Background: Vitamin D and its receptor (VDR) play a crucial role in the development of gynecological cancers. This study aims to evaluate the VDR expression and blood vitamin D 1.25 (OH)2 levels in cervical cancer patients and healthy women.Methods: This is a cross-sectional study. In vitro quantitative examination (ELISA) was used for the measurement of vitamin D 1.25 (OH)2 and Sandwich-ELISA was applied for quantitative determination in vitro concentration of Human VDR in serum.Results: The number of research subjects consisting of 20 cervical cancer patients based on clinical and histopathological results and 20 women without cervical cancer based on clinical and pap smear results. The mean vitamin D 1.25 (OH)2 levels in the cervical cancer group of 209.23 ± 71.476 pg/mL were significantly lower than in the group of normal women of 339.79 ± 139.003 pg/mL (P=.001). The mean VDR expression in the cervical cancer group of 5.38 ± 5.478 ng/mL was significantly higher than the group of normal women of 1.89 ± 1.657 ng/mL (P=.018). The best cut-off value for vitamin D levels is 239.25 pg/mL (sensitivity 70% and specificity 75%). The cut-off value for VDR expression is 2.23 ng/mL (sensitivity 60% and specificity 75%). Low vitamin D levels increase the risk of cervical cancer incidence by 2.7 times greater, and an increase in VDR expression increases the risk of cervical cancer incidence 2 times greater.Conclusions: The study results indicated a higher expression of VDR and lower levels of vitamin D 1.25 (OH)2 in cervical cancer compared to normal women. Low levels of vitamin D increase the risk of cervical cancer incidence by 2.7 times greater, and higher VDR expression increases the risk of cervical cancer incidence 2 times greater.
Tujuan: memahami modalitas terapi terhadap lesi prakanker serta keuntungan dan kerugiannya. Tujuh puluh persen kanker serviks di Indonesia ditemukan dalam stadium lanjut. Salah satu faktor yang menunjang keberhasilan pengelolaan kanker serviks adalah usaha penemuan stadium prakanker dan stadium dini serta bagaimana pengelolaannya. Penemuan dan pengelolaan yang tepat pada stadium dini akan memberikan hasil penyembuhan antara 66,3% - 95,1%. Sedangkan jika pengelolaan pada stadium lanjut akan memberikan hasil yang kurang baik, di samping biaya yang cukup tinggi.1,2Lesi prakanker serviks yang sangat dini dikenal dengan neoplasia intraepitelial serviks atau NIS, yang ditandai dengan adanya perubahan displastik epitel serviks. Sampai saat ini, pemeriksaan sitologi dengan test Pap masih merupakan pemeriksaan standar untuk deteksi dini keganasan serviks. Sejak 1985, WHO merekomendasikan suatu pendekatan alternatif bagi negara yang sedang berkembang dalam deteksi dini kanker serviks dengan konsep inspeksi visual dengan asam asetat (IVA).3Terminologi NIS dibagi menjadi 3. NIS 1 sesuai dengan displasia ringan, NIS 2 sesuai dengan displasia sedang, dan NIS 3 meliputi displasia berat serta karsinoma insitu. Terminologi ini juga dikonfirmasikan dengan sistem Bethesda, yaitu NIS 1 dan infeksi HPV sebagai lesi intraepitelial skuamosa derajat rendah (LISDR) serta NIS 2 dan NIS 3 sebagai lesi intraepitelial skuamosa derajat tinggi (LISDT). Karena tidak dapat diketahui risiko untuk menjadi progresif dari semua tingkatan lesi prekursor maka semua lesi NIS sebaiknya diobati. Berdasarkan perjalanan alamiah dari NIS, disimpulkan bahwa makin rendah derajat kelainan maka makin besar kemungkinan regresi menjadi normal. Sebaliknya, makin berat derajat kelainan maka makin besar kemungkinan menjadi lesi yang lebih berat.Modalitas yang dimiliki dalam penatalaksanaan lesi prakanker cukup banyak, biasanya dibagi dalam 2 golongan, yaitu destruksi dan eksisi. Pada tindakan destruksi, kita tidak dapat memiliki bahan untuk melakukan pemeriksaan histopatologi, sedangkan pada eksisi kita sekaligus dapat memiliki bahan untuk melakukan pemeriksaan histopatologi. Laser ablation, kauterisasi, serta krioterapi merupakan terapi destruksi yang biasa digunakan untuk displasia ringan. Sebenarnya, kauterisasi atau krioterapi masih punya tempat untuk displasia sedang keras. Sedangkan LEEP, LLETZ, konisasi dengan cold knife atau laser, serta histerektomi merupakan tindakan eksisi yang biasanya digunakan untuk displasia sedang - keras.Pemilihan terapi harus dipertimbangkan secara hati-hati dalam melihat efektivitas terapi serta efek samping. Keberhasilan destruksi lokal dalam pengelolaan lesi prakanker mencapai 95%. Ini berarti, ada faktor 5% kegagalan pengelolaan dengan destruksi lokal ini. Oleh sebab itu, sebagai operator harus teliti dalam mengelola lesi prakanker.Kesimpulan: pengelolaan lesi prakanker dengan destruksi lokal mencapai 95%. Penggunaan metode destruksi lokal sebagai salah satu manajemen lesi prakanker dapat menghindari terjadinya terapi yang berlebihan (over treatment). Tetapi, peningkatan kemampuan dalam menggunakan metode ini sangat diperlukan, di samping pengamatan lanjut yang adekuat.Kata kunci: terapi, lesi, prakanker, serviks
Introductions: Epithelial ovarian cancer accounts for 90% of all ovarian malignancies. More than 70% of patients will experience a relapse even after receiving operative therapy and chemotherapy. There are several prognostic factors that influence the recurrence of ovarian cancer. In Indonesia, especially at Dr. Kariadi Hospital, Semarang, the data as mentioned above is still very limited.objective: Knowing the disease-free survival rate, optimizing surgery and factors related to the incidence of recurrence in epithelial ovarian cancer patients at Dr. Kariadi Hospital SemarangMethods: This study is a retrospective cohort study with survival analysis. Data were collected through medical records, with the study population are patients with a diagnosis of epithelial ovarian cancer who were treated at Dr. Kariadi Hospital Semarang in period January 2018-December 2019. Furthermore, patients who had been remission were observed for signs of disease recurrence for 2 years period.Results: There were 361 patients with epithelial ovarian cancer who underwent primary treatment at Dr. Kariadi Hospital, Semarang in 2018-2019. Furthermore, there were observations of recurrence in 148 patients who achieved remission. Of these 76 patients (51.4%) experienced recurrence, while 72 patients not relapse. From 148 epithelial ovarian cancer patients who underwent cytoreduction surgery at Dr. Kariadi Hospital, Semarang, 113 patients (76.4%) achieved optimal operation with a residu less than 2 cm, while 35 patients (23.6%) were not optimal with a residu more than 2 cm. FIGO stage (HR 2.44) and tumor residu (HR 2.15) were shown to be significant factors associated with the recurrence of epithelial ovarian cancer.Conclusion: Overall disease-free survival in epithelial ovarian cancer at Dr. Kariadi Semarang were 74.8% (6 months), 57.1% (1 year), 42.5% (18 months), and 37.4% (2 years). Tumor residual factors and FIGO stage were shown to be significant prognostic factors influencing the recurrence of epithelial ovarian cancer.
Introduction: Extrauterine metastases often occur in patients with advanced stages of endometrial carcinoma. Retroperitoneal lymph nodes and pelvic lymph nodes are the most common metastatic sites for endometrial carcinoma, while distant metastases, including those to the lung, liver, and brain, are uncommon. This study compares the characteristics of endometrial carcinoma with or without extrauterine metastases and evaluates risk factors associated with extrauterine metastases. Methods: A retrospective analytical study of 155 women with a history of endometrial cancer following complete surgical staging treatment from January 2017 to December 2021 at Dr. Kariadi General Hospital Semarang. All data were obtained using medical records. The clinical and pathological characteristics were compared using the Unpaired T-test and Chi-Square test. Multivariate logistic models were performed to estimate the odds ratio (OR) and 95% CI to analyze independent risk factors for extrauterine metastases. Results A total of 155 endometrial cancer patients were included in this study. Of these, 77 patients have extrauterine metastases (49.67%). The most common site for extrauterine metastases is ovarian metastases (26.5%). Using univariable and bivariate analysis, tumor differentiation grading (OR=3.69, p=0.027) and myometrial invasion (OR=2.84, p=0.027) were the two risk factors associated with extrauterine metastases. Conclusion: There were significant differences in clinicopathological characteristics between the two groups with and without extrauterine metastases. Tumor differentiation grading and myometrial invasion were two independent risk factors.
Introduction: Lymph node metastasis is considered one of the most significant prognostic markers in endometrial cancer, particularly in the initial stages. As the incidence rate of endometrial cancer increases, appropriate treatment is needed to increase the survival rate, including lymphadenectomy. This study aims to compare the characteristics of endometrial cancer with or without lymph node metastasis. Methods: A retrospective analytical study of 155 women with a history of endometrial cancer following complete surgical staging treatment from January 2017 to December 2021 at Dr. Kariadi General Hospital Semarang. All data were obtained using medical records. Results: All 155 patients were divided into two groups, with and without lymph node metastasis. Of these, 19 patients have lymph node metastasis (12.25%). The body mass index is the only subject characteristic that is statistically significant between the two groups (p=0.024). In our multivariable risk analysis, three clinical variables were identified that might predict the probability of lymph node metastasis, including ovarian metastasis (OR=2.98, p<0.01) and cervical metastasis (OR=8.27, p=0.002), and tumor differentiation grading (OR=6,77, p<0,01). Conclusion: The study results indicated ovarian metastasis, cervical metastasis, and tumor differentiation grading were independent prognostic factors for lymph node metastasis.
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