SHORT RUNNING HEAD Breast cancer survival in different age group CONFLICTS OF INTEREST OF ALL LISTED AUTHORSKing Fang Tan: The author has no conflicts of interest to declare for this study.

Cervical cancer, along with breast, colorectal, and lung cancer, has become increasingly problematic in Malaysia. The prevalence of cervical cancer in Malaysia is projected to rise in younger women, and Malaysia views this prediction with concern and awareness of the need to take action to prevent the illness among those who are currently healthy. Providing free HPV vaccination is a way to lower the risk of developing cervical cancer among women in Malaysia. However, while Malaysia has been able to provide this vaccination at minimal or no cost, changes in socio-economic circumstances have stretched the demand. This review aims to highlight the probability of HPV vaccination acceptance and the reasons for it. An extensive literature review of acceptance, knowledge, attitude, practice, and decision making about HPV vaccination was performed to describe issues related to vaccination. The evidence presented herein can help identify ways to improve the HPV vaccination program in Malaysia.

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Decision of relaparotomy is usually become a surgical dilemma as one may encounter dense adhesion before reaching the target site. This may end up with unwanted complication such as iatrogenic injury to adjacent structures as well as bleeding. This is a case of a 46-year-old lady with underlying history of ovarian carcinoma who needed to go for relaparotomy and debulking of recurrent tumour. The attempt to release adhesions was complicated with bleeding at presacral venous plexus. Due to difficulty in achieving haemostasis, bilateral internal iliac artery ligation was done. This procedure did not completely solve the bleeding, so the subsequent step to apply thumbtacks and roller gauze packing were done to create tamponade. The gauzes were removed piece by piece starting from day 8 through small incisional wound without needing to go for another laparotomy.

The practice of brachytherapy in unresectable tongue carcinoma is gaining popularity. However, this procedure poses specific anesthetic challenges, particularly challenges of airway sharing and a higher rate of difficult airway. We report a 74-year-old chronic smoker, chronic alcoholic with history of stroke, who had undergone brachytherapy for tongue carcinoma. Apart from a huge tongue tumor, he had an epiglottic mass but refused elective tracheostomy. This had led to a few critical states throughout the process of treatment, including a metabolic crisis due to thiamine deficiency and difficult airway crisis. To our best knowledge, there have been no reported case on a patient with vocal cord mass undergoing tongue brachytherapy. We hope sharing of this experience may aid the management of similar patients in future.