Biomedical subjects
Publications and source records attributed to H R Barber.
It would appear that, stage-for-stage, the cure rate has not improved in the treatment of carcinoma of the cervix in the last four decades. However, the overall survival rate has improved, and this has been due to the number of cases that have been diagnosed at an earlier stage. It is obvious that new methods must be explored for the treatment of carcinoma of the cervix.
A survey of the literature over a 30-year period suggests that exenteration operations have not been widely accepted or perhaps not commonly reported except in the United States. Even in the United States, the series reported are usually of very small numbers. The reasons for this are difficult to explain except to say that the most widely indicated factor is carcinoma of the cervix and this has been decreasing in incidence as far as the more advanced stages are concerned. It is being detected at an earlier stage with a greater chance for cure without recurrence. Endometrial and ovarian cancer have been on the increase, with endometrial cancer being diagnosed early with excellent results and ovarian cancer occurring in an advanced stage with a presentation that does not lend itself readily to radical pelvic surgery. It must be stated that in cases where pelvic exenteration is indicated, and these are highly selective ones, there is no other equally curative form of therapy that exists for the distressing problem of recurrent pelvic cancer. With the new stapling techniques and the use of clips along the pelvic wall to control bleeding from the blood vessels in this area, it is possible to perform a pelvic exenteration with much less blood loss and in considerably less time than previously. The improved methods of monitoring these patients with a Swan-Ganz catheter and a better understanding of the metabolic and physiologic process has reduced the mortality rate to less the 5%. Having given these patients a quantity of life, it is important to give them a quality of life. These patients should be rehabilitated and, if needed, a vagina should be reconstructed and the patient encouraged to lead a normal life. Perhaps these patients cannot be described as happy, but at least given a second chance for life they can become well adjusted and make significant contributions to their family and the community.
Early diagnosis is the most effective means of reducing the currently high mortality rate associated with ovarian cancer. A better informed public and profession is aiding in this campaign. The palpation of what appears to be a normal-sized ovary in a premenopausal woman suggests an ovarian tumor in a postmenopausal woman. It is becoming obvious that ovarian cancer is a disease that affects the gastrointestinal tract, and physicians treating ovarian cancer should be prepared to deal with bowel-associated problems. The practice of tapping women with ascites for diagnosis as well as doing an exploration merely to obtain a biopsy should be discouraged. Unless the physician is prepared to carry out the optimal surgical approach for the patient, it is crucial that the patient be referred to either a center or to a physician who is actively engaged in the day-to-day care of cancer patients. Tumor markers such as CA125, alpha-fetoproteins, and human chorionic gonadotropin have been of help in monitoring the management of ovarian cancer. One of the most exciting areas of gynecologic oncology is the effort being made to diagnose ovarian cancer with immunologic techniques as well as treating the patient with immunotherapy. These methods promise a hope for early diagnosis and a method to control the disease without destroying a great deal of normal tissue. With the combined use of all the available treatment methods, patients with ovarian cancer are now living longer and more comfortably.(ABSTRACT TRUNCATED AT 250 WORDS)
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Ovarian cancer is the leading cause of death from gynecological cancer in the United States. Early diagnosis is a matter of chance rather than a scientific method. Although it is stated that there are no symptoms in the early stage of ovarian cancer, a careful history often reveals vague gastrointestinal symptoms that have been persistent. Surgery is the treatment of choice for ovarian cancer, with chemotherapy employed as adjunctive therapy. Radiation therapy has limited application in treating common epithelial cancers but is valuable in the management of germ cell and gonadal stromal tumors. Of the numerous laboratory tests available, only immunologic assay appears to have the potential for making an early diagnosis and monitoring treatment.
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In dealing with ovarian tumors in children, the gynecologist must use the same principle of assessing operability as those used for adults. This approach offers the maximum opportunity for successful treatment. The ancient medical philosophy of not inflicting harm if one cannot achieve good is especially applicable to children with ovarian cancer. It is better for a child to die at home in the loving care of her parents than alone in a cold, forbidding hospital room. There are certain characteristics that distinguish ovarian tumors in childhood from that in adults: (1) Limited space for tumor expansion. (2) A high degree of virulence in cancer. (3) A less effective immunologic response. (4) The possibility that therapy may affect future physical and emotional development.
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All vertebrates have a defense mechanism, the immune defense system, that protects them from disease-causing microorganisms. Its deliberate exploitation has conquered many infectious diseases and has been a major achievement of medical science in preventing suffering and saving lives. At the beginning of this century, hope was held that dissimilarities between normal and neoplastic cells could be demonstrated by immunologic methods and that vaccination against cancer might become possible. When it was recognized that the many claims of tumor=specific antigenicity were based on experiments in which an immunity to normal alloantigens, rather than tumor-specific antigens, had been demonstrated, the field of tumor immunology came into disrepute. The work of Gross in 1943 and Prehn and Main in 1957 rekindled interest in tumor immunology. Many contributions have advanced the concept of tumor immunology. They are the following: (1) an abundant supply of highly inbred (syngeneic) animals; (2) extensive work on experimental transplantable tumors; (3) an understanding of the mechanism causing rejection of grafted normal and cancerous tissues in animals; (4) identification of the function of the humoral and cell-mediated mechanisms following organ transplantation; (5) the observation that cancers do arouse a specific immune response in the organisms in which they appear; (6) antigenic differences represent the first known qualitative distinction between cancer cells and their normal counterparts; (7) the application of improved technology--columns, use of fluorescein-tagged antibodies, urea as a chaotropic agent, nephelometer; (8) hybridoma to produce a supply of monoclonal antibodies; (9) new vaccines directed against invasive tumors, and (10) the exploration of the role of immune complexes in oncology. The areas of promise and the future of cancer immunology have once again challenged the minds of scientists.
Cancer prevention as related to the problem of cervical and endometrial cancer involves a great number of factors that are considered contributory to the development of neoplasms in the uterus. Lifestyles encouraging the development of cervical cancer are different from those encouraging endometrial cancer. Cancer of the cervix is a disease of the inner city. It is seen in those staring intercourse in their teens, having multiple partners, having many children, and coming from the low socioeconomic groups. Semen and herpes virus II may have an adverse effect on immature cells, but there are no hard data to confirm these roles. Cancer of the endometrium is a disease of suburbia. The American Cancer Society estimates that there will be 38,000 new cases of endometrial carcinoma in 1980, making it the most common female genital cancer. Women at highest risk for later carcinoma of the endometrium are those who have obesity, diabetes, infertility, irregular menses and failure of ovulation, adenomatous hyperplasia, and/or prolonged estrogen administration. For both cervical and endometrial cancers, it is possible to identify the high-risk patient, to detect changes at an early stage, and, by instituting appropriate therapy, to prevent a more serious problem. It is obvious that prevention, detection, and treatment are all closely intertwined. This paper identifies the patient at high risk and makes suggestions for correcting any imbalance that may predipose to the development of invasive cancer.
Microsurgical nonvascularized transplantation of a 1-cm segment of fallopian tube was performed using the rabbit as a model. Autograft experiments showed survival of a 1-cm tubal segment for as long as 10 months postoperatively. Allografts survived equally as well, and one rabbit became pregnant.
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