2004, Vol 2, No 4
The etiology of cancer in historical view
GIN ONKOL, 2004, 2 (4), p. 214-222
ABSTRACT

The lack of significant progress in combating cancer, is the result of focusing on the molecular biology of cancer, as genetic, chemical, physical and biological factors, without the use of the basic knowledge, mainly the quantum thermodynamics. A lot of oncogenetic theories concern various estimation of the same phenomena, what has created the necessity of their generalization, through the presentation of neoplasm as a self-organizing dissipative structure, dispersing the mass and energy in the host organism as its biological environment. It decides on unique entity of each other. The neoplastic disease is caused by a neoplasm, which is the different, thermodynamically more efficient, biological system (diminishing production of its own entropy), than the host organism tissue, that is originating from. The sufficient condition of the neoplasmatic transformation of the cell in multicellular organism, is the dissipathogenic status of the cell, which organizes into a new dissipative structure, unless it dies! A lot of various, necessary factors are responsible for the critical internal status of the cell, and the response of the cell depends on the combination and time of their act (influence) on the cell. The dissipathogenic status of the cell is the sufficient condition, none of the necessary factors should be analyzed alone, because the status is already determined. The development of neoplasm, even after the elimination of the reasons of its growth, which are necessary factors, is being explained by the presence of sufficient factor (dissipathogenic status of the cell).

Keywords: medical thermodynamics, neoplasms, dissipative structures
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The comparison of the results of a surgical treatment in endometrial cancer patients using laparoscopy and laparotomy
GIN ONKOL, 2004, 2 (4), p. 223-231
ABSTRACT

Objective: The objective of the current study was to compare the results of surgical treatment in endometrial cancer with use of laparoscopy and traditional approach by laparotomy. Our goal was to evaluate and compare the recurrence rate and disease free survival in both groups. Study design: This article is a retrospective study. The chart review of 45 patients treated by laparoscopy between 1994 and 2002 and 136 patients treated by laparotomy between 2001 and 2002 was performed. Disease free survival in both group was evaluated with Kaplan-Meier method and was compared using the log-rank test. Results: The rate of recidive was 6% in laparoscopy group and 13% in laparotomy group. There was no significant difference in disease free survival and recidive rate between laparoscopy and laparotomy group. Conclusion: Laparoscopic management in endometrial cancer do not worse the prognosis and the disease free survival is similar when compare with traditional approach. The benefits of minimal invasive surgery are: quicker postoperative recovery, shorter hospital stay and no wound complications.

Keywords: endometrial cancer, laparoscopy, laparotomy, laparoscopic lymphadenectomy
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A 500 kHz hyperthermia assisted interstitial HDR brachytherapy in recurrent cervical and endometrial cancer treatment in previously irradiated field
GIN ONKOL, 2004, 2 (4), p. 232-236
ABSTRACT

Introduction: The biological effectiveness of elevated temperature (hyperthermia) on the cancer cells is a well known issue. Nevertheless it is still not widely used in clinical practice, due to the technical difficulties. The main limiting factor is healthy tissue protection during the hyperthermia procedure. Hyperthermia, used as adjuvant treatment to brachytherapy, provides the possibility of lowering total radiation dose, without reduction its biological effect. Material: Hyperthermia procedures were performed in 8 endometrial cancer and cervical cancer patients with early recurrent local disease in previously irradiated area. Method: One to two interstitial hyperthermia procedures was performed, using rigid, metal needles, both for brachytherapy and temperature elevation. The total radiation dose was 30 Gy, delivered in 3 or 6 Gy per fraction. In case of 3 Gy per fraction, the two fractions per day, separated by at least 8 hours, scheme was used. The total treatment time ranged between 5 and 14 days. Hyperthermia was performed concurrently with brachytherapy. Results: During the treatment, no acute reactions were observed. In each case, the tumor regression over 50% was noted. During the 3 to 14 months follow-up period, the complete vaginal tumor regression was seen in 6 of 8 cases.

Keywords: cervical cancer, endometrial cancer, hyperthermia, brachytherapy
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TGF-b1 cytokine and TGF-b1 receptors I, II, III expression in vulvar carcinoma
GIN ONKOL, 2004, 2 (4), p. 237-244
ABSTRACT

The aim of the study: Evaluation of the expression of TGF-b1 and its receptors in vulvar tissues with neoplastic lesions. Material and methods: 28 vulvar tissue samples with neoplastic lesions (16 cases of non-keratinous vulvar carcinoma, 12 – keratinous) obtained during diagnosis or surgery from patients hospitalized in Department of Obstetrics and Gynecology in Bytom. Vulvar tissue samples obtained during plastic surgery and distinguished as normal on histopathological examination were used as a control group. Histopathological examination and molecular analysis were performed on all of the samples to assess the presence of TGF-b1 and its receptors I, II, III genes. Quantitative analysis was performed using QRT-PCR (TaqMan) technique. Results: Mean number of mRNA copies in non-keratinous carcinomas was: for TGF-b1 – 9631.6, for TGFR1 – 12431.1, for TGFR2 – 12034.8, for TGFR3 – 16793.7; in keratinous carcinomas: for TGF-b1 – 14054.8, for TGFR1 – 14772.9, for TGFR2 – 8239.4, for TGFR3 – 17751.5 – in 1 mg of total RNA. The mean number of mRNA copies in 1 mg of total RNA in the control group was: TGF-b1 – 463.9, TGFR1 – 1185.9, TGFR2 – 3450.9, TGFR3 – 340.9. Conclusions: 1. The highest expression of TGFR3 gene is found in vulvar carcinoma, and in healthy tissues the highest expression was found for TGFR2 gene responsible for cell proliferation inhibition. 2. Increased expression of TGFR3 gene in planoepithelial vulvar carcinoma may indicate its influence on changes of cell growth cycle supporting carcinogenesis.

Keywords: vulvar carcinoma, cytokine, transforming growth factor b1 (TGF-b1), TGF-b1 receptors, SMAD, QRT-PCR
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HPV16 and HPV18 E6, E7 genes expression analysis in surgical material of patients with vulvar carcinoma
GIN ONKOL, 2004, 2 (4), p. 245-251
ABSTRACT

The aim of the study: HPV16 and HPV18 E6, E7 genes expression assessment in tissues during surgical from patients with vulvar carcinoma. Material and methods: The material was 121 tissue samples obtained during oncological surgery in patients with vulvar carcinoma, which were distinguished on histopathologic examination as vulvar carcinoma (group A), metastases of vulvar carcinoma in lymphatic nodes (group B), no metastases in lymphatic nodes (group C), tissues without neoplastic lesions (group D). Further analysis was performed with QRT-PCR (TaqMan). Results: E6 HPV16 gene was highly expressed in all examined samples. E7 HPV16 was increasingly expressed only in vulvar tissues with neoplastic lesions and in lymphatic nodes with metastatic lesions. E7 HPV18 gene expression was not increased in vulvar carcinoma tissues and its expression was increased only in the lymphatic nodes without metastatic changes. Conclusions: There is a reverse expression of HPV genes in lymphatic nodes compared to the tissues of vulva, with a definite predominance of HPV18 in nodes without metastatic lesions and HPV16 in nodes with metastases, contrary to the tissues of vulva, where the predominancy of HPV16 is found in the tissues without neoplastic lesions, and HPV18 in vulvar carcinoma, which indicates worse predictions in patients with HPV16 infections.

Keywords: vulvar carcinoma, E6 HPV16, E6 HPV18, E7 HPV16, E7 HPV18
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The association of selected biochemical and clinical factors with the result of interval cytoreductive surgery in patients with advanced ovarian cancer
GIN ONKOL, 2004, 2 (4), p. 252-261
ABSTRACT

Objectives: In patients with advanced ovarian carcinoma interval cytoreductive surgery has gained some popularity despite the lack of conclusive evidence that these patients have more favorable prognosis in comparison with patients after primary debulking surgery. However, the reduced morbidity and mortality in patients with FIGO III and IV ovarian carcinoma warrants consideration of interval cytoreductive surgery after 3-4 courses of chemotherapy as an alternative mode of approach. The main question is selection of patients in whom interval surgery after neoadjuvant chemotherapy will allow for optimal cytoreduction. Design: Retrospective assessment of factors, which may help to predict the feasibility of optimal interval cytoreductive surgery following neoadjuvant chemotherapy. Material and methods: 51 patients with advanced ovarian carcinoma of FIGO IIIC after explorative laparotomy and neoadjuvant chemotherapy treated in Holy Cross Cancer Center in years 2000-2004 were divided into two groups. The first group consisted of 23 patients, in which optimal interval cytoreductive surgery was performed (residual tumor size <1 cm). The second group included 28 patients where optimal interval cytoreductive surgery could not be achieved (residual tumor size >1 cm). The two groups were compared with regard to: patient age, histological type of carcinoma, tumor grade, localization of neoplastic lesions, presence of ascites, preoperative serum Ca 125 level, platelet count. The quantified variables were compared with the use of U Mann-Whitney test. To compare qualified variables exact Fisher test was applied. In order to assess the influence of a few factors on the result of surgery logistic regression was used. Results: Statistically significant relationship between impossibility of performing optimal interval cytoreductive surgery and superficial metastases to the liver (p<0.05) was detected. No other factors were statistically related to the result of interval surgery. Conclusions: In our study only the presence of superficial liver metastases before application of neoadjuvant chemotherapy was associated with a low probability of achieving optimal interval cytoreduction. The influence of other factors was not confirmed.

Keywords: Ca 125, cytoreduction, ovarian cancer, neoadjuvant chemotherapy
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Prognostic value of the sTNF-R and sICAM-1 serum levels in serous ovarian cancer
GIN ONKOL, 2004, 2 (4), p. 262-266
ABSTRACT

TNF-a affecting the majority of biologically active cells, plays a pivotal role in the antineoplasmatic answer. The soluble forms of TNF-a (sTNF-R) have the possibility of their neutralization. The intercellular adhesion molecules (ICAM-1) in ovarian cancer come from neoplasmatic cells surface and indicate the troubles of interaction between them and immunocompetent cells. The aim of the study was the evaluation of the sTNF-R and sICAM-1 serum concentration in ovarian cancer patients, and the answer to the question, if they can have any prognostic value. In the first group were the patients in I/II clinical stage of ovarian cancer. In the second group were ovarian cancer patients in III/IV clinical stage, according to FIGO, in the third group were the healthy women. The analysis of the sTNF-R serum concentration has shown the difference only between the group II and III. The sICAM-1 concentrations were statistically higher in the I and II groups, compared to the III group. The significant differences of the sICAM-1 concentration were shown between the group I and II. The correlation between the sICAM-1 and sTNF-R1 and sTNF-R2 in the II group was observed, and also the dependency between sTNF-R1 and sTNF-R2 was noticed. The results of the study suggest, that the high sTNF-R2 and sICAM-1 serum concentration are associated with progression of the disease.

Keywords: serous ovarian cancer, soluble TNF-R1, TNF-R2, soluble intercellular adhesion molecule-1 (sICAM-1)
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Life-threatening clinical course of a vascular tumor of the vulva – a case report
GIN ONKOL, 2004, 2 (4), p. 267-270
ABSTRACT

Vasculogenic tumors of the vulva are very rare, with the exception of congenital cavernous hemangiomas. This paper presents a case of a large vascular tumor of the vulva, pathologically hemangiopericytoma, diagnosed in a 65-year-old woman. The patient was operated for a Bartholin gland’s tumor of the same histology 20 years before. Advancing growth of the tumor was observed, with ulcerations on its surface, that had caused periodic hemorrhages. The size and localization of the tumor made radical surgery impossible. Embolization of the tumor’s arteries with subsequent excision of the necrotic tissues were performed twice. Despite this treatment, slow growth of the tumor has been observed. Most probably, the present tumor is a relapse of the neoplasm removed 20 years ago. Taking into account the local aggressive character and the intensity of hemorrhages, the prognosis is poor.

Keywords: vulvar hemangioma, cavernous hemangioma, hemangiopericytoma, embolization
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