The Value of Agnor Study in Radiotherapy Treated Squamous Cell Carcinoma of the Cervix - As a Diagnostic and Prognostic Marker.

Carcinoma Cervix Is The Second Most Common Cancer Worldwide Especially In Perimenopausal Period. In Developing Countries Like Asia, Africa And South America It Is The Commonest Malignancy Largely Due To Lower Socioeconomic Status, Poor Hygiene, Illiteracy And Paucity Of Screening Programs.(14,15,51) Pre – Cancerous Lesions Precedes A Majority Of Cervical Carcinoma And May Exist In The Non Invasive Stage For Longer Periods And Shed Abnormal Cells Which Can Be Detected By Exfoliative Cytology Using Papanicoloau Stain (2,14,15). Papanicoloau Smears Remain A Simple Screening Method For Detecting The Precancerous Lesions Of Cervix Inspite Of Limitations Due To Sampling And Preparation Errors. With Effectiveness Of Papanicoloau Cytological Test And The Accessibility Of The Cervix By Colposcopic Examination And Biopsy, The Detection Rate Of Precancerous Lesions Have Improved. In Invasive Carcinoma Of Cervix, Which Are Largely Detected By Biopsies, Cancer Cell Proliferation Greatly Influences The Clinical Out Come Of The Patients. The Available Evidences Indicate That Evaluation Of Cell Kinetic Parameters May Help Surgical Pathologists And Oncologist To Define The Biological Behaviors Of Cancer. A Variety Of Tests Are Available For The Assessment Of Cellular Proliferative Activity. Mitosis Count Has Been The Traditional Method, However It Detects Only Major Differences And Can Be Technically Difficult And Time Consuming. With Flow Cytometry, The Percentage Of Dividing Cells Calculated As The S-Phase Fraction. The Main Disadvantage Is That Specimen Is Destroyed In The Process, Thus Cellular Subpopulations Within The Tumour Or Admixtures Of Normal Cells Cannot Be Evaluated. Immunohistochemical Methods For Cell Proliferation Markers Like Ki – 67, PCNA (Proliferating Cell Nuclear Antigen), DNA Polymerases Can Be Used, But They Are More Complicated And Expensive Than The Silver Stain Used To Show Nucleolar Organizing Regions.(13,15) A Significant Correlation Between The Interphase Agnor (Argyrophilic Nucleolar Organizer Regions) Quantity And Prognosis Has Been Reported In Many Neoplasms Like Carcinoma Breast, Lung, Gastrointestinal Tract, And Hematological Malignancies (1,3,4,5,6,7,8,13,30). There Was A CLOSE CORRELATION BETWEEN THE PROLIFERATIVE BEHAVIORS AND THE QUANTITATIVE AND QUALITATIVE CHANGE OF Agnor (SILVER STAINED NUCLEOLAR ORGANIZER REGIONS) WAS FOUND IN OBVIOUSLY MALIGNANT NEOPLASMS. There Are Also Many Studies Using Agnor Conducted In Preinvasive And Invasive Squamous Epithelial Lesions Of Cervix And Agnor(20,22,2,3,24,27,28,31,32,34,46,48,51,52,54) Proved To Be A Simple Inexpensive And Reliable Proliferation Marker In Lesions Of Cervix. Radiotherapy, Which Is The Main Mode Of Treatment In Carcinoma Cervix. Agnor Proved To Be A Sensitive Marker To Predict The Prognosis Of The Patient Treated With Radiotherapy. In A Rural And Semi-Urban Areas Where Sophisticated Methods Are Not Available, Agnor COUNTS IN CERVICAL SMEARS PROVE TO BE A SIMPLE AND COST EFFECTIVE METHOD IN THE DIAGNOSIS, PROGNOSIS AND FOLLOW UP OF CARCINOMA CERVIX PATIENTS.(16,21,26) The QUANTITY OF INTERPHASE Agnor (SILVER STAINED NUCLEOLAR ORGANIZER REGIONS) IS CONSIDERED AS A PARAMETER OF CELL KINETICS. Nucleolar Organizer Regions (NOR) Are Components Of Ribosomal DNA Located In The Short Arms Of Acrocentric Chromosomes Of 13,14,15,21 And 22 And Transcribe To Ribosomal RNA. NOR’s Vary In Size And Shape According To Nucleolar Transcription. They Are Intimately Related To The Cell Cycle And May Be RELATED TO PROLIFERATION AND PLOIDY.(1,7,18) A Prospective Study Of Carcinoma Cervix With Agnor Is Undertaken To Confirm The Diagnosis Before Radiation To Access The Prognosis At Consecutive Intervals Of 4 – Weeks And 8 - Weeks With Special Attention To The Nucleolar Changes. In Addition, The Recent Literature Regarding Carcinoma Cervix And Value Of Agnor In Diagnosis And Treatment Of Carcinoma Cervix Is Also Reviewed