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The clinical value of serum TPS in gynecological malignancies.

This study included 75 cases; 39 with gynecological cancer of different types, stages, and grades (14 ovarian, 11 endometrial, 9 cervical, and 5 vulvovaginal); 23 patients with benign gynecological diseases and 13 normal healthy controls. Serum TPS was estimated using the ELISA kit supplied by Beki Diagnostic AB, Bromma, Sweden. The results of the present study revealed that serum TPS was significantly elevated in cancer patients followed by those with benign diseases. When the cutoff values were adjusted to 137 and 101 U/L, we obtained sensitivities of 56.4% and 82.1% at specifities of 100% and 85%, respectively. The benign diseases group had false positive rates of 13% and 34.8%, respectively. When considering tumor site, vulvo vaginal cancer showed the highest sensitivity (80%) followed by cervical (66.7%), ovarian (50%), and lastly endometrial cancer (45.5%). Serial measurement of TPS was shown to be of important value in the post-surgical follow-up of cancer patients.

Adolescent↗

[The results of a selective program to detect intraepithelial neoplasms of the vulva].

Early detection and treatment of preinvasive neoplasias decrease the incidence and mortality of the subsequent invasive cancers. This paper presents the results of a selective program to detect vulvar intraepithelial neoplasia (VIN). The program was selective because only "relative high risk" women were included, i.e. women with one or more of the following items: a) age more than 50 years; b) past history of epidermoid cervical or vaginal cancer (included intraepithelial stages); c) past history of genital radiation; d) past or actual history of genital condyloma; and e) past or actual history of hyperplasic or mixed vulvar dystrophy. Detection was made with the test described by Collins et al., staining the vulva with a toluidine blue aqueous solution and decoloring it with acetic acid. All positive sites (areas retaining the blue color) were biopsied under local anesthesia. Histopathology diagnosis served as gold standard for the program's evaluation. Patient with negative tests and those with NIV I were rescreened each 6 months. From March 1984 to September 1986, 212 patients were admitted in this program and 318 tests were performed. Individual tests varied from 1 (105 patients) to 5 (3 patients). The group was followed-up until March 1989, when the program was evaluated. There were 77 positive tests, among them 21 cases of NIV. Three women with NIV I progressed to NIV II during the observation period. NIV cases were classified as: NIV I, 7 cases (33.3%); NIV II, 10 cases (47.7%); and NIV III, 4 cases (19.0%).(ABSTRACT TRUNCATED AT 250 WORDS)

Biopsy↗

Invasive vaginal carcinoma: analysis of early-stage disease.

From 1960 through 1987, 89 patients with stage I (44 patients) or II (45 patients) vaginal carcinoma (excluding melanomas) were treated primarily at the Mayo Clinic. Treatment consisted of surgery alone in 52 patients, surgery plus radiation in 14, and radiation alone in 23. The median duration of follow-up was 4.4 years. The 5-year survival (Kaplan-Meier method) was 82% for patients with stage I disease and 53% for those with stage II disease (p = 0.009). Analysis of survival according to treatment did not show statistically significant differences. This report is consistent with previous studies showing that stage is an important prognostic factor and that treatment can be individualized, including surgical treatment for primary early-stage vaginal cancer.

Adolescent↗

The role of vaginal hysterectomy in the treatment of endometrial carcinoma.

Between 1964 and 1991, vaginal hysterectomy was performed in 60 patients with clinical stage I endometrial carcinoma, who were not considered candidates for the conventional surgical approach. Of these patients, 66.7% were obese with a median weight of 235 pounds. Other risk factors included hypertension (63%), diabetes mellitus (34%), cardiac disease (28%) and pulmonary disease (12%). Operative mortality was 0%. The complication rate was 14%, with four patients requiring transfusions and four patients developing vaginal cuff cellulitis. Forty per cent of patients received adjuvant pre- or postoperative radiation therapy. Crude survival at 5 and 10 years was 91.1% and 87.1%, respectively. However, only one patient died from disease 6 years after primary treatment. Although we consider surgical staging as the standard of care for the treatment of endometrial cancer, vaginal hysterectomy has a definite place in the management of patients with good prognostic criteria who are at high operative risk for the standard surgical approach.

Journal Article↗

Interaction of drugs, hormones, and nutrition in the causes of cancer.

Hormones may act as promoters in the carcinogenic process, and occasionally their metabolites may act as antihormones or have new physiologic effects. Drugs can interact with the endocrine system in many ways. They can promote secretion of a hormone, alter its rate of removal from plasma, change plasma protein-binding characteristics, or modify routes of metabolism. Estrogens have a preparative effect on the uterine endometrium. There are biologic, clinical and epidemiologic reasons for believing that estrogen administration to postmenopausal women increases the risk for endometrial cancer. Although there are similar biologic reasons to associate prolonged estrogenic stimulation with breast cancerr, evidence for such an association is weak. Oral contraceptive use has been associated with a variety of hepatocellular tumors. Although estrogens, per se, can effect several hepatic functions, it seems likely that the 17 alpha-alkyl and 17 alpha-ethinyl functions of the progestins and estrogens are involved in this process. The role of estrogen use during pregnancy in the causation of vaginal cancer in female offspring and the role of androgens in prostate cancer have been discussed.

Anovulation↗

[Standardization of reference points in gynecologic radiotherapy].

It was the intention of the members of the study group to develop a high-accuracy reference point system for remote-controlled afterloading therapy of the uterine and vaginal cancer with high dose rates. This enables comparisons to be drawn between the results obtained in various hospitals. This standardization should be used as a general basis for computer calculation.

Female↗

The case. What should Leah be told?

Fearing that his 18-year-old daughter will value her fertility more than her life, an Orthodox Jewish father implores physicians not to seek her informed consent for surgery for vaginal cancer.

Adolescent↗

[Are there indications for cryogenically preserving ovarian tissue in gynecologic oncology?].

One of the essential goals of ovarian tissue cryopreservation is to preserve the fertility of young women who will be undergoing sterilizing anticancer treatments, as cryopreservation of sperm serves in men. However, maturation of gametes after thawing has not yet been realized in humans and pregnancies have only been obtained in animal models. It is nonetheless possible today to cryopreserve the ovarian tissue of patients who have nothing to lose as their follicular reserve would in any case be destroyed or severely depleted by cancer treatment. In gynecologic oncology, ovarian tissue cryopreservation may be performed when curative or prophylactic ovariectomy must be undergone, or when chemotherapy with high-dose alkylating agents is planned, particularly in cases requiring chemotherapy combined with pelvic radiation. These clinical situations may be encountered in young women and especially in girls with early-onset forms of ovarian, cervical, uterine, or vaginal cancers. These situations, nevertheless, remain rare as gynecological cancers occur most often in the post-menopausal woman.

Cryopreservation↗

Is cytologic screening an effective surveillance method for detection of vaginal recurrence of uterine cancer?

OBJECTIVE: Cytologic screening is commonly used in follow-up of women with uterine cancer to detect vaginal recurrence. The study objective was to assess the efficacy and costs associated with Pap tests in routine surveillance of women with uterine cancer. METHODS: Medical records and pathology databases identified patients with uterine cancer at one institution from 1990 to 2002. Patients with their cytologic follow-up at our institution were selected for a subset analysis of Pap tests to estimate the number of Paps and associated charges and costs during follow-up. RESULTS: Seven hundred seventeen women were diagnosed with uterine cancer; the mean age was 60.9 years and the median follow-up was 46 months. A total of 36 women had a recurrence in the vagina; 31 (86%) were apparent clinically, and only 5 (14%) were asymptomatic and identified by Pap test. Women with grade 1 tumors had decreased risk of vaginal recurrence, with an odds ratio of 0.186 (95% confidence interval 0.49-0.712) on multivariate analysis (stage and histology were not significant factors for vaginal recurrence). A subset of 435 patients received cytologic follow-up at our institution, with a median 3 Pap tests/patient (mean 4.25, range 1-24). Estimates based on our data demonstrate that 430 Pap tests are required to detect one asymptomatic vaginal recurrence, and the addition of the Pap test increases the cost of surveillance by $15,142 per asymptomatic recurrence detected (but a charge to insurance of $23,487). Pap tests identified an asymptomatic vaginal recurrence in only 0.7% of this uterine cancer population. CONCLUSION: Pap tests after diagnosis and treatment of uterine cancer infrequently detect asymptomatic vaginal recurrences and may not be cost-effective. LEVEL OF EVIDENCE: III.

Adult↗

Interstitial brachytherapy in the management of primary carcinoma of the cervix and vagina.

PURPOSE: The purpose of this study was to determine the role of interstitial brachytherapy in the management of selected primary cancers of the cervix and the vagina. METHODS: Thirty-nine previously untreated patients with histologically confirmed carcinoma of the cervix (31 patients) and of the vagina (8 patients) were treated by a combination of external beam radiotherapy and fluoroscopic-guided interstitial brachytherapy between November 1989 and May 1995 at the Ohio State University Medical Center because they were not suitable for standard intracavitary brachytherapy. Clinical indications for interstitial brachytherapy were extensive parametrial involvement in 22 patients, extensive vaginal involvement in 10, and poor vaginal anatomy in 7. RESULTS: With a median follow-up of 36 months (range 12-66 months), 16 patients (51%) with cervical carcinomas and 5 patients (62.5%) with vaginal carcinomas have experienced local control of their tumor. The local control was better for tumors < 4 cm in largest diameter compared to tumors > 6 cm in largest diameter. The 5-year actuarial survival was 34 and 38% for cervical and vaginal cancers, respectively. Only 1 patient experienced grade 3 complications (2.5%). CONCLUSIONS: Interstitial brachytherapy can be safely used to treat patients unsuitable for standard intracavitary brachytherapy. When intracavitary dose distribution is expected to be suboptimal, interstitial brachytherapy is a good alternative.

Adenocarcinoma↗

Primary invasive and in situ vaginal carcinoma. Flow cytometric analysis of DNA aneuploidy and cell proliferation from archival paraffin-embedded tissue.

Eleven invasive and five non-invasive primary vaginal carcinomas were studied by DNA flow cytometry using archival paraffin-embedded tissue as starting material. Overall frequency of DNA aneuploidy in the invasive carcinomas was 8/11 (73%). DNA aneuploidy occurred in all four advanced stage (III-IV) and in 4/7 (57%) of the early stage (I-II) carcinomas. Among the squamous cell carcinomas aneuploid DNA content was also associated with non-keratinizing tumor type. Invasive vaginal carcinomas showed a high median S-phase fraction (SPF) (18.4%, range 6.9-31.8%). High SPF values were associated with advanced stage and non-keratinizing tumors. Corrected 5-year survival rate in invasive vaginal cancer was 44%, with no significant relation to DNA ploidy or SPF. In situ carcinomas were almost as often DNA-aneuploid (3/5, 60%) as the invasive carcinomas and had comparable median SPF value (13.4%, range 5.5-24.6). One in situ carcinoma with a high DNA-index and SPF relapsed, but overall 5-year survival rate was 100%. In conclusion, both invasive and in situ vaginal carcinomas frequently contain DNA-aneuploid stemlines and show a high SPF. Although DNA aneuploidy and high SPF correlate with advanced stage and non-keratinizing tumor type, they do not have much prognostic relevance in vaginal neoplasia.

Aneuploidy↗

Uterine cancer (corpus uteri).

This synthesis of the literature on radiotherapy for cancer originating in the endometrium of the uterus (corpus uteri) is based on 55 scientific articles, including 2 randomized studies, 1 prospective study, and 48 retrospective studies. These studies involve 13597 patients. Endometrial cancer is a radiosensitive cancer. Research findings compiled for the period 1948 to 1954 showed that 69% of the patients could be cured by radiotherapy alone. During the 1970s it was shown that combined radiotherapy and surgery yielded better results. There is agreement that patients at stage I should receive primary surgery. According to the literature, there is controversy about whether patients with poorly differentiated tumors should be given preoperative radiotherapy. Radiotherapy alone can be used successfully in patients who are inoperable because of age, general condition, or advanced spread of cancer. Vaginal postoperative radiotherapy is used in most patients and reduces the percentage of patients who develop vaginal metastases from 7%-20% to less than 1%. Patients with good prognostic factors have such a low risk for metastasis that withholding radiotherapy may be considered in this group. Postoperative external radiotherapy improves survival in patients with unfavorable prognostic factors, such as deep myometrium invasion or signs of node metastasis. Radiotherapy is delivered, in principle, to all patients with poorly differentiated disease. It can be expected that most cases of endometrial cancer will continue to be referred for some form of radiotherapy.

Brachytherapy↗

Extraintestinal cancers in inflammatory bowel disease.

The case histories of 1961 patients with inflammatory bowel disease (IBD), 1227 with Crohn's disease (CD) and 734 with ulcerative colitis (UC), have been studied for the incidence of extraintestinal malignant neoplasms. There were 54 extraintestinal cancers in 51 patients: 28 patients with CD and 23 with UC; 25 men and 26 women. There were 9 breast, 7 skin, 15 reticuloendothelial, 11 genitourinary, 3 lung, 3 perianal, 2 pancreatic islet cell, and several miscellaneous cancers. The number of patient-years from the onset of disease to the last date of follow-up was calculated for men and women with each form of IBD. The observed number (O) of neoplasms was recorded. The expected number (E) of neoplasms was derived from the Department of Health, Education, and Welfare (DHEW) incidence figures for the same neoplasms that occurred in a standard age- and sex-matched population. The O/E ratio was then calculated for each type of cancer as well as for the entire series. There were no statistically significant increases in overall O/E ratios of extraintestinal cancers for either CD (0.76) or UC (1.32). On the other hand, several specific types of cancer did appear to occur with a frequency that was significantly greater than expected. These cancers were classified into two groups. The first group included reticuloendothelial neoplasms. There was an excess of leukemias in UC (P less than 0.005) and an excess of lymphomas in both UC and CD (P less than 0.005). The second group included three squamous cell cancers of the perianal region, an incidence 30 times greater than expected, and two squamous cell cancers of the vagina, also in excess of the expected number. Lymphoma, leukemia, and squamous cell cancers have been reported to occur in excess in immunosuppressed or irradiated patients. It may therefore be speculated that the apparently increased incidence of these neoplasms in the patients with ileitis and colitis might be related to immunologic deficiencies associated with IBD, to the long-term administration of steroids or other immunosuppressive medications that were given to most of the patients or, possibly, to increased exposure to ionizing radiation. The apparently increased incidence of perianal and vaginal cancers of the squamous variety might be a consequence of the combined effects of chronic inflammatory disease involving these areas and primary immune suppression.

Adult↗

Primary invasive vaginal carcinoma treated with radiotherapy: analysis of prognostic factors.

Between 1965 and 1988, 125 patients with primary invasive vaginal carcinoma were treated with radiation therapy at the Center of Oncology in Kraków. Twenty-two superficial stage I patients received radium or cesium intracavitary radiation alone. The remaining 11 patients with stage I disease whose lesions were either large or thick and 77 patients with stages II and III were treated with a combination of external irradiation followed by intracavitary brachytherapy. Fifteen patients with stage IVA received external irradiation only. Five-year NED survival was achieved in 42.4% of patients. In the Cox multivariate analysis three variable were independently related to beneficial survival: grade G1 + G2, stage I + II, and age below 60 years. Of 66 patients who died of vaginal cancer, locoregional failure was found in 51 (77.3%), locoregional and distant in 5 (7.6%), and distant only in 10 (15.1%) patients. Late radiation morbidity occurred in 16 (12.8%) patients.

Adult↗

Vaginal intraepithelial neoplasia: diagnosis and management.

A review of 42 patients with vaginal intraepithelial neoplasia (VAIN) seen in Gynecologic Department of Veterans General Hospital-Taipei between 1971 and 1987 was made. The patients were from 36 to 79 years of age with a mean 58 of years. Fifteen patients (36%) had synchronous cervical neoplasia, 26 cases (62%) had antecedent cervical neoplasia and one had undergone operation for uterine myoma. Twenty-four of 27 patients with VAIN alone presented an abnormal Papanicolou smear. The upper one third of the vagina was the most common site of the lesion. Multifocal lesions were demonstrated in 58% cases while unifocal disease accounted for 42% cases who had VAIN subsequent to cervical neoplasia. Colposcopically directed biopsies were used for diagnosis in 13 patients. White epithelium and punctation were the most common findings of VAIN. While the results of different treatments were reviewed, surgical excision was found to be the most frequently employed method and radiotherapy was the second. Both were effective and 5 patients died of vaginal disease. On account of the relatively benign nature of VAIN than that of invasive vaginal cancer and the need for preservation of a functional vagina, more conservative approaches, for example, topical 5-Fluorouracil application and carbon dioxide laser vaporization, are discussed.

Adult↗

Clinical highlights from the National Cancer Data Base, 1999.

The National Cancer Data Base (NCDB), a joint project of the Commission on Cancer of the American College of Surgeons and the American Cancer Society, collects and analyzes data from a wide variety of sources throughout the United States, including small community hospitals. Due to this unique reporting system, individual facilities can compare their own data with the aggregate data from the NCDB, using their findings to evaluate local patient care practices. This article highlights the principal findings of the NCDB and Patient Care Evaluation articles published in 1998 on breast, prostate, cervical, endometrial, gallbladder, head and neck, nasopharyngeal, rectal, thyroid, and vaginal cancers, as well as on melanoma, brain tumors, and Hodgkin's disease. With more than five million cancer cases in the NCDB for the years between 1985 and 1995, sufficient numbers of even rare cancers have been accrued to permit some types of epidemiologic and clinical assessments.

Adolescent↗

The importance of brachytherapy technique in the management of primary carcinoma of the vagina.

This retrospective analysis of 49 cases of primary carcinoma of the vagina treated with radiation therapy alone from 1970-1988 examines the results of treatment with an emphasis on the importance of brachytherapy technique. Thirty-six patients were treated with combined external beam radiation and brachytherapy, 11 patients were treated with external beam alone, and two patients were treated with brachytherapy alone. Brachytherapy techniques used included intracavitary implants, temporary Ir-192 interstitial implants, and permanent I-125 interstitial implants. Intracavitary therapy included the use of a fractionated high dose rate intravaginal cylinder, tandem and ovoids, and a low dose rate intravaginal cylinder. The 5-year actuarial survival was 44% for Stage I (six patients), 48% for Stage II (27 patients), 40% for Stage III (10 patients), and 0% for Stage IVa and IVb (six patients). There was a significant increase in the 5-year actuarial survival for those patients who had brachytherapy as part of their treatment compared to those patients treated with external beam alone (50% vs. 9%) (p < .001). For Stages II and III, there was a trend toward improved actuarial and crude disease free survival with the use of a temporary Ir-192 interstitial implant as part of the treatment compared to the use of intracavitary brachytherapy as part of the treatment (80% vs. 45%) (p = 0.25) and (75% vs. 44%) (p = 0.08), respectively. Brachytherapy plays an important role in the management of primary vaginal cancer. A temporary interstitial implant should be used over an intracavitary form of therapy for more invasive disease.

Adult↗

[Persistent and recurrent gynecologic malignant tumor treated within one year: analysis of 1,753 cases from 61 hospitals in China].

OBJECTIVE: To analyze the causes of persistent and recurrent gynecologic malignant tumors treated within 1 year. METHODS: 20,974 cases of gynecologic malignant tumors from 61 hospitals in 24 provinces admitted between 1983-1993 were collected. Out of the total, 1753 cases treated within 1 year with tumor persistence, recurrence or death were retrospectively analysed. RESULTS: The ovarian carcinoma and vaginal cancer had the highest rates of tumor persistence, recurrence or death. Among the 1587 cases of tumor persistence or recurrence, pathological grading were not performed in 56.52% of the cases. For surgical treatment, inappropriate operation were done in 81.68% (767/939) of the ovarian carcinoma, 64.38% (103/160) of the cervical carcinoma, and 70.08% (89/127) of the endometrial cancer. 55.47% (532/959) of ovarian cancer and 38.31% (59/154) of choriocarcinoma and malignant mole had insufficient chemotherapy. For cervical cancer, 54.90% (235/396) of the cases did not receive enough doses of radiotherapy. CONCLUSION: Accurate staging and standardized therapy are important for improving 1 year survival rate in malignant gynecologic tumors.

Choriocarcinoma↗