Medical and vocational rehabilitation of patients with microinvasive cancer of the cervix uteri after organ-sparing surgery

The report discusses the data on rehabilitation of 198 cases of cervical carcinoma in situ following conoid diathermoexcision versus the end results. Organ-saving procedures were shown to considerably cut down duration of treatment, to help restore working ability within relatively short period and to keep generative function intact.     

The effects of radiotherapy on immunity in patients with cured localized carcinoma of the cervix uteri

The effects of radiotherapy on immune status in patients with localized carcinoma of the cervix have been assessed serially up to 5 years remission by a wide range of methods. Neutrophil function and serum immunoglobulins were essentially normal throughout. Peripheral blood neutrophil and lymphocyte counts and the proportions of T and B-cells fell with treatment but were all normal at 5 years, with the exception of B-cell proportions which remained significantly low. Marked deterioration was seen in in vivo cellular immune responses and this persisted even at 5 years remission. Reduced in vitro immunoreactivity is not therefore a reliable marker of disease recurrence and persisting defects in cellular immunity after radiotherapy do not seem to adversely affect the host tumor response. However, in three of the six patients who subsequently relapsed after therapy, subnormal PHA lymphocyte transformation responses were observed at presentation; all patients achieving sustained remission had normal pretreatment responses.     

Characteristics of women with dysplasia or carcinoma in situ of the cervix uteri.

To identify risk factors for various cervical abnormalities, 237 women with abnoromal cervical smears and 422 control women were interviewed. Cervical biopsy specimens taken from the patients with abnormal smears were reviewed according to standard criteria by one pathologist and classified as follows: 65 carcinoma in situ, 81 severe dysplasia, 44 mild dysplasia and 47 normal histology. Factors associated with risk of mild dysplasia, severe dysplasia and carcinoma in situ were similar to those previously identified for invasive carcinoma, and included age at first intercourse, multiple sexual partners and pregnancy outside marriage. Analysis to disentangle correlated factors revealed that number of sexual partners exerted effects independently of age at first intercourse, whereas the reverse was not true. This finding fails to support suggestions that adolescence is a period when the cervix is most vulnerable to the effects of sexual behaviour. Other factors relating to risk of cervical abnormalities were smoking and use of oral contraceptives. It was not possible to show that these relationships were incidental, but further investigation is required to establish whether they are causal.     

Epidemiologic study by interview on carcinoma in situ of the cervix uteri

From 1950 to 1979, 1248 patients with cancer in situ of the cervix uteri were treated at the Department of Gynecology, Cancer Institute Hospital, Tokyo. Information was obtained from 585 of these patients by direct interview. Many patients revealed early experience of first sexual intercourse and many had had more than two sexual partners and a large discrepancy between the age at first sexual intercourse and at first marriage. Early experience of first sexual intercourse, marital status and the number of sexual partners all seem to have a relation to the development of cancer in situ.     

Radioisotopic methods of studying the pelvic lymphatic system in patients with cancer of the cervix and corpus uteri]

An original method of studying the functional state of the lymphatic system-lymphotachoradiography, elaborated in the Institute of Experimental and Clinical Oncology of the USSR Acadeny of Medical Sciences, was found to be rather effective in estimating metastatic spread of the uterine cervix and body cancer. The coefficients of phagocytosis of colloid particles by lymphoid tissue are determined. Normal coefficients are equal for inguinal, iliac and paraaortic groups of lymph nodes to 1.60+/-0.05; 1.40+/-+/-0.04; 1.10+/-0.10 accordingly. In some pathological changes in lymph nodes these coefficients are changed: 0.41+/-0.01; 0.48+/-0.01; 0.24+/-0.05, correspondingly.     

Papillomatous changes in the cervix uteri]

A case of condyloma acuminatum of the uterine cervix and a case of papilloma on the cervix with concomitant adenocarcinoma of the cervix are described. The diagnostic biopsy revealed only the papillomatous lesion, whereas the adenocarcinoma was diagnosed in the surgical specimen after hysterectomy. Referring to the studies of Meisels et al. on condylomatous lesions of the cervix, the possible frequent incidence of this cervical lesion and its role as one possible first step in the pathogenesis of cervical cancer are discussed. The in toto excision is recommended because of diagnostic and therapeutic reasons. Clinical, colposcopic and cytologic check-up has to be done carefully for years after primary treatment.     

Host genetic control of HPV 16 titer in carcinoma in situ of the cervix uteri

Cervical cancer is strongly associated with infection by oncogenic forms of human papillomavirus (HPV). Although most women are able to clear an HPV infection, some develop persistent infections that may lead to cancer. The determinants of persistent infection are largely unknown. We have previously shown that women developing carcinoma in situ of the cervix uteri have higher titers of HPV 16 long before development of cervical neoplasia, indicating that the immune response to HPV is important in determining the outcome of an infection. The HLA class II alleles DRB1*1501 and DQB1*0602 have previously been associated with an increased risk of HPV infection, and carriers of these alleles also tend to have more long-term infections. Together these results indicate that certain HLA alleles may affect the ability to control the HPV copy number. To evaluate this possibility, we studied the HLA class II DRB1*1501-DQB1*0602 haplotype, as well as the alleles individually, and the HPV 16 titer in 928 women from a retrospective case-control study (441 cases and 487 controls). Carriers of the haplotype DRB1*1501-DQB1*0602 allele have a significantly higher HPV 16 titer compared to noncarriers (t-test with unequal variance, p = 0.017). An association was found between the HLA haplotype carrier frequency and HPV 16 titer (Mantel-Haenszel statistics p = 0.005). To study whether titer is related to the persistency of infection, women were divided into groups with long-term and short-term infection. A strong correlation is seen between long-term infection and high viral load and between short-term infection and low viral load. These results show that host genetic factors, e.g., variation at the HLA class II loci studied, may affect the immune reaction to the virus and thereby indirectly increase the susceptibility to carcinoma in situ of the cervix uteri.     

HLA class II allele control of HPV load in carcinoma in situ of the cervix uteri

Human papillomavirus (HPV) infection is the most important risk factor for development of cervical carcinoma. Carriers of certain HLA class II alleles, e.g., DRB1*1501 and DQB1*0602, are more prone to HPV 16 infection and cervical carcinoma, whereas other alleles, e.g., DRB1*1301 and DQB1*0603, render carriers less susceptible to the disease. In our study comprising 484 cases and 601 controls, we examine the effect of HLA class II alleles on viral load of the oncogenic types HPV 18/45 and HPV 31 and risk of developing cervical carcinoma in situ. We find that carriers of the commonly reported protective DRB1*1301 and DQB1*0603 alleles have lower HPV 18/45 load compared to noncarriers and a lower risk of developing HPV 18/45-positive cervical carcinoma. This provides further evidence that the HLA class II-mediated immune response to HPV is important for controlling viral load and outcome of an infection.     

Recent trends in cervix uteri cancer

Since the prevalence of several risk factors for cervix uteri cancer, such as sexual activity patterns, cigarette smoking, and contraceptive use, has changed over time, the authors analyzed US trends for this cancer during the 1970s to 1980s to search for corresponding variations. Invasive cervical cancer incidence and mortality rates continued to decrease among blacks and whites, although declines are moderating or plateauing among young whites. Carcinoma in situ rates have not changed greatly or have declined, more so among blacks than whites. Excess risks among blacks are less evident among younger than older age groups. Increasing trends were seen only among whites in certain age groups or with certain histologic types. Declining trends in cervical cancer appear related to the widespread use of cervical cytologic screening programs, which have counteracted increases anticipated from changes in risk factor prevalence. Continued surveillance is warranted, however, with special attention to the trends in cervical adenocarcinoma.