Indian Journal of Cancer

Global pattern and trend of cervical cancer incidence from 1993 to 2012

Background: Cervical cancer ranks fourth in global cancer incidence and mortality among women. A comparison of the global trends in cervical cancer would help us to identify high focus regions and serves an opportunity to evaluate the impact of the screening programs. Hence, the current study was done to assess the global trend in the incidence of cervical cancer from 1993 to 2012 among individuals aged between 30 and 79 years. Methods: This secondary data analysis was conducted using the World Health Organization (WHO) Cancer Incidence data of five continents plus database (America, Asia, Europe, and Oceania) on the incidence of cervical cancer. Joinpoint regression was performed to determine the average annual percent change (AAPC) in cervical cancer incidence. We performed an age-period-cohort analysis to obtain age, period, and cohort-specific deviations and rate ratio (RR). Results: Out of the four regions studied, all the regions showed a declining trend in cervical cancer incidence. The maximum decline was found in Oceania (AAPC = −3.3%) followed by America (AAPC = −2.0%). There was a consistent rise in cervical cancer incidence across the age groups in all the four continents with the maximum burden among the elderly. All the regions showed a steady decline in the rate of cervical cancer through the periods 1998–2002 to 2007–2012. There was also a steady decline in cervical cancer incidence across the cohorts from 1923–1927 to 1978–1982 in all the regions except America. Conclusion: To summarize, cervical cancer incidence showed a declining trend globally, with the maximum decline in the Oceania region from 1993 to 2012.

Correlation of cell cycle–related kinase and SII with FIGO stage, lymph node metastasis, and prognosis of serous ovarian cancer

Abstract Background: Ovarian cancer has no specific manifestations in the early stage, and most patients have advanced to the advanced stage when diagnosed for the first time. The 5-year survival rate for patients receiving standardized treatment is still low. The systemic immune inflammation index (SII) can comprehensively reflect host inflammation and immune balance status, and has good application value in evaluating the condition and prognosis of various malignant tumors. Cell cycle related kinase (CCRK) can regulate cell cycle, promote cell proliferation and division, and is closely related to the occurrence and development of various malignant tumors. Therefore, to detect the positive expression of CCRK and the level of SII index in serous ovarian cancer tissue, and to explore the relationship between CCRK and SII with the pathological characteristics and prognosis of serous ovarian cancer, analyze the possible mechanisms of CCRK and SII in the occurrence and development of serous ovarian cancer, and provide reference for clinical diagnosis and treatment of ovarian cancer. Methods: The malignant group included 315 patients with serous ovarian cancer who were hospitalized by us from January 2018 to January 2019, and 158 patients with ovarian serous cystadenoma were enrolled in the benign group. During the operation, the cancerous foci and lesion tissues of the two groups were collected. The expression of CCRK in pathological tissues was detected by immunohistochemistry. CCRK expression and SII levels in the benign and malignant groups, and patients with different clinicopathologic features of serous ovarian cancer were compared. Taking the average SII level of the malignant group as the grouping standard, the invalids were divided into SII high- and low-expression groups and observed until January 2022. To analyze the correlation between CCRK expression, SII, FIGO stage, lymph node metastasis, and prognosis of serous ovarian cancer. The survival of patients with CCRK-positive and -negative expression of this disease, and SII high and low expressions were statistically analyzed. Results: Positive CCRK expression was more prevalent in serous ovarian cancer tissues than in serous cystadenoma tissues, and the CCRK-positive grade in serous ovarian cancer was higher than that of cystadenoma. SII of patients with this disease was greater than that of those with serous cystadenoma and the difference was statistically significant (P < 0.05). FIGO stage and lymph node metastases were associated with positive expression of CCRK in serous ovarian cancer (P < 0.05). SII was correlated with FIGO stage, differentiation degree, lymph node metastasis, and serum CA125 level (P < 0.05). Spearman correlation analysis showed that the expression of CCRK in invalids with serous ovarian cancer was positively correlated with FIGO stage and lymph node metastasis of serous ovarian cancer (r = 0.538, r = 0.605, P < 0.001). SII was positively correlated with FIGO stage and lymph node metastasis of serous ovarian cancer (r = 0.689, r = 0.622, P < 0.001). The Kaplan–Meier survival curve and the log-rank test demonstrated that the CCRK-positive expression group had an lower survival rate than the CCRK-negative expression group, and that the SII high-expression group had an lower survival rate than the SII low-expression group (rank = 19.504, 16.184, P < 0.05). Conclusion: Positive CCRK expression and an elevated SII have a role in the development of serous ovarian cancer and have the potential to predict the prognosis of patients.

The prognostic role of omental, ovarian chemotherapy response score and CA125 in predicting survival in patients with tubo-ovarian high-grade serous carcinoma/primary peritoneal carcinoma receiving neoadjuvant chemotherapy

Abstract Objective: To assess the role of omental and ovarian chemotherapy response score (CRS) and CA125 as a predictor of prognosis in patients with tubo-ovarian high-grade serous carcinoma (HGSC)/primary peritoneal carcinoma (PPC) receiving neoadjuvant chemotherapy (NACT). In addition, to study the correlation of omental CRS with chemoresistance. Methods: A retrospective record review of patients with tubo-ovarian HGSC/PPC receiving NACT followed by interval debulking surgery (IDS) between January 2012 and May 2020 was done. The slides of the omentum and ovarian tissue of the patients were retrieved and reviewed by a trained pathologist. During analysis, CRS 1 and CRS 2 were merged together for comparison against CRS 3. Results: A total of 44 patients with a mean age of 54 years were included in the study. Among the patients, 29.5%, 38.6%, and 31.8% had a CRS of 1, 2, and 3, respectively, on the omental specimen and 31.8%, 43.2%, and 25% on the ovarian specimen. Median PFS and OS was significantly better with omental CRS 3 (P = < 0.0001 and P = < 0.00065). No significant difference in median OS of patients was noted with ovarian CRS 1, 2, or 3 (P = 0.057); however, the median PFS was significantly better in patients with CRS 3 on ovarian tissue (P = 0.036). Platinum resistance was significantly lower in patients with CRS 3 on omentum (P = 0.001). The value of CA125 post NACT had a significant association with PFS on both univariate and multivariate analyses. There was no statistically significant correlation between CA125 and omental CRS. Conclusion: Omental CRS has a prognostic significance for patients with tubo-ovarian HGSC/PPC receiving NACT and correlates significantly with PFS and OS. Ovarian CRS correlates significantly only with PFS. Post NACT CA125 value had a significant association with PFS.

Survival outcomes of epithelial ovarian cancer treated at a tertiary-level hospital in India

Abstract Background: One needs to choose wisely between primary neoadjuvant chemotherapy and primary cytoreductive surgery in ovarian cancer. The aim was to determine the recurrence free survival and overall survival after surgery for epithelial ovarian cancer and also the risk factors for recurrence and death. Methods: Electronic medical records of 322 women operated for ovarian, fallopian or primary peritoneal cancer between 2011 and 2015 were reviewed. Descriptive statistics were used to describe patients and their clinical outcomes. Cox proportional hazard models were used for risk factor analysis. Adjusted hazard ratios were obtained for recurrence and death, adjusted for stage, primary treatment modality, residual disease and histology. Kaplan-Meier curves were drawn for probability of recurrence-free survival and overall survival. The log rank test was used to compare survival probabilities. Results: The majority were stage III or stage IV (78%), serous histology (71%) and high grade (64%). Primary cytoreduction was done in 48% and interval cytoreduction in 52%. The median duration of follow up (survival) was 77 months (95% CI 72-82). There were 179 known recurrences (55.6 %). The estimated median time to recurrence was 22 (95% CI 14.5- 29.5) months. The independent risk factors for recurrence were neoadjuvant chemotherapy [HR 2.14, 95% CI 1.48-3.09], stage III/IV [HR 2.75; 95% CI 1.40-5.41], high grade serous histology [HR 1.69; 95% CI 1.12-2.54] and sub-optimal debulking [HR 3.15, 95% CI 2.19-4.55]. There were 78 known deaths (24.2 %) with a mean time to death of 24.3 (SD 16.1) months. The independent risk factors for death were sub-optimal debulking [HR 3.07; 95% CI 1.78-5.29] and stages III and IV cancer [HR 3.07; 95% CI 1.14-8.27]. Conclusions: Most ovarian cancers recur within 2 years. Risk factors for mortality are advanced stage and sub-optimal debulking. Maximal efforts at down staging and surgical resection will increase survival.

Prevalence, distribution, and risk markers for the development of gonadal germ cell tumors in patients with certain types of disorders of sexual differentiation with Y chromosome – A retrospective study

Purpose: To study the prevalence, subtypes, and risk markers for the development of gonadal germ cell tumors (GCT’s) among disorders of sexual differentiation (DSD) patients with the Y chromosome. Materials and Method: Design: A retrospective review of the patient’s case records from 2010 to 2020 in Government Medical College, Thiruvananthapuram, India was studied. The study participants included 54 subjects with DSD containing the Y chromosome. Demographic data, external masculinization scoring, associated congenital anomalies, karyotyping, intraoperative findings such as gonadal location and internal genital ducts, histopathology of the resected gonads, and its immunohistochemistry were collected. The prevalence of gonadal GCT’s was estimated from paraffin-embedded gonadectomy samples (S = 82). Results: The median age of occurrence of gonadal GCT’s was 18 years. The prevalence of malignant gonadal GCT’s was highest among the PAIS group (19.2%) followed by gonadal dysgenesis (15.8% each in MGD and CGD) and least among CAIS (7.7%) (p < 0.01). The most common type of malignant gonadal GCT’s in the descending order of frequency was dysgerminoma, seminoma, mixed GCT, and yolk sac tumor. Multivariance logistic analysis showed post-puberty and the presence of congenital anomalies were associated with the occurrence of gonadal GCT’s (P < 0.01). Conclusion: The overall prevalence of gonadal GCT’s (malignant and premalignant) among DSD with Y chromosomes is nearly 25%. Dysgerminoma is the most common malignant gonadal GCT’s. Age at or above 18 years and the presence of congenital anomalies like renal agenesis, retroperitoneal vascular defects, and congenital diaphragmatic hernia were independent risk markers for the development of gonadal GCT’s.

Feasibility of using pemetrexed as a salvage regimen in heavily pre-treated patients with ovarian cancer: A retrospective review

Safety of laparoscopic surgery in the management of endometrioid endometrial cancer

Abstract Background: Laparoscopic surgery has increasingly been preferred in recent years. However, data regarding the safety of laparoscopy in endometrial cancer are not sufficient. The aim of this study was to compare perioperative and oncologic outcomes of laparoscopic and laparotomic staging surgery in patients with endometrioid endometrial cancer and to evaluate the safety and efficacy of laparoscopic surgery in this population. Methods: Data of 278 patients, who underwent surgical staging for endometrioid endometrial cancer at the gynecologic oncology department of a university hospital between 2012 and 2019, were analyzed retrospectively. Demographic, histopathologic, perioperative, and oncologic characteristics were compared between laparoscopy and laparotomy groups. A subgroup of patients with a body mass index (BMI) >30 was further evaluated. Results: Demographic and histopathologic characteristics were similar between the two groups, while laparoscopic surgery was seen to be significantly superior in terms of perioperative outcomes. The number of removed and metastatic lymph nodes was significantly higher in the laparotomy group; however, this difference did not affect the oncologic outcomes, including recurrence and survival rates, and the two groups had similar results in this aspect. The outcomes of the subgroup with BMI >30 were also in accordance with the whole population. Intraoperative complications in laparoscopy were managed successfully. Conclusions: Laparoscopic surgery appears to be advantageous over laparotomy, and depending on the surgical experience, it may be performed safely for surgical staging of endometrioid endometrial cancer.

Olaparib, a new hope for ovarian cancer

Primary pure angiosarcoma of the ovary: A case report

Abstract Ovarian angiosarcomas are rare tumors, with an incidence of one in 1,000,000 malignant ovarian tumors, which may present in a background of carcinosarcoma or teratoma. However, primary pure ovarian angiosarcoma is even rarer with a few cases published in the literature. Here, we present a case of a perimenopausal woman who presented with a 16 cm adnexal mass. She underwent bilateral salpingo-oophorectomy with omentectomy, which on histopathological examination revealed an ovarian angiosarcoma with tumor deposits in the pelvic peritoneum. No other component was demonstrable within the tumor, in light of which it was reported as a primary pure ovarian angiosarcoma. She received adjuvant paclitaxel- and carboplatin-based chemotherapy after discussion in a multispecialty tumor board. This case highlights the gross and microscopic findings of primary ovarian angiosarcomas and their distinction from their differential diagnosis.

Long-term survival outcome of advanced epithelial ovarian cancer: A single institutional study

A number of patients with advanced-stage epithelial ovarian cancer do survive beyond 5 years. The long-term follow-up data are limited, especially for the Indian setting. We evaluated the 10-year survival outcome and influencing clinicopathological factors. A retrospective analysis of advanced-stage epithelial ovarian cancer patients who underwent primary cytoreductive surgery (PCS) or interval cytoreductive surgery (ICS) from 2005 to 2008 was conducted. Survival analysis was performed with the Kaplan-Meier method, and the Cox proportional hazards model was used for prognostic clinicopathological factors analysis. Ninety-four patients with a median age of 54.5 (18-79) years were evaluated. The median follow-up period was 11.2 years. The overall survival (OS) rates at 5, 7, and 10 years were 37%, 23%, and 18%, respectively. The median OS (MOS) was 46 (95% confidence interval [CI], 36-55.8) months and progression-free survival (PFS) was 19.5 (15.3-23.6) months. Long-term survival was significantly predicted by R0 resection (complete cytoreduction with no macroscopic residual disease) and PFS >20 months while prolonged PFS was influenced by age ≤55 years and R0 resection. For the R0 resection group, patients who underwent PCS had better overall survival in comparison with ICS [72.1(25.2-119) months vs 47.4 (34.9-59.9)months] on 10 years follow-up but was not significant statistically. Patients with age ≤55 years, R0 resection, PFS >20 months have a better 10-year survival outcome. Among R0 resection, patients undergoing PCS have clinically a better outcome on 10-year follow-up.

Intraperitoneal dissemination of primary dedifferentiated liposarcoma of omentum simulating an ovarian cancer – A case report

Dedifferentiated Liposarcoma (DDLPS) is a rare subtype of liposarcoma with a high preponderance of local recurrence and distant metastasis. The frequent site of DDLPS is the retroperitoneum, followed by the limbs and trunk. The primary omental DDLPS is very rare and only a few cases have been reported in the literature. Here we report a rare case of primary giant DDLPS of omentum with intraperitoneal metastasis in a 61year old woman. The present case report adds to our knowledge, that a case of intraperitoneal DDLPS can mimic ovarian cancer clinically and should be considered in the differential diagnosis of a pelvic mass in postmenopausal women.

Diagnostic dilemma in hyperechoic breast masses

Hyperechoic breast lesions are relatively uncommon, constituting only 0.6–6% of all breast masses and 0.6% of all biopsied lesions. The majority of these lesions are benign. There are rare malignancies that can present as hyperechoic masses and careful ultrasonographic assessment must be employed to avoid misdiagnosis.[1] We discuss the case of a 67-year-old female patient with a strong family history of breast and ovarian cancer, who presented with one such rare breast cancer in a hyperechoic mass.

MCQs on “Feasibility, uptake and real-life challenges of a rural cervical and breast cancer screening program in Vellore, Tamil Nadu, South India”

Screening for cervical cancer in HIV-infected women: A review of literature

Globally, the cervical cancer burden is huge, more so in low-resource countries. Human immunodeficiency virus (HIV) infection increases a woman's risk of human papillomavirus (HPV) infection and cervical cancer. There is a lack of opportunistic, as well as, organized cervical cancer screening structure for HIV-positive women. A large proportion of women have invasive cervical cancer as their initial acquired immune deficiency syndrome (AIDS)-defining illness. There is an especially high-incidence in countries where there are no organized cervical cancer prevention programs. Additionally, there are cultural, social, psychological, and system barriers that women living with HIV have to overcome when accessing healthcare services. We believe that educating women and healthcare providers regarding the need for screening, early detection, and treatment is as important as bringing about a systematic change in healthcare services to improve participation of HIV-positive women in screening for cervical cancer.

Feasibility, uptake and real-life challenges of a rural cervical and breast cancer screening program in Vellore, Tamil Nadu, South India

Early detection of breast and cervical cancer by organized screening has been found to reduce mortality rates in trials, but documentation of programme results and challenges is rarely done from non-trial settings. This study reports results of a population-based cancer control programme in a rural block in Vellore, Tamil Nadu, population size (116,085), targeting a population of 18,490 women aged 25-60 years, between November 2014 and March 2018. Village-based health education sessions were conducted by social workers, using trained volunteers and health workers to motivate eligible women. Screening was done at a secondary level hospital, by trained general physicians using visual inspection with acetic acid and clinical breast examination, followed by colposcopy, radiological imaging (breast) and biopsy as required. A total of 8 volunteers and 17 health workers motivated women for 93 health education and screening sessions, in 46 out of 82 villages. While 1,890/18,490 (10.2 per cent) were screened for breast cancer, 1,783 (9.6 per cent) were screened for cervical cancer, with a yield of 3.4/1,000 for cervical pre-cancer/cancer. The main challenges were creating time for screening activities in a busy secondary hospital and difficulty in ensuring treatment completion of screen-detected cases. Population-based cancer screening programs can be offered by secondary hospitals that also run primary care services, to increase screening rates. Clear referral systems need to be established, bearing in mind that social factors, especially poor family support, may pose a threat to treatment, in spite of easy availability of cure.

Evaluating the feasibility of utilizing Gynocular-triage-to-diagnose application with VIA (Visual inspection with Acetic acid) in community cervical cancer screening programs in rural Mysore, India

Cervical cancer is the third most common cancer among women in India. The aim of the study is to determine the feasibility of using the Gynocular-triage-to-diagnose (Gynocular T2D/GT2D) in conjunction with visual inspection with acetic acid (VIA) in community-based cervical cancer screening programs in rural Mysore, India. Between November 2015 and August 2016, the Public Health Research Institute of India (PHRII) implemented a mobile cervical cancer-screening in Mysore district using VIA and GT2D. Women underwent speculum exams and VIA positive cases were identified. Swede score was assessed using GT2D and a score >4 indicated further monitoring or referral for treatment. Papanicolaou (Pap) smears were conducted for selected cases. Statistical analysis was performed using Chi-square and Fisher's exact tests. Among 199 women registered in the camp, 176 were included in the final analysis. 23 women were excluded due to vaginal bleeding. The average age of women was 39 years (range = 27-59 years). Among the 176 cases, 38 (21.6%) were VIA positive and 138 (78.4%) were VIA negative. Swede score of >4 was observed in 6 VIA positive and 7 VIA negative women. Two cases among VIA negative with a score of >4 were suggested biopsy. Gynocular triaging prevented overtreatment of 32 (18.1%) participants, and identified 7 subjects with >4 Swede score even in VIA negative cases, which would have been ignored if VIA alone was used. In summary, our study demonstrates that Gynocular triaging is feasible in community cervical cancer screening programs.

Effect of educational intervention on knowledge of HPV and HPV vaccine and vaccine acceptability among teachers: A pilot investigation

Abstract Background: Human papillomavirus (HPV) is a leading cause of cancer worldwide. In India, cancer of the cervix is ranked as the second and the first most frequent cancer for women in the state of Himachal Pradesh. The HPV vaccine has the potential to prevent cancers, but vaccine uptake has been low in India due to a lack of awareness, cultural acceptance, and non inclusion in the national immunization program. With the introduction of the indigenous vaccine, ‘Cervavac’, by the Government of India, a school based intervention can prove to be a cost effective and successful strategy in promoting the uptake of the HPV vaccine. Methods: The current pilot study aimed to determine the impact of an educational intervention on HPV and HPV vaccine knowledge and the acceptability of the HPV vaccine among teachers who are parents of children aged 9 19 years in Shimla, a town in the North Western Himalayas. Twenty three teachers’ participated in the pilot intervention. A paired ‘t’ test was used to find out the difference in HPV and HPV vaccine knowledge and HPV vaccine acceptability in pre and post intervention conditions. Results: The results revealed that there was a significant increase in knowledge of HPV (t = 6.97), knowledge of vaccine, and an increase in the acceptability in general (t = 2.78), HPV vaccination knowledge (t = 6.99), and HPV vaccine acceptability (t = 11.76) scores among the participants. Conclusion: This study highlights the importance of HPV knowledge and awareness in improving vaccine acceptability, suggesting a tailored approach that engages the target population in vaccination decisions to augment uptake.

Successful treatment of a patient with recurrent metastatic clear cell carcinoma of the uterine cervix

Clear cell carcinoma (CCC) of the uterine cervix is a rare gynecologic cancer that accounts for 4–9% of adenocarcinoma of the uterine cervix. Two types of uterine cervical CCCs are known: A type that is associated with in utero exposure to diethylstilbestrol (DES) and idiopathic type that is unrelated to DES exposure. Due to its rare incidence, the clinical behavior and pathological characteristics of CCCs are not fully described and treatment recommendations are not standardized. Moreover, only a few cases are reported on the recurrent metastatic CCCs and the results of various treatment trials are inconsistent. We present a case of successfully treated idiopathic metastatic CCC of the uterine cervix that recurred after concurrent chemoradiotherapy.

Leiomyomatosis peritonealis disseminata associated with large uterine myoma without history of surgery: A case report and review of literature

Abstract Leiomyomatosis peritonealis disseminata (LPD) is a rare benign disease characterized by multiple smooth muscle nodules disseminated on the omental and peritoneal surfaces. Its pathogenesis remains unknown. Parasitic LPD is thought to result from uterine myoma surgery and myoma morcellation. Here, we report the first case of LPD associated with a large uterine myoma without a history of surgery. A 47-year-old woman presented with abdominal distension and a palpable abdominal mass at an outpatient clinic. During surgery, a myoma of approximately 30 cm and multifocal myofibroblastic tissue spreading on the omentum, which was compressed by uterine myoma, were observed. The patient underwent a total hysterectomy and omental resection. The pathological examination confirmed the diagnosis of LPD. This report reveals that LPD can be detected in a patient with a large uterine myoma that developed in a nulligravida woman who was not administered exogenous hormones and had no history of uterine surgery. Therefore, we should examine the intraperitoneal cavity closely to identify LPD during large myoma surgeries.

Evaluation of acute hematological toxicity by machine learning in gynecologic cancers using postoperative radiotherapy

Background: The aim of the study is to investigate the factors affecting acute hematologic toxicity (HT) in the adjuvant radiotherapy (RT) of gynecologic cancers by machine learning. Methods: Between January 2015 and September 2018, 121 patients with endometrium and cervical cancer who underwent adjuvant RT with volumetric-modulated arc therapy (VMAT) were evaluated. The relationship between patient and treatment characteristics and acute HT was investigated using machine learning techniques, namely Logistic Regression, XGBoost, Artificial Neural Network, Random Forest, Naive Bayes, Support Vector Machine (SVM), and Gaussian Naive Bayes (GaussianNB) algorithms. Results: No HT was observed in 11 cases (9.1%) and at least one grade of HT was observed in 110 cases. There were 55 (45.5%) cases with ≤grade 2 HT (mild HT) and 66 (54.5%) cases with grade ≥3 HT (severe HT). None of the patients developed grade 5 HT. Of 24 variables that could affect acute HT, nine were determined as important variables. According to the results, the best machine learning technique for acute HT estimation was SVM (accuracy 70%, area under curve (AUC): 0.65, sensitivity 71.4%, specificity 66.6%). Parameters affecting hematologic toxicity were evaluated also by classical statistical methods and there was a statistically significant relationship between age, RT, and bone marrow (BM) maximum dose. Conclusion: It is important to predict the patients who will develop acute HT in order to minimize the side effects of treatment. If these cases can be identified in advance, toxicity rates can be reduced by taking necessary precautions. These cases can be predicted with machine learning algorithms.

Referral mechanism and beneficiary adherence in cervical cancer screening program in Tiruchirappalli district, Tamil Nadu state, India, 2012–2015

Background: A screening program for cervical cancer was established in 2011 in Tamil Nadu. Since the inception of the program, coverage, and dropout of screening has not been analyzed. We conducted a study to describe the referral mechanism in the cervical cancer screening program implemented in Tamil Nadu, to estimate the level of adherence to the referral process by the beneficiaries, and to identify strengths and weaknesses related to the referral mechanism in the program. Methods: This descriptive study was conducted during 2015–2016 in the Tiruchirappalli administrative district of Tamil Nadu. All women aged 30 years and above, who were screened in public health facilities, were the participants. Using a structured form, we collected the data maintained in the registers at the district health administration. We estimated the screening coverage, follow-up evaluation, and dropout rates at different stages of the referral mechanism. We used SPSS and Epi Info software for analysis. Results: Coverage of cervical cancer screening was 4,838(41.6%). We estimated 4,838(41.6%) of screened positives were lost to follow-up for a colposcopy examination. Biopsy samples were obtained from 3425(84%) of those who required a biopsy. Cervical cancer was diagnosed in 159(4.6%) and precancerous lesions in 528(15.4%) women. Conclusion: More than half of the target population was screened in public health facilities. The dropout rate was less than half of those screened at the colposcopy evaluation level. Major pitfalls of the program were human resource issues at referral centers and poor maintenance of meaningful data.

Factors influencing women to participate in cervical cancer screening by providing menstrual pads

Background: India accounts for a quarter of the world cervical cancer burden. Cervical cancer is highly preventable. However, low level of participating women in screening is one of the major issues. The aim of this work was to study the factors that influence women to participate in cervical cancer screening by providing menstrual pads for human papillomavirus (HPV) testing. Methods: Menstrual clothes were collected from two different populations from the rural areas of Maharashtra state for HPV testing to screen for cervical cancer. For this study, out of 945 participated women, 557 (58.9%) provided their menstrual pads. Multivariate logistic regression was applied to calculate the odds ratio (OR) and 95% confidence interval (95% CI). Results: The probability of providing the menstrual pads was high among the women who were highly educated compared to those with less education (OR: 1.4; 95% CI: 1.0–1.9), having mobile phone facilities as compared to those with no mobile phones (OR: 1.4; 95% CI: 1.0–2.0), who were using new cloths as menstrual pads compared to those who did not use the same (OR: 8.5; 95% CI: 5.0–14.3), who did not have tobacco habit as compared to those who had tobacco habit (OR: 1.4; 95% CI: 1.1–1.9) and in the village where health worker was stationed as compared to the village where health worker was not stationed (OR: 1.8; 95% CI: 1.4–2.5). Conclusion: Factors including health worker availability, using mobile phones for communication and high education level facilitate women’s participation. To improve the participation, there is need to apply special strategies for older age group, less educated women and women having tobacco habit.

Association of p73 G4C14-A4T14 and p53 codon 72 polymorphism with cervical cancer in Chinese population

Background: Cervical cancer is known to be the fourth most common cancer among women globally. In various factors, genetic factors have been considered as one major risk factor for cervical cancer. The research of genetic susceptibility to cervical cancer can be greatly helpful in studying the complex mechanism. This study was conducted to identify whether polymorphic variants of p73 G4C14-A4T14 and tumor protein p53 (p53) codon 72, either independently or jointly, might be associated with the risk of cervical cancer. Methods: The genotypes of p73 G4C14-A4T14 and p53 codon 72 polymorphisms of peripheral blood DNA from 190 cervical cancer patients and 210 controls were investigated using polymerase chain reaction with confronting two-pair primers and polymerase chain reaction-restriction fragment length polymorphism, respectively. Results: The frequency of p73 G4C14-A4T14 AT/AT (P = 0.013) or p53 codon 72 GG (P = 0.026) genotype was associated with an increased risk of cervical cancer by comparing with the p73 G4C14-A4T14 GC/GC or p53 codon 72 CC genotype, respectively. In addition, the interaction between the p73 G4C14-A4T14 and p53 codon 72 polymorphisms increased the risk of cervical cancer in a multiply manner, with the odds ratio being 3.692 (95% confidence interval =2.106-6.473) for subjects carrying both p73 G4C14-A4T14 GC/AT+AT/AT and p53 codon 72 GG genotypes. Conclusion: These results suggest that there is a statistical difference between p73 and p53 gene polymorphism and the risk of cervical cancer in Chinese women, and there is a potential gene-gene interaction in the incidence of cervical cancer.

Prevalence and determinants of breast and cervical cancer screening among women aged between 30 and 49 years in India: Secondary data analysis of National Family Health Survey – 4

Background: Breast and cervical cancers are the two leading causes of cancer-related morbidity and mortality in India. Early diagnosis of these cancers through screening offers the best chance to achieve successful treatment outcomes. Hence, the current study was done to determine the prevalence and predictors of breast and cervical cancer screening among women aged 30-49 years in India. Methods: We have analyzed the most recent National Family Health Survey-4 data (NFHS-4) gathered from Demographic Health Survey program. Stratification and clustering in the sample design were accounted using svyset command. Adjusted prevalence ratio (aPR) with 95% confidence interval (CI) was reported. Results: In total, 336,777 women aged 30-49 years were included. Proportion of women aged 30-49 years with history of breast cancer examination in their lifetime was 12.9% (95% CI: 12.6-13.2%), while it was 29.8% (95% CI: 29.3-30.3%) for cervical cancer. It was found that women aged 45-49 years (aPR=1.09), married (aPR=2.18), higher educational level (aPR=1.28), richest quantile (aPR=1.96), no history of pill use (aPR=1.24), obese (aPR=1.06), and healthy dietary habits (aPR=1.47) were more likely to be screened for breast cancer. Predictors for cervical cancer screening were higher age group (aPR=1.06), married (aPR=2.94), secondary educational level (aPR=1.05), richest quantile (aPR=2.24), nonpill user (aPR=1.24), nontobacco user (aPR=1.07), and lower parity (aPR=1.09). Conclusion: A total of 1 out of 10 women in reproductive age group were screened for breast cancer while less than one in three for cervical cancer. Hence, it is important to spread awareness and increase access to screening services to achieve early diagnosis and better treatment outcomes.

Risk factors and prevalence of cervical squamous intraepithelial lesions among women in south India: A community-based cross-sectional study

Background: Cervical cancer in India accounts for one-fifth of the global burden. Well-defined precancerous stages help early detection of the disease. Apart from human papillomavirus, the risk factors include age, education, occupation, early age at marriage and first delivery, abortions, and multiple sexual partners. Prevalence and risk factors for cervical squamous intraepithelial lesions (SIL) among women by Pap smear screening in south India were analyzed through a cross-sectional study. Methods: Women from rural and urban area were motivated by local accredited social health activists to attend pre-fixed Pap smear clinics in government hospitals. Pap smears collected in these clinics were taken to the Regional Cancer Centre, Thiruvananthapuram, processed, and cytology reports were prepared. Multiple logistic regression analysis was used to identify risk factors for SIL and high-grade SIL (HSIL). Results: The number of SIL was 67 out of 10,580 and HSIL was 39. Having higher education (Odds Ratio, OR:0.05(95% Confidence Interval, CI: 0.01-0.2), being married but living single (OR : 5.3, 95%CI:2.4-11.5), Having >2 abortions (OR:21, 95% CI:4.5-24), having younger age at delivery (OR : 0.1, 95% CI:0.01-0.3) and having unhealthy cervix (OR: 16.4, 95% CI:6.2-42.7) were the factors found to be the associated risk factors in multiple regression analysis. Conclusion: Pap smear screening can be focused on women with risk factors such as low education, married but living single, having >2 abortions, younger age at delivery, and unhealthy cervix on per speculum examination.

Evaluation of factors influencing lymph node metastasis in endometrial cancers: A retrospective study

Abstract Objectives: The role of lymphadenectomy in the management of early endometrial cancer remains controversial. The aim of our study was to evaluate risk factors associated with nodal metastases in endometrial cancer and to devise a predictive risk model based on the significant risk factors in predicting node metastasis. Materials and Methods: A retrospective study was conducted on women diagnosed with uterus-confined endometrial cancer, and who underwent surgical staging with pelvic and/or paraaortic lymphadenectomy from our center during July 1, 2017 to June 30, 2019. Clinical details, Magnetic Resonance imaging (MRI)-detected myometrial invasion, and pre and post-operative histological details of tumor were correlated with pelvic and/or para-aortic lymph node metastasis. Risk factors were assessed using logistic regression model and risk models devised. Results: 128 patients were included in the study. Paraaortic lymphadenectomy was done in 72.7% patients. Nodal metastasis was seen in 14.8% of patients. Logistic regression analyses revealed lymphovascular invasion (P = 0.002), parametrial involvement (P = 0.017) and nonendometrioid histology (P = 0.004) to be significant risk factors. Tumor size >2 cm, grade 3 and deep myometrial invasion had higher risk for nodal metastasis, although non-significant. Risk models were derived with sensitivity of 79–89.5%, specificity of 58.7–69.7%, Negative predictive value (NPV) of 95–97% and accuracy of 63–71%. Conclusion: Lymphovascular invasion, nonendometrioid histology and parametrial involvement are independent predictors of lymph node metastasis in endometrial cancer. Risk models using these risk factors can better predict the risk of nodal metastasis and thus avoid lymph node dissection in low risk patients. Our risk models had reasonably good sensitivity in nodal metastasis prediction and require further validation.

Association of molecular subgroups with pathological parameters in endometrial carcinomas

Background: The integration of molecular features into the already existing pathological classification of endometrial carcinomas will offer significant prognostic information. As the literature search reveals, there are no studies from India that have classified these carcinomas based on molecular subtypes. The aim of the study was to classify endometrial carcinomas into four subtypes based on their molecular and immunohistochemical features and to find out the association of each of these molecular subtypes with the other pathological parameters. Methods: A prospective study was done on 37 consecutive cases of fresh hysterectomy specimens, biopsy-proven as endometrial carcinomas between November 2019 and August 2020. Three immunohistochemical markers (p53, mismatch repair proteins, MutS homolog6 and Postmeiotic seggregation 2 respectively[MSH6, and PMS2]), along with DNA (deoxyribonucleic acid) sequencing of selected regions of the POLE gene was performed in each of the 37 cases. Endometrial carcinomas were subclassified into four subtypes, and the association of each of these four subtypes with the other pathological parameters was also explored. Statistical analysis was done using the IBM Statistical Package for the Social Science (SPSS) Version 20.0 software (IBM SPSS, USA). Results: Among the 37 cases studied, eight (21.6%) cases were p53 abnormal, eight (21.6%) cases showed MMR-D (mismatch repair deficient), one case (2.7%) showed mutation of POLE, and 21 cases (56.8%) were assembled under p53 wild-type. Higher grade endometrial carcinomas showed more (80.0%) p53 abnormal (P < 0.001). All the p53 wild-type (100%) were of Type 1 endometrial carcinoma subtype (P = 0.001) and low-grade type (90.5%; P = 0.005). Conclusion: Our study confirms that the type of carcinoma and grade correlates with p53 expression, p53 abnormal being associated with higher grade and type 2 endometrial carcinomas, whereas p53 wild-type is associated with low-grade and type 1 endometrial carcinoma. There was only one case of the POLE subtype identifiable in our study.

Primary retroperitoneal serous adenocarcinoma: A case report of rare malignancy with literature review

The primary retroperitoneal serous adenocarcinoma (PRSAC) is a rare malignant tumor of the retroperitoneum. It shares the same pathological and biological behavior with ovarian serous carcinoma. Most of the cases develop as peritoneal adenocarcinoma and rarely occur in the retroperitoneum. It is reported as serous surface papillary carcinoma of the peritoneum and extraovarian peritoneal serous papillary carcinoma. We present a case of PRSAC in a 60-year-old woman. Only 11 cases of PRSAC have been reported from 1983 to 2019. Histopathological features with immunohistochemical expressions are important to diagnose PRSAC. The outcome and survival mainly depend on the possibility of surgical resection. Molecular genetics of PRSAC should also be studied in relation with its ovarian counterpart.

BRCA mutations

Ovarian cancer (OC) is one of the most lethal gynecological cancers with a 5-year survival rate that ranges from 30% to 40%. Breast cancer genes (BRCA1 and BRCA2) play a key role in maintaining genomic stability. Mutations in BRCA1/2 genes lead to the accumulation of double-strand breaks, resulting in tumorigenesis. The risk of developing OC in women with BRCA1 and BRCA2 mutations is 39% and 11%, respectively, by 70 years of age. BRCA1/2 mutation testing is thus important to identify women at greatest risk of developing OC in addition to its impact on diagnosis, prognosis, and targeted therapy. Genetic testing is required to identify the BRCA mutations and thus select patients who can benefit from polyadenosine diphosphate (ADP)–ribose polymerase (PARP) inhibitor therapy. Tumor BRCA mutation testing can detect both germline and somatic mutations allowing implementation of preventive strategies on a broader population. Various international guidelines recommend BRCA1/2 mutation genetic testing in all OC patients irrespective of age and family history. This review focuses on the role of BRCA mutation testing in OC.

Bartholin’s gland adenoid cystic carcinoma: Report of three cases and the review of literature

The adenoid cystic carcinoma (ACC) of Bartholin’s gland is a very rare tumor that usually grows aggressively due to perineural invasion. Although there is no guideline for the treatment due to the small number of patients, the primary treatment is considered as surgery. Adjuvant radiotherapy has also been shown to be beneficial. Three cases, which were histopathologically confirmed as ACC of Bartholin’s gland and received adjuvant radiotherapy treatment, were presented in this study.

Role of Serine arginine protein kinase 1 and Minichromosome maintenance protein 2 in predicting epithelial ovarian cancer response to treatment and prognosis

Abstract Background: Serine-Arginine (SR) proteins are a conserved family of proteins involved in RNA splicing and are reported to be over-expressed in multiple cancers. The aim of the study is evaluation of the expression of Serine arginine protein kinase 1 (SRPK1) and Minichromosome maintenance protein 2 (MCM2) in epithelial ovarian cancer (EOC) and their correlation with clinicopathological features, response to therapy, progression-free survival (PFS), and cancer-specific survival (CSS). Methods: This study was carried out on surgical specimens of 65 patients diagnosed with EOC which were submitted to immunohistochemical staining by SRPK1 and MCM2 antibodies. Results: About 89.2% of cases showed SRPK1 expression and its high expression was significantly associated with type II tumors and advanced stage. All cases showed nuclear immunoreaction for MCM2 with high expression in 49.2% of cases. There was a significant relationship between high values of SRPK1 H-score and percentage of MCM2. Postmenopause, type II pathology, advanced stage, absence of complete response to the treatment, resistance to platinum-based chemotherapy, and surgery done by a general surgeon were the factors affecting PFS. Response to treatment and platinum sensitivity were the most independent factors affecting patients’ PFS. The factors associated with shorter CSS were suboptimal debulking, advanced stage, absence of complete response to the treatment, platinum resistance, and high SRPK1. High SRPK1 expression and platinum sensitivity were the independent factors affecting patients’ CSS. Conclusions: SRPK1 is an unfavorable biomarker in EOC patients because of its association with aggressive histologic type, advanced International Federation of Gynecology and Obstetrics (FIGO) stage, and worse survival. SRPK1 could promote the proliferation of EOC by up-regulation of MCM2.

Upfront debulking surgery or delayed surgery after neoadjuvant chemotherapy for advanced-stage epithelial ovarian cancer: Comparison of survival from a noncancer center in India

Abstract Background: In advanced-stage epithelial ovarian cancer (EOC) standard of care is upfront debulking surgery (UDS) followed by adjuvant chemotherapy. Interval debulking surgery after neoadjuvant chemotherapy (NACT-IDS) is a reasonable alternative. Methods: This study was a retrospective review of patients of Stage III/IV EOC treated either by UDS or NACT-IDS between January 2016 and December 2018 to report the comparison of progression-free survival (PFS) and overall survival (OS) of patients with advanced-stage EOC treated with either UDS or NACT-IDS. Results: Out of 50 patients, 19 (38%) underwent UDS, and 31 (62%) received NACT. The mean follow-up duration was 27.7 months. No gross residual disease was achieved in 52.6% of the UDS group and in 70.4% of the NACT-IDS group. The median PFS of 20 and 30 months was observed in the UDS and NACT-IDS groups, respectively (log-rank P = 0.054). The median OS was 36 months in the NACT-IDS group and could not be reached in the UDS group (log-rank P = 0.329). Only residual disease was significantly associated with survival (hazards ratio 3.03, 95% confidence interval: 1.19–7.74) on multivariate Cox regression analysis. Conclusions: In advanced-stage EOC, the survival outcomes of NACT-IDS are comparable with those of UDS. Apart from the patient-specific parameters, the decision for UDS or NACT-IDS should take in account the expertise of the surgeon and the institutional capacity as a whole.

Is there a role of cytoreductive surgery with HIPEC in recurrent ovarian granulosa cell tumors? An Indian cancer center experience with review of literature

Abstract Background: Granulosa cell tumors of the ovary represent the most common sex-cord stromal tumors. Though characterized by an indolent course and a good five-year survival rate, they tend to have late recurrences and subsequent poorer survival. The role of hyperthermic intraperitoneal chemotherapy (HIPEC) in women with recurrent granulosa cell tumors with peritoneal dissemination has not been well defined. Methods: All patients with adult or juvenile type granulosa cell tumors who underwent cytoreductive surgery with HIPEC with 70 mg/m2 of cisplatin for 60 minutes over a period of four years were retrospectively evaluated. We also performed a review of the literature on similar cases reported. Results: We identified eight patients with recurrent adult granulosa cell tumors (AGCT) who fulfilled our inclusion criteria. The mean operative duration was 340 minutes, inclusive of the duration of HIPEC. Fifty percent of patients suffered from postoperative morbidity. Grade 4 morbidity was observed in one patient. At a median follow-up of 35 months, four patients experienced disease recurrence. The median disease-free survival was 10 months (range: 6–31 months) and the median overall survival was 11.5 months (range: 7–40 months). Conclusion: Cytoreductive surgery (CRS) and HIPEC provides a unique opportunity for treating peritoneal dissemination in patients with recurrent ovarian AGCTs. This procedure is well tolerated with acceptable morbidity. Prospective studies are warranted to further elucidate the efficacy of this novel therapeutic approach in recurrent ovarian granulosa cell tumors.

Pilot study on inguinofemoral lymphadenectomy by sealing device – Ilsede study

Abstract Objective: Our objective was to evaluate the impact of the use of a sealing device during inguinofemoral lymphadenectomy on the reduction of postoperative complications. Methods: A single-institution, prospective, nonrandomized study was carried out. Fifteen patients with vulvar cancer underwent wide excision and inguinal lymphadenectomy between May 2017 and April 2019. Five patients underwent lymphadenectomy with a bipolar sealing device, whereas the remaining 10 patients received the standard procedure. Postoperative complications including wound infection, seroma, and lymphedema were selected as the primary outcome. Results: Patients who underwent surgery using a sealing device showed significantly lower wound infection rate (0 cases, 0%) compared with patients who underwent the standard procedure (7 cases, 70%; P = 0.026). Incidence of seroma and lymphedema did not show statistically significant differences between groups. Conclusions: The use of a sealing device to perform the inguinofemoral lymphadenectomy in vulvar cancer could reduce the rate of wound infection compared with the standard procedure.

High-risk human papillomavirus infection among women with atypical squamous cells of undetermined significance in Pap smear: A seven-year follow-up study in South India

Abstract Background: Well-defined pre-cancerous stages help early detection of uterine cervical cancer by Pap smear or human papillomavirus (HPV) analysis. HPV induces atypical squamous cells of undetermined significance (ASCUS) which can progress to higher grade lesions depending on persistence of infection with High-risk human papillomavirus (HrHPV). The HrHPV prevalence and persistence after 18–36 months, associated risk factors for persistence among women with ASCUS, and the effect of persisting HrHPV in the cytological progression upto a period of seven years are analyzed. Methods: In the routine Pap smear clinic of a Women and Children Hospital, women who had ASCUS in Pap smear in 2009–2011 were the sample for the study. A sample of 152 women with ASCUS in Pap smear, were subjected for HrHPV (16, 18, 31, 33 and 42) analysis. These women were invited for a repeat Pap smear and HrHPV analysis after 18 months. Women with HrHPV in both the rounds were advised to come for yearly routine follow-up Pap smear upto seven years. Results: The HrHPV prevalence was 46%, HrHPV persistence within 18–36 months was 60.8% and clearance was 39%. Among many risk factors for HrHPV persistence in univariate analysis, having more than two pregnancies and unhealthy appearing cervix were significant in multivariate analysis. 94% of the women with persistent ASCUS or higher lesion within seven years were initially persistent HrHPV positives. Conclusion: Since persistence of HrHPV in the cervix at least for 2 years helps in the persistence or progression of ASCUS even after seven years, routine HPV analysis should be done for women with ASCUS cytology, and who have high parity and unhealthy cervix. These women should be closely followed up to identify the progression to higher grade lesions.

Rare complication of chylous ascites following surgery and radiotherapy in endometrial carcinoma managed by diet modification: Case report

Abstract Chylous ascites is an uncommon complication seen in gynecological malignancies. The incidence of postoperative chylous ascites in gynecological malignancies is 0.17%. It is the extravasation of milky chyle into the peritoneal cavity due to lymphatic obstruction or injury and is diagnosed by the detection of triglyceride levels greater than 200 mg/dl in ascitic fluid. The site of leakage can be determined by lymphangiography or lymphoscintigraphy. The majority of the cases of chylous ascites can be treated by conservative methods, such as a dietary modification to a low-fat high-protein diet, bowel rest, total parenteral nutrition, medications, and large-volume paracentesis. If these measures fail, surgical modalities such as laparotomy or peritoneovenous shunting are employed. In our case, the patient was successfully managed on dietary modification alone. This case report emphasizes the importance of conservative management for chylous ascites following surgery and radiotherapy in endometrial carcinoma.

Screening for cervical and breast cancer among community health care workers (ASHAs) of Puri district, Odisha

Abstract Background: Breast cancer and cervical cancer are the leading causes of cancer-related mortality in Indian women. As part of the Indian national guidelines for population-based cancer screening, village-level accredited social health activists (ASHAs) are the key mobilizers for encouraging women to undergo cervical and breast cancer screening. Assessing screening rates in these health workers themselves, can improve implementation of the national program by identifying some of the facilitators and barriers for screening. Methods: A cross-sectional study was conducted among ASHAs in Puri, Odisha, in eight primary health centers (PHCs) randomly selected from 10 blocks. Of all 291 ASHAs in these PHCs, 242 (83.2%) who consented, were given a self-administered questionnaire to assess screening and its associated factors. Results: The screening rates for cervical and breast screening in ASHA workers were 9.1% (95% CI: 5.4%–12.8%, 22/242) and 14.9% (95% CI: 10.3%–19.5%, 36/242), respectively. Having undergone screening themselves, was associated with referring others for screening (83.3% of those screened for breast cancer had referred others vs 37.4% of those never screened; 86.4% of those screened for cervical cancer had referred others vs 34.1% of those never screened). Conclusions: ASHAs reported low rates of screening for breast and cervical cancer. History of screening significantly influenced the referral of others for screening. ASHAs need to be empowered with both educational exposure as well as motivation for health-promoting activities for themselves, in order to increase population-wide screening coverage.

Factor structure of the brief COPE in spouses of women with gynecological cancer

Abstract Objective: The purpose of the current study was to verify the factor structure of the Brief Coping Orientation to Problems Experienced (Brief COPE) inventory among spouses of women with gynecological cancer. Design: A descriptive study was conducted involving 351 spouses of gynecological cancer patients admitted to a hospital. Setting: Gynecological ward of a tertiary hospital of China. Main Outcome Measure: Confirmatory factor analysis and exploratory factor analysis were performed to test the factor structure of Brief COPE among participants. Results: The results showed that the soundness of data fitting three previous models of spouse caregivers were poor. A new three-factor structure was identified: avoidant coping (12 items), active coping (8 items), and seeking support (4 items), with four original items dropped. Conclusion: The findings suggest that the new three-factor structure has good construct validity, which can be used to measure the coping strategies of spouses of women with gynecological cancer.

A review on mechanisms of resistance to PARP inhibitors

Standard therapy for advanced ovarian cancer (OC) consists of radical debulking cytoreductive surgery followed by adjuvant chemotherapy. An important risk factor for OC is genetic predisposition, with BRCA1 or BRCA2 mutations accounting for the majority of hereditary OC. Mutation in BRCA ultimately causes accumulation of genetic alterations because of the failure of cells to arrest and repair DNA damage or to undergo apoptosis, resulting in tumorigenesis. Poly (ADP-ribose) polymerase (PARP) inhibitors have emerged as a promising approach for managing BRCA-associated cancers, especially high-grade OC and breast cancers. They lead to synthetic lethality in BRCA-mutated cells by stalling the replication forks in homologous recombination-deficient (HR) cells. Four PARP inhibitors (olaparib, niraparib, rucaparib, and talazoparib) are currently approved by the Food and Drug Administration for OC, breast, and pancreatic cancer indications and are being evaluated for other BRCA-associated cancers. Despite their clinical efficacy, cancer cells generally develop resistance to them through several mechanisms. Understanding these mechanisms is crucial for developing strategies to counter resistance and identify the basic mechanisms of DNA damage response. This review focuses on the mechanism of action of PARP inhibitors, understanding various causes of resistance, and building strategies to overcome PARP inhibitor resistance.

Quality of life in long term survivors of cervical cancer: A cross sectional study

Quality of life (QOL) is an important parameter to evaluate and modify in patients treated for cervical cancer as long-term survival is excellent in early-stage and reasonably good in locally advanced stage compared to other solid cancers. The aim of the study was the cross sectional evaluation of the quality of life in survivors completing at least 3 years of follow-up after curative therapy for cervical cancer at a tertiary cancer institute. All patients, following primary curative treatment with no evidence of recurrence and completing at least 3 years follow-up, were assessed for QOL using the European Organization for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire (QLQ)-30 and its cervical cancer module (Cx24). Patients were subdivided based on the modality of treatment. Analysis was done using Kruskal-Wallis and Mann-Whitney U test. One hundred seven patients were analyzed out of the 113 patients initially included. Treated patients showed good global QOL (mean value: 84.07) and functional scores (covering all domains). In the cervical cancer module, sexual activity, sexual enjoyment, and sexual function were low in the majority of the respondents. Chronic lymphedema, symptom experience, and sexual worry were significant across all the treatment arms. Cervical cancer survivors have an overall good QOL. However, certain concerns related to the sexual quality of life, symptom experience, and chronic lymphedema need to be addressed appropriately.

Outcomes of locally advanced cervical cancer presenting with obstructive uropathy: An institutional audit

There is paucity of outcome data of patients with cervical cancer presenting with malignant obstructive uropathy. The present retrospective study describes outcomes of patients with cervical cancer who presented with obstructive uropathy at the time of diagnosis and underwent urinary diversion with percutaneous nephrostomy (PCN) before/during treatment. Patients who underwent PCN from January 2010 to June 2015 were included. Intent of treatment (radical or palliative) was decided within multidisciplinary team depending on disease stage, Karnofsky performance status (KPS), and degree of renal derangement. Treatment and outcome details were retrieved from electronic records. Time to normalization of creatinine, feasibility of delivering planned treatment, and overall survival (OS) were determined. Impact of various prognostic factors on outcomes was determined using univariate or multivariate analysis. After PCN and double-J stenting, 50% were eligible for (chemo) radiation. All radically treated patients (26/52) received brachytherapy. The median EQD2 to point A was 78 Gy (72-84 Gy). The median OS was 10 (0.5-60) months. Patients who completed chemoradiation had median OS of 31 months. Those receiving radical radiation and palliative radiation had median OS of 11 and 6 months, respectively. On univariate analysis, smaller tumor size (p = 0.03), high KPS (P = 0.04), and radical intent of treatment (P = 0.05) predicted for OS. Patients presenting with obstructive uropathy have median OS less than a year despite urinary diversion. Select cohort with good performance status, small tumor size, and serum creatinine of ≤3 mg/dL may be selected for diversion procedures and potential radical treatment.

Comparison of thermoplastic masks and knee wedge as immobilization devices for image-guided pelvic radiation therapy using Cone Beam Computed Tomography

Pelvic radiotherapy is generally performed with the use of an immobilization and positioning device. The objective of the study was to ascertain and compare setup errors between the two positioning devices. A total of 35 patients of stage II and III cervical cancers were enrolled in the study and divided into two groups, one using knee wedge and the other using thermoplastic pelvic mask as an immobilization device. Radiation was planned by four field box conformal technique. The random and systematic setup errors were then calculated for each patient in both the groups in the mediolateral (ML), superoinferior (SI), and anteroposterior (AP) directions. The translational mean setup variation in the lateral, longitudinal, and vertical direction is 0.17 ± 0.24, -0.12 ± 0.48, and -0.18 ± 0.27 cm for thermoplastic pelvic mask and -0.03 ± 0.26, -0.04 ± 0.48, and -0.09 ± 0.37 cm for knee wedge, respectively. The systematic setup error and random errors were 0.24, 0.48, 0.27 cm and 0.31, 0.60, and 0.40 cm for thermoplastic mask and 0.26, 0.48, and 0.37 cm and 0.38, 0.37, and 0.45 cm for knee wedge in ML, SI, and AP axis, respectively. The one way analysis of variance test was applied to compare the setup errors in between the three axes for both the immobilization devices. To compare the positioning accuracy of thermoplastic mask and knee wedge, Student's t-test was applied. Both the tests were found to be insignificant (P value > 0.05). Thermoplastic mask and knee wedge are equally effective as immobilization devices for treating cervical cancers with conformal techniques.

Para testicular cellular angiofibroma (AF)/angiomyofibroblastoma (AMF)-like tumor: A case report of a rare diagnosis in an elderly male

Cellular angiofibroma (AF)/Angiomyofibroblastoma (AMF)-like tumor is a rare benign mesenchymal neoplasm. It is very challenging to distinguish benign versus malignant mass radiologically. It is of paramount importance to distinguish Cellular Angiofibroma (CAF) microscopically from its differential diagnoses. A 64-year-old man presented with scrotal swelling. Pathological examination showed features of cellular AF/AMF- like tumor, which shows positivity for CD34, with negativity for S-100 Protein, smooth muscle actin and desmin.

Does educational-supportive program affect anxiety in women with endometrial cancer? Result from a randomized clinical trials

Following a diagnosis of cancer, distress is a common reaction. For Iranian women with endometrial cancer, treatment and survivorship can result in disabling symptoms of depression, anxiety, social, and spiritual crises. The aim of this study was to determine whether a combination of education and support intervention as a comprehensive program focusing on education, coping, and support had better short- and long-term effects on anxiety of these patients. The current randomized clinical trial was performed on a sample of 140 women with endometrial cancer. A two-part instrument was used - a demographic information form and "Beck's Anxiety" questionnaire. The intervention was an educational-supportive program in 3 weekly sessions in experimental group (N = 70), whereas control group (N = 70) received routine care. Descriptive statistics, Chi-square test, t-tests, and repeated measure analysis of variance were used to analyze data. P value less than 0.05 was considered as statistically significant. The total scores of anxiety (mean± standard deviation) was significantly lower in the experimental group immediately after intervention (8.46 ± 5.17, P < 0.001), 1 month (7.78 ± 4.59, P < 0.001) and 2 months (7.55 ± 4.55, P < 0.001) after intervention to compare with before intervention (16.82 ± 10.19). In this study, this program could decrease the anxiety in women with endometrial cancer.

Power Doppler sonography – A supplement to hysteroscopy in abnormal uterine bleeding

Background: Abnormal Uterine Bleeding (AUB) is a very frequent cause of gynecological visits in women of all age groups. Ultrasound pelvis with or without endometrial sampling have been conventionally used to make diagnosis. Power Doppler is a comparatively recent modality which can be used to screen patients who will need endometrial biopsy/ curretage. We hereby conducted a study to compare the diagnostic accuracy of power Doppler sonography and hysteroscopy with histopathology associated with abnormal uterine bleeding. We also calculated the incidence of uterine pathology in AUB by power Doppler ultrasound and hysteroscopy and compared it with histopathology. Methods: This prospective cohort study was conducted at the Department of Obstetrics and Gynaecology, Institute of Medical Sciences, Banaras Hindu University. After excluding 42 women, a total of 100 women fulfilling the inclusion criteria contributed to our study. Selected women underwent power Doppler ultrasound and hysteroscopy with guided biopsy. Results were compared with histopathology as per the gold standard. Evaluation of sensitivity, specificity, positive and negative predictive values were performed for each modality. All statistical analyses were performed using the SPSS 11.0 statistical package. P value ≤0.05 was considered statistically significant for all tests used. Results: Sensitivity and specificity of power Doppler are 75% and 100% for carcinoma endometrium, 72.72% and 98.9% for endometrial hyperplasia, and 81.81% and 100% for endometrial polyp, respectively. Conclusion : Power Doppler sonography can be used to screen outpatients who do not need an endometrial biopsy for abnormal uterine bleeding. This will avoid unnecessary hysteroscopy in definitive benign cases, and watchful hysteroscopy in suspected premalignant and malignant cases. Irregular branching vessels and color splashes were found to be the best parameters for diagnosing endometrial carcinoma. Power Doppler should be done along with transvaginal sonography in all cases of abnormal uterine bleeding.