Women's Experiences of Sexual Problems After Cervical Cancer Treatment: Lessons From Indonesian Women

Cervical cancer remains the most common cancer among women. It is the second major cause of women’s deaths in Asia as well as in Indonesia. Cervical cancer treatment also raises issues of long-term physical, psychological, sexual, and social adaptation. The purpose of the study was to describe and to interpret the experiences of Indonesian women who have experienced sexual dysfunction after cervical cancer treatment. Thirteen Indonesian women who were participated in this study described their experiences on the first to two years after cervical cancer treatment. Data were collected through in-depth interviews. Four themes were identified (1) physical and psychological sexual complaints after cancer treatment; (2) negative effects of cancer treatment towards intimate relationship with their spouse; (3) efforts to overcome sexual problems; and (4) women’s needs for help to improve their sexual health. These studyfindings offer providing new insights into the experiences of Indonesian women with sexual health problems following cervical cancer treatment. This study can provide nurses and other health care providers with better understanding of the experiences, concern and needs of the cancer survivors

Prognostic Significance of Serum Vascular Endothelial Growth Factor-C (Serum Vegf-C) and Lymph-Vascular Space Invasion in Early Stage Cervical Cancer

Background: Management of early stage cervical cancer is still challenging. Several clinical-pathological prognostic factors that are currently used in clinical practice include stage, bulky tumor, stromal deep invasion, differentiation, histology, lymph vascular space invasion and status of lymph-node. Serum Vascular Endothelial Growth Factor-C (VEGF-C) has an important role in metastasis as an angiogenic and lymphangiogenic factor. This study aimed to determine prognostic significance of serum VEGF-Cand lymph-vascular space invasionin early stage cervical cancer. Subjects and Method: This was a case-control study conducted at January to October 2007. A sample of47 early-stage cervical cancer patients including 14 patients with lymph node metastasis (case) and 33 patients without lymph node metastasis (control) was selected for this study. The dependent variable was lymph node metastasis. The independent variables were serum VEGF-C and lymph vascular space invasion. Serum VEGF-C levels were examined by ELISA method. The data were analyzed by logistic regression. Results: A cut-off point of serum VEGF-C level of 10.07 pg/ mLresulted in 78.57% sensitivity and 96.97% specificity. The risk of lymph node metastasis increased with serum VEGF-C level > 10.07 pg/ mL (OR= 80.0; 95% CI=7.99 to 800.71; p< 0.001) and lymph vascular space invasion (OR= 20.00; 95% CI=2.32 to 171.7; p= 0.006). Conclusion: Serum VEGF-C and lymph vascular space invasion can be used as independent prognostic factor on the risk of lymph-node metastasis in early stage cervical cancer. Keywords: cervical cancer, prognostic factor, serum VEGF-C, lymph node metastasis

The Association of Parametrial Invasion with the Expression of Vascular Endothelial Growth Factor-C and Other Factors in Squamous Cell Cervical Carcinoma Stage IB and IIA

BACKGROUND: The presence of parametrial invasion in early stage squamous cell cervical cancer (SCCC) indeed indicates worse prognosis and need more adjuvant treatment. This study aimed to investigate the association between parametrial invasion and clinicohystopathology variables.METHODS: This retrospective study used specimens of squamous cell carcinoma stage IB-IIA. The inclusion criteria were cervical cancer stage IB-IIA and post radical hysterectomy with lymph node dissection and exclusion criteria was damaged and or insufficient histological preparations. The clinicohystopathology variables included age, tumour size and stage, differentiation and inflammation grade, lymphatic vascular and parametrial invasion, and lymph node metastasis. Histopathology staining, immunohistochemistry examination, and vascular endothelial growth factor-C (VEGF-C) expression were evaluated according to the standard procedure. The independent-T, Chi square, and Fisher’s exact test were applied to evaluate the association. The significance was set at p4 cm (OR 4.32, 95% CI 1.29-14.38, p=0.01), lymphatic node metastasis (OR 3.90, 95% CI 1.17-13.03, p=0.02), and VEGF-C (OR 0.75, 95% CI 0.65- 0.87, p=0.03).CONCLUSION: Tumor size of >4 cm and lymph node metastasis (LNM) had a higher risk of parametrial invasion in SCCC stage IB-IIA.KEYWORDS: cervical carcinoma, parametrial invasion, vascular invasion, peritumoral stroma, VEGF-C expressio

The Effect of High Poly Unsaturated Fatty Acid (PUFA) Dietary Supplementation on Inflammatory Status of Patients with Advanced Cervical Cancer on Radiation Treatment

Aim: to identify the effect of high-PUFA dietary supplementation on inflammatory status of patients with advanced cervical cancer. Methods: a randomized double-blind clinical trial was conducted in patients with advanced cervical cancer who had undergone external radiation therapy at Department of Radiotherapy, Cipto Mangunkusumo Hospital, Jakarta, between April 2013 and April 2014. The inflammatory status was evaluated based on serum prostaglandin E2 (PGE2) levels using ELISA method. The dietary supplementation was isocaloric, isoprotein and contained PUFA with a ratio of ω-6: ω-3 fatty acid = 1.27:1 and supplementation without PUFA. Data were analyzed with statistical tests, including Shapiro-Wilk test, independent T-test and Mann–Whitney test. Results: there was statistically no significant difference on PGE2 level between treatment and control groups (p=0.127). However, there was clinically significant difference, in which the treatment group had reduced PGE2 level by 8.9%; while the control group had increased level by 28.1%. Conclusion: dietary supplementation enriched with PUFA can reduce inflammatory status in patients with advanced cervical cancer. Reduced PGE2 level will lower the survival of cancer cells; therefore dietary supplementation enriched with PUFA with a ratio of ω-6 : ω-3 fatty acid = 1.27 : 1 along with radiation therapy may improve tumor response to radiation.Key words: cervical cancer, ω-3 PUFA, ω-6 PUFA, PGE2 level

Efficacy of Trichloroacetic Acid (TCA) Compared to Cryotherapy in Treating Patients with Positive VIA Result: Efikasi Trichloroacetic Acid (TCA) Dibandingkan Krioterapi sebagai Terapi Pasien dengan IVA Positif

Objective: To investigate the effectiveness TCA 85% compared to cryotherapy to treat patients with positive IVA result.Method: This is a non-inferiority randomized controlled trial study. Patients with positive VIA result referred to Jatinegara Primary Health Center were included in this study. Eligible samples were then treated with either TCA 85% or cryotherapy. The treatment was determined using a random block sampling method. Samples were then followed up 3 months after treatment in order to determine VIA result conversion.Result: Thirty-six patients were treated with TCA 85% and 36 others were treated with cryotherapy. 35 (97,2%) patients treated with TCA 85% converted to negative VIA, whereas all of the patients that were treated with cryotherapy converted to negative VIA. Bivariate analysis fisher’s exact test was then conducted with a result P-value of 1.00 (p &gt; 0,05).Conclusion: There was no statistically significant difference of result between TCA 85% and cryotherapy for treating patients with positive VIA result.Keywords: cervical cancer, cryotherapy, TCA 85%, VIA test. Abstrak Tujuan: Mengetahui efikasi TCA 85% pada tatalaksana IVA positif dibandingkan dengan krioterapiMetode: Penelitian ini merupakan penelitian randomized control trial menggunakan metode non-inferiority study. Subyek penelitian ini merupakan pasien dengan hasil IVA positif yang dirujuk ke Puskesmas Kecamatan Jatinegara, Jakarta Timur. Tatalaksana yang diberikan ditentukan menggunakan metode random block sampling. Subyek diikuti selama 3 bulan setelah tindakan untuk menentukan hasil konversi pemeriksaan IVA.Hasil: Sbenyak 36 subjek diterapi dengan TCA 85% dan 36 lainnya diterapi dengan krioterapi. Sebanyak 35 (97,2%) pasien yang ditatalaksana dengan TCA 85% mengalami konversi menjadi IVA negatif pada follow-up bulan ke-3, sedangkan seluruh pasien yang ditatalaksana dengan krioterapi menjadi konversi menjadi IVA negatif. Dilakukan analisis bivariat fisher’s exact test dan didapatkan nilai p sebesar 1,00 (p&gt;0,05).Kesimpulan:Tidak ada perbedaan bermakna dari efikasi penggunaan TCA 85 % dibandingkan dengan krioterapi pada terapi IVA positif.Kata kunci: kanker serviks, krioterapi, pemeriksaan IVA, TCA 85%

Kajian pemberian neoadjuvant kemoterapi pada karsinoma ovarium stadium lanjut di RS Dr. Cipto Mangunkusumo tahun 2000 - 2005

Tujuan: Mengevaluasi pemberian perioperatif neoadjuvant kemoterapi pada penderita karsinoma ovarium stadium lanjut di RS Dr. Cipto Mangunkusumo Jakarta, serta mengetahui pencapaian sitoreduksi optimal, morbiditas pembedahan dan kualitas hidup. Rancangan/rumusan data: Studi retrospektif deskriptif pada pasien karsinoma ovarium lanjut yang mendapat neoadjuvant kemoterapi antara 1 Januari 2000 hingga 30 Juni 2006. Bahan dan cara kerja: Data diambil secara berurutan dari status penderita karsinoma ovarium stadium lanjut yang ada di catatan medik rawat inap dan rawat jalan di bagian Obstetri dan Ginekologi RS Dr. Cipto Mangunkusumo Jakarta antara 1 Januari 2000 hingga 30 Juni 2006. Data yang diperoleh diolah dengan menggunakan program statistik SPSS 12. Hasil: Didapatkan 29 pasien selama kurun waktu penelitian. Pemilihan pasien yang akan diberi neoadjuvant kemoterapi tidak berdasarkan pada nilai CA 125 > 500 U/mL, serta tidak berdasarkan temuan ascites dan efusi pleura. Kemungkinan berdasarkan dari keadaan umum pasien, sayangnya data tersebut tidak diperoleh pada penelitian ini karena ketidaklengkapan data. Dari 29 pasien tersebut, 8 pasien respon terhadap terapi dan kemudian dilakukan pembedahan. Pencapaian sitoreduksi optimal pasien karsinoma stadium lanjut yang diberikan neoadjuvant kemoterapi sebesar (37,5%), lebih tinggi dibandingkan penelitian multicenter pada terapi konvensional yang hanya 20-30%. Namun, belum dapat dilihat bahwa pemberian neoadjuvant kemoterapi juga dapat menurunkan morbiditas pembedahan dan memperbaiki kualitas hidup pada pasien dengan keadaan umum buruk, karena ketidaklengkapan data. Kesimpulan: Sitoreduksi optimal dilakukan pada 37,5% pasien yang mendapat neoadjuvant kemoterapi, lebih tinggi dibandingkan dengan pencapaian dengan terapi konvensional. Belum didapatkan perbedaan dalam hal morbiditas dan perbaikan kualitas hidup. [Maj Obstet Ginekol Indones 2007; 31-2: 86-91] Kata kunci: karsinoma ovarium stadium lanjut, neoadjuvant kemoterapi, residu tumor, perdarahan, perawatan ICU, kualitas hidu

Primary Prevention of Gynecologic Cancers

Pendahuluan: Terdapat tiga jenis kanker yang banyak diderita oleh wanita dalam bidang ginekologi, yaitu kanker serviks, kanker ovarium dan kanker endometrium. Patofisiologi kanker serviks hampir dikenal dengan baik, sedangkan patofisiologi kanker ovarium mulai terbuka, dan patofisiologi kanker endometrium juga mulai diketahui. Dengan dasar tersebut dilakukan penelitian terhadap faktor risiko timbulnya kanker ginekologi. Pengenalan faktor risiko yang didapat dari penelitian epidemiologi menjadi dasar untuk melakukan upaya pencegahan primer kanker ginekologi. Pencegahan primer dilakukan dengan memberikan nasihat dan terapi yang mempunyai pengaruh menurunkan risiko timbulnya kanker ginekologi. Tujuan: Menyampaikan kebijakan pencegahan primer kanker ginekologi berdasarkan hasil penelitian epidemiologi. Bahan dan cara kerja: Kajian pustaka. Hasil: Kanker serviks risikonya dapat diturunkan dengan menghindari pola pasangan ganda, menghindari merokok, mengkonsumsi makanan yang kaya vitamin C. Kanker ovarium risikonya dapat diturunkan dengan memberi kontrasepsi oral, menyusui, sterilisasi ataupun histerektomi. Kanker endometrium dapat diturunkan risikonya dengan memberikan kontrasepsi oral kombinasi, menurunkan berat badan. Kesimpulan: Dapat dilakukan upaya menurunkan risiko timbulnya kanker ginekologi melalui pencegahan primer. [Maj Obstet Ginekol Indones 2006; 30-4: 245-8] Kata kunci: pencegahan primer, kanker ginekolog

Construction of plasmids expressing recombinant B cell epitopes of PD1

Latar Belakang: Pengobatan kanker di Indonesia umumnya menggunakan pengobatan dengan kemoterapi atau dengan operasi. Efek samping dari pengobatan ini antara lain adalah kerontokan rambut, mual dan penurunan berat badan. Saat ini sedang berkembang alternatif terapi kanker dengan menggunakan immunoterapi. Kemampuan sel kanker untuk menghindar dari sistem imun disebabkan adanya protein PD-1 pada sel T yang berikatan dengan ligannya PD-L1. Metode: Penelitian ini merupakan penelitian awal yaitu pembuatan rekombinan PQE PD-1 dan menggunakan bagian soluble dari PD-1 yang disebut dengan EP2PD1 yang akan digunakan untuk pembuatan antibodi monoklonal dan sistem pendeteksi antibodi monoklonal. Metode pembuatan rekombinan PD-1 dan EP2PD1 dengan cara penentuan sekuens epitop sel B yang paling imunogenik dilanjutkan dengan amplifikasi sekuen tersebut dengan PCR dan diligasi ke vektor pengekspresi PQE80. Hasil: Telah terbentuk konstruksi rekombinan PQE80 PD-1 dan PQEEP2PD1 yang diverifikasi menggunakan PCR koloni, pemotongan enzimatik dan sekuensing. Hasil penelitian menunjukkan bahwa epitop PD1 telah terklona ke PQE 80 dan tidak ditemukan mutasi dalam urutan asam amino. Kesimpulan: Konstruksi yang dibuat tidak mempunya mutasi dan dapat dilanjutkan untuk pembuatan antibodi monoklonal.&nbsp; Kata Kunci: PD1, Epitop, Kanker, Immunotherapy &nbsp; Abstract Background: Medications on cancer to date in Indonesia is mostly by surgical or chemotherapy, this type of medications is not always curing the patients. The side effect of the chemotherapy drugs sometimes more challenging such as hair loss, nausea and lost weight. One of the promising targets for cancer is using immune therapy. Cancer cells can avoid immune response by surprising immunity through activation of specific inhibitory signalling pathways, referred to as immune checkpoints. Immune check points like PD-1, PD-L1 are breakthrough therapies in oncology and this monoclonal antibody have been approved by the FDA for treatment. In this research we develop full PD-1 and part of PD1 sequence as an insert then we construct with plasmid PQE80L. This recombinant called PQE PD-1 and PQEEP2PD1. The aim of this study is to make recombinant which would be used to detect PD1 full clone monoclonal antibodies. Methods: In this study, we designed our recombinants using Indonesian HLA and others using in silico models, this prototype will not only cover Indonesian patients but also other country. Results: The result showed that the epitope sequence of PD1 has been clone to PQE 80 wt and verified using colony PCR, Enzyme Digestion and Sanger Sequencing. The Clone than will be expressed and injected to animal model to produce antibody. Conclusion: Construction of recombinant PQE PD-1 and PQE EP2PD1 are constructed without any mutation in the sequence, this recombinant can be used in the next study for protein expression of PQE PD-1 and PQE EP2PD1.&nbsp; Keywords: PD1, Epitope , Cancer, Immunotherapy &nbsp