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Cervical cancer - steps in the right direction

Pillay B, Kandiah N

Family Practitioner, 1988;11:86-87.

Matched MeSH terms: Uterine Cervical Neoplasms
Roles of probiotics against HPV through the gut-vaginal axis

Xu P, Mageswaran UM, Nisaa AA, Balasubramaniam SD, Rajendran D, Ismail EHBE, et al.

Int J Gynaecol Obstet, 2025 Apr;169(1):1-8.
PMID: 39520180 DOI: 10.1002/ijgo.16005

Human papillomavirus (HPV) is a sexually transmitted virus, whose persistent infection is the main reason for invasive cervical cancer (ICC), which is the fourth most common type of cancer in women, with more than 500 000 new cases every year. After infection, various alterations occur in the host, facilitating the virus's evasion of immune system clearance and promoting its proliferation. Oral probiotic consumption can influence the whole body's immunity, inflammatory reflection, neural, endocrine humoral, metabolic pathways and other organs by adjusting the components of gut microbiota (GM). Some evidence shows there is a tight connection between GM and vaginal microbiota (VM), which is referred to as the gut-vaginal axis. This review investigates the potential role of probiotics in clearing HPV via the gut-vagina axis, emphasizing the effectiveness of Lactobacillus in preventing vaginal diseases and suggesting its potential for HPV clearance. Understanding the role of probiotics in the gut-vagina axis could pave the way for new strategies to reduce and eliminate HPV and related diseases.

Matched MeSH terms: Uterine Cervical Neoplasms/microbiology; Uterine Cervical Neoplasms/prevention & control; Uterine Cervical Neoplasms/virology
Survival rates of cervical cancer patients in Malaysia

Muhamad NA, Kamaluddin MA, Adon MY, Noh MA, Bakhtiar MF, Ibrahim Tamim NS, et al.

Asian Pac J Cancer Prev, 2015;16(7):3067-72.
PMID: 25854407

Cervical cancer is the most common malignant cancer of the female reproductive organs worldwide. Currently, cervical cancer can be prevented by vaccination and detected at an early stage via various screening methods. Malaysia, as a developing country faces a heavy disease burden of cervical cancer as it is the second most common cancer among Malaysian women. This population based study was carried out to fulfil the primary aim of determining the survival rates of Malaysian women with cervical cancer and associated factors. Data were obtained from two different sources namely, the Malaysian National Cancer Registry (MNCR) and National Health Informatics Centre (NHIC) from 1st January 2000 to 31st December 2005. Kaplan Meier analyses were conducted to identify the overall survival rates and median survival time. Differences in survival among different ethnic and age group were compared using the log-rank test. A total of 5,859 patients were included. The median survival time for cervical cancer in this study was 65.8 months and the 5-year survival rate was 71.1%. The overall observed survival rates at 1, 3 and 5 years were 94.1%, 79.3% and 71.1% respectively. The log-rank test finding also showed that there were significant differences in the 5-year survival rate among different ethnic groups. Malays had the lowest survival rate of 59.2% followed by Indians (69.5%) and Chinese (73.8%). The overall 5-year survival rate among patients with cervical cancer in Malaysia is relatively good. Age and ethnic groups remain as significant determining factors for cervical cancer survival rate.

Matched MeSH terms: Uterine Cervical Neoplasms/diagnosis*; Uterine Cervical Neoplasms/mortality*
Fulltext Carcinoma of the uterine cervix: a review of its pathology and commentary on the problem in Malaysians

Cheah PL, Looi LM

Malays J Pathol, 1999 Jun;21(1):1-15.
PMID: 10879274

Since its recognition about 150 years ago, there has been much progress in the understanding of the pathogenesis, prevention, early detection and management of carcinoma of the uterine cervix. Important historical landmarks include the (1) recognition of pre-invasive and pre-clinical lesions, and the devise of various systems for reporting these lesions, (2) improvements in diagnostic techniques particularly colposcopy, (3) advent of therapeutic procedures (electrocoagulation, cryotherapy, laser therapy and loop electrosurgical excision), and (4) recognition of the aetiological relationship between the human papillomavirus and cervical neoplasia. The susceptibility of the cervical transformation zone to malignant change is now well recognised. The WHO classification system remains the one most commonly utilised for histological reporting of cervical cancers. In the recent 1994 update, cervical carcinoma is divided into 3 main categories: squamous cell carcinoma, adenocarcinoma and other epithelial tumours. Squamous cell carcinoma (60-80%) predominates among invasive cervical carcinoma. Recognised variants include verrucous, warty (condylomatous), papillary squamous (transitional) and lymphoepithelioma-like carcinoma. Adenocarcinoma (5-15% of invasive carcinomas) shows an increasing trend in young females. Like its squamous counterpart, preinvasive and microinvasive versions are known. Variants such as mucinous, endometrioid, clear cell, mesonephric, serous, villoglandular and minimal deviation carcinoma are now defined. Adenosquamous carcinoma (5-25%), adenoid-cystic, adenoid-basal, neuroendocrine and undifferentiated carcinomas constitute other epithelial tumours of the cervix. The management of invasive cervical carcinoma remains heavily dependent on its stage. The FIGO staging system remains the most widely used. The 1995 update provides more definite criteria in subdividing stage IA tumours by delimiting stromal invasion of stage IA1 lesions to a maximum depth of 3 mm and a horizontal axis of 7 mm. In Malaysia, an appreciation of the cervical carcinoma problem has to take into consideration the population at risk, its multi-ethnicity, its socio-economic and geographical diversities and the constraints of the health care system. Females form 48.9% of the Malaysian population. 52.9% of them are in the sexually active age group of 15-50 years, indicating a significant population at risk for cervical carcinoma. Cervical carcinoma was the third most common cause of death due to solid tumours among Malaysian females in 1995 following carcinoma of the breast and respiratory tract. East Malaysia is predominantly rural with many communities having limited modern facilities. Such areas imply a lower educational and socio-economic status, raising the worry of a population at higher risk for developing cervical carcinoma. The population: doctor for Malaysia of 2153:1 compares poorly with nearby Singapore. Besides a shortage of doctors, there is also an uneven distribution of doctors, resulting in a ratio in East Malaysia of > 4000:1. Although Malaysia does not have a national cervical cancer-screening programme, many action plans and cancer awareness campaigns have been launched throughout the years, which appear to have made an impact as evidenced by the decreasing mortality rates from cervical carcinoma. Another interesting feature of cervical carcinoma in Malaysia relates to its multiethnic population. In Malaysian Chinese and Malay females, the prevalence of cervical carcinoma ranks second to breast cancer whereas the pattern is reversed in Malaysian Indian females. Studies into its aetiology and pathogenesis are being undertaken and may shed more light on this matter.

Matched MeSH terms: Uterine Cervical Neoplasms/classification; Uterine Cervical Neoplasms/pathology*
Fulltext The problem of uterine cervical carcinoma in Singapore and West Malaysia

Chan LKC

Singapore Med J, 1970 Sep;11(3):140-6.
PMID: 5472054
Matched MeSH terms: Uterine Cervical Neoplasms/diagnosis; Uterine Cervical Neoplasms/epidemiology*
Fulltext High dose rate intracavitary radiation therapy of carcinoma of the cervix using a linear source

Azhar T, Kamada T, Lopez F, Harun R, Nor I, Lim A

Med J Malaysia, 1991 Jun;46(2):123-8.
PMID: 1839415

One hundred patients with carcinoma of the cervix stages 1B to 4A were treated with intracavitary high dose rate radiation using a linear cobalt source. All cases have received external beam pelvic irradiation to 4500cGy mid plane in twenty fractions over four weeks. The results in terms of patient compliance and convenience were good while acute and late morbidities were comparable to standard Manchester technique of low dose rate intracavitary therapy as practised in the Institute of Radiotherapy and Oncology General Hospital Kuala Lumpur. The four year actuarial survival rate is 76% for stage II and 48% for stage III. All three stage IV patients died within 1 year. Four out of seven stage I patients are alive (minimum follow-up 18 months, longest 43 months). One died of systemic spread at 33 months while one is lost to follow up.

Matched MeSH terms: Uterine Cervical Neoplasms/radiotherapy*
Cervix Cancer Research Network (CCRN): Improving Access to Cervix Cancer Trials on a Global Scale

Gaffney D, Small B, Kitchener H, Young Ryu S, Viswanathan A, Trimble T, et al.

Int. J. Gynecol. Cancer, 2016 11;26(9):1690-1693.
PMID: 27779548

Eighty-seven percent of cervix cancer occurs in less-developed regions of the world, and there is up to an 18-fold difference in mortality rate for cervix cancer depending on the region of the world. The Cervix Cancer Research Network (CCRN) was founded through the Gynecologic Cancer InterGroup with the aim of improving access to clinical trials in cervix cancer worldwide, and in so doing improving standards of care. The CCRN recently held its first international educational symposium in Bangkok. Sixty-two participants attended from 16 different countries including Pakistan, India, Bangladesh, Thailand, Malaysia, Singapore, Philippines, Taiwan, China, Vietnam, Korea, Japan, Columbia, Brazil, Canada, and the United States. The focus of this symposium was to evaluate progress, to promote new clinical trials for the CCRN, and to provide education regarding the role of brachytherapy in the treatment of cervical cancer.

Matched MeSH terms: Uterine Cervical Neoplasms/radiotherapy*
THE USE OF RADIATION RESPONSE IN SELECTING THE METHOD OF TREATMENT OF CARCINOMA CERVICIS UTERI

CHESTERMAN JN

Med J Malaysia, 1963 Jun;17:263-8.
PMID: 14060502
Matched MeSH terms: Uterine Cervical Neoplasms*
Fulltext The deceiving encounter of a spontaneously ruptured urinary bladder

Salleh H, Azli S, Khairul-Asri MG, Jagwani A

Ann R Coll Surg Engl, 2022 Mar;104(3):e67-e69.
PMID: 34812665 DOI: 10.1308/rcsann.2021.0129

Spontaneous urinary bladder rupture is a rare condition. Radiotherapy treatment for malignancy of a pelvic organ such as cervix or prostate is one cause of this condition. We report a case of a 71-year-old woman who presented with this illness 30 years after radiotherapy treatment.

Matched MeSH terms: Uterine Cervical Neoplasms/radiotherapy
IPVS STATEMENT on HPV vaccination: No longer supply constraints: Towards achieving WHO vaccine targets

Garland SM, Bhatla N, Woo YL, IPVS Policy Committee

Vaccine, 2024 Dec 02;42(26):126400.
PMID: 39366196 DOI: 10.1016/j.vaccine.2024.126400

The global supply of human papillomavirus (HPV) prophylactic vaccines has been constrained since 2020.Vaccine manufacturers have increased capacity and new HPV vaccines are now available. Vaccine supply is now able to meet the full HPV vaccine demand which has been achieved earlier than predicted.

Matched MeSH terms: Uterine Cervical Neoplasms/prevention & control
Estimating the five-year survival of cervical cancer patients treated in hospital universiti sains malaysia

Razak NA, Mn K, Zubairi YZ, Naing NN, Zaki NM

Asian Pac J Cancer Prev, 2013;14(2):825-8.
PMID: 23621246

OBJECTIVE: The objective of this study was to determine the five-year survival among patients with cervical cancer treated in Hospital Universiti Sains Malaysia.
METHODS: One hundred and twenty cervical cancer patients diagnosed between 1st July 1995 and 30th June 2007 were identified. Data were obtained from medical records. The survival probability was determined using the Kaplan-Meier method and the log-rank test was applied to compare the survival distribution between groups.
RESULTS: The overall five-year survival was 39.7% [95%CI (Confidence Interval): 30.7, 51.3] with a median survival time of 40.8 (95%CI: 34.0, 62.0) months. The log-rank test showed that there were survival differences between the groups for the following variables: stage at diagnosis (p=0.005); and primary treatment (p=0.0242). Patients who were diagnosed at the latest stage (III-IV) were found to have the lowest survival, 18.4% (95%CI: 6.75, 50.1), compared to stage I and II where the five-year survival was 54.7% (95%CI: 38.7, 77.2) and 40.8% (95%CI: 27.7, 60.3), respectively. The five-year survival was higher in patients who received surgery [52.6% (95%CI: 37.5, 73.6)] as a primary treatment compared to the non-surgical group [33.3% (95%CI: 22.9, 48.4)].
CONCLUSION: The five-year survival of cervical cancer patients in this study was low. The survival of those diagnosed at an advanced stage was low compared to early stages. In addition, those who underwent surgery had higher survival than those who had no surgery for primary treatment.

Matched MeSH terms: Uterine Cervical Neoplasms/mortality*; Uterine Cervical Neoplasms/surgery; Uterine Cervical Neoplasms/therapy
Genetic susceptibility to cervical cancer: role of common polymorphisms in apoptosis-related genes

Tan SC, Ankathil R

Tumour Biol., 2015 Sep;36(9):6633-44.
PMID: 26242271 DOI: 10.1007/s13277-015-3868-2

Cervical cancer is a common malignancy which poses a significant health burden among women, especially those living in the developing countries. Although human papillomavirus (HPV) infection has been unequivocally implicated in the etiopathogenesis of the cancer, it alone is not adequate to contribute to the malignant transformation of cervical cells. Most HPV infections regress spontaneously, and only a small proportion of women have persistent infections which eventually lead to malignancy. This suggests that interplays between HPV infection and other cofactors certainly exist during the process of cervical carcinogenesis, which synergistically contribute to the differential susceptibility of an individual to the malignancy. Undoubtedly, host genetic factors represent a major element involved in such a synergistic interaction, and accumulating evidence suggests that polymorphisms in apoptosis-related genes play an important role in the genetic susceptibility to cervical cancer. This review consolidates the recent literatures on the role of common polymorphisms in apoptosis-related genes in genetic susceptibility to cervical cancer.

Matched MeSH terms: Uterine Cervical Neoplasms/genetics*; Uterine Cervical Neoplasms/pathology; Uterine Cervical Neoplasms/virology
Fulltext Radiotherapy in locally advanced cancer of the cervix

Biswal BM, Rath GK, Joshi RC, Mohanti BK, Ganesh T, Singh R

Med J Malaysia, 1998 Mar;53(1):30-6.
PMID: 10968134

Radical radiotherapy is considered as the treatment of choice in locally advanced cancer cervix. In late stages radiotherapy produce optimum palliation and to some extent cure. Three hundred cases of cancer cervix (stage I-IV) comprising stage-I (7), stage-II (144), stage-III (145) and stage IV (4) were evaluated and treated with radiotherapy between April 1990 to July 1994. FIGO stage IB, IIA and IIB (early), were treated with predominant intracavitary radiotherapy (34 Gy X 2 fractions; within one week) followed by external pelvic radiotherapy to a dose of 36 Gy in 18 fractions; treating 200 cGy per fraction, 5 days a week. The late stage (stage-IIB, IIIA and IIIB, IVA) of disease were managed with initial external radiotherapy to a dose of 50 Gy, followed by a single intracavitary dose of 30 Gy to point-A. The median follow up was 33 months (range 12-72 months). The tumor volume less than 100 cc were associated with better survival than volume more than 100 cc (p < 0.05). The five year actuarial survival was 83%, 68% and 58% respectively in FIGO stage I-III disease. There were 0.33% and 2.6% late grade-III bladder and rectal complications. Our experience shows effectiveness of radiotherapy in the management of locally advanced cancer of the cervix.

Matched MeSH terms: Uterine Cervical Neoplasms/mortality; Uterine Cervical Neoplasms/pathology; Uterine Cervical Neoplasms/radiotherapy*
Comparative study of cytologic and colposcopic findings in preclinical cervical cancer

Maziah AM, Sharifah NA, Yahya A

Malays J Pathol, 1991 Dec;13(2):105-8.
PMID: 1823091

Seventy-seven patients who had PAP smear cytology and colposcopic examination in a 2-year period between 1988 and 1989 were reviewed. Those with findings indicative or suspicious of malignancy were subjected to biopsy. All 50 patients thus biopsied were confirmed to have preclinical cancer on histological examination. Compared against histology, PAP smear cytology gave an accuracy rate of 90% (5 false negatives) and colposcopy gave an accuracy rate of 94% (3 false negatives). These results demonstrate that the two techniques are useful as screening tests for preclinical cervical cancer. The results are improved if they are used complementarily. However, there was poor specificity in the categorisation of cervical cancer by both methods. This was probably due to the subjectiveness of the two procedures. The study also raised the possibility of a higher incidence of preclinical cervical cancer in the Chinese ethnic group.

Matched MeSH terms: Uterine Cervical Neoplasms/diagnosis*; Uterine Cervical Neoplasms/ethnology; Uterine Cervical Neoplasms/pathology
Cytological characteristics of gynaecological specimens referred to cytology division, I.M.R. in 1970

Tang SK, Welch QB

Med J Malaya, 1972 Jun;26(4):238-43.
PMID: 5069412
Matched MeSH terms: Uterine Cervical Neoplasms/diagnosis; Uterine Cervical Neoplasms/epidemiology; Uterine Cervical Neoplasms/pathology*
'Lest we forget' as we move forward with cervical screening

Saville M, McNally O

Aust N Z J Obstet Gynaecol, 2018 Jun;58(3):265-266.
PMID: 29864221 DOI: 10.1111/ajo.12813
Matched MeSH terms: Uterine Cervical Neoplasms/epidemiology; Uterine Cervical Neoplasms/prevention & control*; Uterine Cervical Neoplasms/virology
Fulltext Clinical Practice Guideline: Management of Cervical Cancer (2nd Edition)

Citation: Clinical Practice Guidelines: Management of Cervical Cancer, Second Edition. Putrajaya: Ministry of Health, Malaysia; 2015
Quick reference: http://www.acadmed.org.my/view_file.cfm?fileid=754
Training manual: http://www.acadmed.org.my/view_file.cfm?fileid=796

Older version: First Edition (2003)
Keywords: CPG

Matched MeSH terms: Uterine Cervical Neoplasms
Cervical cancer prevention

Khoo EM

Family Physician, 1996;8:8-10.

Matched MeSH terms: Uterine Cervical Neoplasms
Comparative analysis of SD biosensor standard™ M10 HPV and seegene anyplex™ II HPV HR for detecting high-risk human papillomavirus: a concordance study

Jerip AR, Noni V, Anthony VK, Bong ACS, Adam J, Tan CS

BMC Infect Dis, 2025 Mar 03;25(1):304.
PMID: 40033233 DOI: 10.1186/s12879-025-10714-y

BACKGROUND: Cervical cancer, primarily caused by persistent high-risk human papillomavirus (hrHPV) infections, is a significant health burden, particularly in low-resource settings such as Sarawak, Malaysia. Effective prevention depends on effective vaccination and early hrHPV detection. This study compares the performance of the point-of-care test (POCT) SD Biosensor Standard™ M10 HPV and laboratory-based Seegene Anyplex™ II HPV HR assay, focusing on their ability to detect and genotype hrHPV in self-collected high vaginal swab samples.
METHODS: A total of 151 archived self-sampled high vaginal swabs from the Sarawak Urban and Rural Action for Cervical Cancer Elimination Programme (Program SUARA) were analyzed. hrHPV detection and genotyping were performed using Anyplex, which identifies 14 hrHPV genotypes, and M10, which detects HPV16, HPV18, and other hrHPV categorized into six genogroups. Agreement between the assays was evaluated using Cohen's Kappa (κ), McNemar's test, and overall agreement percentages. Statistical significance was determined with p-values, and discordant results were further analyzed for potential diagnostic implications.
RESULTS: The overall agreement between M10 and Anyplex for hrHPV detection was 92.05% (κ = 0.84, 95% CI 0.75-0.93), indicating almost perfect agreement. M10 demonstrated comparable sensitivity for detecting HPV16, HPV18, and other hrHPV genotypes, achieving 96.91% agreement (κ = 0.89, 95%CI 0.73-1.00) in hrHPV classification when discordant results were excluded. Genogrouping also showed almost perfect agreement (κ = 0.91, 95% CI 0.82-0.98). McNemar's test indicated no significant difference in hrHPV detection rates (p > 0.05), affirming their comparable performance in detecting clinically significant hrHPV infections.
CONCLUSION: The SD Biosensor Standard™ M10 HPV POCT and the Seegene Anyplex™ II HPV HR assay demonstrated almost perfect agreement in hrHPV detection and classification, supporting their complementary roles in cervical cancer prevention. M10's rapid, field-deployable design makes it suitable for resource-limited settings, while Anyplex provides enhanced genotyping capability in laboratory environments, allowing informed vaccine strategy. Incorporating both assays into cervical cancer prevention programs can improve screening coverage and accessibility, particularly in underserved areas. These findings align with the World Health Organization's cervical cancer elimination goals, reinforcing the importance of adaptable diagnostic tools in diverse healthcare contexts.

Matched MeSH terms: Uterine Cervical Neoplasms/diagnosis; Uterine Cervical Neoplasms/prevention & control; Uterine Cervical Neoplasms/virology
Silencing E6/E7 Oncoproteins in SiHa Cells Treated with siRNAs and Oroxylum indicum Extracts Induced Apoptosis by Upregulating p53/pRb Pathways

Sisin NNT, Kong AR, Edinur HA, Jamil NIN, Che Mat NF

Appl Biochem Biotechnol, 2024 Jul;196(7):4234-4255.
PMID: 37922032 DOI: 10.1007/s12010-023-04762-w

E6 and E7 human papillomavirus (HPV) oncoproteins play a significant role in the malignant transformation of infected cervical cancer cells via suppression of tumour suppressor pathways by targeting p53 and pRb, respectively. This study aimed to investigate the anticancer effects of Oroxylum indicum (OI) leaves' methanol extract on SiHa cervical cancer cells. Expression of apoptosis-related proteins (Bcl-2, caspase (cas)-3, and cas-9), viral oncoproteins (E6 and E7), and tumour suppressor proteins (p53 and pRb) were evaluated using western blot analysis before and after E6/E7 small interfering RNAs (siRNAs) transfection. In addition, the E6/E7 mRNA expression levels were assessed with real-time (RT)-PCR. The present study showed that the OI extract effectively hindered the proliferation of SiHa cells and instigated increments of cas-3 and cas-9 expressions but decreased the Bcl-2 expressions. The OI extract inhibited E6/E7 viral oncoproteins, leading to upregulation of p53 and pRb tumour suppressor genes in SiHa cells. Additionally, combinatorial treatment of OI extract and gossypin flavonoid induced restorations of p53 and pRb. Treatment with OI extract in siRNA-transfected cells also further suppressed E6/E7 expression levels and further upregulations of p53 and pRb proteins. In conclusion, OI extract treatment on siRNAs-transfected SiHa cells can additively and effectively block E6- and E7-dependent p53 and pRb degradations. All these data suggest that OI could be explored for its chemotherapeutic potential in cervical cancer cells with HPV-integrated genomes.

Matched MeSH terms: Uterine Cervical Neoplasms/drug therapy; Uterine Cervical Neoplasms/genetics; Uterine Cervical Neoplasms/metabolism; Uterine Cervical Neoplasms/pathology

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