2007, Vol 5, No 4
New trends in the management of primary vaginal squamous cell carcinoma
GIN ONKOL 2007, 5 (4), p. 190-199
ABSTRACT

Primary vaginal cancer is a rare disease constituting approximately 2% of gynaecological malignancies. Most vaginal cancers are in fact metastases from adjacent organs, mostly cervix and vulva and, much less frequently, bladder, sigmoid colon or rectum. Major part (80%) of primary vaginal cancers are squamous cell carcinomas located usually in the upper 1/3 of the vagina. Little is known about aetiology of this tumour. The patients’ age range is wide with preinvasive lesions affecting predominantly the younger age group. VAIN-lesions are mostly asymptomatic and are first detected by an abnormal PAP-smear. Location of the lesion can be defined by colposcopy. Surgical excision or ablation of atypical epithelium using CO2 laser or radiation therapy are usually highly effective. It is probably unnecessary to treat VAIN 1 and VAIN 2 lesions unless they are persistent. All VAIN 3-lesions should be actively treated. In the case of histologically proven cancer, radiotherapy combining external and internal sources of radiation is the treatment of choice in most centres. In young women the key issue is to prevent radiation-induced castration. Recent studies show that conservative treatment options sparing reproductive and sexual function in young women at an early stage of the disease are feasible and effective. In more advanced stages radiation therapy is indicated, but survival rates obtained are worse than in cervical cancer patients. Tumour morphology, grade and stage are important prognostic factors. Common background factors with no prognostic significance are prior hysterectomy, other gynaecological malignancies and pelvic irradiation. Better understanding of prognostic factors and biologic tumor markers may help to discriminate between low- and high-grade tumours and to develop guidelines for tayloring tumour- and patient-specific therapies.

Keywords: primary squamous cell vaginal cancer, precancerous lesions, invasive cancer, diagnostic and therapeutic strategies, radiotherapy, surgery
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Uterine sarcoma in young women – analysis of 17 cases
GIN ONKOL 2007, 5 (4), p. 200-207
ABSTRACT

Uterine sarcoma are characterized by aggressive clinical course, poor prognosis and early development of metastases. According to various authors, they constitute 1-5% of all malignant uterine neoplasms. Already in clinical stage I, uterine sarcomas may produce metastases to pelvic lymph nodes in about 30% of the cases and to periaortal lymph nodes – in about 15%. Uterine sarcomas are particularly noteworthy because of limited experience in their management and lack of generally accepted diagnostic criteria and effective therapy. Preoperative diagnosis is possible in about 30% of the patients undergoing uterine cavity curettage. The treatment of choice of uterine sarcoma is radical surgery. The aim of this paper was clinical analysis of 17 patients aged 24-43, operated on for uterine sarcoma at the Department of Gynaecology, Obstetrics and Oncological Gynaecology of the Silesian Medical University in Bytom, Poland, since 2002 thru 2006. Analysed variables included: patients’ age, type and severity of ailments preceding diagnosis of uterine sarcoma, histopathologic diagnosis, type of surgical and adjuvant treatment implemented, treatment outcome and postoperative course. Microscopic examination of surgical specimens revealed leiomyosarcoma (47%), stromal sarcoma (29.4%) and less often necrotising leiomyosarcoma (11.8%), necrotising fibrosarcoma (5.9%) and undifferentiated sarcoma (5.9%). Upon completion of surgical treatment, all patients were referred for adjuvant treatment at the Department of Oncological Gynaecology of the Institute of Oncology in Gliwice, Poland.

Keywords: uterine sarcoma, diagnosis, surgical treatment, adjuvant treatment, young women
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Historic perspective of breast cancer treatment
GIN ONKOL 2007, 5 (4), p. 208-217
ABSTRACT

The authors took interest in historical aspects of treatment of breast cancer over past centuries. The first mentions of breast tumours or lumps appeared in Egyptian writings 3 thousand years ago. Etymology of the word “cancer” was explained by Paul of Egina by the resemblance of blood-engorged veins adjacent to breast tumour to crab legs. Ancient doctors not only diagnosed this disease, but also made attempts at treating it. Roman doctors considered breast cancer as a local disease and treated it by radical excision, including pectoral muscle. Greek doctor, Galen, was the first to consider breast cancer as a systemic disease and tried to treat it conservatively using herbal extracts of mandrake and cabbage. Cessation of progress of medicine characteristic for the Middle Ages resulted in a dramatic reduction in the scope of surgical techniques available. A renewed interest in science, including a return to Galen’s theory and ancient surgical techniques, took place in the Renaissance. At this time, European surgeons – Ambroise Paré, Wilhelm Fabry, Jacques Guillemen and others – made ever bolder attempts at surgical treatment of breast tumour. The XVIII century witnessed further progress of medical science, while the work by William and John Hunter enabled a better understanding of structure and principles of function of the lymphatic system. The XIX century is marked by tremendous progress in surgery, including surgical treatment of malignant tumours. Introduction of ether anaesthesia in 1846 by William T. Morton, paved the way for implementation of general anaesthesia in clinical practice. Subsequent achievements of this epoch were: understanding of aseptic and antiseptic principles and examination of tissues using a microscope. The XIX century was also marked by a search of non-surgical modalities of treatment of malignant breast tumours. In 1895 Emile Grubbe was the first to use radiotherapy after mastectomy. The XX century witnessed a tremendous progress of all hitherto available diagnostic and therapeutic techniques used in the management of patients with breast cancer, particularly those based on molecular biology and gene therapy.

Keywords: breast cancer, history, treatment, surgical techniques, hormone therapy, chemotherapy, radiotherapy
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Prognostic significance of HER-2/neu expression in patients at early clinical stages of invasive cervical cancer
GIN ONKOL 2007, 5 (4), p. 218-235
ABSTRACT

HER-2/neu overexpression is considered an important prognostic factor, which may predict an aggressive clinical course of several tumours, including cervical cancer. Material and method: HER-2/neu expression was assessed by immunohistochemical technique in 298 patients with stage IB and IIA cervical cancer, of either planoepithelial or adenomatous type. HER-2/neu expression was compared in groups of patients selected based on generally accepted prognostic factors, e.g. clinical stage, histological type, presence of metastases to regional lymph nodes, invasion of vascular space and degree of radiation-induced destruction of tumor. Using the Cox model, a multivariate analysis of effect of selected prognostic factors was performed, both in relation to overall survival and to symptom-free survival. Results: Positive reaction to HER-2/neu was obtained in 135 cases (45.3%); the reaction was pronounced (3+) in 23 cases (7.8%) and moderate (2+) in 41 cases (13.7%). No positive reaction was obtained in 163 cases (54.7%). Analysis of survival yielded the following results: probability of 5-year overall survival for the entire patient population was 90.9% and that of 10 years – 85.2%. Overall survival curve for the entire study population is presented. Recurrence-free 5- and 10-year survival rates were 83.3% and 82.3%, respectively. Symptom-free 5- and 10-year survival rates were significantly influenced by: lymph node involvement and their number, invasion of vascular space, histological type and HER-2/neu expression. Cox analysis demonstrated a significant correlation between risk of recurrence or death and the following factors: lymph node metastases and their number, invasion of vascular space, histological type of tumour and HER-2/neu expression. The risk of recurrence or death with a single nodal metastasis and several nodal metastases is 2.4- and 5.1-fold greater than when no nodal metastases are present. The fact of vascular space involvement results in a 3-fold increase of risk of recurrence or death. In the case of planoepithelial cancer, the risk of recurrence or death is 0.4-fold that for adenomatous cancer. Finding of a strong HER-2/neu expression (2+, 3+) increases 2.7-fold the risk of therapeutic failure. Conclusions: No statistically significant differences were found in the HER-2/neu expression in groups of patients defined based on clinical-pathological parameters (i.e. clinical stage, histological type, regional lymph node metastases, radiation-induced cervix sterilization). The following prognostic factors had a significant impact on symptom-free survival: histological type, presence and numbers of lymph node metastases, invasion of vascular space, as well as TP53, BCL2 and HER-2/neu expression. Among all factors analysed, most significant prognostic impact, both in terms of overall survival and symptom-free survival, was associated with involvement of pelvic lymph nodes.

Keywords: cervical cancer, prognostic factors, immunohistochemistry, HER-2/neu expression, survival rate and mortality rate
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Hereditary ovarian cancer – case report
GIN ONKOL 2007, 5 (4), p. 236-242
ABSTRACT

Hereditary causative factors are present in about 10% of ovarian cancer cases, mainly BRCA1 and BRCA2 mutations. Mean age of women developing hereditary ovarian cancer is about 10 years lower (42-45 years) than that of women with sporadic ovarian cancer (54 years). In both groups prognosis is similar. Most common histological type is serous adenocarcinoma. The paper presents a case of a 44-year-old woman, in the care of genetic outpatient clinic because of BRCA1 mutation. For the first time, the patient presented at the Centre of Oncology in Warsaw, Poland, in 2002, with results of biopsy of a breast lesion. Due to a positive family history, the patient entered of the Program of supervision of families burdened by high, genetically determined risk of malignant tumours, conducted by the Genetic Outpatient Clinic of the Institute. The patient was subjected to a regular follow-up at 6-months’ intervals. Five years after her first visit, in October 2007, transvaginal sonography revealed a small cystic lesion with endophytic excrescences in the left ovary, 3 cm in diameter, with concomitant increase of the Ca 125 level. Control study in December 2007 confirmed the presence of a cystic-solid tumour of the left ovary. The patient was qualified for surgical treatment. Surgery consisted in hysterectomy, adnexectomy, omentectomy, retroperitoneal lymphadenectomy and peritoneal biopsy. Microscopic studies of surgical specimens revealed urothelial adenocarcinoma G3. The patient was referred for paclitaxel- and carboplatin-based chemotherapy.

Keywords: hereditary ovarian cancer, BRCA1, BRCA2, prophylaxis, diagnosis, therapy
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Diagnostic algorithm in uterine mesenchymal tumours
GIN ONKOL 2007, 5 (4)
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