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Objective: To revise FIGO staging of carcinoma of the cervix uteri, allowing incorporation of imaging and/or pathological findings, and clinical assessment of tumor size and disease extent., Methods: Review of literature and consensus view of the FIGO Gynecologic Oncology Committee and related societies and organizations., Results: In stage I, revision of the definition of microinvasion and lesion size as follows. Stage IA: lateral extension measurement is removed; stage IB has three subgroups-stage IB1: invasive carcinomas ≥5 mm and <2 cm in greatest diameter; stage IB2: tumors 2-4 cm; stage IB3: tumors ≥4 cm. Imaging or pathology findings may be used to assess retroperitoneal lymph nodes; if metastatic, the case is assigned stage IIIC; if only pelvic lymph nodes, the case is assigned stage IIIC1; if para-aortic nodes are involved, the case is assigned stage IIIC2. Notations 'r' and 'p' will indicate the method used to derive the stage-i.e., imaging or pathology, respectively-and should be recorded. Routine investigations and other methods (e.g., examination under anesthesia, cystoscopy, proctoscopy, etc.) are not mandatory and are to be recommended based on clinical findings and standard of care., Conclusion: The revised cervical cancer staging is applicable to all resource levels. Data collection and publication will inform future revisions., (© 2019 International Federation of Gynecology and Obstetrics.)

Cervical cancer takes the lives of more than 250,000 women each year globally, particularly in under-resourced areas of low-, middle-, and high-income countries. Options for cancer control and treatment have reached a point that there are interventions for control that could be adopted for virtually every resource and demographic situation. Women die despite the availability of attractive control options, which means that educating policy makers, women's health professionals, as well as women themselves, must become a major focus for ongoing control of this disease. The human right to life, to prevention of suffering, and to education are all key rights linked to improving the control of cervical cancer and saving the lives of women, particularly in resource-poor parts of the world.

Background: Primary peritoneal malignant mixed Müllerian tumors (MMMTs) are rarely reported in the literature., Methods: The clinical, pathologic, and immunohistochemical features of five cases of MMMT of female peritoneum were analyzed. The tumors were also investigated for expression of hormone receptors, specific BRCA-1 mutations, and clonality., Results: The patients' ages ranged from 33 to 67 years. They presented with abdominal pain or mass. One case of peritoneal MMMT was associated with a synchronous endometrial carcinoma whereas another case was detected 2 years after the diagnosis of a primary adenocarcinoma of the fallopian tube. One patient died 1 month after diagnosis whereas 2 patients died with disease within 1 year. Both carcinomatous and sarcomatous elements are present in all the tumors. Squamous differentiation was noted in two cases. Heterologous elements, including chondroid, rhabodomyoblastic, and osteoid differentiation were detected in all tumors. Immunohistochemical studies confirm the biphasic differentiation with variable demonstration of neural and smooth muscle differentiation. All five MMMTs were negative for estrogen and progestogen receptors although the related endometrial and tubal carcinomas were positive. Heteroduplex analysis used to screen for specific BRCA-1 mutations were negative in all five MMMTs. Clonality study of the two MMMTs found in association with endometrial carcinoma and tubal carcinoma was inconclusive., Conclusions: Our study confirmed that primary peritoneal MMMTs were aggressive tumors with poor prognosis. The presence of synchronous or metachronous genital carcinomas suggests multifocal tumorigenesis from tissue of same embryologic origin. The lack of hormone receptor in these tumors indicates deviation from hormonal control. Specific BRCA-1 mutations found in ovarian carcinoma in Chinese patients could not be detected in our series., (Copyright 2001 American Cancer Society.)

Background: To assess the use of wide local excision in the treatment of VAIN., Methods: A retrospective review on 40 WLE procedures for VAIN., Results: The mean age was 60 years. Thirty-six (90%) patients had previous treatment for genital tract cancer or pre-cancer. The median duration and blood loss during operation was 45 minutes and 50 mls respectively. Fifteen complications affected 11 patients. Only one of five patients with 'vaginal cancer' was diagnosed prior to WLE. Of the 35 patients treated for VAIN 3, 12 (34%) developed abnormal cytology during follow up three had residual VAIN 3, five had recurrent VAIN 3 and four had invasive cancer diagnosed. The remaining 23 (66%) patients were disease free at a median follow up of 44 months., Conclusions: Ablative therapy for VAIN 3 is unsafe as occult invasive foci can be missed by biopsy. WLE is efficacious in treating high grade VAIN 3. Long term surveillance of the lower genital tract is needed to diagnose metachronous lesions.

Background: To assess the efficacy of mitomycin pleurodesis in women with end stage malignant effusion., Methods: Retrospective analysis., Results: Of the 13 patients treated six had ovarian, six had endometrial and one had cervical adenocarcinoma. The median time of onset of effusion from diagnosis of primary disease was 12 months (range 1-75). Ten patients were evaluable for response. The median age of the patients was 59 years (range 42 to 74). Ten (77%) of them had repeated thoracocentesis prior to mitomycin pleurodesis. The median duration and volume of drainage was 4 days (range 2-11) and 3.1 liters (range 1.2-10.2) respectively. One of two patients developed a pneumothorax and required the insertion of an additional chest drain. Overall, seven patients (70%) responded - one completely (CR) and six partially (PR), while three did not respond. Four of five patients with ovarian cancer had a partial response, two of four patients with endometrial cancer (one CR and one PR) responded. The only patient with cervical cancer had a partial response. Nine patients (69%) had enough symptomatic improvement to be discharged home. The drug cost of bleomycin 60 units (US$191), another commonly used agent, was more than twice as expensive as mitomycin 30 mg (US$84)., Conclusions: Mitomycin pleurodesis can palliate 70% of patients for at least 1 month. It offers cheap and effective palliation. There is a suggestion that patients' quality of life is improved.

Objective: To assess the accuracy of the cervical smear and colposcopy in diagnosing low grade squamous intraepithelial lesions (LSIL), and the natural history of LSIL., Method: The cytological, colposcopic and histological findings of 145 patients with a smear diagnosis of LSIL were compared, and the final outcome studied., Results: The diagnosis of LSIL either by cytology alone or in combination with colposcopy was associated with a rate of overdiagnosis of 11.7% and 6.9%, respectively, and a rate of underdiagnosis of 31.0% and 26.2%, respectively. Spontaneous regression of lesions occurred in 81.1% of patients with proven LSIL, with regression within 24 months in 4/5 of cases., Conclusions: The degree of dysplasia shown in the cervical smear correlated poorly with histology. All patients with cervical smear showing LSIL should have colposcopy and colposcopic-directed biopsy to exclude the presence of more advanced lesions. In the absence of some serious lesions, it is then acceptable to observe the patient for 24 months before adopting definite treatment, as spontaneous regression is common.

Objective: To review the prognostic factors of Chinese women with mixed Müllerian tumors of the uterus., Method: A retrospective review of 21 cases of malignant mixed Müllerian tumors of the uterus treated during the 10-year period from 1980 to 1990., Results: All patients except one were postmenopausal. The incidence of previous pelvic irradiation was 9.5%. The most common presenting symptom was abnormal vaginal bleeding. One-third of patients yielded an abnormal cervical smear. Treatment included surgery, chemotherapy and radiotherapy in the majority of patients. Prognosis was poor with only three long-term survivors, all with stage-I homologous tumors with superficial myometrial invasion. The survival rate for stage-I and -II disease at 2 years was 50% and for more advanced disease extending beyond the uterus was 0%. The survival rate for all stages at 5 years was 14.3%, and the cumulative probability of survival at 5 years was 0.165., Conclusion: The most important prognostic factors appear to be the extent of tumor involvement at the time of diagnosis and the depth of myometrial invasion.

Intravenous leiomyomatosis is considered to be a rare neoplastic disease usually arising from uterine fibromyomata, but its true incidence may be under-recognized. Mortalities from this condition are usually the result of intracardiac involvement. A case report of successful treatment of intravenous leiomyomatosis with intracardiac extension is presented, together with a review of the existing literature concerning this rare condition.

Objective: To find the prevalence of HPV infection in women attending a sexually transmitted disease clinic in Hong Kong., Method: Cervical HPV infection was identified by cervical cytology and DNA filter in-situ-hybridization (Virapap) techniques in 207 women attending a social hygiene clinic. Other risk factors for cervical cancer were assessed and any association with HPV infection was sought. Statistical analysis was carried out using the chi 2-test., Result: The prevalence of HPV infection in the 207 Chinese women was 8.2% by cervical smear and 12.6% by DNA filter in-situ-hybridization. Risk factors for cervical cancer were not significantly associated with HPV infection in this group, 95% of whom were prostitutes., Conclusion: The prevalence of HPV infection in this group at high risk for cervical cancer is higher than in low-risk pregnant women, however the prevalence of HPV infection in Hong Kong is at the low end of the range of figures quoted for Caucasians. The cause of such a low prevalence is yet to be determined.

Thirty-eight patients with histologically proven recurrent cervical cancer were treated with epirubicin, an analogue of anthracycline. There were eight complete responders and ten partial responders. The overall response rate was 47.8%. The survival duration of the responders was significantly longer than that of the nonresponders. The optimal dose of epirubicin has yet to be determined. The dosage of 120 mg/m2 was well tolerated. The role of epirubicin as an adjuvant chemotherapeutic agent in the treatment of cervical cancer was discussed.