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Background: Training senior radiation therapists as "adapters" to manage influencers and target editing is critical in daily online adaptive radiotherapy (oART) for cervical cancer. The purpose of this study was to evaluate the accuracy and dosimetric outcomes of automatic contouring and identify the key areas for modification., Methods: A total of 125 oART fractions from five postoperative cervical cancer patients and 140 oART fractions from five uterine cervical cancer patients treated with daily iCBCT-guided oART were enrolled in this prospective study. The same adaptive treatments were replanned using the Ethos automatic contours workflow without manual contouring edits. The clinical target volume (CTV) was subdivided into several separate regions, and the average surface distance dice (ASD), centroid deviation, dice similarity coefficient (DSC), and 95% Hausdorff distance (95% HD) were used to evaluate contouring for the above portions. Dosimetric results from automatic oART plans were compared to supervised oART plans to evaluate target volumes and organs at risk (OARs) dose changes., Results: Overall, the paired CTV had high overlap rates, with an average DSC value greater than 0.75. The uterus had the largest consistency differences, with ASD, centroid deviation, and 95% HD being 2.67 ± 1.79 mm, 17.17 ± 12 mm, and 10.45 ± 5.68 mm, respectively. The consistency differences of the lower nodal CTV left and nodal CTV right were relatively large, with ASD, centroid deviation, and 95% HD being 0.59 ± 0.53 mm, 3.6 ± 2.67 mm, and 5.41 ± 4.08 mm, and 0.59 ± 0.51 mm, 3.6 ± 2.54 mm, and 4.7 ± 1.57 mm, respectively. The automatic online-adapted plan met the clinical requirements of dosimetric coverage for the target volume and improved the OAR dosimetry., Conclusions: The accuracy of automatic contouring from the Ethos adaptive platform is considered clinically acceptable for cervical cancer, and the uterus, upper vaginal cuff, and lower nodal CTV are the areas that need to be focused on in training., (© 2024. The Author(s).)

Purpose: American Indian/Alaska Native (AI/AN) populations have some of the lowest cancer screening rates compared to other racial/ethnic populations. Using community-based participatory research methods, we sought to characterize knowledge, attitudes, beliefs, and approaches to enhance breast, colorectal, and cervical cancer screening., Methods: We conducted 12 focus groups between October 2018 and September 2019 with 96 eligible AI adults and healthcare providers, recruited using non-probability purposive sampling methods from the Zuni Pueblo in rural New Mexico. We used the Multi-level Health Outcomes Framework (MHOF) to conduct a qualitative content analysis identifying mutable systems- and individual- level constructs important for behavior change that we crosslinked with the Community Preventive Services Task Force (CPSTF) recommended evidence-based interventions (EBIs) or approaches., Results: Salient systems-level factors that limited uptake of cancer screenings included inflexible clinic hours, transportation barriers, no on-demand service and reminder systems, and brief doctor-patient encounters. Individual-level barriers included variable cancer-specific knowledge that translated into fatalistic beliefs, fear, and denial. Interventions to enhance community demand and access for screening should include one-on-one and group education, small media, mailed screening tests, and home visitations by public health nurses. Interventions to enhance provider delivery of screening services should include translation and case management services., Conclusions: The MHOF constructs crosslinked with CPSTF recommended EBIs or approaches provided a unique perspective to frame barriers and promoters of screening utilization and insights for intervention development. Findings inform the development of culturally tailored, theoretically informed, multi-component interventions concordant with CPSTF recommended EBIs or approaches aimed at improving cancer screening., (© 2023. The Author(s).)

We identified preferences toward Community Preventive Services Task Force (CPSTF)-recommended intervention approaches among screen-eligible Zuni Pueblo members in New Mexico, USA and assessed if there were significant differences in those preferences, with the goal of informing the selection of intervention approaches for use in the Zuni Pueblo. We utilize data from a population-based survey (n = 280) focused on 15 CPSTF-recommended intervention approaches designed to improve screening for cervical, breast, and/or colorectal cancer screening. Model-adjusted results suggest some intervention approaches garnered significantly higher support than others. We offer six, data-driven recommendations for consideration by public health practitioners as they endeavor to improve cancer prevention in the Zuni Pueblo. This study provides a replicable model for other public health practitioners and health services researchers to incorporate community preferences in community-level intervention approach selection., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2023 The Authors.)

Background: A persistent infection by high-risk human papillomavirus (HR-HPV) is a prerequisite for the development of cervical neoplasms; however, most studies have focused on risk factors associated with HPV-16 and HPV-18 only., Objectives: We assessed the association of risk factors with the prevalence of HPV-16, HPV-18, and non-16/18 HR-HPV infection and with the occurrence of cervical lesions in the baseline of a cohort study of HPV persistence in a Mexican population., Methods: Cross-sectional study within the baseline of a 5-year dynamic cohort study of HR-HPV persistence in women with an abnormal cytology study result from 2015 to 2021. HPV DNA was detected using the Anyplex II HPV 28 kit. Data on lifestyle, sociodemographic, and reproductive factors were assessed using bivariate and multivariate analyses to determine the association of risk factors with HR-HPV infection status and histopathologic diagnosis., Results: A total of 373 women were included in the study. The overall prevalence of HR-HPV infection was 69.97%. The most prevalent HR-HPV genotypes, including single and multiple infections, were HPV-53 (13.4%), HPV-16 (11.8%), HPV-58 (10.9%), HPV-31 (10.9%), and HPV-66 (10.7%). We found 90 multiple HR-HPV infection patterns, all of them with α-6 and -9 species. Significant associations of multiple HPV-16 and non-16/18 HR-HPV infections were found with marital status, number of lifetime sexual partners, and smoking history. The most prevalent genotype in CIN1 and CIN2 patients was HPV-16. No association was found between biological plausibility risk factors and cervical lesions., Conclusions: The risk factors for non-16/18 HR-HPV multiple infections are no different than those linked to HPV-16 multiple infections.

Background: This paper attempts to conduct a systematic review and meta-analysis of deep learning (DLs) models for cervical cancer CT image segmentation., Methods: Relevant studies were systematically searched in PubMed, Embase, The Cochrane Library, and Web of science. The literature on DLs for cervical cancer CT image segmentation were included, a meta-analysis was performed on the dice similarity coefficient (DSC) of the segmentation results of the included DLs models. We also did subgroup analyses according to the size of the sample, type of segmentation (i.e., two dimensions and three dimensions), and three organs at risk (i.e., bladder, rectum, and femur). This study was registered in PROSPERO prior to initiation (CRD42022307071)., Results: A total of 1893 articles were retrieved and 14 articles were included in the meta-analysis. The pooled effect of DSC score of clinical target volume (CTV), bladder, rectum, femoral head were 0.86(95%CI 0.84 to 0.87), 0.91(95%CI 0.89 to 0.93), 0.83(95%CI 0.79 to 0.88), and 0.92(95%CI 0.91to 0.94), respectively. For the performance of segmented CTV by two dimensions (2D) and three dimensions (3D) model, the DSC score value for 2D model was 0.87 (95%CI 0.85 to 0.90), while the DSC score for 3D model was 0.85 (95%CI 0.82 to 0.87). As for the effect of the capacity of sample on segmentation performance, no matter whether the sample size is divided into two groups: greater than 100 and less than 100, or greater than 150 and less than 150, the results show no difference (P > 0.05). Four papers reported the time for segmentation from 15 s to 2 min., Conclusion: DLs have good accuracy in automatic segmentation of CT images of cervical cancer with a less time consuming and have good prospects for future radiotherapy applications, but still need public high-quality databases and large-scale research verification., (© 2022. The Author(s).)

Despite many efforts to treat HPV infection, cervical cancer survival is still poor for several reasons, including resistance to chemotherapy and relapse. Numerous treatments such as surgery, radiation therapy, immune cell-based therapies, siRNA combined with various drugs, and immunotherapy are being studied and performed to provide the best treatment. Depending on the stage and size of the tumor, methods such as radical hysterectomy, pelvic lymphadenectomy, or chemotherapy can be utilized to treat cervical cancer. While accepted, these treatments lead to interruptions in cellular pathways and immune system homeostasis. In addition to a low survival rate, cervical neoplasm incidence has been rising significantly. However, new strategies have been proposed to increase patient survival while reducing the toxicity of chemotherapy, including targeted therapy and monoclonal antibodies. In this article, we discuss the types and potential therapeutic roles of monoclonal antibodies in cervical cancer., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Aghbash, Hemmat, Fathi and Baghi.)

Background: There are many different variants of squamous cell carcinoma (SCC), and verrucous carcinoma (VC) is a rare and highly differentiated SCC. Due to its preference of local invasion, regional lymphatic involvement rarely occurs. VC is difficult to diagnose using conventional pap smear or cervical punch biopsy, in which adequate stroma including bulbous rete pegs is required for a definitive diagnosis. Surgical management is recommended as the first-line treatment with radiotherapy forbidden due to the risk of anaplastic transformation., Case Report: We presented a 59-year-old Taiwanese female who had postmenopausal bleeding for three months with two consecutive normal pap smear and biopsy at other hospital. Pelvic examination showed a necrotic fungating cervical mass with upper 1/3 vaginal involvement. Colposcopic guided cervical biopsy and fractional dilatation and curettage revealed verrucous hyperplasia (VH) with negative high-risk HPV typing. Pelvic 3T magnetic resonance imaging (MRI) was arranged, and a 3.7 × 3.6 × 4.0 cm necrotic mass at the cervix with an enlarged left pelvic lymph node was found. Positron emission tomography with computed tomography (PET/CT) demonstrated avid uptake at the cervix and left pelvic lymph node. Surgical intervention was performed due to highly suspicious of cervical verrucous carcinoma with positive pelvic lymph node. The final pathologic report was a well-differentiated verrucous carcinoma, IIA2 by International Federation of Gynecology and Obstetrics (FIGO) classification., Conclusion: VC is difficult to diagnose preoperatively, and surgical excision is recommended as the first-line treatment., Competing Interests: The authors declare no conflict of interest., (© 2022 The Author(s).)

Objective: To analyse the impact of screening actions on the incidence and mortality rates of cervical cancer (CC) in the city of Belém, Brazil., Methods: Based on the cancer registry data from 1998 to 2017, collected from the Belém Population-Based Cancer Registry, combined with local population data for the interval 1998-2017, CC incidence and mortality were calculated. The Segi world population 1960 was used for age-standardised incidence/mortality rates., Results: In the period analysed, there were 4,469 new cases and 1,660 deaths from CC. The median age at diagnosis of invasive cases was 51 years. The age-adjusted incidence rate decreased from 18.65/100,000 in 1998 to 11.79/100,000 in 2017, despite the increase observed in the first 5 years of the historical series, while there was stability in mortality rates in the same time lapse., Conclusion: CC is still one of the most common malignant tumours that threaten public health in northern Brazil. The trend of the disease depends on comprehensive prevention and control strategies regarding the local situation and age groups, with emphasis on the organisation of the screening programme and vaccination against human papillomavirus., Competing Interests: The authors declare that they have no conflict of interests., (© the authors; licensee ecancermedicalscience.)

Purpose: Underserved Black and Hispanic/Latinx women show low rates of follow-up care after an abnormal Pap test, despite the fact that cervical cancer is one of the few preventable cancers if detected early. However, extant literature falls short on efficacious interventions to increase follow-up for this population. A concurrent mixed methods study was completed to evaluate the acceptability of a text message-based intervention and identify perceived barriers and facilitators to follow-up after an abnormal Pap test among underserved predominantly Black and Hispanic/Latinx women., Methods: Patients who completed follow-up for an abnormal Pap test were recruited to complete a cross-sectional survey, qualitative interview assessing barriers and facilitators to follow-up, and text message content evaluation (N = 28). Descriptive statistics were performed to describe background variables and to evaluate the acceptability of text messages. A directed content analysis was completed for the qualitative interviews., Results: Participants expressed interest in a text message-based intervention to increase abnormal Pap test follow-up. In the qualitative interviews, low knowledge about cervical risk and negative affect toward colposcopy/test results were identified as barriers to follow-up. Facilitators of follow-up included feeling relieved after the colposcopy and adequate social support. Participants rated the text messages as understandable, personally relevant, and culturally appropriate., Conclusion: The findings suggest that underserved Black and Hispanic/Latinx women experience cognitive and emotional barriers that undermine their ability to obtain follow-up care and a text message-based intervention may help women overcome these barriers. Future research should develop and evaluate text message-based interventions to enhance follow-up after an abnormal Pap test., (© 2022. The Author(s), under exclusive licence to Springer Nature Switzerland AG.)

Objective To investigate the correlations of diffusion weighted imaging (DWI) with pathological grading,typing and clinical staging of cervical adenocarcinoma. Methods The data of 95 patients with cervical adenocarcinoma from May 2011 to February 2018 in Cancer Hospital Chinese Academy of Medical Sciences were collected for retrospective analysis.Before treatment,conventional MRI and DWI (b=0,800 s/mm 2 ) were performed,and the apparent diffusion coefficient (ADC) value of cervical adenocarcinoma was measured.The ADC values were compared among different pathological grades,types,and clinical stages. Results The mean ADC value was (1.00±0.25)×10 -3 mm 2 /s in the poorly differentiation group,(1.09±0.25)×10 -3 mm 2 /s in the moderately differentiation group,and (1.22±0.20)×10 -3 mm 2 /s in the well differentiation group,which showed significant difference between the poorly and well differentiation groups ( P =0.002).The mean ADC values were (1.04±0.24) ×10 -3 mm 2 /s and (1.21±0.26)×10 -3 mm 2 /s in the endocervical adenocarcinoma (usual type) group and mucinous carcinoma group,respectively,which showed significant difference ( P =0.005). Conclusions The worse differentiation of cervical adenocarcinoma corresponded to the lower ADC value.The ADC value of mucinous carcinoma was higher than that of endocervical adenocarcinoma (usual type).

Background: Cervical cancer continues to show a high burden among young women worldwide, particularly in low- and middle-income countries. Limited data is available describing cervical cancer mortality among young women in Latin America and the Caribbean (LAC). The purpose of this study was to examine the mortality trends of cervical cancer among young women in LAC and predict mortality rates to 2030., Methods: Deaths from cervical cancer were obtained from the World Health Organization mortality database. Age-standardized mortality rates per 100,000 women-years were estimated in women aged 20-44 years using the world standard population for 16 countries (and territories) in LAC from 1997 to 2017. We estimated the average mortality rates for the last 4 years (2014-2017). Joinpoint regression models were used to identify significant changes in mortality trends. Nordpred method was used for the prediction of the mortality rates to 2030., Results: Between 2014 and 2017, Paraguay and Venezuela had the highest mortality rates of cervical cancer, whereas Puerto Rico had the lowest rates. Overall, most of the LAC countries showed downward trends of cervical cancer mortality over the entire period. Significant decreases were observed in Chile (Average annual percent change [AAPC]: - 2.4%), Colombia (AAPC: - 2.0%), Cuba (AAPC: - 3.6%), El Salvador (AAPC: - 3.1%), Mexico (AAPC: - 3.9%), Nicaragua (AAPC: - 1.7%), Panama (AAPC: - 1.7%), and Peru (AAPC: - 2.2%). In contrast, Brazil (AAPC: + 0.8%) and Paraguay (AAPC: + 3.7%) showed significant upward trends. By 2030, mortality rates are not predicted to further decrease in some LAC countries, including Argentina, Paraguay, and Venezuela., Conclusions: Mortality trends of cervical cancer among young women have large variability in LAC countries. Cervical cancer screening programs have a high priority for the region. Primary and secondary prevention in the community are necessary to accelerate a reduction of cervical cancer mortality by 2030., (© 2022. The Author(s).)

In Virginia, 56% of colorectal cancers (CRC) are diagnosed late, making it one of three enduring CRC mortality hotspots in the US. Cervical cancer (CCa) exhibits a similar pattern, with 48% late-stage diagnosis. Mortality for these cancers is worse for non-Latinx/e(nL)-Black people relative to nL-White people in Virginia, but preventable with equitable screening access and timely diagnostic follow-up. However, structural barriers, such as fractured referral systems and extended time between medical visits, remain. Because Federally Qualified Health Centers (FQHCs) care for a large proportion of racial and ethnic minorities, and underserved communities, regardless of ability to pay, they are ideal partners to tackle structural barriers to cancer screenings. We piloted a quality improvement initiative at five FQHCs in southcentral Virginia to identify and address structural, race-related barriers to CRC, as well as CCa screening and diagnostic follow-up using evidence-based approaches. Uniquely, FQHCs were paired with local community organizations in a didactic partnership, to elevate the community's voice while together, increase support, acceptance, uptake, and intervention sustainability. We report on project development, and share preliminary data within the context of project goals, namely, to increase cancer screenings by 5-10%, improve knowledge and diagnostic follow-up processes, and build longitudinal partnerships.

The family with sequence similarity 83, member A ( FAM83A ) gene is associated with the occurrence and development of many malignant tumors. Our aim was to explore the role of FAM83A in cervical cancer. FAM83A was overexpressed or knocked down in cervical cancer cells, and the expressions of FAM83A, key proteins involved in the epithelial-mesenchymal transition (EMT), and Wnt signaling pathway-related proteins were detected by western blot analysis. Cell proliferative and invasive abilities were also examined using cell proliferation, colony formation, and Matrigel invasion assays. Cells were treated with the Wnt pathway inhibitor XAV-939 to determine whether Wnt signaling was necessary for the effect of FAM83A on cervical cancer cells. FAM83A was highly expressed in cervical cancer tissues and was associated with differentiation, TNM stage, lymph node metastasis, and poor prognosis in patients with cervical cancer. Knockdown of FAM83A inhibited the proliferation, colony formation, and invasion of cervical cancer cells. The opposite results were observed in FAM83A-overexpressing cells, and FAM83A overexpression also promoted EMT and Wnt signaling. XAV-939 reversed the activation of Wnt signaling and EMT induced by FAM83A. In conclusion, FAM83A expression was increased in cervical cancers and correlated with poor prognosis of patients. FAM83A overexpression can activate the Wnt signaling pathway, facilitate EMT, and promote the proliferative and invasive abilities of cervical cancer cells., Competing Interests: Competing Interests: The authors have declared that no competing interest exists., (© The author(s).)

Background/aim: This study aimed to evaluate the association between the change in peripheral eosinophil count during postoperative pelvic radiotherapy and gastrointestinal (GI) toxicities in patients with cervical cancer., Patients and Methods: The medical records of 163 patients with cervical cancer who underwent postoperative concurrent chemoradiotherapy between 2000 and 2016 were analyzed., Results: Among the peripheral blood cell counts, transient elevation of the eosinophil count was observed during radiotherapy. Of the 163 patients, 117 developed grade ≥2 diarrhea during radiotherapy, and 25 patients developed grade ≥2 late GI toxicities. In multivariate analysis, the maximum eosinophil count and age emerged as independent predictors of grade ≥2 acute diarrhea during radiotherapy, while bowel bag V 40 Gy and age were predictive of grade ≥2 late GI toxicities., Conclusion: Early detection of transient elevation of eosinophil may facilitate early treatment of acute diarrhea during radiotherapy., Competing Interests: All Authors declare no conflicts of interest with regards to preparation and content of this article., (Copyright 2021, International Institute of Anticancer Research.)

Background: The assessment of retroperitoneal lymph node status in patients with locally advanced cervical cancer is still a problem. This study aimed to explore the choice of these assessment methods., Methods: Laparoscopic retroperitoneal lymphadenectomy was performed in 96 patients with advanced cervical cancer. The positive rates of lymph node metastasis were analyzed. The values of computed tomography lymph node minimum axial diameter (MAD) and squamous cell carcinoma antigen (SCC-Ag), and their combination in predicting retroperitoneal lymph node metastasis were compared. High-risk factors for common iliac lymph node (CILN) and/or para-aortic lymph node (PALN) metastasis were analyzed., Results: The lymph node metastasis rate was 62.50% and the CILN and/or PALN metastasis rate was 31.25%. Overall, 96 patients had 172 visible lymph nodes. The positive rate of lymph node metastasis was significantly higher in the MAD ≥1.0 cm group (83.33%) than in the 0.5 cm ≤ MAD < 1.0 cm group (26.82%). The critical values of MAD and SCC-Ag in determining lymph node metastasis were 1.0 cm and 5.2 ng/mL, respectively. The accuracy, specificity, and Youden index of MAD ≥1.0 cm combined with SCC-Ag ≥ 5.2 ng/mL for evaluating lymph node metastasis were 75.71%, 100%, and 0.59, respectively, and were significantly different from the values for the MAD ≥1.0 cm (72.09%, 80.56%, and 0.47, respectively) and SCC-Ag ≥ 5.2 ng/mL (71.43%, 68.97%, and 0.42, respectively) groups. Correlation analysis showed that non-squamous cell carcinoma, pelvic lymph node (PLN) MAD ≥1.0 cm plus number ≥ 2, and 1 PLN MAD ≥1.0 cm with CILN and/or PALN MAD 0.5-1.0 cm were risk factors for CILN and/or PALN metastasis., Conclusion: Patients with MAD ≥1.0 cm and SCC-Ag ≥ 5.2 ng/mL, as well as high risk factors for CILN and/or PALN metastasis, should undergo resection of enlarged lymph nodes below the common iliac gland and lymphadenectomy of CILN/PALN to reduce tumor burden and to clarify lymph node metastasis status for accurate guidance in follow-up treatment. Patients with MAD < 1.0 cm and SCC-Ag < 5.2 ng/mL may be treated with chemoradiotherapy directly based on imaging, given the low lymph node metastasis rate.

Objective: To investigate the clinical significance of separate lateral parametrial lymph node dissection (LPLND) in improving parametrial lymph node (PLN) and its metastasis detection rate during radical hysterectomy for early-stage cervical cancer., Methods: From July 2007 to August 2017, 2,695 patients with cervical cancer in stage IB1-IIA2 underwent radical hysterectomy were included. Of these patients, 368 underwent separate dissection of PLNs using the LPLND method, and 2,327 patients underwent conventional radical hysterectomy (CRH). We compared the surgical parameters, PLN detection rate and PLN metastasis rate between the two groups., Results: Compared with CRH group, the rate of laparoscopic surgery was higher (60.3% vs . 15.9%, P<0.001), and the blood transfusion rate was lower (19.0% vs . 29.0%, P<0.001) in the LPLND group. PLNs were detected in 356 cases (96.7%) in the LPLND group, and 270 cases (11.6%) in the CRH group (P<0.001), respectively. The number of PLNs detected in the LPLND group was higher than that in the CRH group (median 3 vs . 1, P<0.001). The PLN metastases were detected in 25 cases (6.8%) in the LPLND group, and 18 cases (0.8%) in the CRH group (P<0.001), respectively. In multivariable analysis, LPLND is an independent factor not only for PLN detection [odds ratio (OR)=228.999, 95% confidence interval (95% CI): 124.661-420.664; P<0.001], but also for PLN metastasis identification (OR=10.867, 95% CI: 5.381-21.946; P<0.001)., Conclusions: LPLND is feasible and safe. The surgical method significantly improves the detection rate of PLN and avoids omission of PLN metastasis during radical hysterectomy for early-stage cervical cancer., (Copyright © 2020 Chinese Journal of Cancer Research. All rights reserved.)

Neuroendocrine small cell carcinoma of the uterine cervix portends a dismal prognosis with limited treatment options. Rarely, tumors of mixed-lineage appear in gynecologic malignancies. Here, we report a 77-year-old woman who presented with complete uterine prolapse and 4-month history of vaginal bleeding. Histopathologic evaluation revealed a mixed adenoid cystic carcinoma and neuroendocrine small cell carcinoma of the uterine cervix. The tumor was PD-L1 and HPV 35 positive. The patient was treated with up-front surgery and adjuvant radiation. Independent, histology-specific alterations in FGFR2 and a FGFR2-TACC2 fusion were identified. Progression of disease occurred within 6 months for which she received chemotherapy and immunotherapy. However, the patient expired within a year. We comprehensively review how screening for and targeting of FGFR alterations in recurrent and metastatic cervical cancer might serve as a touchstone for future treatment regimens., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2020 The Author(s).)

Lack of attendance to cervical cancer screening (CCS) services is the most attributable factor to the development of cervical cancer. Transgender men, individuals whose gender identity does match with their natal female sex, use CCS less often than the general female population. The underlying reasons for deficient CCS among transgender men relate mostly to their stigmatized identity, such as discrimination and unwelcoming healthcare environments. However, additional research is needed to expand our understanding of this complex issue. This exploratory qualitative research study aimed to identify the determinants of CCS from the perspective of transgender men. Twenty transgender men ages 21-65 were conveniently sampled to participate in a semi-structured interview in 2018. The data were analyzed using a deductive-inductive content analysis approach and the results were sorted into a socioecological framework (SEM). The participants were mostly non-Hispanic and white. The mean age was 33, and 55% of the sample had attended CCS in the last three years. Eight overarching factors were identified in the data. Each factor included descriptive sub-factors. At the institutional and interpersonal SEM levels, factors related to healthcare providers and healthcare organizations. At the individual level, factors related to past negative experiences, gender identity development, and socioeconomic status. To the investigators' knowledge, this is the first study to report the relationship between gender identity development and CCS behaviors. Gender identity development refers to the transition or coming-out process and gender dysphoria. This suggests that attendance to CCS services change as a transgender person's identity evolves., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2020 The Authors. Published by Elsevier Inc.)

Infection with high-risk human papillomavirus (HPV) increases the likelihood of developing cervical cancer (CC). A plethora of cellular processes is required to produce pre-malignant lesions, which in turn may become malignant if left untreated. Those changes are induced by viral oncoproteins, which represent an ideal target to identify the viral presence, or by some particularities of the host that ultimately promote the establishment of CC. This article describes the different methods used for HPV detection and quantification, as well as the current trend of secondary screening approaches to detect premalignant lesions and CC. In addition, we analyzed validated biomarkers and those under clinical investigation for the classification (triage) of women at risk of developing CC after an initial positive HPV test and that could be used as prognostic biomarkers for CC. The use of molecular biomarkers, together with the detection of HPV DNA sequences, provides a high impact diagnostic and prognostic tool in the detection of patients at increased risk of developing CC and also may guide their clinical management. In addition, some of those biomarkers could represent pharmacological targets for the future design of therapeutic approaches to CC treatment., (Copyright: © 2020 Permanyer.)

Objective: To investigate the characteristics of magnetic resonance imaging (MRI) of minimal deviation adenocarcinoma (MDA) of cervix, and improve the diagnostic accuracy of MDA. Methods: The imaging data of eight cases of MDA was retrospectively collected, including tumor size, tumor location, tumor components, signal characteristics, enhancement characteristics and invasive extent. Results: The maximum diameter of tumor was (4.36±1.46) cm. Six tumors were mixed solid and cystic and two were predominantly solid. Six were diffusion limited on diffusion-weighted imaging, and two were not diffusion limited. On multi-phase dynamic contrast-enhanced scan, the enhancement curve of solid components of the tumor showed a plateau-like pattern in three cases and a slow-rising pattern in five cases. Tumors were confined to the cervical canal in three cases, infiltrated to cervical stroma > 1/2 depth in seven cases, and ≤ 1/2 depth in one case. There were four cases of uterine invasion, four cases of vaginal fornix invasion, four cases of bilateral ovarian metastasis and one case of lymph node metastasis. Conclusions: Patients suffering from large amount of vaginal discharge had cervical lesions on MRI showing polycystic and solid component enhancement should be alert to MDA. Deep-seated cervical biopsy and even conization is conducive to early diagnosis, treatment and improvement of prognosis.

Purpose: Cancer-related inflammation plays an important role in tumor development and progression. Platelet-lymphocyte ratio (PLR) has been studied as a biomarker for prognosis in gynecologic cancers. But, the results of previous studies were controversial, so we performed this meta-analysis., Methods: We searched the scientific database of PubMed, Embase, Web of Science, Wanfang, and China National Knowledge Infrastructure (CNKI) using free text and MeSH keywords. Crude HR (hazard ratio) with 95% confidence interval was used to evaluate the risk association between PLR and overall survival (OS) or progression-free survival (PFS) in gynecologic neoplasms., Results: There totally 23 studies, including 6869 patients who were eligible, most of which are published after 2015 or later. PLR greater than the cut-off was associated with poorer survival prognosis in ovarian cancer [OS: HR 1.80 (95% CI 1.37-2.37), p = 0.000; PFS: HR 1.63 (95% CI 1.38-1.91), p = 0.000] and cervical cancer [OS: HR 1.36 (95% CI 1.10-1.68), p = 0.005; PFS: HR 1.40 (95% CI 1.16-1.70), p = 0.002], but not in endometrial cancer [OS: HR 1.95 (95% CI 0.65-5.84), p = 0.234]., Conclusions: The current meta-analysis revealed that pretreatment PLR was a simple, promising prognostic indicator for OS and PFS in ovarian and cervical cancers. But, its significance of prognosis did not agree with endometrial neoplasm. However, due to the limited number of original studies, future large-scale studies with more well-designed, high-quality studies are still needed.

Objective: Human papillomavirus testing by self-sampling and urine sampling might be alternatives to Papanicolaou test (Pap test) for cervical cancer screening (CCS), and may increase compliance and adherence thereto. The present study aimed to explore satisfaction and preferences for cervical screening modalities among Korean women., Methods: In total, 732 women aged between 20 and 69 years responded to a questionnaire designed to survey the women's perceived satisfaction for the 3 CCS modalities: clinician-collected Pap test, self-collected vaginal sampling (self-sampling) and urine sampling., Results: Overall satisfaction was significantly higher with both the self-sampling and urine sampling than the clinician-collected Pap test (odds ratio [OR]=2.01; 95% confidence interval [CI]=1.48-3.00 and OR=2.47; 95% CI=1.75-3.48, respectively). Psychological distress, including embarrassment, pain, anxiety, discomfort, and stress, with self-sampling and urine sampling were significantly lower than that with the Pap test. 52% of participants reported preferences for self-sampling in the next screening round., Conclusions: Korean women were more likely to report satisfaction with alternative modalities (self-sampling and urine sampling) for CCS in comparison to the Pap test. This suggests that self-collected modalities may help with improving CCS uptake rates by eliminating burden related with the Pap test. However, further studies for test accuracy and cost-effective analysis of the alternative modalities should be conducted in order to apply CCS., Competing Interests: No potential conflict of interest relevant to this article was reported., (Copyright © 2019. Asian Society of Gynecologic Oncology, Korean Society of Gynecologic Oncology.)

Introduction: According to recent statistics, there is a high percentage of refusal of cervical cancer screening using the Pap smear test by women in rural communities in developing countries such as Peru. There are few studies on the reasons to explain said refusal in this country. The objective of this study was to determine the barriers related to the non-acceptance of cervical cancer screening using the Pap smear test in women of childbearing age from a rural Peruvian community., Methods: Cross-sectional study, with a total of 892 women of childbearing age from the rural Peruvian community of Marián, Huaraz province, Ancash region, who did not accept screening for cervical cancer using the Pap smear test during their care at the Marián Health Centre. A questionnaire given from September 2017 to April 2018 was used. The information was processed with the statistics programme for social science 22.0 programme, using the Chi-square statistical test., Results: For 4-6 years, 52.5% of women refused cervical cancer screening using the Pap smear test. The barriers that showed a statistically significant relationship to the non-acceptance of cervical cancer screening using the Pap test were socio-demographic (age, marital status, education level, occupation and home income) and institutional barriers (counselling for cervical cancer screening, importance of the gender of health personnel administering the screening, history of mistreatment by health personnel, fear or embarrassment of the screening procedure and a delay in sending the results) ( p < 0.05); while a history of sexually transmitted infections and a feeling of physical well-being in sexual and reproductive health were the only related reproductive barriers ( p <0.05), this was not demonstrated with the age of first sexual activity, number of sexual partners, age of first pregnancy and total number of pregnancies ( p > 0.05)., Conclusions: Socio-demographic and institutional barriers are related to the non-acceptance of cervical cancer screening using the Pap test in women of childbearing age in the rural Peruvian community of Marián, with a lesser emphasis on reproductive barriers. With this in mind, we recommend undertaking broader studies in populations of different age groups, which should be oriented towards the design and application of preventive/promotional programmes by health institutions to promote the participation of community workers with the goal of aiding the identification and control of said barriers, reducing the refusal of cervical cancer screenings by women from rural areas., Competing Interests: The authors declare that there are no conflicts of interest.

Breast and cervical cancer are the first and fourth cancer types with the highest prevalence in women, respectively. The developmental profiles of cancer in women can vary by genetic markers and cellular events. In turn, age and lifestyle influence in the cellular response and also on the cancer progression and relapse. The human DEK protein, a histone chaperone, belongs to a specific subclass of chromatin topology modulators, being involved in the regulation of DNA-dependent processes. These epigenetic mechanisms have dynamic and reversible nature, have been proposed as targets for different treatment approaches, especially in tumor therapy. The expression patterns of DEK vary between healthy and cancer cells. High expression of DEK is associated with poor prognosis in many cancer types, suggesting that DEK takes part in oncogenic activities via different molecular pathways, including inhibition of senescence and apoptosis. The focus of this review was to highlight the role of the DEK protein in these two female cancers., (Copyright © 2018 Elsevier Masson SAS. All rights reserved.)

Background: Cervical cancer is the second most common cancer in women worldwide; early detection can play a key role in reducing the associated morbidity. The objective of this study was to systematically assess the effects of educational interventions on cervical cancer screening (CCS) behavior of women. Methods: In this review the Cochrane library, Web of Science, Science Direct, PubMed, Scopus and search engine of Google scholar were searched for all interventional studies (trails, pre- and post-test or quasi-experimental) published in 2000-2017 for a systematic review, The search was based on the following keywords: cervix cancer, uterine cervical neoplasms, screening, prevention and control, Papanicolaou Test, pap test, pap smear, education, intervention, systematic review. Due to the heterogeneity of the data, a qualitative analysis was performed. Results: Thirty seven articles with 15,658 female participants in different parts of world were included in the review. About three quarters of the articles covered behavior change interventions. About one fourth of the articles were based on health education methods. The heath belief model is the most popular used framework for cervical cancer screening interventions. The results of our study showed that different health education methods (such as calls, mailed postcards, mother/daughter education. consultation sessions, picture books, videos, PowerPoint slides, small group discussions, educational brochures, radio broadcast education, lecture presentations, tailored counseling and a fact sheet, Self-learning package, face-to- face interviews and etc) are effective in modifying cervical cancer screening behavior of women. Conclusions: Our results showed that the different interventions and health behavior change frameworks provide an effective base for cervical cancer prevention. Heath providers can chose educational methods based on the particular client situations., (Creative Commons Attribution License)

Objective: The aim of this study was to investigate the prognostic factors and to evaluate the impact of adjuvant therapy on clinical outcome for early-stage cervical cancer., Methods: The clinical-pathological data of all 1,335 patients with the International Federation of Gynecology and Obstetrics (FIGO) Ib-IIa cervical cancer treated with primary radical surgery at the Chinese National Cancer Center between May 2007 and Dec 2013 were retrospectively reviewed. The median follow-up was 70 months., Results: Of all the patients, 61.6% of the cases received adjuvant therapy, with 5-year disease-free survival (DFS) of 92.1% and 5-year overall survival (OS) of 95.0%. In multivariate analysis, differentiation of G3 (P<0.05), lymph node metastasis (LNM, P<0.05) and lymphovascular space invasion (LVSI, P<0.05) were independent predictors for OS, while LNM (P<0.05), deep stroma invasion (DSI, P<0.05) and LVSI (P<0.05) were independent factors for DFS. The samples were stratified by histologic type, and cervical squamous cell carcinoma (SCC) was found to share the same independent factors except for differentiation of OS. As to patients with cervical adenocarcinoma/adenosquamous carcinoma (AC/ASC), differentiation was the independent predictor of OS (P<0.05); and LVSI of DFS (P<0.05). Of 236 patients with high-risk factors, there was no significant difference in survival between concurrent chemoradiotherapy (CCRT, n=195), radiotherapy (RT, n=24), and chemotherapy (CT, n=17). Among the 190 patients with LNM who underwent CCRT, 124 cases showed improved DFS after sequential CT (P=0.118), with a recurrence rate decrease of 14%, though the difference was not statistically significant. Patients with single intermediate-risk factors like DSI or LVSI were found to partially benefit from adjuvant therapy, but the difference was not statistically significant., Conclusions: LNM, LVSI, DSI and differentiation were found to be independent prognostic factors for operable cervical cancer. Aggressive postoperative adjuvant therapy based on single risk factors in Chinese National Cancer Center could benefit survival. CCRT+CT outperformed CCRT in high-risk patients. For patients with single non-high-risk factor, the role of adjuvant therapy needs to be further discussed.

Objective: To establish a time-resolved fluoroimmunoassay (TRFIA) method to detect p16INK4a., Methods: 119 cases of exfoliative cells following Thinprep cytologic test (TCT) test were selected for TRFIA and biopsy tissues of these patients according to TCT results were collected for immunohistochemical (IHC) staining., Results: There were 40 cases with cervicitis, 16 cases of cervical intraepithelial neoplasia grade 1 (CIN1), 15 cases of CIN2, 26 cases of CIN3, and 22 cases of squamous cell carcinoma (SCC). For each group, TCT results displaying above ASC-US were 7, 6, 12, 23, and 21 cases. IHC results were positive for 2, 13, 14, 26, and 21 cases, while the TRFIA results were positive for 5, 12, 13, 25, and 21 cases, respectively. The sensitivity and specificity were not significantly different between TCT and TRFIA test due to the limited cases. Significantly more CIN1 cases were positive by TRFIA, as compared with cervicitis (75.00% vs. 12.50%, χ 2 =21.116, p<0.001). Most (93.65%) CIN2/3 and SCC cases were positive for p16INK4a (higher than CIN1, χ 2 =4.877 and p=0.027)., Conclusion: Detecting p16INK4a protein by TRFIA is suitable to discriminate cervical dysplastic/neoplastic lesions from cervicitis. A commercial kit which created in the future might be a rapid, simple, and low-cost method to obtain objective results with an instrument automatically on a large scale., (Copyright © 2017 Elsevier Inc. All rights reserved.)

There are approximately 3,000 new UK diagnoses of cervical cancer annually, with many women presenting symptomatically. We aimed to identify and quantify features of cervical cancer in primary care in a case-control study in the UK. Putative features of cervical cancer were identified, and odd ratios and positive predictive values (PPVs) were calculated. About 1,006 women aged ≥40 years diagnosed with cervical cancer and 4,992 age-, sex- and practice-matched controls were selected from the Clinical Practice Research Datalink. Median age at diagnosis was 61 years (interquartile range 51-75). Seven symptoms and two abnormal investigations were associated with cervical cancer: post-menopausal bleeding, odds ratio 43 (95% confidence interval 25, 75); vaginal discharge or vaginitis 8.8 (5.2, 15), intermenstrual bleeding 4.7 (1.6, 14); haematuria 4.6 (2.1, 10); irregular menstruation 3.8 (1.6, 9.0); urinary tract infection 1.9 (1.3, 2.8); abdominal pain 1.8 (1.4, 2.5); high white cell count 5.1 (2.9, 8.8) and low haemoglobin 2.6 (1.8, 3.8): all p < .005. The PPV of cervical cancer in women aged ≥55 with post-menopausal bleeding was 4.6% (2.5, 8.3). Other than for post-menopausal bleeding no symptom is high risk. Some symptoms, particularly haematuria, may be helpful. The primary care clinician must consider the unlikely diagnosis when the likely diagnosis does not settle with treatment., (© 2017 John Wiley & Sons Ltd.)

Background: Alterations in the host cellular immune response allow persistent infections with High-Risk Human Papillomavirus (HR-HPV) and development of premalignant cervical lesions and cervical cancer (CC). Variations of immunosuppressive cytokine levels in cervix are associated with the natural history of CC. To assess the potential role of genetic host immunity and cytokines serum levels in the risk of developing CC, we conducted a case-control study paired by age., Methods: Peripheral blood samples from patients with CC (n = 200) and hospital controls (n = 200), were used to evaluate nine biallelic SNPs of six cytokine genes of the adaptive immune system by allelic discrimination and cytokines serum levels by ELISA., Results: After analyzing the SNP association by multivariate logistic regression adjusted by age, CC history and smoking history, three Th2 cytokines (IL-4, IL-6 and IL-10) and one Th3 (TGFB1) cytokine were significantly associated with CC. Individuals with at least one copy of the following risk alleles: T of SNP (-590C > T IL-4), C of SNP (-573G > C IL-6), A of SNP (-592C > A IL-10), T of SNP (-819C > T IL-10) and T of SNP (-509C > T TGFB1), had an adjusted odds ratio (OR) of 2.08 (95 % CI 1.475-2.934, p = 0.0001), an OR of 1.70 (95 % CI 1.208-2.404, p = 0.002), an OR of 1.87 (95 % CI 1.332-2.630, p = 0.0001), an OR of 1.67 (95 % CI 1.192-2.353, p = 0.003) and an OR of 1.91 (95 % CI 1.354-2.701, p = 0.0001), respectively, for CC. The burden of carrying two or more of these risk alleles was found to have an additive effect on the risk of CC (p trend = 0.0001). Finally, the serum levels of Th2 and Th3 cytokines were higher in CC cases than the controls; whereas IFNG levels, a Th1 cytokine, were higher in controls than CC cases., Conclusion: The significant associations of five SNPs with CC indicate that these polymorphisms are potential candidates for predicting the risk of development of CC, representing a risk allelic load for CC and can be used as a biomarker of susceptibility to this disease.

Purpose: The purpose of this study was to examine the level of sexual function, depression, and quality of life in cervical cancer patients., Methods: This descriptive, correlational, cross-sectional study was conducted at E Hospital, Seoul. A total of 137 women diagnosed with cervical cancer completed a structured questionnaire. Sexual function was measured with the Female Sexual Function Index (FSFI), depression with the Hospital Anxiety and Depression Scale (HADS), and quality of life with the Functional Assessment of Cancer Therapy-General version 4 (FACT-G). Descriptive statistics, ANOVA, Scheffé's tests, and Pearson correlations were computed with SPSS Win 21.0., Results: The participants experienced sexual dysfunction (4.83 ± 4.16) and moderate to severe depression (11.08 ± 5.06). The mean score of quality of life was 57.33 ± 8.47. Sexual function had a negative relationship with depression, while having a positive one with quality of life (p < .001). Also, in relation with subcategories of quality of life, sexual function was positively correlated with physical well-being, social well-being, and functional well-being (p = .001), but not with psychological well-being (p = .223)., Conclusion: This study showed that cervical cancer patients with lower sexual function tended to have lower quality of life and higher levels of depression. Thus, clinical nurses should develop and implement interventions to enhance sexual function for patients diagnosed with cervical cancer.

Background: Poland has one of the highest cervical cancer mortality rates in Europe. It is related to the problem of late diagnosis and low attendance rate in screening programs. The objective of the study has been to assess the annual production loss due to the cervical cancer morbidity and mortality in Poland in 2012. The outcomes have been to provide comprehensive information on cervical cancer's influence on population's ability to work and its overall economic burden for the society. The study has also provided the methodological framework for disease-related production losses in Polish settings., Material and Methods: The human capital method was used. The production losses were calculated in both monetary and quantitative terms (working days lost) due to 4 following reasons: 1) temporary disability to work, 2) permanent disability, 3) informal care, and 4) mortality., Results: Cervical cancer resulted in approx. 702 964 working days lost in 2012 due to absence at work for both patients and care givers and a total number of 957 678 working days lost due to patients' mortality. The total value of production lost was assessed at 111.4 million euros. More than 66% of this value was attributed to women's mortality., Conclusions: The calculation of production lost due to cervical cancer burden provides strong evidence to support adequate health promotion and disease prevention actions. Actions promoting cervical cancer screening should be intensified including workplace health promotion activities. Med Pr 2016;67(3):289-299., (This work is available in Open Access model and licensed under a CC BY-NC 3.0 PL license.)

Introduction: This study aims to compare the antioxidant abilities of cervical squamous carcinoma cells and cervical adenocarcinoma cells and to study the related mechanisms., Material and Methods: Cervical squamous carcinoma and adenocarcinoma cells were treated with H2O2. Cell proliferation was determined with the MTT assay. The reactive oxygen species (ROS) level was detected by the 2',7'-dichlorofluorescein-diacetate (DCFH-DA) method. The 5,5'-dithiobis-2-nitrobenzoic acid (DTNB) method was performed to measure intracellular concentrations of reduced glutathione (GSH) and oxidized glutathione (GSSG). The nitrite formation method, the molybdate colorimetric method, and the DTNB colorimetric method were used to determine activities of superoxide dismutase (SOD), catalase (CAT), and glutathione peroxidase (GPx), respectively., Results: Compared with untreated control cells, cell proliferation of cervical squamous carcinoma cells and cervical adenocarcinoma cells was significantly inhibited by H2O2 treatment (p < 0.05). Reactive oxygen species levels and GSSG levels were significantly increased (p < 0.01), whereas GSH levels were significantly decreased (p < 0.05 or 0.01) in both cells after H2O2 treatment. Thus the ratio of GSH/GSSG was significantly decreased by H2O2 treatment in both cells (p < 0.01). In addition, H2O2 treatment significantly increased activities of SOD, CAT, and GPx in both cells (p < 0.05 or 0.01). Furthermore, the above-mentioned changes induced by H2O2 treatment were more dramatic in cervical squamous carcinoma cells., Conclusions: The antioxidant ability of cervical squamous carcinoma cells is lower than that of cervical adenocarcinoma cells, which may be related to the increased ROS levels in cervical squamous carcinoma cells induced by H2O2 treatments.

The treatment strategy for clinically negative lymph nodes of papillary thyroid carcinoma is controversial. We report the long-term outcomes of a series of cases treated with thyroidectomy without prophylactic central neck dissection. We reviewed 1,397 cases with papillary thyroid carcinoma treated at our institution between 1991 and 2000. One hundred and seventy-two newly diagnosed cases underwent observation for cN0 central neck lymph nodes. Regional recurrence of the ipsilateral side including central compartment and the lateral neck which needs reoperation was considered as key point for analysis. With a mean follow-up of 96.4 months (34-204 months), the overall 10-year disease-specific and recurrence-free survival rates were 99 and 86 %, respectively. The recurrence and reoperation rates of the central compartment were 3 % (5/172) and 4 % (7/172), respectively. Univariate analysis showed that extrathyroidal extension was associated with regional recurrence (99 vs. 82 %; p = 0.002). Central compartment observation is safe in cN0 cases with papillary thyroid carcinoma, particularly in those without extrathyroidal extension.

Primary primitive neuroectodermal tumors (PNETs) are rare and high-grade malignant tumors that mostly occur in children and young adults. The most common sites are the trunk, limbs, and retroperitoneum. Herein, we present a case of a PNET involving the cervix uteri in a 27-year-old woman. The lesion showed characteristic histologic features of a PNET and was positive for the immunohistochemical markers cluster of differentiation (CD) 99, vimentin, neuron-specific enolase, neural cell adhesion molecule 1 (CD56), and CD117 (c-kit), further defining the tumor while helping to confirm PNET. The clinical Stage IIIB tumor was treated with chemotherapy and radiotherapy.

Adenoma malignum is a rare subtype of cervical adenocarcinoma. Clinical presentation is variable with watery vaginal discharge being the most commonly associated finding. We report a case of adenoma malignum incidentally detected on pelvic computed tomography (CT) performed for a trauma patient. The cervical mass was further characterized by magnetic resonance (MR) imaging and remained compatible with adenoma malignum. Local cervical biopsy was suggestive of the diagnosis which was subsequently confirmed by gross surgical pathology. We briefly discuss adenoma malignum with particular attention to CT and MR imaging features.

Background: Cervical cancer is the third most common cancer in women in the world. Papanicolaou smear is known as a standard test for cervical cancer screening; however, the most important challenge is high rates of false negative results. The aim of this study was to compare the quality of smears obtained by anatomical spatula and spatula-cytobrush. The most important factor in false negative result is inappropriate tool of sampling., Methods: One hundred married women participated in this single blind clinical trial. All participants were interviewed; two samples were obtained from every participant: one with spatula-cytobrush and another one with anatomical spatula. All slides were encoded and were assessed by two pathologists. Then, data were analyzed by means of kappa coefficient., Results: Cell adequacy was 96.1 % in anatomical spatula method and 91.2 % in spatula-cytobrush method (p= 0.016). The rates for endocervical cells and metaplasia cells in anatomical spatula method were 70.6% and 24.5% respectively and these amounts were 69.6% and 24.5% respectively in the spatula-cytobrush method (p <0.001). No one reported any pain and the amount of bleeding was 38.2% in both methods (P>0.05). Regarding infection and inflammatory reactions there was no statistically significant difference between two methods (p>0.05)., Conclusion: Based on our findings in this study, results of sampling with anatomical spatula method were more acceptable and better than those with spatula-cytobrush sampling.

The aim of this study was to investigate the role of the cell surface expression levels of HLA class I and II molecules, the costimulatory molecules CD80/B7-1 and CD86/B7-2, and the adhesion molecules CD54 and CD58 during cervical carcinogenesis. The expression levels of MHC class I and II molecules, the costimulatory molecules CD80/B7-1 and CD86/B7-2 and the adhesion molecules CD54 and CD58 on CD14+ peripheral blood monocytes (PBMs) from 21 cases of cervical intraepithelial neoplasia (CIN) II-III, 51 squamous cervical carcinomas (SCCs) and 18 healthy controls were analyzed using flow cytometry analysis. We found increased expression levels of HLA-DR (p=0.000), HLA-DQ (p=0.000), CD86/B7-2 (p=0.002) and CD58 (p=0.000) on PBMs from patients with SCC and CIN II-III, compared with healthy control subjects, whereas no significant difference existed in the expression levels of HLA class I antigens, HLA-DP CD80/B7-1 and CD54. Upregulated expression levels of HLA-DR, HLA-DQ, CD86/B7-2 and CD58 were associated with disease progression, indicating that an increased expression of HLA-DR, HLA-DQ, CD86/B7-2 and CD58 on PBMs may be correlated with the evolution of cervical cancer.

Objective: Hypoxia has been established as a key factor influencing the pathophysiology of malignant growth. Hypoxia-induced changes in gene expression are coordinated primarily by hypoxia inducible factor-1 alpha (HIF-1α) and HIF-2α. The purpose of this study was to determine whether or not HIF-2α expression is associated with survival and response to radiation in patients with cervical cancer., Methods: After reviewing the medical records of 119 patients treated in our institution by primary therapy for stage IIB-IVA cervical cancer, we performed a case-control study. Cases (n=12) were selected from patients with local recurrence or radiation failure after primary radiation therapy with or without concurrent chemoradiation. For each case, we selected two controls from patients who had no evidence of local recurrence. Using pre-treatment paraffin-embedded tissues, we evaluated the expression of HIF-2α by immunohistochemistry. Staining was scored based on intensity (intensity score [IS], 0-3) and proportion (proportion score [PS], 0-100). The results were analyzed by the Student t-test, Mann-Whitney U test, Fisher's exact test, and Cox proportional hazards regression model., Results: Cytoplasmic expression of HIF-2α, representing the degree of hypoxia, had a relationship with poor response to radiotherapy. The hazard ratio of recurrence was 1.71 for the HIF-2α IS (p=0.110) and 1.04 for the HIF-2α PS (p<0.001), indicating that the HIF-2α staining area correlates weakly with the risk for recurrence., Conclusion: The HIF-2α expression area may have an important role in radioresistance in patients with locally advanced cervical cancer. We conclude that a wider area of hypoxia predicts an increased probability of radioresistance.

Two innovative approaches in minimally invasive surgery that have been introduced recently are the da Vinci robotic platform and single port laparoscopic surgery (SPLS). Robotic surgery has many advantages such as 3-dimensional view, the wrist like motion of the robotic arm and ergonomically comfortable position for the surgeon. Numerous literatures have demonstrated the feasibility of robotic surgery in gynecologic oncology. However, further research should be performed to demonstrate the superiority of robotic surgery compared to conventional laparoscopy. Additionally, cost reduction of robotic surgery is needed to adopt robotic surgery into gynecologic oncology worldwide. SPLS has several possible benefits including reduced operative complications, reduced postoperative pain, and better cosmetic results compared to conventional laparoscopy. Although several authors have indicated that SPLS is a feasible approach for gynecologic surgery, there have been few reports demonstrating the potential advantages over conventional laparoscopy. Moreover, technical difficulties of SPLS still exist. Therefore, the advantages of a single port approach compared to conventional laparoscope should be evaluated with comparative study, and further technologic development for SPLS is also needed. These two progressive technologies take the lead in the development of MIS and further studies should be performed to evaluate the benefits of robot surgery and SPLS.

Purpose: To determine the superior chemotherapeutic regimen between monthly 5-FU plus cisplatin (FP) and weekly cisplatin alone in concurrent chemoradiotherapy for locally advanced cervical cancer, the compliance of treatment, response, survival and toxicities were analyzed between the two arms., Materials and Methods: Between March 1998 and December 2001, 61 patients with locally advanced cervical cancer (stage IIB through IVA) and negative para-aortic lymph nodes were randomly assigned to either 'monthly FP' (arm I, n=34) or 'weekly cisplatin' (arm II, n=27) with concurrent radiotherapy. The patients of arm I received FP (5-FU 1,000 mg/m(2)/day + cisplatin 20 mg/m(2)/day, for 5 days, for 3 cycles at 4 week intervals) and those of arm II received cisplatin (30 mg/m(2)/day, for 6 cycles at 1 week intervals) with concurrent radiotherapy. The radiotherapy consisted of 41.4 approximately 50.4 Gy external beam irradiation in 23 approximately 28 fractions to the whole pelvis, with high dose rate brachytherapy delivering a dose of 30 approximately 35 Gy in 6 approximately 7 fractions to point A. During the brachytherapy, a parametrial boost was delivered. The median follow-up period for survivors was 44 months., Results: The compliance of treatment in monthly FP weekly cisplatin arms were 62 and 81%, respectively. The complete response rates at 3 months were 96 and 88% in arms I and II, respectively. The 4-year overall survival and disease free survival rates were 64 and 54% in the arm I and 77 and 66% in the arm II, respectively. The incidence of hematologic toxicity more than grade 2 was 29% in the arm I and 15% in the arm II. Only one patient in arm I experienced grade 3 gastrointestinal toxicity. No severe genitourinary toxicity was observed., Conclusion: No significant difference was observed in the compliance, responses, survival rates and acute toxicities between the two treatment arms. More patients and further follow up will be required.

Purpose: In order to elucidate the antitumor effect of photodynamic therapy (PDT), using a derivative of the photosensitizing agent hematoporphyrin (Photogem) and a diode laser, the cell death of uterine cancer cell lines (CaSki, HT3, HeLa, and SKOV-3), and mice transplanted with TC-1 lung cancer cells, were evaluated., Materials and Methods: The morphological changes, MTT assay, flow cytometry, cytotoxicity and tumor growth inhibition study were evaluated at various time intervals after the PDT., Results: The results showed that the survival rates of each cell line decreased with time and dose response after performing the PDT. Also, the PDT-induced damage of cancer cells was almost entirely confined to necrosis of the tumor cells in the early time courses. The irradiation of CaSki cells in the presence of Photogem induced plasma membrane disruption and cell shrinkage, indicating the plasma membrane as the main target for Photogem. In the in vivo experiment, significantly longer survival and a significantly smaller tumor size were seen over the time courses of the Photogem with irradiation compared to the untreated control groups; resorption of the tumor was also observed after the PDT treatment., Conclusion: Collectively, our results indicated that Photogem possesses anti-tumor effects, and necrosis-like death, with plasma membrane damage, was postulated to be the principal mechanism of the antitumor effect of the PDT using Photogem.

Purpose: Speculoscopy, or magnified chemiluminescent examination (MCE), is a new visual method for the detection of cervical neoplasia. It utilizes low magnification and a special "blue-white" chemiluminescent light. The purpose of this study was to evaluate the screening effectiveness of speculoscopy combined with the conventional Papanicolaou smear, as compared with the latter alone, through a clinical trial in Korea., Materials and Methods: This prospective, randomized, university hospital-based clinical study was performed in the outpatient clinic of the Department of Obstetrics and Gynecology at Dankook University Medical Center from December 1, 2001 to June 30, 2002. Of the 113 patients aged 19~74 years who had undergone both conventional Papanicolaou cervical cytologic test and speculoscopy, 38 cases underwent histologic diagnoses by colposcopy- directed biopsy., Results: Of the 113 patients, there were 87 (77.0%) spe-culoscopy diagnoses of negative, 9 (8.0%) of suspicious, and 17 (15.0%) of positive. Of the 38 histologic diagnoses, there were 19 (50.0%) diagnoses of negative, 7 (18.4%) of LSIL, 1 (2.6%) of HSIL, 10 (26.3%) of SCC, and 1 (2.6%) of ACC. Pap smear showed sensitivity of 77.8% and specificity of 81.3%, whereas speculoscopy showed 94.1% and 100.0%, respectively, and Pap smear combined with speculoscopy showed 100.0% and 81.3%, respectively., Conclusion: Speculoscopy showed a higher sensitivity rate than Pap smear as a screening test, although the sample size was small. Speculoscopy combined with Pap smear is thought to be a very effective method for detecting cervical neoplasia.

Purpose: The molecular pathology of cervical cancers associated with human papillomavirus infection is presently unclear. In an effort to clarify this issue, the gene expression profiles and pathogenic cellular processes of cervical cancer lesions were investigated., Materials and Methods: Cervical cancer biopsies were obtained from patients at the Department of Obstetrics and Gynecology, The Catholic University of Korea. The disease status was assigned according to the International Federation of Gynecology and Obstetrics. The tissue samples of 11 patients (invasive cancer stage Ib- IIIa) were investigated by a cDNA microarray of 4, 700 genes, hierarchical clustering and the Gene Ontology (GO). Total RNA from cervical cancer and non-lesional tissues were labeled with Cy5 and Cy3. The HaCaT human epithelial keratinocyte cell line was used as a negative control cell. The stages of invasive cancer were Ib to IIIb. All specimens were obtained by punch-biopsies and frozen in liquid nitrogen until required., Results: 74 genes, showing more than a 2 fold difference in their expressions, were identified in at least 8 of the 11 patients. Of these genes, 33 were up-regulated and 41 were down-regulated. The gene expression profiles were classified into 345 mutually dependent function sets, resulting in 611 cellular processes according to their GO. The GO analysis showed that cervical carcinogenesis underwent complete down-regulation of cell death, protein biosynthesis and nucleic acid metabolism. The genes related to nucleic acid binding and structural molecule activity were also significantly down-regulated. In contrast, significant up-regulation was shown in the skeletal development, immune response and extracellular activity., Conclusion: These data are suggestive of potentially significant pathogenetic cellular processes, and showed that the down-regulated functional profiling has an important impact on the discovery of pathogenic pathways in cervical carcinogenesis. GO analysis can also overcome the complexity of the expression profiles of the cDNA microarray via a cellular process level approach. Thereby, a valuable prognostic candidate gene, with real relevance to disease-specific pathogenesis, can be found at the cellular process levels.

Objectives: To investigate the association between genetic polymorphisms ofX-ray repair crosscomplementing group 1 (XRCC1) codons 194, 280, and 399 and cervical neoplasm susceptibility., Methods: A community-based nested case-control study was conducted. The study population consisted of women living in Chiayi City, located in southwestern Taiwan, who had received pap smear screening between October, 1999, and December, 2000 (n=32,466). The potential cases were women having lesions greater than cervical intraepithelium neoplasm II (C1N2) reconfirmed by cervical biopsy. The potential controls (case: control=1∶2) were age matched (±2 yrs) and residency matched women who had had normal pap smears. In total, 100 cases (39 C1N2, 12 C1N3, 46 carcinoma in situ (CIS), and 3 invasive cancer) and 196 controls had the information on both questionnaire and data ofXRCC1 polymorphisms., Results: The frequency ofArg/Arg, Arg/Gln, andGln/Gln in codon 399 among cases and controls was 54% (54/100), 38% (38/100), and 8% (8/100) and 58% (114/196), 37% (73/196), and 5% (9/196), respectively, which were not significantly different. No associations were also observed betweenXRCC1 codon 194 and 280 genotypes and cervical neoplasm. While dichotomized by age (<40 vs. ≥40 yrs), smoking status (active and passive smokers vs. non-smokers), and disease status (C1N2 and C1N3 vs. CIS and invasive cancer), the results remained insignificant., Conclusions: The present findings suggest thatXRRC1 codon 194, 280 and 399 genotypes may not influence cervical neoplasm risk in the Taiwanese population.

Purpose: The purpose of this study was to test the hypothesis that neoadjuvant chemotherapy (NACT) does not increase morbidity in patients undergoing radical hysterectomy with lymphadenectomy for locally advanced cervical cancer. MATERIALS AND METGODS: A retrospective study was undertaken of 140 patients with locally advanced cervical cancer (FIGO stage Ia to IIb) who underwent radical hysterectomy with lymphadenectomy by the same surgeon at the same hospital. Among the 140 patients, 39 received NACT followed by radical hysterectomy with pelvic lymphadenectomy (NACT group). This group received three cycles consisting of cisplatin 100 mg/m2/day on day 1 and 5-fluorouracil 1000 mg/m2/day from day 1 to 5. The NACT group was compared, in terms of intraoperative morbidity and postoperative morbidity, with the other 101 patients who underwent radical hysterectomy with lymphadenectomy but without chemotherapy (surgery-only group)., Results: There were no significant differences in mean age, body weight or height between the two groups. The only significant difference was that the NACT patients had higher stages of cancer. The incidence of intraoperative morbidity did not differ between the NACT and surgery only patients. We considered the operation duration, amount of blood loss and need for transfusion as indicators of intraoperative morbidity. We could not find any significant differences in the duration of suprapubic catheterization, days of hemovac drainage, amount of drained hemovac fluid, days of hospitalization or postoperative febrile morbidity between the NACT and surgery-only groups. Patients in the surgery-only group had more postoperative complications (ureteral obstruction, intestinal obstruction, lymphocyst, lymphedema, and death) than the NACT group, although not to a statistically significant degree (P>0.05)., Conclusion: In this retrospective review, there was no evidence that NACT increased intraoperative or postoperative morbidity in patients with locally advanced cervical cancer. As this was a retrospective study, other prospective, randomized studies are needed to confirm these results.