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PubMed1990

Cervical cancer: aetiology, earlier diagnosis and treatment.

Cervical cancer which is one of the commonest genital malignancies in women worldwide including Singapore is reviewed. There is a decreased incidence and mortality rate from cervical cancer with well organised population-based screening programmes using cervical smears. Strong evidence exists for a sexually transmitted etiologic agent in cervical cancer. The evidence of an association between Herpes Simplex Virus Type 2 (HSV-2) and certain Human Papillomavirus (HPV) infections especially HPV 16 and HPV 18 in the etiology of cervical cancer is reviewed. Diagnosis of asymptomatic clinically occult lesions is by cervical cone biopsy following colposcopic evaluation of those with abnormal smears. The diagnosis of clinically invasive lesions is made by careful evaluation of the cervix and confirmed by biopsy. Treatment of occult and early clinically lesions is ideally by a spectrum of surgical procedures which are carefully tailored to the extent of the lesion but of advanced cancers mainly with radiation therapy with adjuvant surgery and/or chemotherapy in selected cases. Best results for cervical cancer treatment are obtained when treatment facilities are centralised and treatment performed by experienced individuals who individualise therapy or integrate the use of all therapeutic modalities of surgery, radiation and chemotherapy.

Female↗
PubMed1993

The impact of symptoms and comorbidity on prognosis in stage IB cervical cancer.

OBJECTIVE: Like other gynecologic malignancies, cervical cancer is classified by the anatomic location and extent of the tumor. Because clinical variables such as patients' symptoms, symptom severity, and comorbidity may indicate a cancer's biologic virulence and the host-tumor interaction, this study was performed to test the hypothesis that clinical variables will also affect survival of patients with stage IB cervical cancer. STUDY DESIGN: From medical records of 251 cases of invasive cervical cancer treated at Yale-New Haven Hospital between 1984 and 1988, information was extracted for patients' demographic characteristics, symptoms, symptom severity, comorbidity, physical findings, laboratory data, treatment, and subsequent course. RESULTS: In the 122 available cases of stage IB cervical cancer the overall 3-year survival rate was 79%. For a composite clinical predictive system on the basis of symptom status and comorbidity, the 3-year survival rates were as follows: symptomatic patients with comorbidity 58% (seven of 12), either symptomatic or comorbid but not both 77% (46/60), and asymptomatic patients without comorbidity 86% (43/50) (p = 0.02 for linear trend chi 2). When entered into a Cox proportional-hazard model along with other variables that might have an impact on prognosis, the composite symptom-comorbidity stage was the only variable that remained statistically significant. CONCLUSION: These findings demonstrate the importance of clinical variables in estimating prognosis in stage IB cervical cancer. Unless these variables are suitably analyzed, prognostic estimates based only on morphologic studies will be imprecise and therapeutic evaluations may be misleading.

Adenocarcinoma↗
PubMedDate not supplied

Factors influencing the return rate in a direct mail campaign to inform minority women about prevention of cervical cancer.

The Forsyth County Cervical Cancer Prevention Project was a 5-year community-based health education program funded by the National Cancer Institute. The program was developed to reduce cervical cancer mortality among black women in Forsyth County, and it was targeted to those ages 18 and older. The program tried to educate the target population through a combination of mass media and direct education. This paper reports on an experiment conducted to investigate sources of influence on the effectiveness of direct mail, a technique used to augment mass media health education. Direct mail has shown promise as a method for reaching target populations that are difficult to reach with other mass media approaches. Using commercially prepared mailing lists sorted by zip code and other characteristics of the resident, health-related materials can be targeted to persons at their homes. A randomized experiment involving 1,000 households was carried out to estimate the influence of type of postage and address (name versus "resident or occupant") on the response rate to direct mail. Results indicated that there was no significant advantage from use of first class over bulk rate postage, but the return was significantly greater when the envelope bore a name rather than "resident or occupant."

Adult↗
PubMedDate not supplied

Hypoxia and expression of the proapoptotic regulator BNIP3 in cervical cancer.

Hypoxia plays a major role in the malignant progression of tumors. Here, we investigate the expression of Bcl-2/adenovirus E1B 19 kd-interacting protein 3 (BNIP3), a proapoptotic Bcl-2 family member, and its relationship to hypoxia in cervical cancer cell lines and clinical samples of cervical cancer. Cervical cancer cell lines were grown under hypoxia or normoxia, and BNIP3 mRNA expression was examined by Northern blot analysis. In 50 patients with cervical cancer, intratumoral oxygen measurement with the Eppendorf electrode and needle biopsies of the tumor were performed. The obtained tissue was subsequently analyzed by immunohistochemistry with an anti-BNIP3 antibody. Cervical cancer tissue collected upon surgery was used for Northern blot analysis of in vivo BNIP3 mRNA expression. BNIP3 mRNA is strongly induced under hypoxic conditions in all cervical cancer cell lines investigated. Furthermore, Northern blot analysis revealed that BNIP3 mRNA is expressed in cervical cancer tissue. Using immunohistochemistry, we demonstrated that BNIP3 protein is expressed in 82% of the investigated cervical cancers and that more advanced tumor stages showed significantly stronger BNIP3 expression. However, we observed no correlation between BNIP3 expression and intratumoral hypoxia. In conclusion, BNIP3 is expressed in different cervical cancer cell lines as well as in clinical samples of cervical cancer. Although BNIP3 is clearly hypoxia-inducible in vitro, our results suggest additional mechanisms of BNIP3 regulation in vivo. Our findings therefore highlight a discrepancy between in vitro models of tumor hypoxia and the complexity of human cancer.

Carcinoma↗
PubMed2005

Estrogen contributes to the onset, persistence, and malignant progression of cervical cancer in a human papillomavirus-transgenic mouse model.

Cervical cancer is a leading cause of death by cancer among women worldwide. High-risk human papillomaviruses (HPVs) are the major etiological agents for cervical cancer, but other factors likely contribute to cervical cancer, because these cancers commonly arise decades after initial exposure to HPV. Estrogen is thought to be one such cofactor; however, its temporal requirements in human cervical cancer are not known. Here we evaluate the temporal requirements of estrogen in cervical carcinogenesis in a mouse model for HPV-associated cervical cancer. Tumors arising in HPV16 transgenic mice treated with estrogen for 9 months were greatly increased in their size compared with tumors developing after 6 months of estrogen treatment. HPV16 transgenic mice treated 6 months with estrogen followed by 3 months without exogenous estrogen had significantly fewer tumors and the tumors were smaller and less aggressive than those arising in mice treated the full 9 months. Importantly, cervical cancers that arose in the mice treated the first 6 of 9 months with estrogen must have regressed, based upon the reduced incidence of cancers in these mice compared with those treated for 6 months with estrogen, then immediately analyzed. We conclude that estrogen plays a critical role not only in the genesis of cervical cancer but also in its persistence and continued development in this mouse model. These findings raise the clinically relevant possibility that, if human cervical cancer has a similar dependence on estrogen for continued tumor growth, then antiestrogen therapy may be effective in the treatment of cervical cancer.

Animals↗
PubMed1990

[Hospital epidemiology--a comparative case control study of breast and cervical cancers].

To promote the comprehensive measure of cancer prevention for future, a hospital-based epidemiological study on a large scale has started at the Aichi Cancer Center Hospital. As the first step of this study by using a common questionnaire, a simultaneous case-control study on the two cancers involving 175 cases with breast cancer, 56 cases with cervical cancer and 231 controls was conducted in 1988. Body weight was positively related to breast cancer only in older (50-69) patients. Young age at first birth (less than or equal to 23) increased the risk of cervical cancer (OR = 4.1). Active and passive smoking increased the risk of cervical cancer (OR = 2.6, 2.3) but only passive smoking increased the risk of older breast cancer (OR = 2.0). Frequent intakes of green vegetables and carrot decreased the risk of younger (30-49) breast cancer (OR = 0.5, 0.5) and cervical cancer (OR = 0.3, 0.5). Some other factors with positive and negative effects on these two cancers were identified in this case-control analysis.

Breast Neoplasms↗
PubMed2002

Cervical Cancer: Etiology, Pathogenesis, Treatment, and Future Vaccines.

Cervical cancer is a sexually transmitted disease caused by the human papillomavirus (HPV), especially HPV-16 and -18. Of the half million new cases of cervical cancer reported yearly, 20% occur in India. Mass cancer screening programs to detect and treat cervical cancer and its precursor lesions are not available in India and most other developing countries because of the lack of resources. Curative and palliative treatments are not the same for all patients with cervical cancer because the result depends on the immunological response of the patient. This article describes the natural history of cervical carcinogenesis and the rational behind various modalities of prevention and treatment for the practising gynecological oncologist. Prophylactic vaccines against HPV-16 and -18 and therapeutic vaccines against cervical cancers should be able to overcome the logistical problems that now exist to screen, diagnose and treat cervical cancer and its precursor lesions.

Journal Article↗
PubMed1977

Marriage and childbearing in relation to cervical cancer.

In order to assess any correlation between cervical cancer and age at marriage and childbearing, matched control groups were formed. From the comparison it appears that cervical cancer patients are more likely to be married and to have married at an earlier age than control women. In the same age groups at marriage there was no difference in the number of children between the cervical cancer patients and the control women. It appeared that cervical cancer patients had their first child earlier than control women. There were more illegitimate children in the cervical cancer groups than in the control groups, but after the wedding date there were no differences between the cervical cancer groups and the control groups in the time between the wedding date and the date of birth of the first child. The data show that after pregnancy or childbirth, in particular at an early age, there is a greater risk of getting a cervical cancer. By contrast, nulliparous married women seem to have a low risk of cervical cancer.

Adolescent↗
PubMed1998

Cervical cancer awareness and risk factors among female university students.

Population cervical screening programmes are necessary for meaningfully reducing cervical cancer morbidity and mortality. Because of the high incidence of cervical cancer in South Africa, the need for a national screening programme has become evident. The success of such a programme will depend on, among others, the level of cervical cancer awareness among the target population, and their willingness to utilise cytological services and to comply with treatment and follow up protocols. We conducted a survey among female university students, as an elite group of women, to determine their level of cervical cancer awareness and the prevalence of the major risk factors for cervical cancer among them, their rate of utilisation of existing Pap smear services, and their attitudes to Pap smears in general. The majority of respondents were young, single (93.0%) and sexually active (86.9%,) having initiated sexual activity at a mean age of 17.27 +/- 2.18 years. There was a high prevalence of the major risk factors for cervical cancer among the respondents, and these included initiation of coitus before 18 years (53.3%), multiple sexual partners (73.6%), male partner with other partners (37.7%), and previous history of sexually transmitted diseases (42.2%) and vulval warts (4.7%). Their overall knowledge of cervical cancer was poor, although the majority of respondents were able to identify the major risk factors from a given list. This level of awareness of cervical cancer risk factors, however, did not translate into appreciation of personal risk of cervical cancer, safer sex practices or utilisation of Pap smear services. In conclusion, this elite group of women is at a high risk of cervical cancer and would benefit from cervical screening programmes. This would have to be coupled with measures to increase the level of awareness and knowledge of cervical cancer and its prevention.

Adolescent↗
PubMed2003

Use of Tc99m-nanocolloid for sentinel nodes identification in cervical cancer.

BACKGROUND: The initial draining lymph node for a primary tumor is referred to as the "sentinel" node. Firstly adopted in the management of patients with cutaneous melanoma and breast cancer, it is now widely tested in cervical cancer. In patients with cervical cancer, lymph node status is the most important prognostic factor for survival. In patients with cervical cancer FIGO stage I and II pelvic lymph node metastases are expected in 0-16 and 24.5-31% and para-aortic lymph node metastases are expected in 0-22 and 11-19% of patients. The removal of pelvic and para-aortic lymph nodes is essential for assessing the biology of the disease. Lymphoscintigraphy enables the visualisation of lymphatic drainage patterns from a great variety of tumour sites prior to surgery. Therefore, the current procedure is to perform the pre-operative mapping of sentinel nodes by static and/or dynamic lymphoscintigraphy, followed by in vivo identification using a gamma detection probe and selective surgical resection. MATERIAL AND METHODS: Between 2001-2003, 37 patients with cervical cancer FIGO stage I-IIa were seemed to be qualified to undergo lymphoscintigraphy. The day before surgery (99m)Tc-nanocolloid (100 MBq; 0.5-1.0 ml in volume) was applied in each quadrant of the cervix or around the tumor. The static scintigraphic scans were performed after 2 hours p.i. using a dual-head large-field-of-view Siemens gamma-camera equipped with high resolution collimators. SNs were identified intra-operatively using a handheld gamma detection probe (Navigator GPS-Tyco) and intra-operative lymphatic mapping with blue dye. After a resection of the SNs, a standard radical hysterectomy with pelvic and low para-aortic lymph node dissection was performed. Tumor characteristics were compared with sentinel node detection and with the histopathological and immunohistochemical results. RESULTS: The scintigraphy showed a focal uptake in 35 of the 37 patients. In all women one or more sentinel lymph nodes were identified intra-operatively. Of them, 24 patients had those located bilaterally. Histologically positive SNs were found in 5 women (13.5%). CONCLUSIONS: A combination pre-operatively administered radioactively labelled albumin with blue dye allows the successful detection of SN in patient with cervical cancer. This technique will result in a real advance in the less aggressive management of patients with early stage cervical cancer. Sentinel lymph node status may be representative of the pelvic lymph nodes status in cervical cancer and thus could provide important information for further treatment.

Adenocarcinoma↗
PubMedDate not supplied

Royal Society of Tropical Medicine and Hygiene meeting at Manson House, London 17 January 2002. Cervical cancer in developing countries.

The public health importance of cervical cancer is now increasingly appreciated as a means to improve the general health of women in many developing countries. Developing countries account for 80% of the world burden, mostly due to the lack of effective control programmes. Infection with oncogenic types of human papillomaviruses (HPV) has been established as the central cause for cervical cancer. Thus, vaccination against HPV is a potentially useful strategy for prevention, but this may take several years to become a reality. Currently, early detection and treatment is the most effective approach to control cervical cancer. Cervical cancer may be controlled through improving awareness and accessibility to diagnostic and treatment services. Cytology-based screening is beyond the capacity of health services in many developing countries, hence, alternative methods to cytology are being investigated. Visual inspection of the cervix after application of 3-5% acetic acid (VIA) seems to be a promising screening test, with a similar sensitivity to that of cytology, but lower specificity. Currently, it is being evaluated for its cost-effectiveness in reducing cervical cancer incidence and mortality in randomized trials. Information from the ongoing studies will be valuable for evolving cervical cancer control policies and programmes in low-resource settings.

Age Distribution↗
PubMed2005

Potentiation of the radiation effect with genistein in cervical cancer cells.

OBJECTIVE: Early stage cervical cancer is treated with surgery or radiation with equivalent results. Radiation is used for curative therapy of locally advanced disease and is combined with additional anti-tumor agents to improve control. We determined the potential role of genistein as a radiosensitizer for cervical cancer cells. METHODS: Human cervical cell lines (CaSki and ME180) were used. Sensitivity of cells to genistein, radiation and the combination was determined by colony assays. Western blotting was used to study the expression of cell-response-related gene products. RESULTS: Genistein results in the dose-dependent inhibition of all cell lines (2.5-40.0 microM). Effect of genistein on the radiosensitivity of the two cervical tumor cells was variable. Me180 cells were more sensitive at 20 and 40 microM of genistein. At 40 microM, less than 5% of Me180 cells survived the radiation (200-800 cGy). Potentiation of the radiation effect in CaSki cells was seen (500-800 cGy). The most significant enhancement of radiosensitivity was seen at 20 and 40 microM genistein at 500 and 800 cGy. G(2)M arrest was demonstrated only in ME180 cells with genistein. There was significant inhibition of Mcl-1 by genistein that correlated with increase in radiosensitivity in Me180 cells. Activated pAKT (Thr 308) was inhibited with genistein and radiation in CaSki cells. CONCLUSIONS.: Genistein inhibits growth of cervical cancer cells. Genistein results in variable and significant enhancement of the radiation effect that may be partially mediated by G(2)M arrest, Mcl-1 and activation of the AKT gene.

Antineoplastic Agents↗
PubMed1992

Ovarian and cervical cancer.

Death rates from cervical cancer have already fallen this century and for patients with invasive cervical cancer five year survival rates are greater than for most solid tumours. Better screening for premalignant changes may further reduce the incidence of invasive cancer; indeed, it has been claimed that the reduction in mortality could be as high as 90%, though estimates of screening efficacy have varied greatly. For those with advanced invasive carcinoma neoadjuvant chemotherapy may reduce the risk of relapse and improve survival.

Combined Modality Therapy↗
PubMed1986

Epidemiological evaluation of early detection of cervical cancer in Slovenia till 1981.

Cervical cancer screening is performed in all Slovenia in connection with normal clinical practice since 1960. The results based on the data of Cancer Registry of Slovenia: trends in age, specific incidence rates and the distribution of intraepithelial and invasive cervical cancer incidence rates by communes revealed that cervical cancer screening is efficient in Slovenia; in two commune aggregates only and up to the age 40. A detailed analysis of cases of FIGO stage I into Ia and Ib stage demonstrated a shift of the peak of Ib stage to younger age in the two commune aggregates mentioned. The question is whether this shift of the peak of Ib stage could be an indicator of the unavoidable percentage of rapidly growing tumors in the population of SR Slovenia.

Adult↗
PubMedDate not supplied

Cervical cancer: improving the service.

Cervical cancer is a major cause of morbidity and mortality, but critics of the cervical cancer screening programme claim not enough is being done to prevent and treat the illness. In particular, the programme has been criticised for failing to target the most appropriate groups of women. The author reviews the current unsatisfactory situation, and suggests possible ways forward.

Contraceptives, Oral↗
PubMed1990

Screening for cervical cancer.

Indirect evidence indicates that cervical cancer screening should reduce the incidence and mortality of invasive cervical cancer by about 90%. In the absence of screening, a 20-year-old average-risk woman has about a 250 in 10,000 chance of developing invasive cervical cancer during the rest of her life, and about a 118 in 10,000 chance of dying from it. Screening at least every 3 years from 20 to 75 years of age will decrease these probabilities by about 215 in 10,000 and 107 in 10,000, respectively, and will increase a 20-year-old woman's life expectancy by about 96 days. The particular age at which screening is begun (for example, 17 or 20 years), the requirement of several initial annual examinations before reducing the frequency, and screening every 1 or 2 years compared with every 3 years improves the effectiveness by less than 5%. Screening is recommended at least every 3 years from about age 20 to about age 65 years.

Adult↗
PubMed2003

[Assessment of the midwives preparation to take care of patients with cervical cancer].

INTRODUCTION: The success of the cervical cancer treatment depends not the only on the early diagnosis, but also on the immediate initiation of the appropriate treatment and proper nursing care, which should be adequate with the present knowledge. OBJECTIVE: The objective of the research was the assessment of the theoretical preparation of nurses taking care of patients with cervical cancer. MATERIALS AND METHOD: 50 nurses, working in the departments of gynecological diseases, have been interviewed. All the nurses graduated from College of Nursing, 3 of them additionally studied in the Pedagogical Graduate School. 60% of the nurses had 10-20 years of professional experience. We used special questionnaire made of 3 parts: describing the objective of the research/test, characteristics of the patient, specific questions. There were 18 questions: 5-closed, 1-open, 12-semiopen. They were checking the knowledge about the diagnostics, preparation of the patient to the operation using Wertheim-Meigs-Valle method, postoperative care until the discharge from the hospital and then oncological care. RESULTS: Almost all of them (88%-92%) have known the sequence of the diagnosis and treatment of the cervical cancer. 90% of them have been knowledgeable what kind of diagnostic and nursing procedures were required before the surgery using Wertheim-Meigs-Valle method. Almost all of the tested nurses (96%-100%) have known the procedure of postoperative care. They had a practical knowledge how to assess the patient condition and components of care that the patients require during the first few days after the surgery. According to the tested nurses, 90% of the patients operated because of cervical cancer, should follow up in oncological centers. CONCLUSION: 1. The nurses' preparation to take care of patients with cervical cancer is sufficient and it affects the effectiveness of the treatment. 2. The nurses have knowledge about pre- and postoperative procedures that the patients require, as well as assessment of general condition and patients' care, which are so important in the first few days after the surgery.

Adult↗
PubMed1994

Pap smear screening and changes in cervical cancer mortality in Sweden.

OBJECTIVES: Age-adjusted incidence of cervical carcinoma has fallen dramatically in Sweden in recent decades. This investigation is an attempt to evaluate the effectiveness of the gynecologic Pap smear screening program in terms of reduction of mortality from cervical cancer. METHODS: Cervical cancer mortality trends in relation to age, calendar period, county and degree of screening activities in the population were analyzed. Multiplicative Poisson regression models were utilized. The reduction of mortality was attributed to the activities of cervical screening. RESULTS: The analysis gave a calculated 53% reduction in cervical cancer mortality (95% confidence limits 23-72%), attributable to screening. CONCLUSIONS: The study supports the hypothesis that gynecological Pap smear screening has had an important impact on the reduction in cervical cancer mortality.

Adult↗