[CERVICAL CANCER REHABILITATION: A PROSPECTIVE STUDY].

Aim - to evaluate the rehabilitation program impact on the quality of life of оncogynecological patients and to introduce this approach in clinical practice. The study included93 reproductive-aged women, who underwent the cervical cancer treatment. Patients were divided into two groups: the experimental group, which received rehabilitation, and the control group. The thrombotic complications risk, lymphatic system condition, cognitive functions and anxiety level were assessed in all patients using special questionnaires, physical examination, and laboratory assessment. The lower limbs lymphedema was observed in 19.1% of cases in the control group and in 2.1% in the experimental group (p <0.05). According to the Moka test data, cognitive impairment level at the end of the study was 24.02 (17-30, CI: = 22.5-25.54) in the control group and 26.85 (19-30, CI: = 26.0 - 27.64) in the experimental group (p <0.05). The cognitive impairment subjective signs were significantly higher in the control group (p <0.05) as well. The anxiety level at the end of the study was 7.022 (1-19, CI: = 5.91-8.13) in the experimental group and 11.02 (4-22, CI: = 9.83-12.22) in the control group (p <0.05). At the end of the study, the following depression levels were obtained: 12.43 (5 - 21; CI: = 11.23 - 13.64) and 7.69 (1 -14; CI: = 6.77 - 8.62) in the control and the experimental group respectively (p <0.05). At the end of the study, deep vein thrombosis was observed in 21 patients in the control group (44.7%) and 7 patients in the experimental group (15.22%) (p <0.05). One patient from the control group had PATE. According to EORTC QLQ-C30, the quality of life and socialization level was significantly higher in the experimental group, while fatigue level was lower. At the end of the study, 36.2% and 76.0% of patients in the control and the experimental group respectively were employed. The rehabilitation program improves the emotional and cognitive functioning, induced menopause associated somatic disorders, quality of life, and work capacity.

The European Society of Gynaecological Oncology/European Society for Radiotherapy and Oncology/European Society of Pathology Guidelines for the Management of Patients with Cervical Cancer.

BACKGROUND: Despite significant advances in the screening, detection, and treatment of preinvasive cervical lesions, invasive cervical cancer is the fifth most common cancer in European women. There are large disparities in Europe and worldwide in the incidence, management, and mortality of cervical cancer. OBJECTIVE: The European Society of Gynecological Oncology (ESGO), the European Society for Radiotherapy and Oncology (ESTRO), and the European Society of Pathology (ESP) jointly develop clinically relevant and evidence-based guidelines in order to improve the quality of care for women with cervical cancer across Europe and worldwide. METHODS: The ESGO/ESTRO/ESP nominated an international multidisciplinary development group consisting of practicing clinicians and researchers who have demonstrated leadership and expertise in the care and research of cervical cancer (23 experts across Europe). To ensure that the guidelines are evidence based, the current literature identified from a systematic search was reviewed and critically appraised. In the absence of any clear scientific evidence, judgment was based on the professional experience and consensus of the development group. The guidelines are thus based on the best available evidence and expert agreement. Prior to publication, the guidelines were reviewed by 159 international reviewers, selected through ESGO/ESTRO/ESP and including patient representatives. RESULTS: The guidelines cover comprehensively staging, management, and follow-up for patients with cervical cancer. Management includes fertility sparing treatment; stage T1a, T1b1/T2a1, clinically occult cervical cancer diagnosed after simple hysterectomy; early and locally advanced cervical cancer; primary distant metastatic disease; cervical cancer in pregnancy; and recurrent disease. Principles of radiotherapy and pathological evaluation are defined.

Prediction of rehabilitation needs after treatment of cervical cancer: what do late adverse effects tell us?

PURPOSE: Women treated for cervical cancer with radiotherapy and chemotherapy have reported serious bowel, vaginal, and sexual late effects. The purpose of this study was to describe late adverse effects, health-related quality of life, and self-efficacy in a representative Danish cervical cancer population in order to describe rehabilitation needs. METHODS: Women, mean age 55 years, treated for cervical cancer from January 2010 to July 2013, who were alive and without known relapse/metastases were included in this cross-sectional study. EORTC QLQ C30 and CX24 and self-efficacy questionnaires were sent to all participants. RESULTS: The participation rate was 85/107 (79%). Participants below 45 years had significantly more menopausal symptoms and lower body image scores compared to elderly women. The frequency of participants with menopausal symptoms decreased with time since diagnosis. Symptom experience was significantly higher in participants with locally advanced disease than in those with local disease. Self-efficacy was significantly lower in participants with locally advanced disease. The incidence of lymphedema was significantly higher among participants who were obese. Multiple analyses showed impaired quality of life, e.g., a lower body image and self-efficacy score, correlated with increasing BMI. Women who had surgery had greater risk of lymphedema, and women who received chemotherapy during treatment had a lower quality of life. All but one received radiotherapy. CONCLUSION: This study found that young, obese survivors with locally advanced cervical cancer and survivors who received chemotherapy may have a serious risk of developing late adverse effects; thus, rehabilitation should target these needs.

Comportamento sexual das mulheres em tratamento radioterápico / Sexual behavior of women in radiotherapytreatment

Women with cancer undergoing radiotherapy, radiotherapy and / or brachytherapy may change in sexual behavior, with influence on psychosocial, sexual and functional aspects as well as quality of life. This study aims to analyze the scientific evidence related to sexual behavior and quality of life of women who underwent radiotherapy. It is literature type integrative review. Data collection was conducted in May 2014 and was carried out through the Virtual Health Library, from the bottom of LILACS and MEDLINE, by combining the descriptors: "sexual behavior and radiotherapy" and "sexual behavior and brachytherapy". They selected 23 studies for the sample with no time limit. With the intention of promoting the contributions the production of knowledge about sexual behavior / symptoms after cancer treatment in women with brachytherapy and radiation, emerging two main themes: psychosocial, sexual and functional changes; quality of life. Identifies what is needed directed multidisciplinary action women with cancer in relation to sexuality, there are weaknesses in the care geared to these. Such assistance needs to be planned for the woman and her partner, so that living with cancer and treatment is quality.

As mulheres com câncer submetidas à radioterapia, teleterapia e/ou braquiterapia podem ter alteração nocomportamento sexual, com influência nos aspectos psicossociais, sexuais e funcionais, bem como na qualidade de vida. Este estudo tem como objetivo analisar as evidências científicas relacionadas ao comportamento sexual e qualidade de vida de mulheres que realizaram tratamento com radioterapia. Trata-se de pesquisa bibliográfica do tipo revisão integrativa. A coleta dos dados foi realizada no mês de maio de 2014, e ocorreu por meio da Biblioteca Virtual em Saúde, a partir das bases de dados LILACS e MEDLINE, através da combinação dos descritores: "sexual behaviorandradiotherapy" e "sexual behaviorandbrachytherapy". Foram selecionados 23 estudos para compor a amostra sem tempo limite. Com a intenção de promover os contributos da produção do conhecimento sobre o comportamento sexual/sintomas após tratamento de câncer em mulheres com braquiterapia e radioterapia, emergindo dois eixos temáticos: alterações psicossociais, sexuais e funcionais; qualidade de vida. Identifica-se que é necessária ação multidisciplinar direcionada as mulheres com câncer em relação à sexualidade, há fragilidade no cuidado voltado a essas. Tal assistência necessita ser planejada para a mulher e seu parceiro, de forma que a convivência com o câncer e tratamento seja de qualidade.

[Case-control study of obstetrical outcomes of conisation]. / Étude cas-témoin des conséquences obstétricales de la conisation.

OBJECTIVES: Evaluate the obstetrical outcomes in the case of women with a history of conization. Determine the role of the cone length in the obstetrical issue. MATERIALS AND METHODS: Retrospective case-control study including the patients (n=39) who had undergone a conization in a university hospital between January 2002 and January 2012. The obstetrical outcomes have been compared to those from a control group (n=78). Into the exposed group the obstetrical outcomes has been compared based on the cone length. RESULTS: Thirty-one patients delivered after a conization (39 deliveries). The obstetrical outcomes have been significantly increased in the exposed group: preterm delivery before 37 weeks gestation (25.6% vs 7.7%, P=0.01), before 32 weeks gestation (15.4% vs 1.3%, P=0.005) and between 28 weeks gestation (10.2% vs 0%, P=0.01), premature onset of labor before 32 weeks gestation (12.8% vs 1.3%, P=0.01) and before 28 weeks gestation (12.8% vs 0%, P=0.01) and preterm premature rupture of membranes before 37 weeks gestation (20.5% vs 1.3%, P<0.001). There was no significant difference for a length cone more than 1.5cm. CONCLUSION: Our study showed that a history of conization is an obstetrical risk factor to consider in the management of a subsequent pregnancy.

Goal setting in cancer rehabilitation and relation to quality of life among women with gynaecological cancer.

BACKGROUND: Rehabilitation should be integrated in the routine cancer care of women treated for gynaecological cancers. Goal setting is expected to facilitate the process through patient involvement and motivation. Our knowledge about goal setting in cancer rehabilitation is, however, sparse. OBJECTIVES: This study aimed to: 1) analyse rehabilitation goals defined during hospital-based rehabilitation in patients with gynaecological cancer, with regard to number, category, changes over time, and differences between cancer diagnosis, and 2) analyse the association between health-related quality of life and goals defined for rehabilitation. MATERIAL AND METHODS: Consecutively, all patients treated surgically for endometrial, ovarian, and cervical cancer were invited for hospital-based rehabilitation at Odense University Hospital, Denmark, including two sessions at the hospital one and three months following surgery and two phone calls for follow-up. Questionnaires from the EORTC were used to prepare patients and facilitate individual goal setting with definitions of up to three goals. All goals were grouped into six categories. RESULTS: A total of 151 (63%) patients accepted the invitation including 50 endometrial, 65 ovarian, and 36 cervical cancers patients. All patients defined goals at the first session, 76.4% defined three goals, 21.9% two, and 1.6% had one goal. Physical goals decreased over time but were the most frequent at both sessions (98% and 89%). At both sessions, the social and emotional categories were the second and third most frequent among patients with endometrial and ovarian cancer. Sexual issues were dominant among the cervical cancer patients. Regression analysis showed significant association between quality of life scores and goal setting within the social and emotional domains. CONCLUSION: Goal setting seemed feasible in all problem areas. The EORTC questionnaires were helpful during the process although expectations of the sub-scores being predictive of which areas to address were not convincing.

Associations between exercise and posttraumatic growth in gynecologic cancer survivors.

PURPOSE: Exercise improves numerous psychosocial outcomes in cancer survivors; however, few studies have examined posttraumatic growth. The primary objective of this study was to examine the association between exercise and posttraumatic growth in gynecologic cancer survivors (GCS). METHODS: Using the Alberta Cancer Registry, a random sample of endometrial, ovarian, and cervical cancer survivors were mailed a self-report survey that assessed demographic and medical variables, aerobic and strength exercise, and posttraumatic growth using the posttraumatic growth inventory, impact of cancer scale, and benefit finding scale. RESULTS: Completed surveys were received from 621 (38 %) of the 1,626 eligible survivors. One-third (32.9 %) of GCS were meeting aerobic exercise guidelines and 19.0 % were meeting strength exercise guidelines. Multivariate analyses of covariance showed significant differences in the posttraumatic growth scales for aerobic exercise guidelines (p < 0.001) and combined (strength and aerobic) exercise guidelines (p < 0.001). Analyses of covariance indicated significant differences favoring those meeting the aerobic exercise guidelines for the negative impact of cancer scale (p < 0.001) and several of its subscales. Moreover, those meeting the combined exercise guidelines reported higher scores for the posttraumatic growth inventory (p = 0.014), the negative impact of cancer scale (p < 0.001), and several of their subscales compared to those meeting only one or neither guideline. Marital status moderated the association between exercise and posttraumatic growth with only unmarried GCS demonstrating the associations. CONCLUSION: Exercise is a modifiable lifestyle factor that is associated with posttraumatic growth in GCS. Randomized controlled trials testing the effects of exercise interventions on posttraumatic growth in this population are warranted.

Quality of life of cervical cancer patients after completion of treatment - A study among Bangladeshi women.

Cervical cancer is the main cause of malignancy-related death among women living in developing countries. The aim of this study is to evaluate the quality of life (QOL) among Bangladeshi cervical cancer survivors and its relationships with demographic and disease related factors A cross-sectional study was carried out onlone hundred nine consecutive cervical cancer survivors in National Institute of cancer Research and Hospital, Dhaka from September 2014 to february 2015 using European organization-for Research and treatment of cancer core Questionnaires (QOL-C30 and QOL- CX24). Demographic condition like education level, occupation and disease related factors like stages, treatment modality and duration of follow-up time were taken as investigating factors against functional scales. Cronbach's alpha was calculated to asses' internal consistency among items. Cervical cancer survivors stated a moderate QOL. Sub-domains of QOL score and global health status were significantly associated with physical function(PF) scales (p=.000), fatigue (p=.045), nausea and vomiting (p=.000), Appetite loss (p=.001), constipation (p=.005), symptom experience (p=.005) and menopausal symptoms (p=.015). QOL mean score were negatively associated with emotional function(EF) scales, pain, fatigue, nausea, appetite loss and financial problems. Education level showed significant association with physical function(PF) (p=.001), emotional function(EF) (p=.027), Cognitive function(CF) (p=.000) and sexual function (p=.001). Duration (Follow-up) time was significance association with PF (p=.005), EF (p=.012), symptoms experience (p=.001). Although, the QOL in cervical cancer survivors was moderate, treatment of related symptoms and improvement of demographic condition can influence the QOL and survivors improve the care of cervical cancer. So, improve the QOL among cervical cancer survivors.

A systematic review of quality of life and sexual function of patients with cervical cancer after treatment.

OBJECTIVES: Quality of life (QoL) and sexual health have become increasingly important in cervical cancer survivors (CCSs). The aims of this review were to summarize research findings of QoL and sexual function in CCSs after treatment on the basis of self-reported questionnaires and to update the current knowledge of overall QoL and sexual function in CCSs. METHODS: Studies from electronic database between May 1966 and May 2013 were rated on their internal validity as methodological assessment. Thirty-two studies were included, wherein 15 studies had a relatively good methodology. RESULTS: Anorectal function, urinary symptoms, and lymphedema were commonly reported as physical symptoms. As to psychosocial domains, the studies illustrated that anxiety decreased with age, whereas depression generally increased with age. Sexual function was involved in most of the studies. Vaginal dryness, dyspareunia, short vagina, and sexual dissatisfaction were prominent issues of sexual dysfunction and vaginal changes in CCSs. In terms of treatment modality, radiotherapy was thought to be associated with worse QoL and sexual function in CCSs. CONCLUSIONS: The studies showed that QoL and sexual function in CCSs were compromised compared with the general population to different extents. Quality of life and sexual function should be paid with more attention in patients with cervical cancer after treatment.

A work-directed intervention to enhance the return to work of employees with cancer: a case study.

The purpose of this case study was to describe how the return-to-work process evolved in an employee with cancer in the Netherlands and how a work-directed intervention supported this process. The patient was a 35-year old female employee diagnosed with cervix carcinoma. After surgery, the patient experienced depression, fatigue, fear of recurrence, and low mental working capacity. Communication with the occupational physician was difficult. A social worker at the hospital provided three counselling sessions aimed to support return to work and sent letters to the occupational physician to improve the communication. The support by the social worker helped the patient to resume work gradually and the sending of information from the treating physician and social worker improved the communication with the occupational physician. This resulted in the patient being able to achieve lasting return to work. This work-directed intervention was highly valued by the patient and could be an important addition to usual psycho-oncological care for employees with cancer.

Toward clinical care guidelines for supporting rehabilitative vaginal dilator use with women recovering from cervical cancer.

PURPOSE: Building upon the findings of a recent qualitative investigation of women's experiences with rehabilitative vaginal dilator use, the primary goal of this article is to outline a set of preliminary clinical care recommendations that health care professionals may draw upon in addressing women's unique experiences with vaginal dilator use including their multifaceted struggles with the procedure, possibly enhancing adherence to this practice. METHODS: Ten women participated in in-depth interviews regarding their experiences with using the dilator as prescribed by their health care providers. Following the analysis of these interviews, members of the interdisciplinary research team met to review and discuss the development of clinical care recommendations stemming from these findings. RESULTS: Eight care recommendations aimed at addressing the concerns expressed by the women interviewed and at improving women's overall experiences with rehabilitative dilator use emerged: (1) introduce the dilator in a light and straightforward manner; (2) enhance dilator accessibility; (3) introduce the vaginal dilator early on in treatment; (4) emphasize health maintenance over intercourse as a benefit of dilator use; (5) explore and acknowledge women's values and views of sexuality; (6) increase awareness and sensitivity to emotional reactions; (7) enhance psychoeducational resources for supporting vaginal dilator use; and (8) ensure consistent institutional practice when introducing the dilator. CONCLUSION: The clinical care recommendations proposed here reflect the various challenges women may encounter when using the vaginal dilator--which vary from practical to, for some, profoundly emotional--and are designed to better position health care providers to help women navigate these challenges.

Attitudes and behavior of radiation oncologists toward sexual issues of cervical cancer patients who receive radiation therapy: a survey in China.

OBJECTIVE: Cervical cancer is known to impair women's sexual function. This study aimed at investigating the attitudes and behavior of radiation oncologists regarding sexual functioning of female cervical cancer patients who receive radiation therapy. METHODS: A total of 186 radiation oncologists were included. A self-reported questionnaire was used to investigate the attitudes and behavior of radiation oncologists. The oncologists were queried on their history of consultation on sexual issues, attitudes, and behavior toward sexual issues and considerations of sexual life for cervical cancer patients who receive radiotherapy. RESULTS: Among 120 radiation oncologists who completed the questionnaires, 101 (84.2%) had been consulted on sexual issues, of whom only 29 (24.2%) were consulted by more than 10% of cervical cancer patients who received radiation therapy or their families. Compared with those without a history of consultation, radiation oncologists with a history of consultation were more likely to agree that "radiation oncologists should deal with a patient's sexual issues" (88.1% vs 68.4%) and disagree that "sex is private and should not be interfered with" (66.2% vs 44.5%). Five radiation oncologists (4.2%) had received special training to deal with the sexual issues of cervical cancer patients who receive radiotherapy, and 112 oncologists (93.3%) did not have any information on sexual functioning to give the their patients. CONCLUSIONS: History of consultation on sexual issues affects radiation oncologists' attitudes and behavior toward sexual issues of cervical cancer patients. Radiation oncologists should have a more positive attitude toward sexual issues and should receive more specific relevant training.

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Vacunación frente al cáncer de cérvix en mujeres fuera de los programas de vacunación sistemática, con o sin infección por el virus del papiloma humano o lesión cervical. Encuesta de opinión y recomendaciones / Vaccination against cervical cancer in women outside of routine immunization programs, with or without infection by the human papilloma virus or cervical lesions. Opinion survey and recommendations

Las vacunas frente al cáncer de cérvix se han implementado, en un amplio número de países del mundo, dentro de los programas de vacunación sistemática. Asimismo se ha recomendado la vacunación de rescate en adolescentes y mujeres jóvenes. Desde la perspectiva de salud pública, la vacunación rutinaria en mujeres de mayor edad no se plantea por motivos de coste-efectividad. En estos casos son el médico y la paciente los que, de forma individualizada, deben decidir sobre la vacunación. Una encuesta de opinión dirigida a ginecólogos españoles que desarrollan su actividad asistencial en el ámbito de la patología cervical y colposcopia evidencia que, incluso en este colectivo, hay un relativo desconocimiento sobre aspectos importantes de la vacuna frente al cáncer de cérvix en mujeres fuera de los programas de vacunación sistemática, con o sin infección por el virus del papiloma humano (VPH) o lesión cervical. Además se constata la demanda de mayor información y poder disponer de recomendaciones específicas acerca de este tema. En el presente artículo se revisan las evidencias sobre la infección VPH y el riesgo de cáncer de cérvix a lo largo de la vida, la eficacia de las vacunas en relación con la edad o tras el tratamiento de lesiones cervicales, y la perspectiva del médico y de la mujer. Finalmente se presentan unas recomendaciones, a modo de guía clínica, sobre la vacunación en mujeres fuera de los programas de vacunación sistemática, con o sin infección o lesión cervical (AU)

Vaccines against cervical cancer have been implemented in a wide number of countries around the world as part of systematic vaccination programmes. In addition, rescue vaccination has been recommended for teenagers and young women. From a Public Health perspective, routine vaccination in older women is not proposed for reasons of cost-effectiveness. In these cases, the physician and the patient must decide about the suitability of vaccination in each individual. An opinion poll of Spanish gynaecologists rendering health-care services in the area of cervical pathologies and colposcopy has shown that, even among this group, there is relative lack of knowledge about important aspects of the vaccine against cervical cancer in women outside systematic vaccination programmes, with or without HPV infection or cervical lesions. In addition, the demand for greater information has been confirmed, as has the wish for specific recommendations on this topic. The present article reviews the evidence on HPV infection and the lifelong risk of cervical cancer, the efficacy of vaccines with respect to age or after the treatment of cervical lesions and the perspectives of physicians and women. Finally, some recommendations are made by way of clinical guidance for the vaccination of women outside systematic vaccination programmes, with or without infection or cervical lesion (AU)

Split-field helical tomotherapy with or without chemotherapy for definitive treatment of cervical cancer.

OBJECTIVE: The objective of this study was to investigate the chronic toxicity, response to therapy, and survival outcomes of patients with cervical cancer treated with definitive pelvic irradiation delivered by helical tomotherapy (HT), with or without concurrent chemotherapy. METHODS AND MATERIALS: There were 15 patients with a new diagnosis of cervical cancer evaluated in this study from April 2006 to February 2007. The clinical stages of their disease were Stage Ib1 in 3 patients, Ib2 in 3, IIa in 2, IIb in 4, IIIb in 2, and IVa in 1 patient. Fluorodeoxyglucose-positron emission tomography/computed tomography (FDG-PET/CT) simulation was performed in all patients. All patients received pelvic irradiation delivered by HT and high-dose-rate (HDR) brachytherapy. Four patients also received para-aortic irradiation delivered by HT. Thirteen patients received concurrent chemotherapy. Patients were monitored for chronic toxicity using the Common Terminology Criteria for Adverse Events version 3.0 criteria. RESULTS: The median age of the cohort was 51 years (range, 29-87 years), and the median follow-up for all patients alive at time of last follow-up was 35 months. The median overall radiation treatment time was 54 days. One patient developed a chronic Grade 3 GI complication. No other Grade 3 or 4 complications were observed. At last follow-up, 3 patients had developed a recurrence, with 1 patient dying of disease progression. The 3-year progression-free and cause-specific survival estimates for all patients were 80% and 93%, respectively. CONCLUSION: Intensity-modulated radiation therapy delivered with HT and HDR brachytherapy with or without chemotherapy for definitive treatment of cervical cancer is feasible, with acceptable levels of chronic toxicity.

Papel de p16 en lesiones preinvasivas e invasivas de cáncer de cuello uterino. Aplicación de la técnica a citología convencional / Role of p16 expression in preinvasive and invasive cervical lesions: application of conventional cytology

Introducción: La detección de la sobreexpresión de la proteína p16 mediante técnicas inmunohistoquímicas e inmunocitoquímicas es un valor seguro en la identificación de lesiones epiteliales cervicales de alto grado, sirviendo al mismo tiempo para detectar aquellas lesiones de bajo grado cito o histológico con integración viral, firmes candidatas a la progresión a lesión de alto grado. Material y métodos: Hemos evaluado la eficacia de la detección inmunohistoquímica e inmunocitoquímica de la sobreexpresión de la proteína p16 sobre muestras de cérvix uterino. Para ello hemos recurrido a 58 casos de biopsias de cérvix y 53 citologías con diagnóstico de positividad para la infección por el virus del papiloma humano. Resultados: Hemos observado cómo el 100% de las lesiones de alto grado eran teñidas mientras que so ́lo un porcentaje de las de bajo grado hacían lo propio. Los resultados obtenidos en citología fueron extrapolados a las citologías (correspondientes a las mismas pacientes que las biopsias) obteniendo similares resultados. Conclusiones: La identificación de la sobreexpresión de la proteína p16 por métodos inmunocitoquímicos sobre citologías cervicovaginales convencionales muestra resultados superponibles a los obtenidos sobre muestras histológicas (AU)

Introduction: Detection of p16 expression by immunohistochemistry and immunocytochemistry is a good standard for the identification of high-grade cervical epithelial lesions and low-grade lesions with DNA HPV viral integration (with a tendency for progression). Material and methods: We evaluated p16 expression in 58 HPV-positive cervical biopsies and 53 conventional cytological samples that tested HPV-positive with immunohistochemical and immunocytochemical techniques. Results: All high-grade lesions were positive for p16 while only some of the low-grade lesions were positive. The results obtained in histological samples could be extrapolated to cytological samples from the same patients. Conclusions: p16 expression in conventional cytology provides similar results to those in histological samples (AU)

Clinical management of HPV-related disease of the lower genital tract.

Cytology remains the mainstay for cervical screening. The need to achieve effective management, limit complications, and preserve reproductive function led to the popularity of local treatment. Although the cure rates for ablative and excisional methods are similar, the excisional method provides a more reliable histopathological diagnosis. Recent evidence revealed increased perinatal morbidity after treatment that appears to be related to the proportion of cervix removed. The human papillomavirus (HPV) DNA test appears to enhance the detection of disease in primary screening, in the triage of minor cytological abnormalities, and in follow-up. Further research on the clinical application of a scoring system is ongoing. The vaccines are now available and appear to be safe, well tolerated, and highly efficacious in HPV naive women. A synergy of vaccination and screening will be required. Treatment for early cervical cancer is increasingly shifting toward more fertility-sparing surgical techniques. Careful selection of patients is essential.

Strategy of cervical myomectomy under laparoscopy.

OBJECTIVE: To evaluate a strategy of laparoscopic excision of a cervical myoma (CM). DESIGN: Prospective study. SETTING: University-affiliated hospital. PATIENT(S): Twenty-eight patients with CM underwent laparoscopic myomectomy. These cases were classified into five types according to the location: [1] anterior cervical myoma (ACM); [2] posterior cervical myoma (PCM); [3] central cervical myoma (CCM); [4] lateral cervical myoma [LCM]; and [5] deep-rooted cervical myoma (DCM). INTERVENTION(S): After preoperative assessment, patients underwent laparoscopic myomectomy. Ligation of the uterine artery and diluted vasopressin injection were performed to decrease bleeding during laparoscopy. MAIN OUTCOME MEASURE(S): Myoma numbers, myoma weight, operative time, estimated blood loss, hospital stay, complication rate. RESULT(S): Most of the lesions were ACM (43%) and PCM (32%). The mean operative time was 121 minutes, mean blood loss was 99 mL, and mean myoma weight was 287 g. The mean hospital stay was 2.2 days. There were no complications. Histopathologic examination showed that all lesions were leiomyoma. Hypermenorrhea, dysmenorrhea, and symptoms of compression improved after the operation. Two infertile patients conceived spontaneously at 1 and 7 months postoperatively, and successfully delivered infants by cesarean section at term. CONCLUSION(S): Surgical treatment of CM is empirically difficult. It is important that the approach be changed according to the location and size of the myoma.

Cancer-related tasks involving employment: opportunities for clinical assistance.

Many cancer survivors experience unmet psychosocial needs related to their jobs, and women often fare worse than men in this regard. However, little research exists on ways to assist patients with cancer in preventing or managing common job problems. We conducted focus groups and a survey among 73 women who were employed at the time of presentation of a gynecologic cancer. We compared the findings with existing recommendations and professional standards for occupational rehabilitation. Participants described different cancer-related employment tasks in three time periods: just after diagnosis, during primary treatment, and after primary treatment is completed. The more difficult tasks included communicating with supervisors and coworkers, determining company policies, applying for employer-sponsored benefits, handling finances, managing symptoms on returning to work, finding effective solutions to cancer-related job problems, leaving the job with dignity if too sick or if the job ended, and making career plans. The cancer care team may be able to help meet the psychosocial needs of employed cancer survivors by screening for job concerns, providing information, formulating a return-to-work plan, treating symptoms, consulting with professionals who have employment-related expertise, and giving other forms of assistance.