2012, Vol 10, No 3
Carcinogenic entropy
CURR. GYNECOL. ONCOL. 2012, 10 (3), p. 185-193
ABSTRACT

According to the laws of thermodynamics, a cell, threatened by the end of its metabolism, can extend its life in a neoplastic form by reducing the production of its entropy while at the same time increasing dissipation of matter and energy in its surroundings. The basis for the progression of all irreversible processes including life and of course carcinogenesis are changes (d) in the value of entropy production (diS) in time (dt), called by the names of the sources of generated entropy: diS/dt≡Sgen, for which Sgen>0. For that reason prophylactic and oncological treatment must always take the ageing of the body and the primary illnesses this brings into consideration. The source of entropy production is life itself, meaning a constant spontaneous exchange of matter, information, and the energy of elementary particles. The entropy of living organisms is produced by coupled molecular processes increasing (positive source) and decreasing (negative source) its magnitude. Is such a transformation of cellular forms of life only the initial states of cells and the neoplasms derived from them, while an intermediate state of dysplasia is characterized by an increased fluctuation of opposing metabolic processes. Human health is determined by the material-energy condition of the germ cells which are responsible for the intergenerational passage of life, thus contributing to the creation of individuals with new identities. The processes are programmed as early as at the time of the conception of an individual. The increasingly widespread use of drugs as well as the rising use of contraceptive pills by women, combined with the ever more numerous Cesarean sections, reduced lactation, or delayed first pregnancy help explain the increasingly frequent incidence of cancer diseases.

Keywords: entropy, neoplasm, neoplastic diseases, dissipation, dissipative structures
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Comparative analysis of Papanicolaou and TBS classification systems in the detection of cervical pathology in selected population of women from the Wielkopolska area
CURR. GYNECOL. ONCOL. 2012, 10 (3), p. 194-203
ABSTRACT

The aim of this paper was to evaluate the efficacy of cervical cancer prevention program in detection of the pathology based on two systems of classification of cytological smears: the Papanicolaou and The Bethesda System. The study encompassed women participating in the Population Cervical Cancer Prevention and Screening Program, not undergoing cytological exams for at least 3 years in the scope of screening tests reimbursed and provided by the National Heath Fund. The study lasted since July 2004 thru December 2006 and recruited female residents of the Wielkopolska voivodeship. Overall, 12 314 women aged 25-59 were included in final analysis. Cytological screening was performed using the Papanicolaou or the Bethesda classification systems. In this population, 99% of results obtained were normal while 1% was pathological. There were 55 abnormal smears assessed using the Papanicolaou classification and 120 abnormal smears when assessed using the Bethesda system. Histological verification of women with abnormal smear in the Papanicolaou group revealed 14 cases of cervical cancer and 31 lesions consistent with intraepithelial neoplasia at various clinical stages. Corresponding figures in the Bethesda group were 13 cervical cancers and 31 intraepithelial neoplastic lesions at various clinical stages.

Keywords: program, prevention, morbidity, cytology, cervical cancer
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Toxicity of combined radiotherapy and cisplatin in patients with FIGO stage IB, IIB and IIIB cervical cancer undergoing radiochemotherapy
CURR. GYNECOL. ONCOL. 2012, 10 (3), p. 204-214
ABSTRACT

Cervical cancer is the sixth most common malignancy in the females worldwide. At the time of detection, over one-half of the patients present with locally advanced disease. Radiotherapy is currently the mainstay of treatment of advanced cervical cancer. The aim of this paper was a critical assessment of tolerance of critical organs to combined radiochemotherapy. Study material consisted of 726 consecutive patients diagnosed with cervical cancer confirmed by histological study at FIGO stages IB, IIB and IIIB, qualified for combined radiochemotherapy at the Department of Oncologic Gynecology at the The Maria Skłodowska-Curie Institute of Oncology in Warsaw. Initially, all patients received external beam radiotherapy over the pelvis encompassing their genital system and electively regional lymph nodes. Patients were irradiated using photons X at 6-15 MeV. Total doses ranged from 44 to 50 Gy, in 2 Gy fractions 5 days-a-week. Hematological toxicity was assessed using NCI-approved tables based of the RTOG/EORTC scale for early radiation-induced bone-marrow reaction. Anemia (Hg<11.0 g/dl) was noticed in 67 (9.8%) patients. In the group of patients under 60, anemia was noticed in 54/494 (10.9%) cases, while in those over 60 – in 13/187 (7%) cases. Thrombocytopenia (PLT<100×109/L) developed in 36 (5.3%) cases. In 242 out of 292 patients diagnosed with leukopenia at grades 2, 3 or 4, this resulted in non-administration of the entire, preplanned number of chemotherapy courses. Conclusions: 1) Combined treatment of late-stage cervical cancer by radiochemotherapy increases toxicity, mainly hematological. Therefore nearly 1/3 of the patients have not received preplanned courses of cisplatin. 2) Slightly increased toxicity in elderly patients did not affect the radiochemotherapy protocol. 3) Early radiationinduced reactions on the part of urinary and digestive systems did not affect the preplanned therapy.

Keywords: cervical cancer, microbiological study, radiation-induced complications, radiotherapy, urine culture
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Intraoperative radiotherapy in the treatment of female genital malignancies
CURR. GYNECOL. ONCOL. 2012, 10 (3), p. 215-225
ABSTRACT

Intraoperative radiotherapy is an innovative boosting technique enabling administration of single high dose of radiation, usually combined with external beam radiotherapy following surgery, used in the treatment of both primary and recurrent lesions. Such an approach offers several radiobiological, physical and clinical benefits. One of them is the option to irradiate selected anatomical areas identified during surgery as high-risk and/or residual tumor sites while protecting adjacent normal tissues, major nerve trunks and blood vessels, which may be displaced out of the irradiated field or covered with special shields. Key benefits of intraoperative radiotherapy include delivery of high total dose of radiation, superior local control and greater influence on overall survival. Available techniques of intraoperative radiotherapy include brachytherapy, generating high energy photon radiation using temporary or permanent applicators and mobile linear accelerators, which are the main source of electrons. Compared with conventional brachytherapy or teleradiotherapy, intraoperative radiotherapy offers several benefits including: ability to irradiate resection margins in order to reduce the risk of recurrence from tumor cells remaining the resection plane and reduction of risk of “geographical error”, enabling real-time inspection or palpation of surgical site. Furthermore, intraoperative radiotherapy makes possible reduction of radiation dose delivered to the skin, subcutaneous tissue and bones, while a large single dose provides an enhanced biological effect as compared with conventional radiotherapy. The aim of this paper was to point out types of female genital tumors which may be treated using intraoperative radiotherapy.

Keywords: intraoperative radiotherapy, surgery, gynecologic cancer, combined treatment, brachytherapy
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Role of classic tumor markers in genital malignancies in the females
CURR. GYNECOL. ONCOL. 2012, 10 (3), p. 226-235
ABSTRACT

Since the 1970s we are witnessing a continuing search for new markers that would assist in the treatment and follow- up of patients with malignant tumors. First reports on benefits of assessment of tumor markers authored by Goldman and Freedman date back to 1965. Discovery of the first carcinoembryonic antigen (CEA) initiate an era of search for substances, still insufficiently sensitive and specific as to be used to screen tumors, but increasingly helpful in the assessment of treatment effects. This paper discusses the role of tumor markers, increasingly often referred to as “classic” in the monitoring of tumors. We present an update on markers with the longest history in oncology practice, e.g. CEA and on the recently introduced marker TATI. Selection of markers was made based on their role in three basic processes taking place in tumor cells, i.e. proliferation, differentiation and apoptosis. We highlight novel and expanding fields of research – genomics and proteomics, which appear to be the future of oncology. They are extremely useful in the evaluation of molecular prognostic factors, enabling implementation of individually tailored targeted therapies in cancer patients. We discuss classic markers and the few known cancer- specific substances. To sum-up, we state that understanding of the role of more sensitive and more specific markers in oncology may contribute to a more personalized treatment and thus may improve the outcome in cancer patients.

Keywords: tumor markers, sensitivity, specificity, prognostic value, TATI, TPS, CA-125, β-HCG, CEA, SCC-AG, TPA, CYFRA 21-1, HE4
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Selected molecular factors associated with metastases of ovarian cancer
CURR. GYNECOL. ONCOL. 2012, 10 (3), p. 236-243
ABSTRACT

Development of metastases is a typical feature of cancer progression and the main cause of treatment failure in cancer treatment. Due to their ability to settle far from original tumor location, cancer cells may preserve the feature of immortal cells, enabling survival of tumor and transition to chronic phase of the disease. Applying currently available techniques of topical treatment, such as surgery and radiotherapy, we are unable to control fully spread of cancer cells, while systemic chemotherapy even in chemosensitive tumors does not eradicate the disease in all cases. Ovarian cancer may spread by dissemination within the abdominal cavity and lymphatic vessels, resulting in distant metastases. The process of metastases’ development is extremely complex, depending on many different factors governing intercellular adhesion and acquisition of ability to move and migrate by cancer cells. Tumors with coexisting distant metastases are considered most advanced, which means also a grim prognosis for the patient. Mechanism of metastases’ development is the subject of several studies, attempting to identify factors which might lend themselves for targeted therapy of cancers, including ovarian cancer. The paper presents genes, their products and other metastases-associated proteins: HER2 gene, AEG-1 gene, kisspeptin, E-cadherin, survivin, uPAR, clusterin, Met gene, claudins 3 and 4, kallikreins, SDF-1 gene. This paper is meant to systematize extensive knowledge on the development of metastases development and synthetic analysis of data concerning this process.

Keywords: ovarian cancer, metastases, HER2 gene, AEG-1 gene, kisspeptin, E-cadherin, survivin, uPAR, clusterin, Met gene, claudins 3 and 4, kallikreins, SDF-1 gene
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Cutaneous and bony metastases after treatment of endometrial cancer – case report and review of the literature
CURR. GYNECOL. ONCOL. 2012, 10 (3), p. 244-252
ABSTRACT

In terms of incidence, endometrial cancer is the sixth most common malignancy in women. Endometrial cancer disseminates mainly by the lymphatics to regional lymph nodes. Hematogenous spread usually concerns lungs, liver and bones. Distant metastases are infrequent, usually develop in the lungs and occur in not more than 4.6% of the cases. Cutaneous metastases of endometrial cancer are extremely rare and are associated with a poor prognosis. We present a case of a 47-year-old patient, operated on for endometrial cancer. Histological study of surgical specimens revealed adenocarcinoma of uterine corpus at moderate grade of histological malignancy and at FIGO stage IIB. Four years after surgery, the patient developed metastases to bones and skin, including scalp. The case is a great rarity not only because of aggressive clinical course concomitant with a prognostically favorable histological diagnosis, but also in view of an highly unusual location of metastases. The paper outlines basic processes governing organ-specific location of metastases. Molecular mechanisms of development of metastases of endometrial cancer, particularly distant ones, is still relatively poorly understood. The paper presents evidence supporting the role of products of genes RUNX1/AML1 and ETV5/ERM in increasing the invasiveness of this tumor and development of metastases. Studies performed to date indicate that assessment of level of expression of these genes might help to identify patients at higher risk for a more aggressive clinical course, thereby contributing to the development of more effective treatment protocols.

Keywords: endometrial cancer, endometrial adenocarcinoma, cutaneous metastasis, bony metastasis, scalp metastasis, RUNX1/AML1, ETV5/ERM
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