Cervical cancer: outcome of treatment and causes of failure

To summarize the data and look into the various treatments offered to cervical cancer patients at Institute of Nuclear Medicine and Oncology [INMOL] to highlight the most likely causes of treatment failure. In this retrospective study, case files of all patients presenting with invasive carcinoma of uterine cervix during 1993-2002 were studied in respect to personal profile, disease related risk factors, pathological characteristics, treatment administered and outcome in the form of tumour response and survival. Early age at marriage, multiple marriages of self or spouse, multiparty, prolonged use of contraceptives and smoking were some of the risk factors for cervical cancer in this group of patients. Out of 618 patients presenting with invasive cervical cancer,65% presented in advanced stages II and III. Apart from advanced stage at presentation, anaemia, poor nutrition, and ignorance about self-hygiene and lack of follow-up were main causes of treatment failure. Outcome of treatment was improved when chemotherapy was added to radiation. Advanced stage at diagnosis and lack of follow-up were main causes of treatment failure. Implementation of screening programs on national level for early detection is therefore recommended

Patterns of care for ovarian cancer patients at institute of nuclear medicine and oncology [INMOL] Lahore

This study was carried out to analyze the incidence of ovarian cancer and changing patterns of therapy during the last six years at INMOL. Main objective was to review the results of treatment given and find out the causes of failure. We reviewed the case files of all the patients diagnosed as ovarian cancer, who reported for treatment at INMOL during 1990-95. Age at presentation, parity, social class, family history, methods of surgery, stage of disease along with histologic type of the tumour was studied. Treatment and its outcome was also recorded to correlate the results with histological subtype and stage of disease. In our series 6.8% of all cancer in females were the ovarian Cancer. Peak age at presentation in our female patients is a decade earlier than the Western population. Seventy five percent of women were multiparous contrary to the text book teachings. Known family history of breast or ovarian cancer was available in 3.5% of cases. Forty two percent of patients presented in stage-III and 38% in stage-II. Standard debulking surgery was performed in only 18% of patients. Chemotherapy was the treatment of choice after initial debulking [92%]. Initial results of chemotherapy were good 46% of the patients achieving excellent clinical response. Epithelial ovarian cancer is not curable at advanced stages. Efforts should be made to find out some effective screening procedures for early detection. Multicentre collaborative studies are required to work out effective combination chemotherapeutic regimens

Radiotherapy of cervical cancer: experience with combined brachytherapy and external beam therapy

Invasive cancer of cervix is diagnosed in about 8% of women presenting with malignancy in Pakistan. A significant number of patients present with advanced cancer. These patients are usually treated with combined external beam and intracavitary radiotherapy. Out of the 444 patients included in this study, 2% were in stage I-A, 8% in stage I-B, 24% in stage II-A, 20% in stage II-B, 38% in stage III and 8% in stage IV-A. Two percent patients were in stage IV-B. All of these patients with stage I-A were free of the disease at 2-5 years after radiotherapy. 80% of stage I-B, 75% of stage II-A, 50% of stage II-B and 16% in stage III are still free of local recurrence after 2-5 years of follow up. Patients in stage IV-A could not achieve long term local control with radiotherapy alone. Ten percent of the patients in stage I-B developed distant metastases, 22% of stage II-A, 20% of stage II- B and 19% of stage III developed distant metastases. Local control as well as disease free survival was good in limited disease and local control with radiotherapy alone was poor in locally advanced stages II-B - N- A cancer cervix. Better pelvic control was observed with concomittant chemo-radiotherapy in such patients. Neo adjuvant chemotherapy with Cis-platinum containing regimens is currently being utilized in patients with poor prognostic factors. This strategy is expected to provide long term controls and improved disease free survival rates