2010, Vol 8, no 3
Cancer: health hazard resulting from attempted health protection
CURR. GYNECOL. ONCOL. 2010, 8 (3), p. 149-159
ABSTRACT

Cancer, a popular name of neoplasm and/or neoplastic diseases, is inseparably bound with equally popular definitions of life, health and death, the former and the latter being natural phenomena. The essence of life continuous, spontaneous and mutual exchange of matter and energy, whereby a significant role is played by information about their state as unity of apparent contrasts. The key issue is that life does not arise de novo, but is passed on. Neoplasm is a final cellular form of life of multicellular organisms, able to prolong life processes by dissipative self-organization of cells threatened by death. Its exceptionality consists in the fact that self-organization of tumors can prolong life in daughter cells only, and only as long as affected host lives, becoming increasingly sick due to increasing tumor-dependent dissipation of matter and energy. Clearly increased dissipation of matter and energy by tumor cell in a hitherto normal tissue is the first and non-specific, but still a universally recognized information about local ineffectiveness of host organism. A sufficiently efficient host organism as a whole is able to use its defense mechanisms not only to destroy such a cell featuring an alien neoplastic identity, but also to eliminate dissipative states in cells threatened by death in own tissue. This process, occurring in multicellular organisms, apart of proliferation and apoptosis, determines the size of cellular populations in tissues and organs. From this point of view, carcinogenesis is also a potent quantitative and qualitative regulator of tissues.

Keywords: neoplasm, neoplastic disease, dissipation, dissipative structures, life forms
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Borderline tumors of the ovary – diagnosis and treatment
CURR. GYNECOL. ONCOL. 2010, 8 (3), p. 160-165
ABSTRACT

Borderline tumors of the ovary account for 10-20% of all epithelial cancers of this organ. They are usually diagnosed at clinical stage I, mainly in women of reproductive age. The tumor is unilateral in 60-90% of the cases. Most of the tumors are serous (37-50% of total). The mucinous variant is less frequent and the least frequent is the endometrioid variety. Histological diagnosis of borderline tumors is based on lack of destructive stromal infiltration. A characteristic feature of these tumors is the presence of peritoneal seeding, both invasive and non-invasive, associated mainly with serous and mucinous tumor types. A special form of borderline tumor is the serous borderline tumor with micropapillary pattern. Unfavorable prognosis is associated with the bowel type of mucinous borderline tumor, particularly when coexisting with peritoneal pseudomyxoma, often originating from the vermiform appendix. Development of borderline cancers results from mutations in the BRAF and KRAS genes, which are present in 47-60% of serous tumors. Sparing surgery indicated in early clinical stages (I and II) in women under 40, who wish to preserve their fertility. In all other cases, even at early clinical stages, standard procedure consists in hysterectomy combined with adnexectomy and omentectomy. In advanced stages, the aim of surgery is total cytoreduction, if feasible. Mucinous tumors require concomitant appendectomy. Recurrent cases usually are reoperated, particularly when the primary procedure was a sparing one. Chemotherapy does not improve treatment outcomes.

Keywords: borderline tumors of the ovary, borderline tumors, borderline-malignancy tumors, peritoneal pseudomyxoma, treatment of borderline ovarian tumors
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Adjuvant chemotherapy of ovarian cancer using paclitaxel/cisplatin protocol in women over 70 – analysis of treatment course and toxicity
CURR. GYNECOL. ONCOL. 2010, 8 (3), p. 166-173
ABSTRACT

Aim of paper: Analysis of clinical course of 1 st line chemotherapy acc. to paclitaxel/cisplatin protocol in women over 70 with ovarian cancer. Secondary endpoint was treatment-related toxicity in this population of patients. Material and method: This retrospective study included 25 patients over 70 with confirmed diagnosis of ovarian cancer at the beginning of their therapy (study group) and 25 patients under 70 continuing their therapy (control group). All patients underwent primary surgery and received adjuvant chemotherapy (paclitaxel 135 mg/m2 and cisplatin 75 mg/m2). Treatment-related toxicity was assessed using Common Terminology Criteria for Adverse Events v. 3.0 (CTCAE). Results: Patients in both groups did not differ significantly in clinical stage of their disease. Women in the study group presented a significantly higher proportion of poorly differentiated ovarian cancer as compared with controls. Baseline mean CA-125 level was similar in both groups. No significant intergroup differences occurred concerning the number of chemotherapy cycles delivered or mortality rate during the therapy. Proportion of patients requiring delay or cessation of treatment was similar in both groups. No significant difference was observed in remission rates between study and control groups. Incidence of hematologic complications, renal failure, neurotoxicity and hepatotoxicity was similar in both groups. No cardiologic complications were noticed in this population of patients and proportion of patients who required blood transfusion was similar in both groups. Conclusions: Course of treatment, toxicity and clinical response are not age-dependent in patients with ovarian cancer receiving paclitaxel/cisplatin protocol.

Keywords: ovarian cancer, adjuvant chemotherapy, paclitaxel, cisplatin, toxicity
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Laparoscopy in the treatment of adnexal tumors
CURR. GYNECOL. ONCOL. 2010, 8 (3), p. 174-179
ABSTRACT

Adnexal tumors are among the most frequent disorders of the female genital system. According to current estimates, they affect up to 10% of all women. Recently, the role of laparotomy in surgical techniques in gynecology increased consi derably, while laparoscopy performed for an adnexal tumor is one of the commonest gynecologic procedures. The aim of this study was a retrospective analysis of 307 laparoscopic procedures performed due to adnexal tumors. In this population of patients, in 2 instances the procedure was converted from laparoscopy to laparotomy because of a suspected malignancy, subsequently confirmed by histological study, while in 2 other cases malignancy was diagnosed post-hoc and a repeat surgery was necessary. The incidence of various types of ovarian lesions was analyzed, whereby the most frequently encountered conditions included simple, endometrioid and dermoid cysts, in decreasing order. No serious lapa roscopy-associated complications were noticed and all patients were discharged from hospital on the first postoperative day. The authors highlight the importance of precise diagnosis of adnexal tumors prior to surgery and role of sonographic study, as the basic diagnostic tool used to determine the nature of lesion. Sensitivity and specificity of this study in the diagnosis of adnexal tumors is discussed, as well as predictive value of the non-specific marker CA-125, which proved useless when suspecting endometrial tumors. At present, laparoscopy is the technique of choice in the diagnosis and treatment of benign genital lesions in the females. Nevertheless, adequate qualification of patients to surgical treatment is still the key issue.

Keywords: laparoscopy, ovarian tumors, ovarian cysts, ovarian cancer, sonography
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Vulvar cancer – limitations of current management options and potential role of immune therapy
CURR. GYNECOL. ONCOL. 2010, 8 (3), p. 180-187
ABSTRACT

Current standard of management of squamous cell vulvar cancer appears overly aggressive for early clinical stages (FIGO I and II), where true incidence of lymph node metastases is below 20%, and far too conservative for late stages (FIGO III and IV), where no effective complementary treatment is available. In view of these facts, entirely novel therapeutic approach should be developed in order to improve treatment outcomes. Nowadays, the role of immune therapy in oncology is increasing rapidly. New antigens and new therapeutic techniques are introduced. Cancer antigens discovered to date may be classified into: widespread antigens – present both in malignant cells and in several normal tissues (MUC2, PRAME, SART-1, RU-1); differentiating antigens – present in malignant cells and in their normal predecessors (CEA, PSA and melanoma antigens: gp100, MART-1, tyrosinase); cancer-specific antigens – present only in malignant cells (ras oncogene, ß-catenin, CDK4, MUM-1); cancer/testis antigens (C/TA), which normally are present in the testes only. The aim of this paper was to present an update on C/TA, this being a relatively novel, poorly understood and very promi sing family of antigens. Absence of C/TA antigens beyond cancer tissue and their exquisite ability to induce immune response (both cell- and humoral-mediated), makes them an attractive target for immune therapy, particularly in the females.

Keywords: vulvar cancer, immune therapy, C/TA, MAGE, NY-ESO-1
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Reduction of risk of developing BRCA-dependent cancer in BRCA1/2 mutation carriers – novel approach to old paradigm
CURR. GYNECOL. ONCOL. 2010, 8 (3), p. 188-199
ABSTRACT

Carriers of mutations in BRCA1 and BRCA2 genes undergo a significantly increased risk of developing breast cancer, ovarian cancer, fallopian tube cancer and peritoneal cancer. Due to genetic homogeneity of Polish population, the key issue are mutations of BRCA1 gene. Mutations of 5382insC, C61G and 4153delA constitute about 90% of all BRCA1 gene mutations. Mean cumulative risk of development of ovarian cancer by carriers of BRCA1 gene mutations under 70 is estimated at 40% and that of breast cancer – at 57%. Management of carriers of BRCA1/2 mutations is multidirectional. Carriers of BRCA1 mutations should be screened for breast cancer. Available data indicate that detection of early forms of ovarian cancer is currently impossible. Use of low-dose oral contraception may reduce the risk of ovarian cancer, while not increasing the risk of breast cancer in BRCA1 mutation carriers. After giving birth to planned/desired number of children, carriers of BRCA1 gene mutation should be offered the option of preventive salpingo-oophorectomy. This may reduce the risk of development of BRCA-dependent tumors to 0.21 (95% CI: 0.12-0.39) and breast cancer to 0.49 (95% CI: 0.37-0.65). Risk reduction for the development of peritoneal cancer is not 100% because some of the patients develop primary peritoneal cancer. The risk of development of this type of tumor is significantly reduced to 0.92% vs. 5.78% in the followed-up group. Upon preventive adnexectomy, these patients may safely benefit from hormonal replacement therapy. Close follow-up is mandatory aiming at an early detection of possible metabolic syndromes. Available model analyzing the impact of several strategies of follow-up and intervention on survival rates of mutation carriers indicates that adnexectomy at the age of 40 is the single most effective intervention in BRCA1 mutation carriers.

Keywords: BRCA1, BRCA2, ovarian cancer, breast cancer, hormonal contraception, hormonal replacement therapy, preventive salpingo-oophorectomy
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HPV infection and HPV-related malignancies
CURR. GYNECOL. ONCOL. 2010, 8 (3), p. 200-213
ABSTRACT

Human papillomavirus (HPV) infection is the most frequent sexually transmitted disease. According to current estimates, there are about 5 500 000 new infections diagnosed annually. Among about 100 known types of HPV, 40 are designed as genital due to their preferential affinity to vulvar, vaginal, cervical, penile and anogenital epithelium. Chronic infection with types 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58 and 59 is associated with an elevated risk of malignant transformation, whereby the type 16 is detected in 50-55% of cases of invasive cervical cancer. Certain diagnosis of HPV infection at every stage of viral life cycle is provided by molecular virological techniques, while detection of viral DNA gains a novel significance as an adjunct to cytological study. Promising diagnostic potential in the setting of chronic HPV infections is associated with the test based on analysis of mRNA transcripts, enabling detection of active oncogenes E6 and E7 of the virus. This enables not only to confirm the presence of virus as such, but also to determine its activity gauged by initiation of transcription, i.e. the earliest phase of carcinogenesis. This is most useful the management of women infected by non-highly oncogenic HPV types. Most vulvar, vaginal and anal cancers are associated with HPV infection. Recently, the incidence of anogenital malignancies is increasing significantly. In view of continuously increasing number of HPV infections, it is reasonable to expect an increased number of anogenital malignancies and precursor lesions thereof, being diagnosed in the near future. Therefore, current epidemiological studied focus on inclusion of HPV testing (HPV DNA, HPV mRNA and early HPV genes) into large-scale screening programs for cervical cancer.

Keywords: HPV infection, cancer, HPV type, intraepithelial neoplasia, extracervical HPV infection
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