Fatigue and quality of life in women treated for various types of gynaecological cancers: a cross-sectional study

Aims and objectives

To examine the prevalence of cancer-related fatigue in women treated for various types of gynaecological cancers and, for these cancers, to assess fatigue in relation to distress, health-related quality of life, demography and treatment characteristics.

Background

Advances in treatment of cancer have improved the likelihood of survival. Consequently, there are a growing number of patients who become survivors after cancer and who face side effects even years after treatment. One of the most frequently reported side effects across all types and stages of the disease is cancer-related fatigue.

Design

A descriptive cross-sectional study.

Methods

One hundred and twenty women treated for gynaecological cancers who were participants in an intervention study were included. Fatigue, psychological distress, health-related QoL and demographics were assessed by questionnaires. Disease and treatment characteristics were extracted from medical records.

Results

Cancer-related fatigue was reported in 53% of the women treated for gynaecological cancers, with a higher proportion in the group of cervical cancer, followed by ovarian cancer. Younger participants reported fatigue more frequently than older participants. When adjusting for age, the type of cancer a woman experiences was shown to have little impact on her risk of experiencing fatigue. The participants with fatigue reported higher levels of anxiety and depression than participants without fatigue. There was a relationship between fatigue and quality of life as measured by SF-36 domains.

Conclusion

The findings underscore the importance of screening for fatigue, patient education and symptom management. This should be included in a standard procedure during treatment and follow-up. Both somatic and psychological aspects of fatigue should be emphasised.

Relevance to clinical practice

The findings imply the need for health personnel to have focus on fatigue during the entire cancer trajectory of women after gynaecological cancers, as well as the need for screening, information, guidance and symptom management.

Antibody-based immunotherapy for ovarian cancer: where are we at?

Cytoreductive surgery and chemotherapy continue to be the mainstay of ovarian cancer treatment. However, as mortality from advanced ovarian cancer remains very high, novel therapies are required to be integrated into existing treatment regimens. Immunotherapy represents an alternative and rational therapeutic approach for ovarian cancer based on a body of evidence supporting a protective role of the immune system against these cancers, and on the clinical success of immunotherapy in other malignancies. Whether or not immunotherapy will have a role in the future management of ovarian cancer is too early to tell, but research in this field is active. This review will discuss recent clinical developments of selected immunotherapies for ovarian cancer which fulfil the following criteria: (i) they are antibody-based, (ii) target a distinct immunological pathway, and (iii) have reached the clinical trial stage. Specifically, the focus is on Catumaxomab (anti-EpCAM×anti-CD3), Abagovomab, Oregovomab (anti-CA125), Daclizumab (anti-CD25), Ipilimumab (anti-CTLA-4), and MXD-1105 (anti-PD-L1). Catumaxomab has reached phase III clinical trials and exhibits promise with reports, showing that it can cause a significant and sustained reduction in ascites. Phase I-III clinical trials continue to be conducted on the other antibodies, some of which have had encouraging reports. We will also provide our perspective on the future of immunotherapy for ovarian cancer, and how it may be best employed in treatment regimens.

Marine compounds selectively induce apoptosis in female reproductive cancer cells but not in primary-derived human reproductive granulosa cells

Anticancer properties of tyrindoleninone and 6-bromoisatin from Dicathais orbita were tested against physiologically normal primary human granulosa cells (HGC) and reproductive cancer cell lines. Tyrindoleninone reduced cancer cell viability with IC₅₀ values of 39 µM (KGN; a tumour-derived granulosa cell line), 39 μM (JAr), and 156 μM (OVCAR-3), compared to 3516 μM in HGC. Apoptosis in HGC's occurred after 4 h at 391 µM tyrindoleninone compared to 20 µM in KGN cells. Differences in apoptosis between HGC and KGN cells were confirmed by TUNEL, with 66 and 31% apoptotic nuclei at 4 h in KGN and HGC, respectively. These marine compounds therefore have potential for development as treatments for female reproductive cancers.

Associated risk factors of lower limb lymphedema after treatment of cervical and endometrial cancer

The scope of the study was to identify the associated risk factors of lower limb lymphedema development in cervical and endometrial cancer patients. We retrospectively analysed 326 patients: 186 cases (57.06%) with cervical cancer and 140 cases (42.94%) with endometrial cancer were treated in Surgery, Radiotherapy, Oncology and Gynaecology Clinics of 'St. Apostle Andrew' Emergency Clinical Hospital Galati over 9 years. Adjuvant radiotherapy was performed in 83.57% of endometrial cancer cases. Adjuvant chemotherapy was performed in 45.16% of cervical cancer cases. Over 10 lymph nodes were removed in 74.73% of cervical cancer patients. Incidence of lymphedema was 15.05% in cervical cancer patients and 10% in endometrial cancer patients, P=0.06. Analysed risk factors for lower limb lymphedema occurrence were: Age, disease stage, radiotherapy, number of invaded lymph nodes (for cervical cancer patients), number of removed lymph nodes (for cervical cancer patients) and obesity. Multivariate analysis for associated risk factors of lower limb lymphedema development in cervical cancer showed that number of removed lymph nodes, OR=2.109 (0.907-4.903), P<0.0001, number of lymph nodes with metastasis, OR=1.903 (0.253-4.332), P=0.004 and obesity, OR=1.713 (0.226-2.967), P=0.006 were found as statistically significant risk factors for lower limb lymphedema onset. For endometrial cancer patients, obesity, OR=1.518 (0.721-2.75), P=0.0003, was the only associated risk factor with statistical significance for the lower limb lymphedema development. Lower limb lymphedema represents one of the adverse reactions of multimodal treatment in gynaecological cancers which affects patient's quality of life. Lower limb lymphedema occurrence is related with number of risk factors, the most important being removed lymph nodes, obesity and radiotherapy.

New Insights into Hormonal Therapies in Uterine Sarcomas

Uterine sarcoma (US) is a rare mesenchymal malignant cancer type, accounting for 3-7% of uterine malignancies. US prognosis is still poor due to high local and distant recurrence rates. As for molecular features, US may present variable oestrogen receptor (ER) and progesterone receptor (PR) expressions, mostly depending on histotype and grading. Surgery represents the mainstay of treatment for early-stage disease, while the role of adjuvant chemotherapy or local radiotherapy is still debated and defined on the basis of histotype, tumour grading and stage. In metastatic setting, uterine sarcomas' treatment includes palliative surgery, a metastases resection, chemotherapy, hormonal therapy and targeted therapy. As for the chemotherapy regimen used, drugs that are considered most effective are doxorubicin (combined with ifosfamide or alone), gemcitabine combined with docetaxel and, more recently, trabectedin or pazopanib. Hormonal therapies, including aromatase inhibitors (AIs), progestins and gonadotropin-releasing hormone analogues (GnRH-a) may also represent an effective option, in particular for low-grade endometrial stromal sarcoma (LGESS), due to their favourable toxicity profile and patients' compliance, while their role is still under investigation in uterine leiomyosarcoma (uLMS), high-grade endometrial stromal sarcoma (HGESS), undifferentiated uterine sarcoma (USS) and other rarer US. The present review aims to analyse the existing evidence and future perspectives on hormonal therapies in US, in order to clarify their potential role in daily clinical practice.

Post-translational regulation of the cleaved fragment of Par-4 in ovarian and endometrial cancer cells

We recently reported the caspase3-dependent cleavage of Par-4 resulting in the accumulation of a 25kDa cleaved-Par-4 (cl-Par-4) fragment and we investigated in the present study the mechanisms regulating this fragment using cl-Par-4-expressing stable clones derived from ovarian and endometrial cancer cell lines.Cl-Par-4 protein was weakly express in all stable clones despite constitutive expression. However, upon cisplatin treatment, cl-Par-4 levels increased up to 50-fold relative to baseline conditions. Treatment of stable clones with proteasome and translation inhibitors revealed that cisplatin exposure might in fact protect cl-Par-4 from proteasome-dependent degradation. PI3K and MAPK pathways were also implicated as evidenced by an increase of cl-Par-4 in the presence of PI3K inhibitors and a decrease using MAPK inhibitors. Finally using bioinformatics resources, we found diverse datasets showing similar results to those we observed with the proteasome and cl-Par-4 further supporting our data.These new findings add to the complex mechanisms regulating Par-4 expression and activity, and justify further studies addressing the biological significance of this phenomenon in gynaecological cancer cells.

Can Vulnerable Elders Survey-13 predict the impact of frailty on chemotherapy in elderly patients with gynaecological malignancies?

The management of gynaecological cancers in elderly women and high-risk patients is an even more relevant issue, because the increase in longevity and comorbidities. The assumption of frailty based on age alone may lead to inadequate and inappropriate treatment and frailty assessment is recommended. The aim of this study was to assess if Vulnerable Elders Survey-13 (VES-13), as indicator of frailty, can predict the toxicity of chemotherapy in gynaecological cancers.VES-13 was administered to patients aged ≥ 70 years with ovarian, endometrial and cervical cancers who underwent chemotherapy from 2010 to 2016.Eighty-four patients aged ≥ 70 years (mean age 74.6) were included, 36 patients (42.9%) resulted vulnerable (score ≥ 3). Thrombocytopenia and anaemia were more prevalent in the vulnerable subjects (81.3% versus 18.7%, P = .0005, and 81.8% versus 18.2%, P = .005, respectively), while neutropenia was similar between the 2 groups. Vulnerable women had higher risk of non-haematological toxicities. Most of the patients (77.4%) completed chemotherapy, but dose reductions and discontinuations were more common in the vulnerable group (66.7% versus 33.3%, P = .07 and 68.4% versus 31.6%, P = .01, respectively).To our knowledge, this is the first study to evaluate VES-13 exclusively in elderly women with gynaecological cancers. VES-13 may be useful to stratify this category of patients according to vulnerability in order to identify women at risk of toxicity and to prevent complications induced by chemotherapy.

Histone Modifying Enzymes in Gynaecological Cancers

Simple Summary

Epigenetics is a process that allows genetic control, without the involvement of sequence changes to DNA or genes. In cancer, epigenetics is a key event in tumour development that can alter the expression of cancer driver genes and result in genomic instability. Due to the critical role of epigenetics in malignant transformation, therapies that target these processes have been developed to treat cancer. Here, we provide a summary of the epigenetic changes that have been described in a variety of gynaecological cancers. We then highlight how these changes are being targeted in preclinical models and clinical trials for gynaecological cancers.

Abstract

Genetic and epigenetic factors contribute to the development of cancer. Epigenetic dysregulation is common in gynaecological cancers and includes altered methylation at CpG islands in gene promoter regions, global demethylation that leads to genome instability and histone modifications. Histones are a major determinant of chromosomal conformation and stability, and unlike DNA methylation, which is generally associated with gene silencing, are amenable to post-translational modifications that induce facultative chromatin regions, or condensed transcriptionally silent regions that decondense resulting in global alteration of gene expression. In comparison, other components, crucial to the manipulation of chromatin dynamics, such as histone modifying enzymes, are not as well-studied. Inhibitors targeting DNA modifying enzymes, particularly histone modifying enzymes represent a potential cancer treatment. Due to the ability of epigenetic therapies to target multiple pathways simultaneously, tumours with complex mutational landscapes affected by multiple driver mutations may be most amenable to this type of inhibitor. Interrogation of the actionable landscape of different gynaecological cancer types has revealed that some patients have biomarkers which indicate potential sensitivity to epigenetic inhibitors. In this review we describe the role of epigenetics in gynaecological cancers and highlight how it may exploited for treatment.

Socio-economic and occupational outcomes of long-term survivors of gynaecological cancer: A French population-based study

OBJECTIVE

To describe socio-economic and professional outcomes in long-term survivors of cervical, endometrial or ovarian cancer, including return to work and problems related to obtaining loans and insurance.

METHODS

Women with cervical, endometrial or ovarian cancers diagnosed from 2006 to 2013 were selected through the French gynaecological cancer registry of Côte d'Or, in a cross-sectional survey. Using a questionnaire established with the help of sociologists and psychologists, social and cancer-related work issues were collected among women aged less than 60 years at the time of cancer diagnosis. The socio-economic status was also assessed, at the time of the survey using the EPICES questionnaire.

RESULTS

A total of 92 gynaecological cancer survivors (CS) participated in this survey. Gynaecological CS reported a decrease in income since cancer diagnosis, difficulties obtaining loans, and a decrease in ability to work, both in the short term after treatment and at the time of survey, on average 6 years after diagnosis. Fatigue, emotional and cognitive difficulties were the reasons cited to explain the decreased ability to work, both immediately after treatment and in the long term.

CONCLUSIONS

Gynaecological CS experienced many problems, such as decreased work capacity, decreased income and difficulty obtaining loans.

The evolving challenges of specialist gynaecological cancer nurse roles - A qualitative study

AIMS

To determine how specialist gynaecological cancer nurses experience and perceive their role.

DESIGN

An Interpretive Description qualitative study employing semi-structured interview methods was conducted.

METHODS

Specialist nurses working in Australia or New Zealand were recruited via the Australia and New Zealand Gynaecological Oncology Group and the Cancer Nurses Society of Australia to contribute to focus group, dyadic and/or individual interviews. Audio-recordings of the interviews were transcribed, de-identified, and subjected to a thematic analysis.

RESULTS

Specialist cancer nurses participated in the study via one focus group interview (N = 6), one dyadic interview (N = 2) and 13 individual interviews between April - August 2016. Three major themes were inductively derived from 19 minor themes: 'Working between worlds' locates the role of the specialist nurse in the provision of gynaecological cancer care; 'The patient's 'go-to' person' highlights participants' relationships with patients; and 'When so much depends on one person' explores the personal and professional impact of working in a specialist nursing role.

CONCLUSION

Specialist nurses identified themselves as an accessible source of support and expertise for both women with gynaecological cancers throughout their disease trajectory and multidisciplinary team members. The main challenges they faced were the evolving and expanding nature of their bespoke roles and the dependence on them as individuals in these roles. Clearer role boundaries, guidelines for practice, effective professional support, and active succession planning are recommended.

IMPACT

This study explored the experiences and perceptions of gynaecological oncology specialist nurses. Despite similar roles being in place across many countries for several years, the roles continue to evolve and lack clear definition which is burdensome to their incumbents. This research indicates that it is now time for nursing leaders and the broader nursing profession to delineate scope of practice, standardise nomenclature and practice and embed these roles in nursing career and education pathways.

Developing an Australian multi-module clinical quality registry for gynaecological cancers: a protocol paper

INTRODUCTION

Gynaecological cancers collectively account for almost 10% of cancer diagnoses made in Australian women. The extent of variation in gynaecological cancer survival rates and treatment outcomes across Australia is not well documented. The purpose of the clinical quality registry described in this paper is to systematically monitor and improve quality of care provided to these women, and facilitate clinical process improvements to ensure better patient outcomes and greater adherence to best practice care. The registry infrastructure has been developed in conjunction alongside the inaugural ovarian, tubal and peritoneal (OTP) module, allowing for concurrent piloting of the methodology and one module. Additional tumour modules will be developed in time to cover the other gynaecological tumour types.

METHOD AND ANALYSIS

The National Gynae-Oncology Registry (NGOR) aims to capture clinical data on all newly diagnosed cancers of the uterus, ovary, fallopian tubes, peritoneum, cervix, vulva and vagina in Australia with a view to using these data to support improved clinical care and increased adherence to 'best practice'. Data are sourced from existing clinical databases maintained by clinicians and/or hospital gynaecological cancer units. A pilot phase incorporating only OTP cancers has recently been conducted to assess the feasibility of the registry methodology and assess the support of a quality initiative of this nature among clinicians and other key stakeholders.

ETHICS AND DISSEMINATION

The NGOR has received National Mutual Acceptance (NMA) ethics approval from Monash Health Human Research Ethics Committee (HREC), NMA HREC Reference Number: HREC/17/MonH/198. We also have approval from Mercy Health HREC and University of Tasmania HREC. Data will be routinely reported back to participating sites illustrating their performance against measures of agreed best practice. It is through this feedback system that the registry will support changes to quality of care and improved patient outcomes.

COVID-19 and its impact on gynaecologic oncology practice in India-results of a nationwide survey

The COVID-19 pandemic sweeping across the world has caused major disruptions in healthcare delivery and practice. A survey was conducted to assess the changes in the care of gynaecologic oncology patients in India.

METHODS

An online survey enquiring about the patient volumes and surgical load, and changes in practice protocols for endometrial, ovarian, cervical and vulval cancers was conducted in May, 2020.

RESULTS

The total number of responses received was 153. Barring duplicates, 148 were analysed. There was a significant drop in gynaecologic oncology patients attending government hospitals as compared to the non-government sector. The drop was not significantly different in areas having low versus high COVID-19 case volumes. The treatment of endometrial cancers remained the same although there was a marked shift from minimal access surgery to conventional surgery. Advanced ovarian cancer was mostly managed by neoadjuvant chemotherapy. Cervical and vulval cancer management remained the same, but radiotherapy protocols were modified by most.

CONCLUSION

Based on clinician responses, it appears that most practices across India have suffered a fall in patient volumes. The responses from government sectors point towards a bigger hit in this segment of practice. While the management of endometrial cancers and cervical cancers was mostly unchanged, most cases of advanced ovarian cancer received neoadjuvant chemotherapy. Cervical cancer, when managed by chemoradiation, was likely to have altered radiation schedules.

Controlling female cancer in Argentina. Divergent initiatives and the road to fragmentation

This article analyses the organisation of cancer control in Argentina, with a special focus on the initiatives, institutions, and models that targeted female or gynaecological cancers. It identifies and examines the main factors in the process of elaborating a national policy to control the disease drawing on a series of actors and instruments such as the state, medical professionals, institutions and services, and the use of technology (notably diagnostic tools) for the detection of the disease. It traces the developments in the organisation highlighting its transformations from a centralising to a decentralised model of service provision. Using the concept of "path-dependence" the article examines the continuities and changes observed in the organisation of female cancer critically signalling the particular time at which a path was taken where "fragmentation" became consolidated within the health system. It also argues that it was within the field of cancer diagnosis that Argentinian doctors first sought to create the foundational structures of cancer organisation. The article contends that the path-dependence analytical approach helps us acknowledge the importance of historical analysis in the identification of factors that led to the lack of service coordination, including the persistent strain between national/provincial states that hampered the development of comprehensive programmes, aspects that have continued to mark efforts in the elaboration of cancer policies to the present day.

Comparison of Serum 25-Hydroxyvitamin D Levels in Patients With Malignant and Benign Gynaecological Disease

BACKGROUND/AIM

Many studies have shown an antiproliferative, anti-inflammatory, anti-angiogenetic, and apoptosis-inducing effect of Vitamin D. A vitamin D deficiency has been associated with an increased risk for different types of cancer. This study examined vitamin D 25(OH)D levels in gynaecological cancers in comparison with benign gynaecological diseases.

PATIENTS AND METHODS

Serum 25(OH)D levels in 688 gynaecological patients (488 with malignant, 200 with a benign gynaecological disease) were assayed between 2009 and 2015 using an electrochemiluminescence immunoassay.

RESULTS

In total, the 25(OH)D levels in cancer patients were lower, but not significantly lower than those in cancer-free patients. Significant results were shown regarding seasonal effects for patients with breast-, endometrial and ovarian cancer. No significant effects occurred with regard to menopause status, nicotine, or grade in relation to 25(OH)D levels.

CONCLUSION

25(OH)D levels seem to influence gynaecological cancers.

Gynaecological Cancer Diagnostics: 99mTc-Cisplatin Complex as a Future Approach for Early, Prompt and Efficient Diagnosis of Gynaecological Cancer

BACKGROUND

Gynaecological cancers (GCCa) are common and have a significant mortality rate all over the world. Early diagnosis of cancer can play a key role in the treatment and survival of a patient. Identification, staging, treatment, and monitoring of gynaecological malignancies is being done successfully by nuclear medicines.

DISCUSSION

Currently, single-photon emission computed tomography (SPECT) and positron emission tomography (PET) centered imaging techniques are being developed for use in patients with GCCa as a diagnostic tool. The present work elucidates several clinical studies on the use of radiopharmaceuticals, based on their effectiveness, in the early detection and management of GCCa. It also highlights the importance of reconsidering the biology for nuclear imaging as a future modality for early, rapid and efficient diagnosis of gynecological cancers. This comprehensive review is a part of our study designed to detect gynaecological cancers at an early stage using radionuclide complex, 99m Tc-Cisplatin.

CONCLUSION

This article summarizes the significance of radioscintigraphy such as single-photon emission computed tomography (SPECT) and PET for identification of GCCa in the experimental humans and animals.

Granulocyte-colony-stimulating factor in elderly patients receiving chemotherapy for breast and gynaecological cancers: results of a French survey

BACKGROUND

Age is a risk factor for chemo-induced febrile neutropenia (FN). According to ASCO guidelines, granulocyte colony-stimulating factor (G-CSF) use should be considered for regimens leading to a 10- to 20-percent risk of FN.

PATIENTS AND METHODS

A survey was undertaken describing the prescription of G-CSF in routine practices by 101 French physicians for 791 patients ≥70 years, having breast or gynaecological cancers, and receiving chemotherapy.

RESULTS

G-CSF was prescribed in 51% of the cases. A primary prophylaxis was prescribed in 90%, 59% and 36% of patients receiving regimens presenting a FN-risk of ≥20%, 10-20% and <10%, respectively. Covariates associated with the use of G-CSF were adjuvant chemotherapy, 3- or 4-weekly regimens, and geriatric assessment. Validated risk factors of FN were rarely considered.

CONCLUSION

The prescription of G-CSF was multi-factorial. The estimation of FN risk was mainly based on physician's experience, explaining differences between guidelines and routine practice.

Women's psychosexual experiences following radical radiotherapy for gynaecological cancer: A qualitative exploration

PURPOSE

To explore psychosexual experiences of women following radical radiotherapy for gynaecological cancer.

METHODS

Seven women who had completed radical radiotherapy for gynaecological cancer were interviewed. Interviews were semi-structured, and data were analyzed using an interpretative phenomenological analysis (IPA) approach.

RESULTS

Five superordinate themes were constructed: (1) No desire for sex since completing treatment; (2) Fear; (3) Unmet information and support needs; (4) Partner support and needs; and (5) Communication. Fear of adverse consequences following sex inhibited return to sexual activity after treatment. Misconceptions and lack of knowledge were evident. Communicating sexual issues was a difficulty that transcended personal relationships, also evident in professional medical relationships.

CONCLUSION

Simple measures, beginning with facilitating understanding and acceptance of psychosexual experiences, can help those experiencing psychosexual problems following radical radiotherapy. Encouraging discussion, providing options and practical knowledge, and clarifying misconceptions about risks from sex after cancer could improve outcomes for gynaecological cancer patients.

The Application of Circulating Tumour DNA (ctDNA) in the Diagnosis, Prognosis, and Treatment Monitoring of Gynaecological and Breast Cancers (Review)

Gynaecological cancers, including endometrial, ovarian, and cervical cancers as well as breast cancer, despite numerous studies, still constitute a challenge for modern oncology. For this reason, research aimed at the application of modern diagnostic methods that are useful in early detection, prognosis, and treatment monitoring deserves special attention, Great hopes are currently being placed on the use of liquid biopsy (LB), which examines various tumour components, including cell-free RNA (cfRNA), circulating tumour cells (CTCs), circulating tumour DNA (ctDNA), exosomes, and tumour-educated platelets (TEPs). LB has shown promise as a minimally invasive means of early diagnosis of cancers, detection of recurrence, prediction of therapy response, treatment monitoring, and drug selection. The integration of this test into clinical practice in modern oncology is challenging, but offers many benefits, including reducing the risks associated with invasive procedures, improving diagnostic and therapeutic efficacy, and improving the quality of life of oncology patients. The aim of this review is to present recent reports on the use of ctDNA in diagnosing, predicting the outcome of, and monitoring the treatment of gynaecological and breast cancers.

Trend, Epidemiology, and Clinical Characteristics of Vulvar Cancers in Lagos, Nigeria: A Facility-Based Study

Background Vulvar cancer (VC) is a rare gynecological cancer (GC) that is not commonly studied. Because of its location, vulvar symptoms are not frequently brought to the clinician's attention. Many women are not aware of VC and frequently attribute its early symptoms to other benign causes. In addition, little is known about the disease epidemiology and clinical characteristics in Lagos, Nigeria. Objectives  Our study aimed to describe the trend, epidemiology, and clinical characteristics of VC in Lagos, Nigeria. Materials and methods Records of women with VC who presented to Lagos University Teaching Hospital between January 2010 and December 2019 were retrieved, and information on their socio-demographic and clinical characteristics was obtained for analysis. Data analysis was done using IBM Corp. Released 2017. IBM SPSS Statistics for Windows, Version 25.0. Armonk, NY: IBM Corp. Results VC accounted for 4.0% of all GC managed in the hospital. There was a rising trend in the number of VCs managed during the study period, with 75.9% of cases managed in the last five years. The mean ± SD age of women with VC was 52.2 ± 11.8 years, with 27 (60.0%) above 50 years old. The majority had low-level occupations, 35 (77.8%), multiple sexual partners, 29 (64.4%); history of genital warts, 35 (77.8%); vulvar skin lesions, 40 (88.9%), and were menopausal, 26 (57.8%). The most common presenting symptom was vulvar swelling 32 (71.1%) and 20 (44.4%) presented with stage III disease. Squamous cell carcinoma was the most common histological type, 35 (77.8%), while the use of only surgery, 15 (33.3%), chemotherapy, 4 (8.9%), radiotherapy, 4 (8.9%), and chemoradiation, 4 (8.9%), were the most common treatment modalities. Conclusion VC accounts for 4.0% of GC in Lagos, Nigeria, and its prevalence is rising. Women with VC are usually advanced in age, postmenopausal, have a history of multiple sexual partners, and frequently present in advanced-stage disease. There is a need to increase awareness about the disease and support its care to improve health outcomes.

Bioinformatics Based Drug Repurposing Approach for Breast and Gynecological Cancers: RECQL4/FAM13C Genes Address Common Hub Genes and Drugs

Objective

The prevalence of breast cancer and gynaecological cancers is high, and these cancer types can occur consecutively as secondary cancers. The aim of our study is to determine the genes commonly expressed in these cancers and to identify the common hub genes and drug components.

Materials and Methods

Gene intensity values of breast cancer, gynaecological cancers such as cervical, ovarian and endometrial cancers were used from the Gene Expression Omnibus database Affymetrix Human Genome U133 Plus 2.0 Array project. Using the linear modelling method included in the R LIMMA package, genes that differ between healthy individuals and cancer patients were identified. Hub genes were determined using cytoHubba in Cytoscape program. "ShinyGo 0.80" tool was used to determine the disease-specific biological KEGG pathways. Drug.MATADOR from the ShinyGo 0.80 tool was used to predict drug-target relationships.

Results

The RecQ Like Helicase 4 and Family with Sequence Similarity 13 Member C genes were found to be similarly expressed in breast cancer and gynaecological cancers. Upon KEGG pathway analyses with hub genes, Drug.MATADOR analysis with hub genes related to cancer related pathways was performed. We have determined these gene/drug interactions: NBN (targeted by Hydroxyurea), EP300 (targeted by Acetylcarnitine) and MAPK14 (targeted by Salicylate and Dibutyryl cyclic AMP).

Conclusion

The drugs associated with hub genes determined in our study are not routinely used in cancer treatment. Our study offers the opportunity to identify the target genes of drugs used in breast and gynaecological cancers with the drug repurposing approach.