Day 2 :
- HPV-Cervical Cancer|Cervical Cancer: Prevention and Early Detection| Cervical Cancer: Treatment and Support | Cervical Cancer Vaccines
Chair
Aleksandar Stefanovic
University of Belgrade, Serbia
Session Introduction
Aleksandar Stefanovic
Clinical Centre of Serbia, Serbia
Title: Fertility sparing procedure in treatment of early stages of cervical cancer
Biography:
Aleksandar Stefanovic has completed his PhD from University in Belgrade, Serbia. He is the Director of Clinic of Ob/Gyn, Clinical Center of Serbia and the President of Association of Gynecologist and Obstetricians of Serbia, Montenegro and Republic of Srpska. He has published more than 35 papers in reputed journals and has been serving as an Editorial Board Member of repute.
Abstract:
Standard surgical approach to invasive cervical cancer carries risks of unfulfilled reproductive plans and morbidity, which could influence quality of life to a greater extent. Radical trachelectomy is a fertility sparing procedure with the aim to preserve reproductive potential of the patient with unchanged oncologic outcome. The procedure can be performed by vaginal or abdominal approach. Abdominal trachelectomy offers greater radicality concerning the parametrial resection with an easier learning curve, although studies demonstrate slightly lower reproductive success. Vaginal radical trachelectomy is combined with minimally invasive lymphadenectomy (laparoscopic or robotic). The procedure is applied to patients with early-stages of cervical cancer, FIGO staged as Ia1, Ia2 and smaller Ib1 tumors. Since the procedure is combined with an ex-tempore histologic analysis, organization and experience of team is of crucial importance. Oncologic outcome is excellent and comparable to standard procedure. Fertility rates are between 40 and 70% with increased rates of pregnancies achieved by assisted reproductive procedures (about 1/3). The rate of pregnancy complication is higher and includes increased rates of abortions, preterm deliveries, chorioamnionitis and cesarean sections. In an attempt to further decrease morbidity and to optimize reproductive outcome, some institutions perform less radical approach conisation or amputation of cervix, preceded by pelvic lympadenectomy. Novel approaches include sentinel node biopsies and neoadjuvant chemotherapy followed by fertility sparing procedures. Since the oncologic safety of these procedures is yet to be determined, for now these procedures have to be considered as experimental. More studies, concerning the safety of above mentioned procedures are needed, before they can fully be utilized in routine practice.
Biography:
Paulo Naud is a full Professor at the Department of Obstetrics and Gynecology at Federal University of Rio Grande do Sul (UFRGS), Brazil. He was the Chairman of the Education Committee of International Federation of Cervical Pathology and Colposcopy Management (IFCPC) from 2011 to 2014. He has published more than 74 papers in reputed journals.
Abstract:
This is a collaborative study with the World Health Organization to use SEMMs device in Latin America. Ablative methods are used to treat cervical intraepithelial neoplasia (CIN's) and among them, cryotherapy is the most used worldwide. Other ablative treatment modality is termocoagulador which have resolution rates similar to cryotherapy with the advantage of being portable, small, powered and having a self-sterilization system. This study aims to analyze the effectiveness and safety of termocoagulador for the treatment of CIN's 2 and 3 after histologic result of HSIL. A prospective study (cohort) including women with cervical intraepithelial high grade lesion (HSIL) treated with thermocoagulation was conducted in the Hospital de Clinicas de Porto Alegre. Patients as the WHO Protocol were followed by 1 year with cytopathology (CP), colposcopy and biopsy if necessary. Among 70 patients 55 (78.5%) had normal pap smears and 15 abnormal pap smears (7 ASCUS, 2 ASC-H, 1 unsatisfactory, 2 abnormalities of epithelial cells, 1 CIN 2/3, 1 LSIL, 1 HSIL). The study showed that the termocoagulador is highly effective and safe but studies are still limited. The cure rate in this study was similar to those found with other ablative methods (cryotherapy) and excisional. Furthermore, it is an inexpensive treatment, without anesthesia or analgesia, running on electricity and self-sterilizing system.
Katarina Jeremic
University of Belgrade, Serbia
Title: Fertility sparing approach in young patients with early stages of endometrial cancer
Biography:
Katarina Jeremic has completed her PhD from University of Belgrade, Serbia. She is the Chief of Gynecologic Oncology Department of Clinic of Ob/Gyn, Clinical Center of Serbia and Member of many scientific projects such as cancer and pregnancy. She is currently working at the Medical School, University Belgrade as a Lecturer/Associate Professor of Gynecology and Obstetrics. She has about 50 publications in CC/SCI expanded and JCR indexed and is an active participant of more than 50 international congresses with total number of publication about 150.
Abstract:
Endometrial cancer is the most common cancer of the female genital tract and female patient less than 40 years may account for 3-14% of all endometrial cancers. The promising fact is that in women <45 years, the tumor is mostly low grade disease localized to the endometrium, whereas survival is almost about 100%. An individualized and multidisciplinary approach is to each patient, intense follow-up, respecting the current recommendations’ for fertility sparing. Conservative approaches of early-stage endometrial carcinoma includes hormonal therapy in selected group of young patients with endometrial carcinoma age less than 45 years and wishes fertility, showing low grade 1 endometrioid adenocarcinomas (by 2 gynecology pathologists review) is requested limited to the endometrium with MRI excluded myomaterial invasion without evidence of lymphovascular space involvement or extrauterine disease. Carefully and accurately pretreatment assessment of patients considering conservative therapy includes radiologic imaging, hysteroscopy preferably but also contrast-enhanced radiologic imaging-MRI imaging of the ovary (5% of patients with endometrial cancer have synchronous primary tumors). Repeating endometrial biopsies by hysteroscopy every 6 months has been recommended, until there is a complete response or achieving pregnancy. Surgery is recommended if there is no response after 6 months of medicational treatment. Hormonal therapy that could be applied is progestin inhibits the estrogenic effect and suppresses cell proliferation (medroxyprogesterone acetate, megestrl acetate), GnRh analogues, but also local gestagens (IUD), oral natural progesterons, aromatase inhibitors, even three step endoscopic (hysteroscopic) resection-remove tumor, surrounding endometrium, myometrium. Fertility after treatment is not guaranteed, even there had been recorded reduced fertility of those treated and there is a significant need ART (18-60%).
Wojciech Kwasniewski
Medical University of Lublin, Poland
Title: Heterogeneity of the cervical microbial communities within HPV-induced carcinogenesis
Biography:
Wojciech Kwasniewski is currently working in the Department of Gynecologic Oncology and Gynecology at Medical University Lublin, Poland.
Abstract:
Introduction & Aim: Human papillomavirus is a key agent in the development of cervical cancer. However, it has been suggested that HPV infection alone may not be sufficient to promote cervical carcinogenesis and that other cofactors could be involved. The purpose of the present study was the evaluation of the existence of an association between cervicovaginal infection and precancerous lesion of the uterine cervix. The study material was cervix microbiota from healthy women and HPV positive women with L-SIL and H-SIL.
Methods: We determined cervicovaginal microbiota by high throughput sequencing of 16S rDNA amplicons and classified it in community state types of healthy women, patients with low-grade squamous intra-epithelial lesions (LSIL) and high-grade squamous intra-epithelial lesions (HSIL).
Results: Clustering analysis of the bacteria classes has indicated that in healthy women and patients with L-SIL, flora is composed predominantly of Bacilli class bacteria. Moreover, in patients with H-SIL, Gammaproteobacteria class is also detectable. Species of bacteria of Actinobacterium class, forming clusters distinct from other species are Gardnerella vaginalis and Propionibacterium acnes for healthy women, Gardnerella vaginalis and Actinomyces turicensis for group with L-SIL diagnosis; Gardnerella vaginalis, Corynebacterium glaucum, Corynebacterium matruchotii, Propionibacterium acnes and Propionibacterium humerusii for patients with H-SIL diagnosis. Bacteria species of Bacilli class forming distinct clusters from other species are Lactobacillus crispatus, Lactobacillus iners and Lactobacillus taiwanensis for healthy women, Lactobacillus iners and Lactobacillus acidophilus for patients diagnosed with L-SIL; Lactobacillus iners, Lactobacillus acidophilus and Lactobacillus crispatus for women with H-SIL diagnosis.
Conclusion: Our findings suggest that the presence and prevalence of specific cervicovaginal microbiome CSTs may be involved in the pathogenesis of cervical cancer. CST for healthy women cervical smear is dominated by Lactobacillus crispatus, Lactobacillus iners and Lactobacillus taiwanensis and depleted by Gardnerella vaginalis and Lactobacillus acidophilus. CST for L-SIL patients is dominated by Lactobacillus acidophilus and Lactobacillus iners and depleted by Lactobacillus crispatus. CST for H-SIL women is dominated by Gardnerella vaginalis, Lactobacillus acidophilus and depleted by Lactobacillus taiwanesis, Lactobacillus iners and Lactobacillus crispatus. Noteworthy, the concentration of Lactobacillus acidophilus in cervical smears from women diagnosed with L-SIL as well as with H-SIL are similar. Our results suggest that HPV-induced cancerogenesis is associated with increasing cervicovaginal microbiota heterogeneity and may be involved in regulating viral persistence and disease progression.
Gerardo C Palacios
Instituto Mexicano del Seguro Social, Mexico
Title: Clinical characteristics, laryngeal dysplasia and HPV genotypes in Juvenile-Onset Recurrent Respiratory Papillomatosis: A prospective observational study in Northeastern Mexico
Biography:
Dr. Gerardo C. Palacios-Saucedo completed his M.D. degree from the Universidad Autonoma de Coahuila, Mexico and completed his Ph.D. from the Universidad Autonoma de Nuevo Leon, Mexico. He is Head of the Health Research Division and Titular B Researcher in the Hospital de Especialidades No. 25 Instituto Mexicano del Seguro Social in Monterrey, and Level II National Researcher by the Consejo Nacional de Ciencia y Tecnología Mexico. He has published 68 papers, most in indexed and high impact journals.
Abstract:
Objective: To evaluate the clinical characteristics, presence and severity of laryngeal dysplasia and human papilloma virus (HPV) genotypes in patients with juvenile-onset recurrent respiratory papillomatosis (JORRP) in a tertiary care facility in Northeastern Mexico. Design: A prospective observational study in patients with JORRP who underwent biopsy by suspension microlaryngoscopy. Setting: A single tertiary care unit with pediatric and adult otolaryngology services in Northeastern Mexico. Participants: Thirty patients with JORRP. Main outcome measures: Clinical data, number of surgical resections, presence and severity of dysplasia, and HPV genotypes as determined by the reverse linear hybridization INNO-LiPA assay. Results: Median age at presentation was 3.5 years (range 8 months to 17 years), 22 patients were females (73.3%) and 8 males (26.7%). The main symptom was dysphonia (53.3%) and the total number of resections per patient ranged 2 to 550 (median 15.5). Dysplasia was identified in 13 patients (43.4%). The most frequent genotypes were HPV-11 (40%) and HPV-6 (36.7%). Co-infection with two or three genotypes was detected in seven patients (23.3%), including the genotype HPV-16 in four of them (10%). Conclusions: Patients with JORRP experienced a significant delay in establishing the diagnosis, required multiple surgical resections, and had a high rate of laryngeal dysplasia. The most common HPV genotypes were 11 and 6, followed by HPV-16. This is the first study in Mexico evaluating clinical characteristics, dysplasia severity and HPV genotypes in patients with JORRP.
Veronica Villagra Carron
Central Laboratory of Public Health, Paraguay
Title: Molecular detection of high risk human papillomavirus in following women treated for squamous intraepithelial lesion
Biography:
Veronica Villagra Carron is a Doctor in Biochemistry from National University of Asuncion and completed her Postgraduate studies in Virology Diagnostics from Max Von Pettenkofer Institute of Munich, Germany. She is the Head of Department of Immunology of Central Laboratory of Public Health of the Ministry of Health of Paraguay. She has published more than 10 papers in reputed national and international journals and she is a categorized Researcher of the National Council of Science and Technology, Paraguay.
Abstract:
Cervical cancer is the leading cause of cancer death in women in developing countries. Persistent infection with human papillomavirus (HPV) is a necessary factor in premalignant lesions and cervical cancer. The Pap smear is the method most commonly used to detect the cervical cancer and its combination with the detection of viral DNA six months post-treatment increases effectiveness to identify women treated which are at risk with residual/recurrent lesion. The aim was to describe the frequency of high-risk HPV (HR) in treated women for squamous intraepithelial lesion (SIL) who attended the Cervical Pathology Service of Hospital San Pablo from January to December/2014. It was a descriptive cross section study which included 80 patients who attended the service for post-treatment control. The 4800 Cobas HPV Test (Roche) was used, which detects HPV-16 and 18 and a pool of 10 HR-HPV (31, 33, 35, 39, 45, 51, 52, 56, 58 & 59) and two "probable" high risks (66 & 68). Viral infection was found in 7.5% (6/80) of patients treated; identifying HPV-16 in 3/6 of positive cases. In Paraguay there is a high incidence of pre-neoplastic lesions and cervical cancer and it remains a public health problem. The observed data suggest that the use of this system for viral detection can lead to optimize the post-treatment monitoring and the identification of HPV-16 and 18 could contribute to the selection of patients at increased risk of developing cervical injury and they should undergo to frequent and careful monitoring.
- Workshop on "Application of most advanced radio wave technique with treatment of all forms of Condylomata with nboth sexes as well as treatment of precancerous lesions on the cervix with young girls who still have not given birth"