Background: Cervical cancer is the commonest cancer in women in developing countries. Visual inspection with acetic acid (VIA) is much popular method as primary screening modalities in low resource setting.Whereas Pap smear is well recognized and popular in developed countries. Colposcopy is recognized as the best method for detection of cervical cancer and cervical intraepithelial neoplasia (CIN) as secondary screening. The present study was intended to compare the accuracy of Pap smear and colposcopy in the detection of pre-invasive cervical lesion in VIA positive cases. Methods: This cross sectional study was carried out in the Colposcopic Clinic of Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka over a period of 1 year from August 2015. All consecutive VIA positive cases were included the study. Results: Mean age of the VIA positive women was 36.9 years with peak age group being 31-40 years (44.0%). Nearly three-quarters of the women (74.0%) were in their 3" and 4 decades of life. Among VIA positive women, 35.0% were Pap positive and 55.0% were colposcopically positive and 41.0% were histopathologically positive. Pap smear had low sensitivity (53.7%) and high specificity (78.0%). Using Pap smear nearly half (46.3%) of the precancerous lesion were escaped. Whereas colposcopy findings, revealed high sensitivity (90.2%) and specificity (69.5%). Both Pap and colposcopy was judged against histopathological diagnosis. Over 40.0% of the VIA positive women were diagnosed as CIN confirmed by histopathology. Strength of agreement test using Kappa statistics revealed a moderate agreement between Pap smear test and colposcopy (49.5%). Conclusion: The study concluded that colposcopy has a high sensitivity, optimum specificity and moderate agreement against histopathology in relation to Pap smear. Pap smear has very little role whereas colposcopy has significant role for diagnosis of CIN. So, it would be adopted and encouraged to do the colposcopy where it is possible. Bangladesh Med Res Counc Bull 2019; 45: 103-107

Background: Ovarian cancer is one of the leading cause of mortality and morbidity of gynaecological malignancies. Lack of early demonstration of symptoms and lack of effective screening tests, ovarian tumours are usually diagnosed at an advanced stage. Different studies shows the association of pre-operative serum CA125 level with the surgical staging of ovarian cancer. Objective: To find out the correlation of pre-operative level of serum CA 125 with the surgical staging (FIGO-2014) of ovarian cancer. Methodology: This cross sectional study was carried out among 81 subjects in the department of gynaecological oncology, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, from August 2018 to September 2019. Sampling technique was purposive. All consecutive patients admitted at department of gynaecological oncology, BSMMU with diagnosed ovarian cancer were included in this study. Data were collected and documented on a preformed and pretested structured questionnaire. Clinical examinations and relevant investigations were done and recorded accordingly. Result: Mean age of the study subjects was 45.7 ± 15.2 years with a range of 13-75 years. Mean BMI was 23.3 ± 3.0 kg/m2 and mean age of marriage was 16.1 ± 2.8 years. Maximum study subjects had stage III (44.4%) followed by stage II (23.5%), stage I (21.0%) and stage IV (11.1%). Preoperative CA-125 was >35 U/ml in 90.1% cases. Serum CA-125 was elevated at the advanced stage of ovarian cancer. Maximum study subjects had serous tumors (70.4%) followed by mucinous tumors (11.5%), endometrioid adenocarcinoma (7.4%), malignant teratoma (4.9%) and clear cell tumors (3.7%). Serum CA-125 had significant positive correlation with surgical stages of ovarian epithelial cancer. Conclusion: Surgical stage of epithelial ovarian cancer significantly correlates with CA-125. Bangladesh Med Res Counc Bull 2021; 47(2): 110-117

Background: Endometrial cancer, previously referred to as carcinoma of the uterus. The incidence of endometrial cancer is raising, due to improved screening causing fewer hysterectomies in ageing population. Several studies are going on to find out the association and effects between DM and DM-related diseases, especially the cancer. Obesity and physical inactivity plays important role as modifiable determinants of insulin resistance, hyperinsulinaemia and diabetes. All these factors are also responsible for endometrial cancer. Objectives: To find out the association between endometrial carcinoma with obesity and diabetes mellitus Methods: This was a cross sectional and observational study, conducted among. 50 consecutive patients admitted as known case of endometrial carcinoma diagnosed by fractional curettage and endometrial biopsy and 50 consecutive patients having other common gynaecological problems in Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka from January 2015 to December 2017. Results: Out of 50 women having endometrial carcinoma, only 4% (n=2) having healthy BMI, 36% (n=18) were overweight, 60% (n=30) were obese. Among 50 healthy women without endometrial carcinoma showed that 4% (n=2) having underweight, 70% (n=35) having healthy BMI, 14% (n=7) having overweight and only 12% (n=6) were obese. Regarding distribution of diabetes mellitus among study population, 50 women having endometrial carcinoma 26 % (n=13) were diabetic and 74% (n=37) were non diabetic.50 healthy women without endometrial carcinoma showed that 8% (n=4) diabetic and 92% (n=46) were non diabetic. Among total 17% (n=17) diabetic patients, 76.5% (n-13) having endometrial carcinoma and 23.5% (n=4) were healthy having no endometrial carcinoma. Among 83% (n=83) women having no diabetes 55.4% (n=46) were healthy having no endometrial carcinoma and 44.6% (n=37) having endometrial carcinoma. Association between Diabetes mellitus and endometrial carcinoma was statistically significant (p=0.017).  Having high BMI (overweight, obese) and diabetics had significant elevated risks of endometrial cancer, compared with non-overweight non-diabetic subjects. Conclusion: Obesity, history of PCOS, physical inactivity and diabetes are the risk factors of endometrial carcinoma. So, it should be treated promptly these diseases to reduce risk factors. Moreover, strengthen public awareness to address these risk factors at earlier to reduce the cancer burden is recommended. Bangladesh Med Res Counc Bull 2020; 46(2): 120-127

Background: Infection with high-risk human papilloma virus (HPV) has been recognised as a causal factor for development of cervical pre-cancerous and cancerous lesions. So far more than 150 types of HPV are identified. Their distribution varies from country to country, also from region to region. Background knowledge about the distribution of HPV genotypes in invasive cervical cancer is crucial to guide the introduction of prophylactic vaccines. Objective: The study was aimed to assess the distribution of type specific human papilloma Virus DNA among cervical cancer patients. Methods: The study was a cross sectional, observational and single centred one. It was carried out in the department of gynaecological oncology, of Bangabandhu Sheikh Mujib Medical University (BSMMU). Purposive sampling was done according to the availability of patients. Results: HPV type 16 was detected in 35 cases (76.1%) followed by type 18 in 4 (8.7%) cases of cervical carcinoma. HPV 39, 56 and 68 were also detected, each was in 1 case (2.2 %). It was to be also found that 1 co-infection (2.2%) with HPV 33+35. HPV 16 was detected in 79.4 % of squamous cell carcinoma and in 70.0% of adenocarcinomas. HPV 18 was detected in 5.9 % of squamous cell carcinoma and 20.0% of adenocarcinomas. HPV 39 was detected in one case of small cell carcinoma (100.0%). One case of HPV 68 (2.9%) and one coinfection with HPV 33+35 (2.9 %) were found in squamous cell carcinoma. One case of HPV 56 (10.0%) was detected in adenocarcinoma of cervix. HPV DNA was not found in 3 cases of squamous cell carcinoma of cervix. Conclusion: The distribution of HPV infection among Bangladesh women is similar to other regions of Asia. However, type specific patterns are different. The study findings will guide the formulation of HPV vaccination policies in Bangladesh, impact of vaccination programmes, to predict the efficacy of cost effective prophylactic vaccine, introduction of newer generation vaccine and finally prevention of cervical carcinoma in the country. Bangladesh Med Res Counc Bull 2022; 48(1): 48-55

Background: Women with postmenopausal bleeding have 10%-15% chance of having endometrial carcinoma and therefore the diagnostic work is aimed at excluding uterine malignancy. For accurate diagnosis of cause of postmenopausal bleeding, endometrial abnormalities can be assessed by hysteroscopy and hysteroscopy directed biopsy or fractional curettage. Objective: To compare the hysteroscopic findings with histopathologic report of endometrium in postmenopausal bleeding. Methods: Cross sectional study was conducted in the department of gynaecological oncology in Bangabandhu Sheikh Mujib Medical University over 1 year from June 2019 to May 2020. Thirty women with the complaints of postmenopausal bleeding were enrolled.   Each women underwent hysteroscopic evaluation and endometrial tissue was obtained by hysteroscopy directed biopsy as well as fractional curettage in some cases, then sent for histopathology. Results were analyzed to find out sensitivity, specificity, accuracy, positive predictive value and negative predictive value of hysteroscopy, taking histopathological diagnosis as gold standard. Analysis was carried out by using SPSS version 26. Results: Hysteroscopic examination findings and histopathology of endometrium in 30 postmenopausal women, 11(36.6%) cases were found normal both on hysteroscopy and histopathology, among them 4(13.3%) cases were proliferative endometrium, 1(3.3%) was secretory endometrium and 5(16.6%) cases were found atrophic endometrium and 1(3.3%) tissue was insufficient. Hysteroscopic view of normal endometrium showed a sensitivity 100%, specificity 100%, positive predictive value 100%, negative predictive value 100% and accuracy 100%. For Endometrial polyp showed sensitivity, specificity, positive predictive value, negative predictive value   and accuracy 100%respectively. For Hyperplasia, hysteroscopy showed sensitivity 100%, specificity 96.2%, positive predictive value 80%, negative predictive value 100% and accuracy 96.7%. Endometrial carcinoma was found in 3(10%) cases and showed sensitivity of 100%, specificity of 96.3%, positive predictive value 75.0%, negative predictive value 100% and accuracy 96.7%. For the atrophic endometrium, sensitivity (100%), specificity (96.0%), positive predictive value (83.3%), negative predictive value (100%) and accuracy (96.7%). 1(3.3%) had in situ endometrial carcinoma and 2(6.6%) had adenomyosis on histopathology. Conclusion: The study concludes that hysteroscopy and directed biopsy or fractional curettage is a highly accurate, sensitive, specific, positive predictive value and negative predictive value for diagnosis of cause of postmenopausal bleeding. Bangladesh Medical Res Counc Bull 2023; 49(1): 1-14