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Background: Sexual satisfaction is vital for the sexual health and well-being of both cervical cancer patients and their spouses. Sexual dissatisfaction can arise from negative treatment, making it important to examine the factors that influence sexual satisfaction., Objective: The purpose of this study was to explore the factors affecting the sexual satisfaction of Thai women with cervical cancer after complete treatment and their spouses., Materials and Methods: A predictive correlational study was conducted with 100 couples using convenience sampling. The study was based on the ecological theory framework. Data were collected from April 2023 to January 2024 in two tertiary hospitals through five questionnaires: a demographic questionnaire, the Thai Hospital Anxiety and Depression Scale, the Charlson Comorbidity Index, the Couple Relationship Scale, Natsal 2000, and the New Sexual Satisfaction Scale. Data analysis was performed using multiple linear regression., Results: The multiple regression analysis showed that sexual difficulties and duration of marriage predicted 25.6% of the variance in sexual satisfaction among women with cervical cancer. The duration of marriage (b = -0.48, p = 0.012) had a stronger impact than sexual difficulties (b = -2.82, p = 0.005). Sexual difficulties and couple relationships accounted for 34.9% of the variance in sexual satisfaction for spouses. Sexual difficulties (b = -3.13, p = 0.004) had a greater effect than couple relationships (b = 0.30, p = 0.003)., Conclusions: Healthcare providers should promote constructive communication between couples through open, respectful, and supportive dialogue to strengthen their relationship, improve mutual understanding, address sexual difficulties, and enhance sexual satisfaction for women with cervical cancer after treatment and their spouses. The findings results can inform future intervention research aimed at improving sexual satisfaction in this population one-year post treatment.

Purpose: In Thailand, Lesbian, Gay, Bisexual, Transgender, and Queer (LGBTQ) individuals face significant health disparities and discrimination in healthcare. A primary cause is the lack of knowledge among doctors and their negative attitudes towards LGBTQ people. The purpose of this study was to explore the current undergraduate medical curricula of medical schools in Thailand concerning learning outcomes, contents, teaching and learning methods, and assessment methods in the field of LGBTQ health. It also sought to gather opinions from principal stakeholders in curriculum development., Methods: The authors employed a mixed-methods approach with a convergent design to conduct the research. Quantitative data were collected from 23 deputy deans of educational affairs using a standardized interview form, and qualitative data were obtained through in-depth interviews with key stakeholders including 16 LGBTQ healthcare receivers, 22 medical students, and three medical teachers. Both datasets were analyzed simultaneously to ensure consistency., Results: The findings indicate that none of the medical schools had established learning objectives related to LGBTQ healthcare within their curricula. Of the institutions surveyed, 8 out of 15 (53.3%) offered some form of teaching on this topic, aligning with the qualitative data which showed 7 out of 17 institutions (41.2%) provided such education. The most frequently covered topics were gender identity and sexual orientation. Lectures were the predominant teaching method, while multiple-choice questions were the most common assessment format. There was a unanimous agreement among all principal stakeholders on the necessity of integrating LGBTQ healthcare into the M.D. program and the professional standards governed by the Thai Medical Council., Conclusions: Although some Thai medical schools have begun to incorporate LGBTQ health into their curricula, the approach does not fully address the actual health issues faced by LGBTQ individuals. Future teaching should emphasize fostering positive attitudes towards LGBTQ people and enhancing communication skills, rather than focusing solely on the cognitive aspects of terminology. Importantly, medical educators should serve as role models in providing competent and compassionate care for LGBTQ patients.

Objectives: To evaluate overtreatment with the 'see-and-treat' approach in patients with high-grade squamous cervical cytology, and identify the clinical factors associated with overtreatment., Study Design: Patients with high-grade squamous intra-epithelial lesion (HSIL) cytology undergoing colposcopy and loop electrosurgical excision procedure (LEEP) in a single visit or the 'see-and-treat' approach from January 2005 to December 2019 were reviewed retrospectively. The overtreatment rate and complications following LEEP were explored., Results: In total, 220 cases were identified. The overtreatment rate was 11.4%, and surgical complications were haemorrhage ( n  = 3, 1.36%) and infection ( n  = 9, 4.09%). On univariable analysis, factors associated with overtreatment were current cytological result and colposcopic impression. On multi-variable analysis, current cytological result of non-HSIL compared with HSIL/cancer, and colposcopic diagnosis of low-grade lesion or normal compared with high-grade lesion or cancer had adjusted odds ratios of 13.81 [95% confidence interval (CI) 1.23-155.20; p  = 0.033] and 3.58 (95% CI 1.32-9.74; p  = 0.013), respectively., Conclusions: The overtreatment rate with the 'see-and-treat' approach was 11.4%. Independent factors associated with overtreatment were current cervical cytological result of non-HSIL, and low-grade or normal colposcopic diagnosis., Competing Interests: None declared., (© 2023 The Authors.)

To evaluate and validate the minor lymphatic pathway for distant metastases in cervical cancer. This is a retrospective cohort of cervical cancer patients underwent curative concurrent chemoradiotherapy. We used original dataset from 1 university hospital and validation dataset from 3 university hospitals. Lymphadenopathy status in CT imaging was reviewed by radiologist in either the obturator and external iliac nodes (major pathway) or the internal iliac and presacral nodes (minor pathway). We then used Cox regression to adjust for all potential confounders, including paraaortic nodes, T stage, histology, age, total treatment time, total number of nodes, total short axis of nodes. 397 and 384 patients were in the original and validation datasets (median follow-up period, 59.5 month's). The minor pathway was independent prognostic factor in multivariable analysis [HR=2.64; 95%CI=1.07-6.55; P = 0.036] and [HR=14.84; 95%CI=3.15-70.01; P= 0.001] in original and validation datasets, respectively. Whereas, the major pathway was statistically non-significant. Further validation showed that the minor pathway had the highest HR for distant metastases with both the EMBRACE (HR=6.05; 95% CI=1.30-28.08; P = 0.022) and the FIGO 2018 (HR=7.43; 95% CI=2.94-18.78; P<0.001) in the original dataset. A similar result was found with the validation dataset: EMBRACE, HR=30.91; 95% CI=2.78-343.62; P = 0.005; and FIGO 2018, HR=42.41; 95% CI=8.83-203.60; P<0.001.This is the first clinical study to validate that the minor lymphatic pathway was predominantly associated with distant metastases in cervical cancer. This finding should be validated in larger cohort to further integrate in standard staging for prediction of distant metastases., (Copyright © 2022. Published by Elsevier Inc.)

The aim of treatment in recurrent or refractory epithelial ovarian cancer is palliation. In a patient with platinum-resistant status, several chemotherapy regimens have been reported with similar response rates. Among these agents, the oral etoposide holds an advantage of the route of administration and management in the out-patient setting. This retrospective study was conducted to evaluate the effectiveness of oral etoposide. Data of patients with recurrent or refractory epithelial ovarian, primary peritoneal and fallopian tube cancer who received oral etoposide treatment in Ramathibodi Hospital, Mahidol University from January 1997 to December 2017 were collected. Progression-free survival (PFS) and overall survival (OS) were primary and secondary outcomes, respectively. The oral etoposide at a dose of 50 mg/m 2 was prescribed. Sixty-six records were analysed. Median OS and median PFS were 8.3 months (95% confidence interval (CI): 6.8, 10.4) and 3.1 months (95%CI: 2.3, 3.9), respectively. Other factors including age, body mass index (BMI), histopathology subtype, primary treatment, result of the primary surgery, platinum status, site and size of recurrent cancer, treatment after discontinuation of oral etoposide and the line of chemotherapy regimen were not associated with the prognosis. The initial cancer stage was the only independent poor prognostic factor. The main toxicity was neutropenia. Impact Statement What is already known on this subject? After the recurrence of epithelial ovarian cancer, peritoneal cancer or fallopian tube cancer, the aim of treatment in this setting is palliation with accentuating on symptomatic control and enhancing the quality of life. According to previous clinical trials, the chemotherapy regimens which were considered as a second-line or beyond the second-line therapy have been reported with similar response rates. Among these agents, the oral etoposide could be administrated by oral route. There were several articles reported the effectiveness of oral etoposide in different dosage. What do the results of this study add? This study adds that administration of oral etoposide at a dose of 50 mg/m 2 showed fairish oncologic outcomes with manageable toxicity. What are the implications of these findings for clinical practice and/ or further research? The results will provide evidence that the oral etoposide can be considerate as a choice of palliative chemotherapy because of an advantage of the route of administration and management in the out-patient setting.

To develop and validate a prognostic model, including the minor lymphatic pathway (internal iliac and presacral nodes)., Study Design: Retrospective cohort., Participants: Locally advanced cervical cancer underwent concurrent chemoradiotherapy., Sample Size: 397 and 384 patients in the development and validation data set., Predictors: Our new nodal staging system with the minor lymphatic pathway., Outcome: Distant metastases., Statistical Analysis: Cox regression; net reclassification improvement (NRI) and decision curve analysis (DCA). Our new nodal system was the strongest predictor. The predictors in the final model were new nodal system, tumor stage, adenocarcinoma, initial hemoglobin, tumor size and age. The nodal system and the pretreatment model had concordance indices of 0.661 and 0.708, respectively, with good calibration curves. Compared to the OUTBACK eligibility criteria, the nodal system showed NRI for both cases (22%) and controls (16%). The pretreatment model showed NRI for cases (31%) and controls (18%). DCA in both models showed threshold probability of 15% and 12%, respectively, when compared with 24% in OUTBACK eligibility criteria. Our new nodal staging system and the pretreatment model could differentiate between high-risk and low-risk patients, thus facilitating decisions to provide more aggressive treatment to prevent distant metastases., (© 2022. The Author(s).)

Objectives: To determine the preoperative clinical characteristics associated with uterine sarcoma in patients with uterine mass., Study Design: We retrospectively reviewed medical records of patients who presented with uterine mass undergoing surgery at Ramathibodi Hospital, with a pathologically confirmed diagnosis, from April 1, 2000 to October 31, 2019. The cases are patients with uterine sarcoma, whereas the controls are patients with leiomyoma diagnosed in the same year, with a proportion of 1 case per 4 controls. The association between preoperative clinical characteristics and uterine sarcoma were analyzed., Results: There were 18,218 patients with uterine mass undergoing surgery at Ramathibodi Hospital during the study period. Uterine sarcoma was diagnosed in 68 patients. Thus, the incidence of uterine sarcoma was 0.37%. Following multivariate regression analysis, the following factors seemed to be independently associated with increased risk of uterine sarcoma. Patients with uterine mass, age ≥ 40 years old, postmenopause, postmenopausal bleeding, abnormal uterine bleeding, palpable mass, recognition of rapid growing mass, and with single uterine mass identified by ultrasonography were more likely to be diagnosed with uterine sarcoma with adjusted odds ratio (95% confidence interval) of 3.30 (1.29-8.43), 8.57 (2.38-30.82), 35.35 (2.94-425.13), 3.39 (1.40-8.23), 4.50 (1.78-11.36), 6.91 (2.08-22.91) and 4.70 (1.91-11.60), respectively., Conclusions: Clinical characteristics, ie, age ≥ 40 years old, postmenopause, postmenopausal bleeding, abnormal uterine bleeding, palpable mass, mass with rapid growth, or single uterine nodule identified by ultrasonography were considered the independently strong association with uterine sarcoma in women who presented with uterine mass., (Copyright © 2022 The Authors. Published by Elsevier B.V. All rights reserved.)

Competing Interests: No potential conflict of interest relevant to this article was reported.

Background: To determine the factors influencing the use of complementary and alternative medicine (CAM) in gynecologic cancer patients and the prevalence and pattern of CAM use., Methods: This was a cross-sectional study of 370 gynecologic cancer patients conducted at the outpatient clinic, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand. After obtaining informed consent, participants were asked to complete a standardized questionnaire including sociodemographic and clinical characteristics, detail of CAM use, attitude of CAM use, and quality of life using EORTC-QLQ-C30., Results: The prevalence of CAM use was 25.13%. The most common type was herbal medicine (55.90%). The participants who resided or had a birthplace in rural areas presented with a higher proportion of CAM use than those in urban areas ( P =0.470 and P =0.004, respectively). Participants who received multiple modalities of cancer treatment reported a significantly higher proportion of CAM use ( P =0.024). Most CAM users agreed that the CAM could be used in combination with standard treatment, and some rather disagreed that CAM could interrupt the treatment effect of the conventional treatment. CAM users had significantly higher role functioning in quality-of-life scores., Conclusion: Factors influencing CAM use in gynecologic cancer patients were rural area birthplace or residency, receiving multiple modalities of cancer treatment, having positive attitude toward CAM use. CAM users had better performance in role functioning in the quality-of-life score. Therefore, gynecologic oncologists should pay attention to these factors in order to communicate with gynecologic cancer patients about CAM use., Competing Interests: The authors declare no conflicts of interest relevant to the study., (Copyright © 2021 Nuntorn Chukasemrat et al.)

Failure to detect early-stage epithelial ovarian cancer (EOC) is a major contributing factor to its low survival rate. Increasing evidence suggests that different subtypes of EOC may behave as distinct diseases due to their different cells of origins, histology and treatment responses. Therefore, the identification of EOC subtype-specific biomarkers that can early detect the disease should be clinically beneficial. Exosomes are extracellular vesicles secreted by different types of cells and carry biological molecules, which play important roles in cell-cell communication and regulation of various biological processes. Multiple studies have proposed that exosomal miRNAs present in the circulation are good biomarkers for non-invasive early detection of cancer. In this review, the potential use of exosomal miRNAs as early detection biomarkers for EOCs and their accuracy are discussed. We also review the differential expression of circulating exosomal miRNAs and cell-free miRNAs between different biofluid sources, i.e., plasma and serum, and touch on the issue of endogenous reference miRNA selection. Additionally, the current clinical trials using miRNAs for detecting EOCs are summarized. In conclusion, circulating exosomal miRNAs as the non-invasive biomarkers have a high potential for early detection of EOC and its subtypes, and are likely to be clinically important in the future.

Background: Palliative care evidently increases the quality of life among the patients with advanced cancer. However, there are very few studies on the aspects of the physicians' ideas, conceptions, or the effects of their ideas in palliative care quality, especially in Asian countries. This study aimed to evaluate the conception and perspective on palliative care in Thai gynecologic oncologists., Methods: The online survey was distributed to all certificated Thai gynecologic oncologists. The survey could be accessed via working email address, hyperlink, or QR code during May 2020 and January 2021. A 5-point Likert scale captured the perspectives and concepts of palliative care. The association between respondents' characteristics and their choices of content in palliative care, together with their decision making in specified clinical scenarios was analyzed., Results: A total of 207 completed surveys from 320 Thai gynecologic oncologists were received (64.69% participation rate). They prospected a willingness to give the advices to both patients and their families (85.50%), and strongly agreed to introduce palliative care in any stage of cancer at the time of diagnosis (75.80%). The numbers of their palliative cases per year were 5-20 (57.97%) and the palliative care teams were available in their hospitals. They decided to offer early palliative care and do-not-resuscitate, especially for the elders, or patients with advance stages, or recurrent disease. We found that gynecologic oncologists who previously experienced a palliative care training did not show any difference in decision making in specified clinical scenarios, compared with who did not., Conclusions: Thai gynecologic oncologists responded to the conceptions and perspectives in palliative care. Their concepts of early and willingness to offer a palliative care especially in the elders, advanced stage, or recurrent patients were proven, regardless of the experience in palliative care training.

Aim: To analyze the use of serum cancer antigen 19-9 (CA19-9), cancer antigen 125 (CA-125) and carcinoembryogenic antigen (CEA) in predicting the malignant potential of mucinous ovarian tumor, and to assess the clinical factors associated with these tumors., Methods: This retrospective study collected the data from 314 patients who were diagnosed with mucinous ovarian tumor. These patients had preoperative serum CA19-9, CA-125, CEA available and underwent surgery at Ramathibodi Hospital between January 2010 and December 2016. The diagnostic performance of CA19-9, CA-125 and CEA was analyzed using the receiver operator characteristic curve. The associations between clinicopathological factors and serum CA19-9, CA-125 and CEA level were also analyzed., Results: A total of 314 patients were recruited in this study. They consisted of 221 patients with benign mucinous ovarian tumor (70.38%), 65 patients with borderline mucinous ovarian tumor (20.70%) and 28 patients with mucinous ovarian carcinoma (8.92%). Multivariate analysis revealed that the tumor size, elevated serum CA19-9, CA-125 and CEA influenced the tumor pathology. The mucinous ovarian tumor with large tumor size, elevated serum CA19-9, CA-125 and CEA more than the cut off values showed a positive correlation with the risk ratio of 1.60 (95% CI = 1.13-2.28; P = 0.005), 1.74 (95% CI = 1.22-2.47; P = 0.002), 1.90 (95% CI = 1.34-2.70; P < 0.001), 1.58 (95% CI = 1.10-2.29; P = 0.020), respectively. CA-125 provided the highest diagnostic performance, with an area under receiver operator characteristic curve of 0.745, to differentiate between borderline, malignant or benign mucinous ovarian tumor., Conclusion: Preoperative elevation of the serum CA19-9, CA-125, CEA and tumor size are useful predictors to differentiate between benign, borderline and malignant mucinous ovarian tumor. The best predictor is CA-125, followed by CA19-9 and CEA., (© 2020 The Authors. Journal of Obstetrics and Gynaecology Research published by John Wiley & Sons Australia, Ltd on behalf of Japan Society of Obstetrics and Gynecology.)

Background and Objective: Ovarian, fallopian tube, or primary peritoneal cancer patients with BRCA gene mutation have enhanced sensitivity to platinum-based regimens and PARP inhibitors. However, the knowledge regarding BRCA mutation in Thai patients is limited. This study aimed at identifying the prevalence and characteristics of somatic and germline BRCA 1 and 2 mutations in Thai patients with these cancers., Materials and Methods: The paraffin blocks of tumors with histology of high grade serous, high grade endometrioid, or clear cell carcinoma obtained between June 2016 and December 2017 were analyzedto evaluate BRCA mutation using next-generation sequencing system. Blood or normal tissue paraffin blocks of positive patients were further tested for germline BRCA mutation., Results: Tissue paraffin blocks of 178 patients were collected but only 139 were analyzed. Positive BRCA mutation was identified in 24 patients (17.3%): BRCA1 in 13 cases, BRCA2 in 10 cases, and BRCA1 and 2 in the rest one. Germline mutation study in blood or normal tissue in 23 positive patients revealed BRCA mutation in 14 cases, BRCA1 in 8 cases and BRCA 2  in 6 cases. Overall, the prevalence of somatic and germline mutation was 6.5% (9 out of 138 patients) and 8.7% (14 out of 138 patients), respectively. The most common histology associated with BRCA mutation was high grade serous cancer (27.3%). No significant difference was found between patients with or without BRCA mutation in terms of stage, outcome, platinum status, and survival outcome., Conclusion: BRCA mutation was demonstrated in less than 10% of Thai ovarian cancer patients. Higher rate of mutation was found in high grade serous cancer., .

Objective: To compare the vaginal stump characteristics following total abdominal hysterectomy between two vaginal incision techniques, electrosurgery versus scalpel or scissors., Material and Method: A randomized single-blind controlled trial was performed in 80 patients scheduled to undergo total abdominal hysterectomy for benign conditions. Either sharp instrument (scalpel or scissors) or electrosurgery was used for vaginal incision following standard surgical technique for total abdominal hysterectomy. The main outcome measures were the vaginal stump characteristics determined by the degree of vaginal mucosal approximation and the presence of vaginal granulation at 6-week postoperatively., Results: Six weeks after surgery, the number of patients with incomplete mucosal approximation following electrosurgical technique was 11 (27.5%), as compared to 8 (20%) (p = 0.43) in the scalpel/scissors technique group. The incidences of vaginal granulation in the scalpel/scissors group and electrosurgical group were 10% and 22.5%, respectively., Conclusion: The vaginal stump characteristics at six weeks following total abdominal hysterectomy between two vaginal incision techniques were not statistically significantly different.

Eighty-seven percent of cervix cancer occurs in less-developed regions of the world, and there is up to an 18-fold difference in mortality rate for cervix cancer depending on the region of the world. The Cervix Cancer Research Network (CCRN) was founded through the Gynecologic Cancer InterGroup with the aim of improving access to clinical trials in cervix cancer worldwide, and in so doing improving standards of care. The CCRN recently held its first international educational symposium in Bangkok. Sixty-two participants attended from 16 different countries including Pakistan, India, Bangladesh, Thailand, Malaysia, Singapore, Philippines, Taiwan, China, Vietnam, Korea, Japan, Columbia, Brazil, Canada, and the United States. The focus of this symposium was to evaluate progress, to promote new clinical trials for the CCRN, and to provide education regarding the role of brachytherapy in the treatment of cervical cancer.

Objective: To compare the cost-effectiveness between actinomycin D (Act-D) and methotrexate-folinic acid (MTX-FA) in the treatment of low-risk gestational trophoblastic neoplasia (GTN) in the Thai population., Study Design: A comparative cost-effectiveness analysis was performed from a societal perspective. A decision tree model was developed comparing 2 alternative treatment options: initial 5-day Act-D and 8-day MTX-FA. Treatment would be switched to another regimen in case of resistance. The outcome of interest is number of days to remission. Clinical data was obtained from our previous study in which Act-D demonstrated 100% remission rates as compared to 73.6% for MTX-FA. Cost of treatment data, which includes chemotherapeutics, accessory medications, laboratory tests, and hospital fees, was obtained from a university hospital. Patient-related travel cost and opportunity cost due to absence from work were also included. All costs were calculated to 2015 base year., Result: Costs per treatment cycle were $308.01 and $227.20 US dollars (USD) for 5-day Act-D and 8-day MTX-FA, respectively. Expected time toward treatment completion for Act-D was 12.6 days shorter than for MTX-FA. Expected costs toward remission for initial treatment with Act-D and MTX-FA were $1,078.04 and $1,064.56 USD, respectively, i.e., an incremental cost effectiveness ratio (ICER) of $1.07 USD/day of earlier treatment completion. After sensitivity analysis, remission rate of lower than 72% would make initial treatment with MTX-FA more expensive than with Act-D., Conclusion: Treatment costs of low-risk GTN are almost equal between the 2 treatment options with different time to remission. Initial treatment with MTX-FA is slightly less expensive, but there is longer time to remission. The ICER of initial treatment with Act-D over MTX-FA is $1.07 USD/day of earlier treatment completion.

Background: Many studies have pointed to strategies to cope with patient anxiety in colposcopy. Evidence shows that patients experienced considerable distress with the large loop excision of transformation zone (LLETZ) procedure and suitable interventions should be introduced to reduce anxiety. This study aimed to investigate the effects of music therapy in patients undergoing LLETZ., Materials and Methods: A randomized controlled trial was conducted with patients undergoing LLETZ performed under local anesthesia in an out patient setting at Ramathibodi Hospital, Bangkok, Thailand, from February 2015 to January 2016. After informed consent and demographic data were obtained, we assessed the anxiety level using State Anxiety Inventory pre and post procedures. Music group patients listened to classical songs through headphones, while the control group received the standard care. Pain score was evaluated with a visual analog scale (VAS). Statistical analysis was conducted using Pearson Chi-square, Fisher's Exact test and T-Test and p-values less than 0.05 were considered statistically significant., Results: A total of 73 patients were enrolled and randomized, resulting in 36 women in the music group and 37 women in the non-music control group. The preoperative mean anxiety score was higher in the music group (46.8 VS 45.8 points). The postoperative mean anxiety scores in the music and the non-music groups were 38.7 and 41.3 points, respectively. VAS was lower in music group (2.55 VS 3.33). The percent change of anxiety was greater in the music group, although there was no significant difference between two groups., Conclusions: Music therapy did not significantly reduce anxiety in patients undergoing the LLETZ procedure. However, different interventions should be developed to ease the patients' apprehension during this procedure.

Objective: To evaluate the effectiveness of naproxen 500 mg taken orally 30 minutes before, endometrial biopsy for pain relief during the procedure., Material and Method: A double blind, randomized, placebo-controlled trial was conducted in 80 patients with indication for endometrial biopsy at Ramathibodi Hospital between April 2013 and January 2014. The patients were randomly allocated into two groups to receive naproxen 500 mg (n = 40) or placebo (n = 40), 30 minutes before endometrial biopsy. Pain score was assessed using Visual Analogue Scale during and 10 minutes after the procedure. Adverse events were observed., Results: The mean pain score during endometrial biopsy in the treatment group was significantly lower compared to the placebo group (5.11 ± 0.18 vs. 6.49 ± 0.17, respectively, p-value < 0.001). However, the mean pain score at 10 minutes after endometrial sampling were minimal and had non-statistical significance in both groups. (0.60 ± 0.56 vs. 0.59 ± 0.64, p-value 0.971)., Conclusion: Naproxen 500 mg taken orally 30 minutes before endometrial biopsy significantly reduce pain score during the procedure.

Background: This study aimed to determine the utility and a cut-off level of serum squamous cell carcinoma antigen (SCC-Ag) to predict lymph node metastasis in locally advanced cervical cancer cases. We also investigated the correlation between SCC-Ag level and lymph node status., Materials and Methods: From June 2009 to June 2014, 232 patients with cervical cancer stage IB2-IVA, who were treated at Ramathibodi Hospital, were recruited. Receiver operating characteristic (ROC) curves were used to identify the best cut-off point of SCC-Ag level to predict lymph node metastasis. Quantile regression was performed to evaluate the correlation between SCC-Ag levels and pelvic lymph node metastasis, paraaortic lymph node metastasis, and parametrial involvement as well as tumor size., Results: Pelvic lymph node metastasis and paraaortic lymph node metastasis were diagnosed in 46.6% and 20.1% of the patients, respectively. The median SCC-Ag level was 6 ng/mL (range, 0.5 to 464.6 ng/ mL). The areas under ROC curves between SCC-Ag level and pelvic lymph node metastasis, paraaotic lymph node metastasis, parametrial involvements were low. SCC-Ag level was significantly correlated with paraaortic lymph node status (p=0.045) but not with pelvic lymph node status and parametrial involvement. SCC-Ag level was also related to the tumor diameter (p<0.05)., Conclusions: SCC-Ag level is not a good predictor for pelvic and paraaortic lymph node metastasis. However, it is still beneficial to assess the tumor burden of squamous cell carcinoma of the cervix.

With economic growth in Asia, cancer has become increasingly prominent as a major health problem. However, discrepancies in infrastructure, economics, and development exist within and between Asian countries. We assess means of primary and secondary prevention for cervical, breast, colorectal, and hepatocellular cancer, and offer recommendations according to resource levels. Primary prevention by health education, lifestyle modification, and avoidance of risk factors should be made available at all resource levels. When resources allow, human papillomavirus and hepatitis B vaccinations should be given to reduce the risk of cervical and hepatocellular cancer, and genetic testing should be offered to detect increased susceptibility to colorectal and breast cancer. Secondary prevention by effective yet affordable screening for precancerous lesions or by early detection of cancer should be offered, followed by appropriate treatment., (Copyright © 2013 Elsevier Ltd. All rights reserved.)

Objective: The primary objective of this study was to compare quality of life of disease-free patients after therapy for gynecologic malignancies at follow-up in comparison with healthy check-up patients. Our second objective was to assess correlation between demographic data, disease and treatment factors and quality of life scores., Methods: Patients completed the Functional Assessment of Cancer Therapy-General (FACT-G) quality of life questionnaire at least 6 months after treatment for a gynecologic malignancy. Responses were compared to unmatched healthy women who were seen for standard gynecologic screening examinations. Statistical calculation was done using chi-squared tests, Wilcoxon rank-sum, and Kruskal-Wallis one-way analysis and Spearman rank correlations. Factors associated with FACT-G scores were evaluated using univariate and multivariate analyses., Results: Eight hundred and seventy patients were recruited. The median time since therapy was 61 months (range, 6 to 173 months). The overall FACT-G scores were higher in the patient group than in the healthy group (p<0.05). The scores of each subscale measuring physical, functional, social/family and emotional well-being were also higher in the patient group (p<0.05). Multivariate analysis revealed correlation between Eastern Cooperative Oncology Group performance status, educational level, care giver, presence of economic problems and FACT-G scores., Conclusion: The quality of life scores were higher in gynecologic cancer patients after treatment. And the factors that associated with the higher score in the patient group are having husband as a caregiver, no financial problem, Eastern Cooperative Oncology Group score 0 or 1 and having high school or higher education.

Aims: The primary prevention for cervical cancer, a human papilloma virus (HPV) vaccine, has been available in Thailand for almost 3 years. The present study evaluates knowledge about the Papanicolaou (Pap) smear, HPV and the HPV vaccine and focuses on identifying predictors for the acceptability of the HPV vaccine., Methods: A sample of 764 women attending the gynecology clinic at Ramathibodi Hospital, Bangkok, was asked to answer a questionnaire on their personal background, their knowledge of the Pap smear and HPV and the HPV vaccine and the acceptability of the HPV vaccine for themselves and their daughters., Results: Knowledge of the Pap smear (96%) is higher than that of HPV (41%) and the HPV vaccine (36%). Only 40% of participants had previously heard about HPV. The acceptability of the HPV vaccine for participants and their daughters was high, 77% and 84%, respectively. Knowing about HPV increases acceptance for the HPV vaccine (adjusted OR = 1.7, 95% CI = 1.2-2.5, in the participants and OR = 2.3, 95% CI = 1.5-3.6 in their daughters). Participants younger than 45 years old (OR = 2.3 and 95% CI = 1.6-3.4 for themselves; OR = 2.2 and 95% CI = 1.4-3.3 for their daughters) were more likely to accept the vaccination than those aged 45 years old and above., Conclusion: Knowledge about HPV and the HPV vaccine is generally poor in Thai women. However, the acceptability of the HPV vaccine is good. Knowing about HPV and age under 45 years predict the acceptability of the HPV vaccine., (© 2011 Blackwell Publishing Asia Pty Ltd.)

Objective: To evaluate the effectiveness of vaginal misoprostol in overcoming an unsatisfactory colposcopy in the patients who had abnormal cervical cytology and to evaluate side effects of vaginal misoprostol., Methods: Sixty patients with an unsatisfactory colposcopy during the period of September 2007-November 2008 were recruited and randomly allocated to receive either two tablets of 200 microg misoprostol (400 microg) or two tablets of similar-looking placebo vaginally. Colposcopic re-examination was performed approximately 6 h later. The results and side effects before and 2 weeks after the colposcopic re-examination were recorded., Results: Six out of 30 patients in the misoprostol group (20.0%) had a satisfactory colposcopic re-examination compared with 2 out of 27 patients (7.4%) in the placebo group without statistically significant difference (P = 0.172). Three patients in the placebo group dropped out due to not present at the appointment time. Six out of 30 patients (20.0%) and 1 out of 30 patients (3.3%) in the misoprostol group had side effects before and 2 weeks after the colposcopic re-examination orderly. Twenty-seven patients in the placebo group did not have any side effects before and 2 weeks after the colposcopic re-examination. All side effects occurred were minimal and well tolerated., Conclusions: Four hundred micrograms of vaginal misoprostol were not proved to be effective in converting an unsatisfactory to a satisfactory colposcopy.

Objective: To find out female hospital-based healthcare professionals' knowledge of cervical cancer, HPV and attitudes towards HPV vaccination., Design: A descriptive cross-sectional hospital-based study., Setting: Ramathibodi Hospital, Mahidol University, Bangkok, Thailand., Sample: A total of 350 female hospital-based healthcare professionals who had not been diagnosed as having any cancer and willing to participate in the study., Methods: Participants completed written consent and an anonymous questionnaire and knowledge of cervical cancer, HPV and attitudes towards HPV vaccination were the main outcome measures., Results: Among 300 responders, the mean age was 36.1 years. Most of them were married with children and had received university education. Nursing assistants accounted for 47.1%, and their income per month was about 5,001-15,000 baht. Most (56.3%) had only one lifetime sexual partner. Sixty-eight to 85.3% have a good knowledge of cervical cancer and Pap smear. However, only 12.0 to 58.3% have some knowledge of HPV, and less than fifty percent of them have knowledge of HPV vaccination. Nevertheless, 51.7 to 60.7% of them have good attitudes toward vaccination. Their age and income might influence their attitudes about having themselves vaccinated, and their career might be a factor which altered their attitudes about having their daughter vaccinated if they have one., Conclusions: Female hospital-based healthcare professionals have a good knowledge about cervical cancer and Pap smears, but they need motivation to have Pap tests regularly. More information regarding HPV and vaccination is needed to provide to them for cervical cancer prevention and best practices.

This study is to compare the remission and complication rates of actinomycin D (Act-D) and methotrexate-folinic acid (MTX-FA) as single-agent treatments of stage I, low-risk gestational trophoblastic neoplasia (GTN). From 1994 to 2005, all women with International Federation of Gynecology and Obstetrics stage I, low-risk GTN were randomly assigned to received either intravenous Act-D 10 microg/kg per day for 5 days every 2 weeks or intramuscular methotrexate 1 mg/kg per day on days 1, 3, 5, and 7 with intramuscular folinic acid 0.1 mg/kg per day on days 2, 4, 6, and 8 every 2 weeks. Forty-nine women met the eligibility criteria. Age, human chorionic gonadotropin level, and International Federation of Gynecology and Obstetrics score were similar in both treatment groups. Of the 22 women who received Act-D, 2 were lost to follow-up. Among the 27 women who received MTX-FA, 2 were lost to follow-up, and 6 had to switch to Act-D because of the rising levels of liver enzymes. All 20 women (100%) in the Act-D arm achieved remission compared with 14 (73.6%) in 19 women in the MTX-FA arm (P = 0.02). Mucositis and alopecia were reported more frequently in the Act-D group, whereas elevations of liver enzyme levels were more frequent in the MTX-FA group. Actinomycin D seems to be more effective than MTX-FA in the treatment of stage I, low-risk GTN. Larger multicenter randomized controlled trials should be conducted to establish the most appropriate regimen for these patients.

Background: Vaginal carcinoma represents 1-2% of all gynecologic malignancies. Most cases reported secondary involvement from adjacent organs including cervix, uterus, and colorectum. Vaginal involvement from adenocarcinoma arising in mature cystic teratoma (MCT) has never been reported., Case: A 29-year-old female presented with postcoital vaginal bleeding. She had had a history of right ovarian adenocarcinoma arising in MCT, FIGO stage IC, for 18 months' duration. Incisional biopsy of the vaginal lesion revealed adenocarcinoma, morphologically and immunohistologically identical to the right oophorectomized specimen. She received three courses of paclitaxel and carboplatin chemotherapy; however, she developed massive right pleural effusion with superior vena cava syndrome and finally succumbed to the disease, three months later., Conclusion: Adenocarcinoma is rarely found in MCT. This is the first case of ovarian adenocarcinoma arising in MCT with secondary vaginal involvement, presenting as postcoital vaginal bleeding.