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PubMed1996

A bleomycin/ifosfamide/cisplatin regimen exhibits poor activity against persistent or recurrent squamous gynecologic cancers.

Persistent or recurrent squamous malignancies of the female genital tract are usually incurable by conventional therapy, and results of single agent chemotherapy have been disappointing. We undertook this study to confirm a previously reported response rate of 69%, using a regimen of bleomycin 30U, ifosfamide 5g/m2 with mesna 6g/m2, and cisplatin 50 mg/m2 (BIP) for recurrent cervical cancer. This regimen was used to treat persistent or recurrent squamous cancers in women with cervical cancer (n = 11), vaginal cancer (n = 1) and vulvar cancer (n = 1). Results were reviewed retrospectively and toxicities graded according to the criteria of the Gynecologic Oncology Group. No complete responses were seen. One patient had a partial response (10%, 95% confidence interval 0-28%). Five patients (50%), exhibiting stable disease during therapy with BIP, progressed after cessation of therapy. Of 9 women with symptoms after one cycle. Significant toxicities included neutropenic fever (3 grade 3, 3 grade 4), emesis (1 grade 3), confusion (2 grade 4), vaginal bleeding (2 grade 3), and renal failure (1 grade 3). Eight patients were transfused with a total of 28 units of red cells. After 23 months of follow-up, all patients were dead of disease. Mean survival was 10 months. Toxicity associated with this regimen can be significant, and results appear no better than those reported with single agent therapy.

Adult↗
PubMed1989

Gynecologic cancer in the very elderly.

Due to the increasingly elderly population of the United States, it was elected to review the experience at the Cleveland Clinic Foundation in treating women older than 75 years of age for gynecologic cancer. The charts of 114 patients were reviewed to study the presentation of primary cancers, the morbidity and mortality associated with therapies, and patient survival. Cardiovascular disease, including hypertension, and diabetes mellitus were the most common associated medical problems. 36% of patients had endometrial cancer, 25% cervical cancer, 19% vulvar cancer, 12% ovarian cancer and 7% vaginal cancers. Compared to data for patients of all ages in Annual Report on the Results of Treatment in Gynecologic Cancer (Vol. 18), patients with endometrial, cervical, and vulvar cancers were of a significantly more advanced stage than expected. Therapy was modified due to patient age or medical status in 42 patients. No postoperative mortality was encountered, although patients often required multiple prolonged hospitalizations. The projected overall survival rate (Kaplan-Meier Analysis) was 44% at 5 years. It is concluded that despite their advanced age and associated medical problems, very elderly patients can usually receive definitive cancer therapies, including surgery, after careful preoperative medical evaluation and therapy.

Actuarial Analysis↗
PubMed1989

[Interstitial irradiation of malignant neoplasms of the female genitalia].

The paper is concerned with the results of interstitial radiotherapy of 31 patients aged 30 to 76. Of them 18 patients had recurrences or metastases to the vagina, 9 patients--vulvar cancer, 4 patients--vaginal cancer. Interstitial radiotherapy with Co and 252Cf sources was used. A method of successive manual administration of intrastats and ionizing radiation sources was employed. The chief modality was interstitial radiotherapy supplemented with teletherapy or application gamma-beam therapy taking into account the time and doses of previous radiotherapy. Complete tumor regression was observed over time (4-27 mos.) in 23 (74.2%) of 31 patients. Radiation effects were manifested in hyperemia, edema of the mucous membrane and filmy epitheliitis at the site of administration of radioactive sources. Interstitial therapy can be a method of choice for a certain group of patients, especially in case of a limited tumor without infiltration to the adjacent organs.

Adult↗
PubMed1995

Female genital tract cancer.

BACKGROUND: Site-specific cancer frequencies and incidence rates are reported regularly by the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) program, but not by histologic type within site. This report reviews data for 160,977 histologically or cytologically confirmed invasive and in situ cancers of the female genital tract. METHODS: Data were supplied by the SEER program for histologically confirmed cases of uterine corpus, uterine cervix, ovary, vulva, vagina, fallopian tube, and placental cancers diagnosed between 1973 and 1987. Histologic types were reviewed for race, age at diagnosis, incidence, stage, and survival. RESULTS: There were 89,943 invasive and 71,034 in situ neoplasms. Squamous carcinoma was the most common invasive malignancy of the cervix (77.1%), vulva (74.4%), and vagina (70.8%). Adenocarcinoma was the most frequent malignancy in the uterine corpus (81.5%) and ovary (86.6%), with these percentages reaching 91.6% for corpus and 86.9% for ovary if adenosquamous carcinoma and adenocarcinoma with squamous metaplasia are included. Cervical carcinoma in situ accounted for 91.0% of all in situ cancers. In situ cancers made up 78.5% of all cervical cancers, 35.1% of vaginal cancers, and 50.4% of vulvar cancers. CONCLUSIONS: There are dominant histologic groups in each female genital tract site that are largely responsible for incidence and survival statistics. Within the groups, however, there are subtypes with differing features. Epidemiologic studies may provide more definite information by considering the effect of these subtypes in examining risk factors.

Adult↗
PubMed1988

Cystosonography: a diagnostic adjunct for the staging of advanced gynecologic malignancies.

Thirty-five patients with advanced gynecologic malignancies (cervical cancer, N = 26; endometrial cancer, N = 5; ovarian cancer, N = 2; vaginal cancer, N = 2) underwent cystoscopy and subsequent cystosonography. The mean age was 61.6 years (range 33-78). The bladder wall was found intact in three patients regardless of the diagnostic procedure. A mere displacement of the bladder wall was observed in four cases using cystoscopy. In all of these women, tumor invasion was ascertained by cystosonography alone. Edema of the bladder mucosa was found in 14 women by cystoscopy and in six women by cystosonography. Endosonography detected tumor invasion of the external layers of the bladder in eight of 14 women. In six of 14 patients, edema was caused by bladder displacement without neoplastic infiltration. Tumor invasion of the bladder was ascertained in six women by cystoscopy and intravesical sonography. Both cystoscopy and intravesical sonography demonstrated neoplastic infiltration and edema of the bladder mucosa in eight patients. Compared with cystoscopy, cystosonographic demonstration of the perivesical region provided better evaluation of the extent of bladder invasion. Cystosonography is a diagnostic adjunct to mere cystoscopy for patients with gynecologic malignancies. This modality is an excellent diagnostic tool, especially if cystoscopy reveals pathologic findings such as edema and displacement or invasion of the bladder wall.

Adult↗
PubMed1985

[Results of registration of gynecologic malignant neoplasms in Shizuoka Prefecture--evaluation for one and a half years].

To eliminate death by cancer, it would be necessary for us to register newly developed cancer in certain districts. We have registered all gynecologic malignant neoplasms in Shizuoka Prefecture, Japan, since October 1982 using a microcomputer. Analysis for one and a half years was performed as follows. Gynecologic malignancies are as detailed below: cervical cancer 304 cases, corpus cancer 58 cases, ovarian cancer 51 cases, vaginal cancer 4 cases, vulvar cancer 5 cases. A study of the correlation between detected malignancies and gynecologic examinations, particularly concerning cytologic check-up, revealed the importance of cytology in early cancer detection.

Adult↗
PubMed1997

[The percutaneous placement of intra-arterial catheters with "reservoirs" for subcutaneous infusion. The technic and preliminary results].

INTRODUCTION: We report our personal technique and the preliminary results of percutaneous implantation of intraarterial catheters connected to a subcutaneous infusion reservoir (Port-a-cath) for the regional chemotherapy of hepatic and extrahepatic tumors. January, 1996, to February, 1997 fifty patients underwent the procedure: 44 had liver cancers (42 had metastases and 2 hepatocellular carcinomas), 4 pelvic tumors (2 bladder carcinomas, one uterine cancer and one vaginal cancer), one had inoperable pancreatic tumor and one breast cancer. MATERIALS AND METHODS: The access was the left axillary artery in 45 cases, the femoral artery in 4 and both the femoral and the axillary artery in one case. The infusion catheter was placed in the hepatic artery in 44 cases, in the splenic artery in one case of pancreatic cancer, in the hypogastric artery in 4 cases and in the internal mammary artery in one case. When the catheter was positioned in the hepatic artery, embolization of the gastroduodenal or accessory hepatic arteries was performed using metallic coils; when the catheter was positioned in the hypogastric artery, the contralateral hypogastric artery and the ipsilateral gluteal branches were embolized. The catheter was then tunnelled and connected to a subcutaneous reservoir, sutured to the pectoral fascia or to the inguinal ligament. After the injection of heparinated solution, infusion chemotherapy was started the day after the procedure. RESULTS: We obtained immediate technical success in all cases. Four major complications occurred: a pseudoaneurysm of the left axillary artery (percutaneously treated by placement of a covered stent), 2 thromboses of the hepatic artery and one case of gastritis. Among minor complications, the catheter was displaced in 9 cases and 7 catheters were percutaneously replaced. Side-effects, not related to the procedure, were pain, nausea, vomiting and mucositis. During the follow-up, 7 patients died (6 for tumor progression); median catheter patency was 5.14 months. Though the aim of this work is to present the technical aspects of the procedure, we report the preliminary clinical data: radiological examinations showed partial tumor regression in 15 of 33 patients with 3-month follow-up; no change was shown in 2 patients and disease progression was found in 4; the response could not be assessed in the other cases. CONCLUSIONS: In conclusion, the percutaneous placement of intraarterial catheters for continuous regional chemotherapy is a feasible, safe and tolerable procedure and can represent an alternative to the surgical implantation of catheters in the hepatic artery for the treatment of liver metastases from colorectal cancer. The technique opens new therapeutic possibilities for the local treatment of extrahepatic tumors (such as gynecologic, vesical, pancreatic and breast cancers), even though its clinical efficacy must be assessed in selected trials.

Aged↗
PubMed1999

Primary invasive cancer of the vagina: outcome and complications of therapy.

The aim of the present study was to review the characteristics of cases of vaginal cancer, results of treatment and complications occurring at Westmead Hospital over the period 1979-96. International Federation of Gynaecology and Obstetrics (FIGO) staging and Eastern Cooperative Oncology Group (ECOG) status had been recorded prospectively, while other information was obtained retrospectively, including complications using the Franco-Italian Glossary. There were 37 eligible patients, 34 of whom were treated radically. Five-year survival for stage I was 90%, for stage II it was 50%, and for stage III it was 40%. There was only one stage-IV patient. The majority of patients who relapsed did so locally (63%). Using the Franco-Italian Glossary 10.8% of patients had, at worst, G0 toxicity, 21.6% had G1 toxicity, 29.7% had G2 toxicity, 37.8% had G3 toxicity, and no patients had G4 toxicity. Seven patients (18.9%) had a laparotomy for a complication of therapy. Excluding the three palliative patients and controlling for disease stage, it was found that there was a trend to improved survival in patients who had brachytherapy and those who suffered worse complications. While results for treatment of early stage vaginal cancer appear good, new techniques, particularly those that improve local control, are required for higher stage disease.

Adult↗
PubMed1990

Vaginal intraepithelial neoplasia: methodologic problems in a case-control study.

Vaginal Intraepithelial Neoplasia (VAIN) has recently received increased attention as a precursor to vaginal cancer, yet its natural history remains largely obscure. Several case series have implicated hysterectomy as a risk factor for the subsequent development of vaginal neoplasia. A recent case-control study failed to support an association with vaginal cancer when controlling for age, sex, and prior cervical dysplasia or neoplasia. In order to further investigate the possible association of hysterectomy with vaginal neoplasia, we performed the following retrospective case-control study. We compared 39 cases of VAIN with 39 controls matched for age, race, and prior cervical dysplasia or neoplasia. Matched-pair analysis yielded an odds ratio of 7.0 with a 95% confidence interval of 1.7 to 28. This would suggest that previous hysterectomy is indeed associated with the development of VAIN. However, several potential sources of systematic error were identified in the study design. Thus this association can not be supported. Further, this study exemplifies the difficulty of generalizing study results from a tertiary care population to primary care settings.

Bias↗
PubMed1996

Cytopathological findings on vaginal Papanicolaou smears after hysterectomy for benign gynecologic disease.

BACKGROUND: Periodic, routine Papanicolaou smears of cells from the vagina are commonly examined in women who have undergone a hysterectomy for benign gynecologic disease. The benefits of this method of screening are not known. METHODS: We analyzed Papanicolaou smears obtained from the vaginal apex (cuff) in 6265 women at Charity Hospital in New Orleans between January 1, 1992, and December 31, 1994. Of the 10,595 vaginal smears, an estimated 9610 were obtained during follow-up examinations of 5682 women who had undergone hysterectomy for benign gynecologic disease. RESULTS: Among these 9610 vaginal smears, 104, from 79 women, were abnormal. The abnormal smears were categorized according to the findings, as follows: atypical squamous cells of undetermined significance, 52 (0.5 percent of all smears); low-grade squamous intraepithelial lesion, 44 (0.5 percent); high-grade squamous intraepithelial lesion, 6 (0.1 percent); and squamous-cell carcinoma, 2 (0.02 percent). In five women, biopsies revealed vaginal intraepithelial neoplasia type I or II; there were no biopsy-proved cases of vaginal cancer. The probability of an abnormal Papanicolaou smear in this group of women was 1.1 percent, and the positive predictive value of the Papanicolaou test for detecting vaginal cancer was 0 percent (95 percent confidence interval, 0 to 33 percent). CONCLUSIONS: The prevalence of abnormal findings on cytopathological examination of vaginal Papanicolaou smears after hysterectomy for benign gynecologic disease is extremely low.

Adult↗
PubMed2005

Invasive squamous cell carcinoma of the vagina in the setting of true hermaphroditism.

BACKGROUND: Primary vaginal cancer constitutes less than 2% of all malignancies of the female genital tract and is even rarer in true hermaphrodites. A unique case report of the occurrence of both of these developments in the same patient is presented. CASE: A 31-year-old 46,XX hermaphrodite presented with a history of vague abdominal symptoms and weight loss. Surgery was performed, and pathology revealed invasive squamous cell cancer arising in an epithelial-lined tissue consistent with vagina. The patient subsequently completed whole pelvic external-beam radiation therapy with cisplatin chemosensitization. CONCLUSION: This is a case of primary vaginal cancer in a patient with true hermaphroditism, which is exceedingly rare. It is a reminder that malignant changes in residual mullerian tissue should be considered in these patients.

Adult↗
PubMed1999

[Carcinoma of the vagina].

In our study we present the cases with vaginal cancer treated in the gynaecological clinic of the National Oncological Centre in Sofia for the period from 1989 till 1998. Most of the women were with squamous cell carcinoma of the vagina. Twenty seven patients were examined--19 of them were operated, 18 patients received radiotherapy and 2 chemotherapy. The tumors that were localized in the upper 2/3 of the vagina were operated by radical hysterectomy a modo Wertheim-Meigs and extirpation of the vagina. When the tumor was localized in the lower third of the vagina we performed additionally radical vulvectomy and bilateral inguinofemoral lymph-node dissection. For more advanced cancers we did exenteration anterior and posterior. When there was no possibility for surgical approach or for radiotherapy we did chemotherapy with 5-Fu, methotrexate, cyclophosphamide and vincristin. The prognosis for the vaginal cancers is not good, in 25-30% of the patients survive 5 years. As a whole we assess that we are having the same results, as well as survival rate like other western clinics.

Carcinoma↗
PubMed1988

Vagina: evaluation with MR imaging. Part II. Neoplasms.

The potential of magnetic resonance (MR) imaging in the detection of vaginal tumors and the assessment of their extent was evaluated retrospectively in 87 patients in whom primary, metastatic, or recurrent vaginal cancer was clinically suspected. MR findings were compared with the results of surgery and/or biopsy. Results of histopathologic study verified a normal vagina in 51 patients, benign cysts in two, primary tumor in four, metastatic cancer in 22, and recurrent tumor in eight. MR imaging demonstrated the two benign cysts, correctly depicting their size and location, and demonstrated and enabled correct staging of the four primary tumors. MR accuracy for demonstrating metastatic cancer was 92%, sensitivity was 95%, and specificity was 90%. Tumor extension to the vagina was reliably excluded (negative predictive value = 97%), but false-positive interpretations occurred (positive predictive value = 84%) primarily because inflammation (n = 2) and congestion (n = 2) could not be distinguished from tumor invasion. An additional role of MR imaging was the ability to differentiate tumor from fibrotic tissue in patients with suspected recurrent vaginal carcinoma. The overall accuracy of MR imaging for recurrent vaginal cancer was 82% (14 of 17).

Adult↗
PubMed1975

[Early identification of cancer through vaginal cytology in a venereal disease clinic].

100 women, routinely and regularly examined in a venereal disease clinic, have been investigated using Papanicolaou smears of the uterine cervix for. 1. Papanicolaou group, 2. trichomonas infection, 3. assessment of vaginal microbiology. A group III was determined in 11, a group IV/V in 2 women. Trichomonas vaginalis was present in 60% of the cases. Only 9% of the smears showed normal Döderlein bacteria; 91% contained mixed bacteria. The findings are compared with a control group and are discussed in the light of epidemiologic studies indicating the close rôle of certain factors in the sexual life for the development of cervical cancer. The necessity to regard this population as a high risk group in general cytological screening has been stressed, especially to the advantage of the adolescent and young females in this group.

Adolescent↗
PubMed2004

Sentinel node detection in patients with vaginal carcinoma.

OBJECTIVE: The objective was to describe sentinel ode detection in patients with primary and recurrent vaginal carcinoma. METHOD: Preoperatively 60-mBq technetium-labeled nannocolloid was injected in the mucosa at 3, 6, 9, and 12 o'clock, just adjacent to the vaginal cancer. Sentinel nodes were detected using a laparoscopic or hand-held probe (Navigator) and removed for pathological assessment. RESULTS: Sentinel nodes could be found in two of three patients with primary stage I or II carcinoma of the vagina. In the first patient the sentinel nodes, located in the groin and obturator region, proved to be negative and she was treated with a wide local excision of the tumor, pelvic and groin lymphadenectomy, and adjuvant radiotherapy. The second patient had tumor metastases in the sentinel node, which was found just below of the junction of the iliac vessels, and she underwent combined chemo- and radiotherapy. In a third patient no sentinel node could be detected at lymphoscintigraphy. A last patient with stage III carcinoma of the upper vagina was initially treated by combined chemo-radiotherapy but recurred 6 months later. During a staging procedure the sentinel nodes could be detected in the right obturator fossa and were removed laparoscopically. As they were negative, she underwent a posterior pelvic exenteration with complete resection of the tumor. CONCLUSION: Laparoscopic detection of sentinel nodes using 99mTc-labeled colloid is feasible in patients with primary and recurrent vaginal cancer and may provide important information to direct further management.

Adult↗