2013, Vol 11, No 4
Practical considerations for intraoperative anesthesia in patients undergoing surgery in combination with hyperthermic intraperitoneal perfusion chemotherapy – a series of 60 cases
CURR. GYNECOL. ONCOL. 2013, 11 (4), p. 255–263
DOI: 10.15557/CGO.2013.0023

The use of hyperthermic intraperitoneal perfusion chemotherapy has allowed to significantly improve treatment outcomes in patients with cancer dissemination within the peritoneal cavity. The hyperthermic intraoperative chemotherapy is based on a significantly enhanced efficacy of oncolytic drugs when acting at a temperature of 42–43°C. The paper presents an accurate description of intraoperative anesthetic management in patients undergoing hyperthermic intraperitoneal chemotherapy (HIPEC). The suggested management method was developed based on literature data as well as own clinical observations. Particular emphasis was placed on the maintenance of normovolemia as well as on the necessity of extended hemodynamic monitoring during procedures, with particular emphasis on the hyperthermic stage. A total of 60 (56 females, 4 males) anesthetic procedures for surgeries involving the use of hyperthermic intraoperative chemotherapy were performed between April 2012 and November 2013 in The Maria Skłodowska Curie Memorial Cancer Centre and Institute of Oncology in Warsaw. Standardized anesthetic management based on literature data and extended with certain modifications resulting from pharmacovigilance reports as well as own experience was used in all patients anesthetized for hyperthermic intraoperative chemotherapy. The authors believe that a series of 60 cases from a single center allows to propose a standard anesthetic management in these complex surgical procedures requiring close teamwork.

Keywords: hyperthermic intraperitoneal chemotherapy (HIPEC), general anesthesia, perioperative management, ovarian cancer, intraperitoneal cancer dissemination
Treatment of ovarian germ cell and gonadal tumors in the gynecology and obstetrics department
CURR. GYNECOL. ONCOL. 2013, 11 (4), p. 264–273
DOI: 10.15557/CGO.2013.0024

Introduction: Germ cell tumors are the second (after epithelial cancers) most common ovarian cancers. They account for 25–30% of all tumors and 5–9% of malignant ovarian cancers. Gonadal tumors are the third most common ovarian cancers and account for 5–8% of all ovarian tumors and 7% of malignant ovarian cancers. Aim: The paper presents the results of surgical treatment of germ cell and gonadal tumors performed between 1985 and 2001 in the Department of Gynecology and Obstetrics of the District Hospital in Lipsko. Material and methods: Study material comprised cases of patients undergoing surgeries due to ovarian germ cell and gonadal tumors. Supplementary interviews on the postoperative period were conducted with patients or their family members dozen to several dozen years after procedures. Individual histological types of tumors as well as the proportion of their incidence in the analyzed groups were presented. Results: A total of 38 germ cell tumor cases were reported. Benign tumors (teratoma adultum) were found in 35 (92.1%) patients, and malignant tumors were found in 3 (7.9%) cases. Granulosa cell tumor, theca cell tumor and fibroma, i.e. 6 (60%), 3 (30%) and 1 (10%) case, respectively, were identified among the 10 gonadal tumors. Conclusions: In the case of germ cell malignant tumor, fertility-sparing surgical treatment in women of childbearing age allows to preserve the fertility of a patient. Radical surgery combined with adjuvant therapy allowed for a full recovery even in the cases of advanced malignant ovarian tumor. Metachronous occurrence of mature teratoma and granulosa cell tumor was observed in one (2.0%) out of 48 patients. In the case of dermoid cysts, struma ovarii was left-sided.

Keywords: ovarian germ cell and gonadal tumors, coexistence of germ cell and gonadal tumors, struma ovarii, surgical treatment
Influence of the level of the sense of coherence on the choice of the stress-coping style in women diagnosed with cancer of the genital organs
CURR. GYNECOL. ONCOL. 2013, 11 (4), p. 274–285
DOI: 10.15557/CGO.2013.0025

Introduction: Cancer is a very difficult experience for every person who had to face it. The sense of coherence (SOC) is the factor that has an influence on the ability to cope with stress. People with strong SOC are able to use their potential resources in a better way. These resources help patients in their struggle for health. The aim of the paper was to define the relation between the level of the sense of coherence and preferred styles of dealing with difficult situations in women diagnosed with cancer of the genital organs, as a predictor in the struggle with the disease. Material and methods: The research was conducted among 73 women diagnosed with cancer of the genital organs, who were hospitalized in Gynecologic Oncology Clinic in Oncology Center in Bydgoszcz. The sense of coherence was assessed using Life Orientation Questionnaire by Antonovsky (SOC-29) and preferred styles of coping with stress in a difficult situation were tested using CISS questionnaire by Endler and Parker. Results: It was demonstrated that women diagnosed with cancer of the genital organs do not differ from one another in the level of the sense of coherence, and global SOC levels were average. The women gained the highest results in manageability, followed by the feeling of meaningfulness and comprehensibility which obtained the lowest results. The most frequent style was the evasion one. The patients with a high SOC level preferred the style focused on the problem. Rarely did they choose emotional or evasion styles in dealing with the problem. Conclusions: Defining the level of the sense of coherence may have an impact on the care of patients. It may also influence education in neoplastic disease.

Keywords: sense of coherence (SOC), difficult situation, ways of coping with stress, genital organ cancer, disease acceptance
Treatment with bevacizumab in ovarian cancer – clinical trials review
CURR. GYNECOL. ONCOL. 2013, 11 (4), p. 286–294
DOI: 10.15557/CGO.2013.0026

Angiogenesis is a process which has been in the focus in the last decade due to its role in the development of cancers. The identification of vascular endothelial growth factor (VEGF) in the beginning of the 80’s became the new objective of therapies of cancers. The finding of angiogenesis inhibitors has brought the therapy of cancers including ovarian cancer in a new era. Apart from the “golden standard” such as the taxans and platinum components, the treatment of ovarian cancer has not introduced any new front-line drugs for many years. The registration of bevacizumab has changed data regarding in particular the progression-free survival (PFS), which was confirmed by GOG-0218 and ICON-7 clinical trials. The aim of the article was to put clinical trials that pointed to the efficiency of bevacizumab in order as well as presenting those whose results may allow in the nearest future for a wider use of bevacizumab – not only in the front-line chemotherapy of ovarian cancer, but also in neoadjuvant therapy and the treatment of a recurrent neoplasm, both platinum-sensitive and platinum-resistant. Studies of predictive factors, which allow for a group of patients who benefit most from anti-angiogenic drugs treatment to be singled out, are also important. At present, clinical trials and scientific studies are under way and maybe they will help identify patients whose PFS and the overall survival (OS) time is be prolonged as a result of treatment with bevacizumab.

Keywords: ovarian cancer, angiogenesis, bevacizumab, clinical trials
Paraneoplastic syndromes in gynecologic cancers
CURR. GYNECOL. ONCOL. 2013, 11 (4), p. 295–301
DOI: 10.15557/CGO.2013.0027

Paraneoplastic syndromes (PS) involve signs and symptoms from various organs, which accompany tumors at various stages of their development: they may precede the development of cancer by a few months or even years, may be detected during the diagnosis or treatment of a malignant tumor, or they may precede its relapse following treatment. The most frequent mechanism of their development is thought to involve disturbances in the endocrine or autoimmune system, due to the hormones secreted by the tumors, their precursors or cytokines (secretion of ADH, PTHrP, PTH, ACTH, IL-1, IL-6, TNF). Immune mechanisms result in the development of antibodies specific for antigens of own healthy tissues, e.g. in neurologic PS antibodies are detected which are specific for Yo, CV2 and Ri. Among many types of PS in tumors of female genital organs, the most frequent ones involve endocrine syndromes leading to hormonal dysregulation, neurologic ones which result in occasionally severe disturbances of the central nervous system, hematologic PS, the most common one being thromboembolic lesions, and dermatological PS. The other PS found in early and, more frequently, in more advanced cancer include the syndrome of neoplastic cachexia, sometimes encountered in ovarian and cervical cancer.

Keywords: paraneoplastic syndromes, ovarian cancer, endometrial cancer, breast cancer, cervical cancer
Psychiatric disorders in cancer patients
CURR. GYNECOL. ONCOL. 2013, 11 (4), p. 302–321
DOI: 10.15557/CGO.2013.0028

Cancer and its treatment affect the mental state of patients as manifested by adjustment disorders. The group includes both anxiety and depressive disorders, which are variously classified according to the ICD classification system. Therefore it is suggested to include these disorders in a separate category of so-called “psychological responses to traumatic cancer-related distress.” Implementation of screening for distress (e.g. using distress thermometer) in each Cancer Center is a precondition for good cancer care. Anxiety and depressive syndromes, which require professional treatment and care, are particularly common adjustment disorders. Furthermore, cancer patients may experience so-called organic mental disorders caused by permanent or transient impairment of central nervous system (CNS) function. Disorders of consciousness (delirium) are particularly common, especially in the elderly as well as in individuals with advanced disease stages. It is a known fact that the elderly prevail among cancer patients, thus they often suffer from cognitive impairment (dementia) as well as from personality and behavioral disorders associated with CNS damage. These disorders may coexist with cancer or may be triggered by brain tumors. Cancer patients with mental disorders should be treated with caution due to possible drug interactions and other coexisting somatic disorders. Implementation of psychological support for oncological patients on a larger scale than before is also crucial.

Keywords: cancer, adjustment disorders, delirium, dementia, behavioral disorders, treatment