Endometriosis and Cancer

Endometriosis is a chronic debilitating inflammatory disease of women, with the growth of ectopic endometrium in extrauterine sites like rectovaginal septum, peritoneal surfaces, or ovaries, etc. Though endometriosis is not regarded as a malignant disorder, it does have some features common to malignant disease. They are; local and distant metastasis, invasion and destruction to adjacent structures, unrestricted growth, development of new blood vessels. The association between endometriosis and ovarian, endometrial, and cervical cancers and between endometriosis and extra-ovarian malignancies has been reported in different kinds of literature. Clear cell and endometrioid ovarian carcinomas are presumed to have developed from endometriosis. Ovarian seromucinous borderline tumors, low-grade serous ovarian carcinomas, adenosarcoma, and endometrial stromal sarcomas may also arise from endometriosis. However, it is not very clear whether endometriosis has undergone malignant transformation or simply is found co-existent with cancer. Endometriosis itself may increase a woman’s risk of developing non-Hodgkin’s lymphoma, malignant melanoma, and breast cancer

HPV Genotypes distribution in Indian women with and without cervical carcinoma: Implication for HPV vaccination program in Odisha, Eastern India

Abstract Background Considering the limited cross protection offered by the current HPV vaccines, understanding the HPV genotype distribution among the different population is essential in predicting the efficacy of current vaccine and devising new vaccine strategy. The present work aimed at investigating the HPV genotypes distribution among women with and without cervical carcinoma in Odisha, Eastern India. Methods A total of 607 participants have been enrolled between January 2014 and June 2016. L1-PCR, sequencing, and E6/E7 nested multiplex type- specific PCR were performed for HPV detection and genotyping. Cytological distribution of 440 cases includes invasive cervical carcinoma or ICC ( n \u2009=\u2009210), inflammatory smear ( n \u2009=\u2009162), normal cytology ( n \u2009=\u200968). Statistical analyses were performed by using SPSS version 20.0 software and MediCal version 14.10.2(7). A p -value of\u2009\u2264\u20090.05 was considered statistically significant. Results The overall prevalence of HPV infection was (359/595) 60.33%. Prevalence of HPV infection was 93.80% (197/210) in invasive cervical cancer (ICC) cases, 54.32% (88/162) in inflammatory smear and 19.11% (13/68) in normal cervical cytology. The most prevalent genotype was HPV16 (87.28%) followed by HPV18 (24.56%) and HPV 51(3.46%). The overall prevalence of single type was 76.58% and highest (78.9%) among ICC cases. The most frequent genotype combination after HPV16\u2009+\u200918(9.4%) was HPV16\u2009+\u200966\u2009+\u200968(2.7%) which was frequently observed in inflammatory cytology. Age\u2009>\u200945years, parity \u22653, low socio-economic condition, rural residential area and post menopause state were significantly associated with HPV infection. Multiple infections did not have a significant association with any of the clinicopathological variables (stage, LN metastasis, cell type) except tumor size\u2009\u2265\u20092cm in ICC cases. The impact of 2v, 4v, and 9v vaccines in preventing cervical cancer in Odisha were 89.99, 91.65, and 92.16% respectively. Conclusion This data would help planning an appropriate strategy for disease monitoring and provides baseline data for post-vaccination surveillance in the region. The nonavalent vaccine would be significant in preventing cervical carcinoma in Odisha. Hence an effective vaccination program based on regional HPV epidemiological profile along with the cervical cancer screening is necessary to reduce the cervical cancer burden in India

HPV genotypes co-infections associated with cervical carcinoma: Special focus on phylogenetically related and non-vaccine targeted genotypes.

HPV is the major causative agent for cervical cancer. Study on the risk of cervical cancer associated with different hr-HPV genotypes would be useful for disease management and new vaccine strategy. With limited reports available, the present study aimed to investigate the pattern of HPV genotypes coinfections and risk of cervical carcinoma associated with them in Indian population. 15 HPV genotypes were detected by E6/E7 multiplex nested type-specific PCR in the HPV-positive cervical samples of 172 cervical cancer cases and 174 subjects with normal cytology. Association between the genotypes and cervical cancer was estimated by calculating the Odds ratio and 95% confidence interval. Risk of cervical carcinoma was associated with multiple genotypes excluding HPV16 (OR:5.87; 95% CI-1.28-26-29; p = .02), multiple genotypes excluding HPV18 (OR = 2.5; 95% CI = 1.09-6.05; p = .03), multiple genotypes of α9 species(OR = 5.3 95% CI = 1.14-24.03; p = .007), and multiple genotypes of α7 species (OR = 2.5; 95% CI = .49-13.45; p = .2). Genotypes not targeted by quadrivalent vaccine types (OR = 2.94 95% CI = 1.48-5.80; p = .001) conferred 2.94 fold higher risk of cervical carcinoma. Cases those coinfected with phylogenetically related genotypes (OR = 2.29; 95% CI(.69-7.59) p = .17) were at 2.9 fold higher risk of invasive cervical carcinoma than those infected with other genotypes although it is not statistically significant. Whereas phylogenetically unrelated genotypes coinfection is negatively associated with cervical carcinoma (OR = .44 95% CI (.244-.8) p = .007) and it is statistically significant.Genotypes not targeted by 9-valent vaccines (OR = .40; 95% CI = .19-.85; p = .017) associated with lesser risk of cervical carcinoma as compared to other genotypes. Subjects infected with any HPV genotype/genotypes excluding HPV16 in association with HPV 18 (OR = 4.1; 95% CI = 1.81-9.25 P = < .001) were at 4.1 fold higher risk of developing invasive cervical carcinoma.In conclusion, the risk of development of cervical cancer is genotype specific and might be associated with type-specific interactions between the genotypes in multiple infections

Geographical distribution of cervical cancer in Odisha: A 5-year retrospective study at a regional cancer center

Background: Cancer cervix and breast are the two major female health problems in India. A hospital-based, 5-year (2010–2014) retrospective study was conducted at a regional cancer center of Odisha to analyze the present burden of cancer cervix in this state, which has a population of more than 45.5 million at present. Materials and Methods: All the patients suffering from cancer cervix that was treated by radiotherapy during 2010–2014 at this center were analyzed year wise for age, stage of disease, and native area. Results: Based on the Census 2011 data, it was calculated and found that from the low-literacy area on an average of 4.62 cervical cancer patients per million, from the medium-literacy area 6.56 patients per million, and from high-literacy area 19.11 patients per million of population have received radiotherapy in this hospital. More than 60% of patients with cervical cancer were from stage IIIB and in the age group of 50–55 years. Discussion: Odisha has 83.7% female population in rural areas with literacy rate below 50%. Due to lack of awareness and unavailability of cancer care facilities at their reach, they mainly depend on various alternative medicines in unscientific manner for their health care. Conclusion: Strengthening of existing regional cancer center, development of oncology wings in all medical college hospitals by providing basic radiotherapy facilities, emphasizing more on district cancer control programs, decentralizing of NGO schemes, and facilitating with more cancer screening and awareness programs may help better registration, prevention, and treatment of cancer in Odisha

Association of multiple infections with the risk of cervical cancer.

<p>Association of multiple infections with the risk of cervical cancer.</p

Distribution of cases infected with different species of HPV genotypes.

<p>Distribution of cases infected with different species of HPV genotypes.</p

Enrollment of cases and outcomes.

<p>Enrollment of cases and outcomes.</p

Distribution of HPV genotypes as single and coinfection in different phylogenetic groups.

<p>Distribution of HPV genotypes as single and coinfection in different phylogenetic groups.</p

Demographic factors associated with cervical carcinoma.

<p>Demographic factors associated with cervical carcinoma.</p