Early Stage Invasive Cervical Cancer Research Articles

Clearance of high-risk HPV after large loop excision of the transformation zone of early-stage invasive cervical cancer or adenocarcinoma in situ is highly correlated with the absence of residual cancer

Clearance of high-risk HPV after large loop excision of the transformation zone of early-stage invasive cervical cancer or adenocarcinoma in situ is highly correlated with the absence of residual cancer

Robotic piver class III hysterectomy with preserving ureteral branch of uterine artery on early-stage invasive cervical cancer.

Robotic piver class III hysterectomy with preserving ureteral branch of uterine artery on early-stage invasive cervical cancer.

Surgical technique of robotic Piver class III hysterectomy with preserving ureteral branch of uterine artery on early-stage invasive cervical cancer

Surgical technique of robotic Piver class III hysterectomy with preserving ureteral branch of uterine artery on early-stage invasive cervical cancer

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

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

Meta-Analysis the Prognosis of Surgical Treatment for Early-Stage Invasive Cervical Cancer

Meta-Analysis the Prognosis of Surgical Treatment for Early-Stage Invasive Cervical Cancer

Building workforce capacity for the surgical management of cervical cancer in a fragile, low-income African nation-Democratic Republic of the Congo.

ObjectivesSurgery is a cornerstone of the management of cervical cancer. Women diagnosed with cervical cancer in sub-Saharan Africa have very little access to specialised (gynaecologic oncology) surgical services. We describe our experiences and challenges of training local general gynaecologists to surgically treat early stage invasive cervical cancer at a private sector healthcare facility in a fragile, low-income African nation.MethodsImplementation of the training curriculum began with assigned self-directed learning. It continued with on-site training which consisted of preoperative surgical video reviews, pre- and intra-operative assessment of disease status, deconstruction of the designated surgical procedure into its critical subcomponents and trainees orally communicating the steps of the surgical procedure with the master trainers. High-volume repetition of a single surgical procedure over a short time interval, intra-operative bedside mentoring, post-operative case review and mental narration were critical to the process of surgical skills transfer.ResultsNineteen radical abdominal hysterectomies were successfully performed over four training visits; trainees were able to perform the procedure alone after eight cases; surgical complications decreased over time. The trainees have continued to perform the surgical procedures independently.ConclusionLife-saving surgical capacity for the treatment of cervical cancer has been established and sustained at a private sector healthcare facility in a fragile, low-income African setting, through an innovative model of surgical training.

Distribution patterns of lymph node metastasis in early stage invasive cervical cancer.

The spatial distribution of lymph node (LN) metastasis was analyzed to provide data for an evidence-based approach to radiotherapy field design, particularly for guiding intensity-modulated radiation therapy. A total of 1886 postoperative patients were retrospectively reviewed. Pelvic LNs were classified as common iliac nodes, external iliac nodes, internal iliac nodes/obturator nodes, and deep inguinal nodes. The distribution of LN metastasis in these subgroups was calculated, and the distribution patterns of LN metastasis according to the pathologic types were investigated.We identified 392 eligible patients with LN metastasis. The frequency and number of external iliac node metastasis were higher in the left side in both single subgroup (P < .01) and cosubgroup (P = .04) analyses, whereas few differences were found in other subgroups. Among patients with squamous cell carcinoma, left external iliac node metastasis was observed in 102 (15.13%) patients, whereas right metastasis was observed in 65 (9.64%) patients, and the difference was significant (P < .01).The present results indicated uneven distribution of LN metastasis in the different subgroups, which could help surgeon focus on the dissection of the left subgroups, and help oncologists define margins, refine target volumes for radiation, and improve the accuracy of postoperative radiotherapy especially in patients with squamous cell carcinoma.

Rethinking Minimally Invasive Surgery for Cervical Cancer

Although open (i.e., abdominal) radical hysterectomy has been the standard for early-stage invasive cervical cancer, minimally invasive surgery (MIS;

PO-398 Markers of immune exhaustion and immune suppression in immunoregulatory network of virus-associated cervical cancer: putative contribution in the induction of invasive tumour growth

IntroductionAchieving positive outcomes of using immunotherapeutic approaches in cancer treatment implies multifaceted targeting of functionally different mechanisms of immune response, including immune exhaustion mechanisms, regulatory cell-mediated pathways, and inflammation. Of particular interest are molecular mechanisms that accompany the initial steps of invasive tumour growth. In the case of virus-associated cancer, particularly cervical cancer, there are still many questions to be answered regarding this issue.Material and methodsTranscriptomes of pre-invasive and invasive cervical cancer tissue samples were explored using RNA sequencing (RNAseq) on the Illumina MiSeq platform followed by bioinformatic analysis of immune-related signalling pathways. Flow cytometry was used to phenotype peripheral blood lymphocytes and tumor-infiltrating lymphocytes in enzymatically dissociated tissue samples.Results and discussionsAs follows from RNAseq data, in early-stage invasive cervical cancer, the expression of a wide set of interferon-induced genes and inflammatory response genes (including a specific group of innate molecular sensors of nucleic acids) was significantly elevated, as compared to pre-invasive carcinoma. In contrast, effector T and NK-cell activation markers were expressed at low levels. Interestingly, many markers of immune exhaustion and inhibitory ‘immune checkpoint’ molecules didn’t show any noticeable increase in mRNA levels, furthermore, some of them were found to have lower expression levels in invasive cancer. Pathway analysis revealed that, among the mechanisms most significantly upregulated in invasive vs. pre-invasive cancer, those mediated by immunosuppressive cytokines and implicated in differentiation of regulatory T cells were prevalent, while IL12-dependent pathways of T and NK-cell activation and differentiation were enriched among the downregulated genes. The results of transcriptome analysis are in agreement with our findings from flow cytometric assessment of regulatory (suppressive) cell populations within tumor-infiltrating lymphocytes and co-expression of PD-1, TIM-3, and LAG-3 in major subsets of peripheral blood lymphocytes in patients with early forms of cervical cancer.ConclusionThe observed relationships may be considered a direct consequence of impaired immune cell activation processes and an essential condition for further progression of inflammatory environment required for invasive growth of a tumour. The work is supported by the Russian Science Foundation (project №17-75-10027).

Fertility-sparing Surgery for Presumed Early-stage Invasive Cervical Cancer: A Survey of Practice in the United Kingdom.

To explore current practice in fertility-sparing surgery for cervical cancer in the UK. A web-based structured questionnaire was designed and circulated to all members of the British Gynaecological Cancer Society. From 111 recipients, a total of 49 responses were collected. The majority of centres treated between 20-29 cases of invasive cervical cancer surgically (21/49, 42.9%) and performed between 0-5 cases of radical trachelectomy annually (29/49, 59.2%). The vaginal approach was the one most commonly used and was offered by almost half of the centres (21/49, 42.9%); laparoscopic techniques were offered in 13 (13/49, 26.6%). The responses were divided as to whether these cases should have been referred to supra-regional centres (25/49, 51.0%). With the use of Human Papillomavirus vaccination leading to a projected decrease in the number of cervical cancer incidence, patients may need to be referred to supraregional centres in the future.

Positive Correlation Between Clearance of High-Risk Human Papillomavirus and Lack of Residual Disease After Loop Excision of the Transformation Zone in Early Stage Cervical Cancer.

In cervical cancer, a number of pathological parameters have been explored for their utility in tailoring a less aggressive approach for patients with low-risk early stage disease. We examined whether, in patients with cervical cancer stage IA1 to IB1, diagnosed by loop excision of the transformation zone (LLETZ), positive for high-risk human papillomavirus (hrHPV), clearance of hrHPV after LLETZ correlates with absence of residual disease at the final pathology after definitive or further surgery. Data were collected from patients diagnosed with early stage invasive cervical cancer and positive hrHPV DNA, who had a repeat cervical HPV test 3 to 12 weeks after LLETZ and before final surgical treatment. We compared characteristics of patients with post-LLETZ negative and positive hrHPV. Of 28 patients, 13 were post-LLETZ negative hrHPV; of these, 11 did not have residual cancer in the final pathological specimen; two patients had cervical intraepithelial neoplasia 3. Of the 15 women who had post-LLETZ positive hrHPV, 10 had residual cancer in the final pathological specimen and 3 had cervical intraepithelial neoplasia or adenocarcinoma in situ; only 2 were negative for cancer. The post-LLETZ hrHPV test shows a sensitivity of 86.7% and specificity of 84.6%. Clearance of hrHPV from the cervix after LLETZ was found to correlate with the absence of residual cancer in the final surgical specimen. Testing for hrHPV post-LLETZ might serve as a new parameter for risk assessment and tailoring of a less radical operation in women with early stage cervical cancer.

Should the Ovaries Be Spared at Hysterectomy for Early-Stage Cervical Cancer?

In reproductive-age women with early-stage invasive cervical cancer, surgery or radiation is associated with favorable prognosis. National

Primary tumor SUVmax on preoperative FDG-PET/CT is a prognostic indicator in stage IA2-IIB cervical cancer patients treated with radical hysterectomy.

The objective of the present study was to investigate the prognostic value of 18F-fluoro-2-deoxy-D-glucose (FDG) uptake by primary tumors on positron emission tomography/computed tomography (PET/CT) in surgically resectable cervical cancer. A total of 59 patients with stage IA2-IIB cervical cancer who underwent preoperative FDG-PET/CT, followed by radical hysterectomy and lymphadenectomy, were included in the study. The maximum standardized uptake value (SUVmax) of the primary tumor was measured, and the association between the SUVmax and clinicopathological factors or patient outcomes was analyzed. The SUVmax was significantly higher in patients with an advanced stage, lymph node metastasis, lymph-vascular space involvement and large tumors. The overall survival (OS) and progression-free survival (PFS) of patients with a high SUVmax were significantly lower compared with patients with a low SUVmax, using an optimal cut-off value of 7.36 for OS and 5.59 for PFS obtained from receiver operating characteristic curve analysis. Similarly, OS and PFS in patients with a high SUVmax were significantly lower in 39 patients with stage IB using a cut-off value of 7.90 and 6.69 for OS and PFS, respectively. Finally, multivariate analyses showed that the SUVmax of the primary tumor was an independent prognostic factor for impaired PFS in all patients and those with stage IB alone. These findings demonstrated that a high SUVmax on preoperative PET/CT was correlated with unfavorable clinical outcomes in patients receiving radical hysterectomy, suggesting that the SUVmax of the primary tumor may be a prognostic indicator for surgically-treated, early-stage invasive cervical cancer.

Colposcopic-histologic eligibility criteria for fertility-sparing surgical management in early-stage cervical cancer

The decision whether fertility-sparing surgical management may be successfully applied in women with cervical cancer who wish to preserve their fertility remains a great therapeutic challenge. Such management is possible if no node metastases are expected and the risk of cancer spread beyond the cervix is limited. Thus, precise evaluation of tumor size is necessary. The aim of the study was to establish cytologic, colposcopic and histologic eligibility criteria for fertility-sparing treatment in women with early-stage cervical cancer. The study included 119 women (aged 25-43 years) diagnosed and operated on due to malignant changes within the cervix. Each subject underwent cytologic and colposcopic examination, followed by histologic evaluation of a large, target section from the most suspicious area of the lesion. Histologic evaluation revealed stage IA1 in 60 (50.4%), IA2 in 53 (44.5%), and IB1 in 6 (5.1%) patients. Histologic compatibility between target sections and evaluation of the surgical material was 59 (98.4%), 51 (96.2%), and (100%) for stages IA1, IA2, and IB1, respectively Proper colposcopic assessment of early-stage invasive cervical cancer (IA) allows to identify the most adequate area for large wedge biopsy That in turn makes it possible to establish proper histologic pre-treatment diagnosis, with an over 95% compatibility with the final histologic evaluation, what conditions fertility-sparing surgical treatment.

Genomics of Cervical Cancer and the Role of Human Papillomavirus Pathobiology

Cervical cancer represents one of the most common malignancies in women worldwide and predominantly affects women of poor socioeconomic status. Persistent infection with high-risk human papillomavirus (HPV)3 is an essential factor for development of cervical cancer. HPV infection is also associated with cancers of the vulva, vagina, anus, and oropharynx. Globally, an estimated 610 000 (4.8%) of the 12.7 million new cancer cases that occurred in 2008 could be attributed to HPV infection, and >500 000 of those cases represent cancers of the cervix alone (1). Within the last 2 decades, research has culminated in major advances in techniques for cervical cancer screening using HPV DNA and has led to a vaccine to prevent HPV infection. Yet, our strategies for the care and treatment of today's patients already infected with HPV need urgent attention. Women diagnosed with invasive and metastatic cervical cancer are in critical need of more-sophisticated prognostic markers, targeted therapeutic options, and more-accurate surveillance strategies. There are about 120 HPV types, and types 16 and 18 are associated with 70% of the cases of cervical cancer worldwide. Many studies have shown that HPV-18–associated cervical cancer is a strong independent prognostic factor for poorer disease-free survival for women undergoing surgery or radiation for early-stage invasive cervical cancer (2). The biology behind the poorer outcomes is unknown, but studies have suggested that sequence variation in HPV genes produces differences in their oncogenic potential. For example, HPV-18 E6 4 (E6 transforming protein) oncogene variants differentially regulate members of the Akt/P13K pathway and show increased expression of genes involved in cancer cell extravasation and metastasis (3, 4). HPV integration into the host genome is a critical step in cervical carcinogenesis and is found in almost all invasive cervical cancers. Integration frequently disrupts HPV E2 (E2 regulatory protein) gene expression, …

Less Radical Surgery for Patient With Early-Stage Cervical Cancer

IntroductionSurgery in cervical cancer should be used with intention of cure. Radical abdominal trachelectomy is a feasible operation for selected patients with stage Iα-1β cervical cancer which fertility can be preserved.Case ReportA 30-years-old woman with squamous cell cervical cancer stage (1 A II) diagnosed at September 2011 expressed a wish for fertility-sparing treatment. Radical abdominal hysterectomy and pelvic and para-aortic lymphadenectomy were performed which showed no evidence of lymphatic metastasis. Subsequently, at last follow-up (5 months post-surgery), good oncologic outcomes were found after this procedure. This was the first case of fertility-sparing radical trachelectomy procedures performed at our institution.ConclusionsTrachelectomy represents a valuable conservative surgical approach for early stage invasive cervical cancer.

Less Radical Surgery for Fertility Preservation in Patients with Early-Stage Invasive Cervical Cancer Contemporary Problematics

Cervical cancer, is a middle age women’s disease. Nowadays, because of the postponement of childbearing at older age, women younger than 45 years old who are diagnosed with cervical cancer, have a strong desire for preserving fertility. For this reason, Radical Trachelectomy (Vaginal and Abdominal) is used worldwide. In this article, we review data on procedures for fertility preservation, namely Radical Trachelectomy, less invasive procedures and Neoadjuvant Chemotherapy, based on the literature over the past 12 years. Oncological and Obstetrical outcomes are analyzed. In conclusion, Radical Trachelectomy, is an oncologically safe procedure for women with early invasive cervical cancer. However, a number of considerations regarding the selection criteria, patient’s information and especially the complications and the postoperative quality of life, should be taken into account.

Laparoscopic Nerve-Sparing Radical Parametrectomy for Occult Early-Stage Invasive Cervical Cancer After Simple Hysterectomy

To investigate the feasibility and surgical outcomes of laparoscopic nerve-sparing radical parametrectomy (LNSRP) and lymphadenectomy for treatment of occult early-stage invasive cervical cancer after simple hysterectomy. From 2006 to 2010, 28 patients who were discovered to have occult early-stage invasive cervical cancer after a simple hysterectomy underwent LNSRP, upper vaginal resection, and pelvic lymphadenectomy. A retrospective analysis of these cases was performed. All patients underwent successful LNSRP. There was no conversion to laparotomy. The mean ± SD operation time was 173.30 ± 56.20 minutes. The mean ± SD estimated blood loss was 230.00 ± 109.55 mL. Two intraoperative complications were recorded. The median number of extracted pelvic and para-aortic lymph nodes was 23 (range, 12-36) and 7 (range, 3-15), respectively. The mean ± SD time before Foley catheter removal was 5.6 ± 2.74 days (range, 3-14 days ), and bladder voiding function recovery to grade 0 to grade 1 was observed in 26 patients (92.9%). Of the 28 patients, 3 patients received further adjuvant therapy. The median follow-up period was 38 (range, 4-62) months for all patients. No recurrence case was found in this series. Laparoscopic nerve-sparing radical parametrectomy is a therapeutic option for occult early-stage invasive cervical cancer discovered after hysterectomy. Nerve-sparing radical surgery in indicated patients may lead to optimal preservation of bladder function.

Outcomes and disease progression after cervical excisional procedures (EPS), loop electroexcisional procedure (LEEP) or cone biopsy specimens (CKC), and radical hysterectomy (RH) for early stage invasive cervical cancer

Outcomes and disease progression after cervical excisional procedures (EPS), loop electroexcisional procedure (LEEP) or cone biopsy specimens (CKC), and radical hysterectomy (RH) for early stage invasive cervical cancer

Change in clinical management of sentinel lymph node location in early stage cervical cancer: The role of SPECT/CT

Objective The aim of this study was to investigate the feasibility of the sentinel lymph node (SLN) identification with SPECT/CT lymphoscintigraphy imaging in the early stage invasive cervical cancer in patients undergoing radical hysterectomy and pelvic lymphadenectomy. Methods Between March 2007 and June 2009, a prospective consecutive study was designed for SLN mapping. Twenty-two patients with cervical cancer FIGO stage IB1 (n = 20) or stage IIA1 (n = 2) underwent SLN identification with preoperative SPECT/CT and planar images (technetium–99 m colloid albumin injection around the tumor) and posterior intraoperative detection with both blue dye and a handheld or laparoscopic gamma probe. Complete pelvic lymphadenectomy was performed in all cases by open (n = 2) or laparoscopic (n = 20) surgery. Results In the present series, a total of 35 SLN were detected with planar images and 40 SLN were identified and well located by SPECT/CT lymphoscintigraphy (median 2.0 nodes per patient). In 5/22 patients (22.7%) SPECT/CT procedure improves the number of localized SLN. Intraoperatively, 57 SLNs were identified, with a median of 3 SLNs per patient by gamma probe (a total of 53 hot nodes) and a median of 2 nodes per patient after blue dye injection (a total of 42 blue nodes). Microscopic nodal metastases (eight nodes, corresponding to four patients) were confirmed in 18.18% of cases; all these lymph nodes were previously detected as SLN. The remaining 450 nodes, including SLNs, following complete pelvic lymphadenectomy, were histologically negative. Conclusions Sentinel lymph node detection is improved by SPECT/CT imaging because of the increased number of SLN detected and the better tridimensional anatomic location, allowing easier intra-operative detection with gamma probe and showing, in this series, a 100% negative predictive value.