2010, Vol 8, no 1
Selected prognostic factors in ovarian cancer
CURR. GYNECOL. ONCOL. 2010, 8 (1), p. 8-20
ABSTRACT

The authors discuss several predictive factors related to ovarian cancer, both those associated with prognosis and those potentially useful in targeted therapy thereof. Expression of mRNA BRCA1, VEGF and its receptors, CXCR4, HER-2, HIF-1α, COX-2, NM-23, KAI 1, IGF-1R, kisspeptin, neuropilin and Prox 1 gene are discussed. Expression of mRNA BRCA1 is associated not only with hereditary ovarian cancer, but also with its sporadic form. Higher expression correlates with a better response to taxanes. Hopefully, mRNA BRCA1 level in women with sporadic ovarian cancer will become a useful parameter, qualifying patients for a particular chemotherapy protocol. BRMS1 acts as a gene inhibiting development of metastases in ovarian cancer. Levels of mRNA for BRMS1 are lower in late than in early stage ovarian cancer. The VEFG family is involved in angio- and lymphangiogenesis and includes 5 glycoproteins (VEGF-A, VEGF-B, VEGF-C, VEGF-D and VEGF-E), which acting upon receptors VEGFR1-3. Neuropilin 1 plays a role in angiogenesis, while neuropilin 2 modulates lymphangiogenesis, similar to the Prox-1 gene. COX-2 mediates the release of pro-angiogenic factors. HIF-1α expression is associated with resistance of hypoxic cancer cells against cytostatics and radiation. Expression of c-Met correlates with poorly differentiated cancer types. The SDF-1/CXCR4 complex plays a key role in the development of cancer metastases. Survivin is present in cancer cells only, where it inhibits apoptosis and promotes the development of cancer. Metastases suppressor gene (BRMS1) and receptors for VEGF, CXCR4, HER-2, HIF-1α and COX-2, may serve as targets for targeted therapy. At present, an increasing number of studies focus on VEGF receptors. Poor expression of NM-23 and KAI 1 correlate with tumor ability to form metastases. The authors discuss the role of biological markers for clear-cell ovarian cancer (IGF-1R and kisspeptin). Promising topics for future studies are survivin, neuropilin and the Prox-1 gene.

Keywords: prognostic factors in ovarian cancer, targeted therapy, mRNA, BRCA1, VEGF, HIF-1α
DOWNLOAD ARTICLE (PDF)
Preoperative brachytherapy with hyperthermia in the treatment of endometrial cancer – own preliminary results
CURR. GYNECOL. ONCOL. 2010, 8 (1), p. 21-26
ABSTRACT

Endometrial cancer became recently the most frequently diagnosed female genital malignancy in highly developed countries. In 2003 in Poland, 3953 new cases were diagnosed (standardized coefficient: 13.00) and 783 women died thereof (standardized coefficient: 2.2). In the treatment of malignant tumors, heat has been used since Antiquity. Beneficial effect of hyperthermia relies on direct cytotoxic effect, manifesting after elevation of tissue temperature to 41-43°C. Studies performed hitherto combined hyperthermia with standard therapeutic modalities – radiotherapy and chemotherapy. The aim of this paper was to assess the effectiveness of treatment, based on determination of degree of destruction of tumor cells as assessed by histological studies, evaluation of toxicity of the treatment, assessment of quality of life one year after completion of treatment protocol and determination of 3-years’ survival rate. To date, the study encompassed 18 patients with the diagnosis of clinical stage I endometrial cancer, based on histological study of scrapings from uterine cavity and cervical canal. In 14 patients, study of material obtained at fractionated curettage of cervical canal and uterine cavity revealed endometrial cancer of the endometrioid type, in 1 – papillary type and in 3 – no histological tumor type could be determined. Surgery was performed 15-85 days (mean: 34.88 days) after completion of brachytherapy combined with hyperthermia. Based on histological study of surgical specimens, in 6 out of 18 patients (33.3%) no tumor tissue could be detected. In 2 cases (11.1%) after surgery a FIGO stage IIIC cancer was diagnosed in view of presence of metastases to inguinal lymph nodes. These patients were referred for adjuvant teleradiotherapy. In the remaining 10 cases (55.5%), FIGO stage I endometrial cancer was diagnosed. Based on the results obtained, the following conclusions were reached: 1) No complications directly associated with neoadjuvant brachytherapy with hyperthermia were noticed in any of our patients. 2) Alterations detected at surgery, purportedly associated with the treatment performed, did not compromise course or scope of surgery. 3) In 1/3 of our patients, examination of surgical specimens failed to reveal malignant tissue.

Keywords: preoperative (neoadjuvant) radiotherapy, hyperthermia, endometrial cancer, brachytherapy, combined treatment
DOWNLOAD ARTICLE (PDF)
Distribution of lymph node metastases in patients with ovarian cancer
CURR. GYNECOL. ONCOL. 2010, 8 (1), p. 27-33
ABSTRACT

Background: Ovarian cancer disseminates by lymphatic vessels much more frequently than any other gynecological malignancy. Assessment of regional lymph nodes is an integral part of diagnostic work-up in ovarian cancer patients. It contributes essential information enabling correct clinical staging and, by the same token, definition of optimal therapeutic management. Aim of paper: Determination of distribution of lymphatic metastases in ovarian cancer patients. Material and method: Retrospective analysis of 211 consecutive patients with ovarian cancer, treated at the Institute of Oncology, Warsaw, Poland, since 1998 thru 2006. All patients underwent surgical treatment, according to currently valid protocol, including pelvic and periaortal lymphadenectomy, followed by complementary chemotherapy. Analysis encompassed location of lymph node metastases and correlation thereof with key clinical-pathological variables, including clinical stage, grade of differentiation and histological tumor type. Results: Ovarian cancer patients diagnosed with FIGO stage I and II had a similar prevalence of pelvic and periaortal lymph node metastases. In advanced ovarian cancer cases (FIGO stage III and IV), periaortal lymph nodes were invaded more often than pelvic ones. Conclusion: Lymph node metastases are frequent in ovarian cancer patients. Their incidence depends on clinical stage (acc. to FIGO classification), as well as tumor grade and type.

Keywords: ovarian cancer, lymph nodes, distribution, incidence, staging
DOWNLOAD ARTICLE (PDF)
Prognostic value of serum levels of SCC-Ag and CYFRA 21-1 in early-stage squamous cell carcinoma of the uterine cervix
CURR. GYNECOL. ONCOL. 2010, 8 (1), p. 34-39
ABSTRACT

Several markers present in tumor tissues and body fluids considerably aid in early diagnosis, enabling both correct decision-making qualifying patients to high-risk groups, monitoring of the patients’ response to treatment implemented and heralding the possibility of distant metastases or local recurrence. The paper presents correlations of elevated serum levels of CYFRA 21-1 and SCC-Ag with clinical stage, histological differentiation grade and survival rates of 89 patients with FIGO stage IB/IIA squamous cell carcinoma of the uterine cervix. Marker levels were assessed prior to surgery using immunoenzymatic assay kits. Two groups of patients were defined: I (n=31; 35%) surviving less than 5 years and II (n=58; 65%) surviving more than 5 years. CYFRA 21-1 levels exceeding 3.5 ng/ml were present in 42% of patients. Elevation of SCC-Ag level above 1.5 ng/ml was seen in 48% of patients. No correlations were noticed between elevation of serum levels of markers studied and clinical stage nor histological differentiation grade. Patients presenting marker levels below reference values benefited from longer survival. Patients surviving less than 5 years had a statistically significant elevation of baseline serum SCC-Ag levels (p<0.001). These results suggest that patients presenting at an early clinical stage of squamous cell carcinoma and having elevated serum levels of CYFRA 21-1 and SCC-Ag, require neoadjuvant chemotherapy prior to surgical treatment.

Keywords: squamous cell carcinoma of the uterine cervix, CYFRA 21-1, SCC-Ag, serum, prognosis
DOWNLOAD ARTICLE (PDF)
Human papillomavirus infection – current diagnostic techniques
CURR. GYNECOL. ONCOL. 2010, 8 (1), p. 40-46
ABSTRACT

Human papillomavirus (HPV) belongs to the family of DNA viruses. Infection by HPV is associated with the development of benign or malignant lesions within mucosal membrane and skin of the genitals, anus, head and neck. Presence of the virus, particularly of the highly oncogenic variants in epithelial cells of uterine cervix directly influences the development of cervical cancer. In a considerable proportion of cases, HPV infections are asymptomatic and this is probably associated with lack of proliferation phase of viral life cycle, or may be transient, which greatly complicates early detection of the virus. Diagnostic techniques enabling diagnosis of HPV infection include: cytological exam (PAP smear), colposcopy, histological study, as well as increasingly sophisticated molecular techniques, enabling detection of viral DNA when other indices of infection are lacking. These techniques include Southern Blot, Dot Blot, in situ hybridization, polymerase chain reaction (PCR) and Hybrid Capture System I and II (HCI, HCII). Increasingly often authors refer to tests based on isolation of viral mRNA (PreTect HPV-Proofer test). These techniques detect integrated form of HPV, the so-called episomal form of the virus. In general opinion, the presence of HPV in this form is directly associated with progression of lesions developing as a result of this infection. While the PreTect HPV-Proofer test detects a smaller number of cases of HPV infection, its use enables selection of patients most at risk of developing cervical cancer.

Keywords: cervical cancer, human papillomavirus, PCR, Hybrid Capture System, mRNA
DOWNLOAD ARTICLE (PDF)
Neutropenia – ASCO 2009 report on diagnosis and treatment
CURR. GYNECOL. ONCOL. 2010, 8 (1), p. 47-50
ABSTRACT

The aim of this paper is to present most recent reports dealing with neutropenia and febrile neutropenia as complications of chemotherapy in oncology. The problem is not isolated but concerns a large proportion of oncologic patients undergoing antitumor therapy. Considering that most oncologic patients are elderly people whose bone marrow reserve is not entirely efficient, palliative prolongation of survival of oncologic patients and more aggressive therapeutic protocols using cytostatic drugs, neutropenia becomes an increasingly frequent sequel of side effects of chemotherapy, rated among acute complications of treatment (developing several days to several weeks after cessation of administration of cytostatics). Qualification of patients to one of three risk groups for febrile neutropenia distinguished by the National Comprehensive Cancer Network (NCCN) and European Organisation for Research and Treatment of Cancer (EORTC), facilitates prediction of the patients’ response to treatment instituted. Reports presented at the 2009 ASCO meeting significantly advance our understanding of factors stimulating the growth of granulocytes and particularly their influence on survival of oncologic patients subjected to myelosuppressive chemotherapy. The paper discusses abstracts presented at the 2008 ASCO meeting, which, similar to the 2009 ASCO abstracts, compare the risk of hospitalization of patients receiving filgrastim and pegfilgrastim. Of utmost importance in clinical practice is primary and secondary prevention and treatment of neutropenia and febrile neutropenia, which is substantial cause of mortality in oncologic patients.

Keywords: neutropenia, febrile neutropenia, G-CSF, chemotherapy, neoplasms
DOWNLOAD ARTICLE (PDF)
Primary squamous cell carcinoma of Bartholin’s gland. Report on 3 cases
CURR. GYNECOL. ONCOL. 2010, 8 (1), p. 51-57
ABSTRACT

The greater vestibular gland was first described by Danish anatomist Bartholin in 1675. Cancer of this organ was first reported 190 years later by J.M. Klob. To date, there are about 300 cases of squamous cell carcinoma of Bartholin’s gland reported in the literature. These conditions constitute about 0.03% of all female genital malignancies. During 28 years of activity of the Center of Oncology in Warsaw, Poland, 3 patients with primary squamous cell carcinoma of Bartholin’s gland have been treated. Prior to admission, they were observed at their place of residence and received antiinflammatory treatment. The lesions did not respond to this treatment but did not cause pain either. The patients suffered only moderate discomfort in this area. On admission, tumors measuring 4 cm and over were noticed, deeply infiltrating adjacent tissues without ulceration of overlying skin. One patient had a coexisting rectovaginal fistula. All patients underwent surgical treatment only. Radical vulvectomy with bilateral inguinal and pelvic lymphadenectomy was performed in 2 patients. One patient underwent local vulvectomy without lymphadenectomy due to internal-medical comorbidities and lack of consent to radiotherapy. She survived 30 months with dramatic recurrence of disease taking place during the final 6 months. One patient survived 11 years after undergoing 3 repeated excisions of recurrent tumors. One patient died 3 years after primary surgery due to cardiovascular events.

Keywords: squamous cell carcinoma of Bartholin’s gland, Bartholin’s gland tumor, vulvar tumor, treatment of Bartholin’s gland carcinoma
DOWNLOAD ARTICLE (PDF)