Cytological detection of cancer of the cervix uteri

In spite of the apparent simplicity in detection of dysplasias (cervical intraepithelial neoplasias or CIN I, II, or III) and cancer of the cervix, numerous epidemiologic, biochemical, cytologic and socioeconomic problems are involved. The purpose of this early detection is unquestionably sound, even if the efficiency seems not to achieve high levels in accordance to expectations concerning results and if the cost of reiterated cervical and vaginal scraping smears seems exorbitant. The financial constraints and some cost-effectiveness analyses have promulgated use of longer intervals between cytologic exams (Pap tests). Such an attitude is only acceptable if an improvement in quality and sensitivity of detection is likewise established: other factors such as variable biologic development of epithelial lesions of the cervix must be taken into account; and consideration of cytologic sensitivity of early detection with the difficulties encountered in definition and identification of groups of women at risk. The longer spread between Pap smears exposes some women to the danger of non-detection of certain dysplasias (CIN I, II, or III), rapidly developing carcinomas, and so they lose out on the benefits of an early diagnosis, limited, effective, and less expensive treatment.     

Screening and detection of ovarian cancer

According to the National Cancer Institute, ovarian cancer is the sixth most common cancer in women and the leading cause of death from gynecologic malignancies. Most often the disease is advanced before symptoms are evident. It is estimated that only 15% to 30% of women in advanced stages will survive 5 years, whereas, of women in stage I at the time of diagnosis, 95% are likely to be alive in 5 years, and most are cured following surgery. Current screening techniques recommended for women with known strong risk factors include combination transvaginal sonography with cancer antigen (CA-125). Transvaginal sonography and serum CA-125 have limited diagnostic predictability. A new early detection method that uses proteomic technology will soon be available. The OvaCheck test, as researchers purport, is a highly specific and sensitive early detection method for ovarian cancer in women with strong risk factors. The Food and Drug Administration has yet to approve nationwide marketing of OvaCheck for early detection, because trials are not yet complete. Anticipated commercial availability is scheduled for early 2005.     

Epidemiology and early detection of endometrial cancer

During the last two decades, in the GDR the incidence rate of endometrial carcinoma increased from 17.3 to 23.7/100,000 women. Because the increase was strictly limited to women older than 55 years, a real increase of endometrial cancer risk of younger women seems to be unlikely. As consequences of the relatively high rate of cases detected at stage I (68%) and of improved therapeutic results (overall relative 5-YSR 77%), the mortality rate remained nearly stable and amounted to 9.5/100,000 women in 1983 (4% of overall cancer mortality in females). --Obesity, hypertension, nulliparity and long-term intake of estrogens are the most important risk factors for endometrial cancer providing support for the unopposed estrogen hypothesis of the etiology of endometrial cancer. --In a few investigations, screening asymptomatic women resulted in earlier detection of occult endometrial carcinomas, but up to now there have been considerable lack of informations about cost-benefit-risk relations. Mass screening for endometrial cancer therefore can not be recommended. Women at high risk are suggested to have regular gynaecological examinations and if acceptable endometrial biopsies by suction curettage.     

Cervix uteri cancer and pregnancy

It has been showed effectiveness of cytological screening among 4230 pregnant women for revealing early forms of the cervical cancer. It has been revealed that since the half of gravidity a prognosis of cervical cancer was getting worse. Variants for treatment of patients with combination gravidity and cervical carcinoma are regarded.     

Role of laterally extended parametrectomy in the surgical treatment of cervical cancer stage IB with lymph node metastases (summary of own and foreign experience)

We summarized the world experience as well as our experience in the surgical treatment of women with early cervical cancer stage IB with lymph node metastases, laterally extended parametrectomy was used. 62 women with IB stage cervical cancer who were with metastases of the pelvic lymph nodes were examined. The patients were followed for 20-120 months (median 56 months). 50 patients were alive and free from disease at the end of the researched period. We used the Kaplan-Meier 5 years cumulative proportion survival which was 82%. 8 complications were observed which necessitated a second operation. In 2 patients we had treatment-refractory incontinence. According to the foreign experience as well our experience the metastases in the pelvic lymph nodes can be treated by surgery alone without chemo and radiotherapy especially in the early stages cervical cancers. Additional research in this field will give more light and information in this field.     

Worldwide early detection of cervical cancer

Data available to the World Health Organization on frequency of cancers of the cervix in developing countries are incomplete and fragmentary. There are many indications that cancers of the cervix represent problems of a public health dimension in these countries. With a few exceptions, screening efforts are low-volume institution-based cytology services reaching limited segments of the female population. On the other hand, the recognized risk factors for cancer of the cervix are widely prevalent in developing countries. Cultural and educational constraints often bar women from seeking medical attention. Diagnostic and treatment facilities, particularly radiotherapy, and all levels of trained staff have been insufficient to permit screening programs for cancers of the cervix. Development of future programs must ensure their integration into existing health infrastructures.     

Sentinel lymphonodectomy in breast cancer - our own experience. Part 2

The aim of this investigation was to document the personal learning curve of the sentinel lymphonodectomy in breast surgery and to compare it with the experiences of other authors. RESULTS: Between July 1999 and May 2004, the authors performed 218 sentinel lymphonodectomies, 48 of them during the 24-month evaluation period with consecutive full axillary dissection. The overall detection rate was 212/218 or 97.2%, while during the evaluation period it was 38/48 or 89.6% (failures were procedures No. 6, 7, 22, 24 and 47). Among the first 48 cases, 24 had histologically proven metastasis to one or more of the axillary lymph nodes. In 3 of these cases, we were not able to detect a sentinel lymph node, and 4 times the sentinel lymph node was false-negative after rapid section. The false-negative results during the learning period belonged to cases No. 2, 10, 23 and 29 (4/21 or 19%). From September 2001 until May 2004, the detection rate was over 99% (165/166). DISCUSSION: Our own experience documents the initial difficulties and insecurities with this operative procedure. The common recommendations, i.e. that sentinel lymphonodectomy without axillary clearance should not be offered before having completed one's own learning curve with the aid of experienced surgeons, are to be supported.     

Ovarian cancer: screening and early detection

Ultimately, the timely diagnosis of ovarian cancer will rely on clinical judgment and careful analysis of presenting symptoms within the context of a thoughtful dialogue between the patient and her physician. Symptoms most typical of ovarian cancer include bloating, abdominal or pelvic pain, and difficulty eating. In some studies, urinary symptoms are also a common presenting symptom. When these symptoms occur more than 12 times per month and are of recent onset, then ovarian cancer should be considered as a possibility. Although most women who have these symptoms do not have ovarian cancer, it is important that providers include ovarian cancer in their differential diagnosis. Through research from the past decade, we now understand that there are patterns of symptoms associated with ovarian cancer. Importantly, we now know that ovarian cancer is not a “silent disease.” Finally, clinicians must always listen carefully to their patients avoid potentially harmful delays in diagnosis. Until there is a screening test, awareness is best.     

Cervical precancer and cancer, past, present and future

This review is a short summary of the very long history of invasive and in situ carcinomas of the cervix. The items considered in this paper are the etiology of cervical cancer by a sexually transmitted agent proposed about 150 years ago by Domenico Rigoni Stern, the birth of radical surgery for the treatment of cervical invasive carcinoma with the Wertheim operation in 1898, radium therapy and chemotherapy, cytological diagnosis, the birth of colposcopy, microcolposcopy, the definition of carcinoma in situ, dysplasia and microcarcinoma, the birth of the International Federation for Cervical Pathology and Colposcopy, condylomatosis lesions of the cervix and some HPVs as agents of cervical pre-cancer and cancer, and finally the concept of vaccination against oncogenic HPV types. All these constitute an integral part of common medical practice.     

Increasing experience in laparoscopic staging of early ovarian cancer

We assessed the effect of increasing experience of a single surgeon (learning curve) in the laparoscopic staging procedure for women with early ovarian cancer and compared the results with the literature. We retrospectively analysed a total of 25 women with apparent early-stage ovarian cancer who underwent a laparoscopic staging procedure by the same surgeon. Three time periods, based on date of surgery, were compared with respect to operating time, amount of lymph nodes harvested and surgical outcome. There was no significant difference in operation time, estimated blood loss and hospital stay between the three periods. There was, however, a significant increase in the median number of pelvic and para-aortal lymph nodes harvested (group1 = 6.5, group 2 = 8.0 and group 3 = 21.0; P < 0.005). For the total period, median operation time was 235 min and median estimated blood loss was 100 ml. The median length of hospital stay was 4.0 days. Two intraoperative and two postoperative complications occurred. The upstaging rate was 32%. The mean interval between initial surgery and laparoscopic staging was 51.2 days. Mean duration of follow-up was 43 months, range (1–116 months). Five (20%) patients had recurrences, and two (8%) patients died of the disease. In conclusion, there is a significant learning curve for the laparoscopic full staging procedure in ovarian cancer. In our study this is mainly reflected in the amount of lymph nodes harvested and not in the total operating time.