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PubMed1997

Carotid resection and reconstruction for advanced cervical cancer.

Patients with advanced cervical cancers often have direct invasion of their carotid arteries. The prognosis for these patients with nonsurgical therapy is extremely poor. Because complete tumor removal is the only therapy that can offer these patients a chance for cure, carotid resection should be performed. We performed carotid resection and reconstruction on nine patients with advanced cervical cancers. Of these patients, none suffered from severe neurologic postoperative complications such as permanent hemiplegia. Three of the nine patients have been disease free for more than 24 months. These three patients would not have survived without carotid resection. Further study will show the usefulness of carotid resection and reconstruction in decreasing the morbidity and mortality in patients with cervical cancer involving the carotid artery.

Adult↗
PubMedDate not supplied

Hormonal implication of diet and reproductive activity in the genesis of cervical cancer.

The incidence of cervical cancer is known to decrease with the Westernization of life style. The purpose of this study was to see whether or not the practice of pseudopregnancy conditioning (psp-c) and/or non-Western (rice-rich or rice-and salt-rich) diet conditioning (dt-c) in female mice can reproduce a specific steroidal disorder that is associated with cervical cancer--general depression of androgen and partial depression of corticoid in urine. The effects of psp-c and dt-c were assessed by estimating various steroids in urine and plasma of mice, as collected at the terminal stage of the experiment. Macroscopic and microscopic changes of genital organs were also investigated by dissection. Results obtained are as follows: 1) the practice of psp-c and/or dt-c induced a total of 13 deciduomas in the vagina, the cervix and the corpus of experimental mice. No deciduoma was found in virgin mice fed a standard (Western-style) diet. 2) The combination of 2 reproductive markers (psp-c and non-psp-c) and 3 dietary markers (standard diet, rice-rich diet and rice- and salt-rich diet) produced a variety of changes in the excretions of all androgens, progestins and corticoids in the urine of mice for each of 5 experimental groups. A common steroidal trait was extracted from the urinary steroid data of 5 experimental groups--general depression of androgens, progestins and majority corticoids relative to tetrahydrocortisol. By the collation test, the combination of psp-c and rice- and salt-rich diet conditioning was found to be the best choice for reproducing the urinary steroid changes specific for cervical cancer. 3) The results of plasma steroid analysis, though not incompatible with the urinary steroid data, were fragmentary and not very informative in this study. The observed resistance of mice to carcinogenic insults together with the possible role of deciduoma in cervical carcinogenesis is discussed in the light of relevant information including the anti-carcinogenic action of vitamin C.

Animals↗
PubMed1985

Second cancers following radiation treatment for cervical cancer. An international collaboration among cancer registries.

The numbers of second cancers among 182,040 women treated for cervical cancer that were reported to 15 cancer registries in 8 countries were compared to the numbers expected had the same risk prevailed as in the general population. A small 9% excess of second cancers (5,146 observed vs. 4,736 expected) occurred 1 or more years after treatment. Large radiation doses experienced by 82,616 women did not dramatically alter their risk of developing a second cancer; at most, about 162 of 3,324 second cancers (approximately equal to 5%) could be attributed to radiation. The relative risk (RR = 1.1) for developing cancer in organs close to the cervix that had received high radiation exposures--most notably, the bladder, rectum, uterine corpus, ovary, small intestine, bone, and connective tissue--and for developing multiple myeloma increased with time since treatment. No similar increase was seen for 99,424 women not treated with radiation. Only a slight excess of acute and non-lymphocytic leukemia was found among irradiated women (RR = 1.3), and substantially fewer cases were observed than expected on the basis of current radiation risk estimates. The small risk of leukemia may be associated with low doses of radiation absorbed by the bone marrow outside the pelvis, inasmuch as the marrow in the pelvis may have been destroyed or rendered inactive by very large radiotherapy exposures. There was little evidence of a radiation effect for cancers of the stomach, colon, liver, and gallbladder, for melanoma and other skin cancers, or for chronic lymphocytic leukemia despite substantial exposures. An excess of thyroid cancer possibly was related to the low dose received by this organ. Ovarian damage caused by radiation may have been responsible for a low breast cancer risk (RR = 0.7), which was evident even among postmenopausal women. A substantial excess of lung cancer (RR = 3.7) largely may be due to misclassification of metastases and the confounding influence of cigarette smoking. Women who were under 30 or over 50 years of age when irradiated were at greatest absolute risk for developing a second cancer. The RR, however, was higher among those under age 30 years at exposure (RR = 3.9) than among older women. The expression period for radiation-induced solid tumors appeared to continue to the end of life.

Abdominal Neoplasms↗
PubMed1985

Surgery as diagnostic and therapeutic moment in the management of cervical cancer.

Therapeutical program in cervical cancer usually include surgical or radiotherapeutical interventions or a combination of the two, variously integrated with techniques and sequences of application. Treatment planning and evaluation of results are normally based on the classification into clinical stages codified by the FIGO. But this classification, though providing useful prognostic standards of judgement, has proved to be inadequate to identify specific therapeutical guidance. Within a single clinical stage different risk factors have been identified which influence prognosis thus determining the therapeutical treatment more than staging itself. Furthermore clinical staging has failed to predict the surgical stage correctly in a significant number of cases. The index of correction after surgical staging shows discrepancy in about 1/3 of cases. In these cases a therapeutical program based on clinical examination exclusively may prove to be inadequate. The results reported by Authors warrant a rational resort to operative staging in cervical cancer in order to establish the real topography of the original focus more correctly. This indication is further strengthened by the need to identify lymphatic involvement, notably of para-aortic nodes, in locally advanced cases since such an occurrence bears a significant influence on the patient's prognosis and possibility of treatment. On the bases of these considerations the Authors suggest surgery as primary treatment in the management of cervical cancer.

Adult↗
PubMed1999

Has the use of pap smears reduced the risk of invasive cervical cancer in Guadalajara, Mexico?

In Mexico, cervical cancer is the leading cause of death due to cancer among women 35 years of age and older. Although cytologic screening for cervical cancer was introduced as a national program 24 years ago, the mortality rate for this disease has been increasing. A case-control study was undertaken. Cases were women younger than 70, with newly diagnosed invasive cervical cancer (ICC), who had been residing for at least the past year in the metropolitan area of Guadalajara. They were selected from 5 hospitals belonging to the Mexican National Health System. Controls were women without cervical cancer who were treated in the same health center as the corresponding case. Analysis included 143 cases and 311 controls. Information on risk factors for cervical cancer and prior cervical cytologic screening was obtained through a standardized personal interview. Overall, 54% of the cases reported having had a cervical cytology compared with 82% of controls. When compared with unscreened women, those who had ever had a Pap smear had a significantly lower risk of cervical cancer (OR = 0.3, 95% CI 0.2-0.4), and the protective effect persisted for over 5 years. Utilization of Pap smears in the metropolitan area of Guadalajara exerted a protective effect on ICC. Of the 65 women who reported a negative history of Pap smears, 45 would not have contracted cancer if they had ever had a Pap smear.

Adult↗
PubMed1998

Immunohistochemical prediction of radiation response and local control in radiation therapy for cervical cancer.

Prognosis of 64 cervical cancer patients treated with radiation therapy was analyzed by tumor expressions of c-erbB-2 oncoprotein (CerbB-OPE) and p53 protein (p53-PE), Ki-67 growth fraction (Ki-GF), and the mitotic index of proliferating cell population (pMI). Positivity of CerbB-OPE and p53-PE was 42.4% and 84.6%, respectively. Mean Ki-GF and pMI were 33.0% and 2.7%, respectively. Mean Ki-GF for CerbB-OPE was 38.3%, significantly higher than the 26.2% for the negative patients (p < 0.01). The mean pMI for CerbB-OPE was 2.00%, significantly lower than the 3.70% of the negative patients (p < 0.05). The 5-year survival rate of CerbB-OPE-positive patients was 44.4%, significantly lower than the 74.8% of negative patients (p < 0.01). The survival rates of Ki-GF < 33% was 44.7%, significantly lower than the 87.5% of Ki-GF > or = 33% (p < 0.01). The survival rates of pMI > or = 3.5% was 0%, significantly lower than the 81.8% of pMI < 3.5% (p < 0.001). The survival rates of p53-PE-positive and negative patients were 52.8% and 85.0%, respectively (p > 0.1). The poor prognosis of the cervical cancer with CerbB-OPE, lower Ki-GF, and higher pMI were due to local recurrence following radiation therapy. Multiple regression analysis indicated that pMI was the strongest prognostic factor and was followed by CerbB-OPE, tumor volume, and Ki-GF. In conclusion, the c-erbB-2 oncoprotein expression, Ki-67 growth fraction, and the mitotic index of proliferating cell population were considered to be effective prognostic factors in radiation therapy for cervical cancer.

Biomarkers, Tumor↗
PubMed2007

Cervical cancer screening in India: strategies revisited.

With the change in the life styles and demographic profiles of developing countries, noncommunicable diseases are emerging to be important health problems that demand appropriate control program before they assume epidemic proportion. One of these is the problem of cancer. In India, cervical cancer is a significant problem in terms of incidence, mortality and morbidity. Cervical cancer is a disease that can be prevented through both primary prevention and early detection using screening techniques. Several screening modalities are now available for early detection of cervical cancer and its precursor lesions. They all differ with regard to their test characteristics, feasibility and economic considerations. This communication reviews different aspects of these screening modalities and provides different options considering mass application.

Developing Countries↗
PubMed1984

Cervical cancer in the Republic of Panama.

Cervical cancer is more common in Latin America than elsewhere in the world. Previous work indicated that Panama also had a high incidence of cervical cancer and that the disease clustered in rural Herrera Province; to document this and collect detailed information on risk factors, the authors established a population-based Cervical Cancer Registry in Panama. Cervical cancer cases diagnosed between 1974 and 1979 were identified by visiting every major hospital in the country. The registry abstracted epidemiologic, clinical, and other information from patients' hospital charts. It recorded an age-adjusted invasive cervical cancer incidence of 28.4/100,000 between 1974 and 1979; rural Herrera Province supported the highest rate (79.1/100,000), while urban Panama Province had a low rate (24.6/100,000); in situ disease followed a similar pattern (48.7/100,000 in Herrera Province and 17.6/100,000 in Panama Province). Women born in Herrera Province retained high cervical cancer rates irrespective of residence at diagnosis (64.7/100,000), while women from Panama Province had low rates (12.4/100,000) which were comparable to those seen in US whites. In addition to having high cancer rates, women from Herrera Province developed invasive disease at an unusually young age; women between 35 and 39 years of age had an incidence of 151/100,000.

Adolescent↗
PubMed1986

Comparison of risk factors for cervical cancer in different populations.

The incidence of cervical cancer has been found to vary between populations. Risk factors of cervical cancer include early age at first marriage, multiple marriages and antibodies to herpes simplex virus type 2 (HSV-2). The interrelatedness of these risk factors was examined by comparing data collected from 428 cancer cases and 947 control women selected from 6 populations having standardized cervical cancer incidence rates varying from 9.3 to 85.1 per 100,000. Logistic regression analysis revealed that multiple marriages, early age at first marriage or pregnancy and HSV-2 antibodies were all associated with significant risk when all 3 factors were entered into the model. Cervical cancer incidence rates were best predicted by the occurrence of HSV-2 antibodies among control women. To further assess the relation between cervical cancer rates and HSV-2 antibody, 2,306 additional sera representing an 0.8% random sample of females over 9 years of age residing in the Republic of Panama were assayed for antibodies to the virus, and the occurrence of antibodies was correlated with invasive cervical cancer rates specific to each Province. Data from both the random sample and the other study populations yielded a linear relation between the occurrence of HSV-2 antibodies and the incidence of cervical cancer. An exception was found for women living in Herrera Province, Republic of Panama, who had a higher cancer rate than predicted by HSV-2 antibody occurrence. The data suggested that infection with HSV-2 is a co-variable of venereal factors, although a role for the virus in the genesis of a certain proportion of cervical cancers is not excluded.

Adult↗
PubMed2000

AAC-11 overexpression induces invasion and protects cervical cancer cells from apoptosis.

To identify the genes involved in cervical carcinogenesis, we applied the mRNA differential display (DD) method to analyze normal cervical tissue, cervical cancer, metastatic lymph node, and cervical cancer cell line. We cloned a 491-bp cDNA fragment, CC231, which was present in metastatic tissue and cervical cancer cell line, but absent in normal cervical and cervical cancer tissues. The 491 bp cDNA fragment has 98% homology to the previously published sequence, AAC-11 (antiapoptosis clone 11). The levels of AAC-11 mRNA expressions in nine normal cervical and nine primary cervical cancer tissues were low. Its expression was higher in three metastatic tissues and five cervical cancer cell lines (HeLa, CaSki, SiHa, CUMC-3, and CUMC-6). Invasion of matrigel and adhesion to laminin by AAC-11 transfected CUMC-6 cells were increased by approximately 2-fold and 4-fold, respectively. Northern blot analysis showed that matrix metalloproteinase (MMP)-2 and membrane type 1 MMP (MT1-MMP) genes were found to be expressed in high levels in AAC-11-transfected cancer cells. But MMP-2 and MT1-MMP were not expressed in cells transfected with vector alone or wild-type cells. AAC-11-transfected cells expressed an elevated level of MMP-2 protein as assessed by immunoblotting. On the contrary, tissue inhibitor of MMP (TIMP-2) expression was detectable in cells transfected with vector alone or wild-type cells, respectively. Its expression was undetectable in AAC-11 transfected cells. In cervical cancer cells transfected with AAC-11, the expression of beta-catenin was up-regulated. These suggest that overexpressions of MMP-2 and MT1-MMP, loss of TIMP-2 expression, and up-regulation of beta-catenin by AAC-11 transfection may contribute to the development of cervical cancer invasion. AAC-11 gene transfection increased cervical cancer cell colonization. The effect of AAC-11 on cultured cervical cancer cells was associated with antiapoptotic process. Approximately 50% of the AAC-11 transfected cells in serum-free medium died after 2 weeks, compared to 1 week for vector alone or wild-type cells. These results suggest that AAC-11 may serve as a candidate metastasis-related and apoptosis-inhibiting gene in human cervical cancer.

Apoptosis↗
PubMed2006

Enhanced antiproliferative effects of alkoxyalkyl esters of cidofovir in human cervical cancer cells in vitro.

Nearly all cervical cancers are associated with the high-risk subtypes of human papillomavirus (HPV) expressing the E6 and E7 oncoproteins. The E6 and E7 oncoproteins reduce cellular levels of the p53 and the retinoblastoma (pRb) tumor suppressors, respectively, and represent an important component of the malignant phenotype. Several groups have shown that treatment with cidofovir suppresses levels of E6 and E7, restoring cellular p53 and pRb levels, in turn slowing cell replication and increasing the susceptibility of the cancer cells to radiation and apoptosis. Recently, our group synthesized alkoxyalkyl esters of cidofovir, which were found to be >100 times more active than unmodified cidofovir in vitro against various double-stranded DNA viruses, including cytomegalovirus, herpes simplex virus, adenoviruses, cowpox, vaccinia, and variola viruses. We compared the activity of octadecyloxyethyl-cidofovir (ODE-CDV) and oleyloxyethyl-cidofovir (OLE-CDV) with that of unmodified cidofovir against both HPV-negative and HPV-positive cervical cancer cells. We compared the antiproliferation activity in CaSki, HeLa, and Me-180 cells, prototypical HPV-positive cell lines bearing the HPV-16, HPV-18, and HPV-68 high-risk subtypes, with the activity in C33A cells, a cervical cancer cell line lacking HPV, and in nonmalignant primary human foreskin fibroblast cells. OLE-CDV and ODE-CDV were several logs more potent than cidofovir in CaSki, Me-180, HeLa, and C33A cervical cancer cells as determined by 2,3-bis[2-methoxy-4-nitro-5-sulfophenyl]-2H-tetrazolium-5-carboxanilide inner salt proliferation assay. Cell cycle analysis indicates that the cidofovir analogues interfere with passage of dividing cells through the S phase. ODE-CDV and OLE-CDV were 500 to 17,000 times more active than cidofovir in inhibiting the growth of cervical cancer cells. ODE-CDV and OLE-CDV showed selectivity for cervical cancer cells versus nonmalignant human foreskin fibroblast cells and warrant further investigation as potential therapies for cervical cancer.

Antineoplastic Agents↗
PubMed2005

Coming to terms with Vietnam: the Viet/American Cervical Cancer Prevention Project.

The Viet/American Cervical Cancer Prevention Project embraces a dual mission. We seek to develop sustainable, cost-effective cervical cancer prevention services for women in Vietnam. Because the problem of cervical cancer in Vietnam is in part a legacy of the Second Indochinese War, we also seek to examine obstacles to reconciliation by presenting what most acknowledge to be a remedy in advance of what some will perceive to be an accusation. Certain research and commercial interests have produced obstacles to our dual mission in Vietnam. The Alliance for Cervical Cancer Prevention, supported by the Bill and Melinda Gates Foundation, has failed to endorse Pap screening for developing countries and is conducting clinical trials which may further disaffect medically underserved groups. Visual screening techniques combined with immediate ablative treatment methods are incompatible with the requirements of "first do no harm." Because the Pap smear will probably be a component of any future human papillomavirus (HPV)-based or visual- based screening programs, it serves the interests of those promoting noncytologic screening methods to also support the development of Pap screening services. Research on HPV screening in developing countries raises concerns of commercial exploitation. Because Pap screening is feasible wherever cervical screening is appropriate, it is inappropriate to delay the development of Pap screening services pending research into HPV vaccines or alternative screening technologies. Quality management is the point at which public health and diagnostic pathology intersect and will remain an indispensable element of cervical screening programs irrespective of the screening test(s) eventually used. Pap screening in developing countries is an ethical imperative without a substantial political constituency and will benefit from the engagement of organized cytology.

Female↗
PubMed1998

The viral origin of cervical cancer in Rabat, Morocco.

In Northern Africa, cervical cancer is the second most common cancer among women. The diagnosis is usually made in advanced stages, and mortality is high, yet few studies have investigated the role of human papillomavirus (HPV) and other risk factors in the etiology of cervical cancer. A hospital-based case-control study was completed at the Institut National d'Oncologie (INO) in Rabat, Morocco. The study included 214 cases of invasive cervical cancer and 203 controls. A structured questionnaire was used to investigate known and suspected risk factors for cervical cancer. A GP 5+/6+ polymerase chain reaction system was used to detect the presence of HPV DNA and HPV type distribution. Probes for 30 HPV types were used in one research laboratory. HPV DNA was the central risk factor and accounted for the large majority of the cases. The adjusted odds ratio (ORa) for any HPV was 61.6 (95% CI, 29.2-130) and the corresponding HPV attributable fraction (AF) was 92%. Among cases of cervical cancer, HPV 16 was the most common type (67.7%) followed by HPV 18. The HPV type-specific prevalence was similar for squamous cell carcinomas and adenocarcinomas. In multivariate adjusted or HPV-stratified analyses, in addition to the strong effect of HPV, other risk factors identified were sexual intercourse with multiple partners before the age of 20 and low socio-economic status. Use of oral contraceptives for 5 or more years and high parity were also found to be related to cervical cancer. Screening was rare in this population but offered substantial protection against cervical cancer. In Morocco, cervical cancer is a late sequel of a viral infection with certain HPV types. Developing screening programs for preneoplastic cervical lesions is a public health priority. When available, HPV vaccination would offer a relevant alternative for preventing cervical cancer.

Adenocarcinoma↗
PubMed1997

c-fos overexpression is associated with the pathoneogenesis of invasive cervical cancer.

The molecular genetics of human cervical cancer remains to be defined to a significant extent. The current study examined the prevalence and significance of proto-oncogene c-fos overexpression in cervical cancer. Immunohistochemical staining of c-fos oncoprotein was performed in 27 invasive cervical carcinomas and 30 cervical intraepithelial neoplasias (CINs) managed in our department. Eight normal cervical specimens were used as controls. In the patients with invasive cervical cancer, 8 were stage I, 12 were stage II, and 7 had stage III-IV disease. Three of the cancers were well differentiated, 18 were moderately differentiated and 6 were poorly differentiated. Twenty invasive cervical carcinomas (59%) and 3 CIN (10%) showed overexpression of c-fos. The difference is statistically significant (p < 0.001). No statistically significant relationship was found between c-fos overexpression and clinical stage, histological grade, or survival in invasive cervical cancer. In this population, c-fos overexpression appears to be common in invasive cervical cancer and correlated with the ability of the tumor to become invasive, but is not associated with the progression of cervical cancer.

Female↗
PubMedDate not supplied

Development of a community cancer education program: the Forsyth County, NC cervical cancer prevention project.

The authors outline the development and implementation of a public health education program for cervical cancer screening among black women in Forsyth County, NC. The educational program includes distributing electronic and printed information media messages, a program of direct education for women, and providing information on current issues in cervical screening to primary-care physicians. Program development was based on social marketing principles, the PRECEDE model, and the communication-behavior change (CBC) model. Since a true experimental design was not feasible, program evaluation is based on several complementary quasi-experimental designs. Analysis of baseline data indicate that the county where the intervention is taking place, and the control county, are similar with respect to both demographic characteristics and the current level of screening activity. Preliminary results indicate that the program has been successful in raising women's level of awareness of cervical cancer and cervical screening.

Adult↗
PubMed1985

Bladder cancer after pelvic irradiation for cervical cancer.

Pelvic irradiation for gynecologic malignancy is associated with several late neoplastic and nonneoplastic complications in the irradiated field; however, this association has been infrequently recognized in primary care literature. We present two cases of bladder cancer that developed 16 and 19 years, respectively, after pelvic irradiation for cervical cancer. The frequent occurrence in older women of cystitis, hematuria, and nonspecific bowel and bladder symptoms of a benign origin obscures identification of late neoplastic complications after pelvic irradiation. Based on experimental and epidemiologic evidence, we believe cost-effective screening methods should be investigated to allow earlier detection of neoplasms; and, in the interim, a high index of suspicion for bladder cancer is warranted in this growing population of high-risk patients.

Adult↗
PubMed1987

[An immunohistochemical study with monoclonal antibodies on lymphocytes infiltrating in cervical cancer].

We investigated lymphocytes infiltrating cervical cancer by an immunohistochemical method. Frozen sections (20 with frank invasive cancer, 4 with MIC, 5 with CIS, 6 with dysplasia, 3 normal) were stained by the ABC (avidin-biotin-peroxidase complex) method using monoclonal antibodies to identify functional subsets of lymphocytes. The monoclonal antibodies used were anti Leu 1 (T cell), anti Leu 2a (cytotoxic/suppressor T cell), anti Leu 3a (helper/inducer T cell), anti Leu 10 (B cell) and anti Leu 7 (NK cell). The results were as follows: Many lymphocytes infiltrated and surrounded the cancer nests, and there, T cells predominated over B cells. The intensity of infiltration of T cells was not correlated with the grade and prognosis of cervical cancer. The ratio of Leu 2a+ cells to Leu 3a+ cells tended to change with the advance of cancer. Leu 2a+ cells were relatively predominant in early cases and cases with a good prognosis. There were very few B cells close to cancer nests, and they were not correlated with the grade and prognosis of cervical cancer. NK cells were identified in many cases, but they were scattered and were not correlated with grade and prognosis of cervical cancer.

Antibodies, Monoclonal↗
PubMed1996

Risk factors for invasive cervical cancer in Latino women.

Most invasive cervical cancer research in the United States has been conducted on non-Latino-White (NLW) and African-American women. Incidence, mortality, stage at diagnosis and survival indicators for invasive cervical cancer in Latino women in California are compared to NLW and African-American women. A model is presented which depicts structural, behavioral, genetic and biological risk factors for invasive cervical cancer. A literature review of risk factors and their association with invasive cervical cancer was conducted using MEDLINE and PsychINFO databases to determine if ethnic differences in risk factors explain observed differences in morbidity and mortality. Latino women experience a significantly higher incidence and mortality associated with invasive cervical cancer than NLW women. The review of risk factors found that rate differences of cervical cancer screening, early detection and human papilloma virus (HPV) type-specific infection explain much of the disparity in disease burden. Further research must clarify if ethnic differences exist in risk factors associated with ethnic variation in HPV-type prevalence in both cases and their sexual partners, in host immune responses, and multiparity.

Black or African American↗