Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 5.872
Filtrar
1.
Bull Cancer ; 107(9): 867-880, 2020 Sep.
Artigo em Francês | MEDLINE | ID: mdl-32919610

RESUMO

INTRODUCTION: Few studies have explored the long-term occupational situation after cancer. The aim of our study were to study the employment status among long-term cancer survivors and to compare it to cancer-free controls from the general population at 5, 10 or 15 years after cancer diagnosis. METHODS: From data of a registry-based study, long-term survivors from breast,cervical and colorectal cancer, randomly selected from three tumor registries in France, were compared to cancer-free controls randomly selected from electoral lists. We selected active cancer survivors and cancer-free controls aged less than 60 at the time of the survey. We have studied the employment status of cases vs. controls and the factors associated with employment status. RESULTS: At 5, 10 or 15 years after diagnosis, we did not observe any significant difference in employment status between cases and controls. Among cases, 17% had lost their jobs. Older age, lower incomes, lower education, a short-term employment contract, the presence of co-morbidities, fatigue and a worse quality of life were associated with job loss. DISCUSSION: Although the employment status of the cases was comparable to that of the controls, efforts should be intensified to make it easier for patients diagnosed with cancer to return to work.


Assuntos
Sobreviventes de Câncer , Emprego/estatística & dados numéricos , Adulto , Neoplasias da Mama/terapia , Neoplasias Colorretais/terapia , Estudos Transversais , Feminino , França , Humanos , Masculino , Pessoa de Meia-Idade , Sistema de Registros , Fatores de Tempo , Neoplasias do Colo do Útero/terapia , Adulto Jovem
4.
Lancet Oncol ; 21(8): 1089-1098, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32758463

RESUMO

BACKGROUND: Cervical cancer is the fourth most common cancer among women worldwide, causing more than 300 000 deaths globally each year. In addition to screening and prevention, effective cancer treatment is needed to reduce cervical cancer mortality. We discuss the role of imaging in cervical cancer management and estimate the potential survival effect of scaling up imaging in several different contexts. METHODS: Using a previously developed microsimulation model of global cancer survival, we estimated stage-specific cervical cancer 5-year net survival in 200 countries and territories. We evaluated the potential survival effect of scaling up treatment (chemotherapy, surgery, radiotherapy, and targeted therapy), and imaging modalities (ultrasound, x-ray, CT, MRI, PET, and single photon emission CT [SPECT]) to the mean level of high-income countries, both individually and in combination. FINDINGS: We estimate global cervical cancer 5-year net survival as 42·1% (95% uncertainty interval [UI] 33·8-48·5). Among individual imaging modalities, expanding MRI would yield the largest 5-year survival gains globally (data are absolute percentage point increase in survival 0·6, 95% UI 0·1-2·1), scaling up ultrasound would yield the largest gains in low-income countries (0·5, 0·0-3·7), expanding CT and x-ray would have the greatest effect in Latin America (0·8, 0·0-3·4) and Oceania (0·4, 0·0-3·2), and expanding PET would yield the largest gains in high-income countries (0·2, 0·0-0·8). Scaling up SPECT did not show major changes in any region. Among individual treatment modalities, scaling up radiotherapy would yield the largest absolute percentage point gains in low-income countries (5·2, 0·3-13·5), and expanding surgery would have the largest effect in lower-middle-income countries (7·4, 0·3-21·1) and upper-middle-income countries (0·8, 0·0-2·9). Estimated survival gains in high-income countries were very modest. However, the gains from expanding any single treatment or imaging modality individually were small across all income levels and geographical settings. Scaling up all treatment modalities could improve global 5-year net survival to 52·4% (95% UI 44·6-62·0). In addition to expanding treatment, improving quality of care could raise survival to 57·5% (51·2-63·5), and the cumulative effect of scaling up all imaging modalities together with expanded treatment and quality of care could improve 5-year net survival for cervical cancer to 62·5% (57·7-67·8). INTERPRETATION: Comprehensive scale-up of treatment, imaging, and quality of care could substantially improve global cervical cancer 5-year net survival, with quality of care and imaging improvements each contributing about 25% of the total potential gains. These findings suggest that a narrow focus on the availability of treatment modalities could forgo substantial survival gains. Investments in imaging equipment, personnel, and quality of care efforts will also be needed to successfully scale up cervical cancer treatment worldwide. FUNDING: Harvard T H Chan School of Public Health and National Cancer Institute.


Assuntos
Saúde Global/estatística & dados numéricos , Análise de Sobrevida , Neoplasias do Colo do Útero/diagnóstico por imagem , Neoplasias do Colo do Útero/mortalidade , Neoplasias do Colo do Útero/terapia , Países Desenvolvidos/estatística & dados numéricos , Países em Desenvolvimento/estatística & dados numéricos , Feminino , Humanos , Modelos Estatísticos
5.
Medicine (Baltimore) ; 99(27): e21005, 2020 Jul 02.
Artigo em Inglês | MEDLINE | ID: mdl-32629719

RESUMO

INTRODUCTION: Mild local hyperthermia at 44°C has been proven efficacious in the treatment of cutaneous warts induced by human papillomavirus (HPV), while its effect on cervical intraepithelial neoplasia (CIN) caused by high risk type of HPVs has not been reported. PATIENT CONCERNS: Three patients with low grade CIN and positive high risk HPV types (HPV 16, 31, 52, 56, 58) are reported in this study. DIAGNOSIS: The diagnosis was based on identification of HPV types and abnormal cytological findings. INTERVENTIONS: The 3 patients were treated with local hyperthermia from ceramic heating (surface temperature, 44°C) to cervix. The treatment was delivered once a day for 3 consecutive days, plus two similar treatments 10 ± 3 days later, with each session lasting 30 minutes. HPV and cytology test were performed 3 months thereafter. OUTCOMES: All the 3 patients recovered to normal cytological findings. Two of the patients were negative for HPV, the remaining patient with pre-treatment HPV 56 and 58 positivity changed to HPV58 positive alone. CONCLUSION: This pilot observation inspires that mild local hyperthermia be recommended as a new method in the treatment of CIN patients with persistent HPV infection, once validated by qualified RCT.


Assuntos
Neoplasia Intraepitelial Cervical/terapia , Hipertermia Induzida/métodos , Neoplasias do Colo do Útero/terapia , Adulto , Neoplasia Intraepitelial Cervical/virologia , Feminino , Humanos , Pessoa de Meia-Idade , Papillomaviridae/isolamento & purificação , Infecções por Papillomavirus/complicações , Infecções por Papillomavirus/diagnóstico , Neoplasias do Colo do Útero/virologia
6.
ESMO Open ; 5(Suppl 3)2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32718919

RESUMO

The rapid spread of severe acute respiratory syndrome coronavirus 2 infection and its related disease (COVID-19) has required an immediate and coordinate healthcare response to face the worldwide emergency and define strategies to maintain the continuum of care for the non-COVID-19 diseases while protecting patients and healthcare providers. The dimension of the COVID-19 pandemic poses an unprecedented risk especially for the more vulnerable populations. To manage patients with cancer adequately, maintaining the highest quality of care, a definition of value-based priorities is necessary to define which interventions can be safely postponed without affecting patients' outcome. The European Society for Medical Oncology (ESMO) has endorsed a tiered approach across three different levels of priority (high, medium, low) incorporating information on the value-based prioritisation and clinical cogency of the interventions that can be applied for different disease sites. Patients with gynaecological cancer are at particular risk of COVID-19 complications because of their age and prevalence of comorbidities. The definition of priority level should be based on tumour stage and histology, cancer-related symptoms or complications, aim (curative vs palliative) and magnitude of benefit of the oncological intervention, patients' general condition and preferences. The decision-making process always needs to consider the disease-specific national and international guidelines and the local healthcare system and social resources, and a changing situation in relation to COVID-19 infection. These recommendations aim to provide guidance for the definition of deferrable and undeferrable interventions during the COVID-19 pandemic for ovarian, endometrial and cervical cancers within the context of the ESMO Clinical Practice Guidelines.


Assuntos
Infecções por Coronavirus/terapia , Neoplasias dos Genitais Femininos/terapia , Oncologia/métodos , Pneumonia Viral/terapia , Guias de Prática Clínica como Assunto , Betacoronavirus/fisiologia , Comorbidade , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/virologia , Assistência à Saúde/estatística & dados numéricos , Assistência à Saúde/tendências , Neoplasias do Endométrio/diagnóstico , Neoplasias do Endométrio/epidemiologia , Neoplasias do Endométrio/terapia , Europa (Continente)/epidemiologia , Feminino , Neoplasias dos Genitais Femininos/diagnóstico , Neoplasias dos Genitais Femininos/epidemiologia , Humanos , Oncologia/organização & administração , Neoplasias Ovarianas/diagnóstico , Neoplasias Ovarianas/epidemiologia , Neoplasias Ovarianas/terapia , Pandemias , Pneumonia Viral/epidemiologia , Pneumonia Viral/virologia , Sociedades Médicas , Neoplasias do Colo do Útero/diagnóstico , Neoplasias do Colo do Útero/epidemiologia , Neoplasias do Colo do Útero/terapia
7.
Anticancer Res ; 40(8): 4741-4748, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32727800

RESUMO

BACKGROUND/AIM: We aimed to investigate the efficacy of immune-cell therapy in terms of the survival of patients with neuroendocrine carcinoma of the uterine cervix (NECC), which lacks standardized therapeutic approaches. PATIENTS AND METHODS: We identified 17 patients who were diagnosed as having NECC and treated with immune-cell therapy. The clinical characteristics of these patients were extracted from their records and their overall survival was measured. RESULTS: Of the 17 patients, two patients with early-stage NECC without recurrence and three patients with less than four treatments were excluded. The median survival times from the time of diagnosis and from the initial administration of immune-cell therapy were 49.7 and 24.4 months, respectively. The overall survival rates at 1, 2, and 5 years were 63.6%, 38.2%, and 25.5%, respectively. Long-term survival was observed in the patients with distant metastases. CONCLUSION: The preliminary results of this retrospective study suggested the potential efficacy of immune-cell therapy for NECC.


Assuntos
Carcinoma Neuroendócrino/imunologia , Carcinoma Neuroendócrino/terapia , Colo do Útero/patologia , Neoplasias do Colo do Útero/imunologia , Neoplasias do Colo do Útero/terapia , Adulto , Carcinoma Neuroendócrino/patologia , Terapia Baseada em Transplante de Células e Tecidos/métodos , Feminino , Humanos , Imunoterapia Adotiva/métodos , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/imunologia , Recidiva Local de Neoplasia/patologia , Recidiva Local de Neoplasia/terapia , Estadiamento de Neoplasias/métodos , Prognóstico , Neoplasias do Colo do Útero/patologia
8.
Medicine (Baltimore) ; 99(27): e20897, 2020 Jul 02.
Artigo em Inglês | MEDLINE | ID: mdl-32629680

RESUMO

INTRODUCTION: Acrometastasis is infrequent and generally indicates a wider spread of metastasis with poor prognosis. The diagnosis is challenging, as it might mimic an infectious, inflammatory, or metabolic disease. Acrometastasis are most commonly found in patients with lung, gastrointestinal, kidney, and breast cancer. Only 3 cases of cervical cancer associated with hand metastasis have been reported in the literature. PATIENT CONCERNS: Herein, we report a 58-year-old patient with locally advanced cervical cancer and recurrence in the right thumb as presentation of widespread disseminated disease. She initially presented with adenocarcinoma of the uterine cervix and was treated with concurrent chemoradiation followed by high-dose rate brachytherapy. Six months later, she developed an insidious onset of pain and swelling in the right thumb, erythema, and edema, mimicking cellulitis. DIAGNOSIS: A biopsy of the soft tissues of the thumb was performed, and the histopathology indicated metastasis of adenocarcinoma to the bone and soft tissues. INTERVENTIONS AND OUTCOMES: The patient rejected further treatment and died of progressive disease 4 months after the diagnosis of the recurrence. CONCLUSION: Metastases in unusual sites are a diagnostic challenge, and there is no standardized treatment. Timely diagnosis and treatment can improve the prognosis of these patients and might preserve their quality of life.


Assuntos
Mãos/patologia , Neoplasias do Colo do Útero/patologia , Adenocarcinoma/patologia , Adenocarcinoma/terapia , Feminino , Humanos , Pessoa de Meia-Idade , Metástase Neoplásica , Estadiamento de Neoplasias , Neoplasias do Colo do Útero/terapia
9.
Anticancer Res ; 40(7): 3651-3658, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32620604

RESUMO

BACKGROUND/AIM: The aim of this study was to conduct a review on less radical fertility-sparing surgical treatment for early-stage cervical cancer. MATERIALS AND METHODS: We conducted a Medline search from 2014 to 2018 regarding less radical fertility-sparing techniques, such as simple trachelectomy or cervical conization, with pelvic lymphadenectomy. We also assessed the impact of the removal of the parametrium on the obstetric and oncologic outcome, in women who desire to preserve their fertility. RESULTS: We analyzed studies about cervical conization and simple trachelectomy, together with pelvic lymphadenectomy in early-stage cervical cancer. We also assessed the importance of parametrial involvement in reducing morbidity, without jeopardizing the oncologic outcome of these patients. Studies demonstrate that in tumors ≤2 cm, without lymphovascular Space Invasion and without evidence of parametrial involvement, a less radical fertility-sparing surgical approach could increase pregnancy rates and have a positive effect on the quality of life of these patients. CONCLUSION: Standard fertility-sparing treatment for early-stage cervical cancer is still radical trachelectomy with pelvic lymphadenectomy. However, studies suggest that the omission of parametrectomy is a feasible and safe option. Simple trachelectomy or cervical conization, both combined with pelvic lymphadenectomy are acceptable approaches in a selected group of patients with early-stage cervical cancer.


Assuntos
Neoplasias do Colo do Útero/cirurgia , Neoplasias do Colo do Útero/terapia , Feminino , Preservação da Fertilidade/métodos , Humanos , Excisão de Linfonodo/métodos , Estadiamento de Neoplasias/métodos , Qualidade de Vida , Traquelectomia/métodos
10.
Arch Biochem Biophys ; 690: 108480, 2020 09 15.
Artigo em Inglês | MEDLINE | ID: mdl-32681832

RESUMO

Although a potentially preventable disease, cervical cancer (CC) is the second most commonly diagnosed gynaecological cancer with at least 530,000 new cases annually, and the prognosis with CC is still poor. Studies suggest that aberrant expression of microRNA (miRNA) contributes to the progression of CC. As a group of small non-coding RNA with 18-25 nucleotides, miRNA regulate about one-third of all human genes. They function by repressing translation or inducing mRNA cleavage or degradation, including genes involved in diverse and important cellular processes, including cell cycling, proliferation, differentiation, and apoptosis. Results showed that misexpression of miRNA is closely related to the onset and progression of CC. This review will provide an overview of the function of miRNA in CC and the mechanisms involved in cervical carcinogenesis.


Assuntos
MicroRNAs/metabolismo , Neoplasias do Colo do Útero/genética , Animais , Apoptose/genética , Ciclo Celular/genética , Diferenciação Celular/genética , Linhagem Celular Tumoral , Proliferação de Células/genética , Progressão da Doença , Feminino , Perfilação da Expressão Gênica , Regulação Neoplásica da Expressão Gênica , Humanos , Prognóstico , Neoplasias do Colo do Útero/diagnóstico , Neoplasias do Colo do Útero/terapia
11.
Anticancer Res ; 40(6): 3565-3570, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32487659

RESUMO

BACKGROUND/AIM: We conducted a phase II study of neoadjuvant chemotherapy followed by extended field concurrent chemoradiotherapy in patients with cervical cancer with para-aortic node metastasis. PATIENTS AND METHODS: Thirty-seven women with stage IB1-IVA cervical cancer were enrolled. RESULTS: The median age was 52 years. Thirty-four patients other than 3 progressive disease, proceeded to extended field concurrent chemoradiotherapy. The 3-year overall survival and progression-free survival rates were 70.1% and 48.5%, respectively. The 3-year overall survival according to stages was significantly worse in stage IIIB. Twelve of the 17 patients with stage IIIB died of the disease. CONCLUSION: Neoadjuvant chemotherapy followed by extended field concurrent chemoradiotherapy may improve the prognosis of patients with stages IB and II cervical cancer with positive para-aortic node. However, new strategies should be investigated to improve a poor prognosis in stage IIIB disease with positive para-aortic node.


Assuntos
Linfonodos/patologia , Neoplasias do Colo do Útero/patologia , Neoplasias do Colo do Útero/terapia , Adulto , Idoso , Quimiorradioterapia , Terapia Combinada , Feminino , Humanos , Estimativa de Kaplan-Meier , Metástase Linfática , Pessoa de Meia-Idade , Terapia Neoadjuvante , Prognóstico , Resultado do Tratamento , Neoplasias do Colo do Útero/mortalidade
12.
PLoS One ; 15(6): e0234389, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32530941

RESUMO

GOAL: To assess the impact of chemoradiation on pelvic floor (PF) muscle function after the treatment of cervical cancer (CC). METHODS: We performed a prospective cohort study of women between the ages of 20 and 70 years old who had a diagnosis of CC. Patients were treated with chemoradiation at the Barretos Cancer Hospital (BCH), between August 2016 and July 2017. We performed three evaluations at different time points after chemoradiation treatment to compare changes in muscle function. Pelvic floor muscle function was assessed through perineometry (PNM) and surface electromyography (EMG) at the following time points: Pretreatment Moment 1 (M1): evaluated before chemoradiation; Moment 2 (M2): at the first follow-up medical visit (usually 3 to 4 months after treatment); and Moment 3 (M3): at the second follow-up medical visit (usually after 6 to 9 months after treatment). Mean vaginal squeeze pressure levels were determined by PNM and muscle electromyographic activity by EMG and the results were evaluated by Generalized Linear Model comparisons. RESULTS: Forty-nine patients were evaluated at M1; 35 at M2; and 32 at M3, so that 32 patients had all three muscle evaluations performed. There was a statistically significant increase in the frequency of women with urgency urinary incontinence at the M2 evaluation time (41.9%), compared to pretreatment M1 (18.6%), p<0.001. The means of the vaginal squeeze pressures reduced through M1 to M3 in the phasic (M1: 17.7 mmHg; M3: 11.27mmHg) and tonic contractions (M1: 10.56 mmHg; M3: 7.52mmHg), p = 0.01 and p = 0.03 respectively. There was no difference in pelvic floor function in the three evaluations M1-M3, measured by EMG. The pelvic floor strength assessed by PMN and their interactions with anthropometric, parity and hormonal status variables, showed that a high body mass index (BMI) significantly influenced decreases in pelvic floor muscle function before and after treatment. CONCLUSION: These results show that chemoradiation causes reduction of muscle function of the pelvic floor, especially in the late phase after the end of treatment. Both the high BMI and urgent urinary incontinence symptoms were related to decreased muscle strength.


Assuntos
Quimiorradioterapia/efeitos adversos , Diafragma da Pelve/lesões , Neoplasias do Colo do Útero/terapia , Adulto , Idoso , Estudos de Coortes , Eletromiografia , Feminino , Humanos , Pessoa de Meia-Idade , Diafragma da Pelve/fisiopatologia , Estudos Prospectivos , Lesões por Radiação/etiologia , Lesões por Radiação/fisiopatologia , Incontinência Urinária/etiologia , Adulto Jovem
13.
Support Care Cancer ; 28(10): 4627-4644, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32556622

RESUMO

PURPOSE: Given the high survival rate of cervical cancer patients, understanding women's health-related quality of life (HRQL) during and after treatment is of major clinical importance. We conducted a systematic review to synthesize all available evidence about the effects of each contemporary treatment modality for cervical cancer on all dimensions of women's HRQL, including symptoms, functioning, and global HRQL. METHODS: We searched four electronic databases from January 2000 to September 2019, cross-referenced and searched by author name for studies of patients treated for cervical cancer that reported patient-reported outcomes (PROs) before treatment and with at least one post-treatment measurement. Two independent reviewers applied inclusion and quality criteria and extracted findings. Studies were categorized by treatment to determine specific treatment effects on PROs. Results were narratively summarized. RESULTS: We found twenty-nine papers reporting 23 studies. After treatments with curative intent for early or locally advanced disease, lymphedema, diarrhea, menopausal symptoms, tight and shorter vagina, pain during intercourse, and sexual worries remained long-term problems; however, sexual activity improved over time. HRQL and psychological distress were impacted during treatment with also worsening of global HRQL but improved 3-6 months after treatment. In patients with metastatic or recurrent disease, pain improved during palliative treatment or remained stable, with no differences in global HRQL found over time. CONCLUSION: Whereas most symptoms worsen during treatment and improve in the first 3 months after completing treatment, symptoms like lymphedema, menopausal symptoms, and sexual worries develop gradually and persist after curative treatment. These findings can be used to inform clinical practice and facilitate communication and shared decision-making. More research is needed in very early cervical cancer and the impact of fertility sparing therapy on PROs.


Assuntos
Medidas de Resultados Relatados pelo Paciente , Qualidade de Vida/psicologia , Neoplasias do Colo do Útero/terapia , Feminino , Humanos , Autorrelato , Neoplasias do Colo do Útero/patologia
14.
Life Sci ; 256: 117981, 2020 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-32561395

RESUMO

Cervical cancer (CC) is regarded as the second serious threat to women's health worldwide; it's associated with certain viruses that are transmitted through sexual intercourse. Therefore, the pathogenesis of CC remains to be studied. The identified long non-coding RNAs (lncRNAs) as a key genomic product were found to be commonly dysregulated in CC and to exert significant effects in the initiation, migration, invasion and therapeutic response of CC. Therefore lncRNAs may be used as tumor suppressor genes or oncogenes to interact with DNA, RNA or proteins for the regulation of gene expression and cell signaling pathways. The relationship between single lncRNA and CC has been discovered. However, full-scale reviews on the lncRNAs function in CC are deficiency. In this review, we describe the recent reports on the dysregulated patterns regulation of lncRNAs in CC. We also conclude the recent advances on biologic functions and molecular regulation mechanism and potential clinical application of lncRNAs in CC.


Assuntos
RNA Longo não Codificante/genética , RNA Longo não Codificante/metabolismo , Neoplasias do Colo do Útero/genética , Neoplasias do Colo do Útero/metabolismo , Animais , Biomarcadores Tumorais/genética , Biomarcadores Tumorais/metabolismo , Proliferação de Células/fisiologia , Feminino , Humanos , Neoplasias do Colo do Útero/terapia
15.
Cancer Radiother ; 24(5): 368-373, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32360093

RESUMO

Imaging is involved in the management of uterine cervical cancer with several objectives: 1/to assess local and lymph node extension of the initial disease; 2/evaluate treatment response to conservative therapy; 3/detect recurrences. Pelvic MRI is the first-line examination in all these indications. It is the key element for delineation after image fusion when the indication of chemoradiation therapy is made. It is also essential for guiding the placement of applicators and optimising the dosimetry of brachytherapy. The diffusion-weighted acquisition is a sequence sensitive to the motion of water molecules. It allows distinguishing water molecules with free diffusion from water molecules with diffusion restricted by obstacles such as cell membranes or the cytoskeleton. The diffusion is thus connected to the cellularity of the explored tissue, and the cancers, being hypercellular, will present a high signal. It thus provides additional information thanks to a high contrast between the tumour and the surrounding tissues, facilitating detection, evaluation of the volume and extent of the disease.


Assuntos
Imagem de Difusão por Ressonância Magnética/métodos , Neoplasias do Colo do Útero/diagnóstico por imagem , Água Corporal/diagnóstico por imagem , Braquiterapia/métodos , Quimiorradioterapia , Feminino , Humanos , Recidiva Local de Neoplasia/diagnóstico por imagem , Recidiva Local de Neoplasia/patologia , Estadiamento de Neoplasias/métodos , Órgãos em Risco/diagnóstico por imagem , Planejamento da Radioterapia Assistida por Computador , Neoplasias do Colo do Útero/patologia , Neoplasias do Colo do Útero/terapia
16.
Zhong Nan Da Xue Xue Bao Yi Xue Ban ; 45(3): 297-304, 2020 Mar 28.
Artigo em Inglês, Chinês | MEDLINE | ID: mdl-32386022

RESUMO

OBJECTIVES: To investigate the efficacy and prognostic factors for patients receiving neoadjuvant chemotherapy (NACT) before operation in stage IB2 and IIA2 cervical cancer. METHODS: A total of 187 patients with IB2 and IIA2 cervical cancer who received NACT combined surgery from January 2005 to January 2016 were enrolled. All patients were divided into an effective group (n=142) and an ineffective group (n=45) according to the chemotherapy efficacy. Clinical characteristics (containing tumor diameter, hematological inflammatory indexes, etc.) before chemotherapy and postoperative pathology between the two groups were compared. Patient survival analysis was performed by Kaplan-Meier method. The methods of univariate and multifactor analysis were used to analyze the relationship between NACT curative effect, postoperative pathological factors, and survival of patients. RESULTS: The number of patients with tumor diameter less than 5 cm was more in the chemotherapy effective group than that in the ineffective group (P=0.015). Three hematological inflammatory indexes (systemic inflammatory response index, neutrophil-lymphocyte ratio, and monocyte-lymphocyte ratio) in the effective group were lower than those in the ineffective group, respectively (P<0.05). The rates of pelvic lymph node metastasis and cervical deep myometrial invasion in the effective group were lower than those in the ineffective group (P<0.05). The 3-year and 5-year overall survival of NACT patients were 92.6% and 82.9%, respectively. Univariate analysis showed that chemotherapy efficacy, hematological inflammatory indexes, pelvic lymph node metastasis, and cervical deep myometrial invasion were related to the survival of patients (P<0.05). Further multivariate analysis demonstrated that pelvic lymph node metastasis was an independent risk factor for survival of patients (P<0.001), whereas effective NACT treatment was a protective factor for survival of patients (P<0.001). CONCLUSIONS: Tumor diameter and hematologic inflammation indexes before treatment are the relevant factors for NACT efficacy in patients with IB2 and IIA2 cervical cancer. Chemotherapy efficacy and pelvic lymph node metastasis are prognostic factors for NACT patients.


Assuntos
Terapia Neoadjuvante , Neoplasias do Colo do Útero , Protocolos de Quimioterapia Combinada Antineoplásica , Quimioterapia Adjuvante , Feminino , Humanos , Histerectomia , Estadiamento de Neoplasias , Prognóstico , Estudos Retrospectivos , Resultado do Tratamento , Neoplasias do Colo do Útero/terapia
18.
PLoS One ; 15(5): e0232814, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32413044

RESUMO

BACKGROUND: Cervical cancer screening rates are known to be strongly associated with socioeconomic status. Our objective was to assess whether the rate is also associated with an aggregated deprivation marker, defined by the location of family doctors' offices. METHODS: To access this association, we 1) collected data from the claim database of the French Health Insurance Fund about the registered family doctors and their enlisted female patients eligible for cervical screening; 2) carried out a telephone survey with all registered doctors to establish if they were carrying out Pap-smears in their practices; 3) geotracked all the doctors' offices in the smallest existing blocks of socioeconomic homogenous populations (IRIS census units) that were assigned a census derived marker of deprivation, the European Deprivation Index (EDI), and a binary variable of urbanization; and 4) we used a multivariable linear mixed model with IRIS as a random effect. RESULTS: Of 348 eligible doctors, 343 responded to the telephone survey (98.6%) and were included in the analysis, encompassing 88,152 female enlisted patients aged 25-65 years old. In the multivariable analysis (adjusted by the gender of the family doctor, the practice of Pap-smears by the doctor and the urbanization of the office location), the EDI of the doctor's office was strongly associated with the cervical cancer screening participation rate of eligible patients (p<0.001). CONCLUSION: The EDI linked to the location of the family doctor's office seems to be a robust marker to predict female patients' participation in cervical cancer screening.


Assuntos
Detecção Precoce de Câncer , Neoplasias do Colo do Útero/diagnóstico , Neoplasias do Colo do Útero/epidemiologia , Adulto , Idoso , Feminino , Privação de Alimentos/fisiologia , Humanos , Seguro Saúde , Entrevistas como Assunto , Masculino , Pessoa de Meia-Idade , Teste de Papanicolaou , Consultórios Médicos , Médicos de Família/estatística & dados numéricos , Classe Social , Neoplasias do Colo do Útero/patologia , Neoplasias do Colo do Útero/terapia , Esfregaço Vaginal
19.
Womens Health (Lond) ; 16: 1745506520914804, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32364058

RESUMO

Cervical cancer is the fourth most common cancer among women globally, with approximately 580,000 new diagnoses in 2018. Approximately, 90% of deaths from this disease occur in low- and middle-income countries, especially in areas of high HIV prevalence, and largely due to limited prevention and screening opportunities and scarce treatment options. In this overview, we describe the opportunities and challenges faced in many low- and middle-income countries in delivery of cervical cancer detection, treatment and complete pathways of care. In particular, drawing on our experience and that of colleagues, we describe cervical screening and pathways of care provision in Malawi, as a case study of a low-resource country with high incidence and mortality rates of cervical cancer. Screening methods such as cytology - although widely used in high-income countries - have limited relevance in many low-resource settings. The World Health Organization recommends screening using human papillomavirus testing wherever possible; however, although human papillomavirus primary testing is more sensitive and detects precancers and cancers earlier than cytology, there are currently costs, infrastructure considerations and specificity issues that limit its use in low- and middle-income countries. The World Health Organization accepts the alternative screening approach of visual inspection with acetic acid as part of 'screen and treat' programmes as a simple and inexpensive test that can be undertaken by trained health workers and hence give wider screening coverage; however, subjectivity and variability in interpretation of findings between providers raise issues of false positives and overtreatment. Cryotherapy using either nitrous oxide or carbon dioxide is an established treatment for precancerous lesions within 'screen and treat' programmes; more recently, thermal ablation has been recognized as suitable to low-resource settings due to lightweight equipment, short treatment times, and hand-held battery-operated and solar-powered models. For larger lesions and cancers, complete clinical pathways (including loop excision, surgery, radiotherapy, chemotherapy and palliative care) are required for optimal care of women. However, provision of each of these components of cancer control is often limited due to limited infrastructure and lack of trained personnel. Hence, global initiatives to reduce cervical mortality need to adopt a holistic approach to health systems strengthening.


Assuntos
Infecções por Papillomavirus/diagnóstico , Neoplasias do Colo do Útero/diagnóstico , Neoplasias do Colo do Útero/terapia , Adulto , Países em Desenvolvimento , Detecção Precoce de Câncer/métodos , Feminino , Humanos , Malaui/epidemiologia , Programas de Rastreamento/métodos , Pessoa de Meia-Idade , Papillomaviridae , Pobreza
20.
J Gynecol Obstet Hum Reprod ; 49(6): 101729, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: covidwho-23573

RESUMO

INTRODUCTION: In the context of the COVID-19 pandemic, specific recommendations are required for the management of patients with gynecologic cancer. MATERIALS AND METHOD: The FRANCOGYN group of the National College of French Gynecologists and Obstetricians (CNGOF) convened to develop recommendations based on the consensus conference model. RESULTS: If a patient with a gynecologic cancer presents with COVID-19, surgical management should be postponed for at least 15 days. For cervical cancer, radiotherapy and concomitant radiochemotherapy could replace surgery as first-line treatment and the value of lymph node staging should be reviewed on a case-by-case basis. For advanced ovarian cancers, neoadjuvant chemotherapy should be preferred over primary cytoreduction surgery. It is legitimate not to perform hyperthermic intraperitoneal chemotherapy during the COVID-19 pandemic. For patients who are scheduled to undergo interval surgery, chemotherapy can be continued and surgery performed after 6 cycles. For patients with early stage endometrial cancer of low and intermediate preoperative ESMO risk, hysterectomy with bilateral adnexectomy combined with a sentinel lymph node procedure is recommended. Surgery can be postponed for 1-2 months in low-risk endometrial cancers (FIGO Ia stage on MRI and grade 1-2 endometrioid cancer on endometrial biopsy). For patients of high ESMO risk, the MSKCC algorithm (combining PET-CT and sentinel lymph node biopsy) should be applied to avoid pelvic and lumbar-aortic lymphadenectomy. CONCLUSION: During the COVID-19 pandemic, management of a patient with cancer should be adapted to limit the risks associated with the virus without incurring loss of chance.


Assuntos
Betacoronavirus , Infecções por Coronavirus/epidemiologia , Neoplasias dos Genitais Femininos/cirurgia , Pandemias , Pneumonia Viral/epidemiologia , Quimioterapia Adjuvante , Infecções por Coronavirus/complicações , Infecções por Coronavirus/prevenção & controle , Neoplasias do Endométrio/patologia , Neoplasias do Endométrio/cirurgia , Feminino , França , Neoplasias dos Genitais Femininos/complicações , Neoplasias dos Genitais Femininos/patologia , Neoplasias dos Genitais Femininos/terapia , Ginecologia , Humanos , Comunicação Interdisciplinar , Obstetrícia , Neoplasias Ovarianas/tratamento farmacológico , Neoplasias Ovarianas/patologia , Pandemias/prevenção & controle , Pneumonia Viral/complicações , Pneumonia Viral/prevenção & controle , Receptores de Retorno de Linfócitos , Risco , Sociedades Médicas , Neoplasias Trofoblásticas/tratamento farmacológico , Neoplasias do Colo do Útero/terapia , Neoplasias Vaginais/terapia , Neoplasias Vulvares/cirurgia
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA