2005, Vol 3, No 3
The diagnostics and treatment procedure of adnexal masses in children and juveniles
GIN ONKOL, 2005, 3 (3), p. 129-133
ABSTRACT

The aim of this paper was the presentation of modern standards of treatment of adnexal masses in children and adolescents. Main rules of diagnostic procedures should comprise precise imaging procedures and tumour markers assessment. Proper staging is very important before beginning a treatment procedure. Germinal tumours may cause menstrual disturbances, virilisation or precocious puberty. Teratoma maturum is most common of this type of tumours, and is benign disease. Others, like dysgerminoma, teratoma immaturum, endodermal sinus tumour are malignant tumours and should be treated with combined methods. Chemotherapy and surgery are main types of treatment of such tumours. In these cases surgery has to be conservative, because of high chemosensitivity of these neoplasm. One should remember that adjuvant treatment should be administered as soon as possible. Treatment delay may cause fatal consequences. Gonadal neoplasm are second in frequency among ovarian tumours in young girls. Many symptoms may be determined by secretion of oestrogen within this tumour. Granulosa cell tumour is the most common tumour in this group. Only cases diagnosed in stage II and higher or tumour relapses have to be treated with chemotherapy. Proper surgical staging is mandatory to proper evaluation of clinical stage. Surgery should comprise removal of tumour, biopsy from second ovary, multiple biopsy from peritoneum, omentectomy and pelvic and paraaortal biopsy. Such surgery guarantees good surgical staging. Ovarian cancer fortunately is uncommon lesion in ovary in children or in adolescents. Only in stage IA grade 1 conservative surgery treatment can be allowed. Platinum and taxanes compounds are the gold standard in adjuvant treatment of ovarian cancer patients.

Keywords: terminal tumours, gonada tumours, ovarian cancer, child age neoplasma
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The primary fallopian tube carcinoma – a clinical and morphological analysis of 10 cases
GIN ONKOL, 2005, 3 (3), p. 134-145
ABSTRACT

Introduction: Primary carcinoma of the fallopian tube belongs to the rarest malignant neoplasms of the female reproducting organ. The correct preoperative diagnosis is made very rarely. Both clinical symptoms and the results of further examinations do not indicate unequivocally that the cancer is in progress. Therefore, it is recognized intraoperatively and the final diagnosis is given only after histopathological examination. The aim of the paper was to determinate the frequency of the cancer’s occurrence and the age at which it happens as well as to compare the collected data with the literature. Another step was to analyse some information from patient’s history, ginaecological and other extra examinations and to liken them to the results of the histopathological examination in order to find optimal diagnostics. Material and methods: The research involved the material from 10 cases of the primary carcinoma of fallopian tube which were operated on at Clinical Department of Obstetrics and Ginaecology at Silesian Medical Academy in Katowice between 1999-2004. The research took into consideration the age of patients, part of clinical data and histological type as well as the level of it’s grading. The investigation focussed on comparing preoperative diagnosis and changes occurring within the reproducing organ with the results of histopathological examination. That was followed by correlating staging and grading. Results: The results of the research showed that the average age at which the cancer occur is 63. Clinical data suggested the development of the cancer in just one case. The correct preoperative diagnosis was also given in one case. All the patients reported pain complaint. Nevertheless, the positive correlation between grading and staging was not proved. Conclusions: There’s still lack of certain satisfying methods in diagnosing the primary fallopian tube cancer. Hence, it is essential to pay attention to patient’s history with a focus on pain symptoms and their character. Any unsure cases should be verified by histopathological examination with a particular concern about intraoperative examination. There is also postulation for creating Central Register of Primary Fallopian Cancer that would be useful for obtaining epidemiological data and would be inestimable for looking for efficient methods in preoperative diagnostics. What’s more, bigger number of cases will allow to work out standards in diagnostic process.

Keywords: primary fallopian tube carcinoma, pain complaint, intraoperative histopathological examination, diagnostic’s indications, Central Registry of Primary Fallopian Cancer
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The assessment of the treatment results in cervical adenocarcinoma patients
GIN ONKOL, 2005, 3 (3), p. 146-152
ABSTRACT

The aim of this paper was the assessment of the overall survival in cervical adenocarcinoma patients and its comparison to the data in the literature. The clinical material constituted the group of 142 cervical adenocarcinoma patients, treated between January 1989 and December 1999 at Gynecological Oncology Department of Maria Sklodowska-Curie Memorial Cancer Center – Institute in Warsaw. The analyzed patients were treated with the following methods: surgery with adjuvant radiotherapy, or radiotherapy alone. The analysis of the overall survival in dependence on the selected clinical and population’s factors was performed. The above data were analyzed, using the Kaplan-Meier’s method and Cox’s proportional hazards model. The level of statistical significance was p=0.05. Results: The follow-up median time for surviving patients (N=65) was 81 months (40.5 to 174). The 5-year survival for the whole group was 45%. The 5-year survival for each clinical stage, according to FIGO, was as follows: IB – 63%, II – 48%, III – 18%. Conclusions: In the analyzed material, the 5-year survival rate in cervical adenocarcinoma was lower, when compared to the data in the literature, but similar to the data containing results about the 5-year survival in cervical adenocarcinoma in Poland.

Keywords: adenocarcinoma, uterine cervix, treatment results, radiotherapy, brachytherapy, surgery, literature data
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Effectiveness of 2nd line chemotherapy in the treatment of ovarian cancer using gemcitabine- or ifosfamideand etoposide-based protocols – experience of the Department of Chemotherapy of the Centre of Oncology at Cracow, Poland
GIN ONKOL, 2005, 3 (3), p. 153-159
ABSTRACT

Introduction: Continuous increase of the incidence of ovarian cancer and poor treatment outcomes has prompted many clinical trials dealing with this problem. Chemotherapy based on the so-called golden standard (paclitaxel combined with platinum derivatives) did not result in any breakthrough in long-term survival rates and treatment outcomes. The use of topotecan or liposomal doxorubicin as 2nd line therapy of ovarian cancer has significantly increased treatment costs paralleled by relatively poor response rates. Aim of the study: Evaluation of effectiveness and toxicity of gemcitabine and of a combination of ifosfamide+etoposide in patients with ovarian cancer as 2nd line chemotherapy, implemented as an alternative systemic treatment modality after failure of platinum-based chemotherapy. Material and method: 97 patients were enrolled in this study; 72 thereof received a combination of ifosfamide and etoposide and the remaining 25 – gemcitabine. Results: Both protocols proved similarly active and resulted in clinical response in about 1/3 of patients. Response duration and time to progression were similar in both groups of patients. The use of gemcitabine was more demanding and bothersome, both in terms of administration schedule and toxicity profile. Conclusion: Ifosfamide- and etoposide+gemcitabine-based protocols may be an alternative to more expensive protocols of systemic treatment, resulting in a similar antineoplastic activity. Gemcitabine may be particularly useful in the elderly, in poor-grade patients and in those, who can be treated in the out-patient setting only.

Keywords: ovarian cancer, ifosfamide, etoposide, gemcitabine
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Immunohistochemical assessment of lymphocytic infiltrate and selected markers of activation of the immune system (Fas, HLA-DR) in lichen sclerosus associated with vulvar cancer
GIN ONKOL, 2005, 3 (3), p. 160-169
ABSTRACT

Introduction: Factors causing malignant transformation of vulvar lichen sclerosus are not fully elucidated. In view of available evidence, malignant transformation of keratinocytes in lichen sclerosus is limited to the basal and the peribasal epidermal layers, being the starting point for further stromal invasion. This contradicts the classic theory of vulvar carcinogenesis on the basis of VIN, assuming that cancer develops by gradual replacement of all epidermal layers by atypical keratinocytes. In general opinion, lichen sclerosus may result from prolonged stimulation by antigens (e.g. viral infection). It is supported by observed changes of expression of antigens associated with activation of the immune system (CD3, CD8, CD57, HLA-DR and others). Aim of paper: Evaluation of correlation between change of expression of selected markers of activation of the immune system in vulvar lichen sclerosus (CD4, CD8, HLA-DR, Apo-1/Fas) and the presence of squamous cell cancer of the vulva. Material and methods: Comparison of expression of antigens CD4, CD8, HLA-DR, CD95 (Apo-1/Fas) in vulvar skin preparations obtained from 12 patients with lichen sclerosus (group 1) with those obtained from 14 patients with lichen sclerosus coexisting with squamous cell vulvar cancer (group 2). Expression of selected antigens was assessed quantitatively using digital image analyzer. The number of cells expressing above mentioned antigens was determined in the basal and peribasal epithelial layers. Statistical analysis of the intergroup difference was performed using the Mann-Whitney U test. Results: Statistically significant (p<0.05) increase of CD8(+) lymphocytes and decrease of the number of cells expressing HLA-DR antigens was noticed in the group of women with lichen sclerosus associated with vulvar squamous cell carcinoma. Cells expressing CD4 and CD95 were scarcely represented in epithelial layers of samples studied and their numbers were not significantly different in both groups. Conclusion: An increase in the number of cytotoxic lymphocytes and a decrease in the number of cells expressing HLA-DR antigens and those associated with presentation of antigens to T lymphocytes suggest, that immune factors may play a role in the development of vulvar cancer on the base of lichen sclerosus.

Keywords: lichen sclerosus, vulvar cancer, immunohistochemistry, lymphocytes, HLA-DR, CD95
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Hematopoietic growth factors treatment as a supportive care in gynecologic oncology
GIN ONKOL, 2005, 3 (3), p. 170-177
ABSTRACT

Chemotherapy-induced damage of bone marrow is one of the most important and most frequent adverse effects of antineoplastic treatment. Life-threatening complications resulting from neutropenia, thrombocytopenia and anemia not only compromise patients’ tolerance to treatment, but also have a significant negative impact on patients’ quality of life. At the same time, reduced dosage or increased intervals between consecutive chemotherapy courses lead to a reduced effectiveness of treatment. Recently, many studies have demonstrated that these potential adverse effects of cytostatics may be effectively treated and even prevented by administering suitable hematopoietic factors, which selectively stimulate granulocytopoiesis, erythropoiesis or even thrombopoiesis. These factors constitute a family of molecules playing an active part in the regulation of growth, survival and differentiation of blood progenitor cells and also participate in the modulation of activity of mature cells. At present, most of these factors are commercially available, so they can and should be implemented in everyday clinical practice when treating patients with chemotherapy-induced myelosuppression, in order to improve the effectiveness and safety of antineoplastic therapy. This short review presents basic information concerning the role of some of the hematopoietic growth factors, their influence on tolerance of treatment and on our ability to maintain intensive chemotherapy in patients with gynecological malignancies. The aim of this paper is to encourage clinicians to a more liberal yet fully responsible use of growth factors, in order to improve both patients’ quality of life and results of anticancer therapy.

Keywords: supportive treatment, gynecological neoplasms, erythropoietic proteins, granulocyte colony-stimulating factor, interleukin 11
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Treatment of breast cancer as a chronic disease
GIN ONKOL, 2005, 3 (3), p. 178-183
ABSTRACT

Breast cancer starts to be seen as a chronic disease, which may be controlled for a long time. Considerable merit in this edifying fact popularizing have our patients and their organizations. They testify the success of oncology, appearing publicly. This still need a moral courage, because cancer remains, in social consciousness, a stigmatize disease. During last years, in a lot of developed countries, there have been achieved decrease in mortality due to the breast cancer. This effect was obtained, because of constantly growing morbidity ratio. Acquiring of the death rate decrease with all the time growing morbidity is a huge success, until now not met in oncology. It became possible, because of using achievements of basic sciences in clinical practice, screening introduction, and, what is so important, conjugated treatment in most of patients. This result achievement was possible, because of anxiety reduction campaign, and because of organizational resolutions, making possible diagnosis and treatment in specialistic centers, treating breast cancer patients exclusively.

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