GYNECOLOCICAL ONCOLOGY

athesiology
H.O.D: Dr. Ranajit Kumar Mandal
MBBS, PGDHHM, DNB, MD(PGI)


In the Grade of Specialist Grade I
 


Team

Dr. Pradip Das                                    Chief Medical Officer.
Dr. Dipanwita Banerjee                      Consultant
Dr. Chandrani Bhattacharya                Senior Resident.
Dr. Priyanka Singh                              Senior Resident
Dr. Sk. Abdul Halim                           Junior Resident.

Objectives

  • Diagnostic work up of women with suspected gynaecological cancers

  • Appropriate management through surgery, chemotherapy and radiation therapy and their combinations

  • Screening and early detection of Gynecological cancers

  • Palliative treatment for gynaecological cancer patients

  • Generate trained human resources in early detection and effective management of Gynecological cancers

  • To conduct research in the field of Gynecological Oncology

    Clinical Activities of the Department

    During the period between 1 April 2012 and 31 March 2013 a total of 1125 new cases were registered in the Department. During the same period a total of 6482 patients attended the OPD for follow up visits.

    The total number of patients admitted under the Department for treatment was 248. The diagnoses of the patients who got admitted are given in Table 1.


    Table 1. Diagnosis of the patients admitted in the Department during 2012-13

    Diagnosis

    Number of patients

    Carcinoma Cervix

    85

    Carcinoma Endometrium

    26

    Carcinoma Ovary

    98

    Carcinoma Vulva

    10

    Cervical Intraepithelial Neoplasia

    03

    Uterovaginal Prolapse

    12

    Fibroid Uterus

    07

    Dysfunctional Uterine Bleeding

    5

    Diagnostic Laparoscopy

    2

    Figure 1. Distribution of the admitted patients by the site of malignancy


    During 2012-13 a total 168 major surgical procedures were performed in the Department. The details of the procedures are given in Table 2.

    Table 2. List of major surgeries in the Department during 2012-13

    Surgical Procedure

    Number

    Modified Radical Hysterectomy + Extra-peritoneal pelvic lymphadenectomy

    40

    Exploratory Laparotomy + TAH + BSO + Omentectomy + Appendicectomy + Pelvic & Para-aortic Lymphadenectomy

    8

    Exploratory Laparotomy + TAH + BSO + Omentectomy + Appendicectomy

    43

    Exploratory Laparotomy + TAH + BSO + Omentectomy + Appendicectomy + Sacrospinous Colpopexy

    1

    Exploratory Laparotomy + TAH + BSO + Omentectomy + Appendicectomy + Intestinal Resection-anastomosis

    4

    Radical Vulvectomy + Bilateral Inguinal Lymphadenectomy

    5

    Simple Vulvectomy

    1

    Bilateral Extra-peritoneal Lymphadenectomy

    2

    Total vaginectomy + Bilateral Extraperitoneal Pelvic Lymphadenectomy

    1

    TAH + BSO + Bilateral Extra-peritoneal Lymphadenectomy

    5

    Unilateral Salpingo-oophorectomy + Omentectomy

    3

    Laparotomy & Biopsy of Ovarian & Omental Mass

    2

    Excision of Scar Metastasis

    2

    Ileal Conduit

    1

    TAH + BSO (Total Abdominal Hysterectomy + Bilateral Salpingo-Ophorectomy)

    20

    Total Abdominal Hysterectomy

    3

    Vaginal Hysterectomy + Pelvic Floor Repair

    11

    Broad Ligament Fibroid Myomectomy

    1

    Hernioplasty

    1

    Burst Abdomen Repair

    1

    Colostomy

    2

    Diagnostic Laproscopy

    6

    Laproscopy Assisted Vaginal Hysterectomy

    4

    The distribution of the major surgeries by the sites of malignancies is given in Figure 2


    The total number of minor surgical procedures carried out in the Department was 148. The details are given in Table 3.

    Surgeries

    Number of cases

    Cystoscopy

    95

    Hysteroscopy + D/C Endometrial Biopsy

    10

    Pyometra Drainage

    15

    LEEP (Loop Electro-surgical Excision Procedure)

    7

    Polypectomy + D/C Biopsy

    5

    D/C Endometrial Biopsy

    12

    Vulval Biopsy

    5

    Wound debridement ± Secondary suturing

    3

    The total number of patients who expired while being admitted to the Department was 29; out of which there were 12 cases of ovarian cancer, 16 cases of cervical cancer and 1 case of gestational trophoblastic disease.

    Community Based Cancer Control Activities

    Cervical Cancer Prevention and Control Initiative (CPCI Project)

    Through this community based outreach program more than 30,000 women predominantly from rural areas have been screened for cervical cancer till date. Total 11234 women were screened in the year 2012- 2013 itself. High grade cervical precancers (CIN 2/CIN 3) were detected in 56 women. Among them 48 women were treated by Loop Electrosurgical Excision Procedures, 6 women underwent cryotherapy and 2 underwent hysterectomy. Number of early cervical cancer patients detected and treated under this programme was 16 in the year 2012- 2013.

    District Cancer Surveillance Project

    The project supported by the National Rural Health Mission (NRHM) aims to collect data related to the incidence and prevalence of various cancers from the districts of West Bengal. A web based data capturing system has been developed.

    Training Programs of the Department

    PhD programmes ongoing in the department under the West Bengal University of Health Sciences:

    Name of scholar

    Research topic

    Name of Superviser

    Dr. Partha Sarathi Basu

    Efficacy of Human Papilloma Virus DNA test to triage women with Abnormal Visual Inspection with Ascetic acid test for detection of High Grade Cervical Lesions

    Dr. Jaydip Biswas

    Dr. Srabani Mittal

    Cumulative risk of high grade Intraepithelial neoplasia among high risk Human Papilloma Viruspositive women detected by Hybrid Capture II assay: a population based prospective study

    Dr. Jaydip Biswas

    Dr. Ashis Kumar Mukhopadhyay

    Prospective study of low grade Cervical Intraepithelial Neoplasia with relation to the HPV status

    Dr. Jaydip Biswas

    Dr. Ishita Ghosh

    Association of Infections other than Human Papilloma Virus with Invasive Cervical Neoplasias

    Dr. Ranajit K. Mandal

    Dr. Kalyansree Chowdhury

    Prognostic value of presence of human papilloma virusin histologically negative pelvic lymphnodes in surgically treated invasive cervical carcinoma

    Dr. Prabir Chaudhary

    Field orientation of primary health workers and ASHA workers is also undertaken under the aeges of CPCI from November 2012.

    Hands on Training Workshops on Colposcopy and Management of Cervical Precancers were conducted in the months of May and September 2012.

    DNB trainees of broad and superspecialities of Gynecology, Radiotherapy and Surgical Oncology are trained by means of regular seminars, bedside lectures and demonstrations during surgical procedures, every year.

    Training in Colposcopy and Management of Cervical Precancers was held for a group of clinicians from DPR Korea in September 2012.

    Research Activities in the Department

    Ongoing Research Projects

    1. Phase II Placebo Controlled Study of VGX-3100, (HPV 16 E6/E7, HPV 18 E6/E7 DNA Vaccine) delivered IM followed by Electroporation with CELLECTRA- 5p for the treatment of biopsy-proven CIN2/3 or CIN 3 only with documented HPV 16/18

    2. Prevalence, Genotype, Distribution of HPV in cervical infection and its attribution to Cervical Intra-epithelial Neoplasia and Cervical Cancer in Indian Women

    3. Randomized active therapy controlled phase II study to assess the safety and efficacy of ADXS 11- 001 with and without Cisplatin as 2nd line therapy for the treatment of recurrent cervix cancer

    4. A Phase IV, Observer blind, randomized controlled multicentric study to assess the safety and immunogenicity of GSK Biologicals’ HPV-16/18 L1 VLP ASO4 Vaccine (CervarixTM) administered intramuscularly, according to a 3 dose schedule (day 0, wekk 6, month 6) in Human Immunodeficiency Virus Infected (HIV +) female subjects aged 15-25 years, as compared to Merck’s HPV- 6/11/16/18 vaccine (Gardasil).

    Publications

    1. Partha Basu, Sankhadeep Dutta, Rakiba Begum et al. Clearance of Human Papillomavirus Infection in Cervix by Topical Application of Curcumin and Curcumin Containing Polyherbal Cream - A Phase II Randomized Controlled Study. Asian Pacific Journal of Cancer Prevention. In Press

    2. BASU, P., SAMADDAR, A., MITTAL, S., BASU, U., CHATTERJEE, S., BISWAS, J. Concordance between Hybrid Capture 2 Results Performed on Cervical Samples Obtained before and Immediately after Visual Inspection with Acetic Acid (VIA) Test. International Journal of Preventive Medicine, North America, 0, feb. 2013. Available at: . Date accessed: 04 Aug. 2013.

    3. Partha Basu, Meherbano Kamal, Chinmayi Ray, Dharitri Bhat, Ishita Ghosh, Srabani Mittal, Simi Chatterjee, Anushree Samaddar, Jaydip Biswas. Inter-observer agreement in the reporting of cervical biopsy specimens obtained from women screened by Visual Inspection with Acetic Acid and Hybrid Capture 2. International Journal of Gynecological Pathology. 2013,32(5):509-515

    4. Partha Basu, Prianka Singh, Dipanwita Banerjee, Chandrani Bhattacharya, Jaydip Biswas. Efficacy and Safety of Human Papillomavirus Vaccine for Primary Prevention of Cervical Cancer – A review of evidences from phase III trials and national programs. South Asian Journal of Cancer. In Press

    5. Partha Basu, Srabani Mittal, Suchismita Bhaumik, Shyam Sunder Mandal, Anusree Samaddar, Chinmayi Ray, Maqsood Siddiqi, Jaydip Biswas and Rengaswamy Sankaranarayanan. Prevalence of high risk human papillomavirus and cervical intraepithelial neoplasias in a previously unscreened population – a pooled analysis from three studies. International Journal of Cancer 2013; 132: 1693–9.

    6. Ghosh I, Ghosh P, Bharti AC, Mandal R, Biswas J, Basu P. Prevalence of Human Papillomavirus and Co-Existent Sexually Transmitted Infections among Female Sex Workers, Men having Sex with Men and Injectible Drug abusers from Eastern India. Asian Pacific J Cancer Prevention. 2012; 13(3):

    7. 7.Dutta S, Begum R, Mazumder D, Mandal SS, Mondal , Biswas J, Dey B, Panda CK, Basu P. Prevalence of Human Papillomavirus in Women without Cervical Cancer: A Population-based Study in Eastern India. Int J Gynecol Pathol 2012 31(2):178-183.