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Background: Although modern Thai women have more education and knowledge, from variety sources of information including cervical cancer prevention, cervical cancer screening coverage rate in them is still low at only 5%. Therefore, limitation of their knowledge should not be the cause. Authors did this study to examine all the causes remained after extensive health education given.Objective: To examine reasons why Thai women still do not have Pap smear after extensive health education was providedMethod: We have examined reasons that might be the causes of Pap smear lack after periodically educating 200 women, aged 35-60 years-old, in an inner city community for at least twice within 1 year and asking the ones who still did not have Pap smear at 8-12 months for their reasons.Design: Interventional cohort by health education and descriptive study for their reasons of Pap smear lackSetting: Samliem inner city community, Khon Kaen, ThailandResult: At 8-12 months after extensive health education for at least twice, 63% (126/200) of educated women still did not have Pap smear. The reasons were as follows; busy (67.5%), embarrassment (32.5%) and no symptom (20.6%).Conclusion: Thai inner city women are too busy to have Pap smears. Embarrassment is the second reason. Screening-based cervical cancer prevention programme still needs other supporting strategies to build up an occasion for them.
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Background: Since 1996, endometrial cancer patients at Srinagarind Hospital (SNH) have been surgically staged according to recommendation of International Federation of Gynecology and Obstetrics (FIGO) 1988. However, there was no data about the prevalence and predicting factors of pelvic lymph node metastases in the patients with endometrial cancer in SNH before. These data could lead to either supporting or objection of our practice.Objectives: To determine the prevalence and predicting factors of pelvic lymph node metastases in endometrial cancer patients at Srinagarind HospitalMaterials and methods: Medical records of endometrial cancer patients, whose were primarily surgically treated at Srinagarind Hospital during January, 1996 to July, 2005, were collected and analyzed by retrospective chart reviews.Design: Retrospective descriptive studySetting: Srinagarind Hospital, Faculty of Medicine, Khon Kaen UniversityResults: 199 endometrial cancer patients were treated with surgical staging procedures. Prevalence of pelvic lymph nodes metastases was 11.6% (23/199). Only lymphovascular space invasion was found to be the significant predicting factor for pelvic lymph node metastases.Conclusion: As prevalence of pelvic lymph nodes metastases was 11.6% and postoperative lymphovascular space invasion was the only a significant predicting factor for pelvic lymph node metastases. Routine surgical staging procedures in our endometrial cancer patients were supported.Key words: Prevalence, pelvic lymph nodes, endometrial cancer
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Background: Several studies have demonstrated that anemia is one of the poor prognostic factors for cervical cancer patients treated with radiotherapy. We questioned the necessity of weekly hemoglobin level monitoring in these patients. This study was conducted to evaluate the value of weekly hemoglobin level measurement in cervical cancer patients receiving radiotherapy.Objective: To evaluate the value of weekly hemoglobin (Hb) level measurement in cervical cancer patients receiving radiotherapy.Materials and Methods: The medical records of cervical cancer patients admitted in gynecologic oncology ward between May 2000 and May 2002 were reviewed to evaluate the clinical characteristics and weekly Hb level. Measurement outcomes include grade 2-4 hematologic toxicity, Hb nadir, week of Hb nadir and the number of blood transfusion. Design: Descriptive study.Setting: Chiang Mai University Hospital.Results: There were 113 cervical cancer patients receiving radiotherapy in the study period. Fifty-four patients (47.8%) had Hb level at presentation \< 10 g/dL. Among these patients, grade 2-4 anemia was found in 21-30 patients per week with a mean of 23.5 (43.5%) in week 1-4. Between week 5-8, grade 2-4 anemia was found in 5-22 patients per week with a mean of 15.3 (28.3%). Among 59 patients with Hb level at presentation \> 10 g/dL, grade 2-4 anemia was found in 7-9 patients per week with a mean of 7.5 (12.7%) in the first 4 week. After week 4, grade 2-4 anemia was found in 3-8 patients per week with a mean of 5.8 (9.8%). Patients with Hb level at presentation \> 11 g/dL, grade 2-4 anemia was found in only 0.8% and 4.9% in week 1-4 and week 5-8, respectively. Fourty-seven patients (41.6%) received a blood transfusion. Among these patients, 42 patients (89.4%) had a Hb level at presentation \< 10 g/dL, the remaining 5 patients (10.6%) had a Hb level at presentation \> 10 g/dL(P \< 0.001). Only one patient with Hb level at presentation \> 11 g/dL received a blood transfusion. No blood transfusion was administered in patients with Hb at presentation \> 12 g/dL.Conclusions: For cervical cancer patients with Hb level at presentation \< 10 g/dL, weekly Hb level should be checked during radiotherapy. Among those with Hb level at presentation \> 11 g/dL, Hb level may be checked less frequently.Key words: Hemoglobin level, cervical cancer, radiotherapy
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Objective: To estimate the prevalence of human papillomavirus (HPV) infection, cervical intraepithelial neoplasia (CIN) and cervical carcinoma in patients with atypical squamous cells of undetermined significance (V) from cervical Pap smear.Study design: Descriptive studySetting: Srinagarind Hospital, Faculty of Medicine, Khon Kaen University.Subjects: Two hundred and seventy-three women with a new cervical cytology diagnosis of ASCUS, without prior dysphasia or cervical carcinoma between July 1st, 1999 and June 30th, 2001Method: We reviewed 273 records to collect follow-up Pap smear results, colposcopic results and histological reportsMain out come measures: Prevalence of HPV infection, CIN and cervical carcinoma.Results: The 273 new reported ASCUS cervical smears represented 0.8% of all cervicovaginal smears diagnosed in our center during the same time period (33,744 smears). Ninety five patients (34/8%) were lost to follow-up. Of the remaining 178 patients, 27 cases had cytological follow-up; 24 cases (13.5%) reverted to normal or benign cellular changes, 2 cases (1.1%) persisted as ASCUS and then lost to follow-up, 1 case progressed to high grade squamous intraepithelial lesion, then lost to follow-up; 138 cases underwent colposcopy with or without biopsy as indicated; 5 cases had biopsy without colposcopy; 8 cases had hysterectomy without colposcopy or Pap smear follow-up. The majority of patients (64.5%) underwent histological examination; 72 cases (40.7%) were negative (without HPV and CIN); 16 cases (9.0%) showed HPV infection, 26 cases showed CIN, of which 6 cases (3.4%) were CIN I, 6 cases (3.4%) were CIN II and 14 cases (7.8%) were CIN III and 1 case (0.6%) was invasive lesion.Conclusion: This study showed that 24.2% of ASCUS cervical Pap smears finally had HPV, CIN and invasive cervical carcinoma. Thus, ASCUS should be assessed colposcopically.
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Background: Weekly cisplatin concurrent chemoradiation is a treatment in locally advanced cervical cancer. However, there are only few reports in Thai women about hematologic toxicities of this treatment.Objectives: To evaluate prevalence of hematologic toxicities and early response accompanying weekly cisplatin concurrent chemoradiation in cervical cancer patients.Methods: Medical records of cervical cancer patients treated between January 2003 to December 2005 were reviewed retrospectively. Patients were treated by weekly cisplatin 40 mg/m2 accompanying with radiotherapy of total dose 7500-9000 cGy.Design: Retrospective descriptive studySetting: Ubonrajchathani Cancer Center, UbonrajchathaniResults: 89 out of 95 patients diagnosed as locally advanced cervical cancer and treated by weekly cisplatin in concurrent with radiotherapy were eligible and included for analysis. Mean age was 47.5 years (range, 34-71 years). The major histologic types were squamous cell carcinoma (79.8%), and distribution according to International Federation of Gynecology and Obstetrics (FIGO) stage was IB2 19.1%, IIA 6.7%, IIB 38.2%, IIIA 2.2%, IIIB 31.5% and IVA 2.2%, respectively. 80.9% of patients received five or more cycles of weekly cisplatin. Prevalence of hematologic toxicities was 78.7% and grade 3-4 were found in 14.4% of the patients. There were leukopenia 64.0% (9% grade 3-4), neutropenia 40.4% (7.8% grade 3-4), anemia 57.3% (only 1.1% grade 3-4) and no grade 3-4 thrombocytopenia. Only one patient (1.1%) had febrile neutropenia and this was manageable. There was no significant factor associated with clinical response in this study. Clinical response was evaluated. Complete response was 86.5%, partial response was 13.5%.Conclusions: Prevalence of hematologic toxicities accompanying with weekly cisplatin concurrent chemoradiation was 78.7% and grade 3-4 were found in 14.4% of the patients. Hemotologic toxicities were acceptable and managable. Complete clinical response rate was high.