Iraqi Journal of Cancer and Medical Genetics

Background: Cardiovascular diseases and cancer are major causes of mortality worldwide. Comorbidities among cancer patients significantly influence prognosis and quality of life. These comorbidities, including cardiovascular disease, may result from underlying pathology similar to that of noncancer patients, chemotherapy, or direct tumor extension. Our study aims to estimate the burden of cardiovascular diseases among cancer patients in our community.
Methods: This was an observational cross-sectional study conducted at Basra Oncology Center and Basra Hematology Center. In this study, adult patients with different types of cancer, including solid and hematological malignancies, were included. The investigators extracted data from the medical records of the patients, including demographic data, past medical history, cancer type and stage, type of treatment (chemotherapy or radiotherapy), and history of cardiovascular diseases (ischemic heart disease, heart failure, valvular heart disease, pericardial disease, deep vein thrombosis, pulmonary embolism, cerebrovascular accidents, hypertension, hyperlipidemia, and diabetes mellitus).
Results: We randomly enrolled 250 adult patients, including 173 females (average age 53.4 years, range 2087-). Breast cancer was the most common type, followed by gastrointestinal, genitourinary, lung, hematological, and brain tumors. Among the 250 patients, 51 (20.4%) had cardiovascular diseases, with ischemic heart disease being the most frequent, followed by venous thromboembolism, deep vein thrombosis, arrhythmia, heart failure, and valvular diseases. Additionally, 207 patients (82.8%) had cardiovascular risk factors, with hypertension being the most prevalent risk factor.
Conclusion: The burden of cardiovascular disease and risk factors significantly present across all types of cancer. Early diagnosis and management of cardiovascular disease in cancer patients are needed to improve prognosis.

Background: The Odontogenic, Ameloblast-Associated gene (ODAM) encodes a matricellular protein that is involved in cell adhesion and odontogenesis. Emerging evidence suggests a role in tumor biology, with its expression documented in various epithelial malignancies, including breast cancer (BC). This study investigated the expression, clinical significance, and functional role of ODAM in BC, with a focus on its relationship with the AKT signaling pathway.
Methods: ODAM expression in malignant, benign, and control groups (n=35 per group) was quantified via quantitative real-time PCR (qRT‒PCR) and normalized to that of the housekeeping gene GAPDH. Patient classification and dataset generation were based on oncologist evaluations and confirmed mammography findings. Serum AKT concentrations were measured by ELISA. Survival analysis was performed using a large public breast cancer dataset.
Results: ODAM expression was significantly downregulated in malignant breast tissue samples than in benign and control tissue samples, with an approximately 66.6-fold downregulation in ODAM expression in BC patients (p<0.01). This loss of ODAM was inversely correlated with serum AKT levels, which were significantly elevated in malignant patients (3.173 ng/ml) versus controls (1.510 ng/ml; p<0.01). ODAM overexpression in aggressive BC cells suppressed tumorigenic properties by inhibiting growth, migration, and invasion while promoting cell adhesion and apoptosis. Mechanistically, ODAM may be associated with alterations in serum AKT and PI3K/AKT signaling and the upregulation of the expression of the tumor suppressors phosphatase and tensin PTEN. Critically, Kaplan-Meier survival analysis revealed that high ODAM expression is a favorable prognostic biomarker and is associated with significantly improved overall survival in BC patients (HR = 0.89; 95% CI = 0.80–0.98; p = 0.022).
Conclusion: ODAM acts as a novel tumor suppressor gene in breast cancer, whose downregulation is associated with disease progression and poor prognosis. Its anti-neoplastic effects are mediated, at least in part, through changes in circulating AKT protein signaling. These findings suggest that ODAM is a valuable prognostic biomarker and potential therapeutic target in breast cancer.

The intratumoral microbiota, which includes various communities of bacteria, fungi, and viruses within the tumor microenvironment, is increasingly regarded as a multidimensional factor in cancer biology. In this review, the concept of a “microbial conductor” is presented as a conceptual framework for understanding how microbial communities may influence multiple hallmarks of cancer. The intratumoral microbiota exhibits substantial heterogeneity across individuals and is strongly associated with host immune responses, the tumor microenvironment (TME), and therapeutic responses. Current evidence suggests that intratumoral microorganisms are associated with tumor progression across multiple cancer types. Mechanistic studies have demonstrated that specific microbial taxa can modulate proliferative signaling, immune evasion, genomic instability, inflammation, and metabolic reprogramming through distinct molecular pathways. Furthermore, emerging clinical evidence indicates that microbiome composition may influence prognosis and treatment response, although validation in large-scale prospective studies remains limited. Importantly, the current body of evidence ranges from associative observations to mechanistic investigations and limited clinical validation, highlighting the need for further studies to establish causal relationships and therapeutic interventions in targeted oncology approaches.

Drug resistance is one of the greatest obstacles to pharmaceutical success in contemporary medicine and has greatly restricted both antimicrobial and therapeutic approaches to cancer. While microbial multidrug resistance and cancer chemoresistance have been traditionally considered discrete processes, there is growing evidence that they have a number of common survival mechanisms. This narrative analysis critiques and clarifies drug-resistant bacterial pathogens and cancer cell molecular, structural, and physiological processes, including efflux pumps, biofilm-associated protection, and tumour microenvironment-mediated resistance. A comprehensive search of PubMed, Scopus, Web of Science, and Google Scholar for papers on multidrug resistance mechanisms in microbial and cancer systems. This review shows how bacterial resistance-nodulation-division (RND) and cancer-associated ATP-binding cassette (ABC) transporters reduce intracellular drug accumulation and favour treatment failure. Biofilms and solid tumours have remarkable parallels in their extracellular polymeric matrices, which hinder medication penetration and let resistant cell populations survive. Emerging efflux pump inhibitors, antimicrobial peptides, drug delivery systems based on nanocarriers coupled to microenvironmental surveillance and microenvironment targeting technologies are considered among promising mechanisms for combating multidrug resistance. With much advancement, clinical translation continues to be constrained by toxicity, low selectivity, and resistance network complexity. In general, we emphasize that microbial and cancer resistance have in common the adaptive strategies and underscore the critical need for multi domain strategies to develop optimized therapies against multidrug resistance.

Antimicrobial and anticancer drug resistance represent two of the main global challenges for public health and require immediate practical solutions. Drug-resistant cancer chemotherapy and the growing threat posed by antimicrobial resistant infections represent additional biomedical challenges. Thus, one viable way forward to develop multifunctional candidates with improved biological value is by altering existing drugs through chemical modification. Three imine-amoxicillin hybrids, J1-J3, were synthesized from the condensation of amoxicillin trihydrate with 2,4-dihydroxy-3-propylbenzaldehyde, 3-ethyl-4-hydroxy-5-methylbenzaldehyde, and 2-(3-formyl-4-hydroxyphenyl)acetonitrile. All products were successfully obtained as yellow to yellowish-orange precipitates, and subsequent characterization of the products by FTIR demonstrated that azomethine C=N bands formed during the condensation reactions. FTIR data also revealed the formation of new azomethine bands corresponding to derivatives J1 at 1643, J2 at 1620, and J3 at 1644 cm-1, indicating that Schiff base synthesis occurred. Additionally, docking studies were performed against the 6IIO protein, and the results revealed that synthesized derivatives J1, J2, and J3 possessed favorable docking scores of -7.83371, -8.18972, and -8.1703 kcal/mol, respectively. Derivatives J2 and J3 demonstrated the strongest antibacterial activity against S. pyogenes and B. subtilis, producing inhibition zones of 35 mm and 26 mm, respectively, at 0.1 mg/mL within the study. Furthermore, compared with the synthesized derivative J1, the synthesized derivative J3 exhibited stronger cytotoxic activity against the MCF-7 cell line, with IC50 values of 123.8 and 160.3 μg/mL, respectively. Finally, on the basis of ADMET prediction data, the gastrointestinal absorption of all three molecules is expected to be low, and only derivatives J3 and J2 will comply with the proposed rules of Lipinski’s rule.

Colorectal cancer is among the most common cancers worldwide and is the second leading cause of cancer-related mortality. Early detection and screening are crucial for reducing both incidence and mortality. Parasitic diseases may induce anticancer effects through interactions between the parasite and its host. Accumulating scientific evidence has proven the validity of this concept, as some parasites have shown anticancer activity in vitro. This research aims to prepare and characterize hydatid cyst wall antigens by determining protein concentrations and analyzing them using electrophoresis, as well as evaluating their cytotoxic activity in a human colorectal adenocarcinoma cell line (HRT-18) compared with that in a normal human cell line (NHF). Methods: In this study, the Lowry method was used to measure protein concentration, and electrophoresis and MTT assays were used to determine the toxicity and IC50 values of the cyst wall antigens in both cancer and normal cell lines. The results revealed a dose-dependent cytotoxic effect that was significantly greater at the highest antigen concentration (100 μg) for colorectal cancer cells than for normal cells, while the effect was less pronounced on normal cells. The IC50 value of the cyst wall antigens on cancer cells was 24.0 μg/ml, whereas it was 100.8 μg/ml for normal cells, with a high selectivity index (SI) of 4.2, which indicated that the cyst wall antigens selectively target cancer cells while sparing normal cells. Conclusion: Antigens extracted from the cyst wall, including cyst wall antigens, are more cytotoxic to cancer cells than to normal cells; thus, these antigens are potential antitumor agents and warrant further investigation.

Dermatofibrosarcoma protuberans (DFSP) is a rare, locally aggressive soft tissue sarcoma arising from the dermis, representing approximately 0.1% of all malignancies. Although surgical excision with wide margins remains the standard treatment, local recurrence is common, particularly in patients with close or positive margins. Adjuvant radiotherapy is therefore recommended for recurrent disease or inadequate surgical margins. We report a rare case of scalp DFSP in a patient with Down syndrome treated using high-dose-rate (HDR) surface mold brachytherapy with the aid of three-dimensional (3D) printing technology. A 25-year-old woman with Down syndrome presented with recurrent DFSP of the right parietooccipital scalp following an unplanned excision. Wide local resection with an occipital transposition flap and skin graft reconstruction confirmed DFSP with a deep positive margin involving the skull (R1). Owing to the curved scalp anatomy and the patient’s limited cooperation related to cognitive impairment, adjuvant HDR surface mold brachytherapy was selected. Treatment planning was performed using CT simulation under sedation. A 3D-printed skull model allowed the optimization of catheter placement without the need for further resimulation. A total dose of 32.5 Gy in five fractions was delivered using an Ir-192 radioactive source. Treatment was well tolerated, with only mild grade 1 dermatitis and partial alopecia. The irradiated tumor bed showed an initial complete response. Approximately twenty-two months later, a marginal recurrence developed at the edge of the surgical scar in the right temporal region, while the rest of the irradiated field remained free of disease. This nodule was removed by wide local excision, the multidisciplinary tumor board recommended observation, and the patient remained clinically free of recurrence at the most recent follow up. Mild late effects included localized alopecia, hyperpigmentation, fibrosis, and thinning of the skin graft. This case suggests that HDR surface mold brachytherapy combined with 3D printing for treatment planning can be a useful and practical adjuvant option for scalp DFSP, particularly in anatomically complex situations or patients with compliance challenges and multiple recurrences. The marginal recurrence seen here also shows that adequate coverage of the field margins and close follow-up remain important.

Background: It has recently been reported that colorectal cancer is among the most common types of cancer in Iraq. This cancer arises from genetic and hereditary changes in the epithelial cells of the colon or rectum and often progresses from benign adenomatous polyps to invasive cancer.
Methods: A total of 30 Iraqi patients of both genders (11 males and 19 females) with colorectal cancer (CRC) and 15 healthy people (controls) were included in the study. Patients attended the Gastroenterology and Liver Diseases Teaching Hospital, Medical City, Baghdad, between January 2025 and November 2025. Participants underwent diagnosis.
Results: Toll-like receptor (TLR9) gene expression levels were studied in all patient groups. Compared with that in the control group, TLR9 gene expression was significantly greater in colon cancer patients than in rectal cancer patients and control subjects (6.88 ± 0.77, 4.79 ± 0.90, and 1.04 ± 0.19, respectively). With respect to COVID-19, TLR9 gene expression was significantly higher in the colon cancer group than in the rectum and control groups, which were not infected with COVID-19. The values were 10.213.24±6.15 ,0.88±, and 1.080.23±, respectively, with P < 0.001. There was also a significant difference between the two groups of COVID-19-infected and noninfected patients with colon cancer (P < 0.001). In tumor tissue, the size was less than 1 mm, and high TLR gene expression occurred in the patient group compared with that in the control group (P < 0.001). Compared with rectal cancer patients and controls, colon cancer patients were significantly more prevalent (7.750.36±2.42 ,1.11±, and 1.210.32±, respectively), according to the group whose tumor tissue size was above 1 mm (P < 0.001).
Conclusion: These findings indicate that TLR9 expression may represent a potential tissue biomarker in colorectal cancer. However, larger studies are needed to validate these findings.

Background: Acute lymphoblastic leukemia is a heterogeneous malignancy characterized by variable biological and clinical behavior. Multiple diagnostic modalities, including morphological, immunophenotypic, cytogenetic, biochemical and molecular analyses, are essential for its diagnosis and classification. Both CD34 antigen expression and fetal hemoglobin levels have been linked to prognostic outcomes in pediatric acute lymphoblastic leukemia patients.
Objectives: This study aimed to evaluate the prognostic significance of CD34 and hemoglobin F levels in childhood acute lymphoblastic leukemia patients and to explore their correlation with other hematological and clinical parameters.
Method: A cross-sectional study was performed on 28 pediatric patients (<15 years) with a new diagnosis of ALL at the Oncology Department of the Central Teaching Hospital of Pediatrics from August 2017 to April 2018. Data were obtained from each patient using a questionnaire. Peripheral blood and bone marrow samples were analyzed by morphology, cytochemistry and flow cytometry. Hemoglobin F levels were determined using high-performance liquid chromatography.
Results: CD34 expression was detected exclusively among B-lineage acute lymphoblastic leukemia patients and was detected more frequently in children with favorable clinical and hematological prognostic factors.. No associations were detected between HbF levels and any clinical or hematological prognostic factors.
Conclusion: CD34 expression is a common event in childhood B-ALL and is associated with favorable prognostic factors. HbF levels were not associated with any clinical or hematological prognostic factors.

Background: Disorders of sex development (DSD) are congenital conditions involving atypical chromosomal, gonadal, or anatomical sex development. Although sex chromosome abnormalities are well recognized, autosomal alterations remain insufficiently studied, especially in underrepresented populations.
Objective: This study aimed to describe cytogenetic findings related to clinical phenotypes, particularly autosomal rearrangements, in an Iraqi cohort with DSD.
Methods: A total of 81 patients with clinically suspected DSD were subjected to cytogenetic analysis using standard G-banding techniques. Typically, 25 - 30 metaphases were analyzed per case whenever culture quality permitted, with additional metaphases examined when necessary. Chromosomal abnormalities were classified as numerical or structural and involved sex chromosomes and/or autosomes. Descriptive statistics were applied, and associations between chromosomal abnormalities and clinical phenotypes were explored.
Results: Chromosomal abnormalities were identified in 64% (53 / 81) of the patients. Both sex chromosomes and multiple autosomes were involved, with recurrent abnormalities observed mainly on chromosomes 19, 2, 5, 12, and 16. The short arm of chromosome 19 (19p) was the most frequently affected region. Notably, several patients exhibited discordance between their sex and chromosomal constitution, often in association with complex autosomal rearrangements. Autosomal abnormalities were most frequent in ambiguous genitalia and primary amenorrhea.
Conclusion: These findings suggest that autosomal chromosomal abnormalities contribute to the phenotypic diversity of DSD. Recurrent chromosome 19p involvement in female patients may indicate a broader role in sex development beyond male-specific pathways. Further molecular studies are needed. These results emphasize the importance of comprehensive cytogenetic evaluation beyond sex chromosomes in DSD patients.