Histological Diagnosis Of Cervical Cancer Research Articles

A study of risk factors and clinico-pathological profile of patients with cervical cancer at BPKIHS: A descriptive cross-sectional study.

e17515 Background: Cervical cancer is the cancer with highest incidence and mortality among females in Nepal according to GLOBOCAN data 2020. The aims of this study was to evaluate the risk factors and clinico-pathological profile of patients with cervical cancer attending Department of Gynaecology, BPKIHS, Dharan, Nepal. Methods: It was a descriptive cross-sectional study conducted from April, 2019 to February, 2022 among seventy-nine patients with histological diagnosis of cervical cancer after ethical approval. Results: The mean age of these patients was 54.99±12.81 years. The commonest presenting symptom was postmenopausal bleeding (65.8%) and the commonest histological type was squamous cell carcinoma (87.3%). The commonly associated risk factors among them were illiteracy (88.6%), poor local hygiene (78.5%), postmenopausal status (72.2%) and poor socio-economic status (41.8%). The mean age at marriage and first pregnancy were 18.45 (SD=2.32) years and 19.47 (SD=2.51) years respectively. More than one-fourth (29.1%) of the patients had more than or equal to 5 children. Only three (3.8%) patients had undergone cervical cancer screening once in their lifetime.Most of them (n=66; 83.5%) had locally advanced disease at diagnosis. Altogether, sixty-seven (84.8%) patients were referred outside for radiation treatment. Among the surgically treated patients, twelve (63.2%) patients subsequently required dual treatment. Conclusions: Illiteracy, poor hygiene, low socio-economic status, patient’s delays, poor screening programmes, multiparity, early age at marriage and first child birth etc. are the factors requiring major focus to reduce the burden of cervical cancer in developing countries like Nepal.

Abstract 975: Genomic landscape of circulating tumor DNA in cervical cancer in Asia: NCCH1905/A-TRAIN trial

Abstract Background: Cervical cancer is the second most common cancer among women worldwide, with over 500,000 new cases diagnosed annually and a 50% mortality rate in Asia. The incidence and prevalence of cervical cancer is high in Asia due to limited screening, awareness of HPV infection, and access to vaccines. The purpose of this study is to evaluate the comprehensive genomic profiles of circulating tumor DNA (ctDNA) in Asian cervical cancer patients with different histological subtypes and their association with clinicopathological features. Methods: This is an Asian multicenter prospective observational study conducted by nine institutions in Japan, Singapore, Malaysia, Thailand, and Vietnam (NCT05099978, ClinicalTrials.gov). Eligible patients had histological diagnosis of cervical cancer with metastatic or recurrent disease. Patients on chemotherapy or radiotherapy were excluded. ctDNA was analyzed in blood samples collected at newly initial diagnosis of metastatic disease and/or at disease progression. Genomic profiling was conducted by Guardant360 (Guardant Health). Results: Ninety-nine samples from 101 cervical cancer patients were analyzed. ctDNA was detected in 70 (70.7%) samples; median time to test results was 11 days. The median number of genomic abnormalities was 1 (range, 0-22). The most frequently altered genes were PIK3CA (n=28. 28.3%), TP53 (n=18, 18.2%), KRAS (n=12, 12.1%) and STK11 (n=6, 6.1%). Clinical trial-related genomic abnormalities were detected in 59 patients (59.6%) with 40 associated with approved drugs in other indication, including those targeting PIK3CA mutation (n=28), homologous recombination deficiency (BRCA1/2, ATM and CDK12 mutation) (n=5), ERBB2 amplification (n=4) and FGFR3alterations (n=3). In squamous cell carcinoma (n=59), commonly altered genes were PIK3CA (n=21, 35.6%), TP53(n=12, 20.3%), ERBB2 (n=5, 8.5%), NOTCH1 (n=5, 8.5%) and ARID1A (n=5, 8.5%). In adenocarcinoma (n=36), commonly altered genes were KRAS (n=7, 19.4%), PIK3CA (n=6, 16.7%) and TP53 (n=5, 13.9%). The number of patients with genomic alterations relevant for clinical trials was 39 (66.1%) and 19 (52.8%) for squamous cell carcinoma and adenocarcinoma, respectively. There were no differences in the number of genomic alterations according to prior chemotherapy or radiation therapy. Conclusion: Comprehensive genomic profiling using liquid biopsy can rapidly identify potential candidates for targeted therapy in cervical cancer patients, regardless of histopathology. Clinical studies of precision medicines in Asia are encouraged for such patients. Citation Format: Prathepamalar Yehgambaram, Yuki Kojima, Kazuki Sudo, Shu Yazaki, Momoko Tokura, Munehiro Ito, Mai Hoshino, Wong Yoke Fui, Pei Jye Voon, David SP Tan, Arb-aroon Lertkhachonsuk, Anh Tuan Pham, Thinh Dang Huy Quoc, Wan Zamaniah Wan Ishak, Hiroshi Yoshida, Shinji Kohsaka, Yukari Nagasaka, Ryunosuke Machida, Tomomi Hata, Kenichi Nakamura, Kan Yonemori. Genomic landscape of circulating tumor DNA in cervical cancer in Asia: NCCH1905/A-TRAIN trial [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 975.

Diagnostic and pre-treatment intervals among patients with cervical cancer attending care at the Uganda Cancer Institute: a cross-sectional study

BackgroundMajority of patients with cervical cancer in the low- and middle-income countries experience long diagnostic and pre-treatment intervals. This study sought to determine the factors associated with the diagnostic and pre-treatment intervals among patients with cervical cancer.MethodsThis was a cross-sectional study conducted at the Uganda Cancer Institute (UCI) during October 2019 to January 2020. Patients aged ≥ 18 years with histological diagnosis of cervical cancer were consecutively sampled. Data were collected using a pre-tested semi-structured questionnaire and a data abstraction form. Diagnostic intervals, defined as the time between first visit of a patient to a primary healthcare provider to time of getting confirmed diagnosis, of ≤ 3 months was defined as early & >3 months as late. Pre-treatment intervals, which is the time from histological diagnosis to starting cancer chemo-radiotherapy of ≤ 1 month was defined as early and > 1 month as late. Data were analysed using STATA version 14.0. We used modified Poisson regression models with robust variance to determine socio-demographic and clinical factors associated with the intervals.ResultsThe mean age of the participants was 50.0 ± 11.7 years. The median diagnostic and pre-treatment intervals were 3.1 (IQR: 1.4–8.2) months and 2.4 (IQR: 1.2–4.1) months respectively. Half of the participants, 49.6% (200/403) were diagnosed early; one in 5 patients, 20.1% (81/403) promptly (within one month) initiated cancer chemo-radiotherapy. Participants more likely to be diagnosed early included those referred from district hospitals (level 5) (aPR = 2.29; 95%CI: 1.60–3.26) and with squamous cell carcinomas (aPR = 1.55; 95%CI: 1.07–2.23). Participants more likely to be diagnosed late included those who first discussed their symptoms with relatives, (aPR = 0.77; 95%CI: (0.60–0.98), had > 2 pre-referral visits (aPR = 0.75; 95%CI (0.61–0.92), and had advanced stage (stages 3 or 4) (aPR = 0.68; 95%CI: 0.55–0.85). Participants more likely to initiate cancer chemo-radiotherapy early included older patients (≥ 60 years) (aPR = 2.44; 95%CI: 1.18–5.03). Patients likely to start treatment late were those who had ≥2 pre-referral visits (aPR = 0.63; 95%CI: 0.41–0.98) and those that took 3 - 6 months with symptoms before seeking healthcare (aPR = 0.52;95%CI: 0.29 - 0.95).ConclusionInterventions to promote prompt health-seeking and early diagnosis of cervical cancer need to target primary healthcare facilities and aim to enhance capacity of primary healthcare professionals to promptly initiate diagnostic investigations. Patients aged < 60 years require targeted interventions to promote prompt initiation of chemo-radiation therapy.

Is HPV-negative cervical carcinoma a different type of cervical cancer?

Human papillomavirus (HPV), which is known to play a very important role in genital area (vulva, vagina, and cervix) cancers in women, is responsible for almost all cervical cancers. However, a significant proportion of cervical carcinomas (approximately 7%) is HPV-negative. Therefore, there are still two important questions to be answered: 1. Why is HPV Deoxyribonucleic acid (DNA) not found in all cervical carcinomas? 2. Are HPV-DNA-negative cervical cancers a specific subgroup of cervical cancers with different biological behavior (worse prognosis)? In this article, we aimed to evaluate the clinicopathological characteristics and survival of patients with confirmed HPV-negative tumors in order to answer these two questions. A total of 97 patients who underwent HPV-DNA testing and received a histological diagnosis of cervical cancer were included in the study. 14 HPV-DNA negative and 83 HPV-DNA positive cervical carcinoma patients were detected. Demographic profiles, clinicopathological characteristics, progression-free, and overall survival of all patients were analyzed. Women with HPV-negative tumors were diagnosed at an older age range (p=0.05), and their demographic data other than age range were similar to HPV-positive tumors. P16 staining pattern was not observed in any of the HPV-negative tumors (p=0.001), and a positive P53 staining pattern was detected in 35.7% of the HPV-negative tumors. Although disease-free survival (PFS) (p=0.224) and overall survival (OS) (p=0.219) were worse in the HPV-negative patient group, this difference was not statistically significant. HPV-negative cervical cancers do not have a poor prognosis unlike their counterparts in other anatomical regions where HPV-associated tumors are present.

Potential clinical utility of plasma D-dimer levels among women with cervical cancer in Lagos, Nigeria.

The link between plasma D-dimer levels and underlying malignancy has been established. How this translates in clinical practice as a marker of detection and prognosis of cervical cancer (CC) is still unknown. This study compared the plasma D-dimer levels in women with and without CC and assessed the associations between plasma D-dimer levels and the stage and grade of CC. It was a comparative cross-sectional study of 65 women with histological diagnosis of CC and an equal number of age-matched cancer-free women enrolled at the University Teaching Hospital in Lagos, Nigeria. Participants' sociodemographic and clinical data as well as venous blood samples for estimation of plasma D-dimer were collected for statistical analyses. A receiver operating characteristic (ROC) analysis is performed to select the cut-off value of plasma D-dimer for differentiating CC from non-cancer. There was a statistically significant difference in the median levels of plasma D-dimer of women with CC and their cancer-free comparison groups (3,120 (1,189-4,515) versus 210 (125-350) ng/mL; p = 0.001). A plasma D-dimer value of 543 ng/mL was chosen in a ROC analysis as the discriminatory cut-off to differentiate CC from non-cancer. There were significant associations between plasma D-dimer levels and the International Federation of Gynaecology and Obstetrics stage (p = 0.001) or grade (p = 0.001) of CC. The study, therefore, demonstrated the potential clinical usefulness of plasma D-dimer as a diagnostic and prognostic marker of CC.

Vaginal cuff brachytherapy in the adjuvant setting for patients with high-risk early-stage cervical cancer

PurposeTo evaluate local control and survival of high-risk patients with early-stage cervical cancer submitted or not to vaginal cuff brachytherapy in the postoperative setting. Methods and MaterialsIn this retrospective cohort of patients treated from 2010 to 2017, patients were eligible if they had confirmed histological diagnosis of cervical cancer treated with surgery and adjuvant radiotherapy with or without chemotherapy. Vaginal cuff brachytherapy (VCB) was indicated according to the radiation oncologist discretion. ResultsSeventy-nine patients were selected, with a median age at diagnosis of 47.5 years (26–77). Brachytherapy was delivered to 59 patients (74.7%). There were no significant differences between the VCB and the no-VCB groups. A total of 13 (16.5%) patients presented one or more events, 5 (25%) and 8 (13.5%) events in the no-VCB and VCB group, respectively. Most recurrences were pelvic and/or vaginal: 7/20 (35%) in the no-VCB group and 9/59 (10.2%) in the VCB group. There were eight systemic relapses with eight deaths. With a median followup of 45 months, mean overall survival and disease-free survival were, respectively, 85.1 and 83.8 months. No variables were correlated with overall survival. The only factor positively correlated to disease-free survival was VCB, with a mean of 86.9 and 68.4 months for patients who did and did not receive brachytherapy, respectively (p = 0.043). Vaginal recurrence was lower in the brachytherapy group, but with no statistical significance (p = 0.065). ConclusionVCB was associated with a reduced recurrence rate in the postoperative setting of high-risk patients with early-stage cervical cancer.

D-dimer levels as marker of deep vein thrombosis in patients with cervical cancer: A study of a northern Nigerian patient population

Background: Cervical cancer is the most common genital tract malignancy in Nigeria and an important cause of cancer-related death in women. Patients with advanced cervical cancer are often victims of deep venous thrombosis (DVT) that increases morbidity and mortality. Strategies at screening and early diagnosis enable prompt treatment which improves quality of life. Objectives: The objective of this study is to determine the plasma D-dimer level in patients with cervical cancer and its relationship to the presence of DVT, Well's score, and stage of malignancy. Materials and Methods: It is a prospective cross-sectional descriptive study of patients with histological diagnosis of cervical cancer in a Nigerian population. Patients' clinical, laboratory, and radiological data were obtained, and their body mass index (BMI) was calculated. Well's chart 17 was used to categorize patients using a cutoff of 2. Plasma D-dimer was quantified by immunoturbidimetric method and interpreted as significant if >0.099 g/dl. High-resolution ultrasound with 5–10 MHZ linear probe was used to evaluate the lower limbs veins of the patients. Data were analyzed with SPSS version 20. The test of association was done using Chi-square with a P

Association between stage at diagnosis and knowledge on cervical cancer among patients in a Kenyan tertiary hospital: a cross-sectional study.

IntroductionIn Kenya, cervical cancer is the second most common cancer among women; almost half of all women with invasive cervical cancer are diagnosed at a late stage. Few women are aware of the symptoms and risk factors of cervical cancer and that its precursor lesions are detectable through screening thus most women seek treatment when the cancer is at an advanced stage. The study explored the influence of cervical cancer awareness on stage at diagnosis in patients attending Kenyatta National Hospital.MethodsA cross-sectional survey was adapted to obtain socio-demographic information, knowledge on symptoms and risk factors from 361 women with histological diagnosis of cervical cancer conveniently sampled at Kenyatta National Hospital. Associations between stage at diagnosis and knowledge on cervical cancer were tested using chi-square statistic and fisher's exact test at 95% confidence interval.ResultsSeven in every 10 women (72.6%) presented with advanced stage cervical cancer. Knowledge on the sexually transmitted nature of cervical cancer was inadequate, 22% of women with early stage and 23.7% of women with advanced stage cervical cancer (p=0.874). Majority of the women were not aware of the causative link between cervical cancer and human papillomavirus (HPV), 8 (13.1%) of women with early stage and 5 (3.5%) of women with advanced stage cervical cancer (p=0.036).ConclusionStage at presentation was advanced and knowledge on the role of a sexually transmitted virus in the cervical cancer aetiology was poor among the women. Increasing screening programs and providing information highlighting this association is necessary.

Asociación entre parto vaginal y parto exclusivamente por cesárea, con el cáncer epidermoide de cérvix y sus precursores.

Introducción: El virus papiloma humano (VPH) puede infectar el epitelio cervical a través de un traumatismo anterior, con lesión del epitelio, que permite que el VPH alcance las células basales y parabasales. Objetivo: Determinar la existencia de una mayor relación entre las mujeres con parto vaginal que entre las mujeres con parto por cesárea en la presentación del cáncer epidermoide de cérvix y sus precursores. Diseño: Estudio de casos y controles. Lugar: Hospital Regional Docente de Trujillo, Perú. Participantes: Mujeres con diagnóstico clínico e histopatológico de cáncer de cérvix y sus precursores. Intervenciones: Se consideró como casos a 177 mujeres con diagnóstico clínico e histopatológico de cáncer de cérvix y sus precursores, atendidas en los años 2000 a 2002. Los controles fueron 179 mujeres que habían tenido partos vaginales o partos por cesárea, exclusivamente. Para determinar qué características se asocian al cáncer cervical, se aplicó el análisis multivariado, considerando como variables predictoras a la edad, paridad, tipo de parto y edad de la primera relación sexual. Luego, se realizó un análisis de regresión logística, para determinar qué variables constituían factores de riesgo y poder pronosticar la probabilidad de ocurrencia de cáncer en pacientes con tales características. Para cada una de las variables estudiadas se calculó el odds ratio. La significancia estadística se estimó con la prueba chi cuadrado. Principales medidas de resultados: Asociación del tipo de parto con la aparición del cáncer de cérvix. Resultados: De las variables analizadas, la edad de la primera relación sexual, la paridad y gravidez y el tipo de parto se asociaron significativamente con la aparición del cáncer de cérvix (OR 1,13; IC95% 1,17-; 24,11, respectivamente). El parto vaginal mostró un riesgo mayor de 24 veces, en comparación con el parto por cesárea (OR 24,11, p&lt;0,000008). Conclusiones: En la población estudiada, el parto vaginal fue el más fuertemente asociado al cáncer de cérvix y predispuso a las mujeres a desarrollar esta neoplasia y sus precursores.

Abstract 5574: ZNF516 and FKBP6 promoter hypermethylation as a potential companion diagnostic panel for HPV-positive and inconclusive-Pap women

Abstract New biomarkers are needed to improve cervical cancer screening technologies, which are mostly based on cytological examination since the 1940's. HPV testing has been adopted for the triage of patients after a cervical cytology-screening test. HPV testing is now also increasingly used for screening in conjunction with cervical cytology. However, a percentage of HPV-positive and inconclusive-Pap women have negative biopsies when refered to colposcopy clinics. The aim of this study was to use a genome-wide discovery approach to identify novel epigenetic biomarkers for cervical cancer, which could be used as companion diagnostic panels to HPV and PAP. DNA from twelve normal and seven cervical cancer samples was enriched with Methylated DNA Immunoprecipitation (MeDIP), hybridized to Nimblegen 385K CpG Islands plus Promoter arrays and validated by quantitative Methylation Specific PCR in discovery (n=49) and prevalence cohorts (n=108). After correction and normalization performed using Nimblegen algorithms genes methylated in tumor and not in normal samples were ranked by methylation peak values and sequence homology. The most significant loci were verified against a report by Ongenaert et al. (BMC Med Genomics, 2008) that uses a relaxation ranking algorithm to identify re-expressed genes in cervical cancer cell lines after treatment with demethyalting agents. Two genes, ZNF516 and FKBP6, were identified as candidate epigenomic biomarkers after rigourous bioinformatics and in-silico analyses. These genes were also found to be re-expressed by Ongenaert et al. Using the most optimal cut-off as determined by ROC, ZNF516 promoter methylation had 90% sensitivity and 95% specificity (AUC=0.95) in the discovery cohort. FKBP6 promoter methylation had a sensitivity of 73% and a specificity of 79% in the same cohort. Promoter methylation of FKBP6 (OR=4.51, 95%C.I.=2.04-9.97, P&amp;lt;0.001) and ZNF516 (OR=11.84, 95%C.I.=4.59-30.57, P&amp;lt;0.001) was associated to HPV infection in the prevalence cohort. FKBP6 (OR=7.15, 95%C.I.=1.45-35.34, P=0.01) and ZNF516 (OR=26.72, 95%C.I.=2.61-273.05, P &amp;lt;0.01) promoter methylation was associated with histological diagnosis of cervical cancer in the overall cohort, after controlling for age and HPV infection. Promoter methylation of ZNF516 and FKBP6 performed better than HPV at identifying normal from tumor tissue in the overall cohort. Our results suggest that a genome-wide approach using MeDIP-Chip and qMSP is useful for identifying novel screening and diagnostic markers. ZNF516 and FKBP6 were identified as a potential companion diagnostic panel for HPV-positive and inconclusive-Pap women. Examination of these biomarkers in a larger, independent cohort is warranted. Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 103rd Annual Meeting of the American Association for Cancer Research; 2012 Mar 31-Apr 4; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2012;72(8 Suppl):Abstract nr 5574. doi:1538-7445.AM2012-5574

Expression of Mir-21 and Mir-143 in Cervical Specimens Ranging from Histologically Normal through to Invasive Cervical Cancer

BackgroundMicroRNA expression is severely disrupted in carcinogenesis, however limited evidence is available validating results from cell-line models in human clinical cancer specimens. MicroRNA-21 (mir-21) and microRNA-143 (mir-143) have previously been identified as significantly deregulated in a range of cancers including cervical cancer. Our goal was to investigate the expression patterns of several well-studied microRNA species in cervical samples and compare the results to cell line samples.Methodology/Principal FindingsWe measured the expression of mir-21 and mir-143 in 142 formalin-fixed, paraffin embedded (FFPE) cervical biopsy tissue blocks, collected from Dantec Oncology Clinic, Dakar, Senegal. MicroRNA expression analysis was performed using Taqman-based real-time PCR assays. Protein immunohistochemical staining was also performed to investigate target protein expression on 72 samples. We found that mir-21 expression increased with worsening clinical diagnosis but that mir-143 was not correlated with histology. These observations were in stark contrast to previous reports involving cervical cancer cell lines in which mir-143 was consistently down-regulated but mir-21 largely unaffected. We also identified, for the first time, that cytoplasmic expression of Programmed Cell Death Protein 4 PDCD4; a known target of mir-21) was significantly lower in women with invasive cervical carcinoma (ICC) in comparison to those with cervical intraepithelial neoplasia (2–3) or carcinoma in situ (CIN2-3/CIS), although there was no significant correlation between mir-21 and PDCD4 expression, despite previous studies identifying PDCD4 transcript as a known mir-21 target.ConclusionsWhilst microRNA biomarkers have a number of promising features, more studies on expression levels in histologically defined clinical specimens are required to investigate clinical relevance of discovery-based studies. Mir-21 may be of some utility in predictive screening, given that we observed a significant correlation between mir-21 expression level and worsening histological diagnosis of cervical cancer.

A study of Pap test history and histologically determined cervical cancer in NSW women, 1997–2003

To determine the risk of a histological diagnosis of cervical cancer following a given Pap test result and for a given history of Pap test results in a screened population across the full spectrum of possible cytological results. All the Pap screening results held on the New South Wales Pap Test Register for 1997-2003 (five million tests for 1.87 million women) were analysed using Cox proportional hazards regression to estimate the odds of having a histologically determined cervical cancer for a given Pap test result and test result history. The hazard ratios of having cervical cancer in relation to Pap test result histories were estimated: (i) in regard only to the last Pap test result adjusting for age, frequency of Pap testing and proportion of high grade (>or=cervical intraepithelial neoplasia 2 [CIN2]) abnormalities found in a woman's total recorded test result history; and (ii) with regard to the last Pap test result against the highest grade of cytological abnormality found prior to the last Pap test result. The hazard ratios are for a cancer diagnosis occurring before the next Pap test and were adjusted for age, quintile of socioeconomic status of residence, frequency of past Pap testing and proportion of high-grade abnormalities detected in each woman's prior Pap test history. The adjusted hazard ratios were then applied to the tabulated proportions of referent women with negative cytology in each broad age group, and for all women, to estimate the '1 in n' odds of being diagnosed histologically with cervical cancer for a given last Pap test result, and by a given last Pap test result for various prior Pap test result histories. After adjusting for age, socioeconomic status, frequency of previous Pap testing and proportion of past high-grade screen-detected abnormalities, the adjusted hazard ratio of having a subsequent cervical cancer diagnosis for women with a negative Pap test result was 1 in 5,546, compared with 1 in 833 for a low-grade epithelial abnormality (atypia, CIN1), 1 in 56 for a high-grade epithelial abnormality and 1 in seven for a cytological prediction of cervical cancer. These odds estimates were significantly modified by age and by the highest Pap test result prior to the most recent Pap test result: the higher the age and, less consistently, the higher the previous highest Pap test result for a given last Pap test result, the shorter the odds of having a subsequent histological diagnosis of cervical cancer. The results presented here will enable clinicians to inform their patients of their chances of being diagnosed with cervical cancer for a given Pap test result, and for some combinations of the last Pap test result and highest recorded prior Pap test result.

A review of cervical cancer patients presenting in Harare and Parirenyatwa Hospitals in 1998.

To document the socio-demographic profile, presenting symptoms, disease stage and treatment modality offered to all women attending Harare and Parirenyatwa Hospitals with a histological diagnosis of invasive cervical cancer in 1998. A cross sectional study. Parirenyatwa Hospital and Harare Central Hospital. All women with a histological diagnosis of cervical cancer admitted between 11 January 1998 and 14 December 1998 were recruited into the study. A total of 196 patients, with a median age of 47 years (range 24 to 80 years) were recruited into the study. A high proportion (63.3%) of the women were from rural areas. The mean age at first pregnancy was 17.9 years (SD 2.8) and 112 (63.3%) first sought treatment at the primary health care centre. Persistent vaginal discharge was the most frequent (69.4%) presenting complaint. One hundred and ninety five patients (99.5%) had histological confirmation of invasive cervical cancer (91.8% squamous cell carcinoma, 7.7% adenocarcinoma). Clinical staging by The International Federation of Gynaecology and Obstetrics (FIGO) classification confirmed that the majority (80.3%) of the cancers had spread from the cervix into the parametrium and beyond (stage 2b and above) at the time of presentation. Radiation therapy was the most commonly used (77.0%) treatment modality. This study demonstrates that the burden of cervical cancer occurs around the peak age of 47 years and that the majority of women present with advanced disease. None of the women had ever been screened for cervical cancer. The planned introduction of a cervical cancer screening programme by visual inspection of the cervix with acetic acid (VIA), together with a health education campaign may result in a shift towards more women presenting with early curable cervical cancer cases.

Early Histological Diagnosis of Cervical Cancer

This attractive volume presents a minutely detailed account of the early development of cervical cancer based on an extensive review of the literature and the author's own painstaking studies. The final reconstruction of events is stimulating because of the presentation of new data and several unorthodox interpretations. As one example, the evidence for a progression of dysplasia through carcinoma in situ into invasive carcinoma is challenged. The author emphasizes that dysplasia and carcinoma in situ have separate sites of origin in the cervix, and invasive carcinoma may be associated with the former as well as the latter. The major faults of the text are its organization and style. The sequence of presentation is such that full comprehension of the earlier chapters and pictures depends on reading and viewing those that appear later. The inevitable repetition that results, the occasional verbosity and lack of clarity of the text contribute to difficult

Book ReviewEarly Histological Diagnosis of Cervical Cancer.

Book ReviewEarly Histological Diagnosis of Cervical Cancer.