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PubMed1976

Use of the neonatal mouse in studying long-term effects of early exposure to hormones and other agents.

The neonatal female mouse is considered as a model for studying the long-term consequences of exposure of the human fetus and neonate to hormones and other agents. Parallelism is noted between the results of administration of sex steroids and diethylstilbestrol (DES) to newborn mice and the phenomenon of vaginal cancer in young women whose mothers were given DES for threatened abortion. The progression of the neonatally steroid-treated mouse lesions from persistent vaginal cornification through hyperplastic lesions to tumors is described. The interaction of progesterone with estradiol is considered (lesions are fewer but more severe at 12 months of age following neonatal exposure to a combination of estradiol and progesterone), and the ability of neonatal progesterone treatment alone to result in cervicovaginal lesions in intact mice is emphasized. All steroids result in increased mammary tumor incidence and lowered age of tumor onset in intact mice bearing the mammary tumor virus; both the ovary and the virus are required for these effects. Possible ramifications of early perinatal exposure are indicated in regard to the male, to nongenital structures, to the endocrine system generally, and to immunologic mechanisms.

Animals↗

PubMed1984

Five-year cure of cervical cancer treated using californium-252 neutron brachytherapy.

Female pelvic carcinoma is one of the common malignancies seen at the University of Kentucky Medical Center and often presents in an advanced stage. In 1976, we began to test californium-252 neutron brachytherapy (NT) for its efficacy for control of primary and recurrent advanced uterine, cervix, and vaginal cancers. The first protocol used was 5000-5500 rad of whole pelvis irradiation followed by 1-2 Cf-252 insertions using a single tandem placed in the utero-cervico-vaginal region. Of 27 patients with primary carcinomas treated, 10 are alive and well 5 years later (37%). Two of two recurrent tumors were locally controlled but failed later. These patients had advanced cervical, vaginal, or endometrial carcinomas. In 1977, a transitional year, treatment of only unfavorable stages and presentations with NT was initiated. Similar results were obtained with NT as compared to conventional photon therapy (PT). Further improvement in treatment results can be anticipated as NT brachytherapy is used for advanced cancer therapy by more effective treatment schedules and radiation doses. Cf-252 can be used as a radium substitute and achieved similar rates of tumor control and 5-year survivals.

Adenocarcinoma↗

PubMed2005

[HPV and cancer].

Human papillomavirus (HPV) has been largely demonstrated involved in the pathogenesis of several intraepithelial lesions and cancers. The role of HPV in the carcinogenesis of intraepithelial and invasive anogenital lesions is currently well established, characterized by integrated DNA HPV inside the lesions. HPV genotypes are classified according to their risk of oncogenesis and HPV16 remains the most common and higher oncogenic types. HIV-infected patients have a higher rate of HPV infection with a higher persistence and higher viral loads than general population, which can explain the increasing risk of cancers in such patients. However, independently of HIV infection, HPV infections seems to be strongly associated with several neoplasms, including head and neck, oral, cervical, anal, vulvar, vaginal cancers and probably some lung cancers. Paradoxically, little information about the immunity role and virological factors involved in the occurrence and outcome of HPV epithelial lesions are currently available, leading to more effective and biological approaches, in this HPV infection setting.

Antiretroviral Therapy, Highly Active↗

PubMed1996

[Current aspects of ovarian carcinoma].

Ovarian cancer is still an unsolved therapeutical problem in gynaecology. Inspite the occasional use of therapies exercising a great strain, the resulting overall 5-year survival is hardly unchanged. Genetic factors are probably involved in the origin of the cancer. Vaginal sonography and CA-125 screening determination have not yet been routinely established. Primary cytoreductive surgery is meanwhile a cornerstone of the treatment of advanced stages of ovarian cancer. In contrast, secondary cytoreduction is restricted to individual cases. For the second line-chemotherapy taxol was introduced. This substance has a new principle of efficacy and can obtain response rates in cisplatinum-nonresponders. An efficient treatment of ovarian cancer can only be carried out by a systemic approach involving immunological and genetic methods.

Chemotherapy, Adjuvant↗

PubMed2006

Long-term risk of invasive cervical cancer after treatment of squamous cervical intraepithelial neoplasia.

Invasive cancer of the cervix after treatment for cervical intraepithelial neoplasia (CIN) is becoming more important, as screening reduces the incidence of invasive disease. The rate of invasive cervical or vaginal cancer following treatment for CIN in UK remains elevated for at least 8 years. The aim of our study was to determine from international data how long this rate remains elevated and whether the rate of invasive disease reflects the rate of posttreatment CIN. The aim was to determine why the rate of invasive disease does not fall. A search of Medline and a secondary search of cited references identified 1,848 articles referring to the success rate of the treatment of CIN. Only 26 cohorts from 25 articles met all the inclusion criteria. The policy in these was to perform at least annual smears. After the first year following treatment for CIN, the rate of invasive disease remained about 56 per 100,000 woman years until at least 20 years after treatment. This rate is approximately 2.8 times greater than expected. In contrast, the risk of posttreatment CIN declined steadily with time to about 190 per 100,000 women in the 10th year. Although the posttreatment rate of CIN falls with time, the rate of invasive disease remains static. It seems likely that this is due to diminishing compliance with follow-up. Women should be encouraged to persevere with annual smears for at least 10 years after their treatment as this may offer them the best chance of detecting recurrence at a treatable stage.

Cohort Studies↗

PubMed1999

Intraepithelial neoplasia and early stage vulvar cancer. Epidemiological, clinical and virological observations.

OBJECTIVE: Evaluation of vulvar intraepithelial neoplasia (VIN) and early vulvar cancer risk factor occurrence, frequency, localization and development. STUDY DESIGN: A clinical study carried out on 293 women aged 23-76 years with VIN and vulvar cancer stage I and in a control group of 115 cytologically and colposcopically negative women. METHODS: Clinical, colposcopic and morphological evaluation of the localization of VIN and vulvar carcinoma stage I concomitant with intraepithelial neoplasia in other parts of the lower genital tract. Anamnestic inquiry regarding risk factors. In situ hybridisation technique for HPV detection. Thomson's method for blood serum vitamin A level assessment. RESULTS AND CONCLUSION: An increased frequency of VIN and Ca stage I, especially in young women, has been observed in the past 15 years. In a group of young women under 45 years of age, those lesions were multifocal in 43 cases (63.2%), and unifocal in 25 patients (36.8%). In women over 45 years of age, multifocal lesions occurred in 35 (31.8%), and unifocal in 75 patients (68.2%). HPV infections concomitant with VIN and vulvar cancer stage I occurred in 61.5% of young women and in 17.5% of older females. VIN and stage I vulvar carcinoma coexisted with cervical intraepithelial neoplasia and cervical and/or vaginal cancer in 14 women (7.9%). The risk factor for VIN and early vulvar carcinoma occurrence in young women was different than in older patients. Long-term follow-up of VIN 1 and VIN 2 showed that in over 1/3 of cases the lesions were persistent or recurred after a transient remission. Progression depended not only on dysplasia stage, but also on histological pattern.

Adult↗

PubMed2001

[Primary lymphoma of the vagina].

Primary vaginal non-Hodgkin's lymphomas (NHL) are rare, and are clinically difficult to differentiate from inflammatory diseases or vaginal cancer. Here, we present such a case in a 74-year-old woman complaining of fever and difficulty with urination. Pelvic examination revealed a tumor involving most of the vaginal wall, and pelvic MRI demonstrated vaginal wall thickening. A biopsy of this lesion confirmed NHL (diffuse large B-cell lymphoma), and the patient was admitted. Abdominal CT and MRI detected a vaginal tumor, and Ga scintigraphy confirmed accumulation in the pelvis, but no abnormalities were seen in other areas. Therefore, the patient was diagnosed as having NHL at clinical stage IB with low-intermediate risk (international prognosis index) (LDH 1,309 IU/L). The patient underwent three courses of CHOP therapy followed by radiotherapy, and complete remission was achieved. Primary vaginal NHL often affects women younger than 50 years of age, and abnormal hemorrhage is the initial symptom in many cases. There have been a number of reports of long-term survival following appropriate early chemotherapy and radiation therapy, suggesting that early diagnosis and treatment based on vaginal biopsy findings greatly influence the prognosis.

Aged↗

PubMed1993

Treatment of vaginal dysplasia with loop excision: report of five cases.

Five patients with vaginal intraepithelial neoplasia were treated with loop electrosurgical excision procedure on abnormal tissue under general anesthesia; there was no intraoperative or postoperative morbidity. Surgery was performed rapidly and with no blood loss. Pathologic specimens were adequate in all cases; one unsuspected invasive vaginal cancer was found. Further study of this technique seems warranted.

Adolescent↗

PubMed2004

Estrogen and combined hormone therapy for women after genital malignancies: a review.

This review summarizes information regarding estrogen therapy (ET) and hormone therapy (HT) for women with endometrial cancer as well as other gynecologic malignancies. The cumulative experience from 4 case-control studies consists of 537 affected women. Of the 228 patients who received estrogen therapy, 3.5% developed recurrences as opposed to 16.5% among the 309 women receiving no therapy. Administration of ET at an early stage of disease is therefore appropriate if a few conditions are fulfilled. The impact of estrogen on other gynecologic malignancies is not as evident. As to ovarian cancer, the information on hormone employment is scantier and derives mainly from statistical analysis of data on healthy users of estrogen alone or combined with progestin. Several age-matched, case-control studies and 4 meta-analyses disclosed a higher rate, though not significant, of the later development of ovarian cancer among hormone users. Focusing on patients with disease, 2 trials conducted so far have failed to demonstrate any change in survival or mortality from ET or HT. It is agreed, however, that the histologic type of the tumor is an important factor to consider prior to the initiation of such therapy. The current literature permits ET in most cases of ovarian cancer, but further studies are needed to clearly delineate specific contraindications. Utilizing estrogen compounds has no bearing on risks of later developing squamous cell carcinoma of the cervix, or tubal, vulvar or vaginal cancer. Those conditions do not seem to contraindicate later employment of ET or HT. A previous history of cervical adenocarcinoma, however, definitely prohibits the use of these hormonal regimens.

Adenocarcinoma↗

PubMed2006

Neoadjuvant chemotherapy in gynecological cancers.

Neoadjuvant chemotherapy in gynecological cancers is an approach that is shown to have positive effects on survival. It increases the rate of resectability in ovarian and cervical cancers and thus contributes to survival. However, there are studies reporting that despite increasing operability, the approach does not make any changes in terms of survival. Nevertheless, no negative effects have been reported in studies conducted till today. Prospective and randomized well-designed studies that encompass a high number of cases and parameters, including cost-effectiveness, are needed in both types of cancers. Until the results of such studies are obtained, neoadjuvant chemotherapy may be taken into consideration as an alternative when conventional methods do not suffice. The number of studies concerning endometrial, vulvar and vaginal cancers are few in the area of neoadjuvant chemotherapy.

Adult↗

PubMed1979

[Carcinoma in situ of the uterine cervix: treatment (author's transl)].

Persisting dysplasias are nothing but carcinomas in situ with special differentiation. As such they become directly invasive and are differently located as classical carcinomas in situ. Intraepithelial lesions arise in clearly defined fields and do not spread into neighbouring epithelia. Most lesions are located within the cervical mucosa and less frequent in the region of original squamous epithelium. Treatment must be based on the knowledge of changes being truly intraepithelial and upon their extent. When primarily extirpating the uterus such knowledge is not available. Of 160 cases of primary hysterectomy two patients died of cancer. Vaginal hysterectomy produced better results than the abdominal. Electrocoagulation, cryosurgery and laser treatment destroy lesions without exact knowledge of their extent. Conisation combined with careful sectioning of specimen gives the best survey of the lesions. Of 1 219 conisation cases conisation was the only therapy in 918 patients. None of these died of cancer.

Carcinoma in Situ↗

PubMed2007

Positron emission tomography imaging for gynecologic malignancy.

PURPOSE OF REVIEW: The utility of positron emission tomography (PET) in gynecologic malignancy has increased rapidly in recent years. This review examines publications in this area. RECENT FINDINGS: PET scans are mostly performed using 18-fluorodeoxyglucose (FDG-PET). It is valuable in primary staging of untreated advanced cervical cancer, for posttreatment unexplained tumor marker elevation and restaging of potentially curable recurrent cervical cancer. Its value in early-stage cervical cancer is limited. In ovarian cancer, sequential imaging predicts response to neoadjuvant chemotherapy and survival. It also provides benefits when increases in serum CA 125 or computed tomography/magnetic resonance imaging defined recurrence is noted but biopsy deemed infeasible. A few studies have shown that FDG-PET may facilitate optimal management of endometrial cancer, especially for posttherapy surveillance and after salvage therapy. FDG-PET is potentially useful in selected gestational trophoblastic neoplasia by monitoring response and localizing viable tumors after chemotherapy. Scanty studies have been reported in vulvar and vaginal cancer. The methodology and prospects of using integrated PET/computed tomography in the management of gynecological cancer are discussed. Other PET compounds are briefly introduced. SUMMARY: The role of PET or PET/computed tomography has evolved from a diagnostic tool into a potential indicator of response to treatment and prognosis. Evaluating this tool by clinical impact is an attractive end point.

Endometrial Neoplasms↗

PubMed1985

Carcinoma of the vagina. A case report and review of the literature.

The clinical details of a case of primary carcinoma of the vagina are described. The literature on the management of vaginal cancer is reviewed. Treatment must be individualized and planned according to the location and stage of the primary tumour. All patients treated for malignant lesions of the vagina must be followed up for life with regular pelvic and vaginal cytological examinations.

Carcinoma, Squamous Cell↗

PubMed1989

The value of CT scanning in the management of patients with gynecologic malignancies.

The management of gynecologic malignancies is exceedingly complex, requiring thoughtful coordination of surgery, radiation therapy and chemotherapy. Despite the fact that the natural history and clinical course of these cancers are generally well understood, the scarring caused by surgery and/or radiation, and the marked limitations of pelvic examination make clinical staging and evaluation of limited value and known inaccuracy in following women with ovarian, cervical, uterine, vulvar and vaginal cancers. Understandably, the development of computerized axial tomography (CT), and its ability to visualize the abdomen and pelvis, lead to rapid acceptance of CT scans in defining extent of cancer and following patient response to various therapeutic interventions (Chen et al. 1980; Feigen et al. 1987; Photopoulos et al. 1977). Authors have compared the accuracy of CT findings with physical examination, surgical findings, lymphography, conventional radiography or ultrasound (Clarke-Pearson et al. 1986; Vercamb et al. 1987; Amendola 1981; Kerr-Wilson et al. 1984). However, little has been written on the effect of CT scanning on patient management. If we define and accept the accuracy of CT scanning in detecting pelvic and abdominal disease, can we show a benefit in patient management? Or, does CT scanning provide us with expensive information, or misinformation, which fails to translate into better patient care. Do complex imaging modalities compliment thorough examination and experienced clinical judgement, or only duplicate findings and provide extraneous information? To answer these questions, eighty-one months experience in using CT scanning in managing patients with gynecologic malignancies was reviewed.

Biopsy↗

PubMed1990

Human papillomavirus DNA in invasive carcinoma of the vagina.

The presence of human papillomavirus (HPV) DNA in invasive carcinomas of the vagina, in their lymph node metastases, and in corresponding normal tissue was investigated by Southern blot hybridization with 32P-labeled HPV DNA. Tumor tissue from ten of 18 patients with vaginal carcinoma contained HPV DNA. Three of the 18 patients had a history of cervical neoplasia more than 14 years before the diagnosis of vaginal carcinoma. Five of 15 primary squamous cell carcinomas, one primary adenocarcinoma, and a vulvar recurrence of a vaginal squamous carcinoma contained HPV 16. A primary squamous carcinoma yielded HPV-related sequences. The HPV copy number varied from 0.5 to 50 per cellular genome. Four histologically positive inguinal lymph nodes from three patients contained HPV DNA. In six tumor-free control tissues from four patients, no HPV DNA was detected. No relationship was established between HPV positivity, HPV type, or copy number of the tumor and the grade of differentiation or keratinization or the clinical stage. After a median follow-up of 13 months, five of nine HPV-positive patients were alive without recurrence, whereas all seven HPV-negative patients had died because of disease. The results of this study indicate a possible major role of HPV in the development of vaginal cancer.

Adult↗

PubMedDate not supplied

Clinical value of squamous cell carcinoma antigen (SCC-A) in Egyptian gynecologic cancer patients.

Squamous cell carcinoma (SCC) antigen levels were measured by immunoparticle assay (IMx) in the sera of 32 patients with gynecologic malignancies, 15 with benign diseases of the genital system and 14 normal healthy controls. At a cut-off value of 4.8 ng/ml (100% specificity), the rate of SCC antigen elevation was 100% in vulvar and vaginal cancer (n = 5), 90% in ovarian cancer (n = 10), 60.0% in endometrial cancer (n = 10) and 57.2% in cervical cancer (n = 7). The benign disease's group had 80.0% false positivity at the same cut-off value. Serum SCC-A was found to correlate directly with the clinical stage of disease. A sensitivity of 73.3% was obtained at stage I which gives SCC-A a role in screening the high risk population for gynecological cancer. Concerning the histopathologic type of tumor, serum SCCA was highly sensitive in SCC tumors, in ovarian serous cystadenocarcinoma and in patients with recurrent ovarian cancer.

Adolescent↗

PubMed2004

Vaginal metastasis and thrombocytopenia from renal cell carcinoma.

BACKGROUND: Vaginal cancer represents approximately 1-2% of genital tract malignancies. Most cases represent metastasis from the cervix, endometrium, or colon. Metastasis of renal cell carcinoma to the vagina is extremely rare. CASE: A 58-year-old female presented with a bleeding vaginal lesion. Laboratory studies revealed severe thrombocytopenia, and radiological studies revealed a left renal mass; excision was consistent with metastatic renal cell carcinoma. A subsequent nephrectomy confirmed renal cell carcinoma. Postoperatively, the patient underwent immunotherapy and the thrombocytopenia resolved. CONCLUSION: We report the first case of metastatic renal cell carcinoma presenting as a vaginal metastasis with thrombocytopenia as a paraneoplastic manifestation. Renal cell carcinoma must be in the differential diagnosis of a clear cell neoplasm in a postmenopausal woman, particularly with systemic symptoms suggestive of a paraneoplastic syndrome.

Carcinoma, Renal Cell↗

PubMed2004

Production of antimicrobial substances by lactic acid bacteria I: determination of hydrogen peroxide.

Restoration of the balance of different ecological niches has been proposed as a way to control the income of pathogenic microorganisms. The genus Lactobacillus has been used in different human and animal tracts as probiotic microorganisms with this objective in mind. The characteristics of the strains proposed as probiotics have been published or patented under the process of elaboration of different types of products. One of the mechanisms suggested to control the vaginal ecosystem is the production of antagonistic substances (lactic acid, bacteriocins, or H2O2). The H2O2-producing microorganisms present in the vagina of healthy women have been suggested as some of the bacteria responsible for maintenance of ecological balance, mainly in pregnant women. The absence of these microorganisms is related to a higher risk of: bacterial vaginosis, recurrent urinary tract infections by Escherichia coli, and acquisition of human immunodeficiency virus type 1 (HIV-1). Bauer has proposed that H2O2-producing lactobacilli also might exert control over vaginal cancer through specific interactions of reactive oxygen species, such as superoxide anion, hydroxyl radicals, and hypochlorous acid. The conversion of H2O2 into more toxic compounds during the oxidative process is potentiated by peroxidase and halures. This enzyme and some halures, such as chloride and bromide, are present in vaginal washes in sufficient amounts to allow an optimal environment for successful inhibition of pathogens. In vitro tests provide an approach for determining the ability of lactobacilli to produce H2O2. The H2O2 amounts produced in such systems are probably not a direct reflection of what happens in the vaginal tract of women or animals, which is not yet know. However, there is a registered patent with an H2O2-generating L. crispatus strain, also supporting the use of H2O2-producing lactobacilli to restore the vaginal ecosystem.

Anti-Infective Agents↗