Prevalence and pattern of nodal metastasis in pT4 gingivobuccal cancers and its implications for treatment.

Context: The pattern of nodal spread in oral cancers is largely predictable and treatment of neck can be tailored with this knowledge. Most studies available on the pattern are from the western world and for early cancers of the tongue and floor of the mouth. Aims: The present study was aimed to evaluate the prevalence and pattern of nodal metastasis in patients with pathologic T4 (pT4) buccal/alveolar cancers. Settings and Design: Medical records of the patients with pT4 primary buccal and alveolar squamous cell carcinomas treated by single-stage resection of primary tumor and neck dissection at Gujarat Cancer and Research Institute (GCRI), Ahmedabad, a regional cancer center in India, during September 2004 to August 2006, were analyzed for nodal involvement. Materials and Methods: The study included 127 patients with pT4 buccal/alveolar cancer. Data pertaining to clinical nodal status, histologic grade, pT and pN status (TNM classification of malignant tumors, UICC, 6th edition, 2002), total number of nodes removed, and those involved by tumor, and levels of nodal involvement were recorded. Statistical analysis was performed using the Chi-square test. Results: Fifty percent of the patients did not have nodal metastasis on final histopathology. Occult metastasis rate was 23%. All of these occurred in levels I to III. Among those with clinically palpable nodes, level V involvement was seen only in 4% of the patients with pT4 buccal cancer and 3% of the patients with alveolar cancer. Conclusions: Elective treatment of the neck in the form of selective neck dissection of levels I to III is needed for T4 cancers of gingivobuccal complex due to a high rate of occult metastasis. Selected patients with clinically involved nodes could be well served by a selective neck dissection incorporating levels I to III or IV.

Seguimiento de mujeres con anormalidad citológica de cuello uterino, en Colombia / Following-up females having an abnormal Pap smear in Colombia

Objetivo Evaluar el acceso y la oportunidad al diagnóstico y al tratamiento que tienen las pacientes con lesiones cervicales de alto grado o cáncer de acuerdo con el reporte citológico, en Colombia entre junio 2005 a junio del 2006. Metodología Estudio retrospectivo mediante encuestas a una muestra de mujeres con anormalidad citológica residentes de cuatro departamentos de Colombia seleccionados por conveniencia en relación con diferentes tasas de mortalidad. Se realizó análisis descriptivo y se compararon las diferencias entre los departamentos. Resultados El 27 por ciento de las mujeres con lesiones de alto grado o invasoras no tuvieron acceso a alguno de los servicios diagnósticos o terapéuticos por razones de tipo administrativo de los servicios de salud, razones clínicas y culturales de las mujeres. Discusión Un elemento crítico que explica el bajo impacto en la mortalidad por cáncer de cuello uterino en la mayoría de los países de Latino América es la disociación entre actividades de tamización y las de tratamiento.

Objective Evaluating the opportunity and access to diagnosis and treatment for females having had an abnormal Pap smear (high-grade epithelial lesion and cervical cancer) in Colombia from June 2005 to June 2006. Materials and Methods This was a retrospective appraisal using a semi-closed survey of females having had an abnormal Pap smear with high squamous intraepithelial lesions or cervical cancer living in four Colombian departments. These areas were conveniently selected according to their different mortality rates. A descriptive analysis was made and the departments differences compared. Results It was found that 27 percent of females having high-grade squamous intraepithelial lesion or cervical cancer had no access to any of the diagnostic or therapeutic services. Health service administration problems and clinical and cultural ones affecting the females in the study could explain such results. Discussion Follow-up care after abnormal cytology was very poor and could explain the lack of cervical cancer screening impact in Colombia and in most Latin-American countries.

Prevalence of cervical intraepithelial neoplasia grades II/III and cervical cancer in patients with cytological diagnosis of atypical squamous cells when high-grade intraepithelial lesions (ASC-H) cannot be ruled out / Prevalência de neoplasia intra-epitelial cervical graus II/III e câncer cervical nas pacientes com diagnóstico citológico de células escamosas atípicas, quando não se pode excluir lesão intra-epitelial de alto grau (ASC-H)

Context and objective: The latest update of the Bethesda System divided the category of atypical squamous cells of undetermined significance (ASCUS) into ASC-US (undetermined significance) and ASC-H (high-grade intraepithelial lesion cannot be ruled out). The aims here were to measure the prevalence of pre-invasive lesions (cervical intraepithelial neoplasia, CIN II/III) and cervical cancer among patients referred to Instituto Fernandes Figueira (IFF) with ASC-H cytology, and compare them with ASC-US cases. Design and setting: Cross-sectional study with retrospective data collection, at the IFF Cervical Pathology outpatient clinic. Methods: ASCUS cases referred to IFF from November 1997 to September 2007 were reviewed according to the 2001 Bethesda System to reach cytological consensus. The resulting ASC-H and ASC-US cases, along with new cases, were analyzed relative to the outcome of interest...

Contexto e objetivo: A última atualização do Sistema Bethesda dividiu a categoria de células escamosas atípicas de significado indeterminado (ASCUS) em ASC-US (de significado indeterminado) e ASC-H (quando não se pode excluir lesão intra-epitelial de alto grau). Os objetivos deste estudo foram medir a prevalência da lesão pré-invasiva (Neoplasia Intra-epitelial Cervical, NIC II/III) e câncer cervical, de pacientes que foram encaminhadas ao Instituto Fernandes Figueira (IFF), com citologia ASC-H e compará-la com os casos ASC-US. Tipo de estudo e local: Estudo transversal com coleta de dados retrospectiva, que ocorreu no ambulatório de Patologia Cervical do IFF. Métodos: Casos com diagnóstico de ASCUS recebidos no IFF entre novembro de 1997 a setembro de 2007, foram revisados de acordo com o Sistema Bethesda 2001 até um diagnóstico de consenso. Os casos ASC-H e ASC-US resultantes desta revisão, e os casos novos, foram analisados em relação ao desfecho de interesse...

A comparative study of cervical smears in an urban Hospital in India and a population-based screening program in Mauritius.

OBJECTIVE: To study cervical smear abnormalities in urban women in India and women in Mauritius and to compare the results in the two groups. STUDY DESIGN: An analysis of 6010 cervical smears taken as part of routine check-ups in an urban hospital was done and an analysis of 10,000 cervical smears taken from women participating in a National Cancer Screening Program in Mauritius was done. Emphasis was put on cervical epithelial cell abnormalities and the results in the two populations are compared with that of similar studies in other parts of the world. RESULTS: Non specific inflammation formed 19.6% and 25.34% of the smears in the Indian and Mauritian groups, respectively (with specific infection forming 6.05% and 15.08%). The epithelial abnormalities constituted 1.392% of the Indian group and 0.47% of the Mauritian group. The difference was statistically significant in the atypical squamous cells of uncertain significance (ASCUS) and atypical glandular cells of uncertain significance (AGUS) group. CONCLUSIONS: The prevalence of low-grade squamous intraepithelial lesions (LSIL) and high-grade squamous intraepithelial lesions (HSIL) is similar to that in the developed world.

Factors predicting occult invasive carcinoma in women undergoing a 'see and treat' approach.

This study was undertaken to evaluate the incidence and independent predictors of unexpected invasive cancer of cervix in women with high-grade squamous intraepithelial lesions (HSIL) on Pap smear who had undergone a 'see and treat' approach. Women with HSIL on cervical cytology undergoing colposcopy, followed by loop electrosurgical excision procedure (LEEP) at Chiang Mai University Hospital between January 2001 and April 2006 were analyzed. During the study period, 446 women were identified. Mean age was 45.6 years (range, 25-75 years). One hundred and twenty-one (27.1%) women were postmenopausal. Unsatisfactory colposcopy was observed in 357 (80.0%) women. Of the 446 women, 76 (17.04%, 95% CI=13.67 to 20.86) had invasive lesions on LEEP specimens. Multivariate analysis revealed that unsatisfactory colposcopy and premenopausal status were statistically significant independent predictors for invasive lesions in a 'see and treat' LEEP with an adjusted odds ratio of 4.68 (95%CI=1.82 to 12.03, P<0.01) and 2.10 (95%CI=1.12 to 3.94, P=0.02), respectively. In conclusion, occult invasive lesion of the cervix was noted in 17% of women with HSIL Pap smear who underwent a 'see and treat' approach at our institute. Unsatisfactory colposcopy and premenopausal status were significant independent predictors of having such lesion.

Carcinoma de células escamosas de labio inferior: asociación entre grado de angiogénesis, graduación histológica y frente de invasión tumoral / Lower lip squamous cell carcinoma: relationship between angiogenesis grade, histological grading and invasion tumoral front

El carcinoma de células escamosas de la cavidad oral presenta una alta prevalencia en nuestro país, siendo el labio inferior el sitio más comúnmente afectado. El objetivo de este estudio fue determinar el grado de angiogénesis en el carcinoma de células escamosas de labio inferior, y su asociación con el grado de diferenciación según la Clasificación Internacional de Tumores y el Frente de Invasión Tumoral según el sistema de medición de Bryne, en pacientes con carcinoma de células escamosas de labio inferior, diagnosticados en los hospitales de Talca y Curicó, entre los años 1995 y 2005.

Squamous cell carcinoma of the oral cavity present a high prevalence in our country, become the lower lip the most common site affected. The aim of this study was determinated the angiogenesis grade in the lower lip squamous cell carcinoma and their relationship whit the histological grading according to the International Tumours Classification and the Invasion Tumoral Front according to the Bryne's system measuring in patients with lower lip squamous cell carcinoma diagnosed in the Talca´s and Curico´s Hospital between 1995 and 2005 years.

Pesquisa del cáncer anal / Anal cancer screening

En las últimas 2 a 3 décadas la incidencia del cáncer escamoso del ano aumentó un 96 por ciento en hombres y un 39 por ciento en mujeres. Entre los hombres que tienen sexo con hombres la incidencia estimada es de 35/100000 habitantes, cifra comparable con la incidencia del cáncer anal del cuello uterino antes de que se implementara la práctica del Papanicolau (PAP). Este valor se duplica en portadores del virus de la inmunodeficiencia humana. De acuerdo con múltiples asociaciones histopatológicas y epidemiológicas se cree que el cáncer escamoso del ano se comporta de manera similar al cáncer del cuello uterino: comparten una asociación etiológica común con el HPV de alto riesgo, citología e histología similares. Teniendo en cuenta el impacto que el PAP y la colposcopia cervicales tuvieron sobre el cáncer del cuello uterino y la importancia del diagnóstico precoz para el pronóstico del cáncer del ano, algunos autores sugieren realizar pesquisa del cáncer anal anal. Se recomienda en individuos homosexuales de sexo masculino, hombres o mujeres HIV positivos, pacientes transplantados y mujeres con antecedentes de un cáncer anal, cervical. o vulvar. En el presente trabajo se expone una revisión de los trabajos publicados hasta la fecha acerca de la pesquisa del cáncer anal.

Over the last 2-3 decades the incidence of squamous anal cancer increased by 96 per cent in men and 39 per cent in women in the United States. Among men who have sex with men the incidence has been estimated to be 35 cases per 100000 population. comparable to the incidence of' cervical cancer before the screening was implemented. The incidence in HIV-positive individuals is 70/100000. Given the multiple histopathologic and epidemiologic associations, squamous cancer of the anus is thought to behave like cervical cancer: they share a common ctiology, the association with high risk-HPV, similar cytology and histology. Considering the impact that the cervical PAP and colposcopy had on cervical cancel and the impact the early diagnosis of anal cancer have on morbidity and mortality, some practitioners proposed an anal cancer screening program. It is recommended for men who have sex with men, HIV-positive men of women, transplant recipients and women with history of cervical or vulvar cancer. In this paper we review published data about squamous anal cancer screening.

The impact of a community intervention to improve cervical cancer screening uptake in the Amazon region of Brazil

CONTEXT AND OBJECTIVE: In the northern region of Brazil, cervical cancer is the most important cause of cancer-related deaths among women. There is considerable likelihood, however, that official incidence and mortality figures are greatly underestimated. The aim of this study was to estimate the repercussions from improvement in cervical cancer screening programs on the incidence of pre-invasive and invasive cervical lesions in a municipality in this region. DESIGN AND SETTING: This was a quasi-experimental study that assessed process dimensions relevant to the program objectives. The study comprised a sample of 2,226 women seen at primary healthcare units in Cruzeiro do Sul, a small city in the Brazilian Amazon region, from April 2003 to July 2004. METHODS: Women were recruited through local radio advertisements and by oral communication from the investigators. The women answered a structured questionnaire and underwent pelvic examination, which included Papanicolaou (Pap) smears and naked-eye inspection of the cervix after applying diluted acetic acid. Women with positive Pap smears or abnormal gynecological examination were referred for colposcopy and possible biopsy, diathermic large loop excision of the transformation zone or conization. RESULTS: The results obtained were compared with historical official data retrieved from the Brazilian Ministry of Healths database. Intervention resulted in a 40 percent increase in positive Pap smears and detection of cancer was nine times higher than had been observed in routine screening. CONCLUSIONS: Detection of pre-invasive and invasive cervical lesions in the intervention group was remarkably higher than among women seen during routine screening.

CONTEXTO E OBJETIVO: Na Região Norte do Brasil, o câncer do colo do útero é a mais importante causa de morte, por câncer, entre as mulheres. É muito provável, entretanto, que os dados oficiais referentes à incidência e à mortalidade estejam grosseiramente subestimados. O objetivo foi estimar as repercussões que a melhora dos programas de rastreamento possam exercer sobre a incidência de lesões pré-invasoras e invasoras do colo do útero em uma municipalidade da região Amazônica brasileira. TIPO DE ESTUDO E LOCAL: Este estudo "quasi-experimental" avaliou dimensões processuais relevantes para os objetivos do programa de rastreamento. Foi incluída uma amostra de 2.226 mulheres, atendidas em unidades básicas de saúde de Cruzeiro do Sul, uma pequena cidade da Amazônia Brasileira, entre abril de 2003 e julho de 2004. MÉTODOS: As mulheres foram recrutadas através de anúncio pelo rádio e por comunicação oral desempe-nhada pelos próprios pesquisadores. Após assinarem o Termo de Consentimento Informado, responderam a um questionário estruturado e foram submetidas a exame pélvico, o que incluiu coleta e colpocitologia oncológica (CO) e inspeção da cérvice após aplicação de ácido acético diluído. Mulheres com CO positiva ou exame ginecológico anormal foram encaminhadas para colposcopia e eventual biópsia, excisão diatérmica da zona de transformação ou conização. RESULTADOS: Os resultados obtidos foram comparados a dados históricos oficiais referentes à cidade de Cruzeiro do Sul, recuperados do banco de dados do Ministério da Saúde do Brasil. Em comparação aos dados históricos, a intervenção resultou em um aumento de 40 por cento na freqüência de CO positiva, e a detecção de câncer foi nove vezes superior àquela dos dados oficiais. CONCLUSÕES: A detecção de lesões cervicais pré-invasoras e invasoras no grupo que sofreu intervenção foi marcadamente superior à das mulheres atendidas pelo programa oficial de rastreamento.

Northern Thai women with high grade squamous intraepithelial lesion on cervical cytology have high prevalence of underlying invasive carcinoma.

The aim of this study was to determine the underlying pathology of women with high grade squamous intraepithelial lesion (HSIL) on cervical cytology. A total of 681 women with HSIL cytology undergoing colposcopic examination at Chiang Mai University Hospital (CMUH) between January 2000 and December 2005 were evaluated for the underlying cervical pathology. The final pathology was diagnosed from the most severe lesions obtained by punch biopsy, loop electrosurgical procedure, cold knife conization or hysterectomy. Underlying high grade cervical lesions including cervical intraepithelial neoplasia grade 2, 3 and adenocarcinoma in situ were noted in 502 (73.7%) women. Invasive cervical carcinoma was identified in 141 (20.7%). The remaining 38 (5.6%) had either low grade or no intraepithelial lesions. No significant difference in the prevalence of underlying high grade and invasive lesions was noted between women with cytologic diagnosis of HSIL from CMUH and other hospitals. In conclusion, northern Thai women with HSIL cytology are at significant risk of having underlying severe cervical lesions, and especially invasive carcinoma which is detected in approximately one-fifth of the cases.

Validación de la citología cérvico uterina convencional con prueba de referencia histopatológica en la identificación de cáncer escamocelular invasor / Validation of the cytology in the screening of invading squamous cell carcinoma

Antecedentes: La citología cérvico uterina convencional (CCUC) es la prueba de tamizaje más empleada en la detección del cáncer de cuello uterino, sin embargo su calidad es discutida. Objetivo: Evaluar el rendimiento de la CCUC en el tamizaje de cáncer escamocelular invasor de cuello uterino. Métodos: Fueron seleccionadas 1980 usuarias de la Liga Santandereana de Lucha Contra el Cáncer. Siguiendo un muestreo prospectivo se realizó un análisis estadístico para validar la CCUC en el diagnóstico de carcinoma escamocelular invasor utilizando como prueba de referencia el informe histopatológico de biopsia. Fue determinada la sensibilidad, la especificidad, el valor predictivo positivo (VPP) y negativo (VPN). Resultados: La CCUC tuvo una sensibilidad de 12 por ciento, una especificidad de 99 por ciento, un VPP de 83,3 por ciento y un VPN de 98,2 por ciento en la identificación de carcinoma escamocelular invasor, en una población con una prevalencia de la enfermedad de 2 por ciento. Conclusiones: En este estudio se encontró que la CCUC tuvo unos parámetros de evaluación similares a los patrones internacionalmente definidos. Su baja sensibilidad da a entender que no es un método de tamizaje, por lo cual es recomendable la mejora de los criterios empleados en su interpretación para aumentar este parámetro, así como hacer énfasis en el desarrollo de nuevas tecnologías que permitan un mejor tamizaje y diagnóstico de esta patología, que al igual que la citología convencional ofrezcan su servicio a bajos costos y con facilidad en su implementación.

Morbilidad y mortalidad por cáncer oral y faríngeo en Chile / Morbidity and mortality for oral and pharyngeal cancer in Chile

Background: Most oral cancers are squamous cell carcinomas (90%) which are two to four times more common in men than in women. The reasons for these differences are associated with exposure to factors such as tobacco and alcohol. Age is also considered as a risk factor (about 90% of the cases are diagnosed after 45 years of age). Aim: To analyze the frequency of oral cavity cancer during the last years in Chile. Material and methods: Mortality rates were obtained from death records of the "Instituto Nacional de Estadísticas" and publications of the World Health Organization, from 1955 to 2002. Morbidity from 1969 to 2002 was obtained from hospital discharge records of the Chilean Ministry of Health. Results: Oral cancer corresponded to 1.6% of total cancer cases in Chile, with a male:female ratio of 2.3 to 1. Deaths due to oral cancer was 1% of all cancer deaths, with a male:female ratio of 2.8 to 1. The morbidity rate for both genders increased while the mortality rate was relatively constant. However, we observed an increase in the mortality rate among women from 1980 to 2002, associated with more than 100% increase in the frecuency of smoking, between 1970 and 1998. The most common anatomical location was the tongue. Conclusions: The incidences of oral cancer is increasing in Chilean women, but men are more commonly affected.

Is it relevant to screen women younger than 26 years for precancerous and malignant cervical lesions ?

Cervical cancer is a serious health problem and most of the cases occur in less developed countries where effective screening systems are lacking. The aim of our present study is to delineate the age for early detection of precancerous cervical lesions. Cervical smears were screened (Pap test) over a period of four and half years from January 2000 to June 2004. The pattern of lesions was found to be almost same among the age groups of 26 to 35 years and 36 to 45 years. This result tempted us to think that detection of cervical lesions at an early age younger than 26 years may be an important step forward towards complete cure.

Human papillomavirus prevalence, viral load and cervical intraepithelial neoplasia in HIV-infected women

HIV-infected women from S o Paulo city were enrolled in a cross-sectional study on Human Papillomavirus (HPV) and cervical intraepithelial neoplasia (CIN) prevalence and their association with laboratory markers of AIDS, namely HIV viral load and CD(4)(+) cell counts. A cervical specimen was collected and submitted to Hybrid Capture, a test for HPV viral load determination. HPV-DNA was detected in 173 of 265 women (64.5). Twenty (7.5) women were infected by one or more low-risk viruses, 89 (33) by one or more high-risk viruses, and 64 (24) harbored at least one HPV type from each risk group. Abnormal smears were observed in 19 of the patients, though there were no invasive carcinomas. Severely immunosuppressed patients (CD(4)/microL <100) were at the greatest risk of having a cytological abnormality and a high high-risk HPV viral load.

Enfermedad premaligna y maligna en citologías reportas como ASCUS (células escamosas atípicas de significado indeterminado)

Se realizó un estudio descriptivo y prospectivo entre abril y diciembre de 1996 en el cual se hizo biopsia dirigida por colposcopia a las pacientes con citologías reportadas como ASCUS (Células escamosas atípicas de significado indeterminado). De las 65 pacientes, 63 ingresaron al estudio, excluyendo dos por el antecedente de conización por carcinoma in situ. La mayoría eran relativamente jóvenes (media de 35,8 años), con más de un embarazo y más de un parto vaginal. A 60 pacientes se les realizó colposcopia, todas anormales, siendo el epitelio acetoblanco la alteración más frecuente. El diagnóstico colposcópico más comúnmente propuesto fue el de HPV. La histopatología fue normal sólo en una paciente, encontrándose que el 98.4 por ciento demostró alguna anormalidad distribuidas así: cervicitis crónica 28.6 por ciento, HPV 68.3 por ciento, NIC I 14.3 por ciento, NIC III/ carcinoma in situ 7.9 por ciento, carcinoma microinvasor 1.6 por ciento y carcinoma invasor 1.6 por ciento. El diagnóstico de malignidad se encontró en el 11.1 por ciento de los casos