Duangmani Thanapprapasr

Knowledge of Pap smear HPV and the HPV vaccine and the acceptability of the HPV vaccine by Thai women.

Aims:u2003 The primary prevention for cervical cancer, a human papilloma virus (HPV) vaccine, has been available in Thailand for almost 3u2003years. The present study evaluates knowledge about the Papanicolaou (Pap) smear, HPV and the HPV vaccine and focuses on identifying predictors for the acceptability of the HPV vaccine.

Molecular therapy as a future strategy in endometrial cancer.

Of all gynecologic cancers, endometrial cancer is the most common cancer in the US and Europe. In addition, it is presently the second most common gynecologic cancer in the world. As a result of increasing menopausal, obese and tamoxifen use women, the incidence of the cancer seems to be on the increase. Surgery is the major treatment, whereas postoperative radiation therapy in high-intermediate risk patients many prevent locoregional recurrence. Adjuvant chemotherapy can improve progression free survival in advanced or recurrent cancers. Molecular targeted therapies are now a focus of attention including anti-vascular endothelial growth factor (VEGF), mammalian target of rapamycin (mTOR) inhibitor and tyrosine kinase inhibitor (TKI). They may provide useful future strategies for control of endometrial malignancies in developing countries and across the world.

Age and Survival of Cervical Cancer Patients with Bone Metastasis

BACKGROUNDnTo determine survival times of cervical cancer patients with bone metastasis related to the effect of age at the time of cervical cancer diagnosis, we performed the retrospectively analytical study.nnnMETHODSnA total of 68 cervical cancer patients with bone metastasis were treated at a single hospital, during January 1998 to December 2010. Fifty-two medical records were identified and collected, the remaining sixteen medical records were not found. Main outcome measures were patient characteristics, clinical information, duration from cervical cancer diagnosis to bone metastasis diagnosis, survival time after bone metastasis and overall survival time.nnnRESULTSnAmong fifty-two cervical cancer patients with bone metastasis, there were 13 patients who were less than 45 years old, and 39 patients were 45 years old or more at the time of cervical cancer diagnosis. The younger group had less median overall survival than the older group, with a statistically significant difference (21 months, 95% CI 19.93-22.06; 34 months, 95% CI 23.27-44.72, p = 0.021). However, they were comparable in the duration from cervical cancer diagnosis to bone metastasis diagnosis and the survival time after bone metastasis.nnnCONCLUSIONnYoung patients with bone metastasis aged less than 45 years old at the time of cervical cancer diagnosis have a poorer prognosis than the elderly patients.nnnIMPACTnTo improve survival and quality of life, more intensive and novel multimodal treatments at the time of cervical cancer diagnosis should be considered in patients less than forty-five years, who can tolerate the side effects better.

Cervical cancer screening behaviours among Thai women: results from a cross-sectional survey of 2112 healthcare providers at Ramathibodi Hospital, Thailand.

UNLABELLEDnThis study compares factors and reasons related to female healthcare providers behaviours on their cervical cancer screening using an analytic cross-sectional hospital-based study. A total of 2112 female healthcare providers in Ramathibodi hospital who do not have any cancer and were willing to participate in the study completed written consent and an anonymous questionnaire. We measured characteristics, medical history, life behaviour factors and reasons related to their cervical cancer screening behaviours.nnnRESULTSnFive hundred of the 1365 responders (36.6%) have had at least one Pap test, meanwhile 848 responders (62.1%) have never had a Pap test and the remaining 17 responders (1.3%) did not complete answers. Between the two groups of responders who have had at least one Pap test and never had theirs Pap tests, their ages, careers and marital status influenced their cervical screening behaviours. Most of the reasons to refrain from their tests were their thoughtfulness of having no risks (27.1%), unnecessary (18.5%) and feeling shy (15.3%). In conclusion, the female hospital-based healthcare providers should have more intensive cervical cancer screening behaviours even though having no risks. Their demographic characteristics, medical history and life behaviours influenced their decisions. Their thoughtfulness of no risks, unnecessary and feeling shy overcomes their cervical screening behaviours.

Can Vaginal Misoprostol Effectively Increase Rate of a Satisfactory Colposcopy? A Randomized Double-blind Placebo-controlled Trial

OBJECTIVEnTo evaluate the effectiveness of vaginal misoprostol in overcoming an unsatisfactory colposcopy in the patients who had abnormal cervical cytology and to evaluate side effects of vaginal misoprostol.nnnMETHODSnSixty patients with an unsatisfactory colposcopy during the period of September 2007-November 2008 were recruited and randomly allocated to receive either two tablets of 200 microg misoprostol (400 microg) or two tablets of similar-looking placebo vaginally. Colposcopic re-examination was performed approximately 6 h later. The results and side effects before and 2 weeks after the colposcopic re-examination were recorded.nnnRESULTSnSix out of 30 patients in the misoprostol group (20.0%) had a satisfactory colposcopic re-examination compared with 2 out of 27 patients (7.4%) in the placebo group without statistically significant difference (P = 0.172). Three patients in the placebo group dropped out due to not present at the appointment time. Six out of 30 patients (20.0%) and 1 out of 30 patients (3.3%) in the misoprostol group had side effects before and 2 weeks after the colposcopic re-examination orderly. Twenty-seven patients in the placebo group did not have any side effects before and 2 weeks after the colposcopic re-examination. All side effects occurred were minimal and well tolerated.nnnCONCLUSIONSnFour hundred micrograms of vaginal misoprostol were not proved to be effective in converting an unsatisfactory to a satisfactory colposcopy.

pFAK-Y397 overexpression as both a prognostic and a predictive biomarker for patients with metastatic osteosarcoma

Focal adhesion kinase (FAK) is important for tumor cell survival and metastasis in various cancers. However, its expression and prognostic value in patients with metastatic osteosarcoma remain unknown. We investigated the expression of FAK and its phosphorylated form (pFAK-Y397) in osteosarcoma tissues from 53 patients by immunohistochemistry and evaluated their correlations with clinicopathologic characteristics and outcomes. The prognostic values were assessed using Kaplan-Meier survival and Cox regression analyses. Total FAK and pFAK-Y397 were overexpressed in 48 (90.6%) and 33 (62.3%) cases, respectively. pFAK-Y397 overexpression was correlated with poor histologic response after neoadjuvant chemotherapy in patients with osteosarcoma regardless of the presence of metastasis or not. Kaplan-Meier curve showed that patients with metastatic osteosarcoma with pFAK-Y397 overexpression had significantly worse overall survival (OS) than those with non-overexpression (P = 0.044). Multivariate Cox regression analysis confirmed pFAK-Y397 overexpression as an independent prognostic predictor for OS and post metastases OS (PMOS) (P = 0.017, P = 0.006, respectively). Age at diagnosis was also an independent indicator for PMOS (P = 0.003). However, total FAK expression was not correlated with any clinicopathologic characteristics or OS in patients with metastatic osteosarcoma. In conclusion, our findings identified FAK as a common aberrant protein overexpression in various subtypes of osteosarcoma. pFAK-Y397 overexpression can be used as a prognostic biomarker predicting poor OS for patients with metastatic osteosarcoma, and the expression of pFAK-Y397 differentiated good and poor responders to neoadjuvant chemotherapy.

Screening for Ovarian Cancer in Women

Of all the gynecologic cancers, ovarian malignancy represents the greatest clinical challenge because it is difficult for early detection, difficult to cure, and it has the highest fatality to case ratio of all the gynecologic malignancies. Many studies have been tried to find a novel strategy on early detection of ovarian cancer. Ultimately, successful screening in asymptomatic women could increase cure rate and prolong survival among patients who have to live with ovarian cancer.