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At least 505 records · Page 28Linked to original sources
PubMed2001

High incidence of positive peritoneal cytology in low-risk endometrial cancer treated by laparoscopically assisted vaginal hysterectomy.

OBJECTIVE: Laparoscopically assisted vaginal hysterectomy (LAVH) has evolved into an alternative form of surgical management in the treatment of low-risk endometrial cancer. The purpose of this study was to determine whether low-risk endometrial cancer patients are subject to a higher incidence of positive peritoneal cytology when treated with LAVH compared to total abdominal hysterectomy (TAH). METHODS: We retrospectively reviewed the medical records of patients with low-risk endometrial cancer (grade 1--2 endometrioid type with no evidence of extrauterine spread or grade 3 with <50% myometrial invasion (MI), no cervical or adnexal involvement, and negative lymph nodes when sampled) treated at Memorial Sloan-Kettering Cancer Center from January 1993 to September 1999. We compared 131 patients treated with LAVH to 246 controls who underwent TAH. The two groups were compared for known prognostic factors including grade, MI, vascular space involvement, and lower uterine segment extension. RESULTS: The mean age of patients who underwent LAVH (61 years) was similar to that of the controls (62 years). Fourteen (10.3%) of the patients treated with LAVH had positive peritoneal cytology compared to only 7 (2.8%) of the control population. Factors including FIGO grade, myometrial invasion, and preoperative hysteroscopy did not influence the final results. When stratifying for these factors, the odds ratios of having positive peritoneal washings in those patients treated by LAVH were 5.2, 5.2, and 3.7, respectively. CONCLUSION: Treatment of low-risk endometrial cancer by LAVH is associated with a significantly higher incidence of positive peritoneal cytology. This may be due to the retrograde dissemination of cancer cells into the peritoneal cavity during uterine manipulation. The clinical significance of these findings is yet to be determined.

Adult↗
PubMed2004

Vaginal radical trachelectomy in the treatment of cervical cancer: the role of frozen section.

Vaginal radical trachelectomy (VRT) is a new, alternative surgical procedure to radical hysterectomy for early stage invasive cervical carcinoma in women who desire to preserve fertility. The specimen includes the cervix, parametria, and the vaginal cuff. This study was designed to determine the indications and the best method for evaluating the resection margins of VRT specimens intraoperatively by frozen-section examination. We reviewed 61 VRT specimens planned between October 1991 and January 2002 in our center. A complementary radical hysterectomy is recommended when the tumor extends to within <5 mm of the margin. Of 61 patients, 56 were eligible (5 excluded; 53 VRT and 3 VRT followed by hysterectomy). Of 56 cases, 17 had no macroscopic or microscopic residual tumor. Of 27 cases with a nonspecific macroscopic lesion, more than one-half had no residual microscopic tumor, and the others had minimally (<1 mm) invasive residual carcinoma. In the remaining two cases with a macroscopic tumor, a longitudinal rather than a transverse frozen section was preferred, because it allowed the evaluation of the distance between the tumor and the endocervical margin. We recommend a frozen section, using a longitudinal section, only in those VRT specimens with a grossly visible lesion.

Female↗
PubMed1980

[Vaginal radical hysterectomy with and without systemic extraperitoneal pelvic lymphadenectomy for cervical cancer. A report of 666 patients operated upon between the years 1957 and 1973 (author's transl)].

The report presents 850 patients with cervical cancer operated with vaginal method 1957-1973. Vaginal radical hysterectomy and systemic extraperitoneal pelvic lymphadenectomy were done in 590 patients. A 5 year survival rate in Stage I was 90.4%, in Stage II 76.5%, and in Stage III 72.2%. The 10 survival rate for 462 patients were 86.1, 69.9 and 44.4% respectively. No operative mortality has occurred to date. The incidence of lymph node metastasis in stage I was 9.5%, in Stage II 25.9% and in Stage III 34.9%. The 5 year survival rate of the patients without lymph node metastasis was 88.2% and of those with lymph node metastasis 49.5%. Radical vaginal hysterectomy without the removal of regional lymph node were done in 76 patients. The 5 year survival rate was 86.8%. There was one postoperative death in this series. Vaginal hysterectomy were done in 184 patients. The 5 year survival rate was 92.4%.

Adolescent↗
PubMedDate not supplied

Cytolysis and karyopyknosis in postmenopausal vaginal smears as markers of endometrial cancer, diabetes and obesity. Studies based on a ten-year follow-up.

The vaginal cytology of 507 postmenopausal women was followed prospectively for ten years. Of the subjects, the 207 with cytolytic or karyopyknotic vaginal smears constituted the study group and the 300 with atrophic smears (indicating an absence of estrogenic activity) constituted the control group at the beginning of the follow-up. A woman whose initial smear was cytolytic usually had a cytolytic smear ten years later, which implies that high postmenopausal estrogenic activity is constitutional. Both at the beginning of the study and ten years later, the mean body weights were higher in the study group than in the control group. The mean karyopyknotic index and the prevalence of cytolytic smears were significantly higher among women with impaired glucose tolerance than among subjects with a normal glucose tolerance test. During the follow-up period, 3.6% of the women in the study group and 0.7% of the women in the control group developed endometrial cancer (P less than .02). The incidence of 3.6% of endometrial cancer is significantly higher than the corresponding age-specific incidence (P less than .001). We conclude that obese and/or diabetic postmenopausal women with cytolytic or markedly karyopyknotic vaginal smears exhibit a high intrinsic estrogen activity and may thus be at risk for endometrial cancer.

Diabetes Complications↗
PubMed1992

Role of vaginal surgery in the 1st stage endometrial cancer. Experience of the Florence School.

The role of vaginal surgery in first stage endometrial carcinoma is reviewed. Out of total of 231 patients with endometrial cancer, observed at the Gynecologic Clinic of Florence from 1977 to 1981, 187 were at Stage I and 180 of them were submitted to surgery. During the period 1977-1979, the treatment protocol recommended vaginal hysterectomy; since 1980 abdominal surgery has prevailed. Depending on risk factors, adjunctive radiotherapy was employed. No statistically significant difference was observed in the actuarial survival curves between different surgery routes. However, severe complications and operative mortality was significantly lower in patients operated by vaginal hysterectomy. The vaginal route may be considered an adequate alternative therapy for endometrial carcinoma Stage I.

Adult↗
PubMed2000

A patient with 17 primary tumours and a germ line mutation in TP53: tumour induction by adjuvant therapy?

We report the case history of a woman with a germ line mutation in the TP53 gene who developed 17 separate primary tumours. The incidence of new tumours rose steeply after adjuvant tamoxifen treatment for breast cancer and adjuvant vaginal vault radiotherapy for endometrial cancer. This increase could be due to cumulative genetic damage from environmental agents and the fact that the patient lived to the relatively late age of 60 years, or to a high inherent deleterious somatic mutation rate, which could represent the inability of cells from patients with TP53 mutations to repair therapy-induced genetic damage.

Antineoplastic Agents, Hormonal↗
PubMedDate not supplied

Gynecologic cancers: Part. I--Risk factors.

Gynecologic cancers will account for approximately 81,000 new cases of cancer this year. Although much is known about the risk factors for cervical, ovarian, and endometrial cancers, less is known about vaginal and vulvar cancer risk factors. Generally, risk factors and associations for gynecologic cancers are behavioral, reproductive, hormonal, and genetic related. Research continues to verify and refute the impact of certain factors. All nurses must be knowledgeable about the risk factors and associations for these cancers.

Female↗
PubMed1999

Psychoeducational group increases vaginal dilation for younger women and reduces sexual fears for women of all ages with gynecological carcinoma treated with radiotherapy.

PURPOSE: The association between radiotherapy for gynecological carcinoma and sexual dysfunction is well established. Regular vaginal dilation is widely recommended to these women as a way for them to maintain vaginal health and good sexual functioning. However, the compliance rate with this recommendation is low. The purpose of this study was to test the effectiveness of a group psychoeducational program based on the "information-motivation-behavioral skills" model of behavior change in increasing the rate of compliance. METHODS AND MATERIALS: Thirty-two women with Stage I or II cervical or endometrial carcinoma who were being treated with radiotherapy were randomized and received either the experimental group program or the control intervention that consisted of written information and brief counseling. Outcome measures included global sexual health, knowledge about sexuality and cancer, fears about sexuality after cancer, and vaginal dilation compliance. RESULTS: Younger women attending the experimental program (44.4%) were significantly more likely to follow recommendations for vaginal dilation than those who received the control intervention (5.6%). Women, regardless of age, who received the experimental intervention reported less fear about sex after cancer treatment. The older women who received the experimental intervention gained more sexual knowledge. There was no evidence that the experimental intervention improved global sexual health. CONCLUSIONS: This is the first controlled study to provide evidence of an intervention's effectiveness 1. in increasing women's vaginal dilation following radiotherapy for gynecological carcinoma and 2. in reducing their fears about sex after cancer. Most women, particularly younger women, are unlikely to follow the recommendation to dilate unless they are given assistance in overcoming their fears and taught behavioral skills.

Adult↗