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Background: North East is the “cancer capital” of India where there is acute lack of oncologists and oncology facilities. Objectives of the study were to evaluate the trends of gynecological malignancies and to evaluate the need for oncology facility in Sikkim.Methods: This is a retrospective desk review conducted in department of obstetrics and gynecology at Sikkim Manipal institute of medical sciences, India, for a period of three years after the start of oncology surgeries. Women operated for any gynecological malignancy were taken into the study while women referred outside for alternative treatment were excluded from the study.Results: A total 29 women with gynecological malignancies were operated during the 3-year period. Of the total, 17 (58%) were women operated for carcinoma ovary, 6 (21%) for cancer cervix and 6 (21%) for carcinoma uterus. Epithelial ovarian cancer was the most common ovarian cancer. 105 women with large complex ovarian masses were operated during the three-year period, however, only 17 women were diagnosed with cancer of which 8 women had stage I disease while 9 women had advanced disease (stage III-IV). 12 women underwent primary debulking surgery while 5 women underwent interval debulking surgery. Average age for cervical cancer was 48 years, average age for ovarian cancer was 46 years while 52 years was the average age for cancer uterus. Conclusions: High number of gynecological malignancies operated in the only center offering minimum oncological surgical facility points towards the need for a specialized center providing all the needs for treating oncology cases in Sikkim

Background: Ectopic pregnancy is a commonest cause of maternal morbidity and mortality in the first trimester of pregnancy. Clinical presentation of ectopic pregnancy has changed from life threatening disease to a more benign condition for which nonsurgical treatment options are available with methotrexate administered systemically or locally. The study was done to evaluate the outcome of medical management of ectopic pregnancy with single regimen methotrexate.Methods: A cohort study was conducted over 18 months on 60 unruptured ectopic pregnancies who were treated with methotrexate injection.Results: Out of 60 unruptured ectopic pregnancies, 53 (88.3%) were successfully treated with methotrexate. Failure rate was 11.7% (7/60) patients who underwent laparotomy. Success of medical treatment was dependent on pretreatment β-hCG (≤4102.5 mIU/mL), period of gestation (≤5 weeks), size of gestational sac (≤3 cm) above which the failure rate increases. No correlation was seen between fall of β-hCG from day 4 to 7 and the success rate. Mean time to resolution of β-hCG seen was 4.3±1.25 weeks. Mean duration of hospital stay was 8.85±1.603 days. Single dose regimen of methotrexate was given to all patients and only 1/60 patients required second dose of methotrexate for suboptimal decrease of β-hCG.Conclusions: The result showed that pretreatment β-hCG level and period of gestation were good predictors for success of medical treatment.