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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 658 Documents
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Beyond the Beam: A Rare Case Report of Recurring Radiotherapy-Associated Angiosarcoma: Radiotherapy-Associated Angiosarcoma Ignatia Rosalia Kirana; Yusuf Mannagalli; Ferdita Ridha Cahyani; Anita Margaret Wibisono; Jacobus Octovianus
Indonesian Journal of Cancer Vol. 20 No. 3 (2026): September
Publisher : http://dharmais.co.id/

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.33371/ijoc.v20i3.1580

Abstract

Introduction: Radiotherapy-associated angiosarcoma (RAAS) is a rare but highly aggressive secondary malignancy that may arise several years after breast irradiation. The estimated prevalence of RAAS is 0.05%. One of the challenges in treating angiosarcoma is the high rate of recurrence, which was reported at 73%. We present the case of a 52-year-old woman presenting with breast RAAS five years after the primary breast cancer. She then underwent mastectomy and adjuvant chemotherapy, but the RAAS recurred three years later and was then treated with systemic therapy. Case Presentation: A 52-year-old woman had a history of triple-negative right breast cancer stage I and underwent neoadjuvant chemotherapy, breast-conserving surgery, and radiotherapy. Five years later, she developed a lump in her right breast, which was confirmed as high-grade angiosarcoma, sized 15 × 3 mm. We performed a simple mastectomy with R0 ≥ 5 mm followed by chemotherapy. Two years after the mastectomy, upon the request of the patient, she underwent delayed reconstruction with a transverse rectus abdominis myocutaneous (TRAM) flap. However, three years after the initial RAAS treatment, the patient presented with a mass and a bluish-purple discoloration in the upper and lower surgical scar on her right reconstructed breast, respectively, which was confirmed to be recurrent high-grade angiosarcoma. The patient is currently undergoing chemotherapy. Conclusions: RAAS is an aggressive tumor that may recur even after complete surgical resection. Chemotherapy may provide temporary disease control; however, treatment response should be closely monitored to determine the effectiveness of therapy.
Treatment Abandonment in Pediatric Cancer: A 3-Year Study from a Tertiary Referral Center in West Sumatra, Indonesia : Cancer Treatment Abandonment Amirah Zatil Izzah; Ade Nofendra; Maryam Syifaurrahmah; Yank Olivia Diana
Indonesian Journal of Cancer Vol. 20 No. 3 (2026): September
Publisher : http://dharmais.co.id/

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.33371/ijoc.v20i3.1582

Abstract

Background: Childhood cancer is a major global health burden, with survival rates exceeding 80% in high-income countries (HICs) but remaining substantially lower in low- and middle-income countries (LMICs). Treatment abandonment is a key contributor to this disparity. In Indonesia, particularly outside Java, data on treatment abandonment are limited. This study aimed to determine the proportion, temporal trends, reasons for abandonment, time to abandonment, and demographic characteristics associated with abandonment among pediatric cancer patients at Dr. M. Djamil General Hospital, Padang, West Sumatra. Methods: A retrospective descriptive study was conducted using data from the Indonesian Pediatric Cancer Registry (IPCAR) at Dr. M. Djamil Central General Hospital, Padang. The study included all pediatric oncology patients admitted between January 2022 and December 2024. Reasons for treatment abandonment were obtained through follow-up telephone interviews with parents in July 2025. Demographic and clinical variables were analyzed descriptively, while temporal trends were assessed using the Chi-square test for linear trend. Treatment abandonment was defined as discontinuation of curative therapy for ≥4 weeks without any medically justified reason. Results: Among the 367 patients, 57 (15.5%) experienced treatment abandonment, with the rate significantly decreasing from 23.9% in 2022 to 12.1% in 2024. Abandonment was more common in children aged 1–10 years and those above 10 years, those residing outside Padang City, and those diagnosed with hematolymphoid tumors. Financial constraints were the most frequently reported reason for abandonment (33.3%). Most abandonment events (84.2%) occurred within the first six months following diagnosis, with a median time to abandonment of 96 days. Conclusion: Treatment abandonment in pediatric cancer in our center is declining over the three years yet remains a critical challenge. Targeted interventions in the early treatment phase, improved follow-up systems, and strategies to reduce financial constraints and practical access issues are urgently needed to improve adherence and survival.
Detection of Intestinal Protozoa Using Direct Stool Examination in Patients with Colorectal Diseases at Dr. M. Djamil General Hospital, Padang: Intestinal Protozoa in Colorectal Diseases Tazkia Aulia Permata Helena; Selfi Renita Rusjdi; Eka Kurniawan; Hasmiwati Hasmiwati; Dwitya Elvira; Shinta Ayu Intan
Indonesian Journal of Cancer Vol. 20 No. 3 (2026): September
Publisher : http://dharmais.co.id/

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.33371/ijoc.v20i3.1605

Abstract

Background: Colorectal diseases are conditions that affect the colon and rectum, impacting both their functional and structural integrity. Colorectal diseases include inflammatory bowel disease (IBD), colorectal polyps, and colorectal cancer, as they have the potential to cause chronic inflammation in the colon and rectum. Chronic inflammation and mucosal disruption may facilitate protozoan colonization and infection, potentially increasing susceptibility to intestinal protozoa. Conversely, intestinal protozoan infections may promote intestinal inflammation and epithelial damage, potentially contributing to the pathogenesis of colorectal disease. This study explores multiple colorectal diseases such as IBD, polyps, and cancer to provide a broader understanding of intestinal protozoan infections within the colorectal spectrum in West Sumatera, where such data have not been previously reported. This study aimed to determine the prevalence of intestinal protozoa detected by direct stool examination among patients with colorectal diseases at Dr. M. Djamil General Hospital Padang. Methods: This study is a descriptive cross-sectional study using primary data from a total of 73 colorectal disease patients, selected through consecutive sampling. Patient diagnoses were obtained from medical records, while intestinal protozoan infections were identified through stool samples via direct stool examination. Fresh stool samples were examined microscopically and then stained with Lugol’s iodine and eosin. Microscopic observations were performed using a binocular light microscope under 100x, 400x, and 1,000x magnifications. The study employed univariate analysis and presented the results in frequency distribution tables. This study was conducted at Dr. M. Djamil General Hospital Padang and the Parasitology Laboratory, Faculty of Medicine, Andalas University, between December 2023 and February 2024. Results: Among the 73 patients, 79,5% had colorectal cancer, 19.2% had IBD, and 1.4% had colorectal polyps. Intestinal protozoan infections were most frequently observed in patients with colorectal cancer. Most patients were male (60.3%), with the highest prevalence in the 51-60 and > 60 age groups (31.5%). Intestinal protozoan infections were detected in 52.1% (38/73) of colorectal disease patients, with Cryptosporidium sp. found in 52.6% and Blastocystis sp. in 47.4% of cases. The infection rate was higher in the 51-60 age group (36.8%) and predominantly found in males (65.8%). The dominant type of infection was single infection (89.5%). Conclusions: The prevalence of intestinal protozoan infections was found to be relatively high, particularly in colorectal cancer patients. The most frequently detected species were Blastocystis sp. and Cryptosporidium sp. Patients should undergo screening and receive antiparasitic treatment if necessary, along with education on disease prevention related to intestinal protozoan infections.  
Correlation of Treatment Duration and Chemotherapy Cycles with Quality of Life in Breast Cancer Patients at West Nusa Tenggara Hospital: Quality of Life among Breast Cancer Patients Under Chemotherapy Malva Marshaniswa Yasykurah; Candra Eka Puspitasari; Baiq Hawarikatun; Janatul Annisa
Indonesian Journal of Cancer Vol. 20 No. 3 (2026): September
Publisher : http://dharmais.co.id/

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.33371/ijoc.v20i3.1608

Abstract

Background: Breast cancer is the most common type of cancer among women worldwide, and its treatment can affect patients’ well-being. Health-related quality of life (QoL) assessment is essential for evaluating treatment outcomes. This study aimed to examine the QoL of women undergoing chemotherapy at the Oncology Unit of West Nusa Tenggara Hospital and to determine whether treatment duration and chemotherapy cycles were associated with this outcome.  Methods: A cross-sectional study was conducted at the Oncology Unit of West Nusa Tenggara Hospital from October 2024 to April 2025 on 56 women with breast cancer who were undergoing chemotherapy. The treatment duration, chemotherapy cycles, and characteristics were reviewed. The Functional Assessment of Cancer Therapy-Breast (FACT-B) questionnaire was used to assess QoL in this study. The correlation between treatment duration, chemotherapy cycles, and QoL was analyzed using Pearson correlation. Results: The overall FACT-B score in this study was 111.23 ± 19.51, with higher scores reflecting better QoL. The results showed that there was no significant correlation between the treatment duration (r = -0.035) and chemotherapy cycles (r = -0.088) and the  QoL of breast cancer patients. Conclusions: There was no correlation between the treatment duration  and chemotherapy cycles and the quality of life of breast cancer patients undergoing chemotherapy at West Nusa Tenggara Hospital  
Initial Bone Metastasis in Mixed Medullary and Follicular-Cell-Derived Thyroid Carcinoma: A Rare Case Report: Bone Metastasis in MMFCC Ignatius Ferdi Yuatmadja; Herman Saputra
Indonesian Journal of Cancer Vol. 20 No. 3 (2026): September
Publisher : http://dharmais.co.id/

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.33371/ijoc.v20i3.1631

Abstract

Introduction: Mixed medullary and follicular-cell derived carcinoma (MMFCC) is an exceptionally rare thyroid malignancy, accounting for less than 0.1% of all thyroid malignancies, defined by the coexistence of morphologically distinct follicular and C-cell-derived populations. Diagnosis is difficult when bone metastasis is the initial presentation, a pattern more typical of follicular thyroid carcinoma that appears only late in medullary disease. This report describes the clinical, radiological, and pathological features of MMFCC. Case Presentation: A 64-year-old male presented with a three-month history of right hip pain caused by a large destructive lytic lesion of the right iliac bone; needle biopsy suggested metastatic thyroid carcinoma. Neck examination was unremarkable and thyroid function tests were normal. Ultrasound identified a 3 cm Thyroid Imaging Reporting and Data System 5 (TIRADS 5) nodule, and fine-needle aspiration (FNA) suggested a follicular neoplasm. After total thyroidectomy, histopathology showed a "mixed intimate" growth pattern of medullary thyroid carcinoma (MTC) with stromal amyloid and linear cracking artifacts, intermingled with papillary thyroid carcinoma (PTC) showing distinct nuclear features. Because immunohistochemical (IHC) markers were unavailable and high-grade features were absent, the diagnosis rested on strong clinicopathologic correlation and characteristic microscopic findings. Conclusions: Bone metastasis as the initial manifestation of MMFCC is rare and mimics more common follicular-cell malignancies. Although WHO criteria ideally require IHC proof of dual lineage, the diagnosis here was reached through careful morphological identification of coexisting MTC and PTC populations together with clinicopathologic correlation. This allowed a dual management strategy despite limited diagnostic facilities.  
Bilateral Endobronchial Metastasis from Breast Cancer: A Rare Case Revealed by Bronchoscopy : Bilateral Endobronchial Metastases in Breast Cancer Fibrianti Ratnasari; Ungky Agus Setyawan; Christian Surya Eka Putra; Hery Susilo; Hendy Setyo Yudhanto
Indonesian Journal of Cancer Vol. 20 No. 3 (2026): September
Publisher : http://dharmais.co.id/

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.33371/ijoc.v20i3.1646

Abstract

Introduction: Breast cancer often metastasizes to bone, liver, and lungs, while endobronchial metastasis (EBM) is rare, accounting for only 2–28% of cases and is exceptionally uncommon when bilateral. Case Presentation: We report a 37-year-old woman with stage IV breast cancer who developed bilateral endobronchial metastasis (EBM) within three months after completing chemoradiotherapy. She later presented with progressive dyspnea, hemoptysis, and chest pain. Chest radiography revealed bilateral pleural effusion and right lung collapse. Bronchoscopy demonstrated total obstruction (100%) of the right main bronchus and approximately 80% obstruction of the left, with nodular intraluminal masses. Histopathology revealed malignant round-to-oval cells with a high nuclear-to-cytoplasmic ratio. Immunohistochemistry showed ER positivity and TTF-1 negativity, confirming metastatic breast carcinoma. Despite systemic therapy and supportive care, her condition rapidly deteriorated, and she died from respiratory failure. Conclusion: Bilateral endobronchial metastasis from breast cancer is an extremely rare and fatal manifestation. Awareness of this condition is crucial, as it may mimic other pulmonary complications. Early bronchoscopy should be considered in advanced breast cancer patients with compatible clinical and radiological findings to allow timely diagnosis, appropriate management, and improved symptom control. This case highlights the importance of maintaining a high index of suspicion for endobronchial metastasis in patients presenting with unexplained respiratory symptoms.
Thoracic Metastasis in Ovarian Cancer: Clinical Characteristics, CA-125 Levels, and Pleural Fluid Findings in a 3-Year Retrospective Study: Ovarian Cancer with Thoracic Metastasis Khansa Kiasati Chandra Syahbunan; Brahmana Askandar Tjokroprawiro; Arief Bakhtiar; Grace Ariani
Indonesian Journal of Cancer Vol. 20 No. 3 (2026): September
Publisher : http://dharmais.co.id/

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.33371/ijoc.v20i3.1649

Abstract

Background: Ovarian cancer is one of the leading causes of gynecological cancer-related deaths, with most cases diagnosed at an advanced stage and exhibiting high recurrence rates. Approximately 38% of ovarian cancer metastases involve the lungs. Systematic data describing the clinicopathological characteristics of patients with thoracic metastasis remain limited, particularly in Indonesia. This study aims to describe the demographic, laboratory, histopathological, and thoracic radiologic features of these patients. Methods: This retrospective descriptive study included ovarian cancer patients with thoracic metastasis treated at Dr. Soetomo General Hospital from January 2021 to December 2023. Among 393 reviewed cases, 51 patients with complete clinical, laboratory, and radiologic data were included. Data on demographics, menopausal status, CA-125 levels, pleural effusion with cytology, ascites, histopathology, and thoracic imaging findings were summarized descriptively. Results:  Most patients were aged 40–65 years with elevated CA-125 levels. Ascites and pleural effusion were the main clinical features. High-grade serous carcinoma and endometrioid carcinoma were the most frequent histological subtypes. Conclusions: This study provides an overview of the clinical, pathological, and radiologic characteristics of ovarian cancer patients with thoracic metastasis in an Indonesian tertiary center, offering data that have not been systematically documented in this population.  These findings highlight advanced clinical features and provide insight into thoracic metastatic patterns, aiding clinical assessment in this population  
Immune-Excluded CD4⁺ and CD8⁺ T-Cell Depletion Predicts Early Recurrence in Hepatocellular Carcinoma with Microvascular Invasion: T-Cell Depletion and Early HCC Recurrence Lianda Siregar; Rino Alvani Gani; Toar J.M. Lalisang; Irsan Hasan; Suhendro Suhendro; Heriawan Soejono; Siti Boedina Kresno; Nurjati Chairani Siregar; Begawan Bestari
Indonesian Journal of Cancer Vol. 20 No. 3 (2026): September
Publisher : http://dharmais.co.id/

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.33371/ijoc.v20i3.1674

Abstract

Background: Early recurrence within six months after resection continues to pose a major clinical challenge in hepatocellular carcinoma (HCC) patients, occurring in approximately 31.9% of patients. This study aims to investigate whether reduced immune cell infiltration across intratumoral and peritumoral compartments is associated with early HCC recurrence in patients with high angiogenic activity and microvascular invasion (MVI). Methods:  A multicenter nested case–control study was conducted using liver tissue samples from 49 patients with HCC who underwent surgical resection. Clinical data were retrieved from medical records. Pathological and immunological parameters were assessed using hematoxylin–eosin (H&E) staining for tumor-infiltrating lymphocytes (TILs) and immunohistochemistry for VEGF, CD4, CD8, and regulatory T cells. The analytical approach included ROC curve analysis, Kaplan-Meier survival estimation, and multivariate Cox regression. Results: Early recurrence occurred in 11 of 49 patients, all showing high VEGF and most with microvascular invasion. Patients with early recurrence had markedly lower intratumoral CD4⁺ T-cell density and reduced peritumoral CD8⁺ T-cell density, while peritumoral CD4⁺ and overall TILs remained higher than intratumoral. Multivariable analysis identified low intratumoral CD4⁺ (HR 7.98; 95% CI: 1.63–39.07) and decreased peritumoral CD8⁺ (HR 4.98; 95% CI: 1.14–21.70) as independent predictors. Intratumoral and peritumoral Treg densities showed no significant association. Conclusions: Low intratumoral CD4⁺ and peritumoral CD8⁺ infiltration were identified as independent predictors of early HCC recurrence, reflecting an immune-excluded tumor phenotype characterized by high peritumoral CD4⁺ and TILs. In this context, angiogenesis-driven stromal and vascular barriers impede effective T-cell trafficking into the tumor core, facilitating early recurrence, particularly in tumors with microvascular invasion. These findings underscore the need for intensified post-resection surveillance and may define a high-risk subgroup for future evaluation of adjuvant therapies.  

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