Comparative Study of VCE and Cervical Scraping Pap Smear

 Comparative study of VCE and cervical scraping Pap smears of the uterine cervices was done in 470 OPD cases in Srinagarind Hospital from October 1987 to January 1990.  The cervical scraping Pap smear had low sensitivity in detecting endocervical cells and atypical cells when compared with the VCE technique (34.7% and 23.3% respectively), but had high sensitivity in detecting dysplastic cells (72.7%).  However, in the VCE slides the cervical scraping parts © were the most sensitive parts to detect dysplastic cells.

Recurrence Patterns of Cervical Cancer After Radical Hysterectomy and Pelvic lymphadenectomy at Srinagarind Hospital

Recurrent patterns after radical hysterectomy and pelvic lymphadenectomy fo rcervical cancer stage I and II A were analysed. The data collected from 1976 upto June 30 , 1988 , with the total 218 cases operated. The incidence of recurrence in this series was 9.10% ., 8.40%for stage I B, 19.40% for stage II A and no patient with stage I A recurred. There were 45% with central pelvic recurrences, 15% with pelvic sidewall recurrences , 15% with intraabdominl recurrences and 25% with distant recurrences. The recurrent rate in squamous cell carcinoma was 9.09% and adenocarcinoma 16.13% Those who had positive lymph nodes recurred in 15.20% and those who had negative nodes recurred in 8.10 % The treatment after recurrence will be presented.

Epidemiology of ovarian cancer in Thailand : Pilot study from Khon Kaen Population –based cancer registry +

The study was carried out to determine the accurate incidence and magnitude of problems of ovarian cancer in khon Kaen province and also to act as a pilot study for the feaxsibility of conducting the population-based registry of all ovarian cancer cases in Thailand. Under the method of population – based cancer registry , every case of ovarian cancer diagnosed from every health service center in KhonKaen province during the period from January 1,1985 to December 31 , 1987 was collected by the cancer unit , Faculty of Medicine , Khonkaed University both in passive and active methods After carefull check by unit’s staffs and computerized system , the cases were record in computer for further study. There were totally 72 new cases of ovarian cancer collected in this three-year period. The crude incidence rates varied from 3.06 to 3.37 per 100,000 poputation per year while the agestandardized incidence rates compared to standard world population varied from 4.15 to 4.55 per 100,000 population per year. The death cases of this disease in the same period of time were totally 20 with the crude mortality rates varied from 0.64 to  1.30 per 100,000 population per year while the age-standardized mortality rates varied from 0.81 to 1.94 per 100,000 population per year. The result of this study reveals the more reliable statistics about incidence and mortality rates of ovarian cancer than it has previously been reported. It showed the rather low incidence when compared with other countries in the world and still not the major cause of death in KhonKaen female population.

Neoadjuvant Chemotherapy in Advanced Vulvar Cancer : A pilot study

Two cases of FIGO stage IV , inoperable squamous cell carcinoma of the vulva were given primarily with two courses of chemotherapy. The tumor masses in both cases turned to be operable and radical vulvectomy with groin and pelvic nodes and lymph nodes were free of tumor in the first case while the other one had bilateral lymph nodes involved by the tumor and so radio therapy was given. Both patients were in good health and free of disease at the time of last follow-up

Clinical Characteristics of Malignant Gestational Trophoblastic Diseases In Srinagarind Hospital and Problems in Management

 There were 43 malignant GTD patients who were admitted to Srinagarind Hospital from March 1983 to October 1987. The incidence of the disease was 1 :329 patients (62.8%) had pathological diagnosis of  choriocarcinoma and of invasive mole in 22 cases (51.2%) and 5 cases (11.6%) respectively. 28 patients (65.1%) had metastatic disease. The majority of patients had chemotherapy alone. The remission rates of the patients in non-metastatic, low-risk metastatic and high-risk metastatic were 100 , 50 and 36.8% respectively.There were 16 deaths (37.2%) . Only 6 patients (20.7%) visited for follow up examination program completely. The major problems found in this study were the high mortality rate of the patients, the problem of urinary hCG level analysis and the large proportion of patients not attending the follow up program after treatment.

Clinical Characteristics of Hydatidiform Mole Patients in Srinagarind

Thirty six pathologically proved hydatidifoam mole patients during the period from December 1980 to October 1986 were studied. The incidence of the disease  was 1:415 hospital deliveries. The age ranges with the highest incidences were between 16-20 and 26-30 years old. Most of the patients were farmers and had low incomes, with the gravidity of 1-4 and parity of 0-2 .There were 86.11% of the patients with on history of any contraception. The most common symptoms were bleedings ( 91.67% ). The duration of amenorrhea were between 16-19 weeks in 30.56% of the patients. There were 66.67% of the patients with large-for-date uterine size and 13.89% of the patients had theca lutein cysts. One half of the patients were diagnosed by ultrasonography. The evacuation procedures composed largely of suction curettage and dilatation curettage. The major complications of treatments were incomplete evacuations. The incidence of malignant GTD was 17.24 % . Only 8 patients ( 22.22 % ) completely attended the follow up program. The major problems in management of the patients were the problems of quantitative urinary HCG test and the large proportion of the patients not attending follow up program after evacuation of the moles.

Hematuria : An Indication for Cystoscopy in Staging of Cervical Cancer

 From July 1982 to June 1987, a total of 647 cervical cancer patients who had undergone cystoscopy for staging of the disease at Srinagarind hospital were available for the study.  There were 21 patients (3.25%) found to have bladder mucosa involved by the cancer.  Twenty patients were initially in stage III B and 1 patient was in stage IV B.  The result of the cystoscopy changed the initial staging of the disease in only 3.09% of the patients.  The urinalysis of the patients revealed 161 cases (24.88%) with abnormal amount of red blood cells in urine.  One hundred and twelve patients with abnormal urinalysis were in stage III or more advanced disease.  All of the patients who had bladder mucosa involved by the cancer had abnormal amount of red blood cells in urine.  The authors suggest that cystoscopy for staging of cervical cancer be done only in patient with stage III or more advanced disease who has abnormal amount of red blood cells in urine.  By this criterion, only one fifth of the cervical cancer patients would undergo cystoscopy for staging of the disease.

Colposcopy in Srinagarind Hospital

 From January 1981 to the end of 1985, 259 cases of patients with abnormal Papaniculaou smears or abnormal cervical lesions were examined with colposcope. Most patients were in the age of 25-45 years with the peak of 30 to 34 year and 10% were nulliparous. Forty-five percent of the patients lived in Khon Kaen areas where as the rest came from other provinces of north-eastern area of Thailand. Comparing colposcopic directed biopsy with the final histological diagnosis revealed the accuracy of 94%, sensitivity 94.9%, specificity 89.6% , positive predictive value 95.7% and false – negative rate 5.17%. By the indications of conization, all patients with false – negative and underdiagnosis had been corrected and no single case missing for invasive cancer. Colposcopy is a safe accurate test suitable for district community hospital used in Thailand. 

Vulvar Cancer at Srinagarind Hospital

 From January 1978 through September 1985, 23 cases of vulvar cancer were diagnosed and treated at Srinagarind Hospital. The patients’age varied from 25 to 78 years with the mean of 52 years. Most of them came from Khon Kaen area, others from different parts of the northeast. Number of deliveries ranged from 0-16 with the mean of 7.35. Itching of the vulva was the predominant symptom followed by ulceration, valvar mass, leucorrhea and leukoplakia. About forty percent of the patients were in stage 2, one-fourth were in stage 1, whereas stage 3 and 4 comprised about 30%. Most patients (52%) had the primary at the clitoris and both labia with fungating masses. Ninety percent were squamous cell carcinoma. About 75% had been treated by radical vulvectomy with groin nodes and/or pelvic nodes dissection. The five-year survival rate for the whole series was 80.49%, for the surgical cases 92.86% and 0% for the non-surgical cases. The authors recommended radical vulvectomy with bilateral groin nodes dissection to be the first choice of treatment. Other adjuvant therapy should be considered for each special category.

Conization in Abnormal Cervical Cytology

 One Hundred and sixty two patients with abnormal cervical cytology and in whom conization had been  performed were studied. Most of the cytological reports (88.27%) were CIN. The pathological examination of the conized specimens revealed 83.34% to be CIN. Six patients (3.7%) had microinvasive carcinoma and 9 patients (5.5%) had invasive carcinoma. In 90 patients with cytological reported as severe dysplasia. In the cytologically moderarte dysplastic grop, there was no single case of microinvasive or invasive carcinoma in the conized specimens. The common comlocatios of conization were bleeding (11.11%) and infection(7.41%). Thus conization is not appropriate to be the first procedure to obtain specimen for pathological examination in patient with abnormal cervical cytology.