Human papillomavirus in cervical cancers of Malaysians.

AIM: With cervical carcinoma remaining the second leading cancer among Malaysian women, it is imperative to clarify the prevalence of human papillomavirus (HPV) in this respect, considering the dearth of local information. MATERIAL AND METHODS: Formalin-fixed, paraffin-embedded (FP) tissues of 29 invasive cervical carcinoma cases, diagnosed between 1 January 1991 and 31 December 1992, fresh, frozen (FF) and paired FP tissues of 43 cases diagnosed between 1 January 1995 and 31 December 2000, and 21 FF normal control cervices were subjected to polymerase chain amplification (PCR) for HPV following successful amplification of a 268 bp ß-globin fragment using primers specific for HPV types 6, 11, 16 and 18 and consensus L1 ORF (MY09/11). RESULTS: HPV was detected in 69.0% of the cases diagnosed in the earlier, 88.4% of those in the later period and 4.8% of the normal control cervices. HPV 16 formed 80.0% of the HPV types in the earlier and 55.3% in the later period, while HPV 18 formed 5% in the earlier and 13.2% in the later. HPV 16 was more common in squamous (56.4%) than adeno/adenosquamous carcinomas (35.3%), while HPV 18 was detected in 17.6% of adeno/adenosquamous and 5.5% squamous carcinomas. CONCLUSION: HPV prevalence in invasive cervical carcinoma of Malaysians is similar to that observed worldwide. Together, HPV 16 and 18 constituted 85% of the HPV types responsible for cervical carcinogenesis in Malaysians in the earlier and 68% in the later period. Thus, the use of current vaccines should lower cervical carcinoma rate significantly.

Third S. S. Ratnam memorial lecture 2007. Ovarian cancer: Is there hope for women?

Ovarian cancer is today the most lethal female cancer with an overall survival of only 49.9%. The currently available screening modalities are disappointing in detecting highly curable early stage ovarian cancer. Natural history of ovarian cancer is unknown; it appears it can develop quickly from normal looking ovaries. Timely referral of women with non-specific symptoms (such as abdominal bloating, pelvic pain) for an ultrasound scan or blood CA125 assessments may help in the early diagnosis. Patients with Stage IA or IB disease with grade 1 tumors have a cure rate of >90%; this is likely to be compromised by laparoscopic surgery. In selected patients fertility preservation with good obstetric outcome is possible. However, the relapse rate in 'high risk' early stage ovarian cancers is 40-45%; adjuvant chemotherapy is needed. Only 20-25% of those with stage III and IV disease are cured. Despite a high primary response (70%) majority (70-75%) will relapse and all are likely to succumb. Optimal debulking surgery followed by adjuvant chemotherapy are needed for stages III and IV disease; the outcome is superior if managed by gynecologic oncologists. Where cost of drugs is an important consideration, an alternative is carboplatin (an affordable and equally effective drug). The role of vaccines needs further study. When relapses occur palliation will be the aim in most instances. Oral contraceptives, breast feeding, tubal sterilization and hysterectomy also have a protective effect. Risk-reducing salpingo-oopherectomy has been suggested in women with BRCA mutations.