Background: Paclitaxel and platinum analogs are standard drugs implemented as first-line therapy in advanced ovarian cancer, after previous surgery. One of causes of resistance to therapy is, among others, disruption of mechanisms leading to cell apoptosis. Aim of the paper is to determine the significance of expression of TP53, BAX and BCL-2 in response to first-line chemotherapy using paclitaxel in patients with advanced ovarian cancer, as well as to assess the role of TP53 as a prognostic and predictive factor in ovarian cancer. Material and method: The study included 164 patients with advanced ovarian cancer. Immunohistochemical staining was performed on histological specimens obtained from paraffin blocks. Monoclonal antibodies anti-BAX, anti-BCL-2 and anti-p53 were used. Results: Accumulation of TP53 was noticed in 60% of tumors. BCL-2 was absent in half of tumors studied. Significant expression of BCL-2 was noticed in 24% of tumors, while that of BAX was seen in 34% of tumors. There was a correlation of histological grade, volume of residual tumor left after surgery and BAX expression with overall survival. Enhanced expression of BAX correlated directly with increased death risk. Accumulation of none of proteins studied had any influence on disease-free survival. Complete remission was obtained in 106 patients. Size of residual tumor has a significant impact on disease-free survival. Conclusions: 1) In ovarian cancer patients, clinical factors clearly have far greater prognostic value than molecular factors. 2) There was no correlation between TP53 expression and clinical response to first-line chemotherapy using paclitaxel, cisplatin or platinum analogs. 3) TP53 expression is not a prognostic or predictive factor in ovarian cancer.
Recent decade saw a significant progress in the diagnosis of prognostically important features of neoplasm, in particular those influencing critically the choice of techniques and protocols of oncological treatment. Principles of therapeutic approach to patients with genital malignancies, which were valid in the past, most often neither took into consideration the age of patients, nor was the issue of preservation of procreative functions considered as clinically important. In recent years, the situation in this area underwent a dramatic change. In patients of procreative age, the measure of therapeutic success is not as much standard parameters, e.g. long-term survival rate or recurrence risk, but rather overall quality of life and in particular preservation of ability to procreate. At present, in most locations of early-stage female genital malignancy, there is a possibility to spare procreative function. Based on reports in recent publications, we undertook a review of current views on management of malignancies of uterine cervix, uterine mucosa and ovary enabling preservation of procreative potential of women involved.
Ovarian cancer is worldwide the leading cause of mortality in women with genital tract malignancy. Over one-half of patients are diagnosed with their ovarian cancer in the 3rd and 4th clinical stage. Currently, the standard protocol of management consists in surgery aiming at obtaining histological diagnosis, determination of clinical stage and cytoreduction followed by chemotherapy. At present, generally accepted chemotherapy protocol includes paclitaxel and platinum derivates (6 courses 3 weeks apart). Unfortunately, the outcome of this therapy is far from satisfactory and only about 20% of women with late-stage ovarian cancer survive over 5 years. Studies are underway aiming at improvement of the patients’ survival rate. Promising results are associated with intraperitoneal chemotherapy, which may be implemented as first-line treatment, consolidation of remission or salvage treatment. This modality may be an attractive alternative, because it by-passes peritoneal barrier, overcomes resistance of cancer cells, results in less systemic toxicity, increases exposure of tumour to high concentration of cytostatics. The newest GOG172 trial confirmed a 21.6% mean reduction of death risk. This study enabled to define a group of patients who may benefit most of intraperitoneal chemotherapy. These are patients in the 3rd clinical stage, after optimal surgical cytoreduction, with minimal residual disease. At present, great hopes are associated with the protocol including intraperitoneal cisplatin (100 mg/m2) and taxanes administered intravenously only or intravenously and intraperitoneally.
Primary neoplasms of the vagina are rare. Metastatic carcinomas are considerably more frequent. The typical problem is to locate the primary tumor. Cervical cancer is most the common, followed by endometrial carcinoma, colon, rectum, ovary and vulvar cancer. Spread of malignant neoplasms of the urinary tract are rare. Late diagnosis is characteristic, the prognosis depends on primary tumor, early diagnosis and effective therapy.
Mesodermal mixed malignant tumours (MMMT) are the rare neoplasms of postmenopausal women, with extremely poor prognosis. They constitute about 1-2% of all gynaecological malignancies and about 2-5% of uterine corpus malignancies. Due to rare frequency, the exact knowledge about their characteristics is difficult. Therefore, the treatment is based on the treatment methods used in endometrial cancer. For most authors, because of their clinical course, they are treated as more aggressive endometrial carcinomas. In the literature, there were described a lot of cases of endometrial cancer and MMMT development after the chronic therapy with tamoxifen, due to breast cancer, but rare data suggest the possibility of coexistence of the two above neoplasms, without the previous therapy with tamoxifen. In this paper, we present the case of woman, aged 78, with tumour mixtus mesodermalis malignus corporis uteri, coexistent with breast cancer, and unilateral lymph nodes metastases, coming from the uterine tumour, with no previous therapy. In the literature we did not meet any case of breast cancer, coexistent with MMMT with the axillary lymph node metastases of MMMT component.