Brachytherapy in cancer cervix: Time to move ahead from point A?

Brachytherapy forms an integral part of the radiation therapy in cancer cervix. The dose prescription for intracavitary brachytherapy(ICBT) in cancer cervix is based on Tod and Meredith's point A and has been in practice since 1938. This was proposed at a time when accessibility to imaging technology and dose computation facilities was limited. The concept has been in practice worldwide for more than half a century and has been the fulcrum of all ICBT treatments, strategies and outcome measures. The method is simple and can be adapted by all centres practicing ICBT in cancer cervix. However, with the widespread availability of imaging techniques, clinical use of different dose-rates, availability of a host of applicators fabricated with image compatible materials, radiobiological implications of dose equivalence and its impact on tumour and organs at risk; more and more weight is being laid down on individualised image based brachytherapy. Thus, computed tomography, magnetic-resonance imaging and even positron emission computerized tomographyalong with brachytherapy treatment planning system are being increasingly adopted with promising outcomes. The present article reviews the evolution of dose prescription concepts in ICBT in cancer cervix and brings forward the need for image based brachytherapy to evaluate clinical outcomes. As is evident, a gradual transition from "point" based brachytherapy to "profile" based image guided brachytherapy is gaining widespread acceptance for dose prescription, reporting and outcome evaluation in the clinical practice of ICBT in cancer cervix.

Spilled gallstone mimicking metastasis from cervix cancer on positron emission tomography–computed tomography

BACKGROUND Spilled gallstones from previous cholecystectomy is not an uncommon situation.It may further mimic neoplastic disease and can be misled by fluorine 18 fluorodeoxyglucose position emission tomography with computed tomography([18F]FDG PET/CT).CASE SUMMARY A 63 year-old patient was diagnosed with a cancer of the cervix.Pretreatment[18F]FDG PET/CT showed a peritoneal lesion suspicious for metastasis.Surgical exploration and histologic examination revealed the lesion to be a spilled gallstone from a previous cholecystectomy.CONCLUSION[18F]FDG PET/CT carries pitfalls since benign conditions such as intraperitoneal gallstones may be confused as malignant lesions.This case highlights the importance to be aware of the possible implications of dropped gallstones for the future,minimize its occurrence,and make all efforts to properly evaluate cancer staging,particularly for the cervix cancer.

Health Vigilance and Risk Factors for Cervical Cancer: A Study in the State of Maranhão, Brazil

The purpose of this cross-sectional study was to investigate the importance of health vigilance in the prevention of cervical cancer. The sample consisted of 536 women. To identify which risk factors were associated with cervical cancer or with an increase in the mortality rate of this kind of cancer, a logistic regression model was used. The Odds Ratios (OR) and their respective 95% confidence intervals were also calculated. Most of them were at the age of highest incidence of cervical cancer (21 - 59 years old), had an unstable conjugal situation, minimal educational level (78.7%), low income (58.3%), consumed alcoholic beverages (56.4%), had a history of smoking (57.0%) and possessed limited knowledge about the prevention. These results are discussed in terms of a predictive model for cervical cancer that considers the importance of public health vigilance in the screening and precocious diagnosis.

Anti Cervix Cancer Activity of Co-immobilized Tumor Necrosis Factor-α and Interferon-γ

Tumor necrosis factor α （TNF-α） and interferon-γ （IFN-γ） are cytokines with strong antitumor activities. They were reacted with a photoactive arylazide-4-azidobenzoic acid, resulting in photoactive TNF-α and IFN-γ. The infrared （IR） spectra of these products showed the characteristic absorption of an azido group at 2127 cm^-1. By photo-immobilization, this modified TNF-α and IFN-γ were immobilized on polystyrene membranes for cell culture to prepare biomaterials. The micro-morphology of photoactive cytokines was observed with a scanning electron microscope （SEM）. The inhibitory effect on growth of Hela cells and inducing apoptosis activity of these two cytokines were analyzed by growth curve, transmission electron microscope （TEM） and fluorescence active cell sorter （FACS）. The results showed that co-immobilization of IFN-γ and TNF-α had significant inhibitory effect on growth of Hela cells, inhibitory rate up to 82%, and IFN-γ had obviously synergistic action.

Effects of antisense oligonucleotides targeting VEGF on radio sensitivity of uterine cervix cancer Hela cells

决定反的影响的目的察觉到在子宫的宫颈癌症 Hela 细胞的放射敏感度上指向脉管的内皮生长因素(VEGF ) 的 oligonucleotides。方法 VEGF 反感觉 oligodeoxynucleotides (ASODN ) 是进由调停 liposome 的方法的 Hela 房间的 transfected。有 oligodeoxynuclecotide 和 saline 的房间 transfected 被用作控制组。房间被 6 MV X 光线分别地在 0 Gy， 2 Gy， 4 Gy 和 6 Gy 的剂量照耀。VEGF mRNA 的表示被 RT-PCR 决定。Apoptosis 用 FCM 被评估。克隆效率由菌落形成试金是坚定的。结果 VEGF mRNA 的表示被 ASODN 禁止(P 【 0.01 ) 在 Hela 房间。被放射影响的禁止的激活导致了增加 apoptosis (P 【 0.01 ) 并且禁止平皿接种效率(P 【 0.01 ) 。VEGF 的表示在 Hela 房间由 X 照耀导致了的结论能被 VEGF ASODN 堵住。有 VEGF 的治疗可能在 HeLa 房间增加 apoptosis 并且提高放射敏感度。

Epidemiological and Histopathological Aspect of Precancerous and Cancerous Lesions of the Cervix in the Health District of Commune 5 of Bamako, the CHU of Point “G” and the Gabriel TouréUniversity Hospital of Bamako in Mali

Objective: The aim was to take stock of the screening and treatment of precancerous and cancerous lesions of the cervix in the health district of commune V of Bamako, the “G” point and the Gabriel Touré University Hospital in Bamako, Mali. Patients and Methods: This was a descriptive, cross-sectional, analytical study with retrospective and prospective data collection over an 8-year period from January 1, 2010 to December 31, 2017. This was a multi-center study. Results: From January 1, 2010 to December 31, 2017, 42,492 women were screened, representing a frequency of 24.30%. The median age of the women screened was 32 years;25% were under the age of 25. Three-fourth of the women screened was in the 20 - 49 age group. Of the 22,842 women screened, 90.1% of them had a normal col to IVA/IVL. However, 4.1% of cervical positivity had with acetic acid and 5.1% of positivity to Lugol. 0.7% of the women screened clinically had cancerous lesions. Histologically, 96.5% of the women screened had a normal cervix with benign lesions. For pathological histological findings, we noted 2.6% of precancerous lesions and 0.8% of squamous cell carcinomas and 0.1% of adenocarcinoma. Conclusion: Improved screening indicators with IVA/IV reduce the rate of morbidity and mortality from cervical cancer.

Epidemiological and Clinical Profile of Cervix Cancer at Bamako Radiotherapy Center

Cervical cancer remains a major public health problem in Africa, particularly in Mali. The goal of this work was to investigate the epidemiological and clinical aspects of cervix cancer seen at the radiation therapy center. This was a descriptive study on the retrospective collection of data on patients found in the Radiation Therapy Centre of Bamako, for invasive cervical cancer be-tween April 2014 and April 2017. The average age of our population was 52 ± 12.5 years with extremes ranges from 18 to 95 years. The most represented age group was [50 - 65 years] with 44.2%. The predominant histological type was squamous carcinoma (CE) with 94.2%. Bleeding were found in almost all patients, most often associated with foul smelling hydrorrhea;80.3% of our patients were stage III and 12.9% of stage IV according to the IFGO classifi-cation. Cervix cancer remains a major public health problem in Mali. The di-agnosis is often late, therefore, resulting in late care and unfavorable progno-sis. Sensitization, vulgarization of vaccination and systematization of screen-ing could be helpful in the fight against this cancer.

Can Social Support and Control Agency Change Illness Consequences? Evidence from Cervix Cancer Patients

Research has demonstrated facilitative effects of social support on psychological and physical well-being of individuals suffering from chronic health problems. Social support can change not only patients’ perception of their health problems, but also the consequences of their illness. In the present study with cervix cancer patients, the relationship of social support and illness control agency with illness consequences and health outcome beliefs was examined. Emotional, informational, social companionship and practical supports were found to be negatively correlated with the severity of interpersonal, physiological and psychological consequences of illness. Patients’ belief in self-control and doctor-control was related to less severity and less pain of illness, and strong hope for better health outcomes.

Contribution of Colposcopy in the Diagnosis of Precancerous Lesions of the Uterine Cervix at the Douala Gynaeco-Obstetric and Pediatric Hospital, Cameroon

Introduction: Cervical cancer is a public health problem in Cameroon, due to low screening and late diagnosis. We sought to assess practice of colposcopy at the Douala Gyneco-Obstetric and Pediatric Hospital (DGOPH) in Cameroon and its contribution to the fight against cervical cancer in our context. Method: This is a retrospective cross-sectional study of 99 colposcopies after which 71 exploitable biopsies were retained at the Douala for a period of 1year (December 1, 2019-December 1, 2020). The nomenclature of the French Society of Colposcopy and Cervico-Vaginal Pathology (SFCPCV) was used. Results: Mean age of the participants was 44 years, mostly multiparous (80%). Cytological abnormalities were the main reference pattern. During the examination 22% of colposcopies were found to be normal, 37% of TAG 1-2A, 31% of TAG 2B-C, and 5% suspected of cancer. After histological analysis of biopsies guided by colposcopy, we found 42% (30/71) of Cervical Intraepithelial Neoplasia (CIN) 1, 15.5% (11/71) of CIN 2 - 3, and 24% (17/71) cancer. Upon analysis of the diagnosed CIN1/CIN2-3/Cancers, we noted a concordance with colposcopy in 62% (23/37), 37% (10/27) and 85% (6/7) respectively. Colposcopic performance in the detection of high-grade lesions and above was 36% (26/71), with a sensitivity of 92.86%, specificity 83.33%, PPV 78.79% and NPV 94.59%. Conclusion: Despite the difficult socioeconomic context, colposcopy retains all its importance in the diagnosis of precancerous lesions of the uterine cervix. With the imminent putting in place of a national health policy, the goals 90-70-90 by 2030 of the World Health Organization for the fight against cervical cancer can be achieved in our sub-Saharan African countries.

Analysis of the Curative Effect of Preoperative Intra-Arterial Infusion Chemoembolization on Stage IB2-IIB Uterine Cervix Cancer

OBJECTIVETo investigate the short-term and long-termtherapeutic efficacy of preoperative intra-arterial infusion chemo-embolization on stage IB_2-IIB uterine cervix cancer (UCC).METHODS A total of 143 patients with Stage IB_2-IIB UCCwere divided into a clinical trial group and a control group.Thepatients in the clinical trial group(n=86)were treated with acombined therapy,i.e.,preoperative intra-arterial infusion chemo-embolization,surgical therapy and postoperative radiotherapy,and those in the control group (n=57) were given surgical therapyand post-operative radiotherapy.The adverse effects,changes inlocal lesion and pathological examinations of the cancer,and thestate during the surgery were observed after the intra-arterialinfusion chemo-embolization.The survival rate and recurrencerate between the two groups were compared.RESULTS The total effective rate of the intra-arterial infusionchemo-embolization on Stage IB_2-IIB UCC was 93.02%.Thetreatment could reduce tumor size,bring about retro-conversionsof the clinical stage of the tumors and pathological grade of thecancer cells,and decrease the quantity of intra-operative bloodloss as well as the operating time.It could significantly improvethe 5-year survival rate (P<0.05),and reduce the 2 and 5-yeartumor recurrence rates (P<0.05).Moreover,its side effects werelittle.CONCLUSION Preoperative intra-arterial infusion chemo-embolization can create conditions for radical operation,lower thepostoperative recurrence rate,and improve the prognosis in thepatients with UCC.It is an effective therapy in treating UCC.

艾司氯胺酮术后镇痛对宫颈癌术后免疫功能及早期焦虑抑郁状态的影响

目的探讨艾司氯胺酮对腹腔镜宫颈癌根治术患者的术后镇痛效果,免疫功能及术后早期焦虑抑郁状态的影响。方法选取2021年12月至2022年10月拟择期行腹腔镜宫颈癌根治术患者60例,采用随机数字表法分为2组。观察组术后镇痛采用舒芬太尼1μg/kg+艾司氯胺酮1 mg/kg,对照组采用舒芬太尼2μg/kg患者自控镇痛。比较2组患者术后4 h(T_(1))、12 h(T_(2))、24 h(T_(3))及48 h(T_(4))疼痛程度NRS评分和不良反应;ELISA法测定麻醉前30 min、术后24 h及48 h血清IFN-γ、IL-4及IFN-γ/IL-4,比较2组患者于术前1 d,术后第3 d焦虑自评量表(SAS)和患者抑郁自评量表(SDS)。结果2组患者术后各时间点NRS评分差异无统计学意义(P>0.05),观察组术后PONV发生率低于对照组(P<0.05);与T0相比,观察组术后24 h血清IFN-γ水平与IFN-γ/IL-4比值下降,而血清IL-4水平升高(P<0.05);而且术后48 h血清血清IFN-γ水平与IFN-γ/IL-4比值与基线水平相似(P>0.05)。与对照组相比,观察组在术后24 h和48 h血清IFN-γ水平与IFN-γ/IL-4比值增高,而术后24 h时IL-4水平降低(P<0.05)。术后第3天观察组患者SAS评分和SDS评分均高与术前第1天(P<0.05);而对照组术后第3天仅SAS评分高于术前(P<0.05);术后第3天观察组的SAS评分和SDS评分均低于对照组(P<0.05)。结论艾司氯胺酮用于宫颈癌患者术后静脉自控镇痛,可以有效的缓解术后疼痛,调节炎性因子释放,从而改善术后免疫功能,并且有效改善术后早期焦虑抑郁状态。

Potential Anti-cancer Activity of Furanodiene

Objective： To study the isolated from the essential oil VIVO anti-tumor activities of furanodiene of the rhizome of Curcuma wenyujin （C15H200）, a primary sesquiterpene compound YH Chen et C. Ling（Wen Ezhu）, in vitro and in Methods： In vitro MTT assay was used to further study the effects of time and dosage on anti-proliferation of furanodiene against the sensitive Hela, Hep-2, HL-60, U251 cells, based on the cytotoxic effects of furanodiene on 12 human malignant tumor cell lines with the essential oil of Wen Ezhn as control., and the half-inhibitory concentration （IC50） was observed. In vivo uterine cervix （U14） tumor cell was selected and the conventional assay method of anti-tumor activity was employed. Furanodiene liposome was administered intraperitoneally, and tumor-inhibitory rate, thymus and spleen indexes were observed. Results： The inhibitive effects on cell proliferation were shown in all of the twelve cell lines and the cytotoxic effects of furanodiene against Hela, Hep-2, HL-60, U251 cells were observed after 12 h of administration, the effect could last for at least 48 h in a dose dependent manner, and the IC50 values were 0.6, 1.7, 1.8, 7.0μg/ml, respectively. Furanodiene was also found to show inhibitive effects on the proliferation of uterine cervix （U14） tumor induced in mice. The tumor inhibition rates were 36.09% （40 mg/kg）, 41.55% （60 mg/kg）, 58.29% （80 mg/kg）, respectively. Conclusion： Furanodiene is one of primary anti-cancer active components in the essential oil of Wen Ezhu, and also a very effective agent against uterine cervix cancer, and has protection effect on the immune function.

Clinical Significance of CENP-H Expression in Uterine Cervical Cancer

Objective This work aims to investigate the expression pattern and clinicopathologic significance of centromere protein H(CENP-H) in uterine cervical cancer(UCC). Methods The level of CENP-H expression in the paraffin sections of 62 UCC cases was determined by the SP immunohistochemical method,with complete clinicopathologic data in all cases.Statistical analysis was conducted to evaluate the prognostic and diagnostic significance of CENP-H using SPSS13.0 software package. Results Immunohistochemical assay showed strong CENP-H expression in 61.29% (38/62) of the paraffin-embedded cervical cancer tissues.Statistical analysis revealed a strong correlation between the CENP-H expression and the clinical classification(P=0.038) of the cervical carcinoma.The expression increased with rise of the stages.The analysis of Cox proportional hazards regression model suggested that CENP-H expression(P=0.002) and tumor stage(P=0.001) were independent prognostic markers for the survival of UCC patients.The survival analysis showed that the survival rate was significantly lower in patients with high expression of CENP-H than in those with low expression of CENP-H(P=0.001). Conclusions CENP-H is likely to be a valuable marker for carcinogenesis and progression of UCC.It might be used as the important diagnostic and prognostic marker for cervical carcinoma patients,especially for those at early stage.

Müllerian duct anomalies and their effect on the radiotherapeutic management of cervical cancer

Radiotherapy plays a major role in the treatment of cervical cancer. A successful radiotherapy program integrates both external beam and brachytherapy components. The principles of radiotherapy are strongly based on the anatomy of the organ and patterns of local and nodal spread. However, in patients with distorted anatomy, several practical issues arise in the delivery of optimal radiotherapy, especially with brachytherapy. Müllerian duct anomalies result in congenital malformations of the female genital tract. Though being very commonly studied for their deleterious effects on fertility and pregnancy, they have not been recognized for their potential to interfere with the delivery of radiotherapy among patients with cervical cancer. Here, we discuss the management of cervical cancer among patients with Müllerian duct anomalies and review the very sparse amount of published literature on this topic.

Surgery for Early Stage Invasive Cervical Cancer. Experience of the Oncology Department of Ledantec Hospital

Background: Surgery is the treatment for early-stage cervical cancer. Radiochemotherapy is used in the treatment of locally advanced stages. But the choice of treatment can be difficult. Objective: The objective of this work was to evaluate the therapeutic aspects of cervical cancer in the early stages IA to IIA in the oncology department of A Ledantec Hospital in Dakar. Patients and methods: This was a descriptive retrospective study, from January 2015 to December 2020, in the oncology department of A Ledantec Hospital, including all the patients who had been treated for early-stage invasive cervical cancer. Results: We included 28 patients. The average age was 49.54 years old. There were 11 patients (39.3%) with a stage ≤ IB1. Surgery was the first in 14 patients (50%). The initial approach was a midline supra and subumbilical laparotomy. The surgery was R0 in 65.22%. Postoperative complications were found in 4 patients including 1 case of operative wound suppuration, 1 case of dysuria, 1 case of postoperative eventration and 1 case of rectovaginal fistula. Concomitant Radiochemotherapy was neoadjuvant in 7 cases (25%), adjuvant in 14 cases (50%). The chemotherapy was neoadjuvant in 09 cases (56.25%) and adjuvant in 7 cases (43.75%) with minor toxicities. We had recorded 2 deaths. Conclusion: The treatment of the early stages of invasive cervical cancer is based on surgery. Neoadjuvant treatments may be useful in particular situations.

Factors that contribute to delay in seeking cervical cancer diagnosis and treatment among women in Malawi

Cervical cancer is a curable disease if diagnosed early. However, many women in Malawi seek treatment when the disease has reached inoperable stage. This study was conducted to explore factors that contribute to delay in seeking early diagnosis and treatment of cervical cancer among women in Malawi. The study was exploratory and utilized qualitative data collection and analysis method. In-depth interviews were conducted using a semi-structured interview guide on a purposive sample of 24 women who were diagnosed of cervical cancer at the gynaecological wards of Zomba and Queen Elizabeth Central Hospitals in Malawi between July and September, 2011. Thematic content analysis was used to analyze the qualitative data. Two major themes (individual and health facility) emerged from the participants’ narratives as factors that contributed to their delay in seeking early diagnosis and treatment. The individual factors included;limited knowledge on symptoms and signs and limited financial resources. The health facilities factors included;limited accessibility and unavailability of cancer screening facilities in the health centres. Results show that there is a need to strengthen the screening of cervical cancer among women in the country. In addition, there is a need to create community awareness on the signs and symptoms of cervical cancer and the merits of seeking early diagnosis and treatment.

Factors Associated with the Use of Cervical Cancer Screening in the Mbour Health District (Senegal)

Cervical cancer with an estimated incidence between 1700 and 2000 new cases per year and mortality around 70% to 80% has become the leading cancer in Senegal. The objectives of this present work were to study the factors associated with cervical cancer screening in the Mbour health district in 2015. It was a cross-sectional, descriptive and analytical study carried out on a sample of 599 women chosen according to a two-stage survey. The survey used a questionnaire where data on individual characteristics, knowledge, attitudes and practices are collected during an individual interview after informed consent. The data collected were entered in the Epi Info 3.5.3 software and analyzed with the R 3.1.2 software. The average age was 44.4 years with a standard deviation of 8.9. The proportion of women screened for cervical cancer was 19.4%. Screening for cervical cancer was positively related to the possession of an income-generating activity (Adjusted OR = 2.39 [1.4 - 4.2]), increase of education and knowledge of a person suffering from cancer in the environment (adjusted OR = 2.40 [1.3 - 4.2]). Knowledge of the methods of diagnosis of cervical cancer was positively associated with cervical cancer screening (adjusted OR = 20 [11.1 - 33.3]). The lack of awareness and the lack of financial resources and education for women were the main obstacles to cervical cancer screening for women in Mbour. The health system should focus on building the capacity of women to fight cervical cancer.

Prognostic Factors and Treatment Outcome in 178 Locally Advanced Cervical Cancer Patients

Background: To evaluate local control, survival, radiation side effects and treatment outcome in locally advanced cervical cancer patients. Materials and Methods: Among 2006-2011, 178 patients with locally advanced cervical cancer were treated with chemoradiotherapy +/-?radiotherapy and high dose rate (HDR) brachytherapy. Follow-up was complete for all patients. Concomitant chemotherapy was not administered in 44 patients due to renal impairments and ECOG of 2 - 3. Results: The median follow-up period was 34.5 months (range, 5 to 93) and 42 months (range, 14 to 93 months) for alive patients. Five years local-regional control, progression-free survival and overall survival rates were 87.8%, 58.9% and 67.3% in all patients, respectively. In this retrospective study young age, tumor diameter, stage, presence of residual tumor and administration of chemotherapy were effected in survival analysis. The parameters which affected the complete response of patients were defined as presence of concomitant chemotherapy and number of courses <5. Central region recurrence rate was defined higher in the group with treatment duration of 9 weeks and higher (p = 0.044). Conclusion: Primary chemoradiotherapy +/-?radiotherapy achieved a satisfactory rate of local control and survival rates with acceptable complications in locally advanced cervical cancer. Concomitant chemotherapy and treatment duration were the important prognostic factors for completed response locally advanced cervical cancers.

Cervical Cancer Screening by Midwives in the Kara Region of Northern Togo: Knowledge, Attitudes and Practices

Introduction: cervical cancer is common with high mortality. It is diagnosed late in developing countries. Reducing mortality requires better knowledge and screening for cervical cancer. Objective: To study the knowledge, attitudes and practices of midwives in the Kara region of cervical cancer screening. Methods: Cross-sectional, descriptive study from January 2020 to June 2020 conducted with midwives from the Kara region. Results: Fifty midwives participated in the study. The average age was 32.46 years and the majority (92%) had less than 10 years work experience. Thirty seven (74%) said that cervical cancer was due to human papillomavirus oncogenes and 32% to know the two commonly used screening methods (cervical cytology and VIA/VILI). Only 30% and 8% respectively know the pace and target of screening. They had all expressed the desire to be trained and to carry out routine screening. All of the respondents had never practiced a cervical cytology, and only 01 had once practiced VIA/VILI. Conclusion: Midwives have little knowledge of uterine cancer screening and do not practice it. They express the need to be trained in order to popularize the practice.

Epidemiological and Histological Profile of Cervical Cancer in Cameroon: About 2078 Cases

Objective: To describe the epidemiological and histological aspects of cervical cancer in Cameroon. Materials and Methods: It was a descriptive retrospective study carried out over a period of 10 years (2005-2014), on malignant tumors of the cervix observed at the laboratory of Anatomic Pathology in four regions (Center, Littoral, West, South-west). The studied parameters were frequency, age, sex, localization, histological type and the immuno-histochemical aspects. Results: A total of 2078 cases with an annual frequency of 20.78 cases were registered;the peak was reached in 2010 with 304 cases (14.62%). Cervical cancer was the main genital cancer affecting women with a percentage of 82.26%. The average age of the patients was 52.33 ± 12. 80 years old, with extremes from 22 to 93 years old. The age group from 40 to 59 had more than half of the cases, with 1094 cases (52.65%). The major histological types recorded were squamous cell cancer with 1687 cases (81.51%) and adenocarcinoma with 269 cases (12.95%). Conclusion: Cervical cancer is the chief genital cancer affecting female genital organs. The predominant histological types are squamous cell cancers.