2004, Vol 2, No 2
The role of free radicals in the pathophysiology of carcinogenesis – a current overview
GIN ONKOL, 2004, 2 (2), p. 71-85
ABSTRACT

Carcinogenesis, or formation of malignant neoplasms, is a complex process which includes the phases of transformation, promotion and progression. Reactive oxygen species (superoxide radical anion, hydroxyl radical, and hydrogen peroxide) may be generated during all stages of both mutagenesis and carcinogenesis, and consequently contribute to the impairment of cellular genetic material. This paper is a review on current concepts and understanding of the role of free radical involvement into the mechanisms of formation and spread of neoplastic disease.

Keywords: carcinogenesis, hydrogen peroxide, hydroxyl radical, superoxide radical anion, xenobiotics
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Prognostic value of bcl-2 and MMP-2 expression in stage IB invasive carcinoma of the cervix
GIN ONKOL, 2004, 2 (2), p. 86-91
ABSTRACT

Purpose: This study was conducted to evaluated the prognostic significance of immunohistochemical reaction for bcl-2 protein and matrix metalloproteinase type 2 (MMP-2) in stage IB invasive carcinoma of the cervix. Material and methods: The study comprised of 140 patients with squamous cell stage IB invasive carcinoma of the cervix treated with radical Wertheim-Meigs hysterectomy. The results of immunohistochemical study was correlated with principal histopathological features: tumor size, grading, vascular space invasion, microscopic infiltration of parametria and pelvic lymph node metastases. Results: Positive immunohistochemical reaction for bcl-2 was observed in 62% of tumors, and for MMP-2 in 44%. Five years survival was significantly higher in patients with positive reaction for bcl-2, and significantly lower for tumors positive for MMP-2 (p=0,002). On the univariant analysis a significant overexpression of MMP-2 was detected in patients with metastatic pelvic nodes. A bcl-2 expression was significantly higher in tumors negative for vascular space invasion and pelvic node metastases. Conclusion: Expression of bcl-2 and MMP-2 are strong prognostic parameters in early stage squamous carcinoma of the cervix suggesting their involvement in tumor progression and metastasis formation.

Keywords: cervical cancer, MMP-2, bcl-2, prognostic factors
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The assessment of some histoclinical factors influencing on lymph node metastasis and risk of recurrences analysis in endometrial cancer patients
GIN ONKOL, 2004, 2 (2), p. 92-99
ABSTRACT

Objectives: Endometrial cancer is still one of the morbidity leader among women in Poland. The risk of the lymph node involvement depends on some factors i.e.: histological grade, myometrial invasion, histological subtype. Stage IIIC of this cancer, although not very common, makes results of patients treatment unsatisfactory. Design: Taking these facts into consideration the analysis of some histological and clinical factors were assessed in group of patients with endometrial cancer treated in Oncology Center. The subgroup of stage IIIC have been divided, and above mentioned parameters were correlated with time to progression. Material and methods: There were 347 patients selected in to analyzed group. All patients had total hysterectomy with pelvic nodes excision. In some cases with positive pelvic nodes, paraaortic lymphadenectomy were subsequently performed. Age, duration of symptoms, comorbidity, histologic type, grading, and other clinical parameters have been correlated to assess risk of lymph node metastases and time to progression. Results: Tumor diameter, depth of myometrial invasion, histological grade, serous or clear cell carcinoma and spread beyond uterus were main predictive factors of lymph node involvement. It appeared that non-optimal debulking of grossly involved nodes had significant influence on time to progression. Optimal debulking gives, mean 21 months free of disease, comparing with 8 months in patients non-optimally debulked. Serous or clear cell types of cancer, simultaneous involvement of pelvic and paraaortic nodes had also negative prognostic value. Conversely using postoperative radiochemotherapy, time to progression was prolonged. Conclusions: It was noted that lymph node involvement appeared in 13.5% of cases in analyzed group. It should be noted that radiochemotherapy in patients with endometrial cancer stage IIIC is very helpful therapeutic option after complete surgery. Fully excised grossly involved lymph nodes have significant influence on treatment results.

Keywords: endometrial cancer, radiochemotherapy, prognostic factors
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The analysis of intestinal treatment – related sequelae in cervical cancer patients treated with radiotherapy
GIN ONKOL, 2004, 2 (2), p. 100-106
ABSTRACT

Introduction: External beam irradiation together with intracavitary irradiation is intended for delivering the total dose biologically active to cure cervical cancer locally. At the same time it causes the risk of radiation injury. The frequency of radiation complications is generally dependent on the type of the treatment performed. Objective: The factors which have influence on the frequency and the grade of the intestinal radiation complications were evaluated. Material and methods: The retrospective analysis of 1078 patients, treated between 1996 and 2000 at Gynecological Department of Oncological Center in Warsaw, was performed. The treatment consisted of the surgery and adjuvant radiotherapy or radiotherapy alone. The doses delivered with radiotherapy ranged from 41.4 to 46.2 Gy. If there were not conditions to perform the intracavitary radiotherapy, the dose was elevated up to 56-64 Gy. The intracavitary radiotherapy doses at point A were: 45-50 Gy. The Chi2 test to assess the relationship between the radiotherapy sequelae and the treatment-related and clinical-populate factors was performed. The Cox’ analysis was performed to assess the influence of the above factors on the late severe sequelae. Results: The early high grade sequelae were ascertained in 1.1%, late in 6% of patients. The early radiation injury are dependent on: the kind of surgical procedure, the time interval between the surgery and the start of adjuvant radiotherapy. The risk of late high grade sequelae is rising with FIGO stage and the total dose delivered with radiotherapy. Conclusions: The associated treatment, especially, the kind of the surgery performed and the time interval between surgery and adjuvant radiotherapy, plays a decisive role in the treatment tolerance. The risk of late radiation complications is dependent on the total dose and FIGO stage.

Keywords: intestinal complications, radiotherapy, cervix carcinoma
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Laparoscopy in the treatment of endometrial cancer – description of surgical technique
GIN ONKOL, 2004, 2 (2), p. 107-113
ABSTRACT

The objective was to present the current laparoscopic technique used in the surgery of endometrial cancer. Endometrial cancer is the second common malignancy of the female genital tract in Europe. In 80% of cases the disease is limited to the uterus and the stage I according to FIGO classification is recognized. Surgery is the cornerstone of treatment and since 1989 FIGO recommend the surgico-pathologic classification based on operative protocol. The traditional approach in endometrial cancer was laparotomy. The combined vaginal and laparoscopic method to remove uterus and lymph nodes was introduced since 1992. Material and methods: Laparoscopy for the surgical treatment of patients with endometrial cancer in Gynecologic Oncology Department in Warsaw was introduced since 1994. The pelvic and obturator lymphadenectomies were performed by transperitoneal approach described by Querleu. Hysterectomies were performed with LAVH or TLH. The indications for LAVH were: good vaginal access and in multiparity. The laparoscopic part of operation comprised lymphadenectomy and coagulation of infundibulo-pelvic ligaments. Total laparoscopic hysterectomy was performed in patients with narrow vagina and bad vaginal access. In TLH, lymphadenectomy and hysterectomy with coagulation of uterine vessels were performed laparoscopically. Conclusion: LAVH and TLH with lymphadenectomy may be performed in selected cases of endometrial cancer. The both techniques should be applied according to the indications and anatomical conditions.

Keywords: endometrial cancer, laparoscopic lymphadenectomy, LAVH, TLH
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A phantom visualizing the surgery of the vulva
GIN ONKOL, 2004, 2 (2), p. 114-117
ABSTRACT

Objectives: The aim of the study was to construct a phantom to visualize the anatomy and pathologies of the vulva and to imitate the surgery of the vulva. Material and methods: After numerous measurement, sketches and plaster casts on the corps of a woman, the phantom was constructed. Various materials were used. Results: The phantom represents the anatomy of the groins, vulva, perineum, femoral hiatus as well as the iliac and obturatory vessels. On the vulva, a cyst of the Bartholin gland was formed. It can be shifted from the left to the right and backwards. The regions of the pudendal lips were marked white to imitate dysplastic lesions. The shape and color of the tumor of the vulva resembles the real cancer. The tumor as well as lymph nodes is mobile. The phantoms allows the following operations: 1) marsupialization of the cyst of the Bartholin gland; 2) superficial partial vulvectomy; 3) profound total vulvectomy; 4) inguinal and femoral lymphadenectomy; 5) iliac and obturatory lymphadenectomy. Conclusion: The phantom resembles the real conditions of diagnosing pathologies and performing operations of the vulva. According to the introductory data, it makes the process of education easier, quicker and safer.

Keywords: phantom, operations of the vulva
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Laparoscopic unilateral adnexectomy as a type of treatment of the benign ovarian tumors in postmenopausal women – preliminary report
GIN ONKOL, 2004, 2 (2), p. 119-124
ABSTRACT

Objective: The aim of this article was to assess of the efficacy and safety of the laparoscopic adnexectomy in postmenopausal women with ovarian tumors. Material and methods: This article presents results of 50 cases where unilateral laparoscopic adnexectomy due to ovarian tumors in postmenopausal women was performed. Decision considering laparoscopic approach was chosen after an interview, clinical examination, level of Ca 125 antigen and results of sonography. Women with normal level of Ca 125 and not suspected sonographic evaluation of the ovarian tumors were included to our study. Results: In all our cases frozen section and final pathologic examination has shown benign ovarian tumors. Conclusions: It should be stated that in selected cases laparoscopic adnexectomy is efficacious and safe intervention in ovarian tumors treatment in postmenopausal women.

Keywords: laparoscopy, adnexectomy, menopausa
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