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The prevalence of different HPV types, especially HPV16 and 18 in cervical cancer in patients diagnosed 2019–2023 in Stockholm was compared to corresponding data from 2003–2008 before the introduction of HPV vaccination in Sweden. Cervical cancer samples from 125 patients diagnosed 2019–2023 in Stockholm were analysed for 27 HPV types by multiplex assay and the HPV type prevalence data was compared to data obtained in 154 cervical samples from 2003–2008. Patient median age was higher 2019–2023 compared to 2003–2008 (55-years vs. 42-years, p = 0.046). Overall HPV prevalence was 93.6%, HPV16 and 18 accounted for 62.2% of all squamous cell carcinoma cases (SCC) and 63.6% of all adenocarcinoma cases (ADC) vs. 92.9%, 69.7% and 88.6% respectively 2003–2008. The joint prevalence of HPV16 and 18 in SCC and ADC tended to be slightly lower in 2019–2023 as compared to 2003–2008, but the difference was not statistically significant. [ABSTRACT FROM AUTHOR]

Objective: to carry out a quantitative analysis of diffusionweighted magnetic resonance images (DWI) in cancer of the cervix uteri (CCU) and to estimate the possibility of using pretreatment measured diffusion coefficient (MDC) to predict chemoradiation therapy (CRT).Material and methods. The investigation prospectively enrolled 46 women with morphologically verified Stages IB-IVB CCU. All the women underwent diffusion-weighted magnetic resonance imaging of pelvic organs before and after treatment. A semiautomatic method was used to determine tumor signal intensity (SI) on DWI at b 1000 s/mm2 (SI b1000) and tumor MDC. The reproducibility of MDC measurements was assessed in 16 randomly selected women. The investigators compared the pretreatment quantitative DWI measures in complete and incomplete regression (CR and IR) groups and the presence and absence of tumor progression during a follow-up. An association of MDC with progression-free and overall survivals (PFS and OS) was determined in the patients.Results. A semi-automatic tumor segmentation framework could determine the pretreatment quantitative DMI measures with minimal time spent and high reproducibility. The mean tumor MDC was 0.82±0.14×10–3 mm2/s. CR and IR were established in 28 and 18 women, respectively. The MDC ≤ 0.83×10–3 mm2/s predicted CR with a sensitivity of 64.3% and a specificity of 77.8% (р=0.007). The median follow-up was 47 months (range, 3–82 months). With the MDC ≤ 0.86×10–3 mm2/s, 5-year PFS was 74.1% versus 42.1% with a higher MDC (р=0.023) and5-year OS was 70.4 and 40.6%, respectively (р=0.021). The survival difference was insignificant in relation to the degree of tumor regression. The pretreatment IS at b1000 was of no prognostic value.Conclusion. The pretreatment tumor MDC may serve as a biomarker for predicting the efficiency of CRT for CCU.

Cancer of the cervix uteri (CCU) ranks third in the incidence of malignancies in women. The choice of CCU treatment mainly depends on the extent of the tumor process, i.e. the stage of the disease. Determining the stage of CCU is based on the clinical classification of the International Federation of Gynecology and Obstetrics (FIGO) (2009) and has a number of substantial limitations in evaluating parametrial invasion, tumor spread to the pelvic wall, and involvement of regional lymph nodes and in determining the true tumor sizes. Magnetic resonance imaging (MRI) is now the method of choice in staging invasive CCU.Multiparameter MRI will be able to enhance the efficiency of diagnosing microinvasive CCU as well (FIGO 2009), to plan surgical and/or chemoradiation treatment, to evaluate its efficiency, and to diagnose locally recurrent CCU.

The Outpatient Ultrasound Diagnosis Group, Research Consulting Department, N. N. Blokhin Russian Cancer Research Center, studied the results of an examination in 93 patients with the verified diagnosis of cancer of the cervix uteri (CCU). To specify the extent of a tumor process, a comprehensive ultrasound examination was made in all the patients with verified CCU during their first visit. Our findings were statistically processed. According to our findings, ultrasound computed tomography is a highly informative method to diagnose retroperitoneal lymph node (LN) metastases, which defines the shape, sizes, structure, location, and number of metastatic LNs. Iliac LNs with reactive changes were detected in 24.7 % of CCU cases. No ultrasound signs of iliac LN metastatic involvement were found in 4.3 % of cases in the presence of CCU micrometastases. The number of metastatic regional LNs was validly proven to increase with larger tumor sizes. The threshold values of cervicaltumors were determined, which may presume the presence or absence of iliac LN metastases to have a rather high sensitivity and specificity. The risk of LN metastatic involvement was validly proven to be 4.1-fold higher with greater two or more threshold values of a cervical tumor.

Cervical cancer (CC) morbidity is analyzed on the basis of the data of the Karelian cancer register over the period 1998-2007. During this period, 816 cases of CC were registered and 126 were found at an antenatal clinic (AC). Its early detection rate was ascertained to be 96% during screening at the AC. A comprehensive examination was made in 1742 women with various cervical diseases, of them 37.5% were infected with human papillomavirus (HPV). High-grade dysplasia and carcinoma in situ were diagnosed in 6.6% of the HPV-infected patients. Large-scale screening for HPV infection and pretumor disorders with their further treatment will aid in reduc- ing CC morbidity and mortality rates.

The prevention of cancer of the cervix uteri (CCU) is an interdisciplinary problem that may be solved only via joint efforts of gynecol- ogists, oncologists, virologists, and immunologists. Since there is currently strong evidence for the viral origin of CCU, vaccination is prominent in its primary. The present paper considers and comparatively analyzes 2 different lines of biotherapy for CCU.

More than 500,000 cases of cervix uteri cancer are annually registered in the world. Almost half die within the first year due to its late diagnosis. In this connection, the early diagnosis of cancer is a challenge today.

The paper analyzes data on the state-of-the-art of oncological care given to patients with gynecological cancer, considers differences in morbidity rates between individual population groups and regions, and compares the maximum and minimum cancer morbidity rates among different populations.

Researches of the capabilities of radionuclide diagnosis are one of the most important trends in modern medical science and practice, especially in the area of dynamic renal scintigraphy. This technique proved to be safe and highly informative when used in oncogyne- cology to evaluate defects of renal drainage. However, failure to make an objective evaluation of ureteral patency reduces significant- ly the capabilities of the technique in patients after small pelvis surgery and radiotherapy. The study issues presented in this article are devoted to this particular problem. The authors have developed an original procedure for evaluating renal drainage disorders during dynamic renal scintigraphy. The specific visual and digital parameters which characterize both normal and obstructed urine outflow in the supravesical segment are given. Criteria for serious disorders in urine derivation from the kidneys through the ureters are defined. Risk factors for urine outflow disorders are identified in cervical cancer patients who receive various treatments.

Human papillomavirus (HPV) that is a main cause of cancer of the cervix uteri (CCU) has immunogenic properties, i.e. an abilityto activate antiviral immunity responses as adaptive HPV-specific and innate ones. For this reason, despite multiple mechanisms generated by HPV to avoid immunity responses, the human body can eliminate the infection in most cases. At the same time, CCU results from the combined influence of many factors of different nature, among which the factors that impair the normal course of an immune response are of vital importance.This review describes the major factors and mechanisms, which promote the establishment of persistent HPV infection and the progression of dysplasia to cancer, on the one hand, and allow the tumor cells in CCU to restrict the body’s immune reactions, on the other Immune disorders induced by the virus and/or tumor cells are considered at both local and systemic levels. Particular emphasis is placed on the molecular mechanisms that can change the population composition and functional activity of leukocytes and the cytokine profile of cells and can form the tumor suppressor microenvironment.

In women with background diseases of the cervix uteri, human papillomavirus (HPV) types 16 and 18 infection was found in 26.9% of cases, while in those with varying cervical intraepithelial neoplasia, it was in 68.5% of cases, i.e. 2.5 times higher, mainly at the age of 25 to 30 years. Polymerase chain reaction serum assays for HPV infection were negative in 99.9% of cases.After diathermoelectronization of the cervix uteri, HPV was identified in 28.6% of the female virus carriers with background diseases and in 49.9% of the women with varying dysplasia, i.e. half the female virus carriers in this group continued to have the earlier iden- tified HPV types 16 and 18.

The viral nature of many female genital cancers is now beyond question. By taking into account this fact, the problem of qualitative assessment ofthenatureofcervicalintraepithelialneoplasia(CIN)anditsfocusonprogressiontoinvasivecarcinomabecomesquitenatu ral.Studiesof a number of biological markers of carcinogenesis have recently provided a possibility for prospective prediction. The paper con siders the as- pects of importance of the molecular biological markers of proliferation and apoptosis in the etiopathogenesis of genital cancers. It gives the results of examinations of 16 patients with histologically verified squamous cell carcinoma of the cervix uteri, 40 patients di agnosed as having CIN of different grades (CIN-1, CIN-2, CIN-3 — squamous cell carcinoma in situ), and 6 patients with the morphologically unaltered cervi- calepithelium,whosecervicalscrapeswereanalyzedfortheexpressionofthemRNAgenesССNB1,Ki-67,BA G,BCL-2,ESR1,andPRG. It is shown that the molecular genetic findings may be new prognostic markers that reflect the possible disease developmental pathways, sug- gesting the need for further investigation of biomarkers in order to prevent malignancies and to reduce their morbidity.

Metastatic involvement of the central nervous system (CNS) is very rarely observed in gynecological cancer . Ten case histories were analyzed in patients with malignancies of the cervix uteri, endometrium, and ovaries concurrent with metastatic involvement of the brain and spine. The CNS involvement was metachronous in all the patients. The mean interval between the detection of a primary tumor and the emergence of metastases was 3.1, 4.5, and 2.3 years for cervix uteri, corpus uteri, and ovarian cancers, respectively. All patients with gynecological cancer are indicated to undergo a follow-up including neurological examination and X-ray or magnetic resonance imaging of the brain and spine. When meat static CNS involvement is detected, multimodality treatment involving surgery followed by chemoradiation therapy is recommended.

The experience with serial renal scintigraphy demonstrated its high informative value and safety in evaluating the severity of intrarenal urine outflow disorders; however, failure to make an objective assessment of ureteral patency considerably limits its study. The set of studies, which is given in this paper, is devoted to precisely this, highly urgent, problem. The authors describe an original procedure for diagnosing impaired urine outflow along the ureters, which has been used during serial renal scintigraphy, define the visual and digital characteristics of normal and impaired urine outflow in the supravesical segment, and denote the criteria characterizing severe impair- ments of renal urine derivation along the ureters. Risk factors for urine outflow disorders have been identified in patients with cancer of the cervix uteri, who receive various treatment modalities.

Despite great efforts to publish the 7th edition of the clinical TNM classification, the major aim of the International Union Against Cancer continues to create unified statistical information on the prevalence of disease in each specific case. This information can, in the general context, help specialists evaluate a tumor process, avoid disagreements in the planning of treatment and in the assessment of its results, and make a prognosis, thereby favoring further investigations of malignancies.

Cervical intraepithelial neoplasias (CIN), the stages of development in cancer of the cervix uteri (CCU) during persisting infections caused by human papillomavirus (HPV), are a disease frequently occurring in young women. The carcinogenic process lasts 3-5 to 10-30 years during which timely detection and organ-saving treatment for the lesion are possible. The development of markers for the persis- tence of HPV infection and the transition of a productive to transforming phase of infection (from mild to severe CIN) is a basis for the current approach to screening for CIN and BC and to a patient follow-up. The review paper presents the main areas of studies developing markers that are directly associated with HPV infection (HC2 viral load), virus typing, viral physical status, E6 and E7 mRNA, E2/E6 ratio) and its mediated action on host cells (p16INK4a, hTERT). The pathogenetic effect of HPV early genes and their association with the expression of basic surrogate markers are considered in detail. The majority of the presented markers are being actively put into clinical practice in foreign countries.

Objective: to study the urinary levels of estrogen metabolites as a diagnostic criterion in patients with cancer of the cervix uteri (CCU) associated with human papillomavirus (HPV) infection to provide a rationale for the use of pathogenetic therapy in the combination treatment of CCU.Subjects and methods. The study enrolled 26 patients with Stages I-IV CCU who were treated at the Department of Gynecology, Tomsk Research Institute of Oncology. The patients’ mean age was 45.6±1.3 years (range 24 to 72 years), the patients of reproductive age ac- counted for 50%. Tumor was staged in accordance with the FIGO classification. Genotyping was carried out on 12 oncotropic types, by estimating the viral load by polymerase chain reaction. Urinary estrogen metabolite levels were measured in all patients.Results. In the female patients, the urinary level of the metabolite 2-OHE1 responsible for normal cell growth was 8.95±2.9 ng/mg, which was significantly below the values in healthy women (19.7±1.2 ng/mg). The level of the metabolite 16

Objective: to define a role of magnetic resonance imaging (MRI) in the follow-up of patients with cancer of the cervix uteri (CCU), who have undergone radiation therapy and chemoradiation therapy and to describe the types of the MRI pattern of recurrent CCU in the pelvic region.Materials and methods. The results of a follow-up of 82 patients with a 4-47- (median 12 months) month history of invasive CCU were analyzed.Results. Out of the 82 patients with invasive CCU, 25 were found to have pelvic recurrences; in 23 cases MRI revealed the latter (in the cervix uteri (n = 6), corpus uteri (n = 2), vagina (n = 2), parametrium (n = 2), iliac (n = 10), paraaortic (n = 5) lymph nodes, and pelvic wall (n=5).Conclusion. The findings suggest that pelvic MRI is an effective technique to detect and estimate the extent of a pelvic recurrence and it is expedient to incorporate it into the scope of a follow-up after radiation therapy and chemoradiation therapy in patients with invasive CCU.

Based on their observations, the authors have made univariate and multivariate analyses of the prognostic importance of a number of magnetic resonance and clinical factors in cancer of the cervix uteri.

The data obtained by the authors suggest that the efficiency of standard cytostatic therapy for recurrent cervical cancer in combination with chemotherapy and oxygen therapy has increased and the tolerance of cytostatic treatment during oxygen therapy improved.

Early response genes are a group of proto-oncogenes that are the first to be activated in cell stimulation with different growth factors and to be involved in the regulation of cell proliferation and differentiation. Large amount of information supporting that altered expression of these genes is one of the central and earliest events of carcinogenesis has been accumulated. In this connection, it is promising to use early response genes as diagnostic and prognostic markers for the detection and combination therapy of cancer of the cervix uteri, one of the most common gynecological malignancies characterized by high mortality rates and difficulties in early diagnosis. The theoretical basis for these promises is the found mechanisms for the interaction of early response genes with human papillomavirus genome, the main cause of cervix uteri cancer.

The paper analyzes the strategy and tactics of beam and intracavitary radiation within the framework of chemoradiotherapy in 112 pa- tients with inoperable FIGO stages IIa–IIIb cancer of the cervix uteri. The parameters that are important to plan general radiotherapy stages are assessed; the bases for optimization decisions and the specific features of maintenance therapy, which ensure a 15–25 % increase in the efficiency of treatment with its satisfactory tolerability, are given.

Analysis of the results of examining and treating 246 patients with Stages IIA-IIIB cancer of the cervix uteri (CCU), receiving specific chemoradiotherapy (CRT) at the Department of Radiotherapy, National Oncology Center (Baku), has ascertained that CRT using two high-dose (9 Gy) rate brachytherapy fractions and competitive cisplatin chemotherapy is an effective, reasonably safe, and economically sound treatment method for locally advanced CCU. The method shows acceptable toxicity and may be used in routine clinical practice.

Background: Here, we present a review of the revised FIGO (International Federation of Gynecology and Obstetrics) staging system for carcinoma of the cervix uteri, explaining the reasons for the changes and summarizing suitable diagnostic methods and treatment options for particular stages of disease according to current guidelines., Aim: The FIGO staging system has been revised as follows. Measurement of lateral extension has been removed from stage IA; the only criterion is a measurement for the deepest invasion of < 5.0 mm. Stage IB has been divided into three subgroups: IB1, tumors with a largest diameter measuring 5 mm and < 2 cm; IB2, tumors measuring 2-4 cm; IB3, tumors measuring 4 cm. Stage IIIC includes an assessment of retroperitoneal lymph nodes: IIIC1 if only pelvic lymph nodes are involved, and IIIC2 if para-aortic nodes are infiltrated. The revised staging system does not mandate the use of a specific imaging method or surgical assessment of the extent of the tumor. The method used to assign a stage should be recorded and reported. The European Society of Gynaecological Oncology, the European Society for Radiotherapy and Oncology, and the European Society of Pathology have developed clinically relevant and evidence-based guidelines to improve the quality of care for women with cervical cancer. These guidelines cover comprehensive staging, management, and follow-up for patients with cervical cancer. The guidelines are intended for use by gynaecologic oncologists, general gynaecologists, surgeons, radiation oncologists, pathologists, clinical oncologists, radiologists, general practitioners, palliative care experts, and other health professionals., Conclusion: We summarize the new FIGO classification system, including diagnostic methods and treatments for particular stages. We also discuss the main changes and their clinical impact. This work was supported by the Charles University project UNCE 204065. The authors declare they have no potential conflicts of interest concerning drugs, products, or services used in the study. The Editorial Board declares that the manuscript met the ICMJE recommendation for biomedical papers.

The review gives updates on the pathogenesis of background, precancer, and cancer of the cervix uteri. Epidemiological and molecular biological studies have established that human papillomavirus infection is the most important factor of carcinogenesis of the cervix uteri. The impact of reproductive dysfunction on the development of cervical pathology has been assessed and a possible mechanism of involvement of sex steroids in carcinogenesis assumed.