Journal of the Egyptian National Cancer Institute

Factors influencing breast and cervical cancer screening among ever-married women aged 15–49 in Jordan: an analysis of the 2023 Jordan population and family health survey

Abstract Purpose This study sought to investigate the prevalence and sociodemographic determinants related to breast and cervical cancer screening among ever-married women aged 15 to 49 years in Jordan. Methods This research employed secondary data from the 2023 Jordan Population and Family Health Survey (JPFHS), which included 12,547 ever-married women aged 15 to 49. Weighted multivariable logistic regression analyses were conducted to quantify screening prevalence and identify related covariates, presented as adjusted odds ratios (AORs) with 95% confidence intervals (CIs). Results The prevalence of screening for breast and cervical cancer was 15.2% and 16.2%, respectively. Increased screening participation was substantially correlated with advanced age, larger home affluence, higher parity, previous sexually transmitted infections (STIs), and exposure to radio communications. Women aged 35–49 were more likely to receive breast (AOR: 4.0; 95% CI: 2.6–6.0) and cervical cancer screening (AOR: 5.5; 95% CI: 3.3–9.2) compared to those aged 15–24 years. Women in the highest wealth quintile had a greater likelihood of being screened for breast cancer (AOR: 2.1; 95% CI: 1.6–2.8) and cervical cancer (AOR: 2.6; 95% CI: 1.9–3.5). Moreover, breast cancer screening correlated with recent healthcare service consumption (AOR: 1.3; 95% CI: 1.1–1.6), while cervical cancer screening had a favorable association with elevated educational attainment (AOR: 1.6; 95% CI: 1.2–2.3). Living in rural areas was inversely correlated with cervical screening participation (AOR: 0.7; 95% CI: 0.6–1.0).  Conclusion Screening rates for breast and cervical cancer among Jordanian women are inadequate. Interventions that facilitate equitable access—especially aimed at younger, less educated, rural, and low-income women—are crucial for enhancing participation and diminishing inequities in early cancer detection.

Efficacy and safety of cytoreductive surgery combined with hyperthermic intraperitoneal chemotherapy for epithelial ovarian cancer: a systematic review and updated meta-analysis

Abstract Background The high incidence of primary and recurrent ovarian cancer after surgery imposes a significant economic burden. Cytoreductive Surgery combined with Hyperthermic Intraperitoneal Chemotherapy (CRS + HIPEC) shows promise as a treatment for epithelial ovarian cancer (EOC). This study aims to evaluate CRS + HIPEC’s potential to improve survival outcomes, such as overall survival (OS) and progression-free survival (PFS) while reducing adverse events and enhancing cost-effectiveness. Method A literature review was conducted using the PRISMA framework on databases including Scopus, ProQuest, and PubMed, with quality assessment through the Newcastle–Ottawa Scale (NOS) and Risk of Bias (RoB) 2.0. Quantitative analysis employed RevMan 5.4.1 with a pooled randomized effect model using log [hazard ratio]. Result From 15 studies involving 1982 participants, OS analysis showed significantly higher survival in the CRS + HIPEC group (HR = 0.67, p < 0.0004). Although PFS was higher in this group, the result was not statistically significant (HR = 0.86, p = 0.46). Adverse events were more likely in the intervention group compared to control group (OR = 1.81, p < 0.0001). Cost analysis revealed that the Incremental Cost-effectiveness Ratio per Quality-Adjusted Life Year (ICER/QALY) remains below Indonesia’s GDP threshold. Conclusion CRS + HIPEC shows potential benefits in EOC management, particularly in OS and PFS improvement, alongside manageable adverse events and favorable cost-effectiveness. However, study design heterogeneity, differences in HIPEC protocols, and variations in patient populations limit the generalization of outcomes. The difference in response to HIPEC between primary and recurrent EOCs still needs further explanation.

Proposed Nodal Cancer Index (NCI) in ovarian carcinomatosis

Abstract Introduction The nodal positivity in advanced ovarian cancers is approximately 68–70% histopathologically. Even after neoadjuvant chemotherapy (NACT) chance of nodal positivity is around 50–80%. In the prevailing literature, the nodal burden is a neglected entity in both assessment and documentation and complete clearance during the CRS. We aim to highlight the importance of nodal dissection and propose a Nodal Cancer Index (NCI) like PCI for ovarian cancers based on our experience of 105 cases. Materials and methods We included 105 patients with advanced ovarian cancers who underwent CRS. Retroperitoneal lymph nodes and bilateral pelvic lymph node dissection were routinely done in all the cases. For Nodal Cancer Index calculation, the abdomen is divided into 13 zones, zones 1–6 for retroperitoneum, zones 1–6 for Pelvic nodes, and zone 0 for extra-abdominal nodes. Furthermore, a Nodal size score ranging from 1 to 3 has been proposed so that the Nodal Cancer Index ranges from 13 to 39. Results The median age of the patients was 51 years (range 19–71) and the most significant patients were in stage III (65.7%), and 34.3% had stage IV disease at presentation. The lymph nodes were found to be positive in 62 patients (59%), and the positivity rate was higher in patients who underwent upfront surgery 36 (58.1%) as compared to 26 (41.9%) in those who received NACT. The majority of the patients (56.6%) had positive lymph nodes in both the pelvic and retroperitoneal groups, whereas 19.3% had only pelvic nodes positive, and 24.2% had only retroperitoneal nodes positive. The probability of overall survival at 5 years in our patients was 48.9% (95% CI = 35.5–61). Conclusion The results of our analytic observation confirm that systemic lymphadenectomy of all 13 zones proposed by our study should be an integral part of optimal CRS in the advanced carcinoma ovary and this will help us manage these advanced cases in a better objective manner.

An eleven autophagy-related genes-based prognostic signature for endometrial carcinoma

Abstract Background Endometrial cancer (EC) is a common malignant tumor in women with increasing mortality. The prognosis of EC is highly heterogeneous which needs more effective biomarkers for clinical decision. Here, we reported the effect of autophagy-related genes (ARGs) on the prognosis of EC. Methods The expression data of EC tissues and adjacent non-tumor samples were available from the TCGA dataset and 232 autophagy-related genes were from The Human Autophagy Database. A prognostic ARGs risk model was further constructed by using LASSO-Cox regression, and its prognostic and predictive value were evaluated by nomogram. Further functional analysis was conducted to reveal a significant signaling pathway. Results A total of 45 differentially expressed ARGs were obtained, including 18 upregulated and 27 downregulated genes. Eleven ARGs (BID, CAPN2, CDKN2A, DLC1, GRID2, IFNG, MYC, NRG3, P4HB, PTK6, and TP73) were finally selected to build ARGs risk. This signature could well distinguish between the high- and low-risk patients (survival analysis: P = 1.18E-10; AUC: 0.733 at 1 year, 0.795 at 3 years, and 0.823 at 5 years). Furthermore, a nomogram was plotting to predict the possibility of overall survival and suggested good value for clinical utility. Conclusion We established an eleven-ARG signature, which was probably effective in the prognostic prediction of patients with EC.

Vaginal metastasis in solid tumours: our four cases and review of the literature

Abstract Background Vaginal metastasis should be kept in mind when evaluating the staging tests of all cancers, especially endometrial cancer. Case presentation We present four patients with vaginal recurrence who recently applied to our clinic. Three cases were of endometrial cancer and one case of rectal cancer. All patients presented with vaginal bleeding. Conclusion Standard treatment for vaginal metastasis has not yet been established. Therapeutic options for vaginal metastasis—separately or in combination—are surgical resection, radiotherapy, and chemotherapy.

Systemic recurrence of endometrial cancer more than 10 years after hysterectomy: a report of two cases and a brief review of the literature

AbstractBackgroundEndometrial carcinoma is one of the most common female cancers in developed countries. Disease stage is associated with the risk of disease relapse after radical treatment. Typically, the risk of disease relapse peaks at 3 years from local radical treatment and then diminishes over time, so that late relapses (i.e., from year 5 afterward) are extremely infrequent. Here, we report two cases of women with endometrial cancer who developed a disease relapse more than 15 years after radical treatment. A review of the literature revealed other seven reports of women with relapse from endometrial cancer occurring more than 10 years after radical treatment.Case presentationCase report 1 is a 56-year-old woman with an endometrioid cancer who underwent a hysterectomy with bilateral salpingo-oophorectomy in 1998. She relapsed in the lung in 2014, 16 years from radical surgery. Case report 2, a 75-year-old woman, with an endometrioid cancer, was treated by hysterectomy with bilateral salpingo-oophorectomy and adjuvant radiotherapy. The disease relapse in the lung was detected in 2019, 22 years from radical treatment.ConclusionAlthough guidelines do not support oncological follow-up beyond 5 years from surgery, oncologists should consider late recurrence of endometrial carcinoma in the differential diagnosis of women presenting with metastases of uncertain origin and prior history of this disease.

Distribution of high- and low-risk human papillomavirus genotypes and their prophylactic vaccination coverage among West African women: systematic review

Abstract Introduction The second most deadly gynecological cancer worldwide, cervical cancer is steadily on the rise in sub-Saharan Africa, while vaccination programs are struggling to get off the ground. This systematic review’s aim was to assess the prevalence and distribution of high- and low-risk HPV genotypes in West African women. Methods Original studies were retrieved from PubMed/Medline, Embase, Scopus, Google Scholar, and Science Direct. In these studies, Human papillomavirus (HPV) DNA was assessed in cervical samples by polymerase chain reaction (PCR), Hybrid capture, and sequencing. The quality of the articles was assessed and the results were extracted and reviewed. Results Thirty-nine studies from 10 West African countries were included for the systematic review including 30 for the pooled analysis. From an overall of 17358 participants, 5126 of whom were infected with at least one HPV genotype, the systematic review showed a prevalence varying from 8.9% to 81.8% in the general population. In contrast, the pooled prevalence of infection was 28.6% (n = 3890; 95% CI 27.85–29.38), and HPV-52 (13.3%), HPV-56 (9.3%), and HPV-35 (8.2) were the most frequent. Quadrivalent and nonavalent vaccines covered 18.2% and 55.8% of identified genotypes respectively. Conclusion Faced with this growing public health challenge in West Africa, it would be necessary for all its countries to have reliable data on HPV infection and to introduce the nonavalent vaccine. A study of the genotypic distribution of HPV in high-grade precancerous lesions and cervical cancer would be very useful in West Africa.

Potential roles of claudin-3 and claudin-4 in ovarian cancer management

Abstract Background Ovarian cancer has the highest mortality amongst all gynaecological malignancies, with around two-thirds of patients diagnosed with advanced disease due to late presentation. Furthermore, around 90% of patients develop recurrence and eventually become chemoresistant. Therefore, there is a high demand to identify biomarkers specific to this disease for screening for early detection, as well as new therapeutic targets. Tight junctions (TJs) regulate paracellular permeability and are vital in establishing epithelial cell polarity. One hallmark of tumorigenesis is the loss of TJs, with loss of cell-to-cell adhesion. Claudins are integral TJ membrane proteins, which have been found to play a critical role in maintaining the TJ’s barrier function. Furthermore, claudin-3 (CLDN3) and claudin-4 (CLDN4) are overexpressed in ovarian cancer. This article aims to explore the biological role of CLDN3 and CLDN4 and their potential in different aspects of the management of ovarian cancer. Main body CLDN3 and CLDN4 have been shown to be effective markers for the early detection of ovarian cancer. Whilst there is difficulty in screening for both claudins in serum, their assessment by gene expression analysis and immunohistochemical methods shows promising potential as diagnostic and prognostic biomarkers for ovarian cancer. The localisation and overexpression of claudins, such as CLDN3, have been shown to correlate with poorer survival outcomes. The added value of combining claudins with other markers such as CA125 for diagnosis has also been highlighted. Therapeutically, CLDN3 and more so CLDN4 have been shown to be effective targets of Clostridium perfringens enterotoxin (CPE). Interestingly, CPE has also been shown to resensitise chemoresistant tumours to therapy. Conclusions This review presents the diagnostic and prognostic potential of CLDN3 and CLDN4 and their emerging role as therapeutic targets in ovarian cancer. Clinical trials are required to validate the promising results of the in vitro and in vivo studies for CLDN3 and CLDN4, possibly adding onto current ovarian cancer management.

Mucinous cystadenocarcinoma of the breast: a new entity with broad differentials—a case report

Abstract Background Mucinous cystadenocarcinoma is a rare and recently described primary breast cancer with strikingly similar histomorphology to ovarian, pancreatic, and gastrointestinal counterparts. The diagnosis cannot be made until the metastatic lesion is ruled out. Case presentation We are reporting the case of a 65-year-old woman with primary mucinous cystadenocarcinoma of the breast while exploring clinicopathological features and approach to diagnosis. Though the immunohistochemistry panel of CK7, CK20, CDX2, SATB2, PAX8, mammoglobin, and GATA3 plays a crucial role in ruling out metastasis but aberrant CK20 positivity was seen in our case, the final diagnosis was made after a complete radiological workup. We also noted strong membranous HER2-protein expression and HER2-gene amplification by fluorescence in situ hybridization while in literature this tumor is reported to show mainly triple-negative basal type immunophenotype. Conclusion A combined clinic-radio-immunohistochemical approach is essential to make a diagnosis of primary mucinous cystadenocarcinoma.

Subtyping of high grade serous ovarian carcinoma: histopathological and immunohistochemical approach

Abstract Background High-grade serous ovarian carcinoma (HGSOC) is classified into four molecular subtypes; mesenchymal, proliferative, immunoreactive, and differentiated, with suggested different prognosis. Addressing the presence of histopathological and immunohistochemical differences in HGSOC that parallel the molecular subtypes can help in tailoring the management protocol to improve therapeutic response and patient outcome. Methods This retrospective study was conducted on 85 specimens for cases of HGSOC. Cases were classified according to histopathological findings into mesenchymal, proliferative, immunoreactive, and differentiated subtypes. Cases were immunostained with ER, PR, Ki67, CD8, E-cadherin, and vimentin. Results By applying histopathological data, cases were subdivided into 4 groups; mesenchymal type represented by 25 cases, proliferative type which included 14 cases, the immunoreactive type included 14 cases, and differentiated type represented by 32 cases; 13 of them had SET features and 19 had papillary architectural features. A significant correlation was found between Ki67 and proliferative subtype, as well as between CD8 and immunoreactive subtype. ER showed significantly higher expression in proliferative subtype in the group treated by primary debulking. CD8 showed a significant correlation with solid endometroid transitional (SET) pattern in the group that underwent interval debulking. In terms of prognosis, the shortest median progression-free survival (PFS) was for mesenchymal subtype, while the longest median PFS was for differentiated subtype with SET architectural pattern with statistically significant correlation. No correlation was found between any of the studied parameters and overall survival. Conclusion Histopathological features and immunohistochemistry can help to stratify HGSOC into prognostic distinct groups.

Dosimetric impact of variable bladder filling on IMRT planning for locally advanced carcinoma cervix

Abstract Background To evaluate the dosimetric impact of variable bladder filling on target and organ at risk (OARs) in cervical cancer patients undergoing chemoradiation. Forty consecutive patients with cervical cancer underwent radiotherapy planning as per the departmental protocol. All patients were asked to empty their bowel and bladder before simulation and catheterization was done. Normal saline was instilled into the bladder through Foleys till the patient had a maximal urge to urinate. Pelvic cast fabrication and CT simulation was done. Then, 30%, 50%, and 100% of the instilled saline was removed and rescans taken. Planning was done on full bladder (X) and the same plan applied to the contours with bladder volumes 0.7X (PLAN70), 0.5X (PLAN50), and empty (PLAN0). A dose of 50 Gy/25# was prescribed to the PTV and plans evaluated. Intensity-modulated radiotherapy plans with full bladder were implemented for each patient. Shifts in the center of mass (COM) of the cervix/uterus with variable bladder filling identified were noted. Statistical analysis was performed using SPSS software. A p value < 0.05 was considered significant. Results Bladder volume in 70%, 50%, and empty bladder planning was 78.34% (388.35 + 117.44 ml), 64.44% (320.60 + 106.20 ml), and 13.63% (62.60 + 23.12 ml), respectively. The mean dose received by 95% PTV was 49.76 Gy + 1.30 Gy. Though the difference in target coverage was significant between PLAN100 and other plans, the mean difference was minimal. A decrease in bladder filling resulted in an increase in OAR dose. Variation in the increase in dose to OARs was not significant if bladder filling was > 78.34% and > 64.44% of a full bladder with respect to the bowel and rectal/bladder doses, respectively. Inconsistent bladder filling led to a maximal shift in COM (uterus/cervix) in the Y- and Z-axis. Conclusion Bladder filling variations have an impact on cervico-uterine motion/shape, thereby impacting the dose to the target and OARs. It is recommended to have a threshold bladder volume of at least 70–75% of optimally filled bladder during daily treatment. Trial registration Institutional review board (IRB) registered by Drug Controller General (India) with registration number ECR/10/Ins/DC/2013. Trial Registration number - RGCIRC/IRB/44/2016, registered and approved on the 14th of May 2016.

Comparative efficacy and safety of vaginal brachytherapy versus combined pelvic external beam radiotherapy and vaginal brachytherapy in managing intermediate to high-risk endometrial cancer: a systematic review and meta-analysis

Abstract Purpose This review assesses the efficacy and safety of EBRT + VBT versus VBT alone in intermediate- to high-risk endometrial cancer. Methods A systematic review and meta-analysis were conducted using PubMed, EMBASE, ProQuest, Ovid, and Scopus (until February 18, 2025). Studies comparing EBRT + VBT to VBT alone were included. The primary outcome was pelvic recurrence rate, while secondary outcomes included distant recurrence, overall survival, and toxicity. Data extraction, risk of bias assessment (RoB-2, ROBINS-I), and meta-analysis (random-effects models in RevMan) were performed. Certainty of evidence was evaluated using GRADE. PROSPERO registration: CRD420250654411. Results Eight studies comprising 2,672 patients met inclusion criteria (1,347 received EBRT + VBT; 1,325 had VBT alone). EBRT + VBT significantly reduced pelvic recurrence (OR 0.14, p = 0.001) but showed no difference in vaginal recurrence (OR 0.25, p = 0.14), distant metastasis (OR 0.78, p = 0.45) or overall survival (HR 0.82, p = 0.29, I2 = 72%). EBRT + VBT was associated with higher gastrointestinal, genitourinary, and hematologic toxicity. Conclusion EBRT + VBT improves pelvic control but does not enhance survival and increases toxicity. VBT alone remains a viable option, highlighting the need for individualized treatment strategies.

Neoadjuvant chemoradiation and surgical excision versus definitive radiotherapy for locally advanced cervix uteri carcinoma: in terms of early and late complications and locoregional recurrence

Abstract Objectives Following external beam radiation therapy (EBRT) with concurrent chemotherapy, we analyzed the benefits of surgical resection for locally advanced cervical carcinoma in terms of the frequency and severity of complications and disease-free survival, including cases of adjuvant hysterectomy after failure of resolution post-brachytherapy. Patient and methods Retrospective analysis was utilized to determine the eligibility of 145 cases treated at the National Cancer Institute between January 2015 and June 2021. Of those, 17 patients did not match the requirements, and 8 patients declined to take part in the study. Depending on the major treatment technique, 120 FIGO stage IB3–FIGO stage IVA cervical cancer patients were split into two equal groups of 60 patients each. Sixty patients (50%) received neo-adjuvant EBRT and concurrent platinum-based chemotherapy followed by hysterectomy (group A) and 60 (50%) received definitive radiotherapy only (group B). Results The age at diagnosis of patients was similar, with a mean of 52.5 (range 34–77) and 53.4 (range 25 81) years in group A and group B, respectively ( P  = 0.675). Majority of the cases in both groups were pathologically squamous cell carcinomas (88.3% in group A and 83.3% in group B) and of grade II differentiation (73.7% in group A and 71.2% in group B). Majority of cases in both groups being FIGO stage II (45% in group A and 40% in group B) and FIGO stage III (40% in group A and 43.3% in group B). Only 17 patients (28.3%) in group A had postoperative complications, while 37 patients (61.7%) in group B suffered from post-treatment complications ( P value < 0.001). In group B, 14 patients (23.3%) failed to show complete remission of the disease after completion of treatment, with a mean residual disease of 4.3 cm in diameter (range 2–6 cm), either local or nodal. Salvage hysterectomy post-definitive radiotherapy was done for 8 patients with residual disease (13.3%). In group A, 48 patients had no recurrence during follow-up (80%), while 11 of the patients had either locoregional or metastatic recurrences, or both (18.3%). DFS was comparable between both groups ( P  = 0.493), excluding 23.3% of group B where failure of complete remission of the disease after completion of treatment barred the patients from the disease-free calculations. The 1-year DFS was 88.1% in group A and 82.6% in group B, while the 3-year DFS was 74.1% in group A and 70.1% in group B. Conclusion There was no difference in disease-free survival or the incidence of locoregional and metastatic recurrence between patients with cervical cancer who had surgery and those who received brachytherapy following EBRT and concomitant chemotherapy. In almost 50% of cases, the surgical patients showed full pathological recovery.

Programmed death ligand-1 and CD8 tumor-infiltrating lymphocytes (TILs) as prognostic predictors in ovarian high-grade serous carcinoma (HGSC)

Abstract Background P D-L1 is expressed in tumor cells and plays a crucial role in tumor immune escape. Tumor-infiltrating lymphocytes (TILs) as CD8 T cells contribute to reduced tumor growth. Few studies investigated the prognostic effect of PD-L1 and CD8 TILs in ovarian high-grade serous carcinoma (HGSC). In the present study, we analyzed the expression of PD-L1 and CD8 TILs in HGSC by immunohistochemistry, and results were correlated to prognosis. It was carried on 54 cases of ovarian HGSC who attended the Oncology Centre, Mansoura University, Egypt, from 2012 till 2019. Results Nearly 60% of cases showed positive PD-L1 expression in tumor cells. Regarding the clinicopathological characteristics, higher PD-L1 expression was found among patients with residual tumor (82.4%) compared to patients with no residual tumor (54.5%), with marginal statistical significance (p 0.07). PD-L1 was significantly associated with CD8 TILs expression. Higher PD-L1 expression was found among tumors with low expression of CD8 TILs with statistically significant difference (p≤0.001). Disease-free survival (DFS) was significantly lower among the group with positive expression of PD-L1 compared to the group with negative expression of PD-L1 (p 0.01), while overall survival (OS) was not associated with PD-L1 expression. On the other hand, the overall survival (OS) in patients with high CD8 expression was significantly higher than patients with low CD8 expression (p 0.043), while DFS was not significantly different among both CD8 TILS groups. Conclusions PD-L1 and CD8 TILs may become a promising therapeutic target for patients with ovarian HGSC. More studies are needed to further validate their prognostic effect. Precise identification of patients who will benefit from PD-L1 checkpoint blockade and TILs adaptive immunotherapy is mandatory.

A rare case of a concomitant ovarian fibroma and malignant steroid cell tumor: insights into pathogenesis and steroidogenesis

Abstract Background Fibromas are common ovarian stromal tumors, while steroid cell tumors (SCTs) are rare, accounting for < 0.1% of ovarian neoplasms. Approximately, one-third of SCTs exhibit malignant behavior, but predicting malignancy remains challenging. Case presentation A 73-year-old woman presented with nonspecific pelvic pain, and imaging revealed multiple pelvic masses. She underwent a simple hysterectomy and bilateral adnexectomy. Pathological examination revealed a unique colocalization of a fibroma and a SCT in the right ovary. One year later, the SCT recurred with lymph node metastasis. Morphological analysis and whole exome sequencing suggested a shared origin for the fibroma and SCT components. Notably, two missense mutations in MUC4 were identified in the SCT, with immunohistochemistry confirming MUC4 overexpression. Steroidogenesis patterns in the SCT resembled those of adrenocortical carcinoma, indicating disorganized steroidogenesis and potentially explaining the absence of clinical endocrine abnormalities. Conclusion This case underscores the rarity and complexity of concomitant ovarian fibroma and malignant SCT. The identification of MUC4 mutations and disorganized steroidogenesis may provide insights into the pathogenesis of malignant SCTs. Further research is needed to understand the mechanisms and clinical implications of malignant SCT.

CD44+/CD24- Expression as predictors of ovarian cancer chemoresistance: immunohistochemistry and flow cytometry study

Abstract Background The conventional standard treatment for ovarian cancer is not very effective, and the disease is fatal for women. Cancer Stem Cells (CSCs) that express CD44+/CD24- can contribute to chemoresistance and a poor prognosis. We seek to investigate the expression of CSCs (CD44+/CD24-) in ovarian cancer and their predictive significance. Methods The ambispective cohort was performed on 64 patients (32 patients in each group) at four hospitals (Cipto Mangunkusumo, Tarakan, Fatmawati, and Dharmais Hospital). Debulking surgery was performed on the patients, followed by histopathological analysis. The patients had six rounds of chemotherapy and were under monitoring for six months. The therapeutic responses were evaluated using the RECIST criteria (Response Criteria in Solid Tumors) and categorized as chemoresistant or chemosensitive. Using immunohistochemistry, we directly assess the CSCs from ovarian cancer tissue and using flow cytometry to assess the CSCs from the blood. Results High CSCs expression and ovarian cancer chemoresistance were significantly related in both trials (p 0.05). A better outcome was obtained using CD44+/CD24- immunohistochemistry. Conclusions We conclude that there is a substantial association between high CSCs expression and chemoresistance in ovarian cancer and that CSCs immunohistochemistry has a higher predictive value.

Evaluation of a symptom-based score in combination with CA125 to predict ovarian malignancy in women with adnexal mass

Abstract Background Adnexal masses are a common problem seen in women. The aim of this study was to determine the appropriate cut-off for symptom-based score to predict ovarian malignancy in women with adnexal mass and to evaluate it in combination with CA125. Methods This was a prospective study involving 341 women with adnexal mass who underwent surgery. A symptom-based scoring system was administered to the women, preoperatively, and CA125 levels were documented. Receiver operating characteristic curve (ROC) analysis was used to determine the appropriate cut-off for the symptom-based scoring. Results for this symptom-based scoring and CA125 were correlated with surgical pathological findings. Results Out of the 341 women with adnexal mass, 112 were diagnosed to have ovarian malignancy. The mean age of women was 43.6±13.8 years. Using ROC analysis, symptom score ≥9 was determined to be the appropriate cut-off. The area under curve (AUC) at this cut-off score was found to be 0.87 (95% CI 0.83–0.91). The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) at this cut-off was found to be 84.8%, 88.6%,78.5%, and 92.3%, respectively. Combining CA125 and symptom score resulted in higher sensitivity (96.4%) and NPV (97.4%) with specificity and PPV of 65.5% and 57.8%, respectively. Conclusion Symptom score in combination with CA125 has good ability to predict ovarian malignancy in women with adnexal masses.

Spontaneous vaginoperitoneal fistula as a rare complication of carcinoma ovary: a case report

Abstract Background Spontaneous vaginoperitoneal fistula formation in a case of carcinoma ovary is a very rare occurrence and has never been reported. Case presentation A 55-year-old postmenopausal lady presented with complaints of abdominal distention and mass coming out of the vagina for the last 10 days. On examination, she had tense ascites, uterovaginal prolapse and hard, fixed mass felt anteriorly on per-rectal examination. Biochemical investigations and radiological imaging suggested advanced stage ovarian neoplasm. She was planned for neoadjuvant chemotherapy. During the second cycle of chemotherapy, she developed spontaneous vaginoperitoneal fistula which was confirmed on exploratory laparotomy where interval debulking surgery was performed in collaboration with gastro-surgeons on a semi-emergency basis. The postoperative course was uneventful. Conclusion Spontaneous vaginoperitoneal fistula is a rare complication and should be kept in mind while managing advanced ovarian neoplasm.

Vulvar cancer: surgical management and survival trends in a low resource setting

AbstractBackgroundThis study aims to analyze risk factors, clinical profiles, treatment protocols, and disease outcomes in histologically proven resectable vulvar cancer (VC) patients according to tumor stage. This is a retrospective analysis of a prospectively collected database of 20 VC patients from May 2014 to June 2019.ResultsThe mean age of VC diagnosis was 55 years, with a range of 38–84 years. The incidence was four cases per year. The disease incidence was significantly more in post-menopausal (65%) and multiparous (90%) women. According to FIGO staging of vulvar cancer, stages I, II, and III were assigned to 6, 1, and 11 patients respectively. Two patients suffered from stage IVa vulvar melanoma. All patients had undergone surgical interventions. Patients treated with only nonsurgical (chemotherapy/radiotherapy/chemo-radiotherapy) treatment modalities were excluded from the study. Fifteen patients were treated with wide local excision (WLE), bilateral inguinofemoral dissection (B/L IFLND), and primary repair. Four and one patients were treated with radical vulvectomy (RV) and modified radical vulvectomy (MRV) [with or without B/L IFLND and PLND] respectively. Reconstruction with V-Y gracilis myocutaneous and local rotation advancement V-Y fasciocutaneous flaps were done in two patients. Therapeutic groin nodal dissection was performed in 19 patients except in one patient who was treated by palliative radical vulvectomy. In the final histopathology reports, tumor size varies from 0.5 to 6.5 cm (mean 3.35 cm) with the predominance of squamous cell carcinoma (18 out of 20 patients). Only 10 out of 18 eligible patients received adjuvant treatment. Poor patient compliance has been one of the major reasons for adjuvant treatment attrition rate. Systemic and loco-regional metastasis occurred in 3 patients each arm respectively. Poor follow up of patients is the key limitation of our study.ConclusionVulvar cancer incidence was significantly high in post-menopausal and multiparous women. The most important prognostic factors were tumor stage and lymph node status. Oncological resection should be equated with functional outcome. The multidisciplinary team approach should be sought for this rare gynecological malignancy.

Impact of different treatment plans on EQD2 for intracavitary brachytherapy of cervical cancer

Abstract Background Cancer is one of the leading causes of death worldwide. According to GLOBOCAN estimates, there were 341,831 deaths from cervical cancer in 185 countries in 2020. The aim of this study was to compare equieffective dose (EQD2) at 2 Gy per fraction by using dose volume histograms (DVHs) derived from external beam radiotherapy (EBRT) and high-dose rate brachytherapy (HDR-BRT) treatment plans used in cervical cancer radiotherapy. Methods Fifteen patients with stage IIB-IIIB cervical cancer were included in this retrospective study. Treatment with three-dimensional conformal radiotherapy (3D-CRT) or intensity-modulated radiotherapy (IMRT) was planned for all patients in 28 fractions, with a total of 50.4 Gy to be delivered to the whole pelvic region. After EBRT, manual optimization (MO) or inverse optimization (IO) HDR-BRT plans were created in 4 fractions with a total of 28 Gy. The plans obtained were grouped as IMRT + IO, IMRT + MO, 3DCRT + IO, and 3DCRT + MO by calculating EQD2s among these plans. D90, D95, and D98 values were compared in all plans for CTVHR total EQD2. In addition, EQD2 values ​for critical organs at risk (OARs) such as rectum, bladder, small intestine, and sigmoid were compared in all plans for volumes of 2 cm3, 1 cm3, and 0.1 cm3, respectively. Results There was no significant difference between the treatment groups in terms of CTVHR D90 and CTVIR D90 values; However, CTVHR D95 (p = 0.000) and CTVHR D98 (p = 0.000) values ​were found to be better in IMRT + IO technique. The IMRT + IO technique provided better protection for 2 cm3, 1 cm3, and 0.1 cm3 volumes of OARs compared to other techniques. Conclusions Considering all parameters such as CTVHR, CTVIR, rectum, bladder, small intestine, and sigmoid, combination of IMRT + IO treatment option was found to be significantly superior in total EQD2 calculations compared to other plans.

Artificial intelligence-based machine learning models for preoperative diagnosis and staging of ovarian tumors

Abstract Background Ovarian cancer remains the most lethal gynecological malignancy, necessitating precise diagnostic strategies to improve patient outcomes. This study aims to develop and evaluate machine learning models that utilize patient history, imaging, and blood test data to differentiate between benign and malignant ovarian tumors and predict the stage of malignant cases. Methods A total of 357 individuals diagnosed with ovarian tumors participated in the study. Among these, 139 tumors were identified as benign, 40 as borderline, and 178 as malignant. The analysis employed four machine learning classifiers support vector machine (SVM), random forest (RF), logistic regression (LR), and decision tree utilizing 39 features derived from blood tests, imaging, and the patient’s background to generate diagnostic outcomes. The study focused on assessing the significance of these features in predicting malignancy and determining the stage of the disease. Results The RF algorithm demonstrated the highest accuracy, reaching 94% based on imaging and tumor markers, with an AUC of 0.9. Key features contributing to this success include Human Epididymis Protein 4 (HE4) and Cancer Antigen 125 (CA125). In terms of staging malignant tumors, the SVM exhibited lower error rates, particularly in predicting advanced-stage disease (AUC: 0.77). Notably, CA125 and the presence of ascites emerged as the most influential factors for accurately staging the disease. Conclusion The utilization of AI models proves effective in accurately classifying both malignant and benign ovarian tumors, showcasing promising advancements in diagnostic capabilities.