Cervical cancer is a common type of malignancy accounting for about 6% of all cancers found in women. It is a disease in which cancerous cells develop in the uterine cervix (this is the connecting passage between the uterus and vagina). The human papillomaviruses (HPV) are the principal cause of most cervical cancers. The peak incidence of cervical cancer occurs between the ages of 40 to 55. It is rare before the age of 35, however the incidence of cervical cancer in younger women rose dramatically during the two decades after 1960. Regular Pap smear tests may detect abnormal changes in the cervical tissues, before cancer develops. Symptoms of cervical cancer may include vaginal bleeding after intercourse or bleeding between periods. However, in the early stages of the disease there are often no obvious signs or symptoms, so regular smear tests are important.
healthtalkonline.org Detailed information, including snippets from interviews with 25 women, who share their experiences on a broad range of topics related to cervical cancer and treatment and side effects.
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PubMed Central search for free-access publications about Cervical Cancer MeSH term: Uterine Cervical Neoplasms US National Library of Medicine PubMed has over 22 million citations for biomedical literature from MEDLINE, life science journals, and online books. Constantly updated.
A non-profit organisation founded in 1991 to increase awareness and education, support expanded research and training, and provide knowledge and hope for women
diagnosed with cancers specific to them. Gynacological Cancers
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This list of publications is regularly updated (Source: PubMed).
Oh D, Lee JE, Huh SJ, et al. Prognostic significance of tumor response as assessed by sequential 18F-fluorodeoxyglucose-positron emission tomography/computed tomography during concurrent chemoradiation therapy for cervical cancer. Int J Radiat Oncol Biol Phys. 2013; 87(3):549-54 [PubMed] Related Publications
PURPOSE: To investigate the prognostic role of metabolic response by the use of serial sets of positron emission tomography/computed tomography (PET/CT) in patients with cervical cancer who were treated with concurrent chemoradiation therapy (CCRT). METHODS AND MATERIALS: A total of 60 patients who were treated with CCRT between February 2009 and December 2010 were analyzed. Three sequential PET/CT images were acquired for each patient: pre-CCRT, during-CCRT at 4 weeks of CCRT, and 1 month post-CCRT PET/CT. Metabolic responses were assessed qualitatively. The percentage changes in the maximum values of standardized uptake value (ΔSUV(max)%) from the PET/CT images acquired pre-CCRT and during-CCRT were calculated. Receiver operating characteristic (ROC) curve analysis was performed to evaluate whether ΔSUV(max)% could predict complete response (CR) on the post-CCRT PET/CT and to identify the best cutoff value. Prognostic factors of progression-free survival (PFS) were analyzed. RESULTS: During-CCRT PET/CT showed that 8 patients (13%) had CR, and the other 52 patients (87%) had partial response (PR). On the post-CCRT PET/CT, 43 patients (73%) had CR, 12 patients (20%) had PR, and 4 patients (7%) had progressive disease. The average SUV(max) in primary tumors was 16.3 (range, 6.4-53.0) on the pre-CCRT PET/CT images and 5.3 (range, 0-19.4) on the during-CCRT PET/CT images. According to ROC curve analysis, ΔSUV(max)% could predict CR response on post-CCRT PET/CT (P<.001, cutoff value of 59.7%). In all patients, the PFS rate was 71.9% at 2 years. Multivariate analysis showed that ΔSUV(max)% ≥60% (P=.045) and CR response on the post-CCRT PET/CT (P=.012) were statistically significant predictors of PFS. CONCLUSION: Metabolic responses on the during-CCRT images at 4 weeks of treatment and 1-month post-CCRT PET/CT images may predict treatment outcomes in patients with cervical cancer. ΔSUV(max)% ≥60% at 4 weeks of CCRT may predict CR response on 1-month post-CCRT PET/CT and also PFS.
Gandhi AK, Sharma DN, Rath GK, et al. Early clinical outcomes and toxicity of intensity modulated versus conventional pelvic radiation therapy for locally advanced cervix carcinoma: a prospective randomized study. Int J Radiat Oncol Biol Phys. 2013; 87(3):542-8 [PubMed] Related Publications
PURPOSE: To evaluate the toxicity and clinical outcome in patients with locally advanced cervical cancer (LACC) treated with whole pelvic conventional radiation therapy (WP-CRT) versus intensity modulated radiation therapy (WP-IMRT). METHODS AND MATERIALS: Between January 2010 and January 2012, 44 patients with International Federation of Gynecology and Obstetrics (FIGO 2009) stage IIB-IIIB squamous cell carcinoma of the cervix were randomized to receive 50.4 Gy in 28 fractions delivered via either WP-CRT or WP-IMRT with concurrent weekly cisplatin 40 mg/m(2). Acute toxicity was graded according to the Common Terminology Criteria for Adverse Events, version 3.0, and late toxicity was graded according to the Radiation Therapy Oncology Group system. The primary and secondary endpoints were acute gastrointestinal toxicity and disease-free survival, respectively. RESULTS: Of 44 patients, 22 patients received WP-CRT and 22 received WP-IMRT. In the WP-CRT arm, 13 patients had stage IIB disease and 9 had stage IIIB disease; in the IMRT arm, 12 patients had stage IIB disease and 10 had stage IIIB disease. The median follow-up time in the WP-CRT arm was 21.7 months (range, 10.7-37.4 months), and in the WP-IMRT arm it was 21.6 months (range, 7.7-34.4 months). At 27 months, disease-free survival was 79.4% in the WP-CRT group versus 60% in the WP-IMRT group (P=.651), and overall survival was 76% in the WP-CRT group versus 85.7% in the WP-IMRT group (P=.645). Patients in the WP-IMRT arm experienced significantly fewer grade ≥2 acute gastrointestinal toxicities (31.8% vs 63.6%, P=.034) and grade ≥3 gastrointestinal toxicities (4.5% vs 27.3%, P=.047) than did patients receiving WP-CRT and had less chronic gastrointestinal toxicity (13.6% vs 50%, P=.011). CONCLUSION: WP-IMRT is associated with significantly less toxicity compared with WP-CRT and has a comparable clinical outcome. Further studies with larger sample sizes and longer follow-up times are warranted to justify its use in routine clinical practice.
Giorgi Rossi P, Federici A, Zappa M The cancer screening monitoring system: indicators for organised programmes and possible extension to spontaneous screening. Pathologica. 2013; 105(3):83-5 [PubMed] Related Publications
European Commission recommends the implementation of organized screening programs for cervical cancer based on active invitation of the target population and with a systematic monitoring system and quality assurance. Nevertheless, in many Member States opportunistic screening is still the only or the main way to access Pap test. In Italy, Pap test coverage in women aged 25-64 is close to 80%, about half of them are screened in organized programs and half by opportunistic screening. Organized programs are diffused in the vast majority of the country (78% in 2009) even if in some cases they are not able to actively invite all the target population every three years (actual extension 67%); furthermore, participation rate after invitation is quite low (39%). Organized screening programs showed performance indicators in line with most of the international standards: low referral rates (2.4%), low inadequate cytological results (4.7%), and high positive predictive value for high grade cervical intraepithelial neoplasia (16.2%). Opportunistic screening has no systematic monitoring system. The coexistence of the two screening models, organized programs and opportunistic, can be a source of inappropriate use of secondary prevention duplicating the tests and favoring deviations from recommended protocols. The Italian Ministry of Health recommends re-organizing cervical cancer prevention favoring organized programs or integrating spontaneous Pap testing in an organized system. To implement such integration it is necessary to have monitoring system and quality assurance for all providers and to integrate archives in order to avoid over-testing and deviation from protocols.
Stein MD, Fregnani JH, Scapulatempo C, et al. Performance and reproducibility of gynecologic cytology interpretation using the FocalPoint system: results of the RODEO Study Team. Am J Clin Pathol. 2013; 140(4):567-71 [PubMed] Related Publications
OBJECTIVES: To assess whether automated screening in the cytologic examination of Papanicolaou smear slides results in smaller margins of error than manual screening. METHODS: We compared cytotechnologists' performance and reproducibility of manual and automated screening of 10,165 consecutive cervical cytology slides examined at Barretos Cancer Hospital using the FocalPoint system. RESULTS: In total, 83% of atypical squamous cells of undetermined significance and greater were classified as quintiles 1 and 2; no high-grade squamous intraepithelial lesions and greater were observed in quintile 5. No statistically significant differences were found between manual and automated screening, using cervical biopsy specimens as the gold standard. CONCLUSIONS: FocalPoint safely screened high-grade lesions, which can be valuable for high-workload routines.
Kaidar-Person O, Amit A, Berniger A, et al. Primary signet-ring cell adenocarcinoma of the uterine cervix: case report and review of the literature. Eur J Gynaecol Oncol. 2013; 34(4):353-4 [PubMed] Related Publications
Signet-ring cell adenocarcinoma is a rare subtype of the uterine cervix; thus there are no guidelines and the prognosis is unknown. There seems to be a significant role for reporting the treatment and outcome of this rare disease in order to establish guidelines and to assist in decision-making. However, treatment should be tailored to each patient according to clinical status and disease stage. Excluding extra-genital origin is mandatory, as it will change treatment management considerably.
Lopez-Chardi L, González-Bosquet E, Rovira Zurriaga C, Laïlla Vicens JM Mesonephric carcinosarcoma of the uterine cervix: a case report. Eur J Gynaecol Oncol. 2013; 34(4):336-8 [PubMed] Related Publications
Cervical carcinosarcomas are rare neoplasms that aggressively progress and belong to the histological group of mixed tumors with both epithelial and mesenchymal components (malignant mixed Müllerian tumors). At diagnosis, most patients present with vaginal bleeding and a palpable cervical mass. Given the rarity of this neoplasm, there is no consensus regarding the management of these patients and should be approached on a case-by-case basis, taking into consideration the clinical and pathological features of the tumor. The authors describe a woman with mesonephric cervical carcinosarcoma and review the literature regarding these rare tumors to better understand the natural history of these neoplasms.
Wang Y, Mei K, Xiang MF, et al. Clinicopathological characteristics and outcome of patients with small cell neuroendocrine carcinoma of the uterine cervix: case series and literature review. Eur J Gynaecol Oncol. 2013; 34(4):307-10 [PubMed] Related Publications
OBJECTIVE: To analyze the clinicopathological data of 13 cases of small cell neuroendocrine carcinoma (SCNEC) of the uterine cervix who received treatment at this medical institutions over the past five years with patient survival as the primary endpoint. MATERIALS AND METHODS: The clinicopathologic data of 13 cases were reviewed. Immunohistochemistry was performed using antibodies against synaptophysin and chromogranin A and Ki-67. Survival was analyzed using the Kaplan-Meier method and log-rank tests. RESULTS: The median age of these patients was 37 years (range 21-62). Immunohistochemistry showed that the positive rate of synaptophysin and chromogranin A was 100% (13/13) and 69.23% (9/13), respectively. The median survival of patients with early-Stage I-II SCNEC of the uterine cervix (17.5 months) was significantly higher than that of patients with advanced stage SCNEC of the uterine cervix (four months) (p < 0.05). There was no local recurrence in all 13 patients. Five patients died of distant metastasis in less than six months. CONCLUSION: SCNEC of the uterine cervix is a highly-malignant disease and early-stage patients showed significantly longer survival compared to late-stage patients. Early diagnosis and prompt combination treatment may improve the outcome of patients with SCNEC of the uterine cervix.
Meglic L, Pogacnik RK, Rakar S, Smrkolj S Clinical outcome of patients with microinvasive adenocarcinoma of the uterine cervix. Eur J Gynaecol Oncol. 2013; 34(4):296-9 [PubMed] Related Publications
BACKGROUND: The objective of this analysis was to present the clinical outcome of patients with microinvasive adenocarcinoma (AC) of the uterine cervix treated at the Department of Obstetrics and Gynecology between 1999 and 2010. MATERIALS AND METHODS: The authors analysed 125 patients with microinvasive AC. The analysis involved the following parameters: women's age at surgery, type of surgery, number of positive lymph nodes, and patient's survival. Additionally, a questionnaire regarding history and symptoms before diagnosis and postoperative follow-up was developed and analysed specifically for this study. RESULTS: The mean women's age at surgery was 40.58 +/- 9.58 years. In 70 women (56%), the performed treatment was conization, 34 women (27.2%) underwent simple hysterectomy, and 24 (19.2%) women had radical hysterectomy. In 14 (11.2%) women, the margins of the cone were not disease-free, in nine of them the authors later performed radical hysterectomy. From 14 women who became pregnant after treatment, 13 (16.9%) of them gave birth. One of the 125 patients diagnosed with microinvasive AC died and the cause of death was rectal carcinoma. CONCLUSION: The authors may conclude that conservative management of patients with microinvasive AC is safe when exact evaluation of tumor extension and surgical margins of the cone are considered, and results in very low risk of recurrence, lymph node disease, and death caused by cancer.
Smit BJ, van Wijk AL An improved, disposable indwelling intrauterine tube ("smit sleeve") not requiring retaining stitches for brachy-radiotherapy for carcinoma of the cervix. Eur J Gynaecol Oncol. 2013; 34(4):289-90 [PubMed] Related Publications
OBJECTIVE: The objective was to improve the design of the indwelling-intrauterine tube (IIUT) for brachy-radiotherapy of cervical cancer or sleeve, specifically one that would not require stitching to retain it properly in the uterus for periods of one to two weeks and to ensure hygiene by making them disposable, thinner, lighter, more economical, as well as more user-friendly for doctor and patient alike, and to satisfy new developments in terms of computed tomography (CT) and magnetic resonance imaging (MRI) compatibility. MATERIALS AND METHODS: Injection moulding of carefully-selected medical grade polymers enabled ten improvements to the original sleeve; some were impossible to achieve with lathe turned items. The most important innovation was the addition of two delicate and very soft "wings" to the sleeves near the tips The sleeves were used in 50 consecutive patients with advanced carcinoma of the cervix. Metal markers could be eliminated by adding barium to the polymers. RESULTS: Not a single sleeve fell out in any of the 50 patients. No complications related to the use of the sleeves were observed. These sleeves are now used exclusively in this clinic. CONCLUSIONS: The improvements were very successful; none fell out and no suturing was required, which made them still more cost-effective and more comfortable to patients.
Dunn S, Rossiter L, Ferne J, et al. Improved adherence to colposcopy through nurse-led telephone counselling and multifaceted patient support. J Obstet Gynaecol Can. 2013; 35(8):723-9 [PubMed] Related Publications
OBJECTIVES: In 2009, an on-site diagnostic colposcopy clinic was established within a large, urban sexual health clinic to enhance follow-up of abnormal cervical cancer screening among vulnerable women, including those who are uninsured. This service model uses a family physician colposcopist and a colposcopy nurse who provides pre-visit counselling, telephone reminders, patient-tailored ongoing support during the diagnostic process, and tracking of missed appointments. This study examined whether this program was associated with improved adherence to the first colposcopy visit after an abnormal Papanicolau smear among a high needs population. METHODS: We conducted a retrospective chart review of women referred for colposcopy between January 2007 and September 2010, and examined non-adherence before (pre-group) and after (post-group) establishment of the on-site program. Univariable and multivariable logistic regression was used to examine patient and clinical factors associated with non-adherence. RESULTS: Six hundred eighty-five women were referred during the study period, with 302 in the pre-group and 383 in the post-group. Non-adherence to the first colposcopy visit fell from 13% to 4% after institution of the on-site service. Pre-group status, cervical screening performed at an abortion-related visit (as opposed to a contraception or cervical screening visit), parity ≥ 1 and younger age were all associated with non-adherence in the multivariable analysis. CONCLUSION: An on-site colposcopy service that incorporated multifaceted, client-tailored support throughout the diagnostic process significantly reduced non-attendance for an initial colposcopy visit in an urban sexual health clinic population. Broader adoption of this model could improve effectiveness of cervical cancer screening programs. However, future research should determine which specific elements of the model are more important in influencing adherence rates.
Moodley I, Tathiah N, Mubaiwa V, Denny L High uptake of Gardasil vaccine among 9 - 12-year-old schoolgirls participating in an HPV vaccination demonstration project in KwaZulu-Natal, South Africa. S Afr Med J. 2013; 103(5):318-21 [PubMed] Related Publications
BACKGROUND: Cervical cancer is linked to infection of the cervix by oncogenic human papillomavirus (HPV) subtypes. The quadrivalent Gardasil vaccine (against HPV types 6, 11, 16, 18), recommended in girls 9 - 12 years of age, has been shown to be safe, immunogenic and efficacious, with minimal or no side-effects. AIM: To demonstrate the capacity of school health teams to carry out vaccinations within a school environment. OBJECTIVES: To assess the uptake of 3 doses of the vaccine, document lessons learnt and provide recommendations for a national rollout of school-based HPV vaccination for learners. METHODS: Female learners (age 9 - 12 years) from 31 primary schools in Nongoma and Ceza districts (KwaZulu-Natal province, South Africa) were identified for inclusion in the vaccination programme. The 3 doses of vaccine were administered by existing school health teams. Education and training sessions were held with all stakeholders: provincial departments of health and education; school health teams; primary healthcare nurses; hospital doctors and nurses; private practitioners; school principals, teachers and governing bodies; parents; and community and traditional leaders. RESULTS: The overall uptake of the vaccine was found to be high: 99.7%, 97.9% and 97.8% for the first, second and third doses respectively (N = 963). No adverse events were attributed to the HPV vaccine. CONCLUSION: This project demonstrated the successful implementation of HPV vaccination among learners (ages 9 - 12 years) using school health teams.
Richter K, Becker P, Horton A, Dreyer G Age-specific prevalence of cervical human papillomavirus infection and cytological abnormalities in women in Gauteng Province, South Africa. S Afr Med J. 2013; 103(5):313-7 [PubMed] Related Publications
BACKGROUND: Women accessing the public health system in Gauteng province, South Africa are largely unscreened for cervical cancer and have a high background prevalence of human immunodeficiency virus (HIV) infection. OBJECTIVES: This cross-sectional study describes the age-specific prevalence of human papillomavirus (HPV) infection and cytological abnormalities among this urban and peri-urban population. METHOD: Over the period March 2009 - September 2011, 1 524 women attending public sector primary healthcare clinics were invited to participate in a cervical cancer screening study. All participants were screened with conventional cytology and HPV testing undertaken using the HPV linear array genotyping kit (Roche Molecular Systems). RESULTS: Of 1 472 women with valid cytology results, abnormalities were detected in 17.3% (n = 255), of which 9.1% (n = 134) were high-grade squamous intraepithelial lesions, and 0.5% (n = 8) suggestive of squamous carcinoma. Of the 1,445 women with complete data, the overall and high-risk HPV DNA prevalences were 74.6% (n = 1 078) and 54.3% (n = 784), respectively. HPV type 16 and/or 18 were detected in 19.5% (n = 282) of women. Age-specific prevalence of HPV showed a plateau-shaped curve. CONCLUSIONS: The prevalences of HPV infection and abnormal cytology were much higher than previously reported in general populations in South Africa and elsewhere. Higher age-specific prevalence and similar plateau-like age-specific epidemiological curves have previously only been described in studies among HIV-positive women. These findings have implications for planning and development of cervical screening programmes in developing countries with largely unscreened populations with a high background prevalence of HIV.
Obeidat B, Matalka I, Mohtaseb A, et al. Prevalence and distribution of high-risk human papillomavirus genotypes in cervical carcinoma, low-grade, and high-grade squamous intraepithelial lesions in Jordanian women. Eur J Gynaecol Oncol. 2013; 34(3):257-60 [PubMed] Related Publications
PURPOSE: To assess high-risk human papillomavirus (HR-HPV) prevalence, and genotype distribution in invasive cervical cancer (CC) and its precursors in Jordanian patients. MATERIALS AND METHODS: A total of 124 different specimens of formalin-fixed, paraffin embedded samples, including 18 low-grade squamous intraepithelial lesions (LSILs), 28 high grade squamous intraepithelial lesions (HSILs), and 78 CCs were included in this study. HPV detection and typing was done using HPV High Risk Typing Real-TM Kit that enables the concomitant detection of the 12 most common HR-HPVs. RESULTS: Overall, HR-HPV prevalence was 87.2%, 78.6%, and 72.2% in CC, HSIL, and LSIL respectively. Genotype 16 was the most predominant in all cervical lesions, detected in 53.8%, 46.4%, and 38.9% of CC, HSIL, and LSIL, respectively. Among all HPV genotypes, HPV-16 and HPV-18 were found separately or together in 50% of LSILs, 60.7% of HSILs, and 76.9% of CC specimens. HPV-31 was the second most common type detected in LSILs (22.2%) and HSILs (21.4%). HPV-45 was the third most common type detected in CC (11.5%). CONCLUSION: The prevalence and genotypes distribution patterns of HR-HPV types among patients with CC and its precursors in Jordan are similar to known international patterns. The results of this study provide baseline information on the HPV type distribution, which may guide the development of CC prevention and control programs in Jordan.
Gilbaz E, Gungor Ugurlucan F, Aslay I, Yalcin O The effects of simple and radical hysterectomy and radiotherapy on lower urinary tract symptoms and urodynamics. Eur J Gynaecol Oncol. 2013; 34(3):248-53 [PubMed] Related Publications
PURPOSE: To evaluate effects of simple/radical hysterectomy, radiotherapy, and their combination on lower urinary tract symptoms (LUTS) and urodynamics. MATERIALS AND METHODS: Four groups were formed as simple hysterectomy; Group 1 (n = 20), Type-II hysterectomy; Group 2 (n = 11), Type-II hysterectomy + radiotherapy; Group 3 (n = 16), radiotherapy; Group 4 (n = 20). LUTS, bladder diary, pad test, Q-tip test, stress-test, urodynamics, bladder-wall-thickness measurement, King's Health Questionnaire (KHQ) performed prior and at six and 18 months after treatment. RESULTS: Pre-treatment prevalence of LUTS was higher in Group 1 and decreased at six and 18 months. LUTS increased in Groups 2, 3, and 4 at six months; some of the symptoms decreased to pre-treatment levels at 18 months. Quality of life improved in Group 1 and worsened in the others. Maximum bladder capacity increased in Group 1 and decreased in Groups 2 and 3. Bladder-wall-thickness, maximum detrusor pressures increased, urine sensation decreased in Groups 2 and 4. Maximum vesical pressure increased and compliance decreased in Groups 2 and 3. CONCLUSION: LUTS may decrease after simple hysterectomy. Radical hysterectomy and radiotherapy result in voiding dysfunction; however some of the symptoms may decrease to pre-treatment levels during follow-up.
Bae HS, Chung YW, Lee JK, et al. Nestin expression as an indicator of cervical cancer initiation. Eur J Gynaecol Oncol. 2013; 34(3):238-42 [PubMed] Related Publications
Nestin is an intermediate filament protein expressed in proliferating cells during embryonic development of the central nervous system (CNS) and considered to be a neuronal stem cell/progenitor cell marker. This study investigated the difference of nestin expression between pre-cancer (carcinoma in situ - CIS) and cancer of cervix in 129 tissues (49 normal cervix, 41 CIS, and 39 invasive cervical cancer) through the use of a paraffin-embedded tissue array. Immunostaining was evaluated by intensity, proportion of stained cells, and pattern of expression. The expression of nestin was positive in 63.4% (26/41) for CIS and 43.6% (17/39) for invasive cervical cancer, but only 26.5% (13/49) for normal tissues (p = 0.002). Strong positive staining/large proportion staining were 53.7% (22/41) / 36.6% (15/41), 15.4% (6/39) / 61.5% (24/39) in the CIS and invasive cervical cancer tissues, respectively (p = 0.043, p < 0.001). The diffuse stain with basal layer was positive in 90.2% (37/41) for CIS, but only 24.5% (12/49) of the samples were positive in normal tissues (p < 0.001). Based on these results, the authors suggest that nestin expression seems to participate in the step of cancer initiation and could potentially be a useful marker in the early detection of cervical cancer.
Capobianco G, Marras V, Wenger JM, et al. P16 immunostaining and HPV testing in histological specimens from the uterine cervix. Eur J Gynaecol Oncol. 2013; 34(3):227-30 [PubMed] Related Publications
BACKGROUND: The cellular tumor suppressor protein pl61NK4a (p16) has been identified as a biomarker for transforming human papilloma virus (HPV) infections. P16 is a cyclin-dependent kinase inhibitor that regulates the cell cycle and cell proliferation by inhibiting cell cycle G1 progression. PURPOSE OF THE STUDY: To confirm the role of p16 as biomarker for transforming HPV infections and possible clinical applications in histological samples from the uterine cervix. MATERIALS AND METHODS: The subject of this study included 56 biopsies of the cervical canal collected from January 2012 to September 2012 in the Institute of Pathology of the University of Sassari. The search for HPV immunohistochemistry was performed with the monoclonal antibody DAKO 1:25, while for the detection of p16 was used CINtecTM p16 (INK4a) histology kit. RESULTS: In 56 biopsies performed in women aged between 23 and 69 years, the authors highlighted, by histological analysis, 24 cases of low-grade squamous intraepithelial lesion (LSIL) - cervical intraepithelial neoplasia (CIN1) and 31 cases of high-grade squamous intraepithelial lesion (HSIL) - CIN2/3); 15 CIN2, 14 CIN3, and two cervical squamous cell carcinoma in situ (SCIS). One case was an infiltrating squamous cell carcinoma (ISC). In 24 CIN1, there was a 16.67% positivity for p16 and an equal percentage occurred for HPV. In 15 cases of CIN2 the percentage of positivity for p16 was considerably increased (73.33%), unlike the search for HPV which had a positivity rate of 20%. Finally, in 14 cases of CIN3, and in three carcinomas, the positivity for p16 was equal to 100%, however the search for HPV positivity was between 0% and 7.14%. CONCLUSIONS: These results demonstrated that p16 was a highly sensitive marker of cervical dysplasia. The authors have shown that p16 overexpression increased with the severity of cytological abnormalities and that had a greater ability to identify the viral infection compared to the classical immunohistochemical staining for HPV.
Koumousidis AD, Sofoudis CI, Paltoglou GA, et al. Bioethical issues on the role of contemporary gynecologists concerning HPV vaccination. Eur J Gynaecol Oncol. 2013; 34(3):218-21 [PubMed] Related Publications
UNLABELLED: Debate is heating up whether or not to require girls to be vaccinated against the human papillomavirus (HPV), a leading cause of cervical cancer (CC). Prolepsis against this plague is mainly focused on early detection with Pap test (screening) and recently with administrating HPV vaccines in youths. OBJECTIVE: To discuss the increased bioethical role of contemporary gynecologist in the young population, with the aim to contribute to the decrease of this malignancy. MATERIALS AND METHODS: The authors searched the web (data-warehouse: articles, forums, etc., and data-mining: sequence analysis and classification) for HPV vaccination and related bioethical issues. RESULTS: HPV vaccines have already caused debates on whether they must be mandatory and on whether they cause a pseudo-safeness mental state, making youths "forget" necessary annual Pap tests or even worse, urging them in promiscuity, resulting in an increased occurrence of CC. CONCLUSIONS: Greece, in order to appropriately apply the Constitutional Law 5 Section 5 (All persons have the right to the protection of their health...), needs to train contemporary gynecologists in adequate youth consultation and proper family approaches regarding HPV vaccination issues. Enhancing the gynecologist's role, vaccination's effectiveness (sensitivity and specificity) will be increased and on the other hand, a rule of social law will be established in the country.
van den Tillaart SA, Srámek A, Wasser MN, Trimbos JB Barrel index of bulky cervical tumours and intrauterine fluid determined by MRI as additional prognostic factors for survival. Eur J Gynaecol Oncol. 2013; 34(3):208-12 [PubMed] Related Publications
OBJECTIVE: to investigate whether morphologic characteristics determined by magnetic resonance imaging (MRI) can discriminate between bulky cervical tumours with a favourable or worse prognosis. MATERIALS AND METHODS: MRI examinations were performed in 24 patients with cervical cancer Stage >or= 1B2. The ratio between tumour width and length (barrel index: BI) and the presence of intrauterine fluid retention were related to survival in a multivariate regression analysis. RESULTS: BI and intracavital fluid were predictors of survival, independent from tumour diameter and other known important factors for survival. A cut-off value of 1.40 for the BI proved to be the best prognostic factor with respect to recurrence and death: the hazard ratios of BI > 1.40 as compared to BI CONCLUSION: The morphologic characteristic BI and the presence or absence of intracavital fluid as determined by MRI might have predictive value for survival in patients with bulky cervical tumours.
Casey GM, Morris B, Burnell M, et al. Celebrities and screening: a measurable impact on high-grade cervical neoplasia diagnosis from the 'Jade Goody effect' in the UK. Br J Cancer. 2013; 109(5):1192-7 [PubMed] Article available free on PMC after 03/09/2014 Related Publications
BACKGROUND: The celebrity Jade Goody's cervical cancer diagnosis was associated with increased UK cervical screening attendance. We wanted to establish if there was an increase in high-grade (HG) cervical neoplasia diagnoses, and if so, what the characteristics of the women with HG disease were. METHODS: We analysed prospective data on 3233 consecutive colposcopy referrals in North East London, UK, from 01 April 2005 to 30 June 2010. Characteristics and outcomes of pre- and post-Goody cohorts were compared. RESULTS: Goody's diagnosis was associated with an increased incidence of colposcopy referrals in all subsequent annual quarters (incidence rate ratio (IRR) 1.3-1.9, P<0.002-P<0.0005) and increased HG disease diagnoses in the fourth quarter 2008/2009 (IRR 1.3, P=0.05) and first quarter 2009/2010 (IRR 1.3, P=0.07). We observed 1.90-fold (CI: 1.06-3.39), 2.06 (CI: 1.13-3.76) and 2.13-fold (CI: 1.07-4.25) respective increases in the odds of HG disease women being screening-naive in the first and second quarter 2009/2010, and the first quarter 2010/2011 (P<0.04, P<0.02 and P<0.04, respectively). There was a 2.23-fold increase in the odds of screening-naive HG disease women being symptomatic post-Goody's diagnosis (P=0.023). The age distributions of the pre- and post-Goody cohorts did not differ in any study group. CONCLUSION: Continued publicity about celebrities' diagnoses might encourage screening in at-risk populations.
Qmichou Z, Khyatti M, Berraho M, et al. Analysis of mutations in the E6 oncogene of human papillomavirus 16 in cervical cancer isolates from Moroccan women. BMC Infect Dis. 2013; 13(1):378 [PubMed] Article available free on PMC after 03/09/2014 Related Publications
BACKGROUND: Worldwide, cervical cancer is the second most common cancer in women. High-risk human papillomavirus (HPV) play a crucial role in the etiology of cervical cancer and the most prevalent genotype is HPV16. HPV 16 intratypic variants have been reported to differ in their prevalence, biological and biochemical properties. The present study was designed to analyze and identify HPV type 16 E6 variants among patients with cervical cancer in Morocco. METHODS: A total of 103 HPV16 positive samples were isolated from 129 cervical cancer cases, and variant status was subsequently determined by DNA sequencing of the E6 gene. RESULTS: Isolates from patients were grouped into the European (E), African (Af) and North-American (NA1) phylogenetic clusters with a high prevalence of E lineage (58.3%). The Af and NA1 variants were detected in 31.1% and 11.6% of the HPV16 positive specimens, respectively, whereas, only 3% of cases were prototype E350T. No European-Asian (EA), Asian (As) or Asian-American (AA) variants were observed in our HPV16-positive specimens. At the amino acid level, the most prevalent non-synonymous variants were L83V (T350G), H78Y (C335T), E113D (A442C), Q14D (C143G/G145T) and R10I (G132T), and were observed respectively in 65%, 41.8%, 38.8%, 30.1% and 23.3% of total samples.Moreover, HPV16 European variants were mostly identified in younger women at early clinical diagnosis stages. Whereas, HPV16 Af variants were most likely associated with cervical cancer development in older women with pronounced aggressiveness. CONCLUSION: This study suggests a predominance of E lineage strains among Moroccan HPV 16 isolates and raises the possibility that HPV16 variants have a preferential role in progression to malignancy and could be associated with the more aggressive nature of cervical cancer.
Foley ME, Ryan H, Kearney E, et al. Apparent improvement in survival for carcinoma of the cervix following the introduction of chemoradiation--a Will Rogers phenomenon. Ir Med J. 2013; 106(3):74-7 [PubMed] Related Publications
The improved survival for bulky cervical cancers (> 4cm) reported with combination platinum based chemoradiation (1999) prompted a move away from surgery as these cases frequently received adjuvant radiotherapy and were exposed to the morbidity of multimodality treatment. The period pre-1999 (Group 1) was compared with post-1999 (Group 2) when chemoradiation was the preferred treatment for bulky operable cervical cancer. Significantly more cases were treated surgically among Group 1 compared with Group 2 (79% vs. 62%; P < 0.001). Switching from surgery to radiotherapy improved survival in both treatment categories (73% vs. 78% and 37% vs. 44%, respectively) but with no improvement in overall survival (70%/ov.s 70%). Survival (86%) was similar in both groups among surgically treated women with tumors < 4 cm, but significantly more in Group 2 with negative nodes received postoperative adjuvant chemoradiotherapy (Groups 1 vs. 2; 16% vs.37.5%: P < 0.001) and overall the surgically treated patients received more not less multimodality treatment (46.5% vs. 59%; P = 0.7).
Leath CA, Bevis KS, Numnum TM, et al. Comparison of operative risks associated with radical hysterectomy in pregnant and nonpregnant women. J Reprod Med. 2013 Jul-Aug; 58(7-8):279-84 [PubMed] Related Publications
OBJECTIVE: To compare the operative data and complications of radical hysterectomy performed on pregnant women versus nonpregnant women. STUDY DESIGN: Following institutional review board approval, we reviewed our surgical databases to identify pregnant women who had undergone a radical hysterectomy for cervical carcinoma from 1992-2005 (n = 7). A nonpregnant control group (n = 35) of women undergoing radical hysterectomy during the study interval were identified and matched for age, year of surgery, and surgeon. Pertinent operative and outcome data were abstracted and compared. RESULTS: Of the 7 women who had undergone a radical hysterectomy during pregnancy, 4 had a cesarean radical hysterectomy at a mean gestational age of 35.4 weeks (range, 32.3-38 weeks) and 3 had a radical hysterectomy with a previable fetus in situ at a mean gestational age of 14.2 weeks. Demographics were similar between groups. Transfusion rates were significantly higher among pregnant women (57%) as compared to nonpregnant controls (9%) (p = 0.0009). The overall incidence of operative complications was similar between the pregnant women (43%) and nonpregnant controls (40%) (p = NS). CONCLUSION: Radical hysterectomy performed in pregnant women was associated with higher blood loss and increased need for transfusion as compared to nonpregnant controls. No differences were observed in regards to other operative surgical complications between the two groups.
Bernard E, Pons-Salort M, Favre M, et al. Comparing human papillomavirus prevalences in women with normal cytology or invasive cervical cancer to rank genotypes according to their oncogenic potential: a meta-analysis of observational studies. BMC Infect Dis. 2013; 13(1):373 [PubMed] Article available free on PMC after 03/09/2014 Related Publications
BACKGROUND: Mucosal human papillomavirus (HPV) infection is a necessary cause of cervical cancer. Vaccine and non-vaccine genotype prevalences may change after vaccine introduction. Therefore, it appears essential to rank HPV genotypes according to their oncogenic potential for invasive cervical cancer, independently of their respective prevalences. METHODS: We performed meta-analyses of published observational studies and estimated pooled odds ratios with random-effects models for 32 HPV genotypes, using HPV-16 as the reference. RESULTS: Twenty-seven studies yielded 9,252 HPV-infected women: 2,902 diagnosed with invasive cervical cancer and 6,350 with normal cytology. Expressed as (odds ratio [95% confidence interval]), HPV-18 (0.63 [0.51, 0.78]) ranked closest to HPV-16, while other genotypes showed continuously decreasing relative oncogenic potentials: HPV-45 (0.35 [0.22, 0.55]), HPV-69 (0.28 [0.09, 0.92]), HPV-58 (0.24 [0.15, 0.38]), HPV-31 (0.22 [0.14, 0.35]), HPV-33 (0.22 [0.12, 0.38]), HPV-34 (0.21 [0.06, 0.80]), HPV-67 (0.21 [0.06, 0.67]), HPV-39 (0.17 [0.09, 0.30]), HPV-59 (0.17 [0.09, 0.31]), HPV-73 (0.16 [0.06, 0.41]), and HPV-52 (0.16 [0.11, 0.23]). CONCLUSIONS: Our results support the markedly higher oncogenic potentials of HPV-16 and -18, followed by HPV-31, -33, -39, -45, -52, -58 and -59, and highlight the need for further investigation of HPV-34, -67, -69 and -73. Overall, these findings could have important implications for the prevention of cervical cancer.
Kraljević Z, Visković K, Ledinsky M, et al. Primary uterine cervical cancer: correlation of preoperative magnetic resonance imaging and clinical staging (FIGO) with histopathology findings. Coll Antropol. 2013; 37(2):561-8 [PubMed] Related Publications
The most commonly used staging system for cervical cancer is based on the International Federation of Gynaecology and Obstetrics (FIGO) staging system. Magnetic resonance imaging (MRI) has been accepted as the optimal tool for evaluation of the main prognostic factors and selection of therapeutic strategy. The purpose of this study was to compare the preoperative clinical examination FIGO staging findings with MRI and postoperative pathology report in females with primary cancer of the cervix. The study prospectively included 46 females consecutively hospitalized at the Department of Gynaecology and Obstetrics at the "Sestre milosrdnice" University Hospital Center in Zagreb. Interviews, clinical examination, transvaginal ultrasound and MRI were performed in all patients. In selected patients the surgical procedure was done and the correlation of clinical findings according to FIGO classifications, MRI and histopathological findings was completed. According to FIGO classification, positive clinical findings for stage IIA were found in 26/46 (55.5%) and stage IIB in 20/46 (44.5%)patients. FIGO MR modified classification confirmed stage IIA in 30/46 (66.6%) and stage IIB in 16/46 (33.4%) patients. Surgery (Wertheim radical hysterectomy with bilateral pelvic and selective para-aortic lymphadenectomy) was performed in 33/46 (71%) patients with clinically, MR, cytologically and pathohistologically confirmed findings of cervical cancer: 26 patients with IIA clinically FIGO stage and 7 with IIB stage. MRI examination proved better than clinical examination in staging of cervical carcinoma with 90.9% versus 79.0% accuracy rate. We suggest the application of the following MR protocol in all clinically staged FIGO IIA and IIB patients: T1W, T2WI and postcontrast dynamic T1WI after 3 and 60 seconds and after 5 minutes, performed on 1.5T MR machine.
Apgar BS, Kaufman AJ, Bettcher C, Parker-Featherstone E Gynecologic procedures: colposcopy, treatments for cervical intraepithelial neoplasia and endometrial assessment. Am Fam Physician. 2013; 87(12):836-43 [PubMed] Related Publications
Women who have abnormal Papanicolaou test results may undergo colposcopy to determine the biopsy site for histologic evaluation. Traditional grading systems do not accurately assess lesion severity because colposcopic impression alone is unreliable for diagnosis. The likelihood of finding cervical intraepithelial neoplasia grade 2 or higher increases when two or more cervical biopsies are performed. Excisional and ablative methods have similar treatment outcomes for the eradication of cervical intraepithelial neoplasia. However, diagnostic excisional methods, including loop electrosurgical excision procedure and cold knife conization, are associated with an increased risk of adverse obstetric outcomes, such as preterm labor and low birth weight. Methods of endometrial assessment have a high sensitivity for detecting endometrial carcinoma and benign causes of uterine bleeding without unnecessary procedures. Endometrial biopsy can reliably detect carcinoma involving a large portion of the endometrium, but is suboptimal for diagnosing focal lesions. A 3- to 4-mm cutoff for endometrial thickness on transvaginal ultrasonography yields the highest sensitivity to exclude endometrial carcinoma in postmenopausal women. Saline infusion sonohysteroscopy can differentiate globally thickened endometrium amenable to endometrial biopsy from focal abnormalities best assessed by hysteroscopy. Hysteroscopy with directed biopsy is the most sensitive and specific method of diagnosing endometrial carcinoma, other than hysterectomy.
Ports KA, Reddy DM, Rameshbabu A Barriers and facilitators to HPV vaccination: perspectives from Malawian women. Women Health. 2013; 53(6):630-45 [PubMed] Related Publications
The aim of this research was to elucidate potential barriers and facilitators to human papillomavirus (HPV) vaccination in Malawi, a sub-Saharan country. In Malawi, approximately 31 out of every 100,000 women develop cervical cancer annually, and 80% of those affected die from this malignancy. HPV vaccination may provide a feasible strategy for cervical cancer prevention in Malawi. However, important questions and concerns regarding cervical cancer and HPV vaccination acceptance among individuals and their communities must be considered prior to vaccine delivery. Qualitative interviews were conducted with 30 Malawian mothers aged 18-49 years from Chiradzulu District. Women's knowledge and beliefs about HPV, cervical cancer, and vaccination, and their social-ecological contexts were explored in-depth. Thematic analyses revealed that despite women's limited knowledge, cervical cancer was perceived to be a serious disease. Participants believed that as women, they were responsible for their children's health. Women unanimously reported that they would vaccinate their children against HPV, especially if a health professional recommended it. Malawi's health care infrastructure could present challenges to HPV vaccine programs; however, participants did not typically report this to be a barrier to vaccination. These data shed light on factors that may influence HPV vaccination acceptance and uptake in Malawi.
Schoenberg NE, Studts CR, Hatcher-Keller J, et al. Patterns and determinants of breast and cervical cancer non-screening among Appalachian women. Women Health. 2013; 53(6):552-71 [PubMed] Article available free on PMC after 01/01/2014 Related Publications
Breast and cervical cancer account for nearly one-third of new cancer cases and one-sixth of cancer deaths. Cancer, the second leading cause of all deaths in the United States, will claim the lives of nearly 800,000 women this year, which is particularly unfortunate because effective modes of early detection could significantly reduce mortality from breast and cervical cancer. Researchers examined patterns of non-screening among Appalachian women. In-person interviews were conducted with 222 Appalachian women who fell outside of screening recommendations for timing of Pap tests and mammograms. These women, from six Appalachian counties, were participating in a group-randomized, multi-component trial aimed at increasing adherence to cancer screening recommendations. Results indicated that participants who were rarely or never screened for breast cancer were also likely to be rarely or never screened for cervical cancer. In addition, four key barriers were identified as independently and significantly associated with being rarely or never screened for both cervical and breast cancer. An improved understanding of cancer screening patterns plus the barriers underlying lack of screening may move researchers closer to developing effective interventions that facilitate women's use of screening.
Dasgupta S, Aich RK, Deb AR, Gupta P Adenoma malignum of the uterine cervix--an enigma. J Indian Med Assoc. 2012; 110(12):929-30 [PubMed] Related Publications
Adenoma malignum is a rare variant of cervical adenocarcinoma which presents a great diagnostic and therapeutic challenge to an oncologist. A 31-year-old woman presented with a mass filling up whole of the vagina which showed no evidence of malignancy by scraping cytology or punch biopsy. But histological examination of the resected mass turned up to be adenoma malignum of the cervix. The patient was subsequently treated by Wertheim's hysterectomy and radiotherapy.
Bzhalava D, Guan P, Franceschi S, et al. A systematic review of the prevalence of mucosal and cutaneous human papillomavirus types. Virology. 2013; 445(1-2):224-31 [PubMed] Related Publications
Systematic reviews of the prevalence of different types of Human Papillomavirus (HPV) across a broad range of disease grades from normal to cancer are essential to gain basic knowledge of how widespread infections with the different HPV types are, and to provide information on the possible carcinogenicity of different HPV types. For HPV types that infect human mucosa, of which 12 are established causes of cervical cancer, we present the results of a systematic review and meta-analysis of 47 HPV types in cervical samples across the entire range of cervical diagnoses from normal to cervical cancer, restricted to studies using a number of well characterized PCR assays. For the cutaneous HPV types, which have been linked to the development of squamous cell carcinoma of the skin, their presence has been measured in a variety of different sample types and by assays with variable performance. Therefore, we restricted a systematic review of their prevalence to studies that assayed for cutaneous HPV infection in a case-control format.
Jiang H, Qu L, Liu X, et al. A comparison of laparoscopic and abdominal radical parametrectomy for cervical or vaginal apex carcinoma and stage II endometrial cancer after hysterectomy. JSLS. 2013 Apr-Jun; 17(2):249-62 [PubMed] Article available free on PMC after 01/01/2014 Related Publications
BACKGROUND AND OBJECTIVE: Radical parametrectomy (RP), performed either abdominally (ARP) or laparoscopically (LRP), is a viable alternative to radiotherapy in treating invasive cervical cancer, vaginal apex cancer, and endometrial cancer that is more advanced than initially suspected after hysterectomy. We carried out a comparative study on intra- and postoperative parameters between the two performed by similarly experienced surgeons. METHODS: Forty consecutive patients indicative for RP were reviewed: 22 and 18 underwent ARP and LRP, respectively. Information was collected on demographics, indications for initial and this surgery, tumor characteristics, intra- and postoperative parameters, and complications. The lengths of resected parametrial and vaginal tissues were measured. RESULTS: Compared with ARP, LRP resulted in shorter operative time (200 vs 239 min), less blood loss (627.8 vs 929.5 mL), shorter hospital stay (16.8 vs 19.9 days), and removal of more pelvic lymph nodes (27.4 ± 5.9 vs 23.1 ± 7.1). Although it was not attempted in ARP to remove lymph nodes in the deep obturator space, it was attempted in LRP and one positive node was found. In the ARP cohort there was one case of injury to the small intestine during surgery, whereas in LRP there was one instance of lower urologic fistula after surgery. CONCLUSION: LRP is superior to ARP in terms of shorter operative time, less blood loss, and shorter hospital stay while still maintaining the completeness of the procedure. It can be safely performed in the hands of experienced surgeons for cervical or vaginal apex carcinoma and stage II endometrial cancer after hysterectomy.