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The Comparison of Clinical and Surgical Staging of Cervical Cancer: A Retrospective Study on Patients at Dr. Cipto Mangunkusumo General Hospital, Jakarta, Indonesia Pradipta, Bram
Indonesian Journal of Obstetrics and Gynecology Volume. 35, No. 1, January 2011
Publisher : Indonesian Socety of Obstetrics and Gynecology

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Objective: To evaluate the accuracy of clinical examination in determining the stage of operable cervical cancer and the extent of the disease. Method: The study involved 58 subjects from outpatient, emergency unit, and ward of Department of Obstetrics and Gynecology Dr. Cipto Mangunkusumo Hospital, from January 2008 to December 2010 with a diagnosis of cervical cancer. Patients who were diagnosed with cervical cancer up to stage IIA were included and patients lost to follow-up, receiving preoperative neo-adjuvant chemotherapy, and died before getting treatment were excluded. The outcomes evaluation were postoperative clinical staging, including the presence of enlarged lymph nodes, parametrial involvement, and tumor size. Lymph nodes, parametrial, and the tumor size were assessed from the surgery and pathological anatomy results. Result: The age distribution of 58 subjects ranged from 25 to 70 years (mean 48.39 years, SD 8.82). Squamous cell carcinoma was the most frequent type (44.9%), followed by adenocarcinoma (24.1%). Errors in preoperative clinical staging compared with postoperative was 40% in stage IA1, 9.52% in stage IB1, 17.65% in stage IB2, and 7.14% in stage IIA. Sensitivity, specificity, positive predictive value, and negative predictive value for preoperative clinical examination of lymph nodes were 11.1%, 100%, 100%, and 85.96%. Sensitivity, specificity, positive predictive value, and negative predictive value for preoperative clinical examination of parametrial involvement were 37.5%, 100%, 100%, and 90.90%. Sensitivity, specificity, positive predictive value, and negative predictive value for preoperative clinical examination of the tumor size were 91.84%, 88.89%, 97.83% and 66.67%. Conclusion: Clinical examination has limitation, especially in determining lymph nodes and parametrial involvement. Other diagnostic modalities in determining the extent of the disease is necessary. Enforcement of the right diagnosis in patients with cervical cancer is needed to determine the appropriate treatment. [Indones J Obstet Gynecol 2011; 35-1: 25-9] Keywords: staging, cervical cancer, preoperative, postoperative

Effect of Smoking on Advanced Stage Cervical Cancer Patient Survival Pradipta, Bram; Andrijono, Andrijono; Fuady, Ahmad
Indonesian Journal of Obstetrics and Gynecology Volume. 3, No. 3, July 2015
Publisher : Indonesian Socety of Obstetrics and Gynecology

Objective: The researchers aim to investigate the relationship between smoking habit and other factors as prognostic factors of cervical cancer. Method: We performed a retrospective and prospective cohort study with subjects that are stage IIB-IVB cervical cancer patients in Dr. Cipto Mangunkusumo Hospital followed up from August 2009 to April 2014. The subjects’medical records were reviewed, and patients were interviewed about their current condition by telephone. Questions asked include smoking habit, spouse’s smoking habit, and mortality status. Patients that could not be contacted by phone were excluded from the study. Statistical analysis was done using Stata 10. Result: Out of 390 cervical cancer patients stage IIB-IVB in 2009, there were 270 patients (69.2%) that were included in the inclusion criteria. Most of the patients are 40-59 years old (82.2%) and are nonsmokers (91.8%). The most frequent clinicopathological characteristic is IIIB (63.3%) and squamous cell carcinoma (71.9%). The 5- year survival rate is 22.6%. There is no statistical significance between advanced stage cervical cancer survival with the patients’ or patients’ husbands’ smoking habit. Conclusion: In our study, smoking habits do not aggravate survival rate of advanced stage cervical cancer patients but further research must be done with more sample. Stage, and tumor size both by physical examination and ultrasound can be used as the prognostic factor. [Indones J Obstet Gynecol 2015; 3: 170-176] Keywords: Brigmann Index, cervical cancer, smoking, survival

Uterine Perforation on Invasive Hydatidiform Mole during EMACO Treatment Pradipta, Bram
Indonesian Journal of Obstetrics and Gynecology Volume. 2, No. 3, July 2014
Publisher : Indonesian Socety of Obstetrics and Gynecology

Objective: Improving skill and knowledge to recognize and manage a rare case of uterine perforation on invasive hydatidiform mole. Method: Case report. Result: A 42 years old Indonesian woman, Parity 2 Abortus 2 with history of 2 c-sections and 2 curettage, came with chief complaint of recurrent vaginal bleeding since 4 months before admission. Patient had a history of previous curettage with indication of hydatidiform mole and recurrent bleeding with no histopathology results. On examination we found a vesicular mass with infiltration, destroying the right-front uterine corpus, size 8x6 cm with an internal echo mass. Chest x-ray showed multiple nodules in the lung. The patient, considered as low risk Gestational Trophoblastic Neoplasia patient with FIGO Score of 6, underwent chemotherapy with 2 series of methotrexate . Due to the non-declining level of -hCG, the regimen was added with EMACO. In the process of chemotherapy, the pa-tient’s-hCG declined but then she complained of major abdominal pain. Exploratory laparotomy was performed and we found a mass sized 5x5x5 cm on the right side of the uterus at the broad ligament with a rupture at the posterior part of the mass sized 0.5x0.5 cm. Upon incision of the uterus, we found a mass from the right side protruding to the isthmus of the uterus. Histopathology showed necrosis, blood and chorionic villi in myometrium corresponding to invasive mole. Patient was then given another 5 series of EMACO and her condition was unremarkable during the remaining course of treatment. Conclusion: Invasive mole treatment is determined based on the risk factors. Uterine perforation still occurred in this case regardless of the decreasing hCG level during EMACO treatment. It emphasizes the importance of clinical examination as chemotherapy responsiveness. Long-term treatment can have a good prognosis but good collaboration between the gynecologist and the patient is essential. [Indones J Obstet Gynecol 2014; 3: 162-165] Keywords: EMACO, invasive mole, perforation

Uterine Perforation on Invasive Hydatidiform Mole during EMACO Treatment Pradipta, Bram
Indonesian Journal of Obstetrics and Gynecology Volume. 2, No. 3, July 2014
Publisher : Indonesian Socety of Obstetrics and Gynecology

Objective: Improving skill and knowledge to recognize and manage a rare case of uterine perforation on invasive hydatidiform mole. Method: Case report. Result: A 42 years old Indonesian woman, Parity 2 Abortus 2 with history of 2 c-sections and 2 curettage, came with chief complaint of recurrent vaginal bleeding since 4 months before admission. Patient had a history of previous curettage with indication of hydatidiform mole and recurrent bleeding with no histopathology results. On examination we found a vesicular mass with infiltration, destroying the right-front uterine corpus, size 8x6 cm with an internal echo mass. Chest x-ray showed multiple nodules in the lung. The patient, considered as low risk Gestational Trophoblastic Neoplasia patient with FIGO Score of 6, underwent chemotherapy with 2 series of methotrexate . Due to the non-declining level of -hCG, the regimen was added with EMACO. In the process of chemotherapy, the pa-tient’s-hCG declined but then she complained of major abdominal pain. Exploratory laparotomy was performed and we found a mass sized 5x5x5 cm on the right side of the uterus at the broad ligament with a rupture at the posterior part of the mass sized 0.5x0.5 cm. Upon incision of the uterus, we found a mass from the right side protruding to the isthmus of the uterus. Histopathology showed necrosis, blood and chorionic villi in myometrium corresponding to invasive mole. Patient was then given another 5 series of EMACO and her condition was unremarkable during the remaining course of treatment. Conclusion: Invasive mole treatment is determined based on the risk factors. Uterine perforation still occurred in this case regardless of the decreasing hCG level during EMACO treatment. It emphasizes the importance of clinical examination as chemotherapy responsiveness. Long-term treatment can have a good prognosis but good collaboration between the gynecologist and the patient is essential. [Indones J Obstet Gynecol 2014; 3: 162-165] Keywords: EMACO, invasive mole, perforation

Effect of Smoking on Advanced Stage Cervical Cancer Patient Survival Pradipta, Bram; Andrijono, Andrijono; Fuady, Ahmad
Indonesian Journal of Obstetrics and Gynecology Volume. 3, No. 3, July 2015
Publisher : Indonesian Socety of Obstetrics and Gynecology

Objective: The researchers aim to investigate the relationship between smoking habit and other factors as prognostic factors of cervical cancer. Method: We performed a retrospective and prospective cohort study with subjects that are stage IIB-IVB cervical cancer patients in Dr. Cipto Mangunkusumo Hospital followed up from August 2009 to April 2014. The subjects’medical records were reviewed, and patients were interviewed about their current condition by telephone. Questions asked include smoking habit, spouse’s smoking habit, and mortality status. Patients that could not be contacted by phone were excluded from the study. Statistical analysis was done using Stata 10. Result: Out of 390 cervical cancer patients stage IIB-IVB in 2009, there were 270 patients (69.2%) that were included in the inclusion criteria. Most of the patients are 40-59 years old (82.2%) and are nonsmokers (91.8%). The most frequent clinicopathological characteristic is IIIB (63.3%) and squamous cell carcinoma (71.9%). The 5- year survival rate is 22.6%. There is no statistical significance between advanced stage cervical cancer survival with the patients’ or patients’ husbands’ smoking habit. Conclusion: In our study, smoking habits do not aggravate survival rate of advanced stage cervical cancer patients but further research must be done with more sample. Stage, and tumor size both by physical examination and ultrasound can be used as the prognostic factor. [Indones J Obstet Gynecol 2015; 3: 170-176] Keywords: Brigmann Index, cervical cancer, smoking, survival

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