Pain in carcinoma cervix is often managed as visceral pelvic pain. It includes systemic analgesics or use of standard interventions such as superior hypogastric plexus block.However, pelvic malignancies often produce mixed pain syndromes involving visceral,sympathetic, and somatic pathways. Identifying the dominant pain generator is important for effective pain management. We report a 52-year-old woman with locally advanced carcinoma cervix who presented to us with severe perianal and sacral pain refractory to opioid-based therapy. The pain was burning and pressure-like, aggravated by sitting, with defecation, with substantial functional limitation and sleep disturbance. He was taking 60 mg/day of oral morphine and adjuvant analgesics but pain intensity was 8/10 on the numerical rating scale. Clinically and on PETCT imaging, posterior tumour extension to the presacral and perirectal region was observed.This suggested the involvement of perineal sympathetic and sacral somatic pathways rather than isolated visceral pelvic pain. The patient underwent a fluoroscopy-guided ganglion impar block using a trans-sacrococcygeal approach with caudal epidural steroid injection. A significant improvement in pain was noted within 48 hours, with pain scores decreasing from 8/10 to 3/10. The patient reported improved sitting tolerance, better sleep, and enhanced daily functioning. Over the following two weeks, morphine effective daily dose [MEDD]reduced from 60 mg/day to 30 mg/day while maintaining satisfactory analgesia. This case highlights the importance of mechanism based assessment in carcinoma cervix related pain. Posterior pelvic tumour extension can result in perineal and sacral pain patterns that are poorly managed by conventional visceral interventions alone. Targeted interventional techniques such as ganglion impar block and caudal epidural steroid injection can achieve significant symptom relief, decrease opioid requirement and improve quality of life in selected patients.
Aberrant STAT3 activation and persistent expression of HPV16 E6E7 transcripts are pivotal drivers of cervical cancer (CaCx) progression. The present study was aimed to develop a Flow cytometry- based Florescence In situ hybridization (Flow-FISH) assay for simultaneous detection of STAT3 and HPV16 E6E7 transcripts at single-cell level. A set of 48 STAT3 multi locus probes and 18 HPV16 E6E7 probes were designed using Stellaris Probe Designer. Fluorescence microscopy using these probe sets generated discrete punctate signals for both individual and simultaneous hybridizations, enabling accurate transcript identification. Flow-cytometry analysis showed quantifiable STAT3 expression across CaCx cell lines, namely HeLa, SiHa and C33a. However, HPV16 E6E7 probes showed non-specific binding, which was addressed by redesigning the probes with increased stringency. The specificity of both probe sets was then evaluated through extensive sequence alignment against all known STAT3 transcript variants (n = 27) and 98 HPV16 isolates. The redesigned phase 2 HPV16 E6E7 probes were subsequently tested in cell lines, demonstrating robust detection in HPV16-positive SiHa and CaSki cells and complete absence of signal in HPV-negative controls (C33a, MSB1, SF21) or HPV18-positive HeLa cells. Dual-color flow cytometry enabled simultaneous quantification of STAT3 and HPV16 E6E7 transcripts in both cell lines and patient’s exfoliated samples. Increased dual-positive fractions across LSIL, HSIL, and SCC samples were detected that corresponded with progressive viral oncogene activity and STAT3 co-activation. Overall, the optimized probe-based Flow-FISH assay provided a sensitive, specific, and high-throughput method for transcript-level diagnostics, with potential utility for stratifying cervical lesions.
BACKGROUND:Gynecological malignancies, particularly ovarian and endometrial cancers, primarily contribute to cancer-related morbidity and mortality across the world and in India. Debulking surgery is still the cornerstone of treatment for advanced cases, but these procedures are associated with significant perioperative risks that can impact recovery and delay adjuvant therapy. OBJECTIVE:This study intends to identify predictors of 30-day postoperative morbidity and 90-day mortality following debulking surgeries for gynecological malignancies in an Indian tertiary care setting. METHODS:A retrospective observational study was conducted at the National Cancer Institute, AIIMS Jhajjar, including 100 patients who underwent debulking surgery for ovarian, endometrial, or cervical malignancies between January 2022 and June 2023. Data on demographics, disease stage, surgical details, intraoperative events, and postoperative outcomes were collected. Univariate and multivariable logistic regression analyses were performed to identify significant predictors of morbidity and mortality. RESULTS:Major 30-day morbidity occurred in 42% of patients, while no 90-day mortality was noted. On univariate analysis, surgical duration >300 min (odds ratio (OR) 2.72[95% confidence interval {CI} 1.15 to 6.44]; P = 0.021), sustained hypotension (OR 2.67[95% CI 1.05 to 6.75]; P = 0.035), blood loss ≥500 ml (OR 2.56[95% CI 1.11 to 5.89]; P = 0.025), and intraoperative blood transfusion (OR 3.70[95% CI 1.60 to 8.53]; P = 0.002) were significantly associated with increased morbidity. Multivariable analysis revealed that intermediate or high surgical complexity was protective against 30-day morbidity (OR 0.163 [95% CI 0.034 to 0.792]; P = 0.025), which can be attributed to careful patient selection and better perioperative optimization of high-risk patients. CONCLUSION:Prolonged surgery, increased blood loss, and hemodynamic instability are decisive predictors of postoperative morbidity. Selection and perioperative optimization enable safe performance of complex debulking procedures in appropriate patients. Employing structured risk stratification and targeted perioperative interventions is essential for improving postoperative outcomes in this population. Prospective validation and assessment of these strategies should be emphasized.
