Hypoxia, proliferation and its co-localization in cervical cancer

Little is known about the co-localization of hypoxia and proliferation in
cervical cancer. In the future it may be possible that hypoxia and/or
proliferation markers will be used to differentiate between treatment
modalities for cervical cancer. Tumor oxygenation is an important variable in
the efficacy of radiotherapy. The response of human cells to ionizing radiation
is strongly dependent on the availability of oxygen. Different studies have
shown that tumor proliferation and hypoxia are independent predictors of
treatment results in cervical cancer. Exogenous and endogenous hypoxia and
proliferation markers (Ca 9, Ki-67) are available for study. Pimonidazole is a
nitroimidazole and a proven valid marker for hypoxia

1. To what extend does hypoxia occur in cervical cancer and what is the intra-
and intertumor heterogeneity?
2. To what extend does proliferation occur in cervical cancer and what is the
intra- and intertumor heterogeneity?
3. Does co-localization of hypoxia and proliferation markers occur in cervical
cancer and to what extend?

Analysis of co-localization of hypoxia and proliferation in cervical cancer,
using pimonidazole as hypoxia marker and Ki-67 as proliferation marker.
- Administration of an hypoxia marker before the examination under anaesthesia
- Examination under anaesthesia with several biopsies
- Further processing of the biopsy at the department of pathology
- Immunohistochemical staining of tumor biopsies
- Quantifying Pimonidazole and Ki-67 staining
- Correlation with other tumor parameters
- Correlation with clinical parameters (stage, grade, lymphnode status (in case
of surgery), LVSI, etc)

Patients will receive an injection with Pimonidazole before the examination
under anaethesia (Iv access already necessary for the anaesthesia. There will
be extra biopsies taken from the cervix.