Treatment of late-stage cases of vulvar cancer constitutes a significant challenge for any gynecologist oncologist. High local advancement of the tumor, frequent invasion of functionally important organs, e.g. urethra, vagina and rectum, as well as high risk of metastases to regional lymph nodes require a particularly in-depth analysis of prognosis, scope of planned surgery and possible implementation of adjunctive therapeutic modalities. The paper presents our experience in surgical treatment of locally advanced vulvar cancer and a review of current literature concerning these issues. During the last few years, high effectiveness of ultraradical exenteration surgery in persons with locally advanced vulvar cancer, particularly in cases with no metastases to regional lymph nodes, has been confirmed many-fold. Past decade provided a large body of convincing data, indicating high therapeutic effectiveness of less radical procedures, particularly if combined with radiotherapy or radiochemotherapy. Use of neo-adjuvant radiotherapy or radiochemotherapy prior to surgery, yields a high rate of local control with concomitant preservation of sphincter function, thus limiting the indications for ultraradical procedures. In spite of evident progress in the treatment of locally advanced vulvar cancer, cases with invasion of regional lymph nodes still constitute a significant clinical problem. This prognostically unfavorable group of patients urgently requires the development of new systemic therapeutic protocols, including novel chemotherapeutic agents.
Objective: The purpose of this study was to demonstrate the safety of minilaparotomy hysterectomy with adnexectomy in the cases of atypical endometrial hyperplasia. Material and methods: Twelve patients were qualified for hysterectomy according to the gynaecological and sonographic examination. All women had a biopsy of the endometrium and the histopatological report confirmed the atypical endometrial hyperplasia. The incision of abdominal layers not exceeding 6 cm in length is called minilaparotomy. Results: The mean operating time of the surgery was 49.1 min. (35-80 min.). Estimated blood loss was 100-300 ml and the pain was 3.4 points in VAS scale on first day after operation. Hospitalisation after operation was 2 to 5 days (average 3.7). In two cases a temperature higher than 38˚C was observed on the second day after the operation. Those patients were subsequently treated with cefalosporin. Conclusions: Minilaparotomy hysterectomy may be designed for a selected group of patients with atypical hyperplasia of the endometrium.
Radio- and chemotherapy increases the probability of both arterial and venous thromboembolic complications. Increased coagulation activity causes thrombosis and embolisms in the vessels of numerous organs, thus affecting their function.
Aims: The main aims of the research are as follows: 1) Evaluation of the influence of haemostatic disorders on renal function in patients with FIGO stage IIB-IIIB cervical cancer treated with radiochemotherapy. 2) Developing methods of improving renal function in patients with haemostatic and fibrinolytic disorders undergoing radiochemotherapy treatment for FIGO stage IIB-IIIB cervical cancer. Methods: The study was randomized. Treatment design assumes the administration of a total radiation dose of 46-65 Gy (box technique) in 2 Gy fractions and, additionally, cisplatin 40 mg/m2 every 7 days in patients with normal plasma creatinine level. Renal function will be assessed with the aid of dynamic scintigraphy with glomerular filtration rate (GFR) evaluation. Analysis of serum haemostatic system covered D-dimers, PAP, PAI-1, tPA, F1+2, TAT. The patients will be divided into two groups: the study group – i.e. patients with affected glomerular filtration rate and the control group – patients with normal renal dynamic scintigraphy results. Half of study group patients was, throughout the entire treatment, receive nadroparine prophylaxis in a standard dose – 2850 units aXa/0.3 ml every 24 hours during and 6 weeks after the treatment (randomization list). Results: There are statistically significant decreasing of GFR in control (median -9.7%) and study group without nadroparine (median -9.9%). In study group with nadroparine the increasing of GFR (median 22.3%) was noted (p=0.0001). Serum haemostatic system analysis showed activation of fibrinolysis in patients treated with nadroparine and increation of fibrinolysis inhibition in study group without nadroparine and in control group. Conclusion: 1) One of the reasons of subclinical renal insufficiency in patients with advanced cervical cancer may be the inhibition of fibrinolysis with glomerular thrombosis. 2) This insufficiency increasing after the end of radiochemotherapy in patients as well with normal GFR as with primary decreasing GFR. Simultaneously, there are increase pathological changes in serum haemostatic system. 3) The application of nadroparine caused fibrinolysis activation, and increasing of glomerular filtration.
The aim of the study was the evaluation of HER2 status in ovarian tumors. Material consisted of 158 patients with ovarian tumors treated in Center of Oncology since 1995 to 2005: 128 cases were entered to further analysis. Two methods were applied: immunohistochemistry (IHC) for the evaluation of HER2 receptor and fluorescence in situ hybridization (FISH) for the assessment of HER2/neu gene amplification. Into the analysis with the immunohistochemistry method were qualified 54 ovarian cancers, 59 borderline tumors and 11 benign tumors. Into the analysis with FISH method were qualified 53 ovarian cancers, 62 borderline tumors and 11 benign cysts, the other were disqualified because of technical reasons. The analysis of HER2 receptor by IHC resulted in different rate of positive cases according to different criteria of interpretation and varied between 7.4 and 51.85% in ovarian cancer and between 0 and 33.9% in borderline tumors. HER2/neu gene amplification assessed with FISH was observed in 7.55% of ovarian carcinomas and 3.23% of borderline tumors. There was no correlation between positive cases in both methods – IHC and FISH. The work is the part of grant realized with KBN support and the final goal is to compare the HER2 status with clinical outcome in patients with ovarian tumors.
In women, who are BRCA1/2 gene mutation carriers, the risk of breast cancer development is about 50-80%, of ovarian cancer – about 40%, and about 10% of the uterine tube and peritoneal cancer. One of the options, except chemoprevention, in women who are BRCA1 gene mutation carriers, is prophylactic adnexectomy, which significantly reduces the risk of the above cancers development. Prophylactic adnexectomy reduces the risk of ovarian cancer development to 5% and the risk of breast cancer development to 30-40%. In the group of women, who are BRCA1 gene mutation carriers, the changes in expression of the other genes, that can modify occurrence of the breast or ovarian cancer, is being searched. Also, the preneoplastic changes in their ovaries are still being searched. Our studies, concerning the TP53, BRCA1, NM23 and KAI1 proteins expression in that group of women, did not demonstrate important changes because of too low quantity, but they seem to be promising, particularly in the range of BRCA1 and KAI1 mutations.
There has been recently a rising interest in the problems of the sentinel lymph node (SLN). By definition, a sentinel lymph node is the first node draining a given anatomical region. When a region has two or more draining routes separate SLN can be found for each of them. Metastatically changed, in terms of histopathology, SLN may suggest the presence of metastases in the higher lymph nodes, so-called nonSLNs. Additionally, the use of histochemical methods increases the sensitivity of the method. Lymph node mapping and sentinel lymph node biopsy are one of the most promising procedures performed in the diagnosing and treatment in oncology in recent years. The lymph node status is an important prognostic factor. The information obtained from SLN examination can be used to individualize the treatment as well as reduce the possible complications, intra- and postoperative, connected with the extension of the surgery. The paper presents the updated knowledge on this subject with respect to the cervical, vulvar and endometrial cancers.