BACKGROUND

Cervical cancer is a common malignancy among Filipino women, treated through surgery, chemotherapy, or radiation. To improve outcomes and reduce costs, the European Society of Gynaecological Oncology (ESGO) established 15 quality indicators for its surgical management. The aim of the study was to evaluate the quality of cervical cancer surgeries at a tertiary government hospital in the Philippines, using ESGO quality indicators.

A descriptive retrospective review was conducted on medical records of early-stage cervical cancer patients who underwent radical surgery from January 1, 2019, to December 31, 2021. Data were collected using ESGO’s 15 quality indicators. Incomplete records were excluded from the study. Descriptive statistics and Kaplan–Meier analysis were used.

Fifty-four patients underwent surgery, averaging 18 cases per year. Most surgeries (75.93%) were supervised by certified gynecologic oncologists, and 85.2% were discussed in multidisciplinary conferences. All patients had appropriate preoperative assessments and metastatic imaging. Pathology reports met the required standards, and lymph node staging was achieved in all cases. Adequate lymph node harvest was 68.18% (pelvic) and 65.91% (paraaortic). Fertility counseling was provided, although none pursued fertility-sparing treatment. Surgical complications included two vesicovaginal fistulas (3.7%). Clear margins were achieved in 92.59%, with 24.30% upstaged postoperatively. Adjuvant chemoradiotherapy rates were highest in 2019 (93.33%). No recurrences were noted for stage IB1 after a median 34-month follow-up.

The surgeries met ESGO quality standards, demonstrating that these indicators can be adapted locally, ensuring quality assurance in care.

Although commonly seen in the ovary, fallopian tube, peritoneum, and endometrium, the serous carcinoma histology is considered a rare subtype when seen in the cervix. The prevalence of cervical adenocarcinoma, including serous carcinoma, varies between 5% and 15% of all cervical malignancies. A thorough literature study revealed only 113 cases of serous carcinoma of the cervix, highlighting its infrequency relative to other cervical cancer variants. As a subtype of adenocarcinoma, serous carcinoma of the cervix has aggressive characteristics and usually unfavorable prognosis, more so its clinicopathological characteristics are relatively unclear because of its rarity and limited number of cases and reviews seen in literature. This is a case of a 44-year-old G3P3 with a primary complaint of heavy vaginal bleeding. The diagnosis of serous carcinoma of the cervix was made by histopathological evaluation, confirmed by immunostaining. With physical examination and diagnostic imaging confirming an early stage disease, the patient successfully underwent primary surgical management.

Objective: This correlational study was conducted to determine whether factors of the Gynecologic Oncology subspecialty rotation – such as resident rotators’ sex, year level, training institution, academic aptitude, duration of rotation, learning activities, case load, extent of involvement of teachers, and level of involvement of the residents – are associated with clinical competence. Methodology: Thirty-one residents rotating in subspecialty were given MCQ examination and skills evaluation pre- and postrotation. Logbooks were completed listing all learning activities and number of cases encountered. Difference in scores was determined using paired t-test. Association of factors with clinical competence was determined using chi square and Pearson correlation coefficient. Results: There was a statistically significant increase in the overall and skills scores, but not in the knowledge. Training institution, academic aptitude, and duration of rotation were associated with clinical competence. Conference, outpatient duty, case load, fellows as teachers and active participation were strongly associated with clinical competence. Bedside teaching, inpatient duty, and consultants as teachers were moderately associated with clinical competence. Passive participation was weakly associated with clinical competence. Conclusion Overall, the residents did not achieve clinical competence in Gynecologic Oncology as a result of the rotation. Residents from a training institution with a Gynecologic Oncology fellowship training program and with academic aptitude > 60% are more likely to achieve clinical competence. Increasing rotation duration to > 2 weeks, time spent in the different activities, case load, fellows and consultants interaction with residents, and active participation may increase likelihood of achieving clinical competence.
Human ; Female ; Clinical Competence

Uterine carcinosarcoma, also known as malignant mixed mullerian tumor (MMMT) is a rare and aggressive malignancy. It is the only type of uterine carcinoma with both an epithielial-derived carcinoma and a mesodermal-derived sarcoma. Classically, they have been considered as a soft tissue sarcoma, however, recent studies ascertain the pathogenesis of carcinosarcomas as to that of a metaplastic transformation of a carcinoma to give rise to a sarcomatous component. With the paradigm shift on the pathogenesis of disease, treatments have been aligned to follow protocols used in aggressive uterine carcinomas and are in further evaluation for its applicability to the aforementioned carcinosarcoma. This paper presents three cases of MMMT diagnosed in a Private Tertiary Hospital from October 2015 to February 2017. Among the three cases, two cases underwent endometrial sampling with results suggestive of MMMT and one case with an intraoperative frozen section done revealing carcinosarcoma. All cases underwent extrafascial hysterectomy with bilateral salpingo-oophorectomy (EHBSO) and bilateral lymph node dissection (BLND). Post-operatively, two of the cases underwent adjuvant chemotherapy and are currently alive. The one case that did not receive adjuvant chemotherapy succumbed to the disease eight months after diagnosis. With the high propensity of MMMT to metastasis, relapse and recurrence, it is then imperative that all cases are properly managed.
Neoplasms

Prolonged bladder catheterization, the conventional management of urinary bladder dysfunction secondary to radical hysterectomy for gynecologic malignancies, is associated with patient discomfort, higher incidence of urinary tract infection, delayed ambulation and moderate cost.
OBJECTIVE: This study aimed to determine the efficacy and safety of solifenacin succinate in the decreasing mean duration of indwelling catheterization after radical hysterectomy.
METHODS: In this non-blinded, no placebo, randomized controlled trial, patients 19 years old and above, diagnosed with early stage cervical cancer and stage II endometrial cancer were randomized to 2 arms: control arm and treatment arm (given solifenacin succinate 5 mg once a day after radical hysterectomy). Bladder function testing on the 3rd postoperative day and weekly thereafter was done on all patients. The primary endpoint was the mean duration of indwelling catheterization until bladder function recovery was obtained. Patients were monitored for adverse drug reactions and development of urinary tract infection.
RESULTS: Each arm had 18 patients. The clinicopathologic profiles of the patients in the 2 arms were comparable. The mean duration of indwelling catheterization was significantly shorter in the treatment arm (13.33 days ± 10.50 SO) than in the control arm (21.33 days ± 11.66 SO) (P = 0.046). No adverse drug reactions were noted.
CONCLUSION: Solifenacin succinate effectively and safely reduced mean duration of indwelling catheterization among patients who underwent radical hysterectomy. Human ; Female ; Aged ; Middle Aged ; Adult ; Urinary Bladder ; Solifenacin Succinate ; Uterine Cervical Neoplasms ; Urinary Catheterization ; Hysterectomy ; Urinary Tract Infections ; Endometrial Neoplasms ; Drug-related Side Effects And Adverse Reactions

A five-year retrospective study was conducted to determine the fertility and clinical outcomes of ovarian cancer patients undergoing fertility-sparing surgery (FSS). Medical records were evaluated. Menstrual, fertility and clinical outcomes were measured. Of the 44 cases evaluated, 41 (93.18%) were stage I, while 3 (6.82%) had advanced stages. Complete surgical staging was done in 19 (43.18%) patients. All had restoration of menses 1-2 months after surgery with no significant amenorrhea among those given platinum-based chemotherapy. There were 15 successful pregnancies (83.33%). There were only 5 patients (27.78%) with infertility, and 8 (18.18%) cases of tumor persistence/recurrence, all of malignant germ cell tumors without adjuvant chemotherapy. This study confirms FSS as a safe and acceptable treatment for reproductive-age women < 30 years old with no history of infertility, with either stage I epithelial tumors (low malignant potential and frank carcinoma) or malignant germ cell tumors with assured adjuvant chemotherapy.
OVARIAN NEOPLASMS

Cervical cancer remains to be one of the leading malignancies among Filipino women. High-risk human papillomavirus (HPV) types, such as 16 and 18, are consistently identified in Filipino women with cervical cancer. Factors identified to increase the likelihood of HPV infection and subsequent development of cervical cancer include young age at first intercourse, low socioeconomic status, high parity, smoking, use of oral contraception and risky sexual behaviors. Cancer screening programs presently available in the Philippines include Pap smears, single visit approach utilizing visual inspection with acetic acid followed by cryotherapy, as well as colposcopy. However, the uptake of screening remains low and is further compounded by the lack of basic knowledge women have regarding screening as an opportunity for prevention of cervical cancer. Prophylactic HPV vaccination of both quadrivalent and bivalent vaccines has already been approved in the Philippines and is gaining popularity among the Filipinos. However, there has been no national or government vaccination policy implemented as of yet. The standard of treatment of cervical cancer is radiotherapy concurrent with chemotherapy. Current researches are directed towards improving availability of both preventive and curative measures of cervical cancer management.
Acetic Acid ; Coitus ; Colposcopy ; Contraception ; Cryotherapy ; Early Detection of Cancer ; Female ; Humans ; Mass Screening ; Papillomavirus Vaccines ; Parity ; Philippines ; Sexual Behavior ; Smoke ; Smoking ; Social Class ; Uterine Cervical Neoplasms ; Vaccination ; Vaccines