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Resumen El cáncer de cuello uterino ocupa el cuarto lugar dentro de las neoplasias de origen ginecológico a nivel global, representando un 85% de los casos en países en vías de desarrollo. Las metástasis cutáneas de origen ginecológico son altamente infrecuentes, observándose con mayor frecuencia en las neoplasias malignas de ovario, seguidas del adenocarcinoma endometrial y de cuello uterino y, menos frecuentemente, las de subtipo escamocelular. En la actualidad, existen alrededor de 80 reportes de casos citados en la literatura de metástasis cutáneas secundarias a un carcinoma de cuello uterino; sin embargo, ninguno con localización en la piel del cuello que se origine de un subtipo histológico escamocelular. En Colombia, no hay casos reportados hasta la fecha. Se presenta el caso de una paciente de 43 años que consulta por sangrado vaginal, dolor abdominal y una extensa placa tumoral exofítica de aspecto metastásico en la piel del cuello y del hombro izquierdo, encontrando al examen clínico inicial una masa tumoral en el cuello uterino con confirmación histológica de un carcinoma escamocelular como neoplasia primaria. Se hace diagnóstico de Carcinoma de cuello uterino estadio IVB y se inicia un tratamiento con intención paliativa con radioterapia y posterior quimioterapia sistémica. La enfermedad metastásica de origen ginecológico a nivel cutáneo confiere un mal pronóstico, con una supervivencia reportada de 1 a 37 meses después de su diagnóstico, por lo cual se deduce que la prevención y el diagnóstico temprano, particularmente en cáncer de cuello uterino, es de vital importancia en la población general.
Abstract Cervical cancer is the fourth most common cancer among gynecological neoplasms globally, representing 85% of cases in developing countries. Cutaneous metastases of gynecological origin are very rare, observed more frequently in ovarian malignancies, followed by endometrial and cervical adenocarcinoma and less frequently those of the squamous cell subtype. Currently there are about 80 case reports cited in the literature of cutaneous metastases secondary to cervical carcinoma, however, none with localization in the skin of the neck originated from a squamous cell histological subtype. In Colombia, there are no reported cases to date. We present the case of a 43-year-old patient who consulted for abdominal pain, vaginal bleeding and an extensive exophytic tumor plaque of metastatic appearance in the skin of the neck and left shoulder, finding a tumor mass in the cervix with histological confirmation of a squamous cell carcinoma as primary tumor. A diagnosis of stage IVB cervical carcinoma is made, and treatment is initiated with palliative intention with radiotherapy and subsequent systemic chemotherapy. Cutaneous metastatic disease of gynecological origin confers a poor prognosis, with a reported survival of 1 to 37 months after its diagnosis, for which prevention and early diagnosis, particularly in cervical cancer, is of vital importance in the general population.
Subject(s)
Humans , Female , Adult , Carcinoma, Squamous Cell , Uterine Cervical Neoplasms , Cervix Uteri , Adenocarcinoma , Neoplasm MetastasisABSTRACT
F-18 FDG PET-CT is an establish modality for staging of cervical cancer. The high uptake value in PET with no evidence of necrosis in CECT is generally understood malignant pathology in known cancer patients. A 47 year-old-female with cervix carcinoma underwent staging FDG PET-CT. It showed FDG avid primary lesion in cervix with FDG avid pelvic, retroperitoneal, mediastinal and supraclavicular lymph nodes. USG guided FNA from the supraclavicular lymph node revealed tuberculosis. Now patient scheduled for ATT and chemotherapy.
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Introduction: Carcinoma of cervix is a common gynaecological malignancy and remains the third most common cancer in developing countries. While nodal metastases are common in cervical cancer, major sites of the less common haematogenous metastases include lung, liver and bones. Bone involvement in cases of carcinoma of cervix is low and the estimates range from 0.8-16 % according to various series.Several patterns of bone involvement are observed in cases of carcinoma of cervix including, (1) direct extension into bone, either from the parametrial extensions of the primary or recurrent pelvic tumor, (2) direct extension into adjacent bone from the pelvic or distant lymph node metastasis (3) regional or systemic haematogenous metastasis to bones. Aims: To evaluate the pattern of metastases in patients of carcinoma of uterine cervix, with particular emphasis on the pattern of bone involvement on contrast enhanced CT. Settings and Design: Retrospective study. Materials and Methods: This was a retrospective study, where we reviewed the hospital records and data of patients of cervical cancer who underwent contrast enhanced CT (CECT) of the chest and abdomen over a period of one year between January and December 2016. A total of 100 patients of carcinoma cervix were included. CT images were reviewed by two experienced radiologists. The bony erosion due to pelvic mass or lymphadenopathy was classified as subtle or gross. Results: Bone involvement was seen in 11 out of 100 cases (11% cases). Among 13 cases direct bone involvement by the pelvic mass/recurrence and metastatic lymph nodes (8/11; 72.7%) was slightly more common than thehematogenous bone metastasis (5/11; 45.4% cases). Among the direct bone involvement direct erosion of the underlying bone by the nodal metastasis (6/8; 75%) was twice more common than the direct bone involvement by the pelvic mass/recurrence(2/8; 25%). Conclusions: Direct bone involvement by erosion of adjacent bone by nodal metastasis is the most common mechanism of bone involvement in cases of carcinoma of cervix signifying the high propensity of lymph nodal deposits to erode the underlying bone. This finding of direct bone erosion is not seen in any other gynaecological malignancy and should be promptly looked for in all cases of carcinoma of cervix
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Resumen El cáncer de cuello uterino es uno de los más comunes a nivel mundial, causando más de 200 000 muertes al año. Progresivamente, se ha venido reconociendo a Chlamydia trachomatis como cofactor para el carcinoma cervical junto con el papiloma virus. El interés por esta bacteria se relaciona con su naturaleza asintomática, la persistencia de la infección, la modulación de la respuesta inmune del hospedero y la inducción de inflamación crónica y metaplasia. Objetivo: describir los mecanismos de patogenicidad y respuesta inmune de C. trachomatis como cofactor de cáncer de cuello uterino. Método: se revisó la literatura en PubMed/ Medline, Lilacs y Redalyc. Se seleccionaron los artículos que hacían referencia al tema específico. Resultados y conclusiones: C. trachomatis es un cofactor de cáncer de cuello uterino. La infección por C. trachomatis está relacionada con la persistencia dentro de la célula y su capacidad de reactivación y de reinfección, la propiedad de producir lesión tisular, la intensidad de la respuesta inmunológica, la capacidad de la bacteria para modular respuesta inmune y la complejidad de estos mecanismos que, finalmente, inducen a inflamación crónica y alteraciones citológicas. La infección por C. trachomatis confiere un mayor riesgo de desarrollar cáncer de cuello uterino. Se hace necesario el diagnóstico y tratamiento oportuno para evitar complicaciones que puedan relacionarse con el cáncer de cuello cervical. Es importante ampliar los estudios que evidencien los hallazgos encontrados.
Abstract Cervical cancer is one of the most common worldwide, causing more than 200,000 deaths per year. Progressively, Chlamydia trachomatis has been recognized as a cofactor of cervical carcinoma along Papilloma virus. The interest in this bacterium is related to its asymptomatic nature, the persistence of the infection, the modulation of the immune response of the host and the induction of chronic inflammation and metaplasia. Objective: to describe the mechanisms of pathogenicity and immune response against C. trachomatis as cofactors of cervical cancer. Method: the literature was reviewed in PubMed / Medline, Lilacs and Redalyc. Articles that referred to the specific topic were selected. Results and conclusions: C. trachomatis is a cofactor of cervical cancer. C. trachomatis infection is related to persistence within the cell and its ability to reactivate and reinfect, the property of producing tissue damage, the intensity of the immune response, the ability of the bacteria to modulate immune response and the complexity of these mechanisms that, finally, induce chronic inflammation and cytological alterations. Infection with C. trachomatis confers an increased risk of developing cervical cancer. Diagnosis and timely treatment are necessary to avoid complications that may be related to cervical cancer. It is important to expand the studies that show the findings found.
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El cáncer de cuello uterino es una neoplasia maligna frecuente en las mujeres, que se disemina hacia pulmones, ganglios linfáticos supraclaviculares, hígado y hueso como metástasis a distancia. La resultante es mala y la supervivencia varía de 3 a 6 meses. Se presenta un caso de paciente de 67 años de edad con antecedente de carcinoma de células escamosas de cuello uterino estadio IIB hacía 5 años tratada con cirugía más radio-quimioterapia, quien presentó alteraciones de la marcha, cefalea y vómitos. Las imágenes de resonancia magnética revelaron múltiples lesiones con aumento de edema perilesional hipointensas en T1 e hiperintensas en T2. La paciente murió una semana después del diagnóstico. Los hallazgos de la necropsia demostraron carcinoma de células escamosas pobremente diferenciado de origen en cuello uterino.
Cervical cancer is a frequent malignancy of women that spreads to lungs, supraclavicular lymph nodes, liver, and bones as distant metastasis. Prognosis is poor and survival varies from 3 to 6 months. We report the case of a 67-yearold woman with history of squamous cell carcinoma of cervix stage IIB 5 years ago treated with surgery plus radio-chemotherapy who presented walking impairment, headache and vomiting. Cranial magnetic resonance imaging revealed multiple lesions with increasing perilesional edema, T1-hypointense and T2-hyperintense. The patient died one week after the diagnosis. Necropsy findings showed poorly differentiated carcinoma of cervical origin.
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Objective To explore the clinical application value of flow -cytometry combined with colpo-scope ultra high frequency electric knife for diagnosis of uterine cervix carcinoma ( UCC) and cervical intraepitheli-al neoplasia(CIN).Methods A total of 705 cases was included in this study who were screened from April 2014 to April 2016 and accepted colposcopy biopsy .DNA flow cytometry was performed to determine DNA index ( DI) and proliferative index ( PI) .Results Colposcopy diagnosis results showed that the detection rate of CINⅠ,CINⅡ,CINⅢ/CIS and UCC were 62.2%,78.0%,62.2% and 78.0% respectively.The sensitivity and specificity were 87.7%(213/243)and 90.2%(417/462)for DNA ploidy test using flow-cytometry.DI and PI of CINⅠ, CINⅡ,CINⅢ/CIS and UCC increased gradually with significant differences (P<0.05).Conclusion Flow-cytometry combined with colposcopy biopsy may be a useful tool for cervical cancer screening in developing coun -tries and has a competitive sensitivity and specificity ,which is worthy of popularization and application .
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Objective To investigate the clinicopathological significance of upregulated NQO 1 protein expression in uterine cervix carcinoma ( UCC) .Methods Immunohistochemical staining was performed on paraf-fin-embedded UCC specimens from 123 patients.Disease-free survival(DFS)and overall survival(OS)rates for all cervical UCC patients were calculated using the Kaplan -Meier method ,and univariate or multivariate analyses were performed using the Cox proportional hazards regression model .Results The NQO1 protein showed a main-ly cytoplasmic staining pattern in cervical cancer cells ,and the strongly positive rate of NQO 1 was significantly higher in UCC.High-level NQO1 was closely associated with poor differentiation ,late-stage,lymph node metas-tasis and high-risk for HPV infection.Additionally,high-level NQO1 was associated with lower DFS and OS rates .Furthermore ,Cox analysis revealed that NQO 1 expression emerged as a significant independent hazard factor for DFS rate in patients with UCC .Conclusion NQO1 overexpression might be an independent biomarker for prognostic evaluation of UCCs .
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Objective To explore the clinical value of squamous cell carcinoma associated antigen (SCC) and tumor specific growth factor (TSGF) in cervical carcinoma. diagnose. Methods The serum samples of SCC and TSGF were collected from 40 health volunteers, 56 cervical intraepithelial neoplasia (CIN) patients and 101 squamous cell cervical cancer patients. SCC and TSGF amount were measured by MEIA and biochemistry olorimetry method respectively, and were compared. Results The mean level of serum SCC and TSGF in the cervical cancer group was (6.95 ± 1.23) ng/mL and (81.0 ± 16.3)U/mL respectively, significantly higher than that in the CIN group and control group. The sensitivity and accuracy of combining SCC with TSGF in diagnosing cervical carcinoma were 91.1%and 87.4% respectively, both higher than allying SCC or TSGF alone. Conclusions SCC and TSGF levels are helpful in the diagnosis of cervix carcinoma. The combined determination can improve the sensitivity and accuracy of cervical carcinoma diagnose.
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Aim: To evaluate the potential of p16INK4A and MIB-1 and to compare the expression and interrelationship of these markers in cervical preneoplasias and neoplasias. Materials and Methods: Immunohistochemical analysis of p16 and MIB-1 was performed in n = 63 tissue sections and by matching the corresponding Papanicolaou smears. Staining intensity for p16 was determined using the 0-3 grading system. For MIB-1, labelling indices (LI) were calculated and grading was performed using the I-III scoring system. Results: No positive staining of p16 was observed in the normal cervical epithelium. With increasing severity of cervical intraepithelial neoplasias (CIN), the p16 expression increased progressively. Significant up-regulation of p16 was observed in carcinoma cervix. MIB-1 LI was observed to increase with increasing grades of CIN, and significant overexpression of MIB-1 was observed in carcinoma cervix. Correlation between grades of p16 and that of MIB-1 among cervical neoplasias showed an increasing p16 expression with consistently increasing MIB-1 LI in the groups of increasing severity. Conclusion: This pattern of overexpression of p16 and MIB-1 demonstrate their use as a diagnostic marker for cervical neoplastic lesion. Therefore, p16 and MIB-1 markers in tissue sections can be used as an adjunct to definitively diagnose preneoplastic and neoplastic lesions in the cervix.
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We describe here the case a patient with advanced cervix carcinoma and who developed idiopathic thrombocytopenic purpura (ITP). A 63-year-old woman with stage IV squamous cell carcinoma of the uterine cervix and that was complicated by hydronephrosis was treated palliatively with 45Gy of external beam radiation to the pelvis. About 3 years later, she developed hematochezia and severe thrombocytopenia. The laboratory examinations showed no evidence of thrombotic thrombocytopenic purpura or disseminated intravascular coagulopathy, and she was positive for serum anti-platelet antibodies. On the bone marrow examination, there was a normal number and morphology of megakaryocytes with no evidence of malignant cell infiltration. We made the clinical diagnosis of ITP, and the intravenous immunoglobulin and steroid therapy was successful. This case suggests the possibility that ITP can occur in association with advanced cervix carcinoma.
Subject(s)
Female , Humans , Middle Aged , Antibodies , Bone Marrow Examination , Carcinoma, Squamous Cell , Cervix Uteri , Gastrointestinal Hemorrhage , Hydronephrosis , Immunoglobulins , Megakaryocytes , Pelvis , Purpura, Thrombocytopenic, Idiopathic , Purpura, Thrombotic Thrombocytopenic , ThrombocytopeniaABSTRACT
For HDR intracavitary brachytherapy with ovoids and a tandem, we compared the dose discrepancy of treatment plans using two different Ir-192 sources (microSelectron, Varian) and generated on two different treatment planning systems (PLATO, BrachyVision). The treatment plans of ten patient treated from Oct. 2007 to Jan. 2008 were selected for these comparisons. For the comparison of dose calculation using different sources, the average discrepancies were -0.91+/-0.09%, 0.27+/-0.07%, 0.22+/-0.39%, and 0.88+/-0.37% in total treatment time and at B-point and ICRU bladder and rectum reference point, respectively. Comparing the two systems, the average dose discrepancies between treatment planning programs were -0.22+/-0.42%, -0.25+/-0.29%, -0.23+/-0.63%, and -0.17+/-0.76%, and the average dose discrepancies between positioning methods (PLATO with film and BrachyVision with digitial image) were -0.61+/-0.59%, -0.77+/-0.45%, -0.72+/-1.70%, and 0.35+/-2.82% at A-point, B-point, and ICRU bladder and rectum reference points, respectively. The rectal dose discrepancies between two systems were reached 5.87%. The difference in the dwell position expected by each TPS are mainly affected by the differences in the positioning method in TPSs and have an effect on dose calculations of rectal and bladder located in AP direction.
Subject(s)
Humans , Brachytherapy , Rectum , Urinary BladderABSTRACT
PURPOSE: To assess the efficacy of the use of accelerated hyperfractionated radiotherapy (AHRT) for locally advanced uterine cervix cancers. MATERIALS AND METHODS: Between May 2000 and September 2002, 179 patients were identified with FIGO stage IIB, IIIB, and IVA cancers. Of the 179 patients, 45 patients were treated with AHRT (AHRT group) and 134 patients were treated with conventional radiotherapy (CRT group), respectively. Patients undergoing the AHRT regimen received a dose of 30 Gy in 20 fractions (1.5 Gyx2 fractions/day) to the whole pelvis. Subsequently, with a midline block, we administered a parametrial boost with a dose of 20 Gy using 2 Gy fractions. Patients also received two courses of low-dose-rate brachytherapy, up to a total dose of 85~90 Gy to point A. In the CRT group of patients, the total dose to point A was 85~90 Gy. The overall treatment duration was a median of 37 and 66 days for patients that received AHRT and CRT, respectively. Statistical analysis was calculated by use of the Kaplan-Meier method, the log-rank test, and Chi-squared test. RESULTS: For patients that received cisplatin-based concurrent chemotherapy and radiotherapy, the local control rate at 5 years was 100% and 79.2% for the AHRT and CRT group of patients, respectively (p=0.028). The 5-year survival rate for patients with a stage IIB bulky tumor was 82.6% and 62.1% for the AHRT group and CRT group, respectively (p=0.040). There was no statistically significant difference for severe late toxicity between the two groups (p=0.561). CONCLUSION: In this study, we observed that treatment with AHRT with concurrent chemotherapy allows a significant advantage of local control and survival for locally advanced uterine cervix cancers.
Subject(s)
ChemoradiotherapyABSTRACT
OBJETIVO: Analizar la dosimetría en braquiterapia ginecólogica para el dispositivo Fletcher-Suit-Delclos con alta tasa de dosis, mediante placas radiográficas ortogonales (anteroposterior y lateral) versus tomografía axial computada (TAC). MATERIAL Y MÉTODOS: Se compararon dosimetrías de 4 implantes, realizadas con placas ortogonales y TAC pélvico en la Unidad de Braquiterapia del Instituto Nacional del Cáncer durante el mes de febrero del año 2006. Se prescribieron dosis de 8 Gy/fracción a punto H y se evaluó dosis a vejiga, recto y vagina según norma internacional. RESULTADOS: Las dosimetrías por TAC mostraron puntos calientes superiores a las placas ortogonales, para recto un 133% y para vejiga un 260% más aproximadamente. El porcentaje de volumen blanco incluido es subestimado con la dosimetría efectuada por placas ortogonales. CONCLUSIONES: La dosimetría por placas ortogonales muestra menor exactitud que el TAC. Los volúmenes blanco no son satisfactoriamente cubiertos por la curva de isodosis prescrita. La dosis acumulada, probablemente, sea más relevante que la dosis fracción.
OBJECTIVE: We analyze the gynecologycal high dose rate brachytherapy dosimetry using the Fletcher-Suit-Delclos device, comparing orthogonal films (anteroposterior and lateral) versus axial computarized tomography. METHODS: 4 implants were analized with orthogonal films and axial computarized tomography in the Brachyhterapy Unit of the National Cancer Institute on February 2006. The dose/fraction was 8 Gy to the H point. The bladder, rectal and vaginal dose point were evaluated according to international specifications. RESULTS: Axial computarized tomography reveals hot points higher than orthogonal films dosimetries (133% and 260% for bladder and rectum respectively). The target volumen included was underestimated with the classical orthogonal film dosimetry. CONCLUSIONS: The orthogonal film dosimetry shows smaller accuracy than axial computarized tomography. The target volumens were not satisfactorily covered by the prescribed isodosis curve. The dose accumulated could, probably, be more prominent than the dose/fraction.
Subject(s)
Humans , Female , Radiotherapy Dosage , Brachytherapy/methods , Uterine Cervical Neoplasms/radiotherapy , Radiometry/standards , Rectum/radiation effects , Urinary Bladder/radiation effects , Radiotherapy, Computer-AssistedABSTRACT
Las investigaciones sobre el nodo centinela en cánceres del aparato genital femenino, vuelven indispensable el sistematizar los nodos linfáticos pélvicos así como el empleo de una nomenclatura única. La importancia del nodo centinela en el cáncer de cuello uterino es cada vez más evidente. Desde los puntos de vista anatómico y quirúrgico, se debe ser preciso al momento de asignarle una determinada topografía y vincularlo con una cadena nodal. Sólamente unificando criterios, se podrán homogeneizar las distintas series de estudios en búsqueda de resultados comunes. El objetivo del trabajo fue estudiar las cadenas nodales linfáticas de la pelvis y sistematizar la ubicación de sus nodos, como apoyo anatómico a la investigación del nodo centinela en el cáncer de cuello uterino. Mediante abordajes por vía abdominal de 10 pelvis femeninas fueron disecadas las cadenas nodales pelvianas. Los grupos nodales se vincularon con un eje vascular iliaco, tanto arterial como venoso. Se compararon los hallazgos con los de 21 linfadenectomías pélvicas de operaciones de Wertheim-Meigs y con estudios histológicos de linfadenectomías pélvicas operatorias. La cadena iliaca externa fue la más rica en nodos destacándose los nodos ínter ilíacos e infravenoso, junto con los nodos del pedículo obturador, considerados éstos como integrantes de la cadena iliaca externa medial. Menos frecuentemente se encontraron nodos pertenecientes a la cadena iliaca interna. En un 60% de los casos, se comprobó la existencia de nodos iliacos comunes mediales (grupo del promontorio), que no siempre son incluidos en la linfadenectomía. La sistematización de las cadenas nodales linfáticas es la base para asignar la denominación correcta al nodo centinela, en el cáncer de cuello uterino. Los nodos más comúnmente encontrados y que tienen mayor proyección quirúrgica, son los nodos infravenoso, obturadores e inter iliacos.
The investigation studies on the sentinel node in cancers of the feminine genital apparatus return indispensable systematizing the pelvic lymphatic nodes as well as the use of a unique nomenclature. The importance of the sentinel node in the cancer of uterine cervix is more and more evident. From the anatomical and surgical point of view we must be precise at the time of assigning certain topography and his relation with a nodal chain. Only unifying criteria, the different series from studies in search of common results will be able to be homogenized. The objetives to study the lymphatic nodes chains of pelvis and systematize the location of its nodes as an anatomical support to the investigation of the sentinel node in the cancer of uterine cervix. Descriptive study based on anatomical dissections and histological studies of surgical pelvic lymphadenectomies. By abdominal dissection of 10 feminine pelvises the pelvic nodes chains were a boarded. The nodes groups tied with a iliac vascular axis, arterial as much venous. The findings with those of 21 pelvic linfadenectomías of operations of Wertheim-Meigs were compared. The external iliac chain was the richest in nodes standing out the ínter iliac and infra venous nodes as well as the nodes of the obturator pedicule, considered like members of the medial external iliac chain. Less frequently were nodes pertaining to the internal iliac chain In a 60% of the cases the existence of medial common iliac nodes was verified (group of the promontory) that not always are including in the lymphadenectomy. The systematization of the lymphatic nodes chains is the base to assign a correct denomination to the sentinel node in the cancer of uterine cervix. The nodes more commonly found and than have greater surgical projection are the infra venous, obturatores and inter iliac.
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PURPOSE: A number of genes and their products are induced early or late following exposure of cells to ionizing radiation. These radiation-induced genes have various effects on irradiated cells and tissues. Suppression subtractive hybridization (SSH) based on PCR was used to identify the differentially expressed genes by radiation in cervix carcinoma cells. MATERIASL AND METHODS: Total RNA and poly (A)+ mRNA were isolated from irradiated and non-irradiated HeLa cells. Forward- and reverse-subtracted cDNA libraries were constructed using SSH. Eighty-eight clones of each were used to randomly select differentially expressed genes using reverse Northern blotting (dot blot analysis). Northern blotting was used to verify the screened genes. RESULTS: Of the 176 clones, 10 genes in the forward-subtracted library and 9 genes in the reverse-subtracted library were identified as differentially expressed radiation-induced genes by PCR-select differential screening. Three clones from the forward-subtracted library were confirmed by Northern blotting, and showed increased expression in a dose-dependent manner, including a telomerase catalytic subunit and sodium channel-like protein gene, and an ESTs (expressed sequence tags) gene. CONCLUSION: We identified differentially expressed radiation-induced genes with low-abundance genes with SSH, but further characterization of theses genes are necessary to clarify the biological functions of them.
Subject(s)
Female , Humans , Blotting, Northern , Cervix Uteri , Clone Cells , Expressed Sequence Tags , Gene Library , HeLa Cells , Mass Screening , Polymerase Chain Reaction , Radiation, Ionizing , RNA , RNA, Messenger , Sodium , TelomeraseABSTRACT
1. Studies were made on the physiological effects of external pelvic radiation among groups of patients with primary carcinoma of the cervix of variable stages. All of this investigative work as done before and immediately after irradiation, with each patient receiving an average total tumor dose of 5700 r. given for a period of 5-6 weeks2. All of the patients suffered some gastro-intestinal symptoms such as anorexia, nausea, vomiting, and/or diarrhea, the latter being a prominent feature in each case3. There is marked impairment of glucose absorption from the G.I. tract4. There is an increase in fecal water and fat5. There is a decrease in the free HCL in 14 of the 18 patients studied6. Occult blood and sugar in the stools were negative in all of the patients with no significant change of pH in each case7. The excretion of radioactive urokon from the G.I. tract is increased8. In the 3-4 months follow-up post treatment, there is tendency of the oral glucose tolerance curve to reach the pre-radiation treatment levels. (Summary)
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E6 and E7 proteins produced by oncogenic HPV bind to the protein products of cellular tumor suppressor genes p53 and Rb, respectively. This mechanism has been suggested to contribute to the oncogenesis of HPV-infected carcinoma. The cells which are blocked the function of p53 and pub protein continue to divide by bypassing Ml stage known as antiproliferative mechanism but telomeres, the genetic elements at the ends of chromosomes, continue to shorten until the telomeres are so short that further replication is prevented(M2 stage). But telomeres can be maintained if telomerase is derepressed, giving rise to a immortal cell. The present study has been investigated the presence of HPV, telomere length and telomerase activation in cervical carcinomas. HPV DNA were detected by polymerase chain reaction in 17 of 19 precancerous lesions and cervical carcinoma specimens; HPV16 was detected in 12 cases, HPV18 in one case, HPV33 in two cases, and HPV58 in two cases. Overall, the prevalence of HPV was 89.5%. To study the difference of telomere length in cervical carcinomas and each normal counterpart, DNAs were digested with Hinf III and Rsa I to liberate the terminal restriction fragments(TRF). TRFs were resolved on agarose gels and detected by hybridization to the telomeric probe. This result indicated that there were no significant difference of TRF length in samples tested except two cases. TRF length of one carcinoma specimen was found to be significantly increased as compared with normal counterpart, but the other was found to be significantly decreased. Telomerase activity was detected in 4 of dysplasia specimens(5 cases), all of carcinoma in situ(CIS), and 6 of 8 invasive carcinoma. Overall, telomerase activity was detected in 84%. The degree of telomerase activity was high in 2 of dysplasia, 3 of CIS, and 3 of invasive carcinoma. And then there was no apparent association between HPV types and levels of telomerase activity. However, telomerase activity was depressed in invasive carcinoma as compared to dysplasia and CIS. These results suggest that HPV may be a possible causative agent in cervical carcinoma. In addition, telomerase activation may be necessary for the immortalization of cells and the progression of malignancy in cervical carcinoma.
Subject(s)
Female , Humans , Carcinogenesis , Cervix Uteri , DNA , Gels , Genes, Tumor Suppressor , Papilloma , Polymerase Chain Reaction , Prevalence , Sepharose , Telomerase , TelomereABSTRACT
PURPOSE: Patients with cervical cancer who have positive resection margins after radical hysterectomy are at increased risk for local recurrence. The results of postoperative pelvic radiotherapy for cervix cancer with positive resection margins were analyzed to evaluated the role of radiotherapy. MATERIALS AND METHODS: Between 1979 and 1992, 60 patients of cervix carcinoma were treated with postoperative radiotherapy after radical hysterectomy because of positive vaginal(48 patients) or parametrial resection margins(12 patients). Patients were treated with external beam radiation therapy(EBRT) alone (12 patients) or EBRT plus vaginal ovoid irradiation (VOI) (48 patients). The median follow-up period was 5 months. RESULTS: The 5-year actuarial disease free and overall survival rates for all patients were 75.2%, 84.1%, respectively. The overall recurrence rate was 23%(14/60). In 48 patients with positive vaginal resection margins, the pelvic recurrence was 8%(4/48). Distant metastasis was 15%(7/48). Of the 43 patients with positive vaginal resection margins treated with EBRT and VOI, recurrence rate was 21%(9/43), while recurrence rate was 40%(2/5) in the EBRT only treated group. In 12 patients with positive parametrial margins, three patients (25%) had distant metastases. The most significant prognostic factor was lymph node metastasis. Complications resulting from radiotherapy occurred at a rate of 32%(19/60) and grade III complications occurred in three patients (5%). CONCLUSION: Postoperative radiotherapy can produce excellent pelvic control rates in patients with positive resection margins. In patients with positive vaginal margins, whole pelvic EBRT and BOI is recommended.
Subject(s)
Female , Humans , Cervix Uteri , Follow-Up Studies , Hysterectomy , Lymph Nodes , Neoplasm Metastasis , Radiotherapy , Recurrence , Survival Rate , Uterine Cervical NeoplasmsABSTRACT
Epidermal growth factor receptor (EGFR) is an intergral membrane protein. Overexpression or mutation of EGFR may play a role in careinogenesis. Recently, many molecular biologic techniques have been used to study expression of oncogenes. One of them, in situ mRNA hybridization, using paraffin embedded blocks, offers a unique means to allow precise localization within histological preparations, and also overcomes problems relating to translation defects and abnormal translation. In order to confirm the usefulness of epidermal growth factor receptor as a tumor marker, and to compare the expression of EGFR between in situ MRNA hybridization and an immunohistochemical study, in situ MRNA hybridization was performed along with an immunohistochemical study for EGFR in paraffin sections of 84 uterine cervix carcinomas. A positive reaction for EGFR was observed mairdy in the cytoplasm of tumor cells. The vascular muscle layer and uterine muscle tissue around the cancer nest revealed a positive reaction in immunohistochemical stain for EGFR, with a negative reaction for EGFR mRNA. In the cancer nests, the immunohistochemical positive reaction for EGFR was strong in differentiated cells and keratin pearls, but a strong positive reaction for EGFR mRNA was localized in undifferentiated cells. The overall positive of immunostaing for EGFR was 77% for uterine cervix carcinoma; 71 % for carcinoma in situ, 71 % for microinvaseve carcinoma, and 89% for invasive carcinoma. The overall positivity of EGFR from in situ MRNA hybridization was 94% of the uterine cervix carcinoma; 93% for carcinoma in situ, 93% for microinvasive carcinoma, and 96% for invasive carcinoma. From these results, EGFR is a useful tumor marker for uterine cervix carcinoma, and in situ mRNA hybridization has greater sensitivity and specificity than immunohistochemistry.