No. 2 (2026): June
Publisher : http://dharmais.co.id/

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.33371/ijoc.v20i2.1481

Abstract

Introduction: Polymorphous adenocarcinoma (PAC) is a rare, low-grade malignancy primarily arising in the minor salivary glands, accounting for 1-6% of head and neck tumors. It commonly affects the palate, but can rarely manifest in major salivary glands, such as the parotid gland. Although typically indolent, PAC can undergo high-grade transformation (HGT), which presents with histologically aggressive features such as nuclear atypia, high mitotic activity, and extensive necrosis. Distinguishing PAC with HGT from other salivary gland carcinomas is clinically challenging due to its architectural diversity, absence of pathognomonic signs, and overlapping features with other malignancies. Accurate diagnosis is essential, as prognosis and treatment options may vary. This report aims to highlight the diagnostic challenge, raise awareness, and encourage consideration of this disease in the differential diagnosis of salivary gland lesions.Case Presentation: This report presents a rare case of high-grade PAC from the parotid gland, mimicking salivary duct carcinoma (SDC). A 79-year-old male presented with a painless mass on the right cheek, growing over six months. Examination revealed a firm, immobile mass, and biopsy indicated solid growth with extensive necrosis and significant polymorphism. Immunohistochemistry for androgen receptors (AR) and p63 confirmed PAC, distinguishing it from other malignancies like SDC and mucoepidermoid carcinoma. The patient underwent chemotherapy, however, follow-up histopathological examination showed residual PAC with persistent polymorphism and mitotic activity.Conclusions: Polymorphous adenocarcinoma is a rare, low-grade malignancy of the salivary gland that is often underdiagnosed and underreported. Instances of high-grade transformation has made the diagnosis of this entity difficult due to similarities to other malignancies. This case highlights the diagnostic challenges of PAC, especially with HGT, and underscores the importance of immunohistochemistry for accurate diagnosis and treatment planning. Early recognition and differentiation from other salivary gland malignancies are crucial for appropriate management.
The Effect of Papaya—Lime Smoothie (Carica papaya L. & Citrus aurantiifolia) on Constipation Severity in Breast Cancer Patients Undergoing Chemotherapy Agni Shinta Wardhani; Suhaema Suhaema; Ni Ketut Sri Sulendri; Aladhiana Cahyaningrum
Indonesian Journal of Cancer Vol. 20 No. 2 (2026): June
Publisher : http://dharmais.co.id/

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.33371/ijoc.v20i2.1484

Abstract

Background: Constipation is a common gastrointestinal complication among cancer patients undergoing chemotherapy, negatively affecting quality of life and treatment adherence. Non pharmacological interventions such as fruit-based dietary strategies may provide a safe and accessible alternative. This study aims to evaluate the effect of papaya—lime smoothie (Carica papaya L. & Citrus aurantiifolia) on constipation severity in breast cancer patients receiving chemotherapy.Methods: A quasi-experimental non-equivalent pretest—post-test control group design was conducted on 32 breast cancer patients at West Nusa Tenggara Provincial General Hospital. The intervention group (n=16) consumed 280 mL of papaya—lime smoothie daily for three days, while the control group (n=16) received standard care. Constipation severity was assessed using the constipation assessment scale (CAS). Statistical tests included the Wilcoxon signed-rank, the Mann-Whitney U, and the t-tests.Result: The intervention group showed a significant reduction in CAS scores from 10.38 ± 1.99 (moderate constipation) to 1.94 ± 1.69 (no constipation) (p < 0.001), while the control group decreased from 9.88 ± 1.99 to 5.19 ± 1.51 (mild constipation) (p < 0.001). Between-group differences were significant (Δ=8.44 ± 1.50 vs Δ=4.69 ± 2.27, p < 0.001).Conclusion: Daily consumption of papaya—lime smoothie effectively reduced constipation severity in breast cancer patients undergoing chemotherapy and may be considered as an alternative supporting non-pharmacologic therapy in cancer care.
Overall Survival of Oral Cancer Patients: A Retrospective Study in Dharmais National Cancer Center Hospital Denni Joko Purwanto; Arindi Vindi Cahyani
Indonesian Journal of Cancer Vol. 20 No. 2 (2026): June
Publisher : http://dharmais.co.id/

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.33371/ijoc.v20i2.1486

Abstract

Background: Oral cancer ranks as the 16th most common malignancy, with a disproportionately higher incidence in Asia. The 5-year overall survival (OS) of oral cancer shows differences in many countries. In Indonesia, many patients present at advanced stages, making adequate surgery followed by appropriate adjuvant therapy crucial for optimal outcomes. This study aims to evaluate the factors affecting OS, focusing on the comparison between adjuvant radiotherapy and chemoradiotherapy in oral cancer patients at Dharmais Cancer Hospital.Method: A retrospective study was conducted on 51 samples collected from patients’ medical record started in January 2017 to January 2024, and patients were followed up by phone. Overall survival was calculated with Kaplan-Meier analysis, and prognostic factors were analyzed using the Cox-Regression.Result: The 5-year OS rate for oral cancer patients was 58.1%, while patients who underwent adjuvant radiotherapy and chemoradiotherapy had rates of 51% and 40%, respectively (p-value 0.35); this difference was not statistically significant. Cox-regression analysis showed that comorbidities (HR, 2.8; 95 CI, 1.05—7.4; P = 0.04), tumor grade (HR, 11.3; 95% CI, 1.88—67.94; P = 0.008), and stage (HR, 0.11; 95% CI, 0.01—0.9; P = 0.04) were associated with OS in oral cancer patients. Conclusion: Five-year OS of oral cancer patients in Dharmais Cancer Hospital was 58.1%. Patients who received adjuvant radiotherapy tended to have better OS than those who received adjuvant chemoradiotherapy, although the difference was not statistically significant. Additionally, comorbidities, tumor grade, and stage were found to be significantly associated with OS in oral cancer patients.
The Role of Ultrasound in Predicting Malignancy in Ovarian Neoplasm: A Case Report Edward Christopher Yo; Kartiwa Hadi Nuryanto
Indonesian Journal of Cancer Vol. 20 No. 2 (2026): June
Publisher : http://dharmais.co.id/

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.33371/ijoc.v20i2.1493

Abstract

Background: Ovarian neoplasm is associated with the highest mortality rate compared to other gynecologic cancers. Unfortunately, non-specific symptoms and a lack of a reliable screening approach have led to failure in detecting most cases early. At present, there is an ongoing challenge in predicting whether an ovarian tumor is likely to be benign or malignant. This information is crucial as it will guide the treatment plan and inform the prognosis. Hence, this case report aims to elaborate on the role of ultrasound in the prediction of malignant status in ovarian neoplasms. Case Presentation: We present a case of a 59-year-old woman with a history of worsening abdominal pain and unintentional weight loss for 6 months before admission. The pain had significantly become more severe since 1 month before admission. A fixed, right lower quadrant mass was noted upon abdominal examination. TVS showed a right adnexal mass with a size of 11.94 x 9.94 x 9.02 cm with adhesion to the uterus. The mass presented with both solid and cystic components. Intraoperative diagnosis using frozen section showed clear cell ovarian carcinoma. The patient then underwent complete surgical staging.Conclusions: Ultrasound can be a reliable preoperative tool to predict malignancy in ovarian neoplasms, especially in resource-limited settings. Diagnostic accuracy can be improved by using several standardized morphological criteria, such as the IOTA simple rules approach, which is based on the M and B findings. Our patient’s ultrasound findings corresponded to two M-features (M1 and M4), which confirmed the tumor’s malignant status. In addition, a comprehensive assessment of the patient’s history, physical examination findings, and laboratory findings also aids in improving early detection of ovarian neoplasm and prediction of malignancy.
Sonoelastography Findings in Breast Cancer: Correlation with Molecular Subtypes and Ki-67 Expression Lydia Purna Kuntjoro; Ignatius Riwanto; Hermina Sukmaningtyas; Yan Wisnu Prajoko; Suhartono Suhartono; Lina Choridah; Endang Mahati; Clarissa Aulia Pravitha
Indonesian Journal of Cancer Vol. 20 No. 2 (2026): June
Publisher : http://dharmais.co.id/

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.33371/ijoc.v20i2.1503

Abstract

Background: Strain elastography is increasingly used as a complementary imaging tool to assess suspicious breast lesions by evaluating tissue stiffness using the strain ratio and elastography score. Owing to the intertumor heterogeneity of breast cancer, this study aimed to investigate the association between elastography findings and tumor proliferation, as indicated by Ki-67 expression, across different molecular subtypes.Methods: This cross-sectional study prospectively collected data from three hospitals, including Dr. Kariadi Hospital, National Diponegoro Hospital, and Ken Saras Hospital. Patients with BI-RADS ultrasound category 4 or 5 lesions confirmed as malignant on histopathology were included. The elastography score was assessed using the Tsukuba elasticity score, while the strain ratio was calculated by comparing the strain elasticity within a lesion with that within the adjacent normal tissue. Independent t-tests and chi-square tests were employed to assess the correlation between elastography findings and gold standard tests, such as molecular subtype and immunohistochemical results. The most significant results were further evaluated for their diagnostic performance. Data were analyzed using SPSS version 25. Results: This study included 29 patients with a mean age of 52.06 ± 11.99 years. The associations between immunohistochemical markers and both the strain ratio and elastography score did not reach statistical significance, possibly due to the limited sample size. Among molecular subtypes, only luminal B demonstrated a significant association with the strain ratio (p = 0.025). Diagnostic evaluation for luminal B yielded a sensitivity of 61.1%, specificity of 81.8%, and an area under the curve (AUC) of 0.689 at a strain ratio cutoff of 4.27.Conclusions: Increased stiffness in the luminal B subtype suggests the potential of strain elastography as a noninvasive indicator of tumor behavior

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