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Gynecologic Cancers and Lifestyle Medicine
Published in Michelle Tollefson, Nancy Eriksen, Neha Pathak, Improving Women's Health Across the Lifespan, 2021
Nathalie D. McKenzie, Nnamdi I. Gwacham, Sarfraz Ahmad
The early natural history of HPV infection is negatively affected by smoking and the regression of low squamous intraepithelial lesion (LSIL) within 2 years has been found to be significantly lower in smokers than in nonsmokers.56 Roura et al.57 recently noted that women who stopped smoking for at least 10 years had half the risk of developing intraepithelial neoplasia and invasive cancer compared to women who continued smoking. Additionally, current smoking has also been associated with a 45% increase in the risk of disease progression and a 58% increase in the risk of death.58 Women diagnosed with invasive cervical cancer who are still smokers have an associated 35% increase in all-cause mortality and a 21% increase in cervical-cancer-specific mortality.59 It is thereby prudent to encourage the cessation of smoking during treatment for cervical cancer in an effort to abrogate the poorer prognosis that has been demonstrated among smokers.
Carcinoma of the Vagina and Vulva
Published in Pat Price, Karol Sikora, Treatment of Cancer, 2020
Sadaf Ghaem-Maghami, Kostas Lathouras
This is an uncommon condition, similar to that found in the breast. Pruritus is the presenting complaint. The lesion is indistinguishable clinically from squamous intraepithelial neoplasia, and the diagnosis must be made by biopsy. In approximately one-third of patients, there is an adenocarcinoma in the apocrine glands. This has a poor prognosis if the groin lymph nodes are involved, with no survivors at 5 years.
Neoplasia
Published in C. Simon Herrington, Muir's Textbook of Pathology, 2020
This is a key concept in understanding carcinomas. At numerous sites (Table 6.4) it is possible to identify a stage of preinvasive neoplasia, where the epithelial cells show the cytological features of neoplasia, but have not yet developed the ability to invade adjacent normal tissues. This process has been known as dysplasia, carcinoma in situ, and more recently as ‘intraepithelial neoplasia’. It can affect epithelia of all types − squamous, transitional (e.g. bladder), and glandular (e.g. stomach). In squamous epithelia the key feature is a loss of the normal maturation that occurs from the basal layer, where proliferation normally takes place, to the surface where fully mature cells are found. Detection at this early stage allows treatment to be given before local invasion occurs and metastasis is possible. This is the basis of the cervical screening programme (see Chapter 15) in which the abnormal cells from cervical intraepithelial neoplasia (CIN) can be identified in cervical samples.
Factors that affect survival in vaginal cancer: a seer analysis
Published in Journal of Obstetrics and Gynaecology, 2022
Batuhan Bakirarar, Muberra Namli Kalem, Ziya Kalem
Accordingly, the mean survival time was calculated to be 30.72 ± 0.40 years in the patient group for which surgery was not performed; it was significantly longer than the groups for which surgery was not performed and not recommended (15.45 ± 0.65 and 14.48 ± 0.40). As for the causes of mortality, mortality rates were found to be 34.6% and 53.6% for those who died due to cancer and other causes, respectively, in the patient group of surgery. Due to very low incidence of primary vaginal cancer, there is lack of reliable recommendations on primary therapy, follow-up, and therapy modalities in recurrent cases. Indeed, it is stated by the National Comprehensive Cancer Network (NCCN) that ‘vaginal cancer is the only cancer of the female genital system that has no clinical practice guidelines’ (Yang et al. 2020). Surgery is mostly opted for in intraepithelial neoplasia group and surgically resectable disease group for treatment purposes (Hacker et al. 2015). In a series of 100 patients who had been followed up for 30 years, Stock et al. (1995) showed that the most important prognostic factor was surgery for disease-free survival in stage-1 and -2 patients. These results coincide with the results of the present study. Surgical treatment performed in vaginal cancer at early ages might explain higher success of the treatment (Tjalma et al. 2001). Resorting to surgery besides radiotherapy and chemotherapy as part of the combination therapy in advanced and recurrent cases can have a positive impact on survival time (Hacker et al. 2015, Ling et al. 2008).
Squamous cell carcinoma antigen combined with HPV-16 infection in predicting high-grade squamous intraepithelial lesions of the cervix
Published in Journal of Obstetrics and Gynaecology, 2022
Guanglei Zhong, Yuhan Wang, Shixian Yao, Xingyu Fang, Rongchun Lin, Zhongqiu Lin, Yongpai Peng, Tingting Yao
Cervical cancer is the second most common malignancy that affects women’s health in the world. Standard treatment concurrently focussed on surgery, radiotherapy and platinum-based chemoradiation. However, the five-year survival rate of cervical cancer is only 66% (Franco et al. 1999). Hence, early screening of cervical pre-cancerous lesions is of vital importance, it might identify and effectively interfere those patients who would finally develop cervical cancer. Among multiple pre-cancerous lesions, high-grade cervical intraepithelial neoplasia constitutes the major part. Screening methods based on HPV and TCT were highly recommended by the updated American society of clinical pathology screening guidelines for the early detection of cervical cancer and its precursors (Walboomers et al. 1999). However, the detection rate of patients with high-grade cervical intraepithelial neoplasia was less satisfactory.
Factors Correlated with the Accuracy of Colposcopy-Directed Biopsy: A Systematic Review and Meta-Analysis
Published in Journal of Investigative Surgery, 2022
Hongyan Ren, Mengzhe Jia, Shujun Zhao, Hongyu Li, Suzhen Fan
Diagnosis and treatment of cervical intraepithelial neoplasia are the key steps to prevent cancer. If the biopsy results in high-grade lesions, conization or ablation may be performed. However, according to the latest guidelines, the treatment of CIN 2 is not always surgical treatment [14–17]. Conization has risks and complications [27]. Suspicious lesions could be detected using colposcopy [39]. Colposcopy guided biopsy is very important for the diagnosis of high-grade lesions [40]. However, colposcopy may not always represent the true condition of the entire cervix [41]. The accuracy of colposcopy-guided cervical biopsy in the identification of severe lesions has been controversial. One study suggested that among the patients with low-grade lesions in preoperative biopsy, 18% of them came back CIN 2/3 in the cone histology [35]. Stoler, M.H et al. suggested that the overall underdiagnosis of CIN3/AIS (adenocarcinoma in situ) was 42% [42]. Biopsy may be inadequate to judge the severity of cervical dysplasia [33].