Early-stage Cervical Cancer Research Articles

Estimation risk of lymph nodal invasion in patients with early-stage cervical cancer: Cervical cancer application.

IntroductionLymph node status is a major prognostic factor in early-stage cervical cancer. Predicting the risk of lymph node metastasis is essential for optimal therapeutic management. The aim of the study was to develop a web-based application to predict the risk of lymph node metastasis in patients with early-stage (IA1 with positive lymph vascular space invasion, IA2 and IB1) cervical cancer.Materials and methodsWe performed a secondary analysis of data from two prospective multicenter trials, Senticol 1 and 2 pooled together in the training dataset. The histological risk factors were included in a multivariate logistic regression model in order to determine the most suitable prediction model. An internal validation of the chosen prediction model was then carried out by a cross validation of the ‘leave one out cross validation’ type. The prediction model was implemented in an interactive online application of the ‘Shinyapp’ type. Finally, an external validation was performed with a retrospective cohort from L’Hôtel-Dieu de Québec in Canada.ResultsThree hundred twenty-one patients participating in Senticol 1 and 2 were included in our training analysis. Among these patients, 280 did not present lymph node invasion (87.2%), 13 presented isolated tumor cells (4%), 11 presented micrometastases (3.4%) and 17 macrometastases (5.3%). Tumor size, presence of lymph-vascular space invasion and stromal invasion were included in the prediction model. The Receiver Operating Characteristic (ROC) Curve from this model had an area under the curve (AUC) of 0.79 (95% CI [0.69– 0.90]). The AUC from the cross validation was 0.65. The external validation on the Canadian cohort confirmed a good discrimination of the model with an AUC of 0.83.DiscussionThis is the first study of a prediction score for lymph node involvement in early-stage cervical cancer that includes internal and external validation. The web application is a simple, practical, and modern method of using this prediction score to assist in clinical management.

The Role of Conization before Radical Hysterectomy in Cervical Cancer including High Risk Factors of Recurrence: Propensity Score Matching.

Simple SummaryWe investigated the therapeutic role of conization prior to radical hysterectomy for stage IB1 to IIB cervical cancer regardless of pathologic high risk factors, using the propensity score matching method. Additional subgroup analysis was carried out to identify the effect of conization based on clinical and pathologic factors. Conization before radical hysterectomy was associated with reduced recurrence and mortality. Conization had benefit in patients with MIS, negative pelvic lymph nodes, tumor sized less than 4 cm. Delays of definite treatment due to conization did not have an effect on the prognosis of patients with high risk factors. This study reveals the protective role of preoperative conization in early-stage cervical cancer, along with identifying subgroups that may best benefit from the procedure. This information can be used for more tailored patient selection for minimally invasive surgery for cervical cancer.We primarily aimed to investigate the therapeutic role of conization prior to radical hysterectomy for cervical cancer. Secondarily, we aimed to characterize a subgroup of patients who could potentially benefit from preoperative conization. Patients who underwent radical hysterectomy for FIGO 2009 stage IB1 to IIB cervical cancer from 1995 to 2020 were eligible. The patients were divided into two groups: those with and without preoperative conization. To adjust for the baseline characteristics of the two groups, 1:2 case–control propensity score matching was conducted. Survival analysis was performed between the two groups. Subgroup analysis was performed to identify the effect of conization based on clinical and pathological factors. Patients who underwent preoperative conization showed better 5-year overall survival than those who did not (95.9% vs. 93.0%, p = 0.029); however, no difference was observed in progression-free survival (88.9% vs. 85.9%, p = 0.155). In multivariate Cox analysis, conization showed a 55% reduction in recurrence (hazard ratio (HR) 0.65, 95% confidence interval (CI) 0.41–1.01, p = 0.056) and 41% reduction in death (HR 0.59, 95% CI 0.34–1.02, p = 0.059), but with marginal statistical significance. In subgroup analysis, minimally invasive surgery (MIS), negative pelvic lymph node, and tumor size < 4 cm showed improved survival from conization. Conization before radical hysterectomy may be associated with improved survival in patients with early-stage cervical cancer. This information could serve as a basis for a more tailored patient selection for MIS for cervical cancer.

Multi-parametric MRI-based peritumoral radiomics on prediction of lymph-vascular space invasion in early-stage cervical cancer.

PURPOSE This retrospective study aims to evaluate the use of multi-parametric magnetic resonance imaging (MRI) in predicting lymph-vascular space invasion (LVSI) in early-stage cervical cancer using radiomics methods. METHODS A total of 163 patients who underwent contrast-enhanced T1-weighted (CE T1W) and T2-weighted (T2W) MRI scans at 3.0T were enrolled between January 2014 and September 2019. Radiomics features were extracted and selected from the tumoral and peritumoral regions at different dilation distances outside the tumor. Mann-Whitney U test, the least absolute shrinkage and selection operator logistic regression, and logistic regression was applied to select the predictive features and develop the radiomics signature. Univariate analysis was performed on the clinical characteristics. The radiomics nomogram was constructed incorporating the radiomics signature and the selected important clinical predictor. Prediction performance of the radiomics signature, clinical model, and nomogram was evaluated with the area under the curve (AUC), specificity, sensitivity, calibration, and decision curve analysis (DCA). RESULTS A total of 5 features that were selected from the peritumoral regions with 3- and 7-mm dilation distances outside tumors in CE T1W and T2W MRI, respectively, showed optimal discriminative performance. The radiomics signature comprising the selected features was significantly associated with the LVSI status. The radiomics nomogram integrating the radiomics signature and degree of cellular differentiation exhibited the best predictability with AUCs of 0.771 (specificity (SPE)=0.831 and sensitivity (SEN)=0.581) in the training cohort and 0.788 (SPE=0.727, SEN=0.773) in the validation cohort. DCA confirmed the clinical usefulness of our model. CONCLUSION Our results illustrate that the radiomics nomogram based on MRI features from peritumoral regions and the degree of cellular differentiation can be used as a noninvasive tool for predicting LVSI in cervical cancer.

Isolated para-aortic nodal metastasis or recurrence absent after radical hysterectomy for stage IA-IIA cervical carcinoma (401)

Objectives: Accumulating evidence suggests that due to the low risk of initially metastatic para-aortic lymph nodes (PaLNs), patients undergoing surgical management of early-stage cervical cancer could potentially be spared the operative and long-term morbidity of PaLN dissection. We sought to explore the upfront and downstream implications of this management philosophy in women undergoing radical hysterectomy for stage IA - IIA cervical cancer. Methods: A review of institutional data identified women undergoing curative-intent radical hysterectomy with concurrent lymphad- enectomy of any kind for FIGO stage IA - IIA cervical carcinoma from 2004 to 2021. Demographics and clinical-pathologic data were collected. Recurrence rates and locations were analyzed. Patients with no follow-up were excluded. Chi-square and Fisher’s exact test were used for statistical analysis. Results: Three hundred patients were identified, of whom 265 were included in the analysis. The Median follow-up was 56 months. Regarding tumor stages, 31 patients had stage IA, 195 stage IB1, 34 stage IB2, and five had stage IIA. Seventy-one percent of patients underwent pelvic lymphadenectomy only (PLND), with 29% undergoing both pelvic and para-aortic lymphadenectomy (PPaLND). Demographic distribution was similar between groups. LVSI was present in 37% of PLND compared to 32% of PPaLND groups (p = NS). High-risk features (GOG 109 criteria: positive nodes, parametria, or margins) were present in 13% and 15% of patients of each group, respectively (p = NS). Para-aortic nodal metastasis was not detected in any patient with early-stage cervical cancer. Disease recurrence was diagnosed in 13.8% of PLND compared to 10.3% of PPaLND patients (p =NS), of which 65% included distant or multisite recurrences. Among recurrences, median PFS was 15.5 months (IQR 8.2 - 29.7), and OS was 34 months (IQR 21.5 - 54.4). There were no isolated first disease recurrences involving the para-aortic nodal chain. Less than 3% of patients (n = 1) with multi-site recurrence had involvement of the PaLN chain, which was in the setting of receiving no adjuvant treatment with high-risk disease (positive pelvic LNs) on initial surgery. Most common distant and multi-site recurrences occurred in the liver, lungs, and brain. Conclusions: Isolated para-aortic nodal recurrence was absent in patients after surgical management of early-stage cervical cancer, irrespective of histologic type. PaLN involvement in multi-site recurrence was also very uncommon, less than 3%. These findings could potentially be utilized to further refine individualized treatment planning in the upfront setting to spare unnecessary surgical morbidity. Objectives: Accumulating evidence suggests that due to the low risk of initially metastatic para-aortic lymph nodes (PaLNs), patients undergoing surgical management of early-stage cervical cancer could potentially be spared the operative and long-term morbidity of PaLN dissection. We sought to explore the upfront and downstream implications of this management philosophy in women undergoing radical hysterectomy for stage IA - IIA cervical cancer. Methods: A review of institutional data identified women undergoing curative-intent radical hysterectomy with concurrent lymphad- enectomy of any kind for FIGO stage IA - IIA cervical carcinoma from 2004 to 2021. Demographics and clinical-pathologic data were collected. Recurrence rates and locations were analyzed. Patients with no follow-up were excluded. Chi-square and Fisher’s exact test were used for statistical analysis. Results: Three hundred patients were identified, of whom 265 were included in the analysis. The Median follow-up was 56 months. Regarding tumor stages, 31 patients had stage IA, 195 stage IB1, 34 stage IB2, and five had stage IIA. Seventy-one percent of patients underwent pelvic lymphadenectomy only (PLND), with 29% undergoing both pelvic and para-aortic lymphadenectomy (PPaLND). Demographic distribution was similar between groups. LVSI was present in 37% of PLND compared to 32% of PPaLND groups (p = NS). High-risk features (GOG 109 criteria: positive nodes, parametria, or margins) were present in 13% and 15% of patients of each group, respectively (p = NS). Para-aortic nodal metastasis was not detected in any patient with early-stage cervical cancer. Disease recurrence was diagnosed in 13.8% of PLND compared to 10.3% of PPaLND patients (p =NS), of which 65% included distant or multisite recurrences. Among recurrences, median PFS was 15.5 months (IQR 8.2 - 29.7), and OS was 34 months (IQR 21.5 - 54.4). There were no isolated first disease recurrences involving the para-aortic nodal chain. Less than 3% of patients (n = 1) with multi-site recurrence had involvement of the PaLN chain, which was in the setting of receiving no adjuvant treatment with high-risk disease (positive pelvic LNs) on initial surgery. Most common distant and multi-site recurrences occurred in the liver, lungs, and brain. Conclusions: Isolated para-aortic nodal recurrence was absent in patients after surgical management of early-stage cervical cancer, irrespective of histologic type. PaLN involvement in multi-site recurrence was also very uncommon, less than 3%. These findings could potentially be utilized to further refine individualized treatment planning in the upfront setting to spare unnecessary surgical morbidity.

Robotic versus vaginal radical trachelectomy for reproductive-aged women with early cervical cancer: a multi-center Canadian study (097)

Robotic versus vaginal radical trachelectomy for reproductive-aged women with early cervical cancer: a multi-center Canadian study (097)

The status of surgical margins in relation to the type of surgical approach in the management of early-stage cervical cancer: Canadian Cervical Cancer Collaborative (4C) study (533)

<b>Objectives:</b> Surgical margin status in women undergoing surgery for early-stage cervical cancer is considered an important prognostic factor. We sought to determine if positive or close surgical margin status (<3mm) is related to the type of surgical approach and associated with worse outcomes. <b>Methods:</b> A national retrospective cohort study of cervical cancer treated with a radical hysterectomy was conducted. Patients with stage IA1 (LVSI positive) to IIIC2 (FIGO 2018) with lesions up to 4cm at ten Canadian institutions from 2007-2019 were included. Surgical approaches for the radical hysterectomy included robotic/laparo- scopic (RLRH), abdominal (ARH), or laparoscopic-assisted vaginal/ vaginal hysterectomy (LVVRH). Recurrence-free survival (RFS) and overall survival (OS) were estimated using Kaplan-Meier analysis. Chi-square and log-rank tests were used to compare between cohorts. <b>Results:</b> A total of 960 patients met the inclusion criteria. The majority of patients had squamous histology (470, 49%), while 343 (35.7%) had adenocarcinomas and 113 (11.8%) had adenosquamous. Most were stage IB (681, 70.0%) and 183 (19%) were IA. Mode of surgery included: 495 (51.6%) RLRH, 88 (9.2%) LVVRH and 376 (39.2%) ARH. Surgical margins were negative in 819 (85.3%), positive in 15 (1.6%) or close in 103 (10.7%) patients. Factors predictive of close/positive margins included stage, tumor diameter, vaginal involvement, and parametrial extension; the surgical approach was not a predictor of margin status (p=0.38). Close/positive margins were associated with a higher risk of death on univariate analysis (HR: 2.53; 95% CI: 0.78-8.22) for positive margins and 1.83 (95% CI: 1.04-3.24) for close margins, p=0.05), but margin status was not significant for OS or PFS when adjusting for stage, histology, surgical approach, and adjuvant treatment. Overall, 71% of patients with positive margins and 60% of patients with close margins received adjuvant treatment. One patient (6.7%) with positive margins recurred distantly, despite having received adjuvant chemoradiation; 16 patients (15.3%) with close margins recurred (p=0.023), with 73% having received either adjuvant radiation or chemoradiation. The surgical approach was not statistically associated with either OS (p=0.067) or PFS (p=0.06). <b>Conclusions:</b> Positive or close surgical margins were not found to be associated with the use of the minimally invasive surgical (MIS) approach. MIS approach did not appear to negatively impact outcomes. Positive or close surgical margins were not associated with worse outcomes, possibly due to adjuvant treatment.

Outcomes of laparoscopic radical hysterectomy in IA1- IB1 cervical cancer patients with low-risk: A multi-center retrospective study with 10 years’ experience (487)

<b>Objectives:</b> More evidence revealed that the oncological outcomes of open abdominal radical hysterectomy (OARH) were superior to those of laparoscopic radical hysterectomy (LRH) in patients with early-stage cervical cancer (CC). However, limited by the number of CC patients with IA and low-risk IB1, some aspects still needed more study to clarify. This retrospective study aimed to estimate the outcomes of LRH for IA1-IB1 cervical cancer patients with low- risk, which was defined as tumor <2cm, less than one-third stromal invasion, no lymphovascular space invasion (LVSI), no lymph node involvement. <b>Methods:</b> By carefully studying the results of the Laparoscopic Approach to Cervical Cancer (LACC) Trial, we were surprised to find that the number of early-stage CC patients with low risk was relatively insufficient. Therefore, we retrospectively reviewed the medical records to identify the low-risk patients with FIGO 2018 stage IA1, IA2, and IB1 cervical cancer and who received laparoscopic or abdominal radical hysterectomy from January 2010 to December 2020 at four hospitals. The Mann-Whitney U test and the Chi-square test were used for the comparison of categorical variables. Progression-free survival and overall survival were compared between matched groups using Kaplan-Meier survival analysis and log-rank tests, along with univariable and multivariable regression analysis. <b>Results:</b> Of 5360 patients selected, 1850 (35%) met the inclusion criteria for this study from January 2010 to December 2020. Of these, 1090 patients underwent open surgery, and 760 patients had laparoscopic surgery. In the entire cohort, the two groups were similar in regard to clinical characteristics, such as age, body mass index (BMI), FIGO stage, histologic type and grade, pelvic lymph nodes, positive margins, stromal invasion, LVSI, and adjuvant therapy. LRH had better outcomes compared with OARH in terms of blood loss, transfusion rates, and the length of hospital stay. And in the subgroup analysis, when it referred to those patients with low-risk factors (tumor <2cm, superficial stromal invasion, negative LVSI, and no lymph node involvement), the LRH group was equivalent to the OARH group with respect to both disease-free survival (DFS) and 5-year overall survival (OS) rates. What's more, when the tumor was >2cm or accompanied by other medium and high-risk factors, the LRH group showed a significantly shorter DFS and OS than OARH, which was consistent with the LACC Trial. <b>Conclusions:</b> Among FIGO 2018 stage IA1-IB1 CC patients with low- risk, tumor <2cm, superficial stromal invasion, negative LVSI, and no lymph node involvement, there was no detrimental effect on survival between LRH and OARH. And it also needed more prospective studies to explore the oncological outcomes of low-risk CC patients with stage IA1-IB1. Besides, LRH was closely associated with worse oncological outcomes than OARH in patients with risk factors.

Trends and characteristics of ovarian conservation at hysterectomy for young women with cervical cancer (463)

<b>Objectives:</b> The association between early surgical menopause and increased mortality has been well demonstrated. Prior studies have also demonstrated that ovarian conservation is not associated with worse oncologic outcomes in early-stage cervical cancer. This study examined the contemporary trends and characteristics of ovarian conservation at the time of hysterectomy in young women with cervical cancer. <b>Methods:</b> This is a retrospective observational cohort study examining the National Inpatient Sample. The study population was 4,900 women aged ≤50 with cervical cancer who had hysterectomy-based surgical treatment from October 2015 to December 2018. Exposure allocation was the adnexal procedure status (ovarian conservation vs bilateral adnexectomy). The main outcome measures were temporal trends of ovarian conservation over time and per patient age. A multivariable binary logistic regression model (conditional backward selection) was fitted to identify independent characteristics associated with ovarian conservation. <b>Results:</b> A total of 2,940 (60.0%) women underwent ovarian conservation at hysterectomy. The incidence of ovarian conservation increased from 54.7% in Q4/2015 to 64.4% in Q4/2018 (<i>p</i>=0.002). Ovarian conservation rates remained stable until age 37 years, ranging from 82.5% to 77.9% (<i>p</i>=0.502), after which time the rate sharply and significantly decreased from 77.9% to 28.7% (<i>p</i><0.001). In multivariable analysis, recent surgery remained an independent factor for ovarian conservation (adjusted-odds ratio per year-quar- ter: 1.03, 95% CI: 1.01-1.05). In addition, younger age, Hispanic race, self-pay, large hospital bed capacity, Southern region, and minimally invasive hysterectomy were independently associated with ovarian conservation (all, <i>p</i><0.05). <b>Conclusions:</b> Increasing rates of ovarian conservation at the time of hysterectomy in women undergoing surgical management of cervical cancer are encouraging; however, the marked decrease noted in patients in their mid-30s is striking and warrants further investigation.

Practice patterns and 90-day treatment-related morbidity in early-stage cervical cancer

BackgroundTo evaluate the impact of the Laparoscopic Approach to Cervical Cancer (LACC) Trial on patterns of care and surgery-related morbidity in early-stage cervical cancer. MethodsThis is a retrospective, a multi-institutional study evaluating 90-day surgery-related outcomes of patients undergoing treatment for early-stage cervical cancer before (period I: 01/01/2016–06/01/2018) and after (period II: 01/01/2019–06/01/2021) the publication of the results of the LACC trial. ResultsCharts of 1295 patients were evaluated: 581 (44.9%) and 714 (55.1%) before and after the publication of the LACC trial, respectively. After the publication of the LACC trial, the number of patients treated with minimally invasive radical hysterectomy decreased from 64.9% to 30.4% (p < 0.001). Overall, 90-day complications occurred in 110 (18.9%) and 119 (16.6%) patients in the period I and period II, respectively (p = 0.795). Similarly, the number of severe (grade 3 or worse) complications did not differ between the two periods (38 (6.5%) vs. 37 (5.1%); p = 0.297). Overall and severe 90-day complications were consistent between periods even evaluating stage IA (p = 0.471), IB1 (p = 0.929), and IB2 (p = 0.074), separately. ConclusionsThe present investigation highlighted that in referral centers the shift from minimally invasive to open radical hysterectomy does not influence 90-day surgery-related morbidity.

Is less more in the surgical treatment of early-stage cervical cancer?

This article discusses recent developments towards less radical surgical treatment for early-stage cervical cancer. Surgery is the standard treatment for early-stage cervical cancer. In the last decades, new treatment strategies have been developed aiming to reduce morbidity, without hampering oncological safety. We provide an update of the latest knowledge on safety and morbidity following less radical surgical procedures in early-stage cervical cancer. In cervical cancer with a tumour size of 2 cm or less, radical surgery (simple hysterectomy or fertility-sparing conisation) may be a well tolerated option. For patients with larger lesions (>2 cm) and wishing to preserve fertility, administration of neoadjuvant chemotherapy followed by less extensive surgery appears to be a feasible and well tolerated alternative to abdominal trachelectomy. With regard to lymph node assessment, increasing evidence shows the feasibility of the sentinel lymph node procedure instead of full pelvic lymphadenectomy. Prospective trials reporting on oncological safety are awaited.It is important to exercise caution when new surgical strategies are introduced. Despite promising retrospective data, prospective randomized studies may present unexpected results, for instance, minimally invasive radical hysterectomy showed inferior results compared to laparotomy. There is a shift towards less radical treatment for early-stage cervical cancer. This review explores whether and when less is really more.

The MEMORY Study: MulticentEr study of Minimally invasive surgery versus Open Radical hYsterectomy in the management of early-stage cervical cancer: Survival outcomes

ObjectiveThe Laparoscopic Approach to Cervical Cancer (LACC) trial found that minimally invasive radical hysterectomy compared to open radical hysterectomy compromised oncologic outcomes and was associated with worse progression-free survival (PFS) and overall survival (OS) in early-stage cervical carcinoma. We sought to assess oncologic outcomes at multiple centers between minimally invasive (MIS) radical hysterectomy and OPEN radical hysterectomy. MethodsThis is a multi-institutional, retrospective cohort study of patients with 2009 FIGO stage IA1 (with lymphovascular space invasion) to IB1 cervical carcinoma from 1/2007–12/2016. Patients who underwent preoperative therapy were excluded. Squamous cell carcinoma, adenocarcinoma, and adenosquamous carcinomas were included. Appropriate statistical tests were used. ResultsWe identified 1093 cases for analysis—715 MIS (558 robotic [78%]) and 378. OPEN procedures. The OPEN cohort had more patients with tumors >2 cm, residual disease in the hysterectomy specimen, and more likely to have had adjuvant therapy. Median follow-up for the MIS and OPEN cohorts were 38.5 months (range, 0.03–149.51) and 54.98 months (range, 0.03–145.20), respectively. Three-year PFS rates were 87.9% (95% CI: 84.9–90.4%) and 89% (95% CI: 84.9–92%), respectively (P = 0.6). On multivariate analysis, the adjusted HR for recurrence/death was 0.70 (95% CI: 0.47–1.03; P = 0.07). Three-year OS rates were 95.8% (95% CI: 93.6–97.2%) and 96.6% (95% CI: 93.8–98.2%), respectively (P = 0.8). On multivariate analysis, the adjusted HR for death was 0.81 (95% CI: 0.43–1.52; P = 0.5). ConclusionThis multi-institutional analysis showed that an MIS compared to OPEN radical hysterectomy for cervical cancer did not appear to compromise oncologic outcomes, with similar PFS and OS.

Robotic surgery in gynaecology: Scientific Impact Paper No. 71 (July 2022).

The use of robotic-assisted keyhole surgery in gynaecology has expanded in recent years owing to technical advances. These include 3D viewing leading to improved depth perception, limitation of tremor, potential for greater precision and discrimination of tissues, a shorter learning curve and improved comfort for surgeons compared with conventional keyhole and open abdominal surgery. Robotic-assisted keyhole surgery, compared with conventional keyhole surgery, improves surgical performance without increasing operating time, minimises blood loss and intra- or postoperative complications, while reducing the need to revert to abdominal surgery. Moreover, surgeons using a robot experience fewer skeletomuscular problems of their own in the short and long term than those operating without a robot as an additional tool. This Scientific Impact Paper looks at the use of a robot in different fields of gynaecological surgery. A robot could be considered safe and a more effective surgical tool than conventional keyhole surgery for women who have to undergo complex gynaecology surgery or have associated medical issues such as body-mass index (BMI) at 30 kg/m2 or above or lung problems. The introduction of the use of robots in keyhole surgery has resulted in a decrease in the number of traditional open surgeries and the risk of conversion to open surgery after traditional keyhole surgery; both of which should be considered when examining the cost-benefit of using a robot. Limitations of robotic-assisted surgery remain the associated higher costs. In womb cancer surgery there is good evidence that introducing robotics into the service improves outcomes for women and may reduce costs.

Impact of timing of urinary catheter removal on voiding dysfunction after radical hysterectomy for early cervical cancer

ObjectivesTo evaluate whether the timing of postoperative urinary catheter removal is associated with voiding dysfunction after radical hysterectomy for early cervical cancer within contemporary surgical practice.MethodsWe performed an institutional retrospective...

The Relationship between Health Workers’ Support and Frequency of Visual Inspection with Acetic Acid for Cervical Cancer Early Detection among Childbearing Age Women at Pasir Mulya Health Center

Background: Cervical cancer could be prevented through early detection method. Visual Inspection with AceticAcid (VIA) is one of common and simple procedures to screen early stage of cervical cancer. Health workers play arole in helping and encouraging women of childbearing age to be involved in preventing cervical cancer and thusimproving the life quality of women generally. This study was aimed to determine the relationship between healthworkers’ support and frequency of visual inspection with acetic acid (VIA) for cervical cancer early detectionamong childbearing age women at Pasir Mulya Health Center.Materials and Methods: The study design used was analytical research. Participants in this study were287 childbearing age women who regularly visited Pasir Mulya Health Center. The sampling method used waspurposive sampling. The instrument in this study was questionnaire and the research data was analyzed usingthe Chi-square test.Results: Out of 287 participants, 211 participants (73.5%) received support from the health workers while76 participants (26.5%) did not receive support from the health workers. The number of childbearing age womenwho had done the VIA test was 146 participants, whilst 141 participants never had IVA test previously. A totalof 131 childbearing age women received support and had undergone VIA test. The statistical test obtainedP-value = 0.00.Conclusion: There was significant relationship between health workers’ support and frequency of visual inspectionwith acetic acid (VIA) in childbearing age women at Pasir Mulya Health Center.

Investigating the relationship between the cervical mucoprotein levels and cervical intraepithelial neoplasia.

Cervical cancer has been ranked as the fourth most common cancer in women. The role of HPV, the DNA virus identified in the 1980s, in almost all cervical cancers is undisputed. In patients scanned with smear and HPV, a cervical biopsy is performed accompanied by colposcopic examination, and the lesion is defined. The concentration of mucoproteins varies in the structure of the cervical mucus with neoplasms. The major aim of this study was to investigate the changes in the levels of cervical mucoprotein in patients at the early stages of cervical cancer and evaluate if these levels can be used in the early diagnosis of this cancer type. The study was designed as a prospective cohort study. Samples from cervical mucus were taken and stored before colposcopy examination of human papillomavirus (HPV) positive patients (N.=100). According to the pathology results, while 36 cases constituted the precancerous group, no suspicion of cancer was found in 64 cases. To ensure standardization, colposcopy was performed immediately after the menstrual cycle and at least 0.5 mL of the cervical mucus sample was taken from all individual patients used in this study. Cervical mucus samples of the patients were analyzed for mucoproteins MUC1, MUC2, MUC5AC and MUC5B. All mucoprotein levels were found to be higher in patients with cervical intraepithelial neoplasia (CIN) than those of subjects with normal pathology for cervical neoplasia. Significant relationship was obtained between cervical intraepithelial neoplasms and the levels of mucoproteins in cervical mucus. The results showed that diagnosis of neoplasia with HPV may be easily performed by utilizing any mucoprotein test.

Does completion of radical hysterectomy improve oncological outcomes of women with clinical early-stage cervical cancer and intraoperative detection of nodal involvement?: protocol for a systematic review and meta-analysis

IntroductionThe management of women with clinical early-stage cervical cancer and lymph node involvement detected intraoperatively is heterogeneous and controversial. This paper presents the protocol of a systematic review and meta-analysis...

Neoadjuvant Chemotherapy in Stadium IB3, IIA2 and IIB Cervical Cancer a Narrative Review

This study aimed to describe Paclitaxel-Carboplatin chemotherapy as neoadjuvant chemotherapy in stage IB3, IIA2 and IIB cervical cancer. The review was conducted by collecting journals from previous studies discussing neoadjuvant chemotherapy in cervical cancer stages IB3, IIA2, and IIB and in this case specifically discussing Paclitaxel-Carboplatin chemotherapy. Neoadjuvant chemotherapy refers to systemic therapy intended to reduce the size of the tumour before the definitive operation. Several studies have shown that neoadjuvant chemotherapy has greater advantages than surgery alone for early stage cancers (IB3, IIA2, and IIB). Paclitaxel and Carboplatin are known chemotherapeutic agents that can be used as neoadjuvant chemotherapy. Neoadjuvant Chemotherapy regimen Paclitaxel Carboplatin is one of the options in performing therapy for early stage cervical cancer which can be very helpful in healing and cancer-free patient condition. Neoadjuvant chemotherapy followed by radical surgery has significant benefits that have been described in several previous studies. Neoadjuvant Chemotherapy regimen Paclitaxel Carboplatin may be used as therapy regimen for early stage cervical cancer with all advantage compared to only surgery. Thus, this type of regimen can be used to decrease mortality and morbidity in patient with stadium IB3, IIA2 and IIB cervical cancer.

Sexuality and quality of life after nerve-sparing radical hysterectomy for cervical cancer: A prospective study

ObjectiveNerve-sparing radical hysterectomy (NSRH) decreases the negative postoperative consequences of radical surgery for cervical cancer, such as bladder evacuation disorders, colorectal motility disorders, and sexual dysfunction. The aim of this study was to prospectively assess the sexuality and quality of life in a group of women who underwent NSRH with lymphadenectomy for cervical cancer. Materials and methodsA total of 65 patients with early-stage cervical cancer underwent NSRH between 2014 and 2016. Patient examinations and questionnaire surveys (Female Sexual Function Index questionnaire and European Organization for Research and Treatment of Cancer questionnaires QLQ-C30 and QLQ-CX24) were conducted, before and one year after the surgery. ResultsAfter the exclusion of 19 sexually inactive women and 10 women who received adjuvant anticancer treatment, 36 sexually active patients treated solely with nerve-sparing surgery were eligible for evaluation. The mean age was 47 years. The average preoperative vaginal length was 9.4 cm, whereas the postoperative length was shortened to 7.1 cm. This study showed no negative impact of NSRH on sexual desire, arousal, satisfaction, orgasm, pain, sexual activity, sexual enjoyment, and sexual worry. The worsening of sexual functioning was recorded during the one-year follow-up. The QLQ-C30 questionnaire confirmed postoperative improvement in global health status and role, emotional, and social functioning. ConclusionOur study showed using standardized questionnaires that NSRH has no negative impact on sexual desire, arousal, satisfaction, orgasm, pain, sexual activity, frequency of sexual intercourse, sexual enjoyment, and sexual worry, while only the worsening of sexual functioning was recorded. Moreover, NSRH did not cause postoperative deterioration in the quality of life parameters.

Nomogram Predicting Lymph Node Metastasis in the Early-Stage Cervical Cancer.

BackgroundAccurately predicting the risk level of lymph node metastasis is essential for the treatment of patients with early cervical cancer. The purpose of this study is to construct a new nomogram based on 2-deoxy-2-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) and clinical characteristics to assess early-stage cervical cancer patients’ risk of lymph node metastasis.Materials and MethodsFrom January 2019 to November 2020, the records of 234 patients with stage IA-IIA [International Federation of Gynecology and Obstetrics (FIGO) 2018] cervical cancer who had undergone PET/CT examination within 30 days before surgery were retrospectively reviewed. A nomogram to predict the risk of lymph node metastasis was constructed based on it. The nomogram was developed and validated by internal and external validation. The validation cohorts included 191 cervical cancer patients from December 2020 to October 2021.ResultsFour factors [squamous cell carcinoma associated antigen (SCCA), maximum standardized uptake value of lymph node (nSUVmax), uterine corpus invasion in PET/CT and tumor size in PET/CT] were finally determined as the predictors of the nomogram. At the area under the receiver operating characteristic curve cohort was 0.926 in the primary and was 0.897 in the validation cohort. The calibration curve shows good agreement between the predicted probability and the actual probability. The decision curve analysis showed the clinical utility of the nomogram.ConclusionWe had established and verified a simple and effective nomogram, which can be used to predict the lymph node metastasis of cervical cancer patients before surgery.

Does the New FIGO 2018 Staging System Allow Better Prognostic Differentiation in Early Stage Cervical Cancer? A Dutch Nationwide Cohort Study.

Simple SummaryThe introduction of a revised staging system (FIGO 2018 staging system) for cervical cancer has led to a significant change in stage allocation for patients with early stage disease. It remains unclear how this change should be translated into treatment options, including less extensive surgery. With this Dutch national study we evaluated whether the revised staging system resulted in a more accurate prediction of overall and recurrence free survival compared to the previous FIGO 2009 staging system. In addition, we assessed other factors which may help the paradigm of treatment. We concluded that the revised FIGO 2018 staging system gives a more precise indication of survival outcomes of women with early stage cervical cancer. In addition, we believe that aside from stage, tumor characteristics, such as LVSI, and depth of invasion should be considered when offering patients less radical or less extensive treatment.The FIGO 2018 staging system was introduced to allow better prognostic differentiation in cervical cancer, causing considerable stage migration and affecting treatment options. We evaluated the accuracy of the FIGO 2018 staging in predicting recurrence free (RFS) and overall survival (OS) compared to FIGO 2009 staging in clinically early stage cervical cancer. We conducted a nationwide retrospective cohort study, including 2264 patients with preoperative FIGO (2009) IA1, IA2 and IB1 cervical cancer between 2007–2017. Kaplan–Meier analyses were used to assess survival outcomes. Logistic regression was used to assess risk factors for lymph node metastasis and parametrial invasion. Stage migration occurred in 48% (22% down-staged, 26% up-staged). Survival data of patients down-staged from IB to IA1/2 disease were comparable with FIGO 2009 IA1/2 and better than patients remaining stage IB1. LVSI, invasion depth and parametrial invasion were risk factors for lymph node metastases. LVSI, grade and age were associated with parametrial invasion. In conclusion, the FIGO 2018 staging system accurately reflects prognosis in early stage cervical cancer and is therefore more suitable than the FIGO 2009 staging. However subdivision in IA1 or IA2 based on presence or absence of LVSI instead of depth of invasion would have improved accuracy. For patients down-staged to IA1/2, less radical surgery seems appropriate, although LVSI and histology should be considered when determining the treatment plan.