Cervical Cancer

On the other hand, even when a well organised and technically feasible screening programme is in place, uptake rates can be very low. A study performed in Thailand on the feasibility and acceptability of a VIA screening programme reported that even after intensive information campaigns the uptake of screening was only 17% among eligible women (RTOCG 2003). Reasons for this low uptake were not given. Another factor contributing to low uptake of screening services may be the low priority given to seeking health care for symptoms related to cervical cancer (Holroyd et al 2004, Singh et al 1998).

A bilingual questionnaire was sent to 1500 secondary school teachers from 20 urban schools in Malaysia; 1166 completed questionnaires were returned. From this group, 46.1% had never heard of HPV while 50.9% had never had a Pap smear. However, 73.8% have heard of the HPV vaccine with 75% of them agreeing to have it. Almost all (96%) considered themselves religious with 79.8% of them agreeing to have the vaccine. The highest factors that influence the teachers’ decision to accept the vaccine was the safety of the vaccine (84%). Other factors that affected the acceptance were its risk (55.4%), effectiveness (55%) and doctor’s advice (54.4%). Less than half (35.8%) considered the ‘halal-ness’ of the vaccine as a factor. Only 145 (12.7%) teachers felt they have enough knowledge to counsel parents, and 670 (58.7%) felt they did not have enough knowledge to do so. Majority of the teachers (n=1104; 96.8%) felt they needed to be given more information about the vaccine. Almost all (n=1077; 94.6%) of the teachers felt the government should provide more information to educate the public about cervical cancer and the vaccine. Many (n=822; 72.3%) teachers would encourage their students to take this vaccine and 781 (68.5%) teachers would be comfortable discussing the vaccine with their students/parents. Some (n=291; 25.5%) were unsure. This review concluded that a national school-based HPV immunisation program can be implemented effectively in a multiethnic, cultural and religious country despite limited knowledge of HPV-related pathology among teachers 38 . The focus group discussion of 47 participants

adhesion molecule family and is also known as platelet endothelial cell adhesion molecule-1 (PECAM-1) or endothelial cell adhesion molecule (endoCAM-1). It plays a key role in removing aged neutrophils from the body. CD31 has been used to measure angiogenesis, which reportedly predicts tumor recurrence. Micro Vascular Density (MVD) is assumed to reflect the intensity of tumor angiogenesis; indeed, it has been established as a good indicator of prognosis in several cancer types. If validated, CD31 MVD has the potential to identify a group of women who are less likely to benefit from standard adjuvant chemoradiotherapy and might be better served with neoadjuvant chemotherapy and surgery, with a new radiosensitizing regimen like cisplatin and tirapazamine or an anti-angiogenesis drug like bevacizumab which exhibited single-agent activity in recurrent cervical cancer 35, 38 .

ABSTRACT: The healthcare analytics in big data are developing towards digitization of medical records, as pharmaceutical companies and other organization has been researched towards the development of data in electronic database. In healthcare cervical cancer is one among the leading cancer worldwide and also the most typical in developing countries, if it is detected in early stages it is easy to determine which stage it belongs and correct treatment has given in time. The cervical cancer data are in the form of “big data,” and the big data is not only for its volume but for its variety, velocity. In this paper, various techniques for detecting cervical cancer such as penalized matrix decomposition (PMD), nonnegative matrix factorization (NMF), meta sample based SR classification (MSRC), tumor classification based on correlation filters and gene co-expression network have been discussed.

Colombia is currently considering the introduction of HPV vaccination in girls as a measure to improve the prevention and control of cervical cancer. One impor- tant barrier for HPV vaccination in middle income countries is the current price of available HPV vaccines. Goldie et al (2007) has shown that for an average Latin American country prices above USD$50 per vaccine dose are hard to be affordable though vaccination would be cost effective [20]. Other aspect to consider is whether a booster of vaccine is needed to meet the goal of cervical cancer reduction. If vaccine boosters are needed then the cost effectiveness ratio of vaccines would become less attractive. Once vaccine prices become more affordable, a combination of universal vaccination and strengthening of the cervical cancer screening program would become the ideal health policy to control cervical cancer.

Resveratrol is a polyphenol found in the seeds and skins of grapes, red wine, mulberries, and peanuts. It is demonstrated to inhibit proliferation and induce autophagy and apoptotic death in cervical cancer cells. Hence, the study suggested that resveratrol inhibits NF-kB and AP-1 transactivation suppressing the transcription of MMP-9, leading to suppression of migration and invasion of cervical cancer cells [58]. Ruthenium (Ru) complexes were showed cytotoxic and anti- proliferative effects in different human cancers and also exert lower systemic toxicity in vivo as compared to platinum drugs [65]. It seems to be the most promising among the several metals investigated [66]. Lower systemic toxicity has been accredited to the unique ability of Ru compounds to preferably act on cancer cells. Ru complexes in principle may exhibit anticancer activity and toxic side-effects markedly different from that of Pt drugs. Ru complexes are emerging as most promising anticancer drugs in preclinical development in comparisons to other transition metal group and two complexes NAMI-A and KP1019 are currently in clinical trials. Thus, studies demonstrate that anticancer property of these two complexes was due to induction of apoptosis through p53 mediated pathway as well as the arrest of cells in the G2/M phase of cell cycle [65].

However, the study has some limitations. First, the study’s results are limited by its retrospective design and the fact that the data are from a single institution, and we cannot exclude the possibility that other factors correlated with survival. Secondly, older people are less likely to get chemo than younger women, and are obviously less likely to have hematologic toxicities. Thus, that may possibly introduce more bias and skew results. Finally, decreased immunity due to aging should be discussed, as it is highly relevant to the target population. Therefore, further research about older patients with cervical cancer should be undertaken in the future.

Human pathogenic papillomaviruses (HPV) came into the picture many decades later, when in the 1970s Harald zur Hausen focused attention on the family of papillomaviruses which were well documented as etiologically implicated in benign tumors (warts, condylomata acuminata) and malignancies of animals, such as rabbits. The role of these viruses in the development of tumors was confirmed by the discovery of characteristic papillomavirus particles in the coilocytes pathognomonic for preneoplastic cervical lesions. After it had been shown that there is not only one human papillomavirus (formerly known as "wart virus") but in fact a heterogeneous group – today we are aware of more than 100 human pathogenic representatives (the so-called HPV types) – experimental strategies were developed to search for related viruses (2). These investigations led to the identification of the first mucosotropic papillomaviruses (HPV 6 and 11) and the HPV 16 and 18 subsequently classified as the prototypes of human pathogenic high risk papillomaviruses, which together are responsible for around 70% of cases of cervical cancer worldwide (squamous and adenocarcinomas).

Cervical carcinogenesis consists of natural occurring spontaneous cellular processes which may lead to self-organized dissipative structures of cervical cancers what was first explained in 1977 after several years of my biochemical, biophysical, hormonal and clinical studies. That was possi- ble thanks to monograph “Biochemie der Tumoren” written in 1942 by Nobel Prize winner H. von Euler with my master Prof. B. Skarzynski. Today I express my gratitude to Nobelist Harald zur Hausen and his team for they discovered the nuclide sequences of HPV in genomes of cervical cancer cells which opened the possibility to describe the causal role of information in formula of reality. Vaccines built from the protein capsid of HPV have proved only the pathogenic informa- tion about the virus because of its lack of DNAs. All the theories of carcinogenesis have properly described this event from methodologically different point of view. The point is that one should understand the thermodynamic rules underlying each of these approaches. Neoplasms are self-or- ganized from the cells of the patient, who did not provide the necessary conditions for cellular metabolism as defined in the moment of appearance of its zygote. In light of medical thermody- namics all oncogenic factors can divide into sufficient or necessary to events for creating a dissi- pathogenic cellular status. Cervical cancer is a tumor associated with the human papillomavirus as only its pathogenic dissipathogenic factors, but the genome of cervical carcinoma cells maybe the original source of many types of HPV from the peeled off cancer cells of the uterine cervix. Many things are known to increase the risk of carcinogenesis which as a natural process is an alterna- tive of cellular or social death. Neoplasm cell is an effect of carcinogenesis, but not a causal point at which it begins its existence.

Florence’s story is a familiar one in South Africa, where cervical cancer is the most common cancer among women of African descent but the fourth most-common cancer among white women. The country’s screening policies have largely failed. In the 1970s, the health department recommended the use of Pap smears only when the cervix looked abnormal—a course of action that held particular problems, since cervical abnormalities that can be observed without the help of a vinegar or iodine solution tend to indicate advanced cancer. Screening services suffered further in the 1980s, when officials determined that the country faced other, more urgent health challenges than cervical cancer. Today, services remain variable throughout the coun- try. A policy to provide women over age 30 with three free Pap smears, 10 years apart, has not been successfully implemented.

Objective. To describe the incidence, mortality, time trends and prognostic factors for cervical cancer in Cali, Colombia, and to review the molecular epidemiological evidence show- ing that HPV is the major and necessary cause of cervical cancer and the implications of this discovery for primary and secondary prevention. Materials and methods. Incidence rates of cervical cancer during a 45-year period (1962-2007) were estimated based on the population-based cancer reg- istry of Cali and the mortality statistics from the Municipal Health Secretariat of Cali. Prognostic factors were estimated based on relative survival. Review of the molecular epidemio- logical evidence linking HPV to cervical cancer was focused on the studies carried out in Cali and in other countries. Results. Incidence rates of squamous cell carcinoma (SCC) declined from 120.4 per 100 000 in 1962-1966 to 25.7 in 2003-2007 while those of adenocarcinoma increased from 4.2 to 5.8. Mortality rates for cervical cancer declined from 18.5 in 1984-1988 to 7.0 per 100 000 in 2009-2011. Survival was lower in women over 65 years of age and in clinical stages 3-4. Review of the molecular epidemiological evidence showed that certain types of HPV are the central and neces- sary cause of cervical cancer. Conclusions. A decline in the incidence and mortality of SCC and an increase in the incidence of adenocarcinoma during a 45-year period was documented in Cali, Colombia.

For 2009, the CC was the second most common cancer in women worldwide with 86% of cases and 88% of deaths in developing countries and is the leading cause of years of life lost (cancer) between women in Latin America and the Caribbean [2]. The use of conventional Pap smear has reduced mortality from cervical cancer in developed countries [3] when is applied in organized screening programs as when a large propor- tion of women screened in a timely manner [4]. This has not been the case in Latin America, where despite the availability of the Pap test, a lot of women die each year from CC. It has been shown that even with adequate quality control, conventional cy- tology has an average sensitivity of 53% (95% CI: 48.6% - 57.4%) in Europe and the United States [5].

case-control study designed to evaluate the feasi- bility and efficacy of robotic-assisted laparoscopic radical hysterectomy and bilateral pelvic lymph node dissection for early cervical cancer was reported in 7 consecutive patients, compared to 8 patients treated with conventional total laparo- scopic radical hysterectomy. 10 There were no statistically significant differences observed in the 2 groups in regards to operation time (241 vs 300 minutes), number of lymph nodes, and length of resected parametrial tissue, whereas significantly less bleeding (71 vs 160 mL) and shorter hospital stay (4 vs 8 days) were described in the robotic- assisted group (p < 0.05).

Cervical cancer is one of the few cancers with an available routine screening test (Canadian Cancer Society’s Steering Committee on Can- cer Statistics, 2009). The Papanicolaou (Pap) test is the primary screening tool for cervical cancer and has resulted in the drastic drop in cervical cancer rates in the last few decades. The Pap test looks at a sample of cervical cells to detect cancer as well as abnormal (pre- cancer ous) changes. Early detection through screen ing means precancerous cells can be monitored and cervical cancer can be treated. Generally a doctor or a nurse practitioner performs a Pap test, but this may vary by province.

Cervical carcinoma is the most common genital cancer in India and a leading cause of cancer-associated deaths, but the success of large-scale screening programs with the Pap test and the associated reduction in invasive cancer has been well described in developed nations. We determined the level of knowledge of cervical cancer, awareness, and attitude toward the cervical screening program in Chennai. Between April 1, 2014, and April 31, 2015, we studied the knowledge, awareness, and attitude of patients at Sree balaji medical college and hospital,Chromepet,Chennai, tertiary institution concerning cervical cancer and screening methods using a self-administered questionnaire. Of the 255 patients surveyed, data were complete in 238 (93.3%); 112 (47.1%) had heard of cervical cancer, while 94 (39.5%) knew about the Pap test, with health professionals being their most frequent source of information. Fifty-nine (24.9%) had had a prior Pap test, while after counseling on cervical cancer and the screening methods, 213 (89.5%) were ready for routine periodic screening if given the opportunity. Nineteen (8%) would still refuse due to various reasons, and six (2.5%) were not sure. Age and marital status did not influence their knowledge, but the level of education and occupation were found to positively influence their knowledge of cervical cancer and their acceptance of the Pap test. This study shows repeated counseling, being compassionate to the patients and maintaining their privacy will encourage more number of patients to undergo screening procedures, so as to reverse the morbidity and mortality associated with cervical cancer.

In general, all women with locally advanced cervical cancer – International Federation of Gynecology and Obstetrics (FIGO) stage IB2-IVA – should be considered for brachytherapy as part of their definitive treatment management. The initial work-up should include a cervical biopsy for histopathologic diagnosis. As per FIGO recommendations, an examination under anesthesia should be performed to determine clini- cal stage. This includes a pelvic exam, sigmoidoscopy, and cystoscopy. Initial bloodwork should include a complete blood count, basic metabolic panel, liver function tests, and evaluation of renal function. In cases of hydroureter and/ or hydronephrosis from direct tumor extension toward the pelvic sidewall or ureteral obstruction from metastatic lymph- adenopathy, ureteral stents or nephrostomy tube placement may be indicated, to relieve significant obstruction prior to therapy.

HPV type 16 or 18 infections are responsible for approximately 60-80% of all invasive cancers, varying according to the patient ’ s socioeconomic status [6]. Of all new HPV infections, both oncogenic and non-onco- genic type infections last between eight and five months, respectively, and the large majority of initially HPV- infected women show clearance within two years [7]. Pre-invasive surrogate lesions of squamous cervical can- cer would be those of grade II and III, with the lowest potential of regression being that for grade III cervical intra-epithelial neoplasia [8]. Since our patient refused histopathological verification of the first cytological abnormalities in 1993, we were unable to determine whether a single, persistent HPV type 18 infection gave rise to her cervical cancer, which was diagnosed in 2003. The assumption that this was the case is highly likely to be true, since progression from HPV infection to invasive cancer is believed to take place during the course of several years, although we cannot exclude HPV type 18 reinfection after initial clearance. Cervical

In this study, we are the first to report PBK/ TOPK expression in cervical cancer and cervi- cal intraepithelial neoplasia. In order to avoid subjective bias, PBK/TOPK expression was quantitatively evaluated by measuring the PU value. PU value is the protein expression inten- sity of positive cells calculated by Image-Pro Plu image analysis software, and the larger value represents the higher level of protein expression [26, 27]. Therefore, present results indicated that PBK/TOPK highly expressed in cervical cancer and high-grade intraepithelial neoplasia, but is undetectable in CINI. However, PBK/TOPK level in cervical cancer was signifi- cantly higher compared with that in high-grade intraepithelial neoplasia. Moreover, PBK/TOPK has been found to be undetectable in normal cervical tissue [28]. It is well known that low- grade intraepithelial neoplasia (CINI) and high- grade intraepithelial neoplasia have been con- sidered as the precancerous lesion of cervical cancer, which closely associated with the occurrence of cervical cancer [29, 30]. Thus, our results confirm that PBK/TOPK expression is associated with the occurrence of cervical cancer, which may be also involved with the progression of cervical intraepithelial neopla- sia. In addition, the level of PBK/TOPK expres- sion may be beneficial to distinguish high-grade intraepithelial neoplasia and cervical carci- noma.

Given the evidence of bilateral pelvic lymph node involvement, even in the setting of isolated tumor cells, one would be inclined to offer immediate adjuvant therapy in the form of radiation and chemotherapy after termination of pregnancy—highlighting the fact that, at this time, there is no standard recommendation as to the conduct to be followed when finding isolated tumor cells in the setting of early cervical cancer. However, since the patient wished to maintain her pregnancy, one potential option is the consideration of chemotherapy alone until fetal maturity is reached, and then offering definitive treatment. If consid- ering such an approach, a cisplatin-containing regimen such as cisplatin (50 mg/m 2 ) and paclitaxel (175 mg/m 2 ), with a plan for

Abstract: Standard treatment of cervical cancer (CC) consists of surgery in the early stages and of chemoradiation in locally advanced disease. Metastatic CC has a poor prognosis and is usually treated with palliative platinum-based chemotherapy. Current chemotherapeutic regimens are associated with significant adverse effects and only limited activity, making identification of active and tolerable novel targeted agents a high priority. Angiogenesis is a complex process that plays a crucial role in the development of many types of cancer. The dominant role of angiogenesis in CC seems to be directly related to human papillomavirus-related inhibition of p53 and stabilization of hypoxia-inducible factor-1α. Both of these mechanisms are able to increase expression of vascular endothelial growth factor (VEGF). Activation of VEGF promotes endothelial cell proliferation and migration, favoring formation of new blood ves- sels and increasing permeability of existing blood vessels. Since bevacizumab, a recombinant humanized monoclonal antibody binding to all isoforms of VEGF, has been demonstrated to significantly improve survival in gynecologic cancer, some recent clinical research has explored the possibility of using novel therapies directed toward inhibition of angiogenesis in CC too. Here we review the main results from studies concerning the use of antiangiogenic drugs that are being investigated for the treatment of CC.