scholarly journals Surgical candidacy and treatment uptake among women with cervical cancer at public referral hospitals in Kampala, Uganda

2020 ◽  
Author(s):  
Megan L Swanson ◽  
Miriam Nakalembe ◽  
Lee-may Chen ◽  
Stefanie M Ueda ◽  
Jane Namugga ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Early Stage ◽  
Locally Advanced ◽  
Phone Call ◽  
Treatment Recommendation ◽  
Advanced Stage ◽  
Multivariate Statistical ◽  
Recommended Treatment ◽  
Treatment Uptake ◽  
Referral Hospitals

AbstractPurposeCervical cancer is the most common malignancy among women in Uganda. Most present with advanced disease, when hysterectomy is not possible and cure is less likely. This study reports the proportion recommended for hysterectomy and associated factors, recommended treatments by stage, and treatment uptake.MethodsWe conducted a prospective study among patients seeking care for cervical cancer at public referral hospitals in Uganda. In-person surveys were followed by a phone call. Descriptive and multivariate statistical analyses examined associations between predictors and outcomes.ResultsAmong 268 participants, 76% were diagnosed at an advanced stage (IIB-IVB). In total, 12% were recommended for hysterectomy. In adjusted analysis, living within 15 kilometers of Kampala (OR 3.10, 95% CI 1.20-8.03) and prior screening (OR 2.89, 95% CI 1.22-6.83) were significantly associated with surgical candidacy. Radiotherapy availability was not significantly associated with treatment recommendations for early-stage (IA-IIA) disease, but was associated with recommended treatment modality (chemo-radiation versus primary chemotherapy) for locally advanced stage (IIB-IIIB). Most (67%) had started treatment. No demographic or health factor, treatment recommendation, or radiation availability was associated with treatment initiation. Among those recommended for hysterectomy, 55% underwent surgery. Among those who had initiated treatment, 82% started the modality that was actually recommended.ConclusionWomen presented to public referral centers in Kampala with mostly advanced-stage cervical cancer and few were recommended for surgery. Lack of access to radiation did not significantly increase the proportion of early-stage cancers recommended for hysterectomy.

scholarly journals Surgical candidacy and treatment initiation among women with cervical cancer at public referral hospitals in Kampala, Uganda: a descriptive cohort study

BMJ Open ◽  
2020 ◽  
Vol 10 (12) ◽  
pp. e039946
Author(s):  
Megan Swanson ◽  
Miriam Nakalembe ◽  
Lee-may Chen ◽  
Stefanie Ueda ◽  
Jane Namugga ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Cohort Study ◽  
Treatment Initiation ◽  
Early Stage ◽  
Treatment Recommendation ◽  
Secondary Outcome ◽  
Advanced Stage ◽  
Early Stage Disease ◽  
Referral Hospitals ◽  
New Diagnosis

ObjectivesThis study aimed to report the proportion of women with a new diagnosis of cervical cancer recommended for curative hysterectomy as well as associated factors. We also report recommended treatments by stage and patterns of treatment initiation.DesignThis was an observational cohort study. Inperson surveys were followed by a phone call.SettingParticipants were recruited at the two public tertiary care referral hospitals in Kampala, Uganda.ParticipantsAdult women with a new diagnosis of cervical cancer were eligible: 332 were invited to participate, 268 met the criteria and enrolled, and 255 completed both surveys.Primary and secondary outcomes measuresThe primary outcome of interest was surgical candidacy; a secondary outcome was treatment initiation. Descriptive and multivariate statistical analyses examined the associations between predictors and outcomes. Sensitivity analyses were performed to examine outcomes in subgroups, including stage and availability of radiation.ResultsAmong 268 participants, 76% were diagnosed at an advanced stage (IIB–IVB). In total, 12% were recommended for hysterectomy. In adjusted analysis, living within 15 km of Kampala (OR 3.10, 95% CI 1.20 to 8.03) and prior screening (OR 2.89, 95% CI 1.22 to 6.83) were significantly associated with surgical candidacy. Radiotherapy availability was not significantly associated with treatment recommendations for early-stage disease (IA–IIA), but was associated with recommended treatment modality (chemoradiation vs primary chemotherapy) for locally advanced stage (IIB–IIIB). Most (67%) had started treatment. No demographic or health factor, treatment recommendation, or radiation availability was associated with treatment initiation. Among those recommended for hysterectomy, 55% underwent surgery. Among those who had initiated treatment, 82% started the modality that was recommended.ConclusionWomen presented to public referral centres in Kampala with mostly advanced-stage cervical cancer and few were recommended for surgery. Most were able to initiate treatment. Lack of access to radiation did not significantly increase the proportion of early-stage cancers recommended for hysterectomy.

Increased Cyclooxygenase-2 Expression Is Associated With Chemotherapy Resistance and Poor Survival in Cervical Cancer Patients

2002 ◽  
Vol 20 (4) ◽  
pp. 973-981 ◽  
Author(s):  
G. Ferrandina ◽  
L. Lauriola ◽  
M. G. Distefano ◽  
G. F. Zannoni ◽  
M. Gessi ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Cancer Patients ◽  
Early Stage ◽  
Locally Advanced ◽  
Neoadjuvant Treatment ◽  
Rabbit Antiserum ◽  
Immunohistochemical Analysis ◽  
Response To Treatment ◽  
Advanced Stage ◽  
Cox 2

PURPOSE: To investigate the expression of cyclooxygenase (COX-2) and its association with clinicopathologic parameters and clinical outcome in patients with cervical cancer. PATIENTS AND METHODS: The study included 84 patients with stage IB to IVA cervical cancer. Patients with early-stage cases (n = 21) underwent radical surgery, whereas patients with locally advanced cervical cancer (LACC) (n = 63) were first administered neoadjuvant cisplatin-based treatment and subjected to surgery in case of response. Immunohistochemical analysis was performed on paraffin-embedded sections with rabbit antiserum against COX-2. RESULTS: COX-2–integrated density values in the overall population ranged from 1.2 to 82.3, with mean ± SE values of 27.4 ± 2.4. According to the chosen cutoff value, 36 (42.9%) of 84 patients were scored as COX-2 positive. COX-2 levels were shown to be highly associated with tumor susceptibility to neoadjuvant treatment. COX-2 showed a progressive increase from mean ± SE values of 19.9 ± 8.0 in complete responders through 31.5 ± 3.5 in partial responses to 44.8 ± 3.9 in patients who were not responsive (P = .0054). When logistic regression was applied, only advanced stage and COX-2 positivity retained independent roles in predicting a poor chance of response to treatment. COX-2–positive patients had a shorter overall survival (OS) rate than COX-2–negative patients. In patients with LACC, the 2-year OS rate was 38% in COX-2–positive versus 85% in COX-2–negative patients (P = .0001). In the multivariate analysis, only advanced stage and COX-2 positivity retained independent negative prognostic roles for OS. CONCLUSION: The assessment of COX-2 status could provide additional information to identify patients with cervical cancer with a poor chance of response to neoadjuvant treatment and unfavorable prognosis.

Premalignant and malignant disease of the cervix

2020 ◽  
pp. 766-776
Author(s):  
Walter Prendiville
Keyword(s):  
Cervical Cancer ◽  
Ovarian Function ◽  
Early Stage ◽  
Locally Advanced ◽  
Developed Countries ◽  
High Coverage ◽  
Hpv Dna ◽  
Gynecology And Obstetrics ◽  
Cervical Stroma ◽  
Specialist Nurses

Cervical cancer is a disease of poor and unscreened populations. Globally, it is the fourth most common cancer in women with over half a million new cases and over a quarter of a million deaths per year. About 85% of cases occur in less developed regions. Systematic high coverage and quality-assured population screening for precursors to cervical cancer is highly effective. Human papillomavirus (HPV) DNA testing will probably replace or complement cytology as the primary screening tool in many developed countries for women over 30 years of age. Because of the absolute relationship between oncogenic HPV and cervical cancer, its negative predictive value is very high. Management of cervical cancer is to determine the stage of the disease and to treat both the primary lesion and other extracervical disease. Cervical cancers spread by direct spread into the cervical stroma, parametrium, and beyond, and by lymphatic metastasis into parametrial, pelvic sidewall, and para-aortic nodes. Women should be fully staged using the International Federation of Gynecology and Obstetrics system and discussed in expert multidisciplinary forums with specialist surgeons, oncologists, pathologists, radiologists, and specialist nurses. Both surgery and radiotherapy are effective in early-stage disease, whereas locally advanced disease relies on treatment by radiation or chemoradiation. Surgery does provide the advantage of conservation of ovarian function. Women who have been treated for cervical precancer are much more likely to develop cervical cancer. Post-treatment HPV testing is the most sensitive test, has the best negative predictive values, and is the best test of cure.

Expression of immune cell markers and tumor markers in patients with cervical cancer

2020 ◽  
Vol 30 (7) ◽  
pp. 969-974
Author(s):  
Liming Zhang ◽  
Hui Zhang ◽  
Yuheng Huang ◽  
Xiaowei Xi ◽  
Yunyan Sun
Keyword(s):  
Cervical Cancer ◽  
Squamous Cell Carcinoma ◽  
Cell Carcinoma ◽  
Carcinoembryonic Antigen ◽  
Tumor Markers ◽  
Squamous Cell ◽  
Early Stage ◽  
Locally Advanced ◽  
Control Group ◽  
Healthy Women

ObjectiveCervical cancer is one of the most common cancers worldwide, and immune function may impact disease progression. Serum markers may also be associated with diagnosis and progression. The aim of this study was to explore the clinical usefulness of determining the levels of peripheral blood immune cells and serum tumor markers in predicting diagnosis and prognosis of patients with cervical cancer.Methods82 patients with cervical cancer (early stage group: IA–IB1 and IIA1; locally advanced group: IB2 and IIA2), 54 patients with cervical intra-epithelial neoplasia (CIN), and 54 healthy women (control group) were recruited. Inclusion criteria were: (1) patients whose cervical lesions were determined based on biopsy; and (2) patients who had not undergone immunotherapy, chemotherapy, or radiotherapy. The exclusion criteria were as follows: (1) patients with a history of other malignant tumors; (2) patients with heart, kidney, and other organ failure; (3) patients with immune diseases; and (4) pregnant or lactating women. The levels of immunocytes and tumor markers were assayed. The relationships among histopathologic factors were analyzed. The correlation between the levels of immunocytes and tumor markers in patients with different degrees of cervical lesions (pre-invasive or cancer) and healthy women was evaluated.ResultsThe squamous cell carcinoma antigen and carcinoembryonic antigen levels in the control group and the CIN group were significantly lower than those in the cervical cancer groups (p<0.01). The incidence of lymph node metastasis in the early stage and locally advanced groups were 22.9% (11/48) and 46.2% (12/26), respectively, and 58.8% (20/34) and 7.5% (3/37) in the positive and negative lymphovascular invasion groups, respectively (p<0.05). The levels of CD8+ and CD8+ CD28+ T cells in the early stage group were markedly lower than those in the CIN group and the control group (p=0.014, p=0.008, respectively). The ratio of CD4+CD25+/CD4+ in the cervical cancer groups was significantly higher than in the control group (p<0.01). The increased serum squamous cell carcinoma and carcinoembryonic antigen levels and CD4+CD25+/CD4+ ratio were risk factors for cervical cancer by logistic regression analysis (p<0.05).ConclusionsIn patients with cervical cancer, immune function was impaired compared with that in healthy women and patients with CIN, while squamous cell carcinoma and carcinoembryonic antigen levels were increased. Combined detection of the levels of peripheral blood immune cells and serum tumor markers may be helpful for early detection, diagnosis, and prognosis evaluation of patients with cervical cancer.

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