Patients w/ abnormal Pap smear are referred for colonoscopy to screen for presence of cervical cancer.
Colposcopic exam should include inspection of the transformation zone, definition of the extent of the lesion & biopsy of the most abnormal area for tissue diagnosis.
The earliest stages of cervical carcinoma are generally asymptomatic.
Watery vaginal discharge & postcoital bleeding or intermittent spotting may be present & are usually unrecognized by the patient.

Observation After Cone Biopsy

  • If patient is medically inoperable or wishes to preserve fertility, observation after conization or cone biopsy may be appropriate if:
    • Depth of invasion is shown to be <3 mm
    • There are clear margins
      • If margins are positive, repeat cone biopsy or do trachelectomy
      • If margins are still positive on repeat cone biopsy, treat as stage IB
    • No vascular or lymphatic invasion is noted
  • If with lymphovascular invasion, surgical option is cone biopsy or trachelectomy with pelvic lymph node dissection with or without para-aortic lymph node sampling

Principles of Therapy

Surgery vs Radiotherapy (RT) in Patients with Stage IB1 or Stage IIA1

  • Treatment of choice will depend on many factors including the following:
    • Patient preference
    • Desire for preservation of vaginal and ovarian functions
    • Psychological and medical conditions
    • Age
    • Local clinician expertise
    • Size of primary tumor; radiotherapy should be primary treatment for adenocarcinomas that expand the cervix >3 cm
  • Both treatments result in equivalent cure rates

Adjuvant Therapy

Negative Lymph Nodes

  • The following are options in patients with negative lymph nodes after radical hysterectomy:
    • Observation
    • Pelvic EBRT with or without concurrent Cisplatin-containing chemotherapy in patients with high-risk factors (ie lymphovascular invasion, deep stromal invasion, and large primary tumor)
      • Based on a trial that after 2 years, the recurrence-free rate for surgically treated patients on pelvic radiotherapy was 88%; after a 12-year follow-up, an increase in the progression-free survival was noted

Positive Pelvic Lymph Nodes, and/or Parametrial Involvement and/or Surgical Margins

  • Patients should be treated with postoperative pelvic EBRT with concurrent Cisplatin-containing chemotherapy with or without vaginal brachytherapy
  • Based on a study, it showed that pelvic radiation with 5-Fluorouracil and Cisplatin has a statistically significant benefit in patients

Positive Para-aortic Lymph Nodes

  • Further screening with computed tomography (CT) or combined positron emission tomography-computed tomography (PET-CT) scan is required
  • Biopsy of suspicious areas is recommended in patients with positive distant metastases
  • Patients with negative findings should undergo para-aortic lymph node EBRT with concurrent Cisplatin-based chemotherapy and pelvic EBRT
    • Brachytherapy is recommended
  • Patients with positive findings should be treated with chemotherapy and individualized EBRT

Systemic Therapy for Metastatic Disease

  • Patients who develop distant metastasis are rarely curable
  • The following measures, such as surgical resection with or without individualized EBRT, may be done in highly selected patients with isolated distant metastases
  • Palliative measures, in pelvic recurrences with heavily irradiated sites not amenable to surgical resection or local pain control techniques, are unresolved clinical issues
    • Patients may occasionally benefit from radiotherapy to a localized recurrence (eg supraclavicular, bone metastases, or painful para-aortic nodal recurrences)
      • If with limited resources and if feasible, short or single courses of radiotherapy can be utilized with retreatments for recurrent or persistent symptoms


Relapse and Metastases


  • Has a limited role in prolonging survival or improving quality of life
  • Recommended in patients with extrapelvic metastases or patients with recurrent disease who are not candidates for radiotherapy or exenteration
  • Combination platinum-based regimens are preferred over single agents, if Cisplatin has been previously used as a radiosensitizer
  • Cisplatin is the preferred 1st-line single agent for recurrent or metastatic cervical cancer
    • Response rates of approximately 20-30% and overall survival of about 6-9 months
  • Other first-line single agents include Carboplatin and Paclitaxel
    • Carboplatin may also be preferred over Cisplatin due to tolerability, ease of administration, and preservation of renal function
      • In basic-resource settings, single-agent chemotherapy with either Carboplatin or Cisplatin is recommended
    • Paclitaxel has also been reported to be effective and tolerable
  • The following are first-line combination therapies: Cisplatin/Paclitaxel, Cisplatin/Gemcitabine, Cisplatin/Topotecan, Paclitaxel/Carboplatin, Cisplatin/Paclitaxel/Bevacizumab, Topotecan/Paclitaxel, Topotecan/Paclitaxel/Bevacizumab, and Carboplatin/Paclitaxel/Bevacizumab
    • Cisplatin/Paclitaxel or Carboplatin/Paclitaxel is less toxic and provides easier administration
    • Cisplatin/Topotecan has been approved for advanced cervical cancer
      • The combination was shown to be superior compared to single-agent Cisplatin based on overall response rate of 27%, progression-free survival of 4.6 months, and median survival of 9.4 months
    • Cisplatin/Gemcitabine may be useful in patients with neuropathy who cannot tolerate other drug combinations
  • Second-line therapies include Bevacizumab, Docetaxel, Gemcitabine, Ifosfamide, Irinotecan, Mitomycin, Pemetrexed, Topotecan, Vinorelbine, Fluorouracil (5-FU), and albumin-bound Paclitaxel
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27 Nov 2017
Transdermal oestradiol added to progesterone reduces menopause-related depression, researchers reported at the annual meeting of The North American Menopause Society in Philadelphia, US.
Tracy TC Kwan, BSc (Nursing), MPH; Hextan YS Ngan, MBBS, FHKAM (O&G), MD (HK), FRCOG, 01 Aug 2013

Human papillomavirus (HPV) infection is a prevalent disease worldwide. Consequences of HPV infection vary, depending on the infected individuals and the HPV genotype involved. Life-threatening consequences are not uncommon, and cervical cancer is a clear demonstration of the virus’s potency. While the incidence of cervical cancer is heavily concentrated on developing countries,1 the impact of HPV-related diseases on developed countries has not ceased. In the United States alone, HPV infections are the most common sexually transmitted disease with an estimated 5 million new cases being diagnosed in 2000 among young adults, incurring nearly US$3 billion in terms of direct medical costs.2 A multinational study involving 18,498 women showed that cervical HPV prevalence varied greatly geographically, ranging from the low of 1.6% in North Vietnam to the high of 27% in Nigeria. In general, HPV prevalence peaked among young, sexually active women and declined with age. In selected countries, however, a second peak was noted in women older than 55 years.3 The high prevalence of HPV-related diseases incurs a heavy burden on the healthcare systems of developed and developing countries alike, which renders HPV research and prevention a global public health imperative. On an individual level, the afflictions caused by HPV-related diseases go beyond that of physical suffering to affecting the psychological well-being of the infected. This is the focus of our paper.

27 Nov 2017
Chronic hepatitis B virus (HBV) infection is a global problem. Chronic HBV infection is probably the most common maternal infection encountered in Hong Kong, China, and Southeast Asia. In Hong Kong, which is one of the endemic areas, immunisation against HBV was first provided in 1983 to infants born to mothers who were screened positive for hepatitis B surface antigen (HBsAg). Immunisation became widespread since November 1988, but HBsAg-positive mothers are still encountered frequently.1
GC Kang, VK Yeow, 01 Feb 2015

Craniofacial abnormalities affect a significant proportion of society. Cleft lip and/or palate, for example, occurs in 1 per 500–700 births, depending on geography and ethnicity. The costs in terms of morbidity, psychological disturbance, and social and workplace exclusion are considerable for patients and their families, and society. The average incidence of new cleft cases is 2 clefts per 1,000 live births in the combined populations of Thailand, Bangladesh, Bhutan, Brunei, Cambodia, Indonesia, Laos, Malaysia, Nepal, Pakistan, Philippines, Singapore, Sri Lanka, and Vietnam.1