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Abstract: Objective: To evaluate how ovarian recurrences were first detected and the relative role of Ca 125, symptom enquiry and physical examination in recurrence detection. Methods: In this retrospective study, records from women with ovarian cancer recurrences diagnosed between 1999 and 2004 were reviewed to determine how the recurrences were first detected. Women were routinely followed up by a combination of symptom enquiry, physical examination and Ca 125. When recurrence was suspected, further investigations such as imaging and biopsy of the suspected recurrence would be arranged to confirm the diagnosis. The patients were followed up for a median of 53.5 months. Results: Eighty patients were identified to have ovarian cancer recurrences, with median time to recurrence of 12 months. Although 41 (51%) had abnormal physical findings, only three (3.8%) first presented with physical findings and none had positive physical findings alone. Ca 125 taken at the clinic visits in these 3 patients when the signs were detected turned out to be raised. For the remaining 77 patients, 49 (61%) and 28 (35%) first presented with raised Ca 125 level and symptoms respectively. The median survival from the time of recurrence for those first presented with Ca 125, symptoms and physical findings were 25 months, 17 months and 11 months respectively. Conclusion: Routine physical examination had a very limited additional role and could be possibly omitted as part of the routine follow up strategy. [Copyright &y& Elsevier]

Abstract: Background: Intrinsic radiosensitivity using the clonogenic assay and the cell surviving fraction at 2 Gy (SF2) has been shown to be an independent prognostic factor for patient response to radiotherapy in carcinoma of the cervix. The clonogenic assay has significant shortcomings, making it unsuitable for routine clinical use. The ATP cell viability assay (ATP-CVA) has been shown to have a high tumor evaluability rate, technical simplicity, and reproducibility in chemosensitivity testing. Aims: This study compares the ATP-CVA with the clonogenic assay in the in vitro radiosensitivity testing of cervical cancer cell lines. Correlation of in vitro radiosensitivity and in vivo patient response was also determined. Methods: Five cervical carcinoma cell lines (SiHa, HeLa, Caski, C-33A, and C4-1) were tested using the ATP-CVA and the clonogenic assay. Survival curves were plotted and the mean SF2 values obtained by the two different assay methods were compared using ANOVA to see if there were significant differences. Mean SF2 values obtained from 27 cervical cancers were compared with clinical outcomes. Results: The SF2 values for the cell lines ranged from 0.28 to 0.67 when tested using the ATP-CVA. Using the clonogenic assay, the SF2 values ranged from 0.27 to 0.70. ANOVA with Bonferroni pairwise multiple comparison showed no significant difference between the mean SF2 values for the individual cell lines between the two assay methods. Twenty-three cervical cancer samples (85%) were evaluable for SF2 using ATP-CVA. The mean SF2 values of patients who had locoregional failure were significantly higher than those who achieved local control (P < 0.01). Conclusions: Testing intrinsic radiosensitivity using the surviving fraction at 2 Gy (SF2) is comparable using the two assay methods of ATP-CVA and clonogenic assay. The ATP-CVA should be further investigated in the testing of intrinsic radiosensitivity in patients with cervical cancer. [Copyright &y& Elsevier]

To investigate the effects of precolposcopy counseling on women''s anxiety, knowledge about colposcopy and compliance to follow-up.Two hundred and twenty women referred for colposcopy for the first time were recruited. They attended precolposcopy sessions in which written and video information were given and subsequently were randomized to have either further explanation and discussion with an experienced colposcopic nurse (study group) or no further discussion (control group). Each subject completed a Chinese version of the state–anxiety questionnaire (STAI) and a knowledge questionnaire before and immediately after the precolposcopy sessions and also before the colposcopy examination. Women''s concern and opinion on the programme were also assessed. Follow-up data was compared with those who did not attend the precolposcopy sessions.Women''s knowledge about colposcopy significantly improved after the precolposcopy sessions. The improvement was more significant in the study group than in the control group immediately after the sessions (P = 0.003). The difference between the groups in knowledge scores remained statistically significant before colposcopic examination (P = 0.015) but the difference diminished between these two assessment points. There was no statistically significant difference between the two groups in the anxiety scores at all assessment points. Women who attended the precolposcopy sessions had a significantly higher attendance rates and better compliance to follow-up than those who did not attend the sessions.Precolposcopy session with explanation and discussion improves women''s knowledge about colposcopy, but has negligible effects on women''s anxiety before colposcopy. Provision of written and video information at the precolposcopy sessions can improve compliance to follow-up after colposcopy. [Copyright &y& Elsevier]

Objective. The aim of this study is to investigate the prevalence of promotor CpG island methylation of the death-associated protein kinase (DAPK), p16, and O6-methylguanine-DNA methyltransferase (MGMT) genes in both tumor and plasma samples of cervical cancers.Methods. Methylation-specific PCR (MSP) was employed to detect promotor CpG island methylation of the DAPK, p16, and MGMT genes in 85 surgical tumor tissue samples and 40 pretreatment plasma samples from cervical cancers.Results. Promotor CpG island methylation of DAPK, p16, and MGMT was detectable, respectively, in 60%, 28.2%, and 18.8% of cases of cervical tumor DNA; and in 40%, 10%, and 7.5% of cases of patients'' plasma DNA. Moreover, at least one of the three methylated genes was detected in 75.3% (64/85) of cases of tumor and in 55% (22/40) of cases of plasma. Higher prevalence of methylation of DAPK was found in squamous cell carcinoma than in adenocarcinoma in both univariate and multivariate analysis. Methylation of p16 was significantly associated with that of MGMT in both univariate and multivariate analysis. The methylation pattern in primary tumor and plasma was found to be concordant in 23 patients with matched tissue and plasma samples. In cases positive for DAPK and p16 methylation in tumor, detection in the paired plasma sample was 64.3% (9/14) and 33.3% (3/9), respectively.Conclusions. Promotor CpG island methylation is a frequent event in cervical carcinogenesis. Detection of the methylated sequences in the circulation suggests that plasma DNA methylation warrants further study to determine its potential role in cancer management. [Copyright &y& Elsevier]