Clinical Oncology

[Comprehensive care of the carcinoma of the uterine cervix]

ÁROKSZÁLLÁSI Anita1

FEBRUARY 28, 2021

Clinical Oncology - 2021;8(1)

[Cancer of the uterine cervix is a major world health problem for women. Yearly around half a million new cases are diagnosed with cervical cancer having leaded nearly 300,000 deaths in 2018 globally. In developed countries epidemiological data is improving due to the vaccination policy against “high risk” human papilloma viruses (hrHPV) and the population-based screening programs by cytology or hrHPV-testing. However, in developing regions the incidence and mortality data are still dismal. Precancerous lesions and early-stage cervical cancer can be cured solely by surgical approach. Pathological risk factors will determine the need of postoperative radio- or chemoradiotherapy. In advanced-stage disease chemoradiotherapy or systemic therapy are the available options. As a considerable part of the patients are young female, there are some special issues to be faced with like the desire of fertility-sparing or cervical cancer diagnosed in pregnancy. Clinically occult cervical carcinoma recognized after simple hysterectomy is another complex therapeutic field. In modern oncology, the biological agents have also emerged in the therapeutic field of advanced cases: bevacizumab combined with cisplatin and paclitaxel as first line therapy; and pembrolizumab as second line option for tumors with microsatellite instability-high (MSI-H)/mismatch repair deficiency (dMMR) or for tumors express PD-L1 (Combined Positive Score [CPS] ≥1.) The present work provides a short summary of the current literature about the screening, staging, comprehensive management and follow-up of uterine cervical cancer.]

AFFILIATIONS

  1. Debreceni Egyetem, Klinikai Központ, Onkológia Klinika, Debrecen

COMMENTS

0 comments

Further articles in this publication

Clinical Oncology

[SARS-CoV-2 infection-lung demage. Lung cancer and Covid-19 in the TERAVOLT clinical studys]

SZONDY Klára, FUTÁCSI Balázs, KIS Sándor

[Hopefully, towards the end of the Covid-19 pandemic, we intend to provide a brief overview of the infection, the pathogen, most effective treatment options, lung damage, and the results of TERAVOLT clinical trial, about patients with lung cancer, treated or not-treated, infected by SARS-CoV-2 virus. Tried to summarize the new diagnostic and therapy rules (bronchoscopy, chest x-ray, chest CT), and the potential new vaccinations. Authors provide a brief overview of the treatment of respiratory and cancer patients during infection, the continuation of inhalation drugs, immunotherapy and/or chemotherapy.]

Clinical Oncology

[The benefits of vaccination in risk groups]

BÉRES Zsuzsanna Katalin

[As the average age increases, the prevention of infectious diseases is of paramount importance, not just during a pandemic. In terms of volume and complications, pneumococcal and influenza infections are among the top 10 most common causes of death. Timely and properly applied vaccination is an effective weapon against both diseases. This fact is confirmed by several clinical trials. The advent of conjugate vaccination has been a milestone in the history of vaccination. It is important that affected groups are protected from the two seasonal infectious diseases as soon as possible. Always use the conjugate vaccine first to develop protection against pneumococcus, the polysaccharide vaccination, which only broadens the spectrum, is proposed in the second step and needs to be considered for at-risk groups. Influenza vaccination should be repeated annually. The two vaccines can be given at the same time, there is no need to keep the interval.]

Clinical Oncology

[Treatment of cancer associated venous thromboembolism in the age of direct oral anticoagulants]

AY C, BEYER-WESTENDORF J, PABINGER I

[Anticoagulation for cancer-associated venous thromboembolism (VTE) can be challenging due to complications-including bleeding and potential drug-drug interactions with chemotherapy-associated with vitamin K antagonists and inconvenience of low-molecular-weight heparin (LMWH). Direct oral anticoagulants (DOACs) could partially overcome these issues, but until recently there were no large clinical trials assessing their efficacy and safety in cancer patients. This review summarizes clinical treatment guidelines, prior clinical and real-world evidence for anticoagulant choice, recent clinical trials assessing DOACs for cancer-associated VTE (i.e. Hokusai-VTE Cancer, SELECT-D, CARAVAGGIO, and ADAM VTE), and special considerations for DOAC use. Based on established data, clinical guidelines recommend patients with cancer-associated VTE receive LMWH treatment of at least 3-6 months. Nevertheless, LMWH is underused and associated with poor compliance and persistence in these patients relative to oral anticoagulants. Clinical data supporting DOAC use in cancer patients are becoming available. In Hokusai-VTE Cancer, edoxaban was noninferior to dalteparin for the composite of recurrent VTE and major bleeding (12.8% versus 13.5%), with numerically lower recurrent VTE (7.9% versus 11.3%) and significantly higher major bleeding (6.9% versus 4.0%); only patients with gastrointestinal cancer had significantly higher risk of bleeding with edoxaban. In SELECT-D, rivaroxaban had numerically lower VTE recurrence (4% versus 11%), comparable major bleeding (6% versus 4%), and numerically higher clinically relevant nonmajor bleeding (13% versus 4%) versus dalteparin. Most bleeding events were gastrointestinal or urologic; patients with esophageal/gastroesophageal cancer had higher rates of major bleeding with rivaroxaban (36% versus 11%). For comparison of apixaban versus dalteparin, CARAVAGGIO is ongoing, and preliminary results from ADAM VTE are favorable. This review concludes that DOACs appear to be reasonable alternatives to LMWH for treatment of cancer-associated VTE. In patients with gastrointestinal cancer, DOAC use should be considered on a case-by-case basis with consideration of the relative risks and benefits. Kulcsszavak: venous thromboembolism, cancer, treatment, direct oral anticoagulants Nevertheless, LMWH is underused and associated with poor compliance and persistence in these patients relative to oral anticoagulants. Clinical data supporting DOAC use in cancer patients are becoming available. In Hokusai-VTE Cancer, edoxaban was noninferior to dalteparin for the composite of recurrent VTE and major bleeding (12.8% versus 13.5%), with numerically lower recurrent VTE (7.9% versus 11.3%) and significantly higher major bleeding (6.9% versus 4.0%); only patients with gastrointestinal cancer had significantly higher risk of bleeding with edoxaban. In SELECT-D, rivaroxaban had numerically lower VTE recurrence (4% versus 11%), comparable major bleeding (6% versus 4%), and numerically higher clinically relevant nonmajor bleeding (13% versus 4%) versus dalteparin. Most bleeding events were gastrointestinal or urologic; patients with esophageal/gastroesophageal cancer had higher rates of major bleeding with rivaroxaban (36% versus 11%). For comparison of apixaban versus dalteparin, CARAVAGGIO is ongoing, and preliminary results from ADAM VTE are favorable. This review concludes that DOACs appear to be reasonable alternatives to LMWH for treatment of cancer-associated VTE. In patients with gastrointestinal cancer, DOAC use should be considered on a case-by-case basis with consideration of the relative risks and benefits.]

Clinical Oncology

[(K)RAS mutant human cancers]

TÍMÁR József, RÁSÓ Erzsébet

[RAS mutation is the most frequent oncogenic alteration in human cancers and K-RAS is far the most frequently involved among the RAS family members followed by N-RAS. Beside the emblematic K-RAS mutant cancers, pancreatic-, colorectal- and lung adenocarcinomas, urogenital cancers are also belong to this family of malignancies. It is important that K-RAS mutation frequencies are relatively stable around the world in various cancer types with one exeption: lung adenocarcinoma. The variant allele frequencies of K-RAS seems to be cancer-type specific reflecting various carcinogenic processes. Beside point mutation K-RAS allelic imbalances are also frequent in human cancers leading to the predominance of the mutant allele. K-RAS mutant cancers are characterized by typical cancer-type specific co-occurring mutations and well-defined gene expression signatures. ]

Clinical Oncology

[Rehabilitation of cancer patients]

DANK Magdolna, PÉNTEK Irén, JUHÁSZ Ágnes, HAJDÚ Anett

[In our country, the number of neoplastic diseases is constantly increasing. Based on the KSH data 376,709 people had neoplastic diseases in 2017. The disease is a long-term, chronic process, and the physical burden caused by treatments makes it difficult to maintain the physical and mental balance of patients. The quality of life of the neoplastic diseases patient changes, his ability to work will be reduced, his role in the family will be changed, his physical and emotional strength. These problems can be remedied by rehabilitation interventions, but oncology rehabilitation in many places in Hungary is unfortunately not part of the standard of care. In fact, oncology rehabilitation differs from the rehabilitation plan for other diseases. The oncology rehabilitation plan should be treated more flexible and more differentiated, changes due to disease and treatment should always be considered. As a result, the demand for evidence-based rehabilitation interventions is growing therefore, our aim is to apply international literature overview of rehabilitation options for neoplastic diseases patients, including metastatic patients which can be used to reduce pain as a side effect of treatments, musculoskeletal and nutritional problems this will allow for a significant improvement in the quality of life of patients.]

All articles in the issue

Related contents

Journal of Nursing Theory and Practice

[Assessing Quality of life of Women with Cervical Cancer After Treatment]

KOZMANN Krisztina, JÁNOSNÉ PÁNKI Roxána, FERENCZY Mónika, KOMLÓSI Kálmánné, KARÁCSONY Ilona

[To assess sexual function, functionality and quality of life in women with cervical cancer. Descriptive, cross-sectional, quantitative, non-random, purposive sampling of women (N=91) with FIGO stage I/II/III cervical cancer, more than 5 months after last treatment. The study used standard questionnaires with self-designed questions. Data were analysed using Microsoft Excel, descriptive and mathematical statistics (p<0.05). Completers who received radiotherapy scored significantly higher in functional status (p<0.05) and emotional function than those who did not receive radiotherapy (p<0.05). Completers with lower levels of emotional well-being were significantly more likely to have lower levels of sexual function and higher levels of gynaecological problems (p<0.05). Women affected by cervical cancer often experience somatic and psychological disturbances that reflect on quality of life associated with the disease and treatment.]

Hypertension and nephrology

[Subtype diagnosis, treatment, complications and outcomes of primary aldosteronism and future direction of research: a position statement and consensus of the Working Group on Endocrine Hypertension of the European Society of Hypertension – excerpts]

KOVÁTS Viktória, ALFÖLDI Sándor

[Primary aldosteronism is a frequent cause of secondary hypertension requiring a specific pharmacological treatment with mineralocorticoid receptor antagonist or with unilateral adrenalectomy. These treatments have shown to reduce the excess of cardiovascular risk characteristically associated with this disease. In this consensus, we discussed the procedures for the diagnosis of primary aldosteronism, we address the strategies for the differential diagnosis of primary aldosteronism subtypes and therapy. We also discuss the evaluation of outcomes and provide suggestions for follow-up as well as cardiovascular and metabolic complications specifically associated with primary aldosteronism. ]

Clinical Neuroscience

[Cluster headache and its treatment]

JELENCSIK Ilona

[Cluster headache, one of the most painful conditions known, is encountered infrequently in clinical practice. It is characterized by recurrent, unilateral attacks of severe intensity, brief duration and often accompanied by signs and symptoms of autonomic dysfunction. The actual cause of the pain has not been fully elucidated, but most authors believe that the pain arises as a result of a local vasodilatation with a release of certain neuropeptides to the perivascular tissues, resulting in sterile neurogenic inflammation and oedema. Aetiology is absolutely unknown. Treatment can be given as prophylaxis and/or as a symptomatic acute therapy for individual attacks. In the prophylaxis of episodic cluster headache ergotamine, calciumentry blockers, serotonin inhibitors and steroids are used. In chronic cluster headache lithium is the drug of choice, but verapamil may also be tried. Acute therapy has included ergotamine, oxygen inhalation and sumatriptan. Rarely, surgical intervention may be considered.]

Lege Artis Medicinae

[The clinical pathology of prostatic carcinoma]

KISS Ferenc

[On the basis of the actual state of art, the main tasks of clinical pathologists in the diagnostics of prostatic carcinoma may be summarized as follows: Recognition and differential diagnosis of prostatic adenocarcinoma. Estimation of tumour prognosis by means of a reliable histological grading system and establishing the pathological stage. Checking the efficacy of (hormonal) treatment relying upon histological features. An increasing effort to a better understanding and diagnosis of premalignant changes (dysplasia, prostatic intraepithelial neoplasia). In favour of individual characterization of a tumour, one should utilize the attainable modern investigative methods.]

Lege Artis Medicinae

[The relationship between human papilloma virus and cervical cancer]

KOISS Róbert, SIKLÓS Pál

[Worldwide, cervical cancer remains the second most frequent malignancy. The estimated number of new cases is 450,000 per year. Approximately 80% of affected women live in developing countries where access to cervical screening programmes is limited. In Europe, more than 12,800 women die each year from this preventable disease. Human papilloma virus (HPV) infection has been proved to be a potential cause of cervical cancer. Secondary screening decreases the morbidity and mortality of the disease, but does not prevent HPV infection. HPV-DNA can be detected in 90-100% of preinvasive and invasive cervical cancer cases. Trials assessing prophylactic anti-HPV vaccination have confirmed that the vaccination is a suitable method for the primary prevention of precancer lesions and cervical cancer.]