Cervical carcinoma

宫颈癌
  • 文章类型: Case Reports
    背景:后部可逆性脑病综合征(PRES),病因不明的神经系统疾病,以视力障碍为特征,头痛,呕吐,癫痫发作,和短暂的意识改变。病例报告:我们介绍了一名49岁的晚期宫颈癌患者,该患者接受口服安洛替尼(12mg,第1-14天,每21天)和可注射的tislelizumab(200mg,第1天,每21天)。安洛替尼给药7天后,她开始出现提示PRES的症状,并在第11天被诊断出。中断安洛替尼和支持治疗导致她的双眼视力恢复。Naranjo得分(5)将这种反应的因果关系分级为可能,提示该事件可能是安洛替尼的不良反应.伦理:本病例报告经广州中医药大学第一附属医院伦理委员会批准(参考号:K-2023-068,2023/06/09)。从患者及其家人获得知情同意。
    Background: Posterior reversible encephalopathy syndrome (PRES), a neurological disorder with an unknown aetiology, is characterised by visual impairment, headache, vomiting, seizures, and transient alterations in consciousness. Case report: We present the case of a 49-year-old woman with advanced cervical carcinoma who received second-line therapy with oral anlotinib (12 mg, days 1-14, every 21 days) and injectable tislelizumab (200 mg, day 1, every 21 days). After 7 days of anlotinib administration, she began experiencing symptoms suggestive of PRES and was diagnosed on day 11. Interruption of anlotinib and supportive treatment led to recovery of her binocular vision. The Naranjo score (+5) graded the causality of this reaction as probable, suggesting the possibility that the event may have been an adverse reaction to anlotinib. Ethics: This case report was approved by the Ethics Committee of the First Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine (Reference no. K-2023-068, 2023/06/09). Informed consent was obtained from the patient and her family.
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  • 文章类型: Journal Article
    全世界的公共卫生专家都强调宫颈癌,因为它是主要影响妇女的巨大全球健康负担。本文全面回顾了根除和管理宫颈癌的公共卫生方法。公共卫生界寻求降低患病率,发病率,通过接种人乳头瘤病毒(HPV)疫苗,将一级预防与这种可预防疾病有关,使用筛查和早期识别的二级预防,和三级预防通过改善治疗和支持护理。为了实现广泛的疫苗接种覆盖率,最终有效预防宫颈癌,解决疫苗获取障碍仍然至关重要,勉强,和公平分配。早期识别和后续治疗在很大程度上取决于宫颈癌筛查计划。本研究探讨了几种筛选方法,例如基于细胞学的Papanicolaou(Pap)测试以及分子测定和HPV检测等尖端技术。癌前病变和早期恶性肿瘤的检测,允许及时治疗,在将这些技术整合到协调的基于人群的筛查计划中时,已经显示出巨大的希望。该研究还强调了解决宫颈癌负担不平等的重要性,特别是在资源有限的地区,获得预防性和治疗性护理受到限制。研究了解决边缘化群体的创新和负担得起的方法,包括基于社区的外展计划,移动医疗技术,以及当地医疗保健从业人员和社区领导人参与宣传运动。该研究还检查了宫颈癌治疗程序的改进,比如手术,辐射,化疗,和免疫疗法。通过将各种模式纳入多学科策略,可以提高治疗效果和患者生存率。突出的姑息治疗和心理支持对于晚期宫颈癌患者至关重要。
    Public health experts worldwide have emphasized cervical cancer since it is a substantial global health burden primarily affecting women. This article thoroughly reviews the public health approach to eradicating and managing cervical cancer. The public health community seeks to lower the prevalence, morbidity, and mortality linked to this preventable disease by integrating primary prevention by means of vaccination against the human papillomavirus (HPV), secondary prevention using screening and early identification, and tertiary prevention through improved therapy and supportive care. In order to accomplish broad vaccination coverage and ultimately effectively prevent cervical cancer, it remains crucial to address obstacles to vaccine accessibility, reluctance, and fair distribution. Early identification and subsequent treatments depend greatly on cervical cancer screening programs. This study explores several screening methods, such as Papanicolaou (Pap) tests based on cytology and cutting-edge technologies like molecular assays and HPV detection. The detection of precancerous lesions and early-stage malignancies, permitting prompt treatment, has shown significant promise when integrating these technologies into coordinated population-based screening programs. The study also underlines the significance of addressing cervical cancer burden inequities, particularly in resource-constrained areas where access to preventative and curative care is constrained. Innovative and affordable methods for addressing marginalized groups are studied, including community-based outreach programs, mobile health technology, and local healthcare practitioners and community leaders in awareness campaigns. The research also examines improvements in cervical cancer treatment procedures, such as surgery, radiation, chemotherapy, and immunotherapy. It improves therapeutic efficacy and patient survival rates by incorporating various modalities into a multidisciplinary strategy. Highlighted palliative care and psychological support are crucial for patients who have advanced cervical carcinoma.
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  • 文章类型: Journal Article
    宫颈癌是每年夺去妇女生命的最常见的癌症之一。尽管预防性HPV疫苗和常规癌症治疗,每年约有273,000名妇女死于宫颈癌。免疫系统扰动帮助恶性细胞逃避免疫,肿瘤建立,入侵,和转移。深入了解促进或抑制宫颈癌的免疫系统参与者对于开发具有最少副作用的更有针对性的疗法非常重要。免疫疗法已成为靶向癌症的最合规的方法,因为它利用自然的作用过程来刺激免疫系统对抗癌细胞。宫颈癌的主要免疫治疗方法包括单克隆抗体,免疫检查点阻断治疗,过继细胞转移疗法,和溶瘤病毒。2021年10月,FDA批准pembrolizumab联合化疗或贝伐单抗作为宫颈癌的一线治疗药物。癌症免疫治疗方案最近取得了突破,其中单克隆抗体dostarlimab能够完全治愈所有结直肠癌患者,6个月后无病进展并计数。这给人们带来了希望,即免疫疗法可能被证明是这种长达数百年之久的“癌症”流行疾病的最后钉子。
    Carcinoma of the cervix is one of the most common cancers that claims women\'s lives every year. Despite preventive HPV vaccines and conventional cancer treatments, approximately 273,000 women succumb to cervical carcinoma every year. Immune system perturbations help malignant cells in immune evasion, tumor establishment, invasion, and metastasis. An insight into immune system players that promote or suppress cervical cancer is important for the development of more targeted therapies with the fewest side effects. Immunotherapy has emerged as the most compliant approach to target cancer because it utilizes a natural course of action to stimulate the immune system against cancer cells. The major immunotherapy approaches for cervical carcinoma include monoclonal antibodies, immune checkpoint blockade therapy, adoptive cell transfer therapies, and oncolytic viruses. In October 2021 the FDA approved pembrolizumab in combination with chemotherapy or bevacizumab as a first-line treatment for cervical cancer. A recent breakthrough has been made in the cancer immunotherapy regimen in which a monoclonal antibody dostarlimab was able to completely cure all colorectal cancer patients, with disease-free progression after 6 months and counting. This creates hope that immunotherapy may prove to be the final nail in the coffin of this centuries-long prevalent disease of \"cancer\".
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  • 文章类型: Journal Article
    我们回顾了在该主题领域发表的荟萃分析研究中关于衣原体感染作为患宫颈癌的危险因素的患病率的研究。
    系统搜索CochraneLibrary和PubMed数据库,查找2008-2018年发表的文章(观察性和随机对照试验)。进行了一项研究的荟萃分析,以分析衣原体感染与宫颈癌之间的关系。
    最终分析中包括五篇文章(N=5271)。所有五篇文章都是病例对照研究,其中三项研究来自基于人群的登记册。所有研究都涉及至少15岁的性活跃女性。三项研究报告了沙眼衣原体感染宫颈癌的相关性,另外两项研究报道了沙眼衣原体-HPV共感染与宫颈癌的相关性.结果显示,沙眼衣原体的总体患病率为31.9%,子宫颈癌合并OR1.96,95%CI1.05至3.67,OR2.13,95%CI1.78至2.54。在3.0效果估计时检测到轻度发表偏倚。从临床和方法学多样性特别是从沙眼衣原体-HPV共感染亚组分析中检测到的异质性,包括采样偏差,地理菌株多样性,和不同的结果终点测量。
    C.沙眼感染与宫颈癌的发生密切相关。沙眼衣原体-HPV与宫颈癌的共感染似乎是合理的,但沙眼衣原体-HPV与宫颈癌发展的时间性需要在未来的前瞻性队列研究中得到证实。
    UNASSIGNED: We reviewed studies on the prevalence of Chlamydia infection as a risk factor for developing cervical cancer in a meta-analysis studies published in that subject area.
    UNASSIGNED: Cochrane Library and PubMed databases were systematically searched for articles (observational and randomized controlled trials) published from 2008-2018. A meta-analysis of studies was performed to analyse the association between chlamydia infection and cervical cancer.
    UNASSIGNED: Five articles were included in the final analysis (N=5271). All five articles were case-control studies, of which three studies sampled from population-based registries. All studies involved with sexually active women with minimum 15 years old. Three studies reported the association of C. trachomatis infection cervical cancers, two other studies reported C. trachomatis-HPV co-infection in association with cervical cancer. Result showed C. trachomatis has an overall prevalence of 31.9%, pooled OR 1.96, 95% CI 1.05 to 3.67, OR 2.13, 95% CI 1.78 to 2.54 among cervical cancer. There was a mild publication bias detected at 3.0 effect estimation. Heterogeneity detected from clinical and methodological diversities particularly from C. trachomatis-HPV co-infection subgroup analysis, including sampling bias, geographical strain diversity, and different outcome endpoint measured.
    UNASSIGNED: C. trachomatis infection was significantly associated with the development of cervical cancer. Co-infection of C. trachomatis-HPV with cervical cancer is plausibly sound but temporality of C. trachomatis-HPV with the development of cervical cancer need to be proven in future prospective cohort studies.
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  • 文章类型: Journal Article
    由子宫颈引起的癌症是全球女性癌症死亡的第四大常见原因。近90%的宫颈癌死亡率发生在低收入和中等收入国家。导致宫颈癌的主要病因之一是由致癌类型的人乳头瘤病毒引起的持续感染。如果早期发现并有效管理癌前病变,该疾病是可以预防的。在这次审查中,我们概述了几十年来在全球范围内引入和实施的标准指南,包括细胞学,HPV检测和基因分型,和替代标记的免疫染色。此外,用于对宫颈癌前病变和恶性肿瘤进行分类的分期系统,以及宫颈癌临床试验中各种治疗方式的安全性和有效性,也讨论了。在这个千禧年的世界里,计算机辅助技术的进步,包括机器人模块和人工智能(AI),也被纳入筛选,诊断,和治疗平台。这些创新减少了对专家和技术人员的依赖,以及样品处理的工作负担和时间。然而,对这些进步的实用性的担忧仍然存在,由于成本高,缺乏灵活性,以及目前机器无法替代的训练有素的专业人员的判断。
    Cancer arising from the uterine cervix is the fourth most common cause of cancer death among women worldwide. Almost 90% of cervical cancer mortality has occurred in low- and middle-income countries. One of the major aetiologies contributing to cervical cancer is the persistent infection by the cancer-causing types of the human papillomavirus. The disease is preventable if the premalignant lesion is detected early and managed effectively. In this review, we outlined the standard guidelines that have been introduced and implemented worldwide for decades, including the cytology, the HPV detection and genotyping, and the immunostaining of surrogate markers. In addition, the staging system used to classify the premalignancy and malignancy of the uterine cervix, as well as the safety and efficacy of the various treatment modalities in clinical trials for cervical cancers, are also discussed. In this millennial world, the advancements in computer-aided technology, including robotic modules and artificial intelligence (AI), are also incorporated into the screening, diagnostic, and treatment platforms. These innovations reduce the dependence on specialists and technologists, as well as the work burden and time incurred for sample processing. However, concerns over the practicality of these advancements remain, due to the high cost, lack of flexibility, and the judgment of a trained professional that is currently not replaceable by a machine.
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  • 文章类型: Journal Article
    This study aimed to evaluate neoadjuvant chemotherapy (NACT) for locally advanced stage cervical carcinoma.
    Data of 43 patients with locally advanced cervical carcinoma who had NACT were reviewed. NACT protocols implemented included cisplatin/5-fluorauracil, cisplatin/UFT, and carboplatin/paclitaxel. After NACT, the patients were re-examined, and patients who had a tumor size ≤40 mm underwent Piver-Rutledge type III radical hysterectomy, while other patients received radiotherapy. Following NACT, clinical responses were assessed according to the criteria of the World Health Organization.
    The mean age of the patients was 49.4 years, and the median follow-up duration was 48 (range, 5-228) months. The median tumor sizes were 50 and 30 mm before and after NACT, respectively. Complete clinical response was observed in 4 (9.3%) patients, partial clinical response in 8 (18.6%), and pathologic complete response in 3 (6.9%). Stable disease was noted in 30 (69.9%) patients and progression in 1 (2.3%) patient. After NACT, 31 patients have undergone radical surgical procedures. The 5-year disease-free survival rate was 72%, and the 5-year disease-specific survival rate was 91%. Age, International Federation of Gynaecology and Obstetrics 2009 stage, histopathologic type, NACT protocol, rate of decrease in tumor size after NACT, clinical response, number of courses, tumor size before NACT, tumor size after NACT, and lymph node metastasis were not associated with disease-free survival.
    Following NACT, a significant reduction in tumor dimension was observed, and the probability of radical surgery is increased. However, clinical response was not predictive of survival.
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  • 文章类型: Journal Article
    To determine the impact of pathology review on the management of patients with cervical carcinoma, 264 reports of pathology review from 230 patients referred to Erasmus MC (2010-2012) were studied retrospectively. Discrepancies between pathologic diagnoses were classified as \'major\' if they led to changes in treatment, and as \'minor\' where there was no change. Patient and tumor characteristics were analyzed to identify the factors influencing these discrepancies. Fifty-eight (25.2%) discrepancies were identified; 28 (12.2%) were major, these resulted frequently from missing essential information, or discordant assessment of tumor invasion. Pathology review prevented under-treatment of 3.5%, over-treatment of 1.3%, treatment for incorrect malignancy of 1.3%, and enabled definitive treatment of 6.1% of patients. This highlights the importance of pathology review for appropriate management. Major discrepancies were rare (1%) for patients with macroscopic tumor and histologic diagnosis of squamous cell carcinoma (n = 100). For these patients, yield of pathology review may be limited.
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  • 文章类型: Case Reports
    Locally advanced stage cervical cancer diagnosed during pregnancy is a clinical challenge and requires skill in balancing maternal management, fetal care, and oncological treatment. Cisplatin has been routinely used as a first line agent for neoadjuvant chemotherapy in this situation, even though it has also recently been associated with fetal hearing loss. We report a case of stage IB3 cervical cancer diagnosed at 17 gestational weeks successfully treated with neoadjuvant chemotherapy using carboplatin and paclitaxel during pregnancy. Carboplatin is a valid alternative to cisplatin for advanced stage cervical carcinoma in a pregnant patient, in particular in view of the neonatal complications (primarily ototoxicity) that are associated with in utero cisplatin exposure.
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  • 文章类型: Case Reports
    Adenoid basal carcinoma (ABC) is uncommon malignancy of the uterine cervix and it can be pure or combined with cervical intraepithelial lesions. There were less than 20 cases of ABC combined with invasive squamous carcinoma (mixed type) in English literature. These cases had similar properties as seen at postmenopausal women and diagnosed with abnormal cervical smear findings. Here we present a case of 37-year-old woman who suffered from spotting and received endocervical curettage. The pathological report revealed squamous cell carcinoma (SCC) of the cervix. The patient underwent type 3 radical hysterectomy and bilateral pelvic and para-aortic lymph node dissection. The final pathological report revealed SCC coexisting with ABC. Human papillomavirus (HPV) 16,18 and others (11 types) were negative in both components of the mixed tumor by in situ hybridization detection. Our case was cytokeratin 7 negative, cytokeratin 8 positive and p63 positive which supports the hypothesis that mixed type cervical carcinoma originates from endocervical reserve cells.
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  • 文章类型: Journal Article
    OBJECTIVE: Cold coagulation is recognised as a viable, cost-effective and successful treatment for cervical intraepithelial neoplasia (CIN), being used less frequently than excisional treatments for high grade lesions. We set out to demonstrate successful long term follow-up of patient with high grade CIN treated with cold coagulation.
    METHODS: We conducted a retrospective review over a one-year period of women with biopsy-proven CIN 2 and 3 who were treated with cold coagulation to the cervix, attending the colposcopy service of a large tertiary referral hospital. We examined follow-up cervical smear data for three years post treatment of low and high grade CIN, evaluated the success of treatment and re-treatment rates.
    RESULTS: 93 patients were included in our study, with 39 (41.9%) having CIN 1 and 54 (58.1%) diagnosed with CIN 2 or 3. Follow-up smears revealed low levels of recurrent high grade changes in both groups, with 31 (79.5%) of our CIN 1 group having a negative smear one year following treatment with cold coagulation, compared to 44 (81.1%) of patients with CIN 2 and 3. Successful primary treatment (i.e. no requirement for further treatment after 3 year follow-up) occurred in 33 (84.6%) of the CIN 1 group, and 42 (77.7%) of the CIN 2/3 group, demonstrating no statistical significance between re-treatment rates between both groups.
    CONCLUSIONS: This study demonstrates the effectiveness of cold coagulation for the treatment of high grade cervical intraepithelial neoplasia. High success rates, and low re-treatment rates confirm that this is an acceptable primary treatment for CIN 2 and 3.
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