Online ISSN: 2515-8260

Keywords : cervical cancer


IMPACT OF PAP SMEAR SCREENING ON CERVICAL CANCER IN A TERTIARY CARE CENTER IN NORTH INDIA

Nilam Bhasker, Alka Kumari

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 4, Pages 1249-1257

Background: Cervical cancer is the most prevalent malignancy in women that occurs in the cervix, considered as 2nd common cancer that affects the women after most common breast cancer. Pap smear is a simple, cost effective, non-invasive and OPD method for early diagnosis of cervical cancer and pre-cancerous cervical lesions.
Purpose: The purpose of this study was to examine the evidence for the support of patterns of different kinds of cervical lesions and prevalence of epithelial cell abnormalities in our study populations.
Materials and Methods: This retrospective study was carried out in the department of Pathology in collaboration with the department of Gynaecology at ESIC hospital, Lucknow, Uttar Pradesh, India from 01/03/2021 to 30/12/2021 with the duration of 10 months. All Pap smears were taken of women between the age group of 20-70 years in this study. A total of 150 smears were stained with Pap stain and reported by following the New Bethesda system for Reporting Cervical Cytology, 2014.
Results: Out of 150 cases, 17 (11.33%) Pap smears were reported as unsatisfactory or inadequate, 126 (84%) were NILM (negative for intraepithelial lesion or malignancy). Non-specific inflammatory smears were found to be more predominant among NILM. Epithelial cell abnormalities were reported in 07 (4.66%) pap smears examinations. Atypical squamous cells of undetermined significance (ASC-US) in 03(2%) cases, Low grade squamous intraepithelial lesion (LSIL) in 01(0.66%) case, high grade squamous intraepithelial lesion (HSIL) in 01(0.66%) case and squamous cell carcinoma (SCC) were also found in 01(0.66%) case. The most prevalent age group for epithelial cell abnormalities was 40-50 years.
Conclusion: Pap smears is an effective, non-invasive modality and useful in the detection of early diagnosis of cervical cancer and pre-cancerous cervical lesions. 

STUDY OF SPECTRUM OF CERVICAL LESIONS ON PAP SMEARS AND GYNECOLOGICAL CYTOHISTOLOGIC CORRELATION -WHEREVER FEASIBLE, IN A RURAL TERTIARY TEACHING COLLEGE HOSPITAL

Dr. Ashwini Rege-Gundawar, Dr. Sneha Joshi

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 4, Pages 3671-3693

Introduction: Cervical carcinoma (Ca Cx) is a high incidence malignancy in India (6–29% of all cancers in women). The Pap smear test is a proven effective measure for reducing cervical carcinoma incidence. Lack of population level screening program in India corresponds with the detection of most cervical lesions at a late stage of disease (stage II or stage III) with consequent high mortality and morbidity. The hospital where this study was conducted offers Pap smear free of cost.
Aims & Objectives:

1.      To study the spectrum of cervical lesions by analyzing the results of Pap smear tests -for a period of one year.
2.      To evaluate clinical utility of Pap smear testing by studying histopathological correlation- wherever feasible, for the same one-year period.

Materials and Methods: Retrospective observational study conducted by retrieving data for 1 year, pertaining to conventional Pap smear tests and related histopathological examination reports.
Results ([1]): Of 808 Pap smear tests done, 788 (97.5%) were satisfactory for evaluation. These were reported using, “The Bethesda system for evaluation of cervical pathology (2014)”. Results were divided into: i) Inflammatory (70.56%), ii) NILM (23.60%), iii) Atrophic (3.42%) and iv) Epithelial cell abnormalities [ECA] (2.41%). The ECAs included ASCUS, LSIL, HSIL and SCC. The inflammatory Pap smears included 28 cases of Trichomonas vaginalis, 7 cases of Yeast, (likely Candida) infection, and 2 cases with presence of blue wool like microorganisms morphologically resembling Actinomyces. Histopathological report association was done for 118 (14.97%) cases. Of these, 112 (94.91%) cases were reported as inflammatory pathology and 6 (5.08%) cases as ECAs. The ECAs included 3 HSILs, 2 LSIL/inflammatory changes and 1 case of SCC. All 118 cases were reported with 100% concurrence rate for cytopathology –histopathology correlation.
Conclusions: 1) Pap smear is a good screening as well as diagnostic test. 2)However more significant yield towards prevention of Ca Cx will be achieved by adding supplemental testing e.g., HPV DNA testing.3) Concentrated efforts need to be made to target screening efforts towards older age group women and also towards follow up and treatment of the Positive Pap smear cases

EVALUATION OF PATTERN OF CERVICAL PAP SMEAR CYTOLOGY AND TO CORRELATE IT WITH HISTOPATHOLOGICAL FINDINGS

Dr. Prashant Gupta, Dr. Rohini Bansal, Dr. Shraddha Agarwal, Dr. Pankaj Bansal

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 4, Pages 2178-2183

Background: Cervical cancer is the third most common cancer among women worldwide, with 85% of its global burden occurring in less-developed countries. The present study was conducted to evaluate the pattern of cervical Pap smear cytology and to correlate it with histopathological findings.
Materials & Methods: 360 females of age ranged 18-60 years were enrolled. Cervical smears were taken with the help of Ayer’s spatula and cyto brush to collect specimen from thesquamocolumnar junction. Thesmears were stained with Papanicolaou stain(PAP stain) and slides wereexamined under light microscope following 2001 Bethesda system.
Results: Age group 18- 30 years had 68 patients, 31-40 years had 112, 41-50 years had 120 and 51-60 years had 60 patients. The difference was significant (P< 0.05). Maximum number of cases 160 were categorized as negative for intraepithelial lesion or malignancy (NILM). Atypical squamous cells of undetermined significance (ASCUS) seen in 54 followed by followed by low gradesquamous intraepithelial lesion (LSIL) in 50 and high gradesquamous intraepithelial lesion (HSIL) in 30, squamous cell carcinoma 4 and cases of adenocarcinoma 2. 88%diagnosed on Pap smears correlated on histopathology findings.
Conclusion: Pap smears found to be effective in screening for earlydetection of premalignant and malignant lesionsof cervix.

COMPARATIVE STUDY OF LIQUID-BASED CYTOLOGY VERSUS HPV DNA FOR SCREENING OF CERVICAL CANCER AT A TERTIARY HOSPITAL

Virta Chauhan, Sajan Bijyal

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 4, Pages 2129-2137

Background: Among Indian women, cervical cancer is the most common form of genital malignancy. Cytology (conventional or liquid-based) & HPV DNA used for diagnostis of cervical cancer. Present study was aimed to compare liquid-based cytology versus HPV DNA for screening of cervical cancer at a tertiary hospital.
Material and Methods: Present study was single-center, prospective, observational study, conducted women between the ages of 21 - 65 years, with white discharge per vaginum, post coital bleeding or irregular bleeding, unhealthy cervix on speculum examination.
Results: In present study, 220 women were evaluated for LBC & HPV DNA testing. Mean age of women was 42.91 ± 6.19 year, mean age at marriage was 17.41 ± 3.63 years & mean duration of sexual life was 26.81 ± 8.63 years. Majority were from lower socioeconomic status (57.27 %). Common chief-complaint was white PV discharge (64.55 %), Post coital bleeding PV (19.55 %) & intermenstrual bleeding PV (15.91 %). On per-speculum examination cervical erosion (40.45 %) was common finding. Common mode of contraception used was tubectomy (49.55 %), while 28.64 % women were not using any contraceptive. In present study, common LBC findings were Inflammatory / reactive changes (48.18 %), Non-specific inflammation (10.91 %), Candida (5.45 %), Trichomonas vaginalis (3.64 %), Bacterial vaginosis (0.91 %), Atrophy (1.36 %). Pathological findings were ASCUS  (5.00 %), ASC-H (0.91 %), LSIL (0.45 %), HSIL  (0.91 %), HSIL with suspicious of invasion (0.45 %) & Squamous Cell Carcinoma (2.27 %). Normal findings were noted in 18.64 % women while 2 smears were labelled as unsatisfactory smear. HPV DNA was positive in 15.45 % women.  HPV DNA was significantly associated with pathological LBC report (low grade, high grade & neoplasia).
Conclusion: HPV testing in comparison to LBC was more effective, but it is costlier for application as population screening tool.

A Prospective Study to Evaluate the PAPSmear and Acetic Acid Test (VIA) as Cervical Cancer Screening Tools with Histopathological Correlation at Tertiary Care Center

Neha Gupta, Ruchi Agrawal, Shweta Agarwal, Suneeta Meena

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 3, Pages 1383-1387

Background: Cervical cancer is the second most common cancer among women
globally. There are different methods for control and prevention of cervical cancer
which include conventional cytology (Pap smear), liquid-based cytology, human
papillomavirus (HPV) screening, and vaccination against HPV. The aim of this study to
evaluate the pap smear and acetic acid test as cervical cancer screening tools with
histopathological correlation.
Material & Methods: The present study was carried out in department of pathology at
SMS Medical College, Jaipur, Rajasthan, India for one year period. A total of 150
patients attending the gynecology OPD were enrolled in the study. All the patients in the
study were subjected to colposcopy. The cervix was inspected with the naked eye than
with a colposcope. After taking the Pap smear with Ayre’s spatula and cytobrush and
was evaluated by the Bethesda system and then cervix was washed with normal saline
and visualized, followed by application of 3% acetic acid and visualization by
colposcope. Collected data was statistically analyzed to determine specificity and
sensitivity, PPV, NPV of Pap smear, VIA.
Results: Our study shows that majority of cases were seen in 40-50 years of age
group.Sensitivity of VIA was found to be 90% (versus Pap smear, which had 40%) and
specificity of VIA was 87.85% (versus Pap smear, which had specificity of 96.42%).
Conclusion: PAP smear screening needs good infrastructure, trained manpower to
make & interpret the slides which is not feasible considering the facilities available in
the periphery. However, VIA can be done even by sisters in the remotest place with
minimum facilities & patient is diagnosed.

Outcome of cervical cancer screening using Pap smear test on a target population

Dr. Shruti Bhavi Patil

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 2, Pages 122-126

Objective: To evaluate the use of Pap smear screening method for detection of precancerous
lesions.
Methods: Women working in police department and female family members of men working
in police department were screened for Ca cervix. A total of 67 women were recruited for the
study. A clinical examination per speculum and per vaginal examination were performed and
a history taken for all women. A pap smear was used for all women to see for cervical cancer.
The smear was obtained using Ayer’s spatula and spread over a marked glass slide which was
placed in 95% ethyl alcohol and sent to department of Pathology for cytopathological
examination. All data were recorded using a predesigned proforma.
Results: Most women were in age range of 30-50 years. The common complaint was white
discharge per vagina occurring in about 30% of individuals, abdominal pain was in 8.95% of
them, irregular menstrual cycle in 12.78% and 40.29% of them did not have any complaints.
Out of 67 ladies 61 (92.1%) pap smears were taken and 6 were not taken due to post
hysterectomy status or because they were menstruating. The test was negative for malignancy
in 68.6% of individuals and 11% of individuals had inflammatory smear due to infections
with trichomoniasis, bacterial vaginosis or candidiasis. Atypical cells were detected in 2.98%
women and they were advised colposcopy and guided biopsy. 5% of individuals had
unsatisfactory smear due to inadequate sample.
Conclusion: A Pap smear is simple, noninvasive, cost-effective, and easy to perform for
detection of precancerous lesions in a gynecological patient. Awareness about screening in
general population is needed. Women with an abnormal Pap test should undergo a
colposcopy and guided biopsy.

EVALUATION OF EFFECT OF RADIOTHERAPY ON RESPONSE OF CERVICAL CANCER PATIENTS: A MULTI INSTITUTIONAL STUDY

Manoj Kumar Behera, Kailash Kumar Mittal, Samir Kumar Mohanta, Devikalyan Mishra, Samrat Dutta, Dillip Agarwalla

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 3, Pages 12094-12099

Background: Cervical cancer is among the most frequent cancer types in women worldwide. Radiotherapy, including external beam radiation and brachytherapy, is one of the commonly used treatment options for cervical cancer. However, the response and adverse effects of radiation therapy on cervical cancer survival have been poorly investigated with inconclusive result. Therefore, the aim of this study was possibly to explore the potential factors that might affect the response to radiotherapy in patients affected with cervical cancer and thus providing information for an eminent decision making in a way to a better therapy.
Materials and Methodology: This study included 150 cases for the effective analysis. The data of the all the subject analysed were diagnosed with cervical cancer based on histopathology examination where a complete standard-protocol radiotherapy [external curative dose of 46–50 Gy (25 fractions) using Photon on LINAC with 6-10 Mega Volt energy, continued to brachytherapy using the after loading method HDR microselectron unit of 129Ir, dose 700cGy, three times to A-point week apart].
Results: Of the total of 150 cases, 102 cases (68.29%) showed a complete response, 37 cases (24.39%) developed a partial response, seven cases (4.88%) had a stable response, and four cases (2.44%) were progressive. There were no observed gastrointestinal side effects (grade 0) for 121 cases (80.49%), 24 cases were grade 1 (16.26%), five cases were from grade 2 (3.25%), and no cases were seen grade 3.
Conclusion: Most of definitive-curative radiotherapy responses for patients with stage IIA-IIIB cervical cancer were complete (68.29%). Partial response was seen in 24.49%, stable response in 4.88% and progressive response in 2.44%. The clinical characteristics that are significantly associated with the complete response to radiotherapy was seen in the largest tumour diameter. Clinicopathological factors like age, BMI, blood haemoglobin level, blood leucocyte count, serum albumin level, FIGO stage, histopathology and tissue differentiation were not statistically significant.

A MULTIFACETED TACTIC FOR DETECTION OF CERVICAL CANCER USING EXTREME LEARNING MACHINE WITH CROW SEARCH OPTIMIZATION CLASSIFICATION

Geetha .; S. Suganya

European Journal of Molecular & Clinical Medicine, 2021, Volume 8, Issue 2, Pages 934-944

Malignancy or carcinoma is the unrestrained development of cells. There are numerous kinds of malignancies. In this, we are concentrating on one of the normal tumor of females is malignant growth of the cervix. Cervical cancer is the second most kind of malignant growth found in females, apart from the breast cancer which is first existence. There are abundant quantities of screening tests for Cervical cancer in which Pap smear has done. Pap smear is a virtuous device for first screening of this cancer yet it has constraints as there are consistently odds of blunder due to human perceptions. The main aim of this research is to preclude failures by utilizing computerized methods for identifying the cervical cell. Here, the image of Pap smear has been improved by utilizing Kaun Filter. The weight factor in kaun filter is resolved using an optimization technique called Bayesian Optimization Algorithm. Thus it tends to be an upgraded KF. The reformed picture has been segmented by Active Contour model. In this, the weight upgrade issue has been rectified using Analytic Hierarchy Process optimization technique. Hereafter, the solid features are eliminated from the segmented region which is most significant for identifying the cancer by utilizing ELMCSA (Extreme Learning machine with Crow Search optimization) classifier. Experimental results for the cervical cancer identification by the proposed ELM-CSA outperforms 93.5% of accuracy, 88.7% of specificity,79.21% of precision,92.25% of recall and 79.26% of F-measure than the existing classifiers such as ELM, ENN-TLBO, SVM and RBFN

Knowledge And Practice Of Preventive Control Of Cervical Cancer In Housewives

Juvita D. Soto-Hilario .; Silvia A. Martel-y- Chang; Holger A. Aranciaga- Campos; Abner A. Fonseca- Livias

European Journal of Molecular & Clinical Medicine, 2020, Volume 7, Issue 3, Pages 3975-3984

Objective. To determine the relationship between knowledge and the practice of preventive control of cervical cancer. Methods. A correlational study was carried out with 120 housewives attending the CLAS Pillcomarca in Huánuco 2017. In the data collection a knowledge questionnaire and a practice questionnaire were used. For the inferential analysis of the results, the Chi Square Test of independence was used. Results. 50.0% (60 housewives) presented regular knowledge about cervical cancer and 90.8% (109 housewives) had preventive cervical cancer control practices. On the other hand, a significant relationship was found between the knowledge about cervical cancer and preventive control practices (p 0,000). And, the general knowledge of the disease and knowledge about the prevention of the disease relate to the preventive control practices of cervical cancer (p 0.000). Conclusions. There is a significant relationship between the knowledge about cervical cancer and the preventive control practices of cervical cancer of housewives attending the CLAS Pillcomarca - Huánuco.

The Use Of Sonication Method For Reducing Size Of Liposomes In Papaya Leaf Extract (Carica Papaya Linn) Preparations As A Candidate In Treatment Of Cervical Cancer

Yuly Peristiowati; Sandu Siyoto; Koesnadi .; Arina Chusnatayaini; Hariyono .

European Journal of Molecular & Clinical Medicine, 2020, Volume 7, Issue 2, Pages 4703-4709

Liposomes are vesicle-shaped particles whose walls are composed of lipid molecules ( the main constituent is a double layer phospholipid which wraps the liquid compartment inside. Liposomes can be made from natural ingredients in the form of natural phospholipid derivatives mixed with fat chains (eg phosphatidylcholine) by dispersing. Liposomes from papaya leaf extract (Carica Papaya Linn) are made with the aim of increasing the effectiveness of the drug and biocompatible work, as well as protecting healthy tissue from the toxic effects of the drug. The process of making liposom papaya leaf extract using the sonication method by mixing soybean lecithin with papaya leaf extract. Then do the heating and sonication. This method is done to reduce particle size. The aim of this study was to produce an extract of liposomes from papaya leaf phospholipid formulations using a combination of heating and sonication. The method to produce liposomes with a size of <150 nm using a combination of heating 40○C for 40 minutes and stirring using ultraturrax at a speed of 15,000 rpm for 30 minutes, then stirring with a sonicator for 30 minutes. The results showed the liposome nano papaya leaf extract formulation from soybean lecithin by the PSA (Particle Size Analyzertype 1090 / Cilas) method. The liposome product was in the form of liquid, light green and milk white and odorless. Particle size distribution is obtained in the range of 0.04 μm - 500.00 μm / 100 Classes and an average pH of 5.45.

The Use of Sonication Method For Reducing Size of Liposomes In Papaya Leaf Extract (Carica Papaya Linn) Preparations As A Candidate In Treatment of Cervical Cancer

Yuly Peristiowati; Sandu Siyoto; Koesnadi .; Arina Chusnatayaini; Hariyono .

European Journal of Molecular & Clinical Medicine, 2020, Volume 7, Issue 5, Pages 1011-1016

Liposomes are vesicle-shaped particles whose walls are composed of lipid molecules ( the main constituent is a double layer phospholipid which wraps the liquid compartment inside. Liposomes can be made from natural ingredients in the form of natural phospholipid derivatives mixed with fat chains (eg phosphatidylcholine) by dispersing. Liposomes from papaya leaf extract (Carica Papaya Linn) are made with the aim of increasing the effectiveness of the drug and biocompatible work, as well as protecting healthy tissue from the toxic effects of the drug. The process of making liposom papaya leaf extract using the sonication method by mixing soybean lecithin with papaya leaf extract. Then do the heating and sonication. This method is done to reduce particle size. The aim of this study was to produce an extract of liposomes from papaya leaf phospholipid formulations using a combination of heating and sonication.The method to produce liposomes with a size of <150 nm using a combination of heating 40○C for 40 minutes and stirring using ultraturrax at a speed of 15,000 rpm for 30 minutes, then stirring with a sonicator for 30 minutes.The results showed the liposome nano papaya leaf extract formulation from soybean lecithin by the PSA (Particle Size Analyzertype 1090 / Cilas) method. The liposome product was in the form of liquid, light green and milk white and odorless. Particle size distribution is obtained in the range of 0.04 μm - 500.00 μm / 100 Classes and an average pH of 5.45.

Utilization pattern of various cervical cancer screening methods and their outcomes among patients visiting outpatient department of tertiary care hospital Running title: Cervical cancer screening methods

Dr. Anima Prasad; Dr. Amrish Kumar

European Journal of Molecular & Clinical Medicine, 2020, Volume 7, Issue 3, Pages 1006-1010

Background: The present study was conducted to assess utilization pattern of various cervical cancer screening methods and their outcomes among outpatients of tertiary care hospital.
Materials & Methods: 140 women age ranged 20-50 years were recruited. A questionnaire was developed and distributed among all subjects and asked to fill it and return it. Awareness and utilization and pattern of cervical screening was noted.
Results: Age group 20-30 years comprised of 40, 30-40 years had 60 and 40-50 years had 40 subjects. Education level was upto primary in 65, secondary in 45 and no education in 30 subjects. 90 were married, 25 unmarried and 15 were widow. 98 had awareness and 42 had never heard about it. 55 utilized it and 85 never utilized it. The difference was significant (P< 0.05). The type of methods of screening was PAP’s smear in 15, VIA in 35, VILI in 10, frequency of screening was yearly in 35, once in 20 and never in 85. Accessibility to results of screening was 25 received results of screening, 10 not received results of screening and 20 did not indicate receipt of results of screening. The difference was significant (P< 0.05).
Conclusion: Authors found that there was lack of awareness and utilization of cervical screening among subjects. Most commonly used methods was visual inspection with acetic acid.