Epidemiologie und formale Pathogenese des Zervixkarzinoms

Deoxyribose Nucleic Acid Damage and Its Association With Plasma Malondialdehyde Levels Among Patients With Cervical Cancer: A Case-Control Study

Purpose The objective of this research project was to estimate DNA damage in patients diagnosed with cervical cancer using the comet assay, establish a correlation between this quantification and the oxidative stress marker malondialdehyde (MDA; plasma MDA), and compare the resulting parameters between the cases and age-matched controls. Materials and methods This study included 49 cervical cancer cases and 49 age-matched controls to measure DNA damage parameters such as comet length, head diameter, percentage of DNA in the comet head, tail length, percentage of DNA in the comet tail, and oxidative stress marker (plasma MDA) using the thiobarbituric acid reactive substance (TBARS) enzyme-linked immunosorbent assay (ELISA) method. Results Comet metrics suggesting DNA damage, such as comet length, tail length, and percentage of DNA in the comet tail, were considerably higher in cervical cancer cases than in age-matched controls. The proportion of DNA in the comet head, representing undamaged/mild DNA damage, was significantly higher in age-matched controls than in cervical cancer patients. Plasma MDA and comet tail length were shown to have a positive correlation. Compared to the age-matched controls, those between the ages of 30 and 39, with a parity of two to four, who had a history of early age at first pregnancy and a positive family history of cervical cancer, had the highest level of DNA damage. Conclusion The elevated levels of comet parameters and their positive correlation with plasma MDA suggest that individuals diagnosed with cervical cancer have a higher degree of DNA damage compared to the control group. In conjunction with established methods like the PAP smear, this predictive test comprising comet assay and estimation of plasma MDA may be utilized to identify and assess the risk of cervical cancer in individuals aged 30-39 years, with a parity between two and four pregnancies and a prior history of early age at first pregnancy, accompanied by a positive family history of the disease.

Combining T-cell vaccination and application of agonistic anti-GITR mAb (DTA-1) induces complete eradication of HPV oncogene expressing tumors in mice

We generated an adenovirus-based T-cell vaccine (Ad-p14) that reliably elicits T-cell responses to human papillomavirus (HPV) oncogenes of the 2 most common high-risk HPV serotypes. The artificial gene used to create the vaccine comprising 415 aa (1248 bp) was cloned by fusing 14 polymerase chain reaction fragments of HPV16 and HPV18 E6 and E7 oncogenes devoid of sequences with transforming potential. Although ensuring maximal biologic safety, the construct includes approximately 70% of the relevant T-cell epitopes. In a tumor model for cervical cancer (C3), therapeutic vaccination led to complete eradication in 100% of the mice. In a second model (TC1), it induced initial tumor mass reduction, but 90% of the animals showed delayed tumor progression. To further improve the therapeutic effect, vaccination was combined with systemic application of imiquimod, anti-CD4, alpha-interferon, or anti-GITR. Although adding alpha-interferon improved the therapeutic potential of Ad-p14 by 40%, the combination with anti-GITR resulted in complete and permanent eradication of all TC1 tumors. Ad-p14 has clinical potential for treating HPV-induced lesions, and the added effect of immune response modifiers stresses the importance of combined protocols for immunotherapy of malignant tumors.

Laparoscopic staging compared with imaging techniques in the staging of advanced cervical cancer

OBJECTIVE

We evaluated the evidence of laparoscopy for decision regarding treatment options in advanced cervical cancer patients.

METHODS

One hundred nine consecutive patients with cervical cancer FIGO stage Ib2 and higher underwent laparoscopic staging of the extent of disease. Laparoscopic and histopathologic evaluation of tumor involvement of the paraaortic and pelvic lymph nodes, wall of the bladder, and rectal pillar was compared with preoperative findings of MRI and/or CT.

RESULTS

Paraaortic lymphadenectomy was performed in 101 (92.7%) patients and 21 (19.3%) patients had positive paraaortic lymph nodes. Pelvic lymphadenectomy was performed in 75 (68.8%) patients and 20 (26.7%) patients had positive pelvic lymph nodes. In 11 patients (11.5%) infiltration of the bladder and in 6 patients (6.25%) infiltration of the rectal pillar or cul-de-sac was found. Intraoperative complications associated with laparoscopic staging occurred in 3.7% of patients. The negative predictive value for the evaluation of paraaortic or pelvic lymph nodes, the bladder wall, rectal pillar, and cul-de-sac ranged from 73% (CT for pelvic lymph nodes) to 96% (MRI for bladder wall). Lack of information about the extent of disease was adjusted on the basis of laparoscopic findings in 24 (22%) patients and improved treatment plans.

CONCLUSION

Laparoscopic staging of patients with advanced cervical cancer is accurate, associated with low morbidity, and helps to adjust treatment according to extent of disease.

[In situ adenocarcinoma of the uterus cervix: difficulties of its cytohistological diagnosis]

In situ adenocarcinoma is regarded as the precursor of invasive adenocarcinoma. It is asymptomatic and early diagnosis relies solely on cytopathologist. It is usually discovered on a cone for squamous CIN. When diagnosis is made by biopsy, conisation is required to exclude invasive adenocarcinoma. Lesion is histologically characterised by epitheliomatous transformation of endocervical glands without invasion of the chorion. By the appearance of glandular cells, different histological varieties are described. They have no influence on the prognosis. Several benign lesions may mimic adenocarcinoma: tubal metaplasia, glandular atypia due to inflammation or irradiation, mesonephric remnants and microglandular hyperplasia. Precursor lesions (atypical hyperplasia, glandular dysplasia, CIGNI and II) are badly morphologically defined. Preferential location of in situ adenocarcinoma is the transformation zone. Because of this topography, if the surgical margins are disease free, conisation alone may be adequate therapy. HPV infection (mainly HPV 18) are incriminated in its pathogenesis.