Peritumoral stroma and systemic inflammatory response in cervical cancer.

OBJECTIVE: To compare cervical stroma in advanced cervical cancer with the control group; to compare, in the pre-treatment period, hemogram parameters in patients with advanced cervical cancer with the same parameters as the control group; and to verify if there is an association of stromal markers with prognostic factors in cervical cancer. MATERIALS AND METHODS: We prospectively evaluated 16 patients diagnosed with advanced invasive cervical cancer. A control group of 22 patients was used (uterine leiomyoma). Immunohistochemistry was performed to verify the stromal immunostaining of alpha-smooth muscle actin (SMA) and fibroblast activation protein alpha (FAP). Immunostainings and hemogram parameters were compared using Fisher's exact and Mann-Whitney Test, respectively. RESULTS: Strong FAP immunostaining was more frequent in patients with cervical cancer when compared with patients with leiomyoma (P = 0.0002). Regarding SMA, strong immunostaining was also found more in the group of cancer patients compared to the control group (P < 0.00001). The neutrophil-lymphocyte ratio (NLR) values were higher in the cancer patient group compared to the control group (P = 0.0019). There was no association of the parameters studied with prognostic factors. CONCLUSIONS: Strong FAP and SMA immunostaining was found more in patients with cervical cancer when compared to the control group. NLR values were also higher in cervical cancer.

Prognostic value of pretreatment FDG PET/CT in uterine cervical cancer according to two major histologic types: squamous cell carcinoma and adenocarcinoma.

Objectives: The aim of this study was to assess the prognostic value of pretreatment Positron emission tomography / computed tomography using 18F-fluorodeoxyglucose (FDG-PET/CT) in cervical cancer according to two major histologic types. Methods: Eighty-three squamous cell carcinoma (SCC) patients and 35 adenocarcinoma (AC) patients who underwent pretreatment FDG-PET/CT were retrospectively analyzed. Maximum standardized uptake value (SUVmax), mean standardized uptake value (SUVmean), metabolic tumor volume (MTV), and total lesion glycolysis (TLG) of the primary tumor were calculated. Kaplan-Meier analyses were used to compare correlations between each PET parameter and overall survival (OS). The prognostic values of imaging and clinical parameters were assessed using uni- and multivariable Cox proportional hazard models. Results: SUVmax, SUVmean, and TLG were significantly higher in SCC than in AC (p<0.01 each). No significant difference in MTV was seen between the two groups (p=0.10). As for Kaplan-Meier analyses, in SCC, patients with SUVmax, SUVmean, MTV, and TLG exceeding cutoff values tended to show worse OS than patients with lower values (p=0.07, p=0.27, p<0.01, and p=0.01, respectively, for OS). On the other hand, in AC, patients with MTV and TLG exceeding cutoff values showed significantly worse PFS and OS (p<0.01 each for OS), while SUVmax and SUVmean were unrelated to OS (p=0.91 and p=0.83, respectively for OS). As for multivariable analyses, in SCC, TLG was identified as an independent prognostic factor for OS (p=0.01). In AC, MTV was identified as an independent prognostic factor for OS (p=0.02). Conclusion: Our preliminary data suggest that FDG-PET/CT would be useful for predicting prognosis in cervical cancer, although the clinical significance of quantitative values may differ according to histopathological type.

Image guided adaptive brachytherapy of cervical cancer - practical recommendations.

Brachytherapy (BT) is an integral part of radical radiotherapy (RT) or radiochemotherapy (RCT) in patients who are not suitable candidates for surgery. These are usually patients with locally advanced cervical cancer. The goal of all BT planning eff orts has been, still is, and certainly will continue to be, to defi ne the anatomical boundaries of the tumor and the relationship of the tumor to organs at risk (OARs) as best as possible, using available modern imaging techniques. Image guided adaptive brachytherapy (IGABT) is currently the most advanced method of uterovaginal BT. Adaptive planning allows dose escalation from BT to newly defi ned target volumes, according to the risk of recurrence, which is mainly determined by the level of tumor burden. This dose adaptation based on the response to external RCT is a major change in practice compared to conventional BT planning based on dose prescription to point A. The main advantage of the IGABT concept is that it allows the assessment of individual dose distributions in target volumes and OARs, which in turn leads to improved dose coverage of target volumes while decreasing the volume irradiated by the prescribed dose compared to conventional 2D planning. Purpose: In this review article, I provide a comprehensive up-to-date perspective on this issue, particularly in terms of practical recommendations regarding the defi nition of target volumes, the use of diff erent types of uterovaginal applicators, intraoperative complications, and potential manifestations of late gastrointestinal, genitourinary, and vaginal toxicity.

Current knowledge on fertility-sparing treatment of cervical cancer patients.

INTRODUCTION: Cervical cancer directly affects the reproductive function of women of childbearing age. Up to one-third of the disease is dia-gnosed in women younger than 45 years of age, who may still have open reproductive plans. Therefore, in recent years, there has been increasing interest in performing fertility-sparing treatment (FST), which aims to preserve fertility while achieving the same oncologic safety as radical surgical treatment. OBJECTIVE: To summarize the current knowledge on FST in women with early stages of cervical cancer. METHODS: Review of published literature on the topic using medical databases. RESULTS: FST is reserved for patients with HPV-associated cervical cancer up to stage IB with negative nodes. Conservative procedures (conization and simple vaginal trachelectomy) and radical trachelectomy are available. Conservative procedures for tumors 2cm have comparable oncological outcomes as radical treatment with a significantly lower rate of perinatological complications. On average, 55% of patients become pregnant after treatment and of these, on average 70% give birth to a live newborn. Approximately 38% of deliveries are preterm, most often after radical trachelectomy. The most common postoperative complication with direct impact on fertility is cervical stenosis. CONCLUSION: In a selected group of patients with tumors up to 2cm, FST is a safe procedure with good perinatological outcomes. However, it remains unclear whether it is safe to offer this treatment to patients with larger tumors. The use of neoadjuvant chemotherapy followed by conservative surgery is a promising approach but requires further validation in clinical trials.

Current data on the efficacy of prophylactic HPV vaccination in the primary prevention of cervical lesions.

OBJECTIVE: A review of current knowledge on the efficacy of HPV (human papillomavirus) HPV vaccination against pre-cancers and cervical cancer. METHODS AND RESULTS: HPV infection is probably the most common sexually transmitted disease and the cause of approximately 5% of all human cancers. Currently, three prophylactic vaccines against HPV infection are on the market: bivalent Cervarix, quadrivalent Gardasil (formerly Silgard) and nonavalent Gardasil9. The Czech Republic is one of the countries with a national vaccination program where HPV vaccination is covered by health insurance for girls and boys aged 13-14 years. Extensive scientific data on the efficacy of the vaccines clearly demonstrate significant efficacy against the development of cervical pre-cancers for all three vaccines. According to a high-certainty evidence of the Cochrane database, the efficacy of HPV vaccines against cervical intraepithelial neoplasia grade 2 or 3 associated with HPV 16, 18 compared with placebo in girls and women aged 15-26 is 99%. There is also moderate-certainty evidence that HPV vaccines reduce the risk of adenocarcinoma in situ for approximately 90% for the same population. Initial data also demonstrate a direct impact on reducing the incidence of invasive cervical cancer in vaccinated individuals. In addition, quadrivalent and nonavalent vaccines are highly effective in preventing genital warts. CONCLUSION: All three available prophylactic vaccines show high efficacy in preventing the development of cervical lesions. Efficacy is highest against lesions caused by vaccine genotypes and the highest efficacy is achieved in the HPV naive population.

Chemoradiotherapy in the treatment of cervical cancer - a single institution retrospective review.

BACKGROUND: The aim of this study is a retrospective analysis of treatment outcomes and toxicity in a group of patients with cervical cancer who underwent (chemo) radiotherapy at the Institute of Radiation Oncology in Bulovka University Hospital in Prague in the period 2014-2017. PATIENTS AND METHODS: During this period, 141 patients were treated, 105 (74.5%) of them underwent combined (chemo) radiotherapy with radical intent and palliative radiotherapy was performed in 36 (25.5%) cases. According to the International Federation of Gynecology and Obstetrics (FIGO) 2009 classification, the most numerous stages were IIB in 39 (27.7%) and IIIB in 64 (45.4%) cases; according to FIGO 2018, a significant number of newly established stages is evident: IIIC1 in 55 (39.0%) patients and IIIC2 in 22 (15.6%) cases. RESULTS: The median progression-free survival (PFS) and overall survival (OS) reached 31.3, resp. 40.1 months in the whole group. In the subgroup of patients treated with radical intent, the median PFS was 44.0 months and OS 48.8 months; in the palliative subgroup, the median PFS was 9.4 months and OS 14.8 months. In a radically treated subgroup, 7 (6.7%) patients had gastrointestinal or genitourinary manifestations of G3-4 toxicity, and overall acute toxicity (including skin and haematological reactions) of G3-4 occurred in 18 (17.1%) patients. Late toxicity of G3-4 was reported in 13 (12.4%) cases. Patients who underwent complete brachytherapy (BRT) showed significantly better survival compared to patients with a lower number of BRT fractions. The prognostic potential of PS (performance status) and anemia was confirmed; significantly longer overall survival was observed in patients in good general condition or in those without anemia. CONCLUSION: Our results confirmed the key role of BRT for the delivery of the curative dose to the target volume. The prognostic role of PS and anemia is evident. The side effects were in acceptable limits but we expect improvements because of the use of modern radiotherapy technologies.

Citologías alteradas en mujeres pertenecientes a un grupo básico de trabajo de Camagüey

RESUMEN Introducción: El cáncer de cuello uterino es una neoplasia maligna que se encuentra asociada a un número notable de factores de riesgo y, dentro de ellos, a la conducta sexual. Objetivo: Analizar las características clínico-epidemiológicas de mujeres con citologías alteradas de un grupo básico de trabajo perteneciente al Policlínico Comunitario Docente "Joaquín de Agüero y Agüero", municipio Camagüey. Método: Se realizó un estudio de corte transversal, descriptivo, durante el período enero-diciembre de 2020. Se trabajó con un universo de 62 mujeres pertenecientes a los 11 consultorios urbanos del Grupo Básico de Trabajo 1, con presencia de citologías alteradas diagnosticadas mediante estudio histológico y/o citológico. Las variables utilizadas fueron: grupo de edad, antecedentes familiares de patologías de cuello y cuerpo uterino, factores de riesgo, infección con el virus del papiloma humano (VPH) y los resultados histopatológicos de Papanicolaou. El procesamiento y análisis de datos se realizó utilizando el paquete estadístico SPSS versión 21.0. Resultados: La mayor incidencia de lesiones de cuello uterino ocurrió en el grupo de edad de 25 a 34 años (43,5 %), con antecedentes familiares maternos (45,1 %). La infección vaginal (100 %) y la multiparidad (82,2 %) fueron consideradas como principales factores de riesgo. Predominaron las pacientes con el virus del papiloma humano en un 87,1 %. Además, la citología con resultados de neoplasia cervical intraepitelial (NIC I) fue la más diagnosticada (40,3 %). Conclusiones: Los factores de riesgo analizados muestran una importante relación directa entre el virus del papiloma humano y los resultados de las citologías cervicales alteradas.

ABSTRACT Introduction: Cervical uterine cancer is a malignant neoplasm that is associated with remarkable number of risk factors, including sexual behavior. Objective: To analyze the clinical-epidemiological characteristics of women with altered cytology treated by a basic work group at the Policlínico Docente Comunitario "Joaquín de Agüero y Agüero", in Camagüey municipality. Method: A cross-sectional and descriptive study was conducted from January to December 2020. It worked with a total of 62 women (as universe) treated in 11 different urban clinics associated to the Basic Work Group 1, all women with altered cytology diagnosed by histological and/or cytological study. Variables used were as follow: group of age, family history linked to the cervical and uterine body pathologies, risk factors, human papilloma virus (HPV) infection and histopathological Papanicolaou results. Data processing and analysis were performed using the statistical package SPSS version 21.0. Results: The highest incidence of cervical uterine lesions occurred in the group of age 25 to 34 (43.5%), and the 45.1% showed a maternal family history. Vaginal infection (100%) and multiparity (82.2%) were considered the main risk factors. Patients with HPV predominated in 87.1%. In addition, cytology with findings of cervical intraepithelial neoplasia (CIN 1) was the most frequently diagnosed (40.3%). Conclusions: It is concluded that the risk factors analyzed show a significant direct relationship between HPV and altered cervical cytology outcomes.

RESUMO Introdução: O câncer do colo do útero é uma neoplasia maligna que está associada a um notável número de fatores de risco e, entre eles, ao comportamento sexual. Objetivo: Analisar as características clínico-epidemiológicas de mulheres com citologias alteradas de um grupo básico de trabalho da Policlínico Comunitario Docente "Joaquín de Agüero y Agüero", município de Camagüey. Método: Estudo transversal descritivo realizado no período de janeiro a dezembro de 2020. Trabalhamos com um universo de 62 mulheres pertencentes às 11 clínicas urbanas do Grupo de Trabalho Básico 1, com presença de citologias alteradas diagnosticadas por estudo histológico e/ou citológico. As variáveis utilizadas foram: faixa etária, história familiar de patologias cervicais e do corpo uterino, fatores de risco, infecção pelo papilomavírus humano (HPV) e resultado histopatológico do Papanicolaou. O processamento e a análise dos dados foram realizados no pacote estatístico SPSS versão 21.0. Resultados: A maior incidência de lesões cervicais ocorreu na faixa etária de 25 a 34 anos (43,5%), com história familiar materna (45,1%). Infecção vaginal (100%) e multiparidade (82,2%) foram considerados os principais fatores de risco. Pacientes com HPV predominaram em 87,1%. Além disso, a citologia com resultado de neoplasia intraepitelial cervical (NIC I) foi a mais diagnosticada (40,3%). Conclusões: Conclui-se que os fatores de risco analisados apresentam uma relação direta importante entre o HPV e os resultados das citologias cervicais alteradas.

Detección y control del cáncer de cuello uterino en mujeres de 35 a 44 años en Ecuador / Detection and control of cervical cancer in women aged 35 to 44 yearsin Ecuador

INTRODUCCIÓN: El cáncer de cuello uterino es un problema de salud pública que se origina en las células que recubren el cuello del útero, cuya etiología se relaciona frecuentemente con el virus del Papiloma Humano. Esta patología solo se presenta en las mujeres, siendo el segundo más común entre las tipologías de cáncer; su aparición puede ser prevenible mediante el control y la detección oportuna. OBJETIVO: Determinar el nivel de control y detección de cáncer cérvico-uterino que tienen las mujeres de 35 a 44 años. METODOLOGÍA: La investigación es cuantitativa, descriptiva y de corte transversal. La muestra fue de 267 mujeres de 35 a 44 años. Se aplicó una encuesta virtual de manera voluntaria y aleatoria a la población femenina de dichas edades, en la cual se establecieron preguntas categorizadas en: Conocimiento general, Control y Detección, éstas nos ayudarán a comprobar el grado de información, control y detección del cáncer cérvico-uterino que tenga dicha población. RESULTADOS: El porcentaje general varía de acuerdo a las categorías de las encuestas empleadas, a partir de las cuales se refleja que el 52,8% tiene conocimiento acerca de los métodos de control y detección del cáncer cérvico-uterino, el 44,3% no ha recibido información acerca del tema y, el 2,9% tiene un conocimiento incompleto. CONCLUSIÓN: El cáncer cérvico-uterino afecta con mayor frecuencia a las mujeres sexualmente activas dentro del rango de edad de 35 y 44 años, siendo la falta de información de la población femenina y la ausencia de controles sanitarios algunos de los factores que predisponen a una alta incidencia y prevalencia de la morbi ­mortalidad a causa de esta patología.

INTRODUCTION: Cervical cancer is a public health problem that originates in the cells lining the cervix, whose etiology is often associated with the Human Papillomavirus. This pathology only occurs in women, being the second most common among cancer typologies; its appearance can be preventable through control and timely detection. OBJECTIVE: To determine the level of control and detection of cervical-uterine cancer in women aged 35 to 44. METHODOLOGY: The research is quantitative, descriptive and cross-sectional. The sample was 267 women aged 35 to 44 years. A voluntary and random virtual survey was applied to the female population of these ages, in which questions categorized in: General knowledge, Control and Detection were established, these will help us to verify the degree of information, control and detection of cervical-uterine cancer in that population. RESULTS: The percentage varies according to the categories of surveys used, showing that 50.3 per cent have knowledge of methods for the control and detection of cervical-uterine cancer, 41.1 per cent have not received information on the subject and 8.6% have incomplete knowledge. CONCLUSIONS: Cervical-uterine cancer most often affects sexually active women in the 35-44 age range, The lack of information from the female population and the absence of health controls are some of the factors that predispose to a high incidence and prevalence of morbidity -mortality due to this pathology.

Influencia del cáncer cérvico-uterino y la alteración de la salud mental en pacientes menores de 25 años en Ecuador / Influence of cervico-uterine cancer and the alteration of mental health in patients under 25 years of age in Ecuador

INTRODUCCIÓN: Los problemas sanitarios en los pacientes que padecen cáncer cérvico-uterino influyen en la satisfacción personal y evitan una gran adherencia a la terapia médica, y además están relacionados con un número más notable de efectos secundarios y la estancia en la clínica de emergencia junto afecciones depresivas y problemas de ansiedad. OBJETIVO: Identificar la influencia del cáncer cérvico -uterino en las alteraciones en la salud mental de pacientes menores de 25 años en el Ecuador. METODOLOGÍA: La investigación fue de tipo cuantitativo, descriptivo, y de corte transversal. Se utilizaron encuestas de manera virtual dirigida a pacientes menores de 25 años que padecen de cáncer al cuello uterino en diversas Fundaciones que luchan contra el cáncer, contando con una muestra de 178 mujeres, estas se dividieron en 4 categorías: Salud mental, Estrés, Depresión y Total de escalas. RESULTADOS: El porcentaje que se obtuvo de manera general tuvo un rango variado, el 32,9% dio como resultado que la alteración que causa en la mujer es contundente, seguido del 30,6 que su afección en la salud mental es más baja. CONCLUSIÓN: Se concluye afirmando que el cáncer uterino es el segundo cáncer más prevalente en la mujer, el cual influye de manera progresiva en la salud mental, presentando reacciones negativas y percepciones, falta de control en las emociones, consecuentemente aquello debilita el sistema inmunológico previamente comprometido, generando alteraciones en el curso del tratamiento.

INTRODUCTION: Health problems in patients suffering from cervical-uterine cancer influence personal satisfaction and prevent a high adherence to medical therapy, and are also related to a more notable number of side effects and stay in the emergency clinic together depressive conditions and anxiety problems. OBJECTIVE: To identify the influence of cervical cancer -uterine in the alterations in the mental health of patients under 25 years in Ecuador. MATERIALS AND METHODS: The research was quantitative, descriptive, andcross-sectional. Surveys were used in a virtual way directed at patients under 25 years of age who suffer from cervical cancer in various Foundations that fight against cancer, with a sample of 178 women, these were divided into 4 categories: Mental health, Stress, Depression and Total stopovers. RESULTS: The percentage that was obtained in a general way had a varied range, 32.9% gave as a result that the alteration it causes in women is overwhelming, followed by 30.6 that their mental health condition is lower. CONCLUSION: It is concluded by stating that uterine cancer is the second most prevalent cancer in women, which progressively influences mental health, presenting negative reactions and perceptions, lack of control over emotions, consequently that weakens the previously compromised immune system, generating alterations in the course of treatment.

Importance of addition of HPV DNA testing to the cytology based cervical cancer screening and triage of findings with p16/Ki67 immunocytochemistry staining in 35 and 45 years old women LIBUSE trial data analysis.

OBJECTIVE: The study evaluates results of 2-years follow-up of patients in ages 35-36 and 45-46, who are participating in the project LIBUSE, that deals with efficacy of HPV DNA and Pap smear co-testing and p16/Ki67 dual staining in the Czech national cervical screening. DESIGN: Prospective observational study. SETTING: Department of Obstetrics and Gynecology, General University Hospital and 1st Medical Faculty, Charles University, Prague. MATERIALS AND METHODS: Out of all women enrolled in the project LIBUSE only those who were at the beginning of the study 35-36 and 45-46 years old were sellected. Conventional Pap smear and HPV DNA test (Cobas 4800, Roche Diagnostics) had been collected at the baseline. Women were stratified according to their results in the three risk groups: 1. low-risk, 2. high-risk and 3. intermediate risk, who subsequently underwent p16/Ki67 dual staining. All high-risk patients and those with positive result of dual staing were refered to the expert colposcopy. The cases with biopsy proven precancers or cancers were considered as „positive findings“. RESULTS: Altogether 352 women meet the age requirements. In 26 (7.6%) women had been proven HPV DNA positivity and out of the them 9 cases were HPV 16/18 positive. Severe cytological abnormality was found only in one patient (0.3%), who was simultaneously HPV positive. Ten women (2.8%) were classified as high-risk and directly refered to colposcopy. Another 18 patients underwent p16/Ki67 dual staining and 4 positive cases were refered to colposcopy too. After one year further 9 patients were classified as intermediate risk and 6 more were identified after two years of follow-up. Within two years 9 more patient were refered to colposcopy. After the entire period of follow-up in 10 patients biopsy confirmed precancer lesions, none of them had invasive cancer. CONCLUSIONS: Addition of HPV DNA testing with selective HPV 16/18 genotyping to the cytology based screening significantly increases sensitivity and safety of our cervical screening program.

What next in cervical cancer screening?

INTRODUCTION: The main aim of organized national cervical cancer screening programs is to decrease incidence and mortality of this malignancy. A total of 770 cases of cervical cancer and 354 deaths from the disease were noticed in the Czech Republic in 2017 which means the incidence 14,5 new cases per 100 000 women. The Czech national cervical cancer screening program is based on cytology (Pap smear) testing in asymptomatic women once a year. OBJECTIVE: To provide an overview of new possibilities and potential tools in cervical cancer screening worldwide and in the Czech Republic. SETTING: Gynecologic Oncology Center, Department of Gynecology and Obstetrics, Hospital Na Bulovce and 1st Medical School of Charles University, Prague; Gynecologic Oncology Center, Department of Gynecology and Obstetrics, General Faculty Hospital and 1st Medical School of Charles University, Prague. METHODS: For this review, we have used the results of studies, review articles, and guidelines of national cervical cancer screening programs published in English. We summarize the current knowledge of molecular genetic methods being applied in the screening of cervical carcinoma. CONCLUSION: The knowledge that persistent human papillomavirus (HPV) infection is the main cause of cervical cancer has resulted in the development of new possibilities of cervical cancer screening worldwide. HPV testing use for cervical cancer screening is now a reality with a quite lot of countries. Nevertheless, HPV testing is mainly used in the stratification of patients with unclear results of a cytological (PAP smear) result in the Czech Republic. While there is a wide and growing consensus that HPV molecular testing is the most accurate and cost-effective method of primary screening, there is a comparative lack of consensus regarding the optimal stratification of patients with proven HPV infections. Biomarkers, such a p16/Ki67 dual immunostaining, a methylation of viral DNA, a detection of E6/E7 mRNA, and others have been proposed for triage of HPV positive women. New possibilities and approaches in strategy of cervical cancer screening are discussed.

High-dose-rate intracavitary brachytherapy for recurrent cervical cancer in the vaginal stump after hysterectomy.

This study aimed to evaluate the treatment outcomes of patients who received high-dose-rate intracavitary brachytherapy (HDR-BT) using Iridium-192 with or without external beam radiotherapy as definitive treatment for recurrent cervical cancer after hysterectomy. Thirty-six patients with local recurrence after hysterectomy received radiotherapy including HDR-BT from 2005 to 2013. Overall survival, local control rate, and progression-free survival were estimated retrospectively via the Kaplan-Meier method. Late adverse events were also scored using the Common Terminology Criteria for Adverse Events (version 3.0). Median follow-up time was 38 (range, 7.4-101.3) months. The 3-year estimates of overall survival, local control rate, and progression-free survival were 100.0%, 82.8%, and 76.8%, respectively. Two patients (5.6%) had grade 2 lymphedema, but no other adverse events greater than grade 2 were reported. In conclusion, HDR-BT was an effective treatment modality for patients with cervical cancer recurrence in the vaginal stump.

Individualization of surgical management of cervical cancer stages IA1, IA2.

OBJECTIVE: To evaluate the risk of involvement of sentinel lymph nodes in cervical cancer stage IA1 with lymphovascular space invasion and IA2 using the detection of sentinel lymph nodes. DESIGN: Original article. SETTINGS: Department of Gynecology and Obstetrics 3rd Faculty of Medicine, Charles University, Faculty Hospital Královské Vinohrady, Prague; Oncogynecological centrum; Department of Pathology 3rd Faculty of Medicine, Charles University, Faculty Hospital Kralovské Vinohrady, Prague. METHODS: The study included women from prospective protocols LAP I and LAP II with cervical cancer stage IA1 with lymphovascular space invasion and stage IA2 from 2002 to 2018 classified according to FIGO 2014 staging, TNM 8. Detection of sentinel lymph nodes throughout this period was performed using ultra-short protocol with Tc and patent blau and also by histopathological examination. RESULTS: In the first group (28 women) with stage IA1 and lymphovascular space invasion diagnosed from cone biopsy there were two women with positive lymph nodes (7.1%). In the group stage IA2 (34 women) there were 13 women (38.2%) with positive lymphovascular space invasion and two women had positive lymph nodes (5.9%). The risk of positive lymph nodes for stage IA1 with lymphovascular space invasion and for stage IA2 is not statistically significant OR = 0.8125 (95% CI 0.1070-6.172). CONCLUSION: The detection of sentinel lymph nodes aids to individualize the therapy of early stage cervical cancer and helps to reduce the radicalization of surgery. The risk of positive lymph nodes in stage IA1 with lymphovascular space invasion and stage IA2 with/without lymphovascular space invasion is the same. The results confirm, that the detection of sentinel lymph nodes in stage IA1 with lymphovascular space invasion is fully indicated.

"Ter câncer mudou minha vida": cartografia de Luiza na micropolítica das redes de cuidado oncológico / "Having cancer changed my life": Luiza's cartography in the micropolitics of cancer care networks

Resumo Garantir cuidado integral à saúde de mulheres com câncer cérvico-uterino ainda é um desafio para a Saúde Coletiva, embora se evidencie o enraizamento de políticas, práticas e saberes na conformação de redes oncológicas de cuidado. Este estudo apostou na necessidade de mergulhar nas experimentações da micropolítica do cuidado para conhecer as nuances do fenômeno investigado. Ao fundamentar-se no aporte teórico-metodológico de Deleuze e Guattari, objetivou-se cartografar linhas de composição da produção de cuidado oncológico, na cidade de São Luís-MA, tendo como dispositivo a rede da usuária-guia Luiza. Investigaram-se 28 participantes através de entrevistas em profundidade e rodas de conversas. Como resultado, desenhou-se uma rede vulnerável, fragmentada e centralizada no cuidado biomédico, tendo um hospital que acolhe demandas da doença e uma atenção primária que abandona prevenção e promoção de saúde. Destaca-se a importância de conhecer a mulher com câncer atrelada à comunidade, à religiosidade e aos vínculos familiares. Ter câncer mudou a vida de Luiza e demandou conexões para além do biomédico. Essa cartografia convoca à percepção dos gargalos existentes na produção de redes oncológicas, convidando a quebrar muros tecnoassistenciais e criar enfrentamentos centrados na promoção de saúde e qualidade de vida.

Abstract Ensuring comprehensive health care for women with cervical-uterine cancer remains a challenge for public health, although evidence of the established policies, practices and knowledge in shaping of cancer care networks. This study focused on the need to deepen in the micropolitics of care experiments to know the nuances of the investigated phenomenon. Based on the theoretical and methodological approach of Deleuze and Guattari, it aimed to map the composition lines of cancer care production in the city of São Luis-MA, Brazil, using the network of the guide-user Luiza as a device. Twenty-eight participants were investigated through in-depth interviews and conversation groups. As a result, a vulnerable, fragmented, centralized network of biomedical care was designed, with a hospital that welcomes demands of the disease, and primary care that abandons prevention and health promotion. The importance of knowing women with cancer linked to the community, religiosity and family ties is highlighted. Having cancer changed Luiza's life and required connections beyond the biomedical sphere. This cartography calls for the perception of narrowing in the production of cancer care networks, inviting the breaking of techno-assistance walls and creating confrontations focused on health promotion and quality of life.

Educación sobre cáncer cervicouterino en la adolescencia / Education on cervical uterine cancer in the adolescence

RESUMEN El cáncer cervicouterino es el segundo en frecuencia entre féminas y causa importante de mobimortalidad. El riesgo de padecerlo está asociado a estilos de vida insanos, sobre todo en la adolescencia, momento en que se inicia la formación de actitudes y consolidan valores. Con el objetivo de estructurar los referentes teóricos que sustentan la relevancia de la educación en cáncer cervicouterino desde la adolescencia como contribución a su prevención, se revisaron 41 artículos científicos. Este es un proceso anarquicoproliferativo celular que se inicia con cambios neoplásicos intraepiteliales, que entre 10 y 20 años pueden transformarse en invasor. Dentro de los factores de riesgo se destacan el inicio precoz de las relaciones sexuales, promiscuidad, no uso de condón, uso prolongado de contraceptivos hormonales, multiparidad, embarazo juvenil, factores inmunológicos, tabaquismo, dieta baja en carotenos, antecedentes familiares de la enfermedad e infecciones de transmisión sexual, sobre todo por el virus del papiloma humano que constituye el principal. La prevención se sostiene fundamentalmente en la citología cervicovaginal, para la detección precoz de la lesión, así como en la promoción de salud a través de actividades educativas, preferentemente desde la adolescencia. El inicio temprano de la actividad sexual, las conductas sexuales de las nuevas generaciones y la alta frecuencia de infección por papiloma virus en adolescentes, hace que se presente este cáncer a edades más tempranas, por lo que debe modificarse la cobertura de edad para la citología cervicovaginal, así como considerar la vacunación masiva, antes del inicio de las relaciones sexuales (AU).

ABSTRACT Cervical uterine cancer is the second one in frequency among women and an important cause of morbimortality. The risk of suffering it is associated to insane life styles, mainly in the adolescence, when attitudes began their formation and values are consolidated. 41 scientific articles were reviewed with the aim of structuring the theoretical references backing the relevance of education in cervical uterine cancer since the adolescence as a contribution to its prevention. Cervical uterine cancer is an anarchic proliferative cell process that begins with neoplastic intra epithelial changes; during the age period from 10 to 20 years it could become invasive. Among the risk factors stand out the precocious beginning of sexual relations, promiscuity, not using condoms, the long use of hormonal contraceptives, multiparity, youth pregnancy, immunologic factors, smoking, low-carotene diet, familiar antecedents and sexually transmitted diseases, mainly in the case of human papilloma virus. Preventions is sustained mainly on the cervical-vaginal cytology for the precocious detection of the lesion, and also the health promotion through educative activities preferably since the adolescence. The early beginning of the sexual activity, the sexual behavior of the new generations and the high frequency of infections caused by human papilloma virus in teenagers lead to the presentation of this cancer at earlier ages, consequently the age coverage for the cervical vaginal cytology should be modified, and also the massive vaccination before the beginning of the sexual relationships should be considered (AU).

Educación sobre cáncer cervicouterino en la adolescencia / Education on cervical uterine cancer in the adolescence

RESUMEN El cáncer cervicouterino es el segundo en frecuencia entre féminas y causa importante de mobimortalidad. El riesgo de padecerlo está asociado a estilos de vida insanos, sobre todo en la adolescencia, momento en que se inicia la formación de actitudes y consolidan valores. Con el objetivo de estructurar los referentes teóricos que sustentan la relevancia de la educación en cáncer cervicouterino desde la adolescencia como contribución a su prevención, se revisaron 41 artículos científicos. Este es un proceso anarquicoproliferativo celular que se inicia con cambios neoplásicos intraepiteliales, que entre 10 y 20 años pueden transformarse en invasor. Dentro de los factores de riesgo se destacan el inicio precoz de las relaciones sexuales, promiscuidad, no uso de condón, uso prolongado de contraceptivos hormonales, multiparidad, embarazo juvenil, factores inmunológicos, tabaquismo, dieta baja en carotenos, antecedentes familiares de la enfermedad e infecciones de transmisión sexual, sobre todo por el virus del papiloma humano que constituye el principal. La prevención se sostiene fundamentalmente en la citología cervicovaginal, para la detección precoz de la lesión, así como en la promoción de salud a través de actividades educativas, preferentemente desde la adolescencia. El inicio temprano de la actividad sexual, las conductas sexuales de las nuevas generaciones y la alta frecuencia de infección por papiloma virus en adolescentes, hace que se presente este cáncer a edades más tempranas, por lo que debe modificarse la cobertura de edad para la citología cervicovaginal, así como considerar la vacunación masiva, antes del inicio de las relaciones sexuales (AU).

ABSTRACT Cervical uterine cancer is the second one in frequency among women and an important cause of morbimortality. The risk of suffering it is associated to insane life styles, mainly in the adolescence, when attitudes began their formation and values are consolidated. 41 scientific articles were reviewed with the aim of structuring the theoretical references backing the relevance of education in cervical uterine cancer since the adolescence as a contribution to its prevention. Cervical uterine cancer is an anarchic proliferative cell process that begins with neoplastic intra epithelial changes; during the age period from 10 to 20 years it could become invasive. Among the risk factors stand out the precocious beginning of sexual relations, promiscuity, not using condoms, the long use of hormonal contraceptives, multiparity, youth pregnancy, immunologic factors, smoking, low-carotene diet, familiar antecedents and sexually transmitted diseases, mainly in the case of human papilloma virus. Preventions is sustained mainly on the cervical-vaginal cytology for the precocious detection of the lesion, and also the health promotion through educative activities preferably since the adolescence. The early beginning of the sexual activity, the sexual behavior of the new generations and the high frequency of infections caused by human papilloma virus in teenagers lead to the presentation of this cancer at earlier ages, consequently the age coverage for the cervical vaginal cytology should be modified, and also the massive vaccination before the beginning of the sexual relationships should be considered (AU).

Nivel de conocimientos y factores de riesgo predisponentes de cáncer cérvico-uterino en mujeres de Cumanayagua / Level of knowledge and risk factors predisposing Cumanayagua women to cervical-uterine cancer

Introducción: el cáncer de útero es, después del de mama, el que con más frecuencia afecta a la mujer, y su cura depende del diagnóstico precoz. Objetivo: identificar el nivel de conocimientos y factores de riesgo predisponentes de cáncer cérvico-uterino en mujeres de Cumanayagua. Métodos: estudio descriptivo de corte transversal, en el Policlínico de Cumanayagua durante el año 2013. El universo estuvo constituido por 51 mujeres entre 25 y 59 años de edad, con cáncer cérvico-uterino. Para la recolección de la información se revisaron las historias clínicas, tarjetas de citodiagnóstico y se aplicó una encuesta. Para el análisis de los resultados se utilizaron distribuciones de frecuencias absolutas y relativas (porcentajes). Resultados: el 80,39 por ciento tenía algún hábito tóxico, predominó el consumo de cigarrillos con el 41,17 por ciento, el 33,33 por ciento presentó infección por virus papiloma humano, El 23,53 por ciento se practicó abortos, el 17,64 por ciento fueron instrumentados, el síntoma predominante fue dispareunia en 47,05 por ciento, el 88,24 por ciento de las mujeres fueron diagnosticadas en la etapa adulta, el 92,15 por ciento posee desconocimiento sobre el cáncer cérvico-uterino, de ellas el 58,82 por ciento con conocimientos regulares y el 33,33 por ciento malos. Conclusiones: predominaron los factores de riesgo: hábitos tóxicos como tabaquismo; infecciones vaginales, práctica de abortos y dispareunia, el diagnóstico de la enfermedad en etapa adulta e insuficiente nivel de conocimientos sobre la misma(AU)

Introduction: uterine cancer is second to breast cancer as it affects women with the highest frequency, and its cure depends on early diagnosis. Objective: to identify the level of knowledge and risk factors predisposing Cumanayagua women to cervical-uterine cancer. Methods: descriptive cross-sectional study at Cumanayagua Polyclinic during the year 2013. The target group consisted of 51 women at ages 25-59 years and with cervical-uterine cancer. To gather the information, we reviewed the clinical and cytodiagnosis records and conducted a survey. To analyze the results, we used absolute and relative (percentages) frequencies. Results: 80.39 percent had toxic habits, cigarettes consumption predominated (41.17 percent). 33.33 percent presented human papillomavirus infection. 23.53 percent had practiced abortion, out of which 17.64 percent were instrumented. Dyspareunia was the predominating symptom in 47.05 percent. 88.24 percent of the women were diagnosed in adult age. 92.15 percent have any lack of knowledge on cervical-uterine cancer, 58.82 percent out of which with regular knowledge and 33.33 percent with bad. Conclusions: Among the predominating risk factors are toxic habits, such as smoking; vaginal infections, abortion and dyspareunia, the diagnosis of the disease in the adult age and insufficient level of knowledge about the topic(AU)

Nivel de conocimientos y factores de riesgo predisponentes de cáncer cérvico-uterino en mujeres de Cumanayagua / Level of knowledge and risk factors predisposing Cumanayagua women to cervical-uterine cancer

Introducción: el cáncer de útero es, después del de mama, el que con más frecuencia afecta a la mujer, y su cura depende del diagnóstico precoz. Objetivo: identificar el nivel de conocimientos y factores de riesgo predisponentes de cáncer cérvico-uterino en mujeres de Cumanayagua. Métodos: estudio descriptivo de corte transversal, en el Policlínico de Cumanayagua durante el año 2013. El universo estuvo constituido por 51 mujeres entre 25 y 59 años de edad, con cáncer cérvico-uterino. Para la recolección de la información se revisaron las historias clínicas, tarjetas de citodiagnóstico y se aplicó una encuesta. Para el análisis de los resultados se utilizaron distribuciones de frecuencias absolutas y relativas (porcentajes). Resultados: el 80,39 por ciento tenía algún hábito tóxico, predominó el consumo de cigarrillos con el 41,17 por ciento, el 33,33 por ciento presentó infección por virus papiloma humano, El 23,53 por ciento se practicó abortos, el 17,64 por ciento fueron instrumentados, el síntoma predominante fue dispareunia en 47,05 por ciento, el 88,24 por ciento de las mujeres fueron diagnosticadas en la etapa adulta, el 92,15 por ciento posee desconocimiento sobre el cáncer cérvico-uterino, de ellas el 58,82 por ciento con conocimientos regulares y el 33,33 por ciento malos. Conclusiones: predominaron los factores de riesgo: hábitos tóxicos como tabaquismo; infecciones vaginales, práctica de abortos y dispareunia, el diagnóstico de la enfermedad en etapa adulta e insuficiente nivel de conocimientos sobre la misma(AU)

Introduction: uterine cancer is second to breast cancer as it affects women with the highest frequency, and its cure depends on early diagnosis. Objective: to identify the level of knowledge and risk factors predisposing Cumanayagua women to cervical-uterine cancer. Methods: descriptive cross-sectional study at Cumanayagua Polyclinic during the year 2013. The target group consisted of 51 women at ages 25-59 years and with cervical-uterine cancer. To gather the information, we reviewed the clinical and cytodiagnosis records and conducted a survey. To analyze the results, we used absolute and relative (percentages) frequencies. Results: 80.39 percent had toxic habits, cigarettes consumption predominated (41.17 percent). 33.33 percent presented human papillomavirus infection. 23.53 percent had practiced abortion, out of which 17.64 percent were instrumented. Dyspareunia was the predominating symptom in 47.05 percent. 88.24 percent of the women were diagnosed in adult age. 92.15 percent have any lack of knowledge on cervical-uterine cancer, 58.82 percent out of which with regular knowledge and 33.33 percent with bad. Conclusions: Among the predominating risk factors are toxic habits, such as smoking; vaginal infections, abortion and dyspareunia, the diagnosis of the disease in the adult age and insufficient level of knowledge about the topic(AU)

Conocimientos, actitudes y prácticas sobre virus del papiloma humano, cáncer cérvico uterino y prevención / Knowledge, attitudes and practices on human papilloma virus, cervical cancer and prevention

Objetivo: Explorar los conocimientos, actitudes y prácticas ante el cáncer cervicouterino (CCU), el virus del papiloma humano (VPH) y sus formas de prevención entre las mujeres de 25 a 64 años de edad en el Salvador. Métodos: Se llevó a cabo un estudio descriptivo de corte transversal mediante una encuesta poblacional en una muestra probabilística y representativa de 838 mujeres de áreas urbanas y rurales de los departamentos de Santa Ana y Sonsonate. Se aplicó un cuestionario estructurado con 84 preguntas mayoritariamente cerradas o semi-abiertas, este cuestionario fue validado por expertos de la Unión Internacional de Cáncer Control...

Objective: To explore the knowledge, attitudes and practices of Salvadorian women between the ages of 25 and 64 regarding cervical uterine cancer, human papillomavirus (HPV) and their prevention. METHODS: We carried out a cross-sectional descriptive study by conducting a population survey with a probabilistic and representative sample of 838 women in urban and rural areas of the departments of Santa Ana and Sonsonate. We administered a structured survey that was previously validated by experts fron the Union for International Cancer control (IUCC). The questionaire consisted of 84 primarily closed and semi-open questions...

Aplicabilidad del análisis por causa múltiple de muerte para el cáncer cervicouterino: la experiencia en México / Applicability of the analysis by multiple cause of death by cervical cancer: the experience in Mexico

Objecto. Explora-se a aplicabilidad da análise por causa múltipla de morte para o estudo do cancro cervicouterino. Métodos. Desenho de mortalidade proporcional para analisar todas as causas consignadas na totalidade dos certificados de morte por cancro cervicouterino de mulheres maiores de 18 anos do Estado de México (367), e 515 certificados de mulheres falecida por outras causas. Resultados. Encontrou-se uma razão de causa básica/múltipla de 2.9 nos certificados de morte, isto é pela cada causa básica encontraram-se 2.9 As mulheres falecidas por cancro cervicouterino morrem cinco anos dantes que as que morrem por outras causas (p<0.05). Ao ajustar as análise por causa múltipla para cancro cervicouterino por idade, escolaridad, estado civil, e direito habiencia, destaca a participação dos tumores malignos de lugares mau definidos como causas contribuintes e condicionantes [OR=14.24 (1.67-121.0) e OR=18.98 (2.28-157.56, respectivamente]; seguido pela diabetes mellitus também como contribuintes e sócias [OR=1.82 (1.02-3.27) e OR=7.78(1.46-41.37)] e a hipertensión arterial sistémica como causa sócia [OR = 3.0 (1.39-6.47)]. Conclusões. Causa múltipla é uma análise adequada para observar as doenças que intervêm, contribuem, condicionan e se associam ao cancro cervicouterino no momento da morte.

Objective. The study explores the applicability of the multiple-cause-of-death analysis for cervical-uterine cancer. Methods. A proportional mortality hazard design and the analysis of all causes of death due to cervical-uterine cancer from 367 death certificates of women older than 18 years of age from the State of Mexico, and 515 age and year adjusted sample of death certificates of women from the same region who died from other causes. Results. A basic multiple cause of death of 2.9 was observed in the death certificates, i.e., for every basic cause there were 2.9 multiple causes. When adjusting the multiple-causes-of-death analysis for cervical-uterine cancer by age, education, marital and insurability status, the most contributing and associated causes of death were malignant tumors from unspecified sites [OR=18.98 (2.28-157.56) and OR=14.25 (1.67-121.0)] respectively; Diabetes Mellitus as a contributing [OR=1.82 (1.02-3.27) and associated cause [OR=7.78 (1.46-41.37], and systemic arterial hypertension as an associated cause [OR=3.00 (1.40-6.47)]. Conclusions. The multiple-cause-of-death analysis is an adequate to observe the diseases that contribute condition and are associated to the cervical-uterine cancer.