Neoadjuvant and adjuvant chemotherapies are used adjunctively with surgery or radiation and are among the treatment options that are now employed for reducing treatment failure in early-stage cervical cancers with high-risk prognostic factors. Adjuvant therapies have been reported to significantly improve survival than would otherwise be possible with surgery or radiotherapy alone. However, for advanced cervical cancers, sequential or concurrent chemo-radiotherapy does not appear to significantly increase survival. The combination of radiotherapy with IFN-a2a and RA in the treatment of patients with locally advanced cervical cancer showed high response rates, however this should be confirmed in larger studies. Recent reports show that postoperative adjuvant radiotherapy has no benefit in survival, but that postoperative adjuvant chemotherapy has improved survival. Toxicities and the optimum number of cycles of neoadjuvant and adjuvant chemotherapy, as well as biologic therapy, will follow along with individualized treatment based on high-risk prognostic factors. Although more comprehensive studies and longer follow up will be required for complete evaluation of these adjuvant therapies, preliminary results are promising.
Biological Products/therapeutic use ; Cervix Neoplasms/drug therapy* ; Chemotherapy, Adjuvant* ; Female ; Human ; Risk Factors

Skin metastasis from carcinoma of uterine cervix is extremely rare and its incidence is reported as 0.1~1.3%. Common pattern of occurrence is multiple nodules in abdomen, external genitalia, or lower extremeties. It is believed that the pathogenesis of skin metastasis is a result of retrograde spread of the tumor secondary to lymphatic obstruction. Treatment of skin metastasis may consist of surgical excision, local irradiation, or chemotherapy, but the prognosis is very poor and median survival is about 3 months. We have experienced such a case and report the case with brief review of literatures.
Abdomen ; Cervix Uteri ; Drug Therapy ; Female ; Genitalia ; Incidence ; Neoplasm Metastasis* ; Prognosis ; Skin* ; Uterine Cervical Neoplasms*

The majority of patients with recurrent cervical cancer are incurable and treatment is based on the type of primary therapy delivered. Only a very small percentage of the patients with recurrent cervical cancer following primary radiotherapy will have central pelvic recurrences that are amenable to surgical resection and curable by pelvic exenteration. These procedures should be undertaken only after the completion of exhaustive attempts to exclude extrapelvic disease.
Cervix Neoplasms/drug therapy/mortality/*surgery ; Female ; Human ; Neoplasm Recurrence, Local/drug therapy/mortality/*surgery ; Pelvic Exenteration/adverse effects/methods

PURPOSE: This study was conducted to investigate the level of nausea & vomiting, anorexia and food intake during the periods of chemotherapy and 14 days after discharge. METHOD: The subjects were 40 cancer patients(cervix cancer : 20 patients, stomach cancer: 20 patients) who had chemotherapy with Cisplatin & 5-Fu. Data were analyzed by mean & standard deviation, ANCOVA. RESULT: 1. The severity of nausea & vomiting with anorexia in cancer patients receiving chemotherapy was the highest at the 3rd day and then it gradually decreased. At the 14th day after discharge, nausea & vomiting with anorexia still remained with very low levels. 2. The amount of food intake was the lowest on the 3rd day and then gradually increased. However, it was 53.3-72.5% of the ordinary food intake on the 14th day after discharge. Calorie intake was 625.31 Kcal on the 3rd day and 1130.92 Kcal on the 7th day after discharge. 3. There were no significant differences in nausea & vomiting, anorexia, food intake, calory intake between those with cervix cancer and stomach cancer. CONCLUSION: In cancer patients nausea & vomiting and anorexia were severe and food intake was very poor during chemotherapy but afterwards they were gradually improved, but were not completely recovered on the 14th day after discharge. Therefore the nursing intervention regarding the increase of food intake was necessary during chemotherapy and after discharge.
Anorexia* ; Cervix Uteri* ; Cisplatin ; Drug Therapy* ; Eating* ; Female ; Fluorouracil ; Humans ; Nausea* ; Nursing ; Stomach Neoplasms* ; Stomach* ; Uterine Cervical Neoplasms* ; Vomiting*

Neoadjuvant chemotherapy prior to definitive radical surgery or radiotherapy may be effective in reducing tumor volume or clinical stage and may even enhance pelvic control and survival. However, there are significant limitations to the use of neoadjuvant therapy in the non-responder group. They include delayed total treatment course, the presence of drug resistant clones which result in accelerated tumor growth, and limited bone marrow reserve for subsequent definitive therapy. Thus, there is a need to identify parameters providing a more precise indication of the response to neoadjuvant chemotherapy in patients with invasive cervical cancer. From Jan. 1995 to Jan. 1996, neoadjuvant chemotherapy with 3 courses of cisplatin and vincristine was used in 32 patients with invasive cervical cancer (FIGO stage Ib to IIIb; tumor size greater than 2 cm). Prior to chemotherapy, quantitative tissue levels of epidermal growth factor receptor (EGFR) and c-erbB-2 oncogene protein were measured by using an enzyme-linked immunosorbent assay (ELISA). Tumor size was estimated before and after chemotherapy. Relations between oncoproteins and reductions of tumor size were evaluated. Tumor size prior to neoadjuvant chemotherapy did not show any correlation with either the concentrations of EGFR or c-erbB-2 oncoprotein. As well, the tumor reduction index did not manifest any correlation with EGFR, it did had an inverse linear correlation with the c-erbB-2 oncoprotein levels (Rs = -0.71, P < 0.05). The results of this study suggest that c-erbB-2 oncoprotein is associated with a reduced response to neoadjuvant chemotherapy in primary treatment of invasive cervical cancer and may be useful in directing therapeutic approaches.
Adult ; Aged ; Carcinoma/metabolism* ; Carcinoma/drug therapy* ; Cervix Neoplasms/metabolism* ; Cervix Neoplasms/drug therapy* ; Female ; Human ; Middle Age ; Neoadjuvant Therapy* ; Receptor, Epidermal Growth Factor/metabolism* ; Receptor, erbB-2/metabolism* ; Treatment Outcome

The expression of P-glycoprotein in gynecological tissues was studied by immunohistochemical staining methods. Aspects of study included the expression of P-glycoprotein in different tissues throughout the clinical treatment regimen, the relationship between the expression of P-glycoprotein and the degree of pathologic malignancy, and the expression of P-glycoprotein in cancerous tissue before and after chemotherapy. Studies were based on patients who were admitted to the Department of Obstetrics and Gynecology of Chungnam National University Hospital from January 1988 to December 1993. Tissue samples collected prior to chemotherapy included 34 ovarian cancers, 73 cervical cancers, and 11 endometrial cancers. Pre and post-chemotherapy tissue samples included 11 ovarian cancers and 15 cervical cancers. Normal tissue samples included 12 from the ovaries, 15 from the cervix, and 10 from the endometrium. RESULTS ARE AS FOLLOWS:1. p-glycoprotein was mainly found in the cytoplasm of both normal tissue cells and cells of tissues prior to chemotherapy. After chemotherapy it was found more intensely in the cell membrane than in the cytoplasm. 2. For normal tissue, p-glycoprotein was found in 25% of ovarian tissues, 33.3% of uterine cervical tissues, and 40.0% of endometrial tissues. 3. For cancerous tissues prior to chemotherapy, p-glycoprotein was found in 45.5% of ovarian cancer cases, 47.9% of uterine cervical cancer cases, and 45.5% of endometrial cancer cases. There was no statistically meaningful difference in these rates in cancerous versus normal tissues. 4. The expression of P-glycoprotein in cancerous tissues prior to chemotherapy was not related to histologic type. 5. For ovarian cancer tissue, p-glycoprotien was expressed in 45.5% of cases prior to chemotherapy, and 54.4% of cases subsequent to chemotherapy. For uterine cervical cancer tissue, p-glycoprotein expression rates before and after chemotherapy was 46.7% and 60.0% respectively and there was a statistically meaningful difference(p<0.05). 6. There was no relationship between P-glycoprotein expression in cancer tissues after chermotherapy and the presence of cisplatin in chemotherapeutic drugs. 7. For uterine cervical cancer tissues prior to chemotherapy, there was no relationship between the degree histologic differentiation and the expression of P-glycoprotein. 8. For cancerous tissues there was no relationship between clinical stage and the expression of P-glycoprotein. In conclusion, the expression of P-glycoprotein was identified in the tissues before the drug exposure. However, there was no relationship between the expression of P-glycoprotein and hlstologic type, clinical stage, and effectiveness of chemotherapy, This may be related to P-glycoprotein inducing a cellular resistance to chemotherapeutic agents, although the importance of this resistance is thought to be small. Further studies of P-glycoprotein are needed to delineate its role in cellular anticancer drug resistance.
Cell Membrane ; Cervix Uteri ; Chungcheongnam-do ; Cisplatin ; Cytoplasm ; Drug Resistance ; Drug Therapy ; Endometrial Neoplasms ; Endometrium ; Female ; Gynecology ; Humans ; Obstetrics ; Ovarian Neoplasms ; Ovary ; P-Glycoprotein* ; Uterine Cervical Neoplasms

In adults, it is known that tetastatic tumor to the eye and its adnexa is rare compared with other sites. Orbital tumors can be classified as primary, secondary, and metastatic. Secondary orbital tumors are those that extend to the orbit from a contiguous structure. Metastatic tumors are those that spread to the orbit from more distant site in the body. and their prognosis for life is poor because of widespread systemic malignancy. We experienced a case of metastatic uterine cervical carcinoma of the orbit in a 33-year-old female patient who came to us with a history of sudden proptosis and decreased vision. Eighteen months earlier, the patient had been diagnosed with squamous cell carcinoma of the uterine cervix, and she had undergone chemotherapy, irradiation and surgical intervention. Lung and parametrium metastases were also found six months previously. We report a case of metastatic uterine cervical cancer of the orbit with a review of the literature.
Adult ; Carcinoma, Squamous Cell ; Cervix Uteri ; Drug Therapy ; Exophthalmos ; Female ; Humans ; Lung ; Neoplasm Metastasis ; Orbit* ; Prognosis ; Uterine Cervical Neoplasms

OBJECTIVE: To determine the effects of neoadjuvant chemotherapy (5-fluorouracil plus cisplatin) on tumor cell morphology and apoptosis by analyzing the consecutive changes of apoptotic index (AI) and histology observed in the serially obtained cervical cancer tissues during the chemotherapy. METHODS: Cervical cancer tissues were obtained by punch biopsy just before starting the each cycle of neoadjuvant chemotherapy from five patients with locally advanced disease (stage IIb-IIIb), but previously untreated squamous cell carcinoma of uterine cervix. All patients were treated with three cycles of 5-fluorouracil (1,000 mg/m2 at day #1-5) and cisplatin (60 mg/m2 at day #1) at 3 weeks interval. All H & E stained cervical cancer tissue slides were scored for apoptotic index and observed for microscopic changes of tumor cells by a pathologist. RESULTS: After the first cycle of chemotherapy, AI was significantly increased (from 2 times to 8 times). And widespread injury to cytoplasm was observed and followed by karyorrhexis and karyolysis of nucleus of tumor cells. The size of tumor nests was reduced and it was also noted that fibrosis and infiltration of inflammatory cells were increased. The parts of tumor nests were replaced by mature squamous cells and the changes in nuclear morphologic features pointing in a more differentiated direction. But after the second cycle of chemotherapy, only one patient showed an increase in AI by 1.2 times over that after the first cycle of chemotherapy. The rest showed slight decreases in AI compared to that after the first cycle of chemotherapy. In addition, fewer microscopic morphologic changes of tumor cells induced by chemotherapy were observed after the second cycle of chemotherapy compared to those after the first cycle of chemotherapy. CONCLUSION: We found that AI hardly increased or rather decreased, and that microscopic changes of tumor cells were fewer after the second cycle of neoadjuvant chemotherapy compared to the situation after the first cycle of chemotherapy. Thus, we could deduce that chemoresistance might rapidly develop in cervical cancer cells after the first cycle of neoadjuvant chemotherapy using 5-fluorouracil and cisplatin. So we need to consider this problem when we treat the locally advanced cervical cancer patients with neoadjuvant chemotherapy using 5-fluorouracil and cisplatin.
Apoptosis ; Biopsy* ; Carcinoma, Squamous Cell ; Cervix Uteri ; Cisplatin* ; Cytoplasm ; Drug Therapy* ; Female ; Fibrosis ; Fluorouracil* ; Humans ; Uterine Cervical Neoplasms*

OBJECTIVE: The toxicity and effectivity of intravenous paclitaxel and cisplatin as neoadjuvant chemotherapy were assessed in cervical cancer patients. METHODS: Thirty seven consecutive patients affected by FIGO stage IB2 to \\'a5\\'b1B were treated with paclitaxel 60 mg/m2 that was administered intravenously over a 3-hour period, followed by cisplatin 60 mg/m2, also administered intravenously. The chemotherapy was administered every 10 days and for three courses. The toxicity of the regimen in each cycle was determined according to the WHO toxicity criteria and in cases with grade 3 or 4 toxicity, chemotherapy was postponed for one week. The size of the tumor mass was measured prior to the neoadjuvant chemotherapy by means of pelvic examination and pelvic magnetic resonance imaging (MRI). The response to the treatment was determined 10 days after 3 cycles of chemotherapy by means of pelvic examination and pelvic MRI. Two weeks after the neoadjuvant chemotherapy was completed, the patients were either given an operation or radiation therapy, depending on their overall condition, the operational risks and personal willingness for an operation. RESULTS: A total of 37 patients were given a radical hysterectomy and enrolled in this study. Mild myalgia was the most common toxicity. Granulocytopenia was seen in four patients but there was no grade 3 or 4. Grade 1 neurotoxicities developed in four patients. Clinical responses occurred in 94.6% (35/37) of patients, including 35.1% (13/37) with a complete response, 10.8% (4/37) with a pathologically determined complete response, 59.5% (22/37) with a partial response, and 5.4% (2/37) showed stable disease. A down-staging response was seen in 75.7% (28/37) of those patients showing a response. CONCLUSIONS: The combination of paclitaxel with cisplatin for use in neoadjuvnant chemotherapy seems to be tolerated and very active in cervical cancer. Especially, every 10 days treatment did not delay the surgically or radologically optimal time. A larger number of cases need to be studied in order to confirm the efficacy of the treatment.
Agranulocytosis ; Cervix Uteri* ; Cisplatin* ; Drug Therapy ; Female ; Gynecological Examination ; Humans ; Hysterectomy ; Magnetic Resonance Imaging ; Myalgia ; Paclitaxel* ; Uterine Cervical Neoplasms

Neuroendocrine carcinomas of the uterine cervix are very rare cervical neoplasms. It has frequent distant metastasis at diagnosis and high recurrent rate against multimodality therapies such as surgery, chemotherapy and radiation therapy. In 1997, four categories of endocrine tumors of uterine cervix were recommended by the Cancer Committee of the College of American Pathologists and the National Cancer Institute. It has been suggested that infection of human papillomavirus and molecular biologic abnormalities in genomic level are causes of this disease. Although a lot of studies about this disease concerning therapies and prognostic factors have been reported, there is no standard therapeutic regimens because of low incidence and difficulties of histologic diagnosis, so further studies about this issues are required. We report a case of large cell neuroendocrine uterine cervical carcinoma treated with chemotherapy followed by surgery.
Carcinoma, Neuroendocrine* ; Cervix Uteri* ; Diagnosis ; Drug Therapy ; Female ; Humans ; Incidence ; National Cancer Institute (U.S.) ; Neoplasm Metastasis ; Uterine Cervical Neoplasms