Background: Treatments for cancer have negative impact on fertility. Presently, there are technologies available to preserve the fertility of cancer patients even before gonadotoxic treatment is given. Several clinical practice guidelines on fertility preservation interventions for cancer patients have already been released. Among developed countries, Oncofertility is already an established field of clinical practice. Objectives: This study aims to determine the knowledge, attitudes, and practices of Filipino clinical practitioners on fertility preservation in cancer patients. Methodology: This was a cross-sectional study carried out between June and September 2019 using a self- administered questionnaire. The questionnaires were sent to clinicians (medical oncologists, hematologists, surgical oncologists, and radiation oncologists) who were directly involved in the treatment patients with cancer. Results: There were 213 respondents composed of 91 surgical oncologists (varied subspecialties), 81 medical oncologists, and 41 radiation oncologists. Most of the clinical practitioners, 58-85%, have not encountered patients who have availed of any fertility preservation method. In terms of knowledge, 53-73% of respondents were aware about some fertility preservation options, but had minimal knowledge. Ninety five percent of study participants acknowledged the need for more information on fertility preservation. Majority of clinicians (57%) have never referred to a fertility specialist; and only 38% have referred a patient for fertility preservation. The following factors were cited as barriers to discussion of fertility preservation: lack of knowledge of clinicians, poor success rates of fertility preservation, poor prognosis of patients, and prohibitive costs of treatment. Conclusion There is an acute need to increase knowledge and awareness about fertility preservation methods and international fertility preservation guidelines among Filipino health practitioners treating cancer patients.
Fertility Preservation ; Comprehensive Health Care ; Neoplasms

Background: Myo-inositol has emerged as one of the preventive therapies for the development of gestational diabetes mellitus in at-risk populations. This systematic review and meta-analysis was conducted to determine the efficacy and safety of myo-inositol in decreasing the incidence of gestational diabetes in overweight and obese pregnant women. Methodology: This meta-analysis was conducted using the standard Cochrane methodology and reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) 2020 guidelines. Inclusion criteria were randomized controlled trials (RCTs) that enrolled overweight and obese pregnant women and used myo-inositol supplementation. The primary outcome was the incidence of gestational diabetes mellitus at 24-28 weeks. Secondary outcomes included cesarean section rate, the incidence of pregnancy-induced hypertension, macrosomia and preterm delivery. Risk ratios (RRs) and 95% confidence intervals (CIs) were used for dichotomous data. Results: Six RCTs were included. Compared to standard micronutrient supplementation, standard dose of myo-inositol (4 g) may reduce the incidence of GDM (RR 0.54; CI [0.30, 0.96]; n = 887 women), but the certainty of evidence is low to very low. With low-dose myo-inositol however, evidence is uncertain about its benefit on the incidence of gestational diabetes mellitus in overweight and obese women with RR 0.71; CI [0.14, 3.50]. No adverse effects were noted. For the secondary outcomes, standard dose myo-inositol appears to reduce the incidence of pregnancy-induced hypertension and preterm delivery, but the certainty of evidence is low to very low. Conclusion Current evidence is uncertain on the potential benefit of myo-inositol supplementation in overweight and obese pregnant women. While studies show that 4 g myo-inositol per day may decrease the incidence of GDM, pregnancy-induced hypertension and pre-term birth with no associated risk of serious adverse events, the certainty of evidence is low to very low. Future high-quality trials may provide more compelling evidence to support practice recommendations.
Diabetes, Gestational ; Obesity ; Inositol Phosphates

Background: The recurrence of endometriosis after fertility sparing surgery poses a challenge to clinicians. Presently, no treatment option is curative and available medication only changes the hormonal milieu to suppress or delay disease recurrence.
Objective: The aim of this review was to present current literature on recurrent endometriosis including dilemmas in definition, risk factors for recurrence and medical options for the prevention of recurrent endometriosis after surgery.
Methods: A review of literature was done using PubMed, EMBASE and HERDIN, with the following keywords: endometriosis, endometrioma, endometriosis-associated pelvic pain, recurrence of endometriosis. The authors identified reviews, trials and guidelines. The population was limited to reproductive-aged women suspected of having endometriosis.
Results and Discussion: The recurrence rate of endometriosis after conservative surgery ranges from 7.1-56%. The incidence varies according to the criteria used to define recurrence: relapse of pain, physical examination findings, presence of endometrioma on imaging studies, increase in serum CA-125, and intraoperative findings during repeat surgery. The risk factors for disease recurrence include: young age, high body mass index, large endometriomas at diagnosis, severe pre-operative pain, intraoperative findings of extensive adhesions, and positive surgical margins. The identification of patients at high risk for recurrence will enable clinicians to give appropriate post-surgical therapy to prevent recurrence. The choice of pharmacologic agent after conservative surgery includes: combined hormonal contraceptive pills, progestogens, and GnRH agonist. Although no major difference was seen in the effect of available drugs used to relieve endometriosis- associated pain and prevent disease recurrence, differences exist in safety, tolerability and costs.
Conclusion: There is an urgent need to standardize the definition of recurrent endometriosis. Patients should be counselled on the need for long term medical management to delay disease recurrence. A step-wise approach and algorithm in the medical management for the prevention of endometriosis recurrence are proposed.

Background: Pelvic ultrasonography is currently not recommended as a screening tool for endometrial cancer, particularly in asymptomatic women; however, its use for other indications such as pelvic masses has led to incidental findings of thickened endometrium in post menopausal women. Objectives: The aim of the study is to evaluate the clinical utility of endometrial ultrasound in asymptomatic Filipino postmenopausal women and to provide a threshold for invasive endometrial sampling. Methodology: A cohort of postmenopausal women (aged ?50 years) who underwent pelvic ultrasonography at a tertiary hospital for indications other than vaginal bleeding was retrospectively evaluated. Women were included if they had an endometrial lining of at least 5 mm and had an endometrial biopsy. Receiver operating characteristic (ROC) analysis was used to determine the endometrial thickness threshold for which endometrial thickness is able to correctly differentiate benign endometrial pathology from endometrial hyperplasia and carcinoma. Results: Out of 90 women included in the study, carcinoma was identified in 3 (3.33%) and hyperplasia was noted in 4 (4.44%). The most common histopathology noted was: endometrial polyp (35.56%), atrophic endometrium (30%) and benign endometrial tissues (18.98%). The calculated area under ROC curve was 54.39% (95% CI 34.38-79.41%), which indicates the inability of endometrial thickness to differentiate benign endometrium from endometrial carcinoma or hyperplasia in asymptomatic women with an incidentally found thickened endometrium. Conclusion Based on the results of the study, endometrial thickness alone cannot be used as basis for deciding whether to perform endometrial sampling, there is no endometrial thickness threshold for which the endometrial hyperplasia and carcinoma can be correctly identified. The decision to perform an endometrial biopsy should be done on a case to case basis. In the absence of a high index of suspicion for endometrial hyperplasia and carcinoma even in the presence of thickened endometrium, endometrial sampling is unnecessary.
Endometrial Neoplasms ; Endometrial Hyperplasia ; Incidental Findings

Background: Metformin has been studied for its anti-proliferative effects on endometrial cells, and it is hypothesized to have a synergistic effect with progestin therapy in suppressing endometrial cell proliferation. This systematic review and meta-analysis aimed to determine the efficacy of adjunctive metformin in the clinical regression of endometrial hyperplasia and early-stage endometrial carcinoma. Methodology: This meta-analysis followed the Cochrane methodology and adhered to the PRISMA 2020 guidelines. Randomized controlled trials (RCTs) were included if they enrolled reproductive-aged women with endometrial hyperplasia (with and without atypia) and endometrial carcinoma who were treated with progestin and metformin. The primary outcome was the complete response rate at 12-16 weeks, and secondary outcomes included relapse rate, clinical pregnancy rate, and live birth rate. Odds ratios (ORs) and 95% confidence intervals (CIs) were used for dichotomous data. Results: Six RCTs were included. The addition of metformin to progestin therapy may increase the complete response rate of endometrial hyperplasia without atypia (OR 5.12, 95% CI 1.17 to 22.41; n=102) and live birth rates (OR 2.51, 95% CI 1.34 to 4.69; n=188) compared to progestin therapy alone, but the certainty of the evidence is low. Metformin did not have a significant effect on the clinical response of endometrial hyperplasia with atypia and endometrial carcinoma, relapse rates, and clinical pregnancy rates. Conclusion Current evidence is uncertain on the potential benefit of metformin with progestin in endometrial hyperplasia and carcinoma. Future high-quality randomized controlled trials with larger sample sizes and longer follow-up periods are needed to support practice recommendations.
Endometrial Hyperplasia ; Endometrial Neoplasms ; Metformin ; Progesterone

Tuberculosis can coexist with malignancy in the same organ, but cancer with TB in the cervix is rare. This is a case of cervical tuberculosis diagnosed in a cervical cancer patient after concurrent chemoradiotherapy and brachytherapy. This is the case of a 38-year-old G2P2 (2002) diagnosed with squamous cell carcinoma, large cell non-keratinizing cervix, Stage IIIB. The patient underwent concurrent chemoradiotherapy and brachytherapy. One month after the last brachytherapy dose, the attending physician noted a nodularity on the anterior lip of the cervix. A cervical punch biopsy was done to rule out tumor persistence. The histopathology revealed chronic granulomatous inflammation with Langhan’s type multinucleated giant cells consistent with tuberculous infection. She was diagnosed with cervical tuberculosis, postulated to be from latent TB reactivation, and was given Anti-Koch’s medication for six months. After receiving Anti-Koch’s treatment, the cervical nodularity was no longer appreciated, and the rest of the cervix was smooth on palpation. Her Pap Test was negative for any intraepithelial lesion and was declared with no evidence of carcinoma. A possible latent TB infection should always be screened in cancer patients from high-burden areas or those with close contact treated for tuberculosis because immunosuppression during cancer treatment can cause the reactivation of tuberculous disease. Cervical tuberculosis complicating cervical malignancy is treatable with Anti-Koch’s therapy and has not been shown to affect the course of the carcinoma.
Latent Tuberculosis