RESUMO
Os Papilomavírus Humano (HPVs) são membros da família Papilomaviridae. O vírus destaca-se pelo seu tropismo por células epiteliais, infectando exclusivamente mucosa epitelial e cutânea. O HPV-16 e HPV-18 são subtipos classificados como de alto risco, conhecidos por sua oncogenicidade, fortemente associados aos cânceres anais, genitais e de orofaringe. Lesões por HPV representam um grande grupo de doenças sexualmente transmissíveis. O objetivo do presente estudo consistiu em realizar uma revisão narrativa sobre a associação entre lesões por HPV e carcinomas genitais e da cavidade oral. Realizamos uma busca na base de dados eletrônicos PubMed, Lilacs, Scielo, Medline e Google Scholar, sendo utilizados artigos publicados entre os anos de 2017-2021, ao fim, foram selecionados 36 artigos. Grande parte das infecções por HPV são subclínicas, ou seja, não apresentam sintomatologia importante e tendem a desaparecer espontaneamente. Desta forma, faz-se necessário ter conhecimento a respeito dos aspectos clínicos e comportamentais dessas lesões, possibilitando o diagnóstico precoce, evitando a evolução para estágios mais invasivos, favorecendo um tratamento efetivo e melhor prognóstico.
Human Papillomaviruses (HPVs) are members of the Papilomaviridae family. The virus stands out for its tropism for epithelial cells, exclusively infecting epithelial and cutaneous mucosa. O HPV-16 and HPV-18 are subtypes classified as high risk, known for their oncogenicity, strongly associated with anal, genital and oropharyngeal cancers. HPV lesions represent a large group of sexually transmitted diseases. The objective of this study was to carry out a narrative review on the association between HPV lesions and genital and oral cavity carcinomas. We carried out a search in the electronic databases PubMed, Lilacs, Scielo, Medline and Google Scholar, using articles published between the years of 2017-2021, at the end, foram selected 36 articles. A large part of HPV infections are subclinical, or seem to, do not present significant symptoms and tend to disappear spontaneously. In this way, it is necessary to be aware of the two clinical and behavioral aspects of these injuries, enabling early diagnosis, avoiding evolution to more invasive stages, favoring effective treatment and better prognosis.
Los virus del papiloma humano (VPH) son miembros de la familia Papillomaviridae. El virus destaca por su tropismo por las células epiteliales, infectando exclusivamente mucosas epiteliales y cutáneas. El VPH-16 y el VPH-18 son subtipos clasificados como de alto riesgo, conocidos por su oncogenicidad, fuertemente asociados con cánceres anales, genitales y orofaríngeos. Las lesiones por VPH representan un gran grupo de enfermedades de transmisión sexual. El objetivo del presente estudio fue realizar una revisión narrativa sobre la asociación entre las lesiones por VPH y los carcinomas genitales y de cavidad oral. Realizamos una búsqueda en la base de datos electrónica PubMed, Lilacs, Scielo, Medline y Google Scholar, utilizando artículos publicados entre los años 2017-2021, al final se seleccionaron 36 artículos. La mayoría de las infecciones por VPH son subclínicas, es decir, no presentan síntomas importantes y tienden a desaparecer espontáneamente. Por lo tanto, es necesario tener conocimiento sobre los aspectos clínicos y conductuales de estas lesiones, que permitan un diagnóstico precoz, evitando la progresión a estadios más invasivos, favoreciendo un tratamiento eficaz y un mejor pronóstico.
RESUMO
Introduction: The standard of care for treatment of cancer cervix is concurrent chemoradiation followed by brachytherapy in the majority of cases. Conventional radiotherapy with chemotherapy causes haematological toxicities which may be related to radiation to pelvic bone marrow. The present study aims to study the haematological toxicities and correlate with the mean dose to the bone marrow. Material and Methods: Retrospective data of cancer patients treated in the institute in the year 2019 was retrieved. Haematological toxicities were analyzed in terms of CTCAE criteria. Mean dose to bone marrow was calculated after the delineation in the CT scan. The correlation between haematological toxicity and mean bone marrow was done using a paired t-test for statistical significance. Results: The data of 20 patients were retrieved. Anaemia Grade, I and Grade II-IV was seen in 65% and 35% respectively. Leukopenia Grade I and Grade II-IV were seen in 85% and 15% respectively and Lymphopenia Grade I and Grade II-Iv were seen in 55% and 45% respectively. The mean dose to bone marrow did not show any statistical significance with the severity of haematological toxicity. There was no Grade II-IV toxicity of neutropenia and thrombocytopenia. Conclusion: Conventional radiotherapy can safely be practice for patients with cancer cervix with acceptable haematological toxicities.
RESUMO
Background: Nearly every family in the world is touched by cancer, which is now responsible for almost one in six deaths globally. Aim of this study was to access Indian woman's awareness towards cervical screening methods to promote strategies for increasing its uptake.Methods: A comprehensive questionnaire based cross-sectional observational survey was conducted in Pt. JNM Medical College and Dr. BRAM hospital, Raipur, Chhattisgarh from September 2018 to July 2019. Participants were selected by sampling between 21 to 59 years of age who have given consent for study.Results: Out of 1008 participants only 336 (33.3%) participants were aware about screening of cervical cancer and less than 28% participants were aware about pap smear, time of investigation, method of pap smear, health centre, association of HPV virus with cervical cancer, availability at vaccination, and with regard to risk factors only 27.9% women were aware that there is increased risk of cervical cancer due to multiple partners, 17.6% aware of risk due to increase in number of children’s, 11.1% aware of increase in risk of cervical cancer due to early initiation of sexual activity. Younger women (age 30-35, odds ratio 1.24, 95% CI 0.78-1.32, p-value 0.05), low socioeconomic status (odds ratio 1.74, 95% CI 0.76-2.12, p-value 0.01), education level (≤ secondary education odds ratio 1.64 95% CI 0.85-2.18 p-value 0.000, ≥ higher secondary or above education odds ratio 2.32 95% CI 1.21-2.89 p-value 0.001) and age at marriage (odds ratio 2.21, 95% CI 0.78-2.18, p-value 0.000) all had a significant relationship with the awareness of Pap smear test. Two-third of the females in the study stated that lack of awareness as the major reason for not getting a pap smear while another one- third stated lack of recommendation by health care professionals as major hurdle.Conclusions: This study found that woman's fear, pain and embarrassment, along with cultural influences, deterred them from undergoing screening.
RESUMO
Introduction: With sectional imaging, wide variations are reported in pelvic anatomy of individual patients raising concerns over adequate coverage of target volume with conventional radiotherapy based on standard bony landmarks. Three-dimensional conformal radiotherapy (3DCRT) is reported to decrease normal tissue toxicity, along with decrease in chances of geographic miss. Present study is done for dosimetric comparison of Planning Target Volume (PTV) and Organs at Risk (OAR) in cancer cervix patients treated with conventional and conformal radiotherapy along with clinical correlation in terms of side effects and tumor response. Materials and Methods: Fifty patients of cancer cervix underwent planning contrast enhanced CT scan. Target volumes & OAR were contoured. Patients were randomized into conventional & conformal arms. Conventional fields were planned using standard bony landmarks. CT based radiotherapy planning was done for 3DCRT arm. Field sizes &dose volume histogram (DVH) were recorded & compared for target coverage & OAR sparing in both arms. All patients received concurrent chemotherapy followed by brachytherapy. Results: Field sizes used for the 3DCRT plans were significantly larger than those used for the conventional plans (p= 0.000). Optimal PTV coverage was significantly improved using 3DCRT as compared to conventional radiotherapy (p= 0.0001). Dose homogeneity in both arms were almost similar (p= 0.292), while conformity index was better in 3DCRT which was statistically significant between the groups (p= 0.000). Mean dose to the Planning Target Volume was increased significantly in the CT based plan when compared with the standard four field plan (p= 0.0001).Difference in doses to the organs at risk (urinary bladder, and small bowel)and their side effects were statistically significant across both groups. There was no difference in tumor response. Conclusion: The present study showed significantly better target volume coverage & dose homogeneity with 3DCRT which may translate into better local control & survival but longer follow up is required to validate it.
RESUMO
Background:Cancer treatment induced bone loss has been retrospectively studied as a distinct entity in gynaecological cancers. Amongst gynaecological cancers, cervical cancer is the leading cause of mortality and morbidity, majorly in developing countries. Concurrent chemoradiation (CCRT) is considered as the standard of care in managing these patients. Persistent low back ache is often reported as a potential post treatment sequalae by long term survivors of cervical malignancy. Various retrospective studies done have observed reduced density and osteopenia of the bones in the irradiated area, as a possible etiologic factor for persistent low back ache.Methods:We in this prospective clinical trial propose to prospectively and systematically evaluate the changes in pelvic bone density in patients of cervical cancer receiving chemoradiotherapy using dual energy X-ray absorptiometry (DEXA) scan done pre and post treatment, and correlate the changes with occurrence and severity of persistent low back ache.Low back ache will be evaluated using Oswestry low back pain disability scale, scoring for which shall be done pre-treatment and then at post treatment at 2 monthly interval for 1 year on follow up. Conclusions: Results from the trial might bring-forth the changes in the density of pelvic bones in patients of cancer cervix undergoing concurrent chemoradiation and its correlation with low back ache, if any.Trial Registration: This trial is registered with number CTRI/2017/05/008606.
RESUMO
Current evidence on the efficacy and safety of Laparoscopic Radical Hysterectomy for early stage cervical cancer is adequate to support the use of this procedure provided that normal arrangements are in place for clinical governance, consent and audit. This study aims to present our single unit experience of Laparoscopic Radical Hysterectomy performed for early stage cervical cancers. Methods: 74 laparoscopic radical hysterectomies performed for early stage cervical cancers from 2012 to 2017 were reviewed. Results: Key efficacyoutcomes evaluated were completing the procedure without conversion to open surgery ( conversion rate – 3/74),the mean operating time (144 mts), intra operative complications ( rectal injury 2/74, primary hemorrhage 1/74), post operative complications ( ureteric fistula 2/74, vescico vaginal fistula 1/74 , port site hernia 1/74), number of LN removed ( mean - 14 LN on each side), recovery time (6 hrs on average ) and length of hospital stay (average – 5days); lone term outcomes viz recurrence rate and % year survival are under study. Conclusion: Our initial experience indicate that laparoscopic radical hysterectomy is safe ,feasible and effective with low morbidity and with comparable outcome to open approach; It does not compromise oncological radicality of resection; short term results are promising; long term results are awaited.
RESUMO
Background: Gynaecological malignancies constitute a major burden of cancer-related morbidity and mortality amongst females in developing countries including India. Aims and objectives: The study was conducted to study the clinical and morphological characteristics of patients having gynaecological malignancies and treated by radiotherapy with or without chemotherapy, now under follow-up. Study design: Aretrospective observational study in a tertiary care hospital of government set-up over 2 year period. Observations: A total of 3120 patients who reported for follow-up were included, of which 394 patients were of gynaecological malignancies. Carcinoma (Ca) Cervix followed by Ca endometrium were the most common sites (76% and 16% respectively). The most common age group was 7th decade. 33% patients with locally advanced cervical cancer were found to have paraaortic lymphadenopathy on presentation warranting extended field radiotherapy (RT). 73% of locally advanced ca cervix patients received 5 or more cycles of weekly chemotherapy (CT) with Cisplatin. 68% patients were disease-free at the time of follow-up. 11% patients were referred for palliative chemotherapy. 17% patients required hospitalization for symptomatic care during followup. Conclusion: Concurrent chemoradiation is an acceptable and well-tolerated modality of treatment for locally advanced gynaecological malignancies. Multimodal treatment and good collaboration between allied specialists is recommended.
RESUMO
Introduction: Cancer of the cervix is a global health problem and clinical cytopathology brings about detection and diagnosis of disease at stages earlier than possible before which can be further confirmed by histopathology technique. The objective of the present study was to evaluate accuracy of cervical cytology in the diagnosis of cervical lesions including both neoplastic and non neoplastic. Material and Methods: The study comprised of 100 patients with abnormal Pap smear cytology. A detailed clinical history, general physical and systemic examination was conducted and cervical biopsies as well as pap smears received from department of Obstetrics and Gynaecology were processed and stained. Results: A total of seven cases of squamous cell carcinoma were reported majority of which were seen in the advanced age group of greater than 50. In present study 61% cases were reported as NILM, 01% as ASCUS, 06% AGUS. LSIL was diagnosed on cytology in 20% patients, whereas 04% patients had HSIL and 07% patients revealed SCC, and remaining 01 patient (01%) with adenocarcinoma were diagnosed on cytological evaluation. The histopathological findings in 100 cases confirmed 72% cases of chronic cervicitis, 15% as CIN-1, 03% of CIN-2, 01% CIN-3, 01% adenocarcinoma and 08%were diagnosed as invasive squamous cell carcinoma. Cytohistological correlation of 100 cases revealed an overall sensitivity of 95.60% and a specificity of 77.78%. Conclusion: Pap smear test was found to be equally sensitive to histopathological examination for the early detection of different cervical lesions
RESUMO
Objectives: This study is conducted to assess the various predisposing factors for cancer cervix and to correlate the clinicaland pathological finding using cervix histopathology.Background: Cervical cancer is the third most common cancer in women worldwide accounting for 9% of all female cancerand 9% death in female due to cervical cancer. We studied 150 cases of cervical carcinoma with different clinical presentationsand correlated them with histopathological findings in tertiary hospital in Aurangabad, Maharashtra.Materials and Methods: A total of 150 cases histopathologically diagnosed as cervical cancer over a period of 1 year wereconsidered for the study. Clinical details of the patient were noted with the help of semi-structured pro forma. The data wereanalyzed and P value calculated.Results: Of 150 patients, 88 had moderately differentiated squamous cell carcinoma, 24 poorly differentiated, and 32 welldifferentiated. Adenocarcinoma numbered only six. 98 cases were in the age group of 40–59 years, 39 in the age group of 60–80years, and 13 in 20–39 years. All six cases of adenocarcinoma were seen in 40–59 years. 96 presented with white discharge,68 with bleeding per vagina, and 58 had constitutional symptoms. Most of the patients with adenocarcinoma presented withbleeding per vagina. 98 were in Stage 3B, 40 in Stage 2B, 5 in 4A, and 7 in Stage 1B.Conclusions: Screening of cervical cancer must be done in women with white discharge per vagina.
RESUMO
Background: Cervical cancer is the third most commonly diagnosed cancer and the fourth leading cause of cancer death in females worldwide. The disproportionately high burden of cervical cancer in developing countries is largely due to a lack of screening that allows detection of precancerous and early stage cervical cancer. The objective of this study was to identify pre cancer, cancer of cervix by Pap smear test and the factors associated with cervical cancer.Methods: A cross sectional study was done among married women in the reproductive age group of 15-49 years in the urban field practice area of A.J. Institute of Medical Sciences, from Jan 2013 to March 2013. The study comprised of 357 women. A pretested semi structured questionnaire was used to collect data. Screening was done by Pap smear test. Statistical analysis was performed using SPSS software.Results: 49.6% women were in the age group of 40-49 years. 62 (17.4%) were illiterates. 67.5 % belonged to low socioeconomic status. Pap smear test detected premalignant lesions among 2.1% women; no cancer cervix cases were detected. Association between premalignant lesion and educational status, early age at marriage, multi parity, erosion cervix was found to be statistically significant.Conclusions: Regular cytological screening by Pap smear will help in early detection of precancerous lesions and thereby prevent cancer cervix.
RESUMO
Background & objectives: Cancer cervix is one of the most common forms of genital malignancy among Indian women. Recurrence is seen in a significant number of cases. The conventional cervical smear technique has inherent problems and screening and interpretation errors. This study was undertaken to assess the efficacy of liquid-based cytology (LBC) as a method for cytological follow up and detection of recurrence in treated cases of cancer cervix and to compare it with conventional Pap smear technique to find the best screening method for detection of recurrence in these patients. Methods: This cross-sectional study was conducted over a period of one year. Patients attending Gynecology and Radiotherapy outpatient departments for follow up after treatment of cancer cervix were included. Pap smear and LBC were taken in all cases. Colposcopy and biopsy were done for those having epithelial cell abnormality in cytology report. Colposcopy and biopsy were taken as gold standard for diagnosis of cancer cervix recurrence. Results: Ninety four treated patients of carcinoma cervix were studied. The diagnostic accuracy for detection of recurrence of conventional Pap smear was 79.16 per cent, and that of LBC was 97.6 per cent. The difference between the two methods was significant (P<0.001). Interpretation & conclusions: Our findings showed that LBC performed better than the conventional method of cytology to detect recurrence of squamous cell carcinoma. Its sensitivity, specificity as well as accuracy were much higher than conventional method. LBC can be a better method of cytological follow up of post-treated patients of cancer cervix.
RESUMO
El proceso y el significado de la experiencia de las mujeres con cáncer de cérvix no se hacen evidentes dentro del manejo de la enfermedad, sin embargo la mujer se enfrenta a una serie de situaciones desde la sospecha del diagnóstico hasta la fase de superviviente. Objetivo: Proponer un planteamiento teórico que describa los proceso y el significado de la experiencia de las mujeres con cáncer de cérvix Metodología: Se realizó un estudio de tipo cualitativo con el método de teoría fundamentada la cual lleva a generar un planteamiento teórico. Se realizaron 13 entrevistas a profundidad a mujeres con diagnóstico de cáncer de cérvix atendidas en un centro de atención oncológica de la ciudad de Bogotá. Se acudió al análisis propuesto por Corbin y Strauss. Resultados: la realización de 13 entrevistas a profundidad que permiten determinar 5 subcategorías: entrando en un camino desconocido, afrontando lo que nadie se imagina, viviendo la enfermedad, continuando a pesar del cansancio, saliendo del sufrimiento una nueva oportunidad. Estas subcategorías llevan a generar la teoría "Encontrándome como sobreviviente de cáncer de cérvix", las mujeres viven 5 etapas en el proceso del cáncer de cérvix cada una identificada por la presencia de síntomas, el apoyo familiar y la espiritualidad. El proceso del cáncer significa una experiencia traumática, de sufrimiento y dolor pero a la vez otra oportunidad para disfrutar de la vida y de sus familias. Conclusiones: El planteamiento teórico "Encontrándome como sobreviviente de cáncer de cérvix" es el resultado de la interacción con la realidad de la mujer con cáncer de cérvix, donde se determina a la mujer como una persona con fortaleza, capaz de afrontar las dificultades y efectos de una enfermedad catalogada como mortal y dolorosa. (AU)
The process and meaning of the experience of women with cervical cancer are not evident within the pathological process of cancer, however the woman faces a series of situations from the suspicion of diagnosis to the survivor phase. Objective: To propose a theoretical approach that describes the processes and meaning of the experience of women with cervical cancer. Methodology: A qualitative study was carried out with the method of grounded theory which leads to generate a theoretical approach. 13 in-depth interviews were conducted with women diagnosed with cervical cancer treated at the Nogales clinic in the city of Bogotá Results: carrying out 13 in-depth interviews that allow us to determine 5 subcategories: entering an unknown path, facing what nobody imagines, living the illness, continuing despite the fatigue, leaving suffering a new opportunity. These subcategories lead to generate the theory "Finding myself as a survivor of cervical cancer", where women live 5 stages in the process of cervical cancer each identified by the presence of symptoms, family support and spirituality. In the same way women establish the cancer process as a traumatic experience, suffering and pain but allowing them to live another opportunity to enjoy life and their families Conclusions: The theoretical approach "Finding myself as a survivor of cervical cancer" is the result of the interaction with the reality of the woman with cervical cancer, where the woman is determined as a person with strength, able to face the difficulties and effects of a disease classified as deadly and painful. (AU)
Assuntos
Humanos , Feminino , Neoplasias do Colo do Útero , Adaptação Psicológica , Apoio Familiar , Acontecimentos que Mudam a VidaRESUMO
OBJECTIVE: To study the distribution of cancers among females with particular emphasis on cancer cervix in Kashmiri population, which is geographically and socio‑culturally distinct from the rest of India. MATERIALS AND METHODS: All patient records were screened from January 1, 2009 to December 31, 2011 at Regional Cancer Centre, Srinagar. Most common cancers among females were recorded and analysis of cancer cervix cases was performed. RESULTS: Female cancers comprised of 40% of total cancers with oesophageal and breast cancer as most common malignancies. Cancer cervix did not figure in top ten cancers and only 45 (0.01%) cases were recorded of the total of 3084 adult female cancers. CONCLUSION: We conclude that due to different socio‑cultural and sexual practices, this cancer is highly uncommon in Kashmir and screening or possibly should be directed specifically at only high risk selective subjects.
RESUMO
OBJECTIVES: To explore alternate modality of treatment in patients of advanced cancer cervix by neo‑adjuvant chemotherapy (NACT) followed by External Beam Radiotherapy (ERT) and Brachytherapy (BT). Short‑ (6 months) and long‑ (12 months) term follow‑up data from these patients were compared with the retrospective data from an urban cancer centre, where standard protocol of concurrent chemo‑radiotherapy is practiced. MATERIALS AND METHODS: Two hundred patients of advanced cervical cancer, treated at our rural cancer centre between January 2007 and December 2007, were included in the study arm (Group A). These patients received three cycles of neo‑adjuvant chemotherapy with Cisplatin, Bleomycin, and Vincristine before External‑Beam Radiotherapy (EBT) followed by brachytherapy. Patients in the control arm (Group B) of an urban cancer centre, received EBT with weekly concomitant Cisplatin, followed by brachytherapy. Short‑ (6 months) and long‑ (12 months) term follow‑up data from our patients were compared with the retrospective data from the urban cancer centre. RESULTS AND ANALYSIS: Complete response rate was comparatively higher among patients of Group A, also correspondingly proportion of patients showing progressive disease and stable disease was lower among them. Local treatment failure was 87.5% among patients from Group A and 94.4% in Group B patients. Concomitant chemoradiation (CRT) was associated with more GI toxicities. CONCLUSION: Our result suggests NACT arm is as effective as CRT arm in respect of complete response with less pelvic failure and G.I toxicities. Further follow‑up data are needed before arriving at a definite conclusion.
RESUMO
In Himachal Pradesh, cancer cervix is a major public health problem since it ranks as the number one female cancer. A case-control study of 226 newly diagnosed, histopathologically confi rmed cases of cancer cervix and equal number of matched controls was conducted at Regional Cancer Center, Himachal Pradesh during the period from July 2008 to October 2009 with the objective to study the common factors associated with cancer cervix. Univariate analysis identifi ed 10 risk factors associated signifi cantly with the disease. On multiple logistic regression, however, only seven risk factors were found to be associated signifi cantly with the disease. These were: Age at birth of fi rst child, spacing between two children, age at marriage, literacy, socioeconomic status, multiparity, and poor genital hygiene. Risk factors such as poor genital hygiene, age at birth of fi rst child <19 years, early marriage, illiteracy, multiparity, and low socioeconomic status were highly prevalent in the study subjects and were found to be signifi cantly associated with cancer cervix.
RESUMO
To assess pain in cases of cancer cervix and to evaluate the response to pain management according to WHO step ladder pattern in cases of cancer cervix, total 209 carcinoma cervix diagnosed and admitted case were recruited in the study. Baseline pain score was measured for each patient. For mild to moderate pain (VAS ≤ 7) , step 1 analgesic, NSAID, diclofenac sodium (50 mg TDS) was prescribed. Pain scores were reevaluated after 48 hrs and change of score was recorded. If pain persisted (same score), worsened (score increased) or score decreased but with a VAS score of > 4 , case was considered as non responder and patient was switched to step 2 analgesic. Step 2 was also applied directly to patients presenting with severe pain ( VAS >7) at the time of recruitment. Drugs used in step 2 was oral tramadol (50 mg QID ) along with Diclofenac ( 50 mg TDS) . VAS Score was reevaluated after 48 hrs. If score still remained above 4; adjuvant analgesics (Amitryptiline 25-75 mg OD, Prednisolone 5mg BD – 10 mg/day) were added to step 2. Step 2 non responders were treated with step3 protocol. In step 3, tab morphine (10 mg BD upto maximum 30 mg BD) was given after stopping all other drugs . After 48 hrs, scores were re evaluated; if scores remained >4; adjuvant analgesics ( Amitryptiline 25-75 mg OD, Prednisolone 5mg BD – 10 mg/day ) were added. After 48 hrs if still pain scores did not decrease to <4, case was declared as failure . The WHO algorithm was followed as per the response of the patients. Outcome showed decrease in pain score using Visual Analogue Scale Score. 209 patients were enrolled in the study. 60 patients had no pain at baseline. Out of 149 patients with pain, 44.9 % (67) patients achieved complete pain relief at step 1. Out of the remaining 82 patients , 5 were lost to follow up. 49.3 % (38) achieved complete relief at step 2 . Only 39 patients did not reach score of zero after step 2 but 35 (89.7%) out of them achieved complete relief after step 3. Out of 142 patients ( excluding lost to follow up ), 2 cases were declared as failure. Among these failure cases, one of them had metastasis of femur and symphysis pubis; bisphosphonates were started. Other patients had bladder and bowel involvement diagnosed on repeat cystoscopy. This WHO guideline implementation study supports use of algorithm in decision making for cancer pain management. Following the same we were able to achieve effective pain relief in 96% of our patients with failure rate of only 4%. It further helped to reduce patient’s agony and improved the quality of life.
RESUMO
Background: There is limited information on population-based cancer survival data in Latin America. Objective: To obtain estimates of survival for some cancers recognized as a public health priority in Colombia using data from the Cancer Registry of Cali for 1995-2004. Methods: All cancer cases for residents of Cali were included for the following sites: breast (3,984), cervix uteri (2,469), prostate (3,999), stomach (3,442) and lung (2,170). Five-year relative survival estimates were calculated using the approach described by Estève. Results: Five-year relative survival was 79% in patients with prostate cancer and 68% and 60% in women with breast or cervix uteri cancer, respectively. The cure fraction was 6% in subjects with lung cancer and 15% in those with stomach cancer. The probability of dying from breast or prostate cancer in people in the lower socio-economic strata (SES) was 1.8 and 2.6 times greater, respectively, when compared to upper SES, p <0.001. Excess mortality associated with cancer was independent of age in prostate or breast cancer. After adjusting for age, sex and SES, the risk of dying from breast, cervix uteri, prostate and lung cancer during the 2000-2004 period decreased 19%, 13%, 48% and 16%, respectively, when compared with the period of 1995-1999. There was no change in the prognosis for patients with stomach cancer. Conclusions: Survival for some kinds of cancer improved through the 1995-2004 period, however health care programs for cancer patients in Cali are inequitable. People from lower SES are the most vulnerable and the least likely to survive.
Antecedentes: En Latinoamérica existe poca información de estimaciones de supervivencia al cáncer basadas en estudios de población. Objetivo: Obtener estimaciones de supervivencia relativa (SR) para algunos tipos de cáncer reconocidos como prioridad de salud pública en Colombia con la información del Registro Poblacional de Cáncer de Cali. Métodos: Se incluyeron todos los casos de cáncer invasivo ocurridos en residentes de Cali durante el periodo 1994-2005 para las siguientes localizaciones: mama (3,984), cérvix (2,469), próstata (3,999), estómago (3,442) y pulmón (2,170). Las estimaciones de supervivencia relativa a cinco años se calcularon utilizando el método descrito por Estève. Resultados: La SR a cinco años fue 79% en pacientes con cáncer de próstata y 68% y 60% en mujeres con cáncer de mama y cérvix. La fracción de curación fue 6% en sujetos con cáncer de pulmón y 15% en aquellos con cáncer de estómago; en estos pacientes; la SR a cinco años fue 17%. La probabilidad de morir por cáncer de mama o próstata en personas de los ESE más bajos fue de 1.8 y 2.6 veces más, respectivamente, en comparación con los ESE altos, p <0.001. Después de ajustar por edad, sexo y ESE, el riesgo de morir por cáncer de mama, cérvix, próstata o pulmón en el período 2000-2004 se redujo 19%, 13% 52% y 16%, respectivamente, en comparación con el período 1995-1999. No hubo cambio en el pronóstico para los pacientes con cáncer de estómago. Conclusión: La supervivencia para algunos tipos de cáncer ha mejorado a través de los años 1995-2004, pero los programas de atención para los pacientes con cáncer en Cali son inequitativos. Las personas de ESE bajos son más vulnerables y tienen menos probabilidad de sobrevivir al cáncer.
Assuntos
Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias/epidemiologia , Vigilância da População , Colômbia/epidemiologia , Prognóstico , Sistema de Registros , Taxa de SobrevidaRESUMO
The Indian Council of Medical Research initiated a network of cancer registries under the National Cancer Registry Programme (NCRP) in 1981 and data collection commenced in these registries from January 1982. The results on incidence rates provided by the Population Based Cancer Registries (PBCRs) have shown the variation in patterns of cancer in general and that of cancer cervix in particular. Cancer of the cervix has been the most important cancer in women in India, over past two decades. All the urban Population Based Cancer Registries at Bangalore, Bhopal, Chennai, Delhi and Mumbai have shown a statistically significant decrease in incidence rates of this site of cancer. Since over 70 per cent of the Indian population resides in the rural areas, cancer cervix still constitutes the number one cancer in either sex. Based on the data of the PBCRs, the estimated number of new cancers during 2007 in India was 90.708. The relative five year survival reported some time earlier averaged 48.7 per cent.
Assuntos
Feminino , Humanos , Índia/epidemiologia , Sistema de Registros , População Rural , Neoplasias do Colo do Útero/epidemiologia , População UrbanaRESUMO
No presente trabalho, estudamos a frequência de achados de esfregaços anormais pelo exame de Papanicolaou nas populações de adolescentes (idade <=21 anos)e adulta (>21 anos) atendidas pelo Setor de Citologia do Instituto Adolfo Lutz-Programa de Prevenção do Câncer de Colo Uterino nos últimos seis anos (1996 a 2001). Verificamos que a frequência destes achados vem aumentando gradativamente em ambas as populações, sendo sempre mais alta nas adolescentes (1,7 por cento, 2,3 por cento, 1,8 por cento, 1,3 por cento, 2,6 por cento e 4,2 por cento respectivamente). Nas mulheres adultas, as lesões também sobreram progressivo aumento com o passar dos anos, com ocorrência de 1,2 por cento, 1,3 por cento, 1,0 por cento, 0,9 por cento, 1,6 por cento e 2,5 por cento respectivamente. A análise estatística mostrou uma tendência linear de aumento de frequência de exames anormais em ambos os grupos sendo maior nas adolescentes. Acrescendo os dados dos quatro anos precedentes (1992 a 1995) de estudo similar, publicado anteriormente, envolvendo o mesmo tipo de populações, as diferenças foram ainda mais notáveis com relação aos anos posteriores: de 1992 a 1995, a frequência de lesões na população de adolescentes foi de 0,45 por cento, 0,95 por cento, 1,12 por cento e 2,10 por cento, e na população de adultas, 0,44 por cento, 0,72 por cento, 0,87 por cento e 1,18 por cento respectivamente. Uma vez que a progressão das lesões para câncer cervical se dá em um período médio de dez anos, é de grande importância que a população mais jovem, sexualmente ativa, também seja monitorada pelos Programas de Prevenção de Câncer do Colo Uterino. (AU)
The aim of the present study was to ascertain the frequency of abnormal PAP smears(ASCUS, AGUS, SILs and carcinoma) in two populations that search for the Program of Cervical CancerPrevention of the Public Health Services of São Paulo State (Brazil) in the last six years (1996 to 2001):adolescents (up to the age of 21 years) and adults (over 21 years). The samples were examined at Divisionof Pathology of Adolfo Lutz Institute. The frequency of uterine cervix lesions is increasing constantly inboth populations but mainly in adolescents (1.7%, 2.3%, 1.8%, 1.3% 2.6% and 4.2% respectively). Theadult women also have showed a progressive increasing of the lesions during the period studied: 1.2%,1.3%, 1.0%, 0.9%,1.6% and 2.5%, respectively. The addition of data of four anterior years (1992 a1995) of a similar study previously published, involving the same type of populations, the differences werestill further notable if compared to the posterior years: from 1992 a 1995, the frequency of lesions in theadolescent population was 0,45%, 0,95%, 1,12% e 2,10%, and in the adult population was 0,44%, 0,72%,0,87% e 1,18%, respectively.Statistical analysis showed a tendency of linear increase in frequency of abnormal PAP smears in bothgroups, being greater in the adolescent group. Since the progression of intraepithelial lesions to invasivecancer may occur in a period of ten years, the younger sexually active population should be monitored byregular programs for uterine cervix cancer detection. (AU)