Treatment Of Early Cervical Cancer Research Articles

Patient-rating of distressful symptoms after treatment for early cervical cancer.

More refined information on sources of symptom-induced distress in a patient population can improve the quality of pretreatment information, make follow-up visits more efficient and guide research priorities in the efforts to modify treatments. In a population-based epidemiological study covering all of Sweden, data were collected 1996-97 by means of an anonymous postal questionnaire. We attempted to enroll all 332 patients with stage IB-IIA cervical cancer registered in 1991-92 at the seven departments of gynecological oncology in Sweden. A total of 256 cases (77%) completed the questionnaire. After surgery, alone or in combination with intracavitary radiotherapy, several symptoms related to sexual dysfunction are the primary sources of symptom-induced distress (reduced orgasm frequency: much distress 23% (surgery alone) and 23% (intracavitary radiotherapy and surgery), respectively, overall intercourse dysfunction: much distress 17% and 20%, respectively, followed by lymphedema (much distress 14% and 14%, respectively). Dyspareunia (much distress 24%) and defecation urgency (much distress 22%) are two leading causes of distress after surgery and external radiotherapy. After treatment with radiotherapy alone, loose stool and dyspareunia were the two most distressful symptoms (much distress 19% each). When a symptom occurs, fecal leakage and reduced orgasm frequency are the two most distressful ones (measured as much distress, 38% each). The observed symptoms are distressful and should, if one focuses on patient satisfaction, be given priority.

Patient-rating of distressful symptoms after treatment for early cervical cancer

Patient-rating of distressful symptoms after treatment for early cervical cancer

RADICAL ABDOMINAL HYSTERECTOMY

Radical abdominal hysterectomy and pelvic lymphadenectomy remain the gold standard procedures for the treatment of early cervical cancer. Over the years, the establishment of formal gynecologic oncology training programs, general medical advancements, and new surgical techniques have resulted in a satisfactory tumor resection, with improved overall therapeutic index and reliable cure rates. The role of neoadjuvant and adjuvant therapy continues to be defined as the results from randomized trials emerge.

The long learning curve of gynaecological cancer surgery: an argument for centralisation.

To study the development of surgical performance of an unchanging surgical team over 13 years. Prospective, observational study. A university hospital, The Netherlands. Three hundred and eight women who underwent surgical treatment for early cervical cancer. Radical hysterectomy and pelvic lymphadenectomy between 1 January 1984 and 31 December 1996. The surgical procedure and indication for treatment remained unchanged during the study period. This applied also to the surgical team. The women's age increased significantly during the study years, as was the case with the number of nodes removed. The depth of infiltration by the tumour increased steadily throughout the study, but this failed to reach statistical significance. The distribution of FIGO stages, percentage of positive lymph nodes, radicality of the surgical margins and post-operative morbidity remained the same. Overall, the five year survival rate was 83%; for women with negative nodes 91%, and for women with positive nodes 53%. Survival tended to improve during the course of the study, but this was not statistically significant. Blood loss during surgery decreased consistently during the whole study period, from a mean of 1,515 mL at the beginning of the study to a mean of 1,071 mL at the end (P < 0.0001). The operating time also diminished significantly by 8 minutes per year (P < 0.0001). In 1985 the average operating time was 270 minutes, compared with 187 minutes in 1996. These findings indicate that it takes a long time to acquire skill in the surgical treatment of early cervical cancer. Centralisation of relatively infrequent operations for cancer should be encouraged.

Radical trachelectomy: a way to preserve fertility in the treatment of early cervical cancer.

In the Centenary year of Wertheim's hysterectomy for the treatment of invasive cervical cancer, it is appropriate to look at less radical methods of managing early stage disease. Radical trachelectomy with pelvic lymphadenectomy is a conservative but locally radical procedure, preserving the corpus uteri and therefore fertility potential. The first 10 cases in a pilot study are presented. One patient has required post-operative radiotherapy and another a completion radical hysterectomy. Three live births by caesarean section and three other pregnancies have resulted. Careful selection within strict criteria may allow this more conservative approach without compromising cure. These procedures should be carried out in referral centres with continuing follow up and review.

The treatment of stage I carcinoma of the cervix in the west of Scotland 1980-1987.

To examine the results of different treatments for Stage IA and IB carcinoma of the cervix in patients treated in the West of Scotland between 1980 and 1987. A retrospective review of case records. The Beatson Oncology Centre, Western Infirmary and Belvidere Hospital, Glasgow, and the departments of gynaecology of hospitals in the west of Scotland. One hundred and five patients with Stage IA and 420 patients with Stage IB carcinoma of the cervix. A variety of treatments were used for women with Stage IA disease, with an overall actuarial five year survival of 100%. The overall actuarial five year survival for women with Stage IB disease was 79.5%. Patients with Stage IB disease treated by radical hysterectomy (n = 123) or radical radiotherapy (n = 229) had similar five year survival rates (86.3% and 79.5%, respectively), whereas patients treated initially by nonradical surgery (n = 68) had a significantly worse five year survival (68.1%; P = 0.008). These results emphasize the need for adequate and appropriate surgery and the centralisation of treatment for early cervical cancer.

Treatment of early cervical cancer

Treatment of early cervical cancer

Is the published literature a reliable guide for deciding between alternative treatments for patients with early cervical cancer?

The quality of the methodology and reporting of studies on the treatment of early cervical cancer published in English and French language over the period 19752̄985 were examined using an explicit, pre-defined protocol aimed at assessing their internal validity and generalizability. One hundred and fifty-two articles reporting results on over 40,000 patients treated with surgery, radiotherapy, or the combination of the two, were examined. The astonishing lack of formal comparative studies together with the poor quality of those actually carried out were the two major findings of our study. More than half of the reviewed papers (54%) were single series studies.Among the remaining 46% only a few formally compared the two treatments (i.e. surgery vs. radiotherapy), the remainder dealing with comparisons of specific surgical or radiotherapeutic techniques. With reference to study quality, the existence of a pre-specified research protocol could not be ascertained in most studies. A description of patients' characteristics and information on the source population were deficient in most papers reviewed; information on thetwo aspects was in fact satisfactorily reported in only 7% and 47% of the papers, respectively. Finally, the lack of standardization of follow-up methods (i.e. type and modalities) and of information on treatment compliance were two other severe methodological deficiencies. In view of this poor quality and of the intrinsic difficulty of drawing firm scientific conclusions from non-experimental investigations, the reliability of this literature remains highly dubious. Another possible caveat is that what is published is a biased sample of the overall evidence because of the well known tendency of authors to write about and editors to publish positive results more frequently than negative ones.

Early squamous cell carcinoma of the uterine cervix II. Clinical results of a cooperative study in the management of 419 patients with early stromal invasion and microcarcinoma

Clinical studies and therapeutic modalities in 285 patients with early stromal invasion and 134 patients with microcarcinoma collected from six different university hospital departments of gynecology are presented as a contribution to the controversial problem concerning the proper treatment of early cervical cancer. In all six departments, clinical investigation and histologic studies are carried out in a comparable manner. Of the patients, 72% with early stromal invasion and 41% with microcarcinoma were treated with conization or with abdominal, respectively vaginal hysterectomy only, i.e., not with the usual radical cancer therapy. After long-term follow-up, no patient with early stromal invasion has died; in three patients who died from microcarcinoma, a causal relationship seems to have existed between the fatal cause and microcarcinoma. Our own results and comparable data reported in the literature allow the conclusion that in patients with early stromal invasion or microcarcinoma, a restricted cancer therapy may be possible, just as in patients with carcinoma in situ. If intraluminal tumor invasion is demonstrated in the diagnostic biopsy, an additional lymphadenectomy is advisable. A radical extirpation of parametrial tissues is in no case necessary.

Managing cervical cancer in Nepal: Need of consensual guideline

The purpose of this review is to bridge the pattern of intervention in optimal and sub-optimal facility level.Several guidelines for the screening and treatment of cervical cancer are reviewed. Routine screening isfound grossly lacking and non existent outside major health institution. Only nominal data and interventionefforts found published. There are three prongs of intervention level namely prevention/screening, treatmentand palliation together. Pap smear test is the standard screening tool wherever the cyto-diagnostic facilityexists. Visual Inspection with Acetic acid and Lugol's Iodine will be the feasible alternative at low resourcesetting. Primary surgical treatment for early cervical cancer is the best option. Likewise chemo-radiation withor without surgery will be the alternative option. Need of at least an operational guideline in each institutionis realized at this moment as a recommendation.Key words: Cervical intraepithelial neoplasia (CIN); colposcopy; Pap smear (Papanicolou stain); radicalhysterectomy; visual inspection with acetic acid (VIA).DOI: 10.3126/njog.v4i1.3324Nepal Journal of Obstetrics and Gynaecology June-July 2009; 4(1): 3-10

Ovarian function after combined surgical and radiologic treatment of early cervical cancer.

Ovarian function after combined surgical and radiologic treatment of early cervical cancer.

Ovarian Function after Combined Surgical and Radiologic Treatment of Early Cervical Cancer

Ovarian Function after Combined Surgical and Radiologic Treatment of Early Cervical Cancer