Interstitial irradiation in recurrent gynecological cancer

Ninety-six patients with recurrent gynecological, cancer documented by biopsy underwent interstitial implantation at Memorial Sloan-Kettering Cancer Center during the period of 1957–1976. They are divided into two groups: Group I includes 75 patients with recurrent cervical cancer and Group II includes 21 patients with other recurrent gynecological cancer. In Group 1, 63% (47) had previously received a full course of both external and intracavitary radiation, 22% (17) had surgery and 12% (9) had both sugery and radiation as prior management for their primary disease. In two patients, the prior management was not clearly documented. Symptomatic relief was obtained in 70% of the patients who initially presented with symptoms. Without subsequent treatment, 34 of these 75 (45%) patients were alive and disease-free at one year, 15 (20%) at two years, 12 (16%) at three years, 9 (12%) at four years and 7 (10%) at five years. In Group II, 48% (10) were alive and disease free at one year, 33% (7) at two years, 24% (5) at three years, 19% (4) at four years and 5% (1) at five years.     

Disparities in cancer care between the United States of America and India and opportunities for surgeons to lead

The recent report from International Agency for Research in Cancer (IARC) predicted a threefold increase in the global cancer burden by 2030 with a disproportionate rise in cases from the developing world countries such as India. The aim of this study is to compare the cancer care between the developed and developing countries such as the United States of America and India and suggest avenues for surgeons to take a lead in addressing these disparities. J. Surg. Oncol. J. Surg. Oncol. 2010;102:100–105. © 2010 Wiley‐Liss, Inc.     

妇科肿瘤与APC基因启动子甲基化研究进展

腺瘤性结肠息肉病（APC）基因是Wnt信号转导通路重要的抑癌基因,其启动子区域的异常甲基化可影响APC基因mRNA的转录和APC蛋白的表达,导致Wnt信号转导通路异常。近年来在妇科肿瘤的多项研究中发现了APC基因启动子区域异常甲基化,其与肿瘤的发生、发展有关。现就APC基因启动子甲基化与妇科肿瘤的研究进展进行综述。     

妇科恶性肿瘤患者的心理护理效果

目的探讨心理护理在妇科恶性肿瘤护理中的应用效果。方法选取2011年1月至2012年12月间100例妇科肿瘤患者为研究对象,按照随机数字法分为对照组和干预组,对照组给予肿瘤内科的常规护理,而干预组在常规护理基础上实施心理护理干预,观察两组的治疗效果。结果干预组的护理满意度为96.0%,对照组的护理满意度为80.0%,差异有统计学意义(P<0.05)。干预组和对照组护理前的SAS、SDS评分比较,差异无统计学意义(P>0.05);干预组和对照组护理后的SAS和SDS评分较护理前均有明显的改善,差异有统计学意义(P<0.05)。结论对于妇科恶性肿瘤患者实施心理护理干预措施是可行的,能够有效提高患者的临床护理满意度,并且改善患者焦虑和抑郁状况,值得在临床中应用与推广。     

Current status of gynecological cancer in China

The aim of this review is to examine the current status of gynecological cancer in China focusing on epidemiological data. Epidemiological data on gynecological cancer in China is sparse. Therefore, most of the data were estimated via extrapolation based on a few available datasets. Cervical cancer is relatively rare and the incidence and mortality rate are largely decreasing. However, in young women, the incidence and mortality rates are increasing. The overall and age-specific incidence rates of cervical cancer appear to be varied according to geographical areas. The overall prevalence rate of human papillomavirus (HPV) in China is similar with other eastern Asian countries, but the age-specific HPV prevalence showed sustained high HPV prevalence rates in elderly women. There is not yet an established national program for cervical cancer prevention. The incidence rate of corpus and ovarian cancers in China slightly increased between 2000 and 2005, but is still lower than Japan or Korea. There is no reliable, national-level data on mortality rates of corpus and ovarian cancer in China. Breast cancer is one of the most rapidly increasing cancers in China. The increase was sharper in young women than in elderly women. Both increased risk and change of population size/structure contributed to the increase of breast cancer.     

Risk factors according to estrogen receptor status of breast cancer patients in Trivandrum,South India

Estrogen receptor (ER) status is an important biomarker in defining subtypes of breast cancer differing in antihormonal therapy response, risk factors and prognosis. However, little is known about association of ER status with various risk factors in the developing world. Our case–control study done in Kerala, India looked at the associations of ER status and risk factors of breast cancer. From 2002 to 2005, 1,208 cases and controls were selected at the Regional Cancer Center (RCC), Trivandrum, Kerala, India. Information was collected using a standardized questionnaire, and 3‐way analyses compared ER+/ER? cases, ER+ cases/controls and ER? cases/controls using unconditional logistic regression to calculate odds ratios and 95% confidence intervals. The proportion of ER? cases was higher (64.1%) than ER+ cases. Muslim women were more likely to have ER? breast cancer compared to Hindus (OR = 1.48, 95% CI = 1.09, 2.02), an effect limited to premenopausal group (OR = 1.87, 95% CI = 1.26, 2.77). Women with higher socioeconomic status were more likely to have ER+ breast cancer (OR = 1.48, 95% CI = 1.11, 1.98). Increasing BMI increased likelihood of ER? breast cancer in premenopausal women (p for trend < 0.001). Increasing age of marriage was positively associated with both ER+ and ER? breast cancer. Increased breastfeeding and physical activity were in general protective for both ER+ and ER? breast cancer. The findings of our study are significant in further understanding the relationship of ER status and risk factors of breast cancer in the context of the Indian subcontinent. © 2009 UICC     

Burden of preventable cancers in India: Time to strike the cancer epidemic

India has a rapidly growing population inflicted with cancer diagnosis. From an estimated incidence of 1.45 million cases in 2016, the cancer incidence is expected to reach 1.75 million cases in 2020. With the limitation of facilities for cancer treatment, the only effective way to tackle the rising and humongous cancer burden is focusing on preventable cancer cases. Approximately, 70% of the Indian cancers (40% tobacco related, 20% infection related and 10% others) are caused by potentially modifiable and preventable risk factors. We review these factors with special emphasis on the Indian scenario. The results may help in designing preventive strategies for a wider application.     

A retrospective study of the effects of pelvic irradiation for gynecological cancer on anorectal function

To evaluate the prevalence of anorectal dysfunction following therapeutic pelvic irradiation.

Methods and Materials: Anorectal function was evaluated in 15 randomly selected patients (aged 47–84 years) who had received pelvic irradiation for treatment of carcinoma of the uterine body and cervix 5 and 10 years earlier. The following parameters were assessed in each patient: (a) anorectal symptoms (questionnaire), (b) anorectal pressures at rest and in response to rectal distension, voluntary squeeze, and increases in intraabdominal pressure (multiport anorectal manometry with concurrent electromyography of the anal sphincters), (c) rectal sensation (rectal balloon distension) and, (d) anal sphincteric morphology (ultrasound). Results were compared with those obtained in nine female control subjects.

Ten of the 15 patients had urgency of defecation and 4 also fecal incontinence. Basal anorectal pressure measured just proximal to the anal canal (p = 0.05) and anorectal pressures generated in response to voluntary squeeze measured at the anal canal were less (p < 0.01) in the patients. The fall in anal pressures in response to rectal distension was greater in the patients (p < 0.05) and the desire to defecate occurred at lower rectal volumes (p < 0.05). The slope of the pressure/volume relationship in response to rectal distension was greater (p < 0.05) in the patients, suggestive of a reduction in rectal compliance. In 14 of the 15 patients at least one parameter of anorectal motor function was outside the control range. There was no difference in the thickness of the anal sphincters between the two groups.

Abnormal anorectal function occurs frequently following pelvic irradiation for gynecological malignant diseases and is characterized by multiple dysfunctions including weakness of the external anal sphincter, stiffness of the rectal wall, and a consequent increase in rectal sensitivity.     

The Results of a Breast Cancer Screening Camp at a District Level in Rural India

Background: Breast cancer in developing countries is on the rise. There are currently no guidelines to screen women at risk in India. Since mammography in the western world is a well-accepted screening tool to prevent late presentation of breast cancer and improve mortality, it is intuitive to adopt mammography as a screening tool of choice. However, it is expensive and fraught with logistical issues in developing countries like India.Materials and Methods: Our breast cancer screening camp was done at a local district hospital in India after approval from the director and administrators. After initial training of local health care workers, a one-day camp was held. Clinical breast examination, mammograms, as well as diagnostic evaluation with ultrasound and fine needle aspiration biopsy were utilized. Results: Out of total 68 women screened only 2 women with previous history of breast cancer were diagnosed with breast cancer recurrence. None of the women in othergroups were diagnosed with breast cancer despite suspicious lesions either on clinical exam, mammogram or ultrasound. Most suspicious lesions were fibroadenomas. The average cost of screening women who underwentmammography, ultrasound and fine needle aspiration was $30 dollars, whereas it was $16 in women who had simple clinical breast examination. Conclusions: Local camps act as catalysts for women to seek medical attentionor discuss with local health care workers concerns of discovering new lumps or developing breast symptoms.Our camp did diagnose recurrence of breast cancer in two previously treated breast cancer patients, who were promptly referred to a regional cancer hospital. Further studies are needed in countries like India to identify the best screening tool to decrease the presentation of breast cancer in advanced stages and to reduce mortality.     

Advancing Cervical Cancer Prevention in India: Implementation Science Priorities

Cervical cancer is the leading cause of cancer mortality in India, accounting for 17% of all cancer deaths among women aged 30 to 69 years. At current incidence rates, the annual burden of new cases in India is projected to increase to 225,000 by 2025, but there are few large‐scale, organized cervical cancer prevention programs in the country. We conducted a review of the cervical cancer prevention research literature and programmatic experiences in India to summarize the current state of knowledge and practices and recommend research priorities to address the gap in services. We found that research and programs in India have demonstrated the feasibility and acceptability of cervical cancer prevention efforts and that screening strategies requiring minimal additional human resources and laboratory infrastructure can reduce morbidity and mortality. However, additional evidence generated through implementation science research is needed to ensure that cervical cancer prevention efforts have the desired impact and are cost‐effective. Specifically, implementation science research is needed to understand individual‐ and community‐level barriers to screening and diagnostic and treatment services; to improve health care worker performance; to strengthen links among screening, diagnosis, and treatment; and to determine optimal program design, outcomes, and costs. With a quarter of the global burden of cervical cancer in India, there is no better time than now to translate research findings to practice. Implementation science can help ensure that investments in cervical cancer prevention and control result in the greatest impact.     

Projection of Cancer Incident Cases for India -Till 2026

Projection of cancer incidence is essential for planning cancer control actions, health care and allocationof resources. Here we project the cancer burden at the National and State level to understand the magnitudeof cancer problem for the various calendar years from 2011 to 2026 at 5-yearly intervals. The age, sex andsite-wise cancer incidence data along with populations covered by the registries were obtained from the reportof National Cancer Registry Programme published by Indian Council of Medical Research for the period2001-2004. Pooled age sex specific cancer incidence rates were obtained by taking weighted averages of theseseventeen registries with respective registry populations as weights. The pooled incidence rates were assumedto represent the country’s incidence rates. Populations of the country according to age and sex exposed to therisk of development of cancer in different calendar years were obtained from the report of Registrar Generalof India providing population projections for the country for the years from 2001 to 2026. Population forecastswere combined with the pooled incidence rates to estimate the projected number of cancer cases by age, sexand site of cancer at various 5-yearly periods Viz. 2011, 2016, 2021 and 2026. The projections were carried outfor the various leading sites as well as for ‘all sites’ of cancer. In India, in 2011, nearly 1,193,000 new cancercases were estimated; a higher load among females (603,500) than males (589,800) was noted. It is estimatedthat the total number of new cases in males will increased from 0.589 million in 2011 to 0.934 million by theyear 2026. In females the new cases of cancer increased from 0.603 to 0.935 million. Three top most occurringcancers namely those of tobacco related cancers in both sexes, breast and cervical cancers in women accountfor over 50 to 60 percent of all cancers. When adjustments for increasing tobacco habits and increasing trendsin many cancers are made, the estimates may further increase. The leading sites of cancers in males are lung,oesophagus, larynx, mouth, tongue and in females breast and cervix uteri. The main factors contributing to highburden of cancer over the years are increase in the population size as well as increase in proportion of elderlypopulation, urbanization, and globalization. The cancer incidence results show an urgent need for strengtheningand augmenting the existing diagnostic/tr eatment facilities, which are inadequate even to tackle the present load.     

Improving Cancer Care in India: Prospects and Challenges

The World Cancer Report, a 351 - page global report issued by International Agency for Research on Cancer ‍(IARC) tells us that cancer rates are set to increase at an alarming rate globally (Stewart and Kleiues 2003). Cancer ‍rates could increase by 50 % to 15 million new cases in the year 2020. This will be mainly due to steadily aging ‍populations in both developed and developing countries and also to current trends in smoking prevalence and the ‍growing adoption of unhealthy lifestyles. The report also reveals that cancer has emerged as a major public health ‍problem in developing countries, matching its effect in industrialized nations. Healthy lifestyles and public health ‍action by governments and health practitioners could stem this trend, and prevent as many as one third of cancers ‍worldwide. ‍In a developing country such as India there has been a steady increase in the Crude Incidence Rate (CIR) of all ‍cancers affecting both men and women over the last 15 years. The increase reported by the cancer registries is nearly ‍12 per cent from 1985 to 2001, representing a 57 per cent rise in India's cancer burden. The total number of new ‍cases, which stood at 5.3 lakhs Care lakh is 100,000 in 1985 has risen to over 8.3 lakhs today. The pattern of cancers ‍has changed over the years, with a disturbing increase in cases that are linked to the use of tobacco. In 2003, there ‍were 3.85 lakhs of cases coming under this category in comparison with 1.94 lakhs cases two decades ago. Lung ‍cancer is now the second most common cancer among men. Earlier, it was in fifth place. Among women in urban ‍areas, cancer of the uterine cervix had the highest incidence 15 years ago, but it has now been overtaken by breast ‍cancer. In rural areas, cervical cancer remains the most common form of the disease (The Hindu 2004).     

Using Implementation Science to Advance Cancer Prevention in India

Oral, cervical and breast cancers, which are either preventable and/or amenable to early detection andtreatment, are the leading causes of cancer-related morbidity and mortality in India. In this paper, we describeimplementation science research priorities to catalyze the prevention and control of these cancers in India.Research priorities were organized using a framework based on the implementation science literature and theWorld Health Organization’s definition of health systems. They addressed both community-level as well as healthsystems-level issues. Community-level or “pull” priorities included the need to identify effective strategies toraise public awareness and understanding of cancer prevention, monitor knowledge levels, and address fearand stigma. Health systems-level or “push” and “infrastructure” priorities included dissemination of evidencebasedpractices, testing of point-of-care technologies for screening and diagnosis, identification of appropriateservice delivery and financing models, and assessment of strategies to enhance the health workforce. Given theextent of available evidence, it is critical that cancer prevention and treatment efforts in India are accelerated.Implementation science research can generate critical insights and evidence to inform this acceleration.     

Disparity in cancer care: a Canadian perspective

Canada is facing cancer crisis. Cancer has become the leading cause of death in Canada. Despite recent advances in cancer management and research, growing disparities in cancer care have been noticed, especially in socio-economically disadvantaged groups and under-served communities. With the rising incidence of cancer and the increasing numbers of minorities and of social disparities in general, and without appropriate interventions, cancer care disparities will become only more pronounced. This paper highlights the concepts and definitions of equity in health and health care and examines several health determinants that increase the risk of cancer. It also reviews cancer care inequity in the high-risk groups. A conceptual framework is proposed and recommendations are made for the eradication of disparities within the health care system and beyond.     

Communication: common challenging scenarios in cancer care

Good communication is at the heart of effective cancer care. Certain situations which occur commonly in cancer care present particular challenges to the communication skills of healthcare professionals. This paper explores some of the reasons why these situations are difficult and provides frameworks for responding, to stimulate thought and discussion.     

Cancer Incidence and Mortality: District Cancer Registry,Trivandrum, South India

Background: Cancer is emerging as a major cause of morbidity and mortality in low and middle-income countries. Cancer registry figures help for planning and delivery of health services. This paper provided the first results of cancer incidence and mortality [Crude (CR) and age-standardized (ASR)] rates (world-standard population) of Trivandrum district, South India and compared with other registries under the network of National Cancer Registry Programme (NCRP), Government of India. Materials and Methods: Trivandrum district cancer registry encompasses a population of 3.3 million, compiles data from nearly 75 sources (hospitals and diagnostic laboratories) and included under the NCRP in 2012. During 2012-2014, registry recorded 15,649 incident cases and 5667 deaths. Proportion of microscopic diagnosis was 85% and ‘Death certificate only’ was 8%. Results: Total cancer incidence (CRs) rates were 161 and 154 (ASR: 142.2 and 126) and mortality rates were 66 and 49 (ASR: 54 and 37) per 105 males and females respectively. Common cancers in males were lung (ASR:19), oral cavity (ASR:15), colo-rectum (ASR:11.2), prostate (ASR:10.2) and lymphoma (ASR:7) and in females, breast (ASR:36), thyroid (ASR:13.4), cervix-uteri (ASR:7.3), ovary (ASR:7) and colo-rectum (ASR:7). Nationally, the highest CRs for breast, prostate, colo-rectum, corpus-uteri and urinary bladder cancers and low incidence of cervix-uteri cancer were observed in Trivandrum. Conclusion: Cancer incidence (CR) in Trivandrum was the highest in both genders in India (except Aizwal). This is mainly due to the highest life-expectancy in Kerala. Also, an epidemiologic transition in cancer pattern is taking place and is changing to more similar to "western" jurisdictions.