• Asian Pacific Journal of Cancer Prevention
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• v.15 no.4
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• pp.1671-1674
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• 2014

Background: To study the clinical presentation of cervical carcinoma correlating with histopathological findings in a tertiary hospital situated in the southern part of India catering to rural and semi-urban populations Materials and Methods: 199 cases histopathologically diagnosed as cervical cancer over a period of one year were considered for the study. Clinical details of the patients were noted with the help of semi-structured proforma. The data was analysed by descriptive analysis using SPSS software. Results: Out of 199 patients, 109 had moderately differentiated squamous cell carcinoma, 51 poorly differentiated and 35 well differentiated. Adenocarcinomas numbered only four. 121 cases were in the age group of 40-59 years, 59 in 60-80 years and 19 in 20-39 years. All four cases of adenocarcinoma were seen between 40-59 years. 95 (47.7%) cases were in women who had 4 or more children, 120 presented with white discharge, 89 with bleeding per vagina and 68 had constitutional symptoms. Most of the patients with adenocarcinoma presented with bleeding per vagina. 151 was in stage IIIB, 29 in stage IIB, 14 in stage IVA and 5 in stage IB. Conclusions: Screening of cervical cancer should be emphasised in women with white discharge especially in rural areas for early detection of dysplastic cells and reduce mortality and morbidity in productive age. In addition health education has to be given to women regarding the awareness of hygiene, risk factors and symptoms of cervical cancer.

• Radiation Oncology Journal
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• v.14 no.4
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• pp.317-322
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• 1996

Purpose : Patients with cervical cancer who have positive resection margins after radical hysterectomy are at increased risk for local recurrence. The result of postoperative pelvic radiotherapy for cervix cancer with positive resection margins were analyzed to evaluate the role of radiotherapy. Materials and Methods : Between n 1979 and 1992, 60 patients of cervix carcinoma were treated with postoperative radiotherapy after radical hysterectomy and pelvic lymphadenectomy because of positive vaginal (48 patients) or parametrial resection margins (12 patients). Patients were treated with external beam radiation therapy (EBRT) alone (12 Patients) or EBRT plus vaginal ovoid irradiation (VOI) (48 patients). The median followup period was 55 months. Results : The 5-year actuarial disease free and overall survival rates for all patients were $75.2\%$, $84.1\%$, respectively. The overall recurrence rate was $23\%$ (14/60). In 48 patients with Positive vaginal resection margins, the pelvic recurrence was $8\%$ (4/48). Distant metastasis was $15\%$(7/48). Of the 43 patients with positive vaginal resection margins treated with EBRT and VOI, recurrence rate was $21\%$(9/43) , while recurrence rate was $40\%$(2/5) in the EBRT only treated group. In 12 patients with positive parametrial margins, three patients ($25\%$) had distant metastases. The most significant prognostic factor was lymph node metastasis. Complications resulting from radiotherapy occurred at a rate of $32\%$(19/60) and grade III complications occurred in three patients ($5\%$). Conclusion : Postoperative radiotherapy can produce excellent pelvic control rates in patients with positive resection margins. In patients with positive vaginal margins, whole pelvic EBRT and VOI is recommended.

• Radiation Oncology Journal
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• v.9 no.2
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• pp.303-310
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• 1991

Nineteen patients with previously untreated invasive squamous cell carcinoma of the uterine cervix were treated by irradiation alone at the Keimyung University Hospital from January, 1990 to July, 1991. The serial samplings of the tissue taken before and during radiation of the uterine cervix were studied by light and electron microscopic examination. Radiation-induced cellular changes, particularly nuclear degeneration was pronounced. The tumor invasion pattern remained unchanged but the number of mitosis and tumor cells decreased, The number of infiltrating inflammatory cells, multinucleated giant cells and karyolytic cells were increased with radiation. Fibrosis was also increased. Electron microscopically, the amount of tonofilament in the tissue samplings was increased in the postirradiated state, but the desmosomes were decreased in numbers. Fibroblasts began to appear after an irradiation dose of 2700 cGy. After an irradiation dose of 3000 cGy or more, tumor cells were nearly completely degenerated and displaced with mature fibrotic tissue. There was an increase of activated fibroblasts and collagen fibers but a decrease of inflammatory cells in the interstitial tissue. Swelling of the mitochondria and endoplasmic reticulum, loss of intercellular bridges and an increased number of secondary lysosomes were also found with radiation.

• Radiation Oncology Journal
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• v.13 no.2
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• pp.181-189
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• 1995

Pupose: Radiation therapy(RT) is conventionally standard treatment for locally advanced stage for uterine cervix cancer. Recently to improve treatment results, combined chemotherapy and radiation therapy was tried We retrospectively analysed our experience of 122 patients. Comparision of the results in 45 patients treated with RT alone and 77 patients treated with RT plus chemotherapy was made Materials and Mathods: From January 1985 to December 1991 122 patients with cervix cancer were treated with whole pelvic external RT and ICR(34 1 ICR, 77 2 ICR, 11 high dose rate ICR) in our department. Forty five patients were treated with RT alone, and 77 patients were treated with combined RT plus chemotherapy Mean age was 58 years(range:29-81). Histologic types were 111 squamous cell carcinoma, 5 large cell carcinoma, 3 adenocarcinoma, and 2 adenosquamous cell carcinoma. According to the FIGO stage 6 had stage $IA(4.9\%),$ 11 had $IIA(9.0\%),$ 37 had $IIB(30.3\%),$ 3 had $IIIA(2.5\%),$ 63 had $IIIB(51.6\%).$ and 2 had stage $IV(1.6\%).$ In 77 patients with RT Plus chemotherapy, 36 patients were treated with VBP(vinblastin, bleomycin, cisplatinum) , 39 patients with cisplatinum plus 5-FU and 2 patients with 5-FU. Results: Complete response after external RT (3960cGy-5500cGy) was achieved in 61 patients$(50\%).$ The actuarial 5 year and 9 rear survival rate was $57.8\%\;and\;53.9\%,$ respectively. Five rear actuarial survival rate was $63.1\%$with RT alone(n=45) and $55.9\%$ with RT plus chemotherapy(n=77). The 5 rear survival rate was $35.5\%$ for 1 course of ICR and $67\%$ for 2 courses of ICR. There was statistically significant advantage of survival with RT alone group who were treated with 2 courses of ICR and dose to the A Point)=8000cGy (4/25 died). In RT plus chemotherapy group, dose response was not seen and there was no difference in 5 year survival between 1 course and 2 course of ICR $(50\%\;vs\;56.8\%),$ and dose to point A less than 8000 cGy and more than 8000 $cGy(55.6\%\;vs\;55.7\%).$ There was no significant difference in survival between RT alone and RT plus chemotherapy for patients with tumor size greater than 3cm in size. Five year survival rate for early stage (Stage IB and IIA) with RT alone group and with RT Plus chemotherapy group was $60\%\;and\;77.0\%,$ respectively In advanced stage (stage IIB, IIIA, IIIB, IVA) the 5 year actuarial survival rate were $62.6\%,$ for RT alone group vs $53.6\%$ for RT plus chemotherapy group. Conclusion: Present study demonstrates that there is no survival advantage with adding chemotherapy in advanced stage of uterine cervix cancer. RT alone is considered as treatment of choice for patients with locally advanced cervix cancer. There was increased survival in RT alone group treated with RT dose above 8000 cGy to point A and 2 course of ICR. but 2 course of ICR and RT dose above 8000 cGy to point A did not affect survival advantage in RT plus chemotherapy group.

• Asian Pacific Journal of Cancer Prevention
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• v.13 no.7
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• pp.3281-3285
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• 2012

Objectives: To evaluate the clinicopathologic correlation and prognostic value of HPV18 DNA viral load in patients with early-stage cervical neuroendocrine carcinoma (NECA). Methods: Formalin-fixed, paraffin-embedded tissue of cervical NECA patients with known HPV18 infection and clinicopathologic data including follow-up results were collected. The HPV18 DNA load was assessed with quantitative PCR targeting the HPV18 E6E7 region. Results: Twenty-one patients with early-stage (IB-IIA) cervical NECA were identified. HPV18 DNA viral load ranged from 0.83 to 55,174 copies/cell (median 5.90). Disease progression, observed in 10 cases (48%), was not significantly associated with any clinicopathologic variables. However, the group of patients with progressive disease tended to have a higher rate of pelvic lymph node metastasis (50% versus 9%, p=0.063) and a lower median value of HPV18 DNA viral load (4.37 versus 8.17 copies/cell, p=0.198) compared to the non-recurrent group. When stratified by a cut-off viral load value of 5.00 copies/cell, the group of patients with viral load ${\leq}5.00$ copies/cell had a significantly shorter disease-free survival than the group with viral load >5.00 copies/cell (p=0.028). The group with a lower viral load also tended to have a higher rate of disease progression (75% versus 31%, p=0.080). No significant difference in the other clinicopathologic variables between the lower and higher viral load groups was identified. Conclusion: HPV18 DNA viral load may have a prognostic value in patients with early-stage NECA of the cervix. A low viral load may be predictive of shortened disease-free survival in these patients.

• Radiation Oncology Journal
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• v.11 no.2
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• pp.397-401
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• 1993

We investigated the usefulness of tumor-associated antigen (TA-4) by a radioimmunoasay method in estimating the extent of disease and tracking the clinical course of disease in 58 patients with cervical cancer. According to our results and those of other authors, the normal range of serum TA-4 was arbitrarily taken to be less than 2 ng/ml. The proportion of the pretreatment positive serum TA-4 level of 48 squamous cell carcinoma patients was $60\%.$ And $40\%$ in 5 adenocarcinoma patients. Advanced disease group showed higher incidence of positive serum TA-4 level; $40\%,\;72\%,\;63\%,\;and\;100\%$ in stage I to IV, respectively. And the absolute values of TA-4 were higher in advanced disease. In patients treated with radiation, elevated serum TA-4 level usually declined after 3000 cGy and further dropped to normal range in $44\%$ after 5000 cGy. The positive rate in primary cervical cancer was $59\%,$ (32/54) and $100\%$ (4/4) in recurrent conical cancer. And 15 patients with recurrent or persistent disease during follow-up revealed $80\%$ positive serum TA-4 level. In conclusion, it would be suggested that serial serum TA-4 measurements may be helpful in tracking the clinical course during and after treatment.

• The Korean Journal of Cytopathology
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• v.15 no.1
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• pp.28-32
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• 2004

It was reported that the main cause of intraepithelial neoplasm and squamous cell carcinoma of the uterine cervix is human papilloma virus infection, and that the expression of p16 is increased in cells infected by human papilloma virus. We performed an immunocytochemical staining for protein p16 in 17 cases of cervocovaginal smears initially diagnosed as atypical squamous cells of undetermined significance, to know whether the staining could help the differentiation of neoplastic cells from reactive atypical cells. Of 17 smears, 6 were diagnosed finally as high grade intraepithelial neoplasm or invasive squamous cell carcinoma by follow-up biopsy and smear, and 5 of the 6 were positive for p16. Three were diagnosed as koilocytosis, and one of them was weakly positive for p16. Eight were diagnosed as reactive atypical cells, and all of them were negative for p16. We thought that immunocytochemical staining of p16 in cervocovaginal smears could help the differentiation of neoplastic cells from reactive atypical cells.

• Radiation Oncology Journal
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• v.19 no.2
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• pp.136-141
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• 2001

Purpose : To evaluate the significance of serum SCC for the monitoring of treatment response and the early detection of distant metastasis during radiotherapy (RT). Materials and Methods : In 13 patients with histologically proven primary squamous cell carcinoma of uterine cervix, serum SCC values were checked in pre-RT point, weekly during RT, and in post-RT point. Results : In 4 of 13 cases, metastasis appeared at the end of external RT, so that intracavitary radiation couldn't be peformed.01 these 4 cases,3 with elevated pre-RT SCC level, who resulted in lung metastasis on chest PA at the end of external RT showed decreased post-RT SCC value despite of metastasis. Of all 10 cases with elevated pre-RT SCC value (including 3 with metastasis at the end of external RT), SCC value was higher than pre-RT value in 7 at 9 Gy and the difference was statistically significant. At 18 Gy, SCC was higher in 4 and lower in 6 than pre-RT value. After 18 Gy, SCC value decreased continuously to the end of RT in all 10 cases. Conclusion : During RT, SCC value increased initially at 9 Gy. To 18 Gy, SCC value decreased to the nearly same with pre-RT value. After 18 Gy, to the end of RT, SCC value decreased continuously and normalized in completely responded cases. In cases with appearance of lung metastasis, SCC value also decreased with the disappearance of main mass of uterine cervix despite metastasis.

• Asian Pacific Journal of Cancer Prevention
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• v.13 no.9
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• pp.4567-4570
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• 2012

Objectives: The purposes of this study were to determine the prevalence and predictive value to detect significant neoplasia and invasive lesions, and to evaluate the correlation between clinical and histopathology of women with squamous cell carcinoma (SCCA) on Siriraj liquid-based cervical cytology (Siriraj-LBC). Methods: The computerized database of women who underwent Siriraj-LBC at Siriraj Hospital, Mahidol University from January 2007 to December 2010 were retrieved. The hospital records of women with SCCA cytology were reviewed. Results: The prevalence of SCCA cytology was 0.07%. A total of 86 women, mean age was 58.1 years. Sixty-one women (70.9%) were post-menopausal. Overall significant pathology and invasive gynecologic cancer were detected in 84 women (97.7%) and 71 women (82.5%), respectively. The positive predictive values for detection of significant neoplasia and invasive lesion were 97.7% and 82.6%, respectively. The cervical cancer was diagnosed in 69 women and among these 58 women were SCCA. Thirteen women (15.1%) had cervical intraepithelial neoplasia (CIN) 3 and two women (2.3%) had cervicitis. The sensitivity and specificity of colposcopy for cervical cancer detection in SCCA cytology were 83.3% and 75%, respectively. Median follow up period was 17.6 months and 64 patients were alive without cytologic abnormality. Conclusions: The final histopathology of SCCA cytology in our populations demonstrated a wide variety, from cervicitis to invasive cancer and the most common diagnosis was invasive cervical cancer. Colposcopy with biopsy and/or endocervical curettage and loop electrosurgical excision procedure should be undertaken to achieve histologic diagnosis.

• Asian Pacific Journal of Cancer Prevention
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• v.15 no.19
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• pp.8337-8343
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• 2014

Paclitaxel is one of the best anticancer agents that has been isolated from plants, but its major disadvantage is its dose-limiting toxicity. In this study, we obtained evidence that the active mutant IPP5 ($8-60hIPP5^m$), the latest member of the inhibitory molecules for protein phosphatase 1, sensitizes human cervix carcinoma cells HeLa more efficiently to the therapeutic effects of paclitaxel. The combination of $8-60hIPP5^m$ with paclitaxel augmented anticancer effects as compared to paclitaxel alone as evidenced by reduced DNA synthesis and increased cytotoxicity in HeLa cells. Furthermore, our results revealed that $8-60hIPP5^m$ enhances paclitaxel-induced G2/M arrest and apoptosis, and augments paclitaxel-induced activation of caspases and release of cytochrome C. Evaluation of signaling pathways indicated that this synergism was in part related to downregulation of NF-${\kappa}B$ activation and serine/threonine kinase Akt pathways. We noted that $8-60hIPP5^m$ downregulated the paclitaxel-induced NF-${\kappa}B$ activation, $I{\kappa}B{\alpha}$ degradation, PI3-K activity and phosphorylation of the serine/threonine kinase Akt, a survival signal which in many instances is regulated by NF-${\kappa}B$. Together, our observations indicate that paclitaxel in combination with $8-60hIPP5^m$ may provide a therapeutic advantage for the treatment of human cervical carcinoma.