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

Relative Effectiveness of Neoadjuvant Chemotherapy Versus Primary Surgery in Patients with Advanced Ovarian Cancer

Background: This study aimed to compare the morbidity and disease free progression between patients with advanced ovarian cancer treated with neoadjuvant chemotherapy (NAC) followed by surgery and those treated conventionally with cytoreductive surgery followed by cytotoxic chemotherapy. Subjects and method: This was a retrospective-cohort study conducted at Dr. Cipto Mangunkusumo Hospital, Jakarta. A sample of 84 patients with advanced-stage ovarian cancer was selected for this study, consisting of 64 patients treated conventionally (CT group) with primary surgery followed by platinum based adjuvant chemotherapy, 20 patients treated with neoadjuvant chemotherapy, of which 8 patients subsequently underwent interval debulking and adjuvant chemotherapy (NAC group). The dependent variables were morbidity and disease free progression. The independent data were neoadjuvant chemotherapy and cytoreductive surgery followed by cytotoxic chemotherapy. The data were collected from medical record and questionnaire. Difference in means between the two groups was tested by t-test. Difference in percents between the two groups was tested by chi-square. Results: The response rate to the NAC assessed at three cycles was 40%. Performance status (Hb, albumin, ascites, pleural effusion, Ca 125, and stage) in the NAC group was worse than CT group. Disease free progression after 12 and 24 months in the NAC group was 30% and 5%, CT group was 10% and 7.5%, respectively. Parameters of surgical aggressiveness (massive bleeding, organ injury, and ICU stay) were lower in the NAC group than the conventional group. Complication rate of surgical injury in CT group was 17% and zero in the NAC group. Conclusion: Neoadjuvant chemotherapy followed by interval debulking in advanced ovarian cancer does not affect disease free progression but reduces morbidity. Keywords: neoadjuvant chemotherapy, interval debulking, cytoreductive surgery, cytotoxic chemotherapy, disease free progression, morbidity, advanced ovarian cancer

Perbandingan Kadar Laktat Dehidrogenase pada Asites yang disebabkan Kanker Ovarium dengan Asites Nonmaligna (Laporan Pendahuluan)

Tujuan: Membuktikan manfaat pemeriksaan kadar LDH untuk membedakan asites maligna dengan asites nonmaligna. Tempat: Kamar operasi ginekologi bedah pusat RSUPN Dr. Cipto Mangunkusumo, poliklinik Penyakit Dalam dan ruang pera-watan Penyakit Dalam IRNA B RSUPNCM, Jakarta. Bahan dan cara kerja: Analisis potong lintang dengan membandingkan kadar LDH dalam asites kanker ovarium dengan kadar LDH dalam asites nonmaligna. Diambil sampel cairan asites pasien kanker ovarium dan asites pasien bukan kanker dengan cara paresintesis/ aspirasi saat operasi sebanyak 10 cc. Pada asites yang terkumpul, dilakukan pemeriksaan kadar LDH dengan cara enzimatik. Hasil: Data kadar LDH diperoleh dari 17 pasien kanker ovarium (delapan kasus stadium IA, 3 kasus stadium IB, 1 kasus stadium IC, dan 5 kasus stadium IIIC; delapan puluh dua persen dari kasus merupakan adenokarsinoma, sisanya 12% kasus jenis sel granulosa dan 6% kasus dengan germ cell) dan 9 pasien bukan kanker (empat kasus sirosis hepatis, 2 kasus gagal jantung, 1 kasus peritonitis tuberkulosis dan 2 kasus kista jinak ovarium) dengan karakteristik kelompok usia terbanyak 30 - 50 tahun. Didapatkan kadar LDH asites pada pasien kanker ovarium lebih tinggi secara bermakna dibandingkan dengan kadar LDH asites pasien bukan kanker (

Eliminasi Human Papillomavirus (HPV) dan Respons Terapi pada Adenokarsinoma Serviks dan Karsinoma Sel Skuamos Serviks yang mendapat pengobatan Kemoradiasi

Tujuan: Tujuan penelitian ini adalah untuk mengetahui eliminasi DNA HPV risiko tinggi pada karsinoma sel skuamous serviks (KSS) dan adenokarsinoma serviks yang mendapat pengobatan kemoradiasi dan kaitannya dengan respons pengobatan. Bahan dan cara kerja: 22 penderita kanker serviks dengan jenis histopatologi adenokarsinoma dan 26 penderita kanker serviks dengan jenis histopatoloi KSS yang terdiri dari stadium IB-IIIB (FIGO) diambil sebagai sampel secara konsekutif dari penderita yang berkunjung dan dirawat di poliklinik dan ruangan onkologi ginekologi Rumah Sakit Umum Pusat Nasional Dr. Cipto Mangunkusumo Jakarta antara Juli 2005 dan Juli 2006. Pemeriksaan DNA HPV risiko tinggi dengan metode Hybrid Capture 2 (HC2) pada semua sampel tersebut menunjukkan hasil yang positif. Semua penderita mendapat pengobatan kemoradiasi. Pascakemoradiasi dilakukan penilaian respons pengobatan secara klinik dan pemeriksaan HC2 untuk melihat eliminasi DNA HPV risiko tinggi pada penderita tersebut. Hasil: Eliminasi DNA HPV risiko tinggi pada kanker serviks jenis adenokarsinoma lebih kecil dibanding dengan kanker serviks jenis KSS. Pascapemberian kemoradiasi, pada adenokarsinoma terjadi eliminasi DNA HPV 59,1% penderita dibanding dengan kelompok KSS di mana terjadi eliminasi DNA HPV risiko tinggi pada 76,9% penderita. Jenis Adenokarsinoma juga mempunyai angka persistensi DNA HPV risiko tinggi yang lebih besar (40,9%) dibanding dengan jenis KSS (23,1%). Penelitian ini menunjukkan respons pengobatan terhadap kemoradiasi antara kanker serviks dengan jenis adenokarsinoma dan KSS tidak berbeda dan hasil analisis menunjukkan bahwa antara respons terapi dan eliminasi DNA HPV risiko tinggi tidak terdapat hubungan. Pemeriksaan HC2 pascakemoradiasi masih bisa positif pada tumor dengan respons komplit. Kesimpulan: Persistensi DNA HPV risiko tinggi pascakemoradiasi lebih banyak terjadi pada kanker serviks jenis adenokarsinoma dibanding dengan jenis KSS. Untuk melihat apakah hal ini berkaitan dengan terjadinya rekurensi maka diperlukan penelitian dengan waktu pengamatan yang lebih lama. [Maj Obstet Ginekol Indones 2008; 32-2: 105-15] Kata kunci: kanker serviks, HPV, kemoradias

Correlation between Expression of MVP, Index of p53 and AgNOR Value with Chemoradiotherapy Clinical Response of Cervical Cancer

Cervical cancer is the most frequent cancer found in Indonesia. The primary treatment of cervical cancer at the locally advanced stage is usually performed by using radiotherapy and chemotherapy. The combination of the two techniques is often called chemoradioherapy. The response to chemoradiotherapy is influenced by biological and physical factors. Major vault protein (MVP) is a ribonucleoprotein which contributes to drug resistance in some cancers. The purposes of this research were: (1) to determine the correlation between the expression of MVP and the index of p53, including AgNOR values and index of MIB-1; and (2) between MVP and chemoradiotherapy clinical response of cervical cancer. Twenty-one microscopic slides taken from biopsy tissues of cervical cancer patients before undergoing treatment were stained to identify MVP, p53, and MIB-1 by means of immunohistochemistry techniques and AgNORs staining. After undergoing chemoradiotherapy treatment, the patients’ clinical responses were observed by pelvic control method. Experimental results showed that there was a correlation between MVP and AgNOR value (P=0.05), but no correlation between MVP and index of p53 (P=0.729), including MIB-1 LI (P=0.63), in untreated cervical cancer. In addition, there was no association between MVP and chemoradioterapy response. In conclusion, MVP expression correlates with the process of cell proliferation before the G2 phase of cell cycle in untreated cancer cells. Those have no association with clinical responses after the completion of treatment.Received: 20 November 2013; Revised: 18 July 2014; Accepted: 28 September 201

Correlation Between Expression of MVP, Index of P53 and AgNOR Value with Chemoradiotherapy Clinical Response of Cervical Cancer

Cervical cancer is the most frequent cancer found in Indonesia. The primary treatment of cervical cancer at the locally advanced stage is usually performed by using radiotherapy and chemotherapy. The combination of the two techniques is often called chemoradioherapy. The response to chemoradiotherapy is influenced by biological and physical factors. Major vault protein (MVP) is a ribonucleoprotein which contributes to drug resistance in some cancers. The purposes of this research were: (1) to determine the correlation between the expression of MVP and the index of p53, including AgNOR values and index of MIB-1; and (2) between MVP and chemoradiotherapy clinical response of cervical cancer. Twenty-one microscopic slides taken from biopsy tissues of cervical cancer patients before undergoing treatment were stained to identify MVP, p53, and MIB-1 by means of immunohistochemistry techniques and AgNORs staining. After undergoing chemoradiotherapy treatment, the patients' clinical responses were observed by pelvic control method. Experimental results showed that there was a correlation between MVP and AgNOR value (P=0.05), but no correlation between MVP and index of p53 (P=0.729), including MIB-1 LI (P=0.63), in untreated cervical cancer. In addition, there was no association between MVP and chemoradioterapy response. In conclusion, MVP expression correlates with the process of cell proliferation before the G2 phase of cell cycle in untreated cancer cells. Those have no association with clinical responses after the completion of treatment.Received: 20 November 2013; Revised: 18 July 2014; Accepted: 28 September 201

Pendeteksian Ekspresi Biomarker MNK Secara Semi Kuantitatif dan Kuantitatif Pada Kanker Serviks Sebelum Respon Kemoradioterapi

Kanker servik merupakan penyakit kanker yang umum dijumpai pada wanita yang disebabkan oleh virus HPV (Human Papilova Virus). Tujuan penelitian ini adalah untuk mengetahui hubungan ekspresi protein MNK (Mitogen Activated Protein Kinase) pada penderita kanker serviks sebelum tindakan pengobatan terhadap respon kemoradioterapi. Sampel uji yang digunakan adalah sediaan mikroskopis hasil biopsi jaringan kanker dari penderita kanker serviks stadium lanjut (IIB-IIIB) sebanyak 20 sampel. Metode yang digunakan adalah metode imunohistokimia dengan menggunakan biomarker MNK pada biopsi jaringan kanker serviks. Ekspresi protein MNK yang positif ditandai dengan warna coklat tua yang terdapat pada inti sel. Respon kemoradioterapi diperoleh dari RSUPN Dr. Cipto Mangunkusumo Jakarta dan RS Hasan Sadikin Bandung. Hasil penelitian menunjukkan nilai IRS (Imuno Reaktif Score) protein MNK pada grup respon kemoradioterapi baik lebih tinggi dibandingkan grup respon kemoradioterapi buruk dan tidak ditemukan adanya hubungan IRS protein MNK dengan respon kemoradioterapi. Sedangkan hubungan ekspresi MNK terhadap respon kemoradioterapi menunjukkan adanya korelasi perbedaan grup respon kemoradioterapi antara ekspresi protein MNK negatif dan ekspresi protein MNK positif. Cervical cancer is a cancer that common in women caused by HPV (Human Papilova Virus). The purpose of this study is to determine the relationship MNK protein expression (Mitogen-Activated Protein Kinase) in patients with cervical cancer before chemoradiotherapy treatment. Sample used was the preparation of microscopic cancer tissue biopsies from patients with advanced cervical cancer (IIB-IIIB) is 20 samples. The method used is immunohistochemistry using MNK biomarkers in cervical cancer tissue biopsies. MNK positive protein expression marked with dark brown color that is contained in the cell nucleus. Chemoradiotherapy response obtained from RSUPN Dr. Cipto Mangunkusumo and Hasan Sadikin Hospital in Bandung. The results show the value of the IRS (Immuno Reactive Score) MNK protein in response to chemoradiotherapy group either higher than the response to chemoradiotherapy group was bad and did not find any relationship IRS MNK protein with chemoradiotherapy response. While the relationship MNK expression responses show a correlation chemoradiotherapy group differences in chemoradiotherapy response between MNK expression negative and MNK expression positive