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.

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.

Gynecologic Cancers in srinagarind Hospital(1976-1985)

 The total 1033 cases of gynecologic cancers were collected from 1976 to the end of 1985 in the hospital-based cancer registry (Cancer Unit) of the faculty of medicine, Khon Kaen University.  Cervical cancer comprised 815 cases (78.90%), while there were 130 cases of ovarian cancer (12.58%), 59 cases of uterine corpus cancer (5.71%), 23 cases of vulvar cancer (2.22%), 5 cases of vaginal cancer (0.48%) and one cases of fallopian tube cancer (0.10%).  The number of the cancer patients increased year by year.  The average age for cervical, ovarian, uterine corpus, vulvar, vaginal and fallopian tube cancer were 47.53, 43.50, 54.21, 52.00, 57.00 and 55.00 years respectively and the parity were 6, 4, 3, 7, 8 and 0 respectively.  Twenty-eight percent of the patients resided in Khon Kaen area, while the rest were from different part of the northeastern area of Thailand.  Most patients were Thai, Bhuddhist, and farmer.  The FIGO Stages of the diseases varied as the histological types and organs.  The treatment for cervical and vaginal cancers were mostly radiotherapy while for the ovarian cancer were surgery plus chemotherapy and for the uterine corpus, vulvar and fallopian tube cancer were surgery.  The follow-up profile and surival analysis will be presented later.  The authors recommended that cancer registry is the best method for handling cancer problems in Thailand.

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. 

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. 

Routine Preoperative Screening

Preoperative laboratory testing in preparing the patient for surgery should be indicated by the medical history of the patient, type and extent of the planned surgical procedure. Routine screening without indication has very little value in patient care, is not cost effective, and may cause disadvantage to the patient. Hence routine screening is inappropriate and should not be practiced.