{"id":6971,"date":"2022-07-03T11:41:36","date_gmt":"2022-07-03T07:11:36","guid":{"rendered":"http:\/\/irsgo.org\/?p=6971"},"modified":"2022-07-03T13:02:03","modified_gmt":"2022-07-03T08:32:03","slug":"1-cervical-cancer","status":"publish","type":"post","link":"https:\/\/irsgo.org\/en\/1-cervical-cancer\/","title":{"rendered":"Cervical Cancer"},"content":{"rendered":"\n<style type=\"text\/css\" data-created_by=\"avia_inline_auto\" id=\"style-css-av-234mhn-4bac12f91648f4fddaf3f643eca1c58e\">\n.flex_column.av-234mhn-4bac12f91648f4fddaf3f643eca1c58e{\nborder-radius:0px 0px 0px 0px;\npadding:0px 0px 0px 0px;\n}\n<\/style>\n<div  class='flex_column av-234mhn-4bac12f91648f4fddaf3f643eca1c58e av_one_full  avia-builder-el-0  avia-builder-el-no-sibling  first flex_column_div av-zero-column-padding  '     ><section  class='av_textblock_section av-l54xpxl2-2f7c8551527555401cb5c6a291725488 '   itemscope=\"itemscope\" itemtype=\"https:\/\/schema.org\/BlogPosting\" itemprop=\"blogPost\" ><div class='avia_textblock'  itemprop=\"text\" ><p class=\"MsoNormal\" dir=\"ltr\" style=\"margin-bottom: 0in; line-height: normal;\"><span style=\"font-family: 'Times New Roman', Times; font-size: 12pt; color: #000000;\"><b><span lang=\"EN-GB\">Treatment:<\/span><\/b> <\/span><\/p>\n<p class=\"MsoNormal\" dir=\"ltr\" style=\"margin-bottom: 0in; line-height: normal;\"><span lang=\"EN-GB\" style=\"font-family: 'Times New Roman', Times; font-size: 12pt; color: #000000;\">Treatment for cervical cancer depends on the stage of the disease.<\/span><\/p>\n<p class=\"MsoNormal\" dir=\"ltr\" style=\"margin-bottom: 0in; line-height: normal;\"><span style=\"font-family: 'Times New Roman', Times; font-size: 12pt; color: #000000;\"><b><span lang=\"EN-GB\">A.<\/span><\/b><span lang=\"EN-GB\"> In patients who do not want to preserve fertility, from stage IA1 where LVSI is positive to some well-selected patients in stages IB3 and IIA1 will be candidates for radical hysterectomy. The standard approach for radical hysterectomy in cervical cancer is laparotomy, and many studies have confirmed that minimally invasive procedures, both <\/span><span lang=\"EN-GB\">conventional <\/span><span lang=\"EN-GB\">laparoscop<\/span><span lang=\"EN-GB\">y <\/span><span lang=\"EN-GB\">and robotic, are associated with an increased recurrence and mortality rate. The new classification of radical hysterectomy types is based on the Querleu and Morrow system. The types of radical hysterectomy include type A, type B1, type B2, type C1, type C2, and type D. In type C1, which is a radical hysterectomy with nerve preservation, the inferior hypogastric plexus is preserved near the cardinal ligament.<\/span><\/span><\/p>\n<p class=\"MsoNormal\" dir=\"ltr\" style=\"margin-bottom: 0in; line-height: normal;\"><span lang=\"EN-GB\" style=\"font-family: 'Times New Roman', Times; font-size: 12pt; color: #000000;\"><b>B.<\/b> In more advanced stages, chemoradiation is the primary principle of treatment.<\/span><\/p>\n<p class=\"MsoNormal\" dir=\"ltr\" style=\"margin-bottom: 0in; line-height: normal;\"><span style=\"font-family: 'Times New Roman', Times;\"><b style=\"color: #000000; font-size: 12pt;\"><span lang=\"EN-GB\">C.<\/span><\/b><span lang=\"EN-GB\" style=\"color: #000000; font-size: 12pt;\"> Some patients after surgery may also need adjuvant treatments based on pathological findings. Some criteria are associated with a moderate risk of recurrence and these patients should undergo radiotherapy after surgery. These criteria are known as <b>Sedlis criteria:<\/b><\/span><\/span><\/p>\n<p class=\"MsoNormal\" dir=\"ltr\" style=\"margin-bottom: 0in; line-height: normal;\"><span style=\"font-family: 'Times New Roman', Times; font-size: 12pt; color: #000000;\"><span style=\"mso-spacerun: yes;\">&nbsp;&nbsp;&nbsp;&nbsp; <\/span>1. LVSI plus deep one-third cervical stromal invasion and tumor of any size<\/span><\/p>\n<p class=\"MsoNormal\" dir=\"ltr\" style=\"margin-bottom: 0in; line-height: normal;\"><span style=\"font-family: 'Times New Roman', Times; font-size: 12pt; color: #000000;\"><span style=\"mso-spacerun: yes;\">&nbsp;&nbsp;&nbsp;&nbsp; <\/span>2. LVSI plus middle one-third stromal invasion and tumor size &gt;2 cm<\/span><\/p>\n<p class=\"MsoNormal\" dir=\"ltr\" style=\"margin-bottom: 0in; line-height: normal;\"><span style=\"font-family: 'Times New Roman', Times; font-size: 12pt; color: #000000;\"><span style=\"mso-spacerun: yes;\">&nbsp;&nbsp;&nbsp;&nbsp; <\/span>3. LVSI plus superficial one-third stromal invasion and tumor size &gt;5 cm<\/span><\/p>\n<p class=\"MsoNormal\" dir=\"ltr\" style=\"margin-bottom: 0in; line-height: normal;\"><span style=\"font-family: 'Times New Roman', Times; font-size: 12pt; color: #000000;\"><span style=\"mso-spacerun: yes;\">&nbsp;&nbsp;&nbsp;&nbsp; <\/span>4. No LVSI but deep or middle one-third stromal invasion and tumor size &gt;4 cm<\/span><\/p>\n<p class=\"MsoNormal\" dir=\"ltr\" style=\"margin-bottom: 0in; line-height: normal;\"><span lang=\"EN-GB\" style=\"font-family: 'Times New Roman', Times; font-size: 12pt; color: #000000;\">&nbsp;<\/span><\/p>\n<p class=\"MsoNormal\" dir=\"ltr\" style=\"margin-bottom: 0in; line-height: normal;\"><span lang=\"EN-GB\" style=\"font-family: 'Times New Roman', Times; font-size: 12pt; color: #000000;\">Some patients are also at high risk for recurrence after surgery and should receive adjuvant chemoradiation if there are <b>Peters criteria<\/b>:<\/span><\/p>\n<p class=\"MsoNormal\" dir=\"ltr\" style=\"margin-bottom: 0in; line-height: normal;\"><span style=\"font-family: 'Times New Roman', Times; font-size: 12pt; color: #000000;\"><span style=\"mso-spacerun: yes;\">&nbsp; &#8211; <\/span>Positive surgical margins<\/span><\/p>\n<p class=\"MsoNormal\" dir=\"ltr\" style=\"margin-bottom: 0in; line-height: normal;\"><span style=\"font-family: 'Times New Roman', Times; font-size: 12pt; color: #000000;\"><span style=\"mso-spacerun: yes;\">&nbsp;<\/span><span style=\"mso-spacerun: yes;\"> &#8211; <\/span>Pathologically confirmed involvement of the pelvic lymph nodes<\/span><\/p>\n<p class=\"MsoNormal\" dir=\"ltr\" style=\"margin-bottom: 0in; line-height: normal;\"><span style=\"font-family: 'Times New Roman', Times; font-size: 12pt; color: #000000;\"><span style=\"mso-spacerun: yes;\">&nbsp; &#8211;<\/span>&nbsp;Involvement of the parametrium<\/span><\/p>\n<p class=\"MsoNormal\" dir=\"ltr\" style=\"margin-bottom: 0in; line-height: normal;\"><span lang=\"EN-GB\" style=\"font-family: 'Times New Roman', Times; font-size: 12pt; color: #000000;\">&nbsp;<\/span><\/p>\n<p class=\"MsoNormal\" dir=\"ltr\" style=\"margin-bottom: 0in; line-height: normal;\"><span style=\"font-family: 'Times New Roman', Times; font-size: 12pt; color: #000000;\"><b><span lang=\"EN-GB\">D.<\/span><\/b><span lang=\"EN-GB\"> Neoadjuvant chemotherapy is one of the options in cervical cancer patients who are pregnant and want to continue their pregnancy.<\/span><\/span><\/p>\n<p class=\"MsoNormal\" dir=\"ltr\" style=\"margin-bottom: 0in; line-height: normal;\"><span style=\"font-family: 'Times New Roman', Times; font-size: 12pt; color: #000000;\"><b>E.<\/b> <span lang=\"EN-GB\">New treatments such as targeted therapy have been proposed in cervical cancer as well as other gynecological cancers. Different groups of drugs such as monoclonal antibodies have been used for this purpose in different clinical trials, such as: Angiogenesis inhibitors such as bevacizumab, EGFR inhibitors such as cetuximab, PARP inhibitors such as Velioarib, and immunotherapy with pembrolizumab and nivolumab.<\/span><\/span><\/p>\n<p class=\"MsoNormal\" dir=\"ltr\" style=\"margin-bottom: 0in; line-height: normal;\"><span lang=\"EN-GB\" style=\"font-family: 'Times New Roman', Times; font-size: 12pt; color: #000000;\">&nbsp;<\/span><\/p>\n<p class=\"MsoNormal\" dir=\"ltr\" style=\"margin-bottom: 0in; line-height: normal;\"><span style=\"font-family: 'Times New Roman', Times; font-size: 12pt; color: #000000;\"><b><span lang=\"EN-GB\">Fertility sparing surgery in cervical cancer:<\/span><\/b><\/span><\/p>\n<p class=\"MsoNormal\" dir=\"ltr\" style=\"margin-bottom: 0in; line-height: normal;\"><span lang=\"EN-GB\" style=\"font-family: 'Times New Roman', Times; font-size: 12pt; color: #000000;\"><span style=\"mso-spacerun: yes;\">&nbsp;<\/span>Cervical cancer often occurs between the ages of 35 and 44, and preserving fertility is very important in these patients. Fertility sparing methods can include uterine preservation and \/ or ovarian preservation. <\/span><\/p>\n<p class=\"MsoNormal\" dir=\"ltr\" style=\"margin-bottom: 0in; line-height: normal;\"><span lang=\"EN-GB\" style=\"font-family: 'Times New Roman', Times; font-size: 12pt; color: #000000;\">Optimal candidates for preserving fertility:<\/span><\/p>\n<p class=\"MsoListParagraphCxSpFirst\" dir=\"ltr\" style=\"margin: 0in 0in 0in 20.25pt; text-indent: -0.25in; line-height: normal;\"><span style=\"font-family: 'Times New Roman', Times; font-size: 12pt; color: #000000;\"><span lang=\"EN-GB\"><span style=\"mso-list: Ignore;\"><span style=\"font-family: 'Times New Roman', Times; font-style: normal; font-variant: normal; font-weight: normal; font-stretch: normal; line-height: normal;\">&#8211; <\/span><\/span><\/span><!--&#091;endif&#093;--><span lang=\"EN-GB\">Desire to preserve fertility<\/span><\/span><\/p>\n<p class=\"MsoListParagraphCxSpLast\" dir=\"ltr\" style=\"margin: 0in 0in 0in 20.25pt; text-indent: -0.25in; line-height: normal;\"><span style=\"font-family: 'Times New Roman', Times; font-size: 12pt; color: #000000;\"><span lang=\"EN-GB\"><span style=\"mso-list: Ignore;\"><span style=\"font-style: normal; font-variant: normal; font-weight: normal; font-stretch: normal; line-height: normal;\">&#8211; <\/span><\/span><\/span><!--&#091;endif&#093;--><span lang=\"EN-GB\">Young women (Preferably less than 40 years old)<\/span><\/span><\/p>\n<p class=\"MsoNormal\" dir=\"ltr\" style=\"margin: 0in 0in 0in 2.25pt; line-height: normal;\"><span lang=\"EN-GB\" style=\"font-family: 'Times New Roman', Times; font-size: 12pt; color: #000000;\">&#8211; Histological types of squamous, adenosquamous or adenocarcinoma<\/span><\/p>\n<p class=\"MsoNormal\" dir=\"ltr\" style=\"margin: 0in 0in 0in 2.25pt; line-height: normal;\"><span lang=\"EN-GB\" style=\"font-family: 'Times New Roman', Times; font-size: 12pt; color: #000000;\">&#8211; Early stages of the disease, ie IA1 up to a maximum of IB1 and some selected cases of IB2<\/span><\/p>\n<p class=\"MsoNormal\" dir=\"ltr\" style=\"margin: 0in 0in 0in 2.25pt; line-height: normal;\"><span lang=\"EN-GB\" style=\"font-family: 'Times New Roman', Times; font-size: 12pt; color: #000000;\">&#8211; Tumor size \u2264\u06f2 cm <\/span><\/p>\n<p class=\"MsoNormal\" dir=\"ltr\" style=\"margin: 0in 0in 0in 2.25pt; line-height: normal;\"><span lang=\"EN-GB\" style=\"font-family: 'Times New Roman', Times; font-size: 12pt; color: #000000;\">&#8211; Negative margin of at least 5 mm<\/span><\/p>\n<p class=\"MsoNormal\" dir=\"ltr\" style=\"margin: 0in 0in 0in 2.25pt; line-height: normal;\"><span lang=\"EN-GB\" style=\"font-family: 'Times New Roman', Times; font-size: 12pt; color: #000000;\">&#8211; The disease is limited to the cervix <\/span><\/p>\n<p class=\"MsoNormal\" dir=\"ltr\" style=\"margin: 0in 0in 0in 2.25pt; line-height: normal;\"><span lang=\"EN-GB\" style=\"font-family: 'Times New Roman', Times; font-size: 12pt; color: #000000;\">&#8211; There is no lymph node involvement<\/span><\/p>\n<p class=\"MsoNormal\" dir=\"ltr\" style=\"margin-bottom: 0in; line-height: normal;\"><span lang=\"EN-GB\" style=\"font-family: 'Times New Roman', Times; font-size: 12pt; color: #000000;\">&nbsp;<\/span><\/p>\n<p class=\"MsoNormal\" dir=\"ltr\" style=\"margin-bottom: 0in; line-height: normal;\"><span lang=\"EN-GB\" style=\"font-family: 'Times New Roman', Times; font-size: 12pt; color: #000000;\">Types of fertility sparing surgical techniques include:<\/span><\/p>\n<p class=\"MsoNormal\" dir=\"ltr\" style=\"margin-bottom: 0in; line-height: normal;\"><span lang=\"EN-GB\" style=\"font-family: 'Times New Roman', Times; font-size: 12pt; color: #000000;\">&#8211; Simple trachelectomy or radical vaginal trachelectomy (in a tumor less than 2 cm) <\/span><\/p>\n<p class=\"MsoNormal\" dir=\"ltr\" style=\"margin-bottom: 0in; line-height: normal;\"><span lang=\"EN-GB\" style=\"font-family: 'Times New Roman', Times; font-size: 12pt; color: #000000;\">&#8211; Abdominal radical trachelectomy (in a tumor \u2265 \u06f2 cm)<\/span><\/p>\n<p class=\"MsoNormal\" dir=\"ltr\" style=\"margin-bottom: 0in; line-height: normal;\"><span lang=\"EN-GB\" style=\"font-family: 'Times New Roman', Times; font-size: 12pt; color: #000000;\"><span style=\"mso-spacerun: yes;\">&#8211; <\/span>Cone biopsy in lesions less than 1 cm<\/span><\/p>\n<p class=\"MsoNormal\" dir=\"ltr\" style=\"margin-bottom: 0in; line-height: normal;\"><span lang=\"EN-GB\" style=\"font-family: 'Times New Roman', Times; font-size: 12pt; color: #000000;\">&#8211; NACT in lesions larger than 2 cm + a suitable fertility sparing procedure<\/span><\/p>\n<p class=\"MsoNormal\" dir=\"ltr\" style=\"margin-bottom: 0in; line-height: normal;\"><span lang=\"EN-GB\" style=\"font-family: 'Times New Roman', Times; font-size: 12pt; color: #000000;\">&#8211; Ovarian preservation (even in adenocarcinoma, the risk of ovarian metastasis in the early stages is less than 5%, and ovarian preservation in these individuals does not affect the overall or disease-free survival). <\/span><\/p>\n<p class=\"MsoNormal\" dir=\"ltr\" style=\"margin-bottom: 0in; line-height: normal;\"><span lang=\"EN-GB\" style=\"font-family: 'Times New Roman', Times; font-size: 12pt; color: #000000;\">If you choose conization, it is better to use cold knife conization. Although the use of LEEP is acceptable. Be sure to perform endocervical curettage with these methods.<\/span><\/p>\n<p class=\"MsoNormal\" dir=\"ltr\" style=\"margin-bottom: 0in; line-height: normal;\"><span lang=\"EN-GB\" style=\"font-family: 'Times New Roman', Times; font-size: 12pt; color: #000000;\">&nbsp;<\/span><\/p>\n<p class=\"MsoNormal\" dir=\"ltr\" style=\"margin-bottom: 0in; line-height: normal;\"><span style=\"font-family: 'Times New Roman', Times; font-size: 12pt; color: #000000;\"><span lang=\"EN-GB\">In stage IA1, which is associated with LVSI and more advanced stages, pelvic lymphadenectomy should be performed. Sentinel lymph node mapping can be used in lesions up to 2 cm in size. The probability of parameter involvement in lesions less than 2 cm is less than one percent, and currently fertility preserving methods tend to be more conservative. MIS trachelectomy (conventional laparoscopic trachelectomy or robot-assisted trachelectomy) had similar recurrence and survival rates in compare to abdominal approaches. <\/span>Avoiding the use of a uterine manipulator and performing transvaginal closure of the vaginal cuff can reduce the risk of tumor spillage during MIS.<\/span><\/p>\n<p class=\"MsoNormal\" dir=\"ltr\" style=\"margin-bottom: 0in; line-height: normal;\"><span lang=\"EN-GB\" style=\"font-family: 'Times New Roman', Times; font-size: 12pt; color: #000000;\">&nbsp;<\/span><\/p>\n<p class=\"MsoNormal\" dir=\"ltr\" style=\"margin-bottom: 0in; line-height: normal;\"><span style=\"font-family: 'Times New Roman', Times; font-size: 12pt; color: #000000;\">After childbearing is complete, hysterectomy can be considered for these patients:<\/span><\/p>\n<p class=\"MsoNormal\" dir=\"ltr\" style=\"margin-bottom: 0in; line-height: normal;\"><span style=\"font-family: 'Times New Roman', Times; font-size: 12pt; color: #000000;\"><span style=\"mso-spacerun: yes;\">&nbsp;&nbsp;&nbsp;&nbsp; <\/span>&#8211; Chronic persistent HPV infection<\/span><\/p>\n<p class=\"MsoNormal\" dir=\"ltr\" style=\"margin-bottom: 0in; line-height: normal;\"><span style=\"font-family: 'Times New Roman', Times; font-size: 12pt; color: #000000;\"><span style=\"mso-spacerun: yes;\">&nbsp;&nbsp;&nbsp;&nbsp; <\/span>&#8211; Abnormal pap test<\/span><\/p>\n<p class=\"MsoNormal\" dir=\"ltr\" style=\"margin-bottom: 0in; line-height: normal;\"><span style=\"font-family: 'Times New Roman', Times; font-size: 12pt; color: #000000;\"><span style=\"mso-spacerun: yes;\">&nbsp; &nbsp; &nbsp;&#8211; <\/span>Patient\u2019s desire to surgery<\/span><\/p>\n<p class=\"MsoNormal\" dir=\"ltr\" style=\"margin-bottom: 0in; line-height: normal;\"><span dir=\"RTL\" lang=\"FA\" style=\"font-family: 'Times New Roman', Times; font-size: 12pt; color: #000000;\">&nbsp;<\/span><\/p>\n<p class=\"MsoNormal\" dir=\"ltr\" style=\"margin-bottom: 0in; line-height: normal;\"><span style=\"font-family: 'Times New Roman', Times; font-size: 12pt; color: #000000;\"><b><span lang=\"FA\"><span style=\"mso-spacerun: yes;\">&nbsp;<\/span><\/span><\/b><b><span lang=\"EN-GB\">Sentinel lymph node mapping:<\/span><\/b><span lang=\"EN-GB\"> This method is part of the surgical staging of cervical cancer. The cervix is \u200b\u200bin the center of the pelvis and has bilateral lymphatic drainage, and the use of SLN mapping is practical. It is possible to inject blue dye with or without Tc99, but ICG is used if the infrared camera is available.<\/span><\/span><\/p>\n<p class=\"MsoNormal\" dir=\"ltr\" style=\"margin-bottom: 0in; line-height: normal;\"><span style=\"color: #000000; font-family: 'Times New Roman', Times; font-size: 12pt;\">The injection can be done at different hours of the cervix at 2 or 4 points, such as: injection at 2, 11, 5, 7, or 3 and 9, or at 3, 6, 9, and 12. Two injections are performed at each point, one injection with a depth of 2 to 3 mm and the second injection with a depth of 1 cm. The most common areas in SLN are mapping of the lymphatic chain to the inner surface of the external iliac and the upper part of the obturator space.<\/span><\/p>\n<p class=\"MsoNormal\" dir=\"ltr\" style=\"margin-bottom: 0in; line-height: normal;\"><span lang=\"EN-GB\" style=\"font-family: 'Times New Roman', Times; font-size: 12pt; color: #000000;\">The following conditions are necessary to achieve reliable results and proper mapping: <\/span><\/p>\n<p class=\"MsoNormal\" dir=\"ltr\" style=\"margin-bottom: 0in; line-height: normal;\"><span lang=\"EN-GB\" style=\"font-family: 'Times New Roman', Times; font-size: 12pt; color: #000000;\">&#8211; Tumors less than 4 cm (although the best results are obtained in tumors less than 2 cm).<\/span><\/p>\n<p class=\"MsoNormal\" dir=\"ltr\" style=\"margin-bottom: 0in; line-height: normal;\"><span lang=\"EN-GB\" style=\"font-family: 'Times New Roman', Times; font-size: 12pt; color: #000000;\">&#8211; There are no suspicious lymph nodes in the preoperative imaging<\/span><\/p>\n<p class=\"MsoNormal\" dir=\"ltr\" style=\"margin-bottom: 0in; line-height: normal;\"><span lang=\"EN-GB\" style=\"font-family: 'Times New Roman', Times; font-size: 12pt; color: #000000;\">&#8211; bilateral SLN detection <\/span><\/p>\n<p class=\"MsoNormal\" dir=\"ltr\" style=\"margin-bottom: 0in; line-height: normal;\"><span lang=\"EN-GB\" style=\"font-family: 'Times New Roman', Times; font-size: 12pt; color: #000000;\">&#8211; Ultrastaging sentinel lymph nodes<\/span><\/p>\n<p class=\"MsoNormal\" dir=\"ltr\" style=\"margin-bottom: 0in; line-height: normal;\"><span lang=\"EN-GB\" style=\"font-family: 'Times New Roman', Times; font-size: 12pt; color: #000000;\">&#8211; The surgeon adheres to the SLN algorithm<\/span><\/p>\n<p class=\"MsoNormal\" dir=\"ltr\" style=\"margin-bottom: 0in; line-height: normal;\"><span lang=\"EN-GB\" style=\"font-family: 'Times New Roman', Times; font-size: 12pt; color: #000000;\">&nbsp;<\/span><\/p>\n<p class=\"MsoNormal\" dir=\"ltr\" style=\"margin-bottom: 0in; line-height: normal;\"><span style=\"font-family: 'Times New Roman', Times; font-size: 12pt; color: #000000;\"><b><span lang=\"EN-GB\">Surveillance after treatment:<\/span><\/b><\/span><\/p>\n<p class=\"MsoNormal\" dir=\"ltr\" style=\"margin-bottom: 0in; line-height: normal;\"><span lang=\"EN-GB\" style=\"font-family: 'Times New Roman', Times; font-size: 12pt; color: #000000;\"><span style=\"mso-spacerun: yes;\">&nbsp;<\/span>The goal of follow-up after treatment is to identify cancer recurrence early, which could potentially be curable. The main component of survival is clinical examination. Patients should be educated about the symptoms of relapse. lifestyle modification, exercise, smoking cessation, and nutritional improvement are also important. Cervical cytology is performed annually in patients who have used fertility preservation methods. PET \/ CT and other imaging modalities performed if clinically indicated.<\/span><\/p>\n<p class=\"MsoNormal\" dir=\"ltr\" style=\"margin-bottom: 0in; line-height: normal;\"><span lang=\"EN-GB\" style=\"font-family: 'Times New Roman', Times; font-size: 12pt; color: #000000;\">&nbsp;<\/span><\/p>\n<p class=\"MsoNormal\" dir=\"ltr\" style=\"margin-bottom: 0in; line-height: normal;\"><span lang=\"EN-GB\" style=\"font-family: 'Times New Roman',serif; mso-ascii-theme-font: major-bidi; mso-hansi-theme-font: major-bidi; mso-bidi-theme-font: major-bidi;\">&nbsp;<\/span><\/p>\n<p class=\"MsoNormal\" dir=\"ltr\" style=\"margin-bottom: 0in; line-height: normal;\"><span style=\"font-size: 12pt; color: #993300;\"><strong><span style=\"font-family: 'Times New Roman', Times;\"><span lang=\"EN-GB\">Dr. Soheila Aminimoghaddam<\/span><\/span><\/strong><\/span><\/p>\n<p class=\"MsoNormal\" dir=\"ltr\" style=\"margin-bottom: 0in; line-height: normal;\"><span style=\"font-size: 12pt; color: #993300;\"><strong><span style=\"font-family: 'Times New Roman', Times;\"><span lang=\"EN-GB\">Gynecology Oncologist<\/span><\/span><\/strong><\/span><\/p>\n<p class=\"MsoNormal\" dir=\"ltr\" style=\"margin-bottom: 0in; line-height: normal;\"><span style=\"font-size: 12pt; color: #993300;\"><strong><span lang=\"EN-GB\" style=\"font-family: 'Times New Roman', Times;\">School of medicine<\/span><\/strong><\/span><\/p>\n<p class=\"MsoNormal\" dir=\"ltr\" style=\"margin-bottom: 0in; line-height: normal;\"><span style=\"font-size: 12pt; color: #993300;\"><strong><span lang=\"EN-GB\" style=\"font-family: 'Times New Roman', Times;\">Iran University of Medical Sciences, Tehran, Iran<\/span><\/strong><\/span><\/p>\n<p class=\"MsoNormal\" dir=\"ltr\" style=\"margin-bottom: 0in; line-height: normal;\"><span style=\"font-family: 'Times New Roman', Times; font-size: 12pt; color: #000000;\"><span style=\"color: #993300;\"><strong><span lang=\"EN-GB\">Email address: Aminimoghaddam.s@iums.ac.ir<\/span><\/strong><\/span><\/span><\/p>\n<p class=\"MsoNormal\" dir=\"ltr\" style=\"margin-bottom: 0in; line-height: normal;\"><span lang=\"EN-GB\" style=\"font-family: 'Times New Roman', Times; font-size: 12pt; color: #000000;\">&nbsp;<\/span><\/p>\n<\/div><\/section><\/div>","protected":false},"excerpt":{"rendered":"","protected":false},"author":5,"featured_media":6979,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"ngg_post_thumbnail":0,"footnotes":""},"categories":[1196],"tags":[1838,1839,1172],"class_list":["post-6971","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-hot-topic-en","tag-cervical-cancer","tag-dr-aminimoghadam","tag-irsgo-en"],"_links":{"self":[{"href":"https:\/\/irsgo.org\/en\/wp-json\/wp\/v2\/posts\/6971","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/irsgo.org\/en\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/irsgo.org\/en\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/irsgo.org\/en\/wp-json\/wp\/v2\/users\/5"}],"replies":[{"embeddable":true,"href":"https:\/\/irsgo.org\/en\/wp-json\/wp\/v2\/comments?post=6971"}],"version-history":[{"count":16,"href":"https:\/\/irsgo.org\/en\/wp-json\/wp\/v2\/posts\/6971\/revisions"}],"predecessor-version":[{"id":7026,"href":"https:\/\/irsgo.org\/en\/wp-json\/wp\/v2\/posts\/6971\/revisions\/7026"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/irsgo.org\/en\/wp-json\/wp\/v2\/media\/6979"}],"wp:attachment":[{"href":"https:\/\/irsgo.org\/en\/wp-json\/wp\/v2\/media?parent=6971"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/irsgo.org\/en\/wp-json\/wp\/v2\/categories?post=6971"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/irsgo.org\/en\/wp-json\/wp\/v2\/tags?post=6971"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}