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L Elit

Publications and source records attributed to L Elit.

14 recordsLinked to original sources
PubMed2001

Cutaneous metastasis of papillary serous uterine cancer.

BACKGROUND: Cutaneous metastases from uterine cancer are uncommon. They usually indicate the aggressive nature of the underlying disease. CASE: A 65-year-old patient presented with stage 3 papillary serous carcinoma of the uterus. Eight months after surgery and pelvic radiation therapy, this patient presented with cutaneous metastases. A single cobalt field was used on three occasions over the next 9 months to provide symptomatic control of the abdominal and vulvar cutaneous metastases. CONCLUSIONS: This is the first case report of cutaneous metastases from papillary serous cancer of the uterus. Cutaneous metastases were the first indication of unsuspected occult disease. Palliative local radiation has a useful role in controlling symptoms like pruritus.

Aged↗
PubMed2001

Weekly intravenous methotrexate with folinic acid for nonmetastatic gestational trophoblastic neoplasia.

OBJECTIVE: The objective of this study was to determine the complete response rate to weekly intravenous methotrexate at 100 mg/m(2) with folinic acid for patients with nonmetastatic gestational trophoblastic neoplasia. METHODS: From 1988 to 1999, 22 women with nonmetastatic gestational trophoblastic neoplasia were treated with weekly intravenous methotrexate with folinic acid at the Hamilton Regional Cancer Centre. Complete response was defined as the attainment of a serum beta-hCG level <5 IU/L for 3 consecutive weeks. Toxicity was graded according to the National Cancer Institute of Canada-Clinical Trials Group criteria for chemotherapy toxicity. RESULTS: There were 10 women who achieved complete response with weekly intravenous methotrexate alone (45.5%). Of the 12 who did not achieve complete response with methotrexate, 10 received actinomycin D and 2 received EMA as second-line chemotherapy. Patients successfully treated with methotrexate required a median of 6.5 cycles (including 2 cycles for consolidation) to achieve complete response. The only significant prognostic factor for failure with methotrexate was pretreatment beta-hCG (P = 0.01). CONCLUSIONS: Only a select group of patients with low pretreatment beta-hCG titers would be expected to achieve complete response with this regimen. Large randomized studies are required to determine the optimal treatment for nonmetastatic gestational trophoblastic neoplasia.

Adult↗
PubMed2001

Familial ovarian cancer.

OBJECTIVE: To assist family physicians in evaluating patients' risk for hereditary ovarian cancer and to review strategies for preventing ovarian cancer. QUALITY OF EVIDENCE: The MEDLINE, EMBASE, CANCERLIT, and CINAHL databases were searched from 1970 to 1999 using key words related to hereditary ovarian cancer, screening, oral contraceptives, prophylactic oophorectomy, cancer worriers, satisfaction, and perceived risk. Recommendations in this paper are based on evidence from case-control and cohort studies and, where appropriate, consensus conferences. MAIN MESSAGE: Of all women who present with ovarian cancer, 20% have a family history of ovarian cancer and 8% carry a BRCA 1 or BRCA 2 mutation. Women who carry a BRCA 1 mutation have a 63% lifetime risk of developing ovarian cancer, and women who carry a BRCA 2 mutation have a 27% lifetime risk of developing ovarian cancer. Preventive strategies include screening (level 3 evidence for postmenopausal women and level 5 evidence for women with a family history of ovarian cancer), use of oral contraceptives (level 3 evidence for the general population and for mutation carriers), and prophylactic oophorectomy (level 3 evidence in first-degree relatives of patients with breast or ovarian cancer). CONCLUSION: Women who have a family history of ovarian cancer should be offered genetic counseling and discussion of various preventive strategies for minimizing their risk.

Adult↗
PubMed2000

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Journal Article↗
PubMed2000

Is uterine papillary serous adenocarcinoma a manifestation of the hereditary breast-ovarian cancer syndrome?

BACKGROUND: Uterine papillary serous carcinoma (UPSC) shares common pathologic, genetic, and clinical features with other serous cancers of müllerian origin. The most common histologic type of ovarian tumor associated with BRCA mutations is papillary serous. Because of these histologic similarities, we postulated that, in some cases, UPSC may be a manifestation of a field defect in BRCA1 carriers, which also includes ovarian carcinoma, fallopian tube carcinoma, and primary peritoneal carcinoma. METHODS: Fifty-six living patients with UPSC were contacted through their treating physicians and agreed to a family history interview and to provide a blood specimen for BRCA testing. The protein truncation test was used to detect mutations in exons 10 and 11 of BRCA1 and in exon 11 of BRCA2. The presence of four common mutations was assessed by PCR-based specific assays. RESULTS: A high proportion of patients had a past history of breast cancer (11%) or a first-degree relative with breast cancer (29%). Four patients were from families with site-specific hereditary breast cancer. However, there was no clear example of the hereditary breast-ovarian cancer syndrome, and none of the 56 patients was found to carry a BRCA1 or BRCA2 mutation. CONCLUSIONS: BRCA mutations do not appear to predispose to UPSC and this type of cancer does not appear to be a manifestation of the classical hereditary breast-ovarian cancer syndrome. The observed association between UPSC and breast cancer may be due to the presence of mutations in other cancer predisposing genes.

Adult↗
PubMed2000

Novel strategies for systemic treatment of endometrial cancer.

The median survival of women with advanced or recurrent endometrial cancer is less than one year. Of the women with early stage endometrial cancer and poor prognostic factors like high grade or deep myometrial invasion, 40% will recur. Over the last decade, incredible strides have been taken in evaluating systemic therapy for this disease, however, survival rates remain poor. Progestin therapy offers a 10 - 20% response rate and survival of less than one year. Progestins are most effective in women with well-differentiated tumours and long disease-free interval. There is no role for adjuvant progestin therapy in early stage disease. Single-agent chemotherapy with most activity include ifosfamide, cisplatin/carboplatin, doxorubicin and paclitaxel. Combination chemotherapy provides a response rate of 40 - 60%, however, median survival is still less than a year. New areas of research include the identification and evaluation of new active endocrine therapies (i.e., LY-353381.HCl and letrozole), chemotherapeutics (i.e., paclitaxel), evaluating chemotherapeutic agents in combination (i.e., paclitaxel, doxorubicin and platinum), in addition to radiation or instead of radiation. New avenues under development involve the specific molecules and pathways responsible for the initiation and growth of endometrial carcinoma (i.e., Herceptintrade mark). Exciting developments in the understanding of the molecules involved in tumour development and metastasis will allow the development of specific and selective inhibitors.

Antineoplastic Agents↗
PubMed2000

Endometrial cancer. Prevention, detection, management, and follow up.

OBJECTIVE: To review risk factors for uterine cancer; to discuss strategies for detecting uterine cancer; to outline prognostic factors and treatment; and to review the role of follow up for patients who have completed primary therapy. QUALITY OF EVIDENCE: MEDLINE was searched from January 1996 to June 1998 using the terms endometrial neoplasms, estrogen replacement therapy, hormone replacement therapy, tamoxifen, and screening. Only English language articles were reviewed. Study types included reviews. Bibliographies of articles found were searched for further relevant titles. Causation literature is available from well conducted cohort trials. Treatment recommendations are based in part on prognostic information and a few randomized controlled trials. MAIN MESSAGE: Risk factors, both intrinsic and extrinsic, are associated with uterine cancer. Family physicians have a role in preventing disease by ensuring that all women with uteri in situ using hormone replacement therapy (HRT) have progesterone therapy as part of the HRT regimen. Detection is crucial; abnormal uterine bleeding or undiagnosed postmenopausal bleeding warrants investigation with endometrial biopsy. The goal of surgery is to remove the uterus and ovaries and identify factors that make the disease at high risk of recurrence. Although adjuvant radiation therapy does not prolong survival, it does alter the pattern of disease recurrence. The goal of follow up after primary therapy is to identify recurrent disease while it is still curable. CONCLUSIONS: Family physicians play an important role in preventing uterine cancer, initiating early diagnosis of disease, and in the future, might be more actively involved in caring for patients following primary therapy.

Adult↗
PubMed1999

An endodermal sinus tumor diagnosed in pregnancy: case report and review of the literature.

OBJECTIVE: The use of chemotherapeutic drugs in pregnancy is a rare occurrence. Experience and results need to be shared. METHOD: At 23 weeks gestational age, a patient was diagnosed with an endodermal sinus tumor of the ovary. She received one course of postoperative bleomycin, cisplatin, and etoposide. One week later, the patient was investigated for increasing abdominal pain and the fetus was noted to have ventriculomegaly. RESULTS: The baby was delivered, and the patient was surgically staged and completed chemotherapy. Although the patient is alive and well 16 months after delivery, the infant has developed significant ventriculomegaly with cerebral atrophy. CONCLUSION: The etiology of this infant's significant cerebral atrophy is not clear. Tumor-specific, perioperative, or drug-related events must be considered.

Adult↗
PubMed1994

High-dose methotrexate for gestational trophoblastic disease.

Eighty patients with low-risk and 5 patients with intermediate-risk gestational trophoblastic neoplasia (GTN) (WHO classification) were treated with single-agent high-dose methotrexate with folinic acid rescue (MTX/FAR). By the NCI classification, 65 patients had nonmetastatic GTN, 13 patients had low-risk metastatic GTN, and 7 patients had high-risk metastatic GTN. Seventy-one (84%) patients achieved remission (beta HCG < or = 5 IU/liter) with MTX/FAR, whereas 14 (16%) failed to achieve remission with MTX/FAR alone. All failures were salvaged with second-line therapies. Patients successfully treated with MTX/FAR required a median of 4 courses to achieve remission, and a median of 2 consolidative courses. Factors found predictive of failure with MTX/FAR were pretreatment beta HCG (P = 0.003), prior history of GTN (P < 0.04), and time from termination of antecedent pregnancy to initiation of treatment (P < 0.05). No significant difference was noted between the "success" and "failure" groups with respect to MTX dose or infusion time, the timing and dosage of folinic acid rescue, the number of courses of MTX, or the mean interval between courses. Multivariate analysis revealed that the pretreatment beta HCG (P < 0.01) and short time from termination of antecedent pregnancy to initiation of treatment (P < 0.03) were independently significant for failure. No significant (grade 3/4) hematologic or gastrointestinal toxicity occurred, and no treatment delays or dose reductions were required. This regimen is both effective and well tolerated; however, the theoretical advantages of high-dose methotrexate do not appear to offer any clinical advantage over conventional dose MTX in low- and intermediate-risk GTN.

Biomarkers, Tumor↗
PubMed1992

Delayed delivery of second twin: report of four cases and review of the literature.

In four cases of delayed delivery of a twin pregnancy with survival of the second twin, the interval ranged at 41-143 days. Review of the literature and our cases supports the following approach: high ligation of the umbilical cord with an absorbable suture, cervical suture in the presence of cervical dilatation, and serial monitoring of fetal growth and maternal coagulation indices. Disseminated intravascular coagulation has not been reported in such cases.

Delivery, Obstetric↗
PubMed1989

Splenic cyst carcinoma presenting in pregnancy.

A case report of squamous cell carcinoma in an epidermoid cyst of the spleen is diagnosed in a pregnant female. Elaboration on the clinical, radiological, and pathological findings is presented to emphasize the distinguishing features of benign and malignant cysts.

Adult↗
PubMedDate not supplied

A unique BRCA1 mutation identified in Mongolia.

This is a case report of genetic assessment conducted on a family residing in the third world where two sisters have presented with early onset ovarian cancer. Protein truncation testing and DNA sequencing identified a unique mutation on exon 11 (3452delA) of the BRCA1 gene. Buccal swab testing of three siblings and three offspring showed that half of the family members carried the same mutation. Currently, genetic testing in third-world countries is conducted within research budgets, as testing is not affordable or locally available for such high-risk families. Unique mutations in the BRCA1 gene that are expressed in geographically isolated groups will be useful in genetic counseling and preventative maneuvers. The only preventive management strategy available in the third world is prophylactic surgery.

Adenocarcinoma↗
PubMedDate not supplied

Combined analysis of cervical smears. Cytopathology, image cytometry and in situ hybridization.

This study was an attempt to correlate the Bethesda System of Papanicolaou smear classification with DNA content by image analysis and the presence of human papillomavirus (HPV) as determined by in situ hybridization. DNA histograms were classified as normal diploid, diploid proliferative, polyploid and aneuploid. HPV in situ hybridization was performed with a cocktail of probes specific to HPV types 6, 11, 16 and 18. There was a good correlation between normal cytology and normal DNA histograms. Cytologically normal smears with bacterial or fungal infections showed a high proliferation index. HPV infection correlated with DNA polyploidy but was seen in 15 of 29 smears classified as cytologically normal. Morphologically abnormal Papanicolaou smears correlated with aneuploid DNA content. Smears classified as intraepithelial neoplasia correlated with aneuploid DNA content in all 12 cases. Four of five cases cytologically suspicious for HPV infection had HPV by in situ hybridization.

Aneuploidy↗