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PubMed1977

Comparison of cancer cell surfaces of the lower reproductive tract by scanning electron microscopy.

The squamous cells of the cervix simulate those of the vagina and vulva both histologically and by scanning electron microscopy. However, in areas of the cervix undergoing active metaplasia, there are cells which share some of the characteristics demonstrated by scanning electron microscopy of both squamous and columnar epithelium. In these cells there is a wide range of characteristics of each cell type, suggesting a possible gradual transition from columnar to squamous epithelium. Furthermore, the cells of severe dysplasia and of intraepithelial and invasive squamous cancers of the cervix, though histologically similar to those of vaginal and vulvar cancers, are distinctly different when examined by scanning electron microscopy. These findings suggest that both metaplastic and neoplastic squamous cells are derived from the same progenitor columnar cells of the cervix, by orderly transition in the former and by atypical transformation in the latter. Second, the distinctiveness from the vaginal and vulvar cells indicates different embryonic stem cell lines.

Carcinoma in Situ↗
PubMed2002

[Problem of uterine and ovarian cancer mass screening].

We express the mass screening data of uterine cervical cancer, endometrial cancer, and ovarian cancer in Japan. The increase in cervical cancer mass screening rate, correlate well with decreasing mortality for uterine cancer, but mortality is re-increasing now. It is concern to increase of uterine cervical dysplasia and cervical cancer of young women. Then, we need to start the screening for more young women. The detect ratio of uterine corpus cancer is increasing now. Then, we need to change the object, and introduce new screening method for example, trans vaginal echogram. Ovarian cancer screening method is not establishment, but mortality rate in patients with ovarian cancer will be increase in future. Trans vaginal echogram is the better method for the screening. On the economical reason, we have a tendency the cancer screenings are neglected. It is important to watch the policy of health carefully.

Adult↗
PubMed2006

Routine vaginal Pap test is not useful in women status-post hysterectomy for benign disease.

The US Preventive Services Task Force (USPTF) has recommended that routine vaginal Pap (V-Pap) screening is unnecessary for women status-post (S/P) total hysterectomy (T-Hyst) for benign disease (Guide to Clinical Preventive Services. 2nd ed. Baltimore, MD: Williams & Wilkins; 1996. p 105-118). However, many US women continue to have V-Pap despite no risk for cervical cancer and minimal risk for primary vaginal cancer (JAMA 2004;291:2990). Herein, we report our experience with such patients. Computerized data of patients S/P T-Hyst for benign conditions over a 6-yr-period were retrospectively evaluated. Pap diagnoses of epithelial abnormalities (Ep Abnl), negative for intraepithelial lesion or malignancy with/without nonneoplastic findings (NILM-NN and NILM), were reviewed based on three age groups: group A, 18-44 yr; group B, 45-64 yr; and group C, > or =65 yr (JAMA 2004;291:2990). A control group was used.Of 1,860 T-Hyst 1,303 (70%) were for benign disease. Of these 581/1303 (44.5%) patients had 819 current V-Paps (range, 1-5; mean, 1.4). The 581 patients were group A, 288 (49.5%); group B, 272 (46.8%); and group C, 21 (3.6%). Overall, the 819 V-Paps showed Ep Abnl, 28 (3.4%); NILM-NN, 252 (30.7%); and NILM, 539 (65.8%). Of the 28 Ep Abnl, 19 (67.8%) were atypical squamous cells of undetermined significance (ASCUS), and 9 (32%) were low-grade vaginal intraepithelial lesions (LG-VAIN). The NILM-NN findings included organisms, atrophy, and endometriosis. On the basis of individual age groups, Ep Abnl were only seen in V-Paps of 7/288 (2%) of group A and 21/272 (8%) of group B patients. In 23 control patients, 7/71 (9.8%) current V-Paps showed Ep Abnl (ASCUS, 4 (57%); LG-VAIN, 3 (43%)). Continued V-Pap in women S/P T-Hyst for benign disease does not appear to be useful, particularly in those aged > or =65 yr.

Adolescent↗
PubMed1992

Relationship between human papillomavirus infection and tumours of anogenital sites other than the cervix.

Although tissues in the case series of anal, penile, vaginal and vulvar neoplasms that have looked for evidence of HPV infection by probing for HPV DNA have been selected for convenience, they support the view that HPV, especially type 16, is associated with approximately 50% of these tumours. A higher percentage of the anal, vaginal and vulvar tumours are associated with HPV 16 than are penile tumours. This discrepancy may be due to the low number of penile tumours studied or to a true difference in the proportion of penile cancer cases related to HPV. HPV 6/11 and 18 are found less frequently at all anatomic sites. About 10% of tumours that are probed for these viruses are positive, although there are some notable exceptions such as a study that found 39% of penile tumours positive for type 18 and a study that found approximately two thirds of vulvar tumours positive for HPV 18 using Southern blot hybridization. For all of these tumours, there is likely to be a subset of the cases who develop their cancer through mechanisms that do not involve HPV. The case-control studies found a strong association with genital warts, number of sexual partners and, with the exception of vaginal cancer, smoking and/or heavy smoking at the time of diagnosis of the disease. A history of genital warts, smoking at diagnosis, and seropositivity to HSV2 are exposures that have also been found to be associated with cervical cancer. A population-based case-control study in western Washington and Vancouver, British Columbia that studied all anogenital cancers found that a history of genital warts was stronger among patients with vulvar, anal, vaginal and penile cancer than among those with cervical cancer. This was also true of smoking at diagnosis, with the exception of vaginal cancer, where there was little excess risk. This study and other supporting data indicate that these anogenital tumours share many of the same risk factors as cervical cancer.

Anus Neoplasms↗
PubMed2000

Laparoscopically assisted radical vaginal versus radical abdominal hysterectomy type II in patients with cervical cancer.

BACKGROUND: In a retrospective study, we compared a laparoscopic radical vaginal approach with abdominal radical hysterectomy type II for treatment of patients with cervical cancer at International Federation of Gynecology and Obstetrics (FIGO) stages I to III. METHODS: Between January 1991 and March 1994, 70 patients with cervical cancer were treated by radical abdominal hysterectomy, and between August 1994 and May 1999, 70 patients with cervical cancer were treated by laparoscopically assisted radical vaginal hysterectomy. Data from both the abdominal group and the laparoscopic-vaginal group were obtained retrospectively. RESULTS: The mean duration of surgery was significantly longer for the laparoscopic-vaginal approach than for the abdominal approach (292.9 vs 209.9 min). Significantly more pelvic lymph nodes were removed by laparoscopy (27 vs 10.7). Blood loss and transfusion rates were significantly lower in the laparoscopic-vaginal group. Intraoperative complications were seen more often during laparoscopic-vaginal surgery (p < 0.05). Early postoperative complications occurred significantly more frequently after the abdominal approach. The mean duration of hospital stay was significantly shorter for patients treated by laparoscopic-vaginal surgery (11.4 vs 22.8 days). CONCLUSION: Compared with laparotomy, the laparoscopic-vaginal approach for treatment of cervical cancer is associated with lower rates of transfusion and early postoperative morbidity.

Adult↗
PubMed2006

Vaginal evisceration during intraperitoneal chemotherapy for advanced ovarian cancer.

BACKGROUND: Recent studies have established that intraperitoneal chemotherapy is associated with improved outcomes compared with intravenous treatment in patients with advanced, optimally cytoreduced ovarian cancer, but at the expense of increased toxicity. We present a case of vaginal evisceration during intraperitoneal chemotherapy for advanced ovarian cancer. CASE: Following an optimal cytoreduction including total hysterectomy for advanced ovarian cancer, a 63-year-old woman underwent intraperitoneal chemotherapy. On pelvic examination prior to her second cycle of chemotherapy, she was found to have vaginal evisceration of small bowel. CONCLUSION: Intraperitoneal chemotherapy imparts an improved survival, but at the expense of increased toxicity. It is possible that the increased abdominal pressure during intraperitoneal chemotherapy contributes to the risk for vaginal evisceration. In patients planning on undergoing intraperitoneal chemotherapy, supracervical hysterectomy should be considered in appropriate candidates.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1998

Pregnancies after radical vaginal trachelectomy for early-stage cervical cancer.

OBJECTIVE: The purpose of this study was to evaluate the role of fertility-preserving surgery in the treatment of early-stage cervical cancer. STUDY DESIGN: We retrospectively reviewed our first 30 patients treated by laparoscopic pelvic lymphadenectomy, followed by radical vaginal trachelectomy, from October 1991 to April 1998. RESULTS: The median age of the patients was 32 years (range 22-42 years); 15 were nulligravid and 19 nulliparous. Twenty cancers were at stage IB, 1 was at stage IA1, 7 were at stage IA2, and 2 were at stage IIA. The majority (18/30) were squamous. Two lesions were >2 cm in size, and only 4 had vascular space invasion. The median operative time was 285 minutes (range 155-455 minutes), median blood loss 200 mL (range 50-1200 mL), and median hospital stay 4 days (range 2-9 days). There were 4 intraoperative complications-2 attributed to the trachelectomy and 2 resulting from the lymphadenectomy. The current median follow-up time is 25 months (range 1-79 months). One patient had a recurrence in the left parametrium 18 months after vaginal radical trachelectomy and died of metastatic disease. The only 6 patients attempting pregnancy so far have succeeded: 4 have had healthy babies delivered by cesarean section at 39, 38, 34, and 25 weeks of gestation. Two are currently 33 and 8 weeks pregnant. CONCLUSION: Radical vaginal trachelectomy appears to be a valuable procedure in well-selected patients with early-stage cervical cancer. Successful pregnancies are definitely possible after this procedure. This new surgical technique warrants further careful evaluation to determine precise indications.

Adult↗
PubMed1992

Human papillomavirus infections.

Though the existence of disease associated with HPV has been documented for centuries, it has been only within the past 2 decades that we have recognized the clinical diversity and significant morbidity and mortality associated with HPV infections. The original lack of interest and nonavailability of in vitro culture systems has hampered research. However, with the advent of molecular diagnostic techniques, strong evidence suggests that HPV plays a major role in the development of specific anogenital cancers, including cervical, vaginal, vulvar, penile, and anal. It is this association between anogenital cancers and HPV that may result in treatment guidelines that eventually will eliminate these cancers. Moreover, to the extent that this association has resulted in overdiagnosis and unnecessarily aggressive treatment, new and ongoing research may create more appropriate treatment options. The principles for diagnosis and treatment should be based on adequate evaluation, including colposcopic examination and histologic confirmation for suspected neoplastic lesions. The majority of HPV-induced disease should be treated conservatively (often best with observation). The role of HPV DNA testing in clinical outcome is yet to be defined, with the exception of high-grade neoplastic disease, which should be treated aggressively.

Adult↗
PubMed1994

[Criteria for choice of vaginal hysterectomy for lesions other than invasive cancer].

The authors analyse in retrospect a continuous series of 208 hysterectomies, for lesions other than invasive cancer, in order to try to define precise objective criteria for the choice of the vaginal way. What essentially commands the choice of this way are: high parity, large size of the uterus, the existence of prolapsus, effort-linked urinary deficiency and no annexial pathology.

Adult↗
PubMed2004

Laparoscopically assisted radical vaginal hysterectomy vs. radical abdominal hysterectomy for cervical cancer: a match controlled study.

OBJECTIVES: The technical feasibility of laparoscopically assisted radical vaginal hysterectomy has been well described, but its advantages over the open technique remain largely unproven. We reviewed and compared our experiences with both approaches. METHODS: All patients undergoing laparoscopically assisted radical vaginal hysterectomy (LARVH) between 1996 and 2003 were identified and matched for age, FIGO stage, histological subtype and nodal metastases using a control group of women who underwent radical abdominal hysterectomy (RAH) during the same time period. RESULTS: Fifty-seven women were listed for LARVH, resulting in five conversions. Fifty cases were matched successfully using the criteria above. The majority of cases were FIGO stage 1B1. Statistically significant differences (P < 0.05) were present when the following were compared for LARVH vs. RAH: duration of surgery (median 180 vs. 120 min), blood loss (median 350 vs. 875 ml), hospital stay (median 5 days vs. 8 days) and duration of continuous bladder catheterisation (median 3 days vs. 7 days). There were no statistically significant differences with regard to nodal yield, completeness of surgical margins or perioperative complication rate. Four major complications (8%, three cystotomies and one enterotomy) occurred in the LARVH group and three in the RAH group (6%, one pulmonary embolism, one ureteric injury and one major haemorrhage). Three women in LARVH group had seen a specialist regarding postoperative bladder dysfunction, versus 12 in the RAH group (P = 0.04). No patients in the LARVH group reported constipation requiring regular laxatives, versus six in the RAH group (P = 0.03). Median follow-up was 52 months for LARVH and 49 months for RAH. There was no significant difference between recurrence rates or overall survival (94% for LARVH vs. 96% for RAH). CONCLUSIONS: Despite the inherent limitations of LARVH and its associated learning curve, the procedure conveys many advantages over the open technique in terms of blood loss, transfusion requirement and hospital stay. In addition, the incidence of postoperative bladder and bowel dysfunction appears low-suggesting improved quality of life-without compromising survival.

Adult↗
PubMed1990

Vaginal radical hysterectomy for uterine cervical cancer.

The incidence of uterine cervical carcinoma, though decreasing in many cities of China, dose not show any diminution in the rural areas where it appears to be high in some regions. Therefore, radical hysterectomy is particularly important for the patients with cervical adenocarcinoma and squamous adenocarcinoma which are insensitive to chemotherapy and radiotherapy. The operation is effective in the treatment of early cervical carcinoma and even late carcinoma when the procedure is combined with extraperitoneal radical lymphadenectomy, radiotherapy and chemotherapy reinforced by the traditional Chinese medicine. This operation gets rid of technical difficulties in manipulating the deep pelvic cavities of obese patients, and is suitable for those patients with general weakness, heart and renal diseases, hypertension, severe tuberculosis complicated by the poor tolerance of the abdomen or fear to transabdominal procedures. The detailed procedures of the operation and its results are described.

Adenocarcinoma↗
PubMed1976

Vaginal reconstruction following extensive treatment for pelvic cancer.

Since 1970, 23 patients at UCLA and The City of Hope who have undergone extensive treatment for pelvic malignancy have had vaginal function successfully restored. A combination of methods, including split-thickness skin graft and the construction of an external vulvar pouch, is often necessary to obtain maximal functional results. The external vulvar pouch was very useful, although not as anatomically appealing as internal methods of reconstruction. In young patients who required an exenteration, a new technique using part of the anterior bladder fundus was developed. Preliminary experience with this method was promising. Among the gorup of 23 patients, there have been no overt failures. By combining restoration of rectal function with vaginal reconstruction, two major steps have been taken toward total rehabilitation of the patient undergoing extensive treatment for pelvic malignancy. Persistence, ingenuity, and planning by the surgeon are essential to obtain a maximum functional result for each patient.

Adolescent↗
PubMed2006

Successful delivery after vaginal radical trachelectomy for invasive uterine cervical cancer.

A 32-year-old Japanese woman was diagnosed as having stage Ib1 adenocarcinoma by diagnostic laser conization at a local hospital. She was admitted to our hospital for fertility-sparing treatment. A radical trachelectomy (RT) was performed using the laparoscopic vaginal procedure. The procedure was started with a laparoscopic pelvic lymphadenectomy. As the lymph nodes were tumor free, RT was carried out transvaginally. The excised uterine cervix and lymph nodes were pathologically negative for cancer. Eight months after the operation, the patient became pregnant without any artificial reproduction techniques. At 17 weeks of gestation, she was admitted to our hospital again for a threatened abortion. Continuous tocolytic treatment with ritodrine and daily administration of a granulocyte elastase inhibitor vaginal suppository were given. At 32 weeks of gestation, she underwent emergency cesarean section because of sudden premature rupture of the membranes. A girl weighing 1991 g was delivered, with Apgar scores of 7 and 8 at 1 and 5 min, respectively. Both the mother and the baby were discharged without trouble. This is the first successful case in Japan of delivery after vaginal RT for invasive uterine cervical cancer.

Adult↗
PubMed2003

Laparoscopic radical parametrectomy including paraaortic and pelvic lymphadenectomy in women after prior hysterectomy: three cases.

BACKGROUND: Radical abdominal surgery in patients who have previously undergone a hysterectomy is a surgical challenge. This type of surgery for invasive cervical cancer after a hysterectomy or for vaginal stump metastasis traditionally requires a major laparotomy; however, a minimal access approach is now being applied to this type of procedure. METHODS: A laparoscopic radical parametrectomy including a paraaortic and pelvic lymphadenectomy was performed on two patients with invasive cervical cancer diagnosed after a simple hysterectomy and one patient with recurrent endometrial cancer in the vaginal stump. RESULTS: All three patients had an excellent clinical outcome and made a rapid recovery, even though two cases involved a bladder laceration. CONCLUSION: A laparoscopic radical parametrectomy including a paraaortic and pelvic lymphadenectomy is a viable technique for women with invasive cervical cancer or recurrent endometrial vaginal cancer after a prior hysterectomy.

Adult↗