A case of breast cancer metastasizing to cervix after resection of pancreatic metastasis

A case of breast cancer that metastasized to the cervix 10 years and 8 months after mastectomy is reported. The patient had undergone pancreaticoduodenectomy due to solitary metastasis to the head of the pancreas 4 years previously. The cervical metastasis was associated with abnormal genital bleeding. After pancreaticoduodenectomy the serum levels of CEA, CA15-3 and NCC-ST-439, which are markers of breast cancer, were within normal limits, but the serum level of CA15-3 had increased month by month. The patient had abnormal genital bleeding and presented to the department of gynecology at our hospital. The tumor was in the cervix, bled easily and 2.5x2.0 cm in size on ultrasonography. It was thought to be carcinoma of the cervix, but biopsy revealed the tumor to be an adenocarcinoma pathologically and CA15-3 was immunohistochemically demonstrated in the resected specimen, similar to lobular carcinoma of the breast. Abdominal CT scan revealed involvement of the ovaries and uterus, prompting hysterectomy with bilateral oophorectomy. After discharge, she received chemoendocrine therapy. However, she subsequently died due to peritoneal carcinomatosis.     

上海市杨浦区妇女乳腺与生殖器官癌症死亡流行特征

[目的]探讨上海市杨浦区妇女乳腺与生殖器官癌症死亡现状及流行特征,为今后妇女癌症防治提供一定的参考依据。[方法]收集1988年至2007年杨浦区共20年的肿瘤死亡监测资料,分析女性乳腺癌与主要生殖器官癌症死亡情况。[结果]1988年到2007年杨浦区妇女乳腺癌与主要生殖器官癌症死亡率分别是乳腺癌12．53／10万、宫颈癌2．15／10万、子宫体癌和未特指部位子宫恶性肿瘤2．69／10万、卵巢癌4．68／10万、外生殖器癌0．25／10万。乳腺癌、宫颈癌、子宫体癌和未特指部位子宫恶性肿瘤死亡主要以70岁以上老年人群为主,卵巢癌死亡以50岁以上人群为主。[结论]加强杨浦区女性乳腺与生殖器官的保健．减少女性乳腺与生殖器官癌症的死亡．仍是今后杨浦区妇女保健工作和癌症防治工作的重要内容。     

Effects of Tamoxifen on the Cervix and Uterus in Women with Breast Cancer: Experience with Iranian Patients and a Literature Review

Objective: Invasive breast cancer is the most common malignancy in women. Due to the declining mortalityrate that is partly attributable to the use of screening mammography and effective adjuvant therapy, morewomen survive their breast cancers. The aim of this study was to evaluate the effects of tamoxifen on the genitaltract with particular attention to the uterus and cervix. Methods: We investigated the relationship betweentamoxifen and cervical or uterine cancer in Iran, reviewing all the studies performed by the Vali-Asr GynecologyOncology Clinic in Tehran. In addition, the available data on Medline from 1980 until 2009 were reviewed.Results: A total of 182 articles showed associations with gynecologic malignancies. Although as many as 121refered to links between the drug and endometrial abnormalities (polyps or cancers), 55 articles studied therelationship with changes of pap smears, four of which indicated isolated cervical metastasis followed tamoxifenuse in patients with breast cancer. Conclusion: In spite of the significant relationship between tamoxifen andendometrial cancers, cervix is rarely involved in breast cancer patients. However, vaginal bleeding or abnormalvaginal discharge has been reported in all cases before the diagnosis was made. To rule out genital tract malignancy,it is necessary, therefore, to have an annual pelvic exam, pap smear and early endometrial with endocervicalcurettage for tamoxifen users following a breast cancer in those with abnormal uterine bleeding or persistentvaginal discharge.     

Mortality from major cancer sites in the European Union, 1955-1998.

After long-term rises, over the last decade age-standardised mortality from most common cancer sites has fallen in the European Union (EU). For males, the fall was 11% for lung and intestines, 12% for bladder, 6% for oral cavity and pharynx, and 5% for oesophagus. For females, the fall was 7% for breast and 21% for intestines. There were also persisting declines in stomach cancer (30% in both sexes), uterus (mainly cervix, -26%) and leukaemias (-10%). Mortality rates for other common neoplasms, including pancreas for both sexes, prostate and ovary, tended to stabilise. The only unfavourable trends were observed for female lung cancer (+15%). Lung cancer rates in women from the EU are approximately one-third of those in the USA, and 50% lower than breast cancer rates in the EU. Lung cancer rates in European women have also tended to stabilise below the age of 75 years. Thus, effective interventions on tobacco control could, in principle, avoid a major lung cancer epidemic in European women.     

Sheep and goats: separating cervix and corpus uteri from imprecisely coded uterine cancer deaths, for studies of geographical and temporal variations in mortality

Analysing time trends in mortality from cancers of the cervix and corpus uteri using routine data sources (such as the World Health Organistion mortality database) involves two major problems: deaths certified as “uterus, unspecified site”, and the presence of a combined category comprising unspecified and corpus uteri cancer deaths. To avoid misleading interpretations, the unspecified and the misclassified data must be incorporated into the analysis to produce rates that allow meaningful comparisons between populations and over time. Reallocation methods based on age- and time-specific distributions of cervix and corpus uteri cancer are applied to the unspecified deaths, while for those in the combined category, the age- and time-specific distributions of unspecified and corpus uteri cancer are considered. Adjustments of the general strategies for reallocation were developed to take into account the different quality of the data. Results from eight European countries with different degrees of coding precision are presented. The reallocation methods bring the cervix and corpus uteri mortality trends more in line with the trends for countries with more precise data while keeping the country-specific characteristics. In addition, the methods ensured the availability of time trends for corpus uteri cancer in women age 50 years and older, which were completely missing without reallocation. We propose generally applicable reallocation methods that allow valid time trend analysis of cervix and corpus uteri cancer mortality using datasets of varying precision. Our results show that any sensible analysis of time trends must involve procedures for correcting for unspecified and misclassified uterine cancer deaths. The modified data are available at http://www-dep.iarc.fr/hmp/reallocation.htm.     

Trends in cancer incidence in female breast, cervix uteri, corpus uteri, and ovary in India.

Trends in breast, cervix uteri, corpus uteri and ovarian cancers in six population based cancer registries (Mumbai, Bangalore, Chennai, Delhi, Bhopal, and Barshi) were evaluated over a period of the last two decades. For studying trends we used a model that fits this data is the logarithm of Y=ABx which represents a Linear Regression model. This approach showed a decreasing trend for cancer of the cervix and increasing trends for cancers of breast, ovary and corpus uteri throughout the entire period of observation in most of the registries. The four cancers, breast, cervix, corpus uteri and ovary, constitute more than 50% of total cancers in women. As all these cancers are increasing, to understand their etiology in depth, analytic epidemiology studies should be planned in a near future on a priority basis.     

Survival of women with cancers of breast and genital organs in Europe 1999–2007: Results of the EUROCARE-5 study

BackgroundSurvival differences across Europe for patients with cancers of breast, uterus, cervix, ovary, vagina and vulva have been documented by previous EUROCARE studies. In the present EUROCARE-5 study we update survival estimates and investigate changes in country-specific and over time survival, discussing their relationship with incidence and mortality dynamics for cancers for which organised screening programs are ongoing.MethodsWe analysed cases archived in over 80 population-based cancer registries in 29 countries grouped into five European regions. We used the cohort approach to estimate 5-year relative survival (RS) for adult (⩾15 years) women diagnosed 2000–2007, by age, country and region; and the period approach to estimate time trends (1999–2007) in RS for breast and cervical cancers.ResultsIn 2000–2007, 5-year RS was 57% overall, 82% for women diagnosed with breast, 76% with corpus uteri, 62% with cervical, 38% with ovarian, 40% with vaginal and 62% with vulvar cancer. Survival was low for patients resident in Eastern Europe (34% ovary–74% breast) and Ireland and the United Kingdom [Ireland/UK] (31–79%) and high for those resident in Northern Europe (41–85%) except Denmark. Survival decreased with advancing age: markedly for women with ovarian (71% 15–44 years; 20% ⩾75 years) and breast (86%; 72%) cancers. Survival for patients with breast and cervical cancers increased from 1999–2001 to 2005–2007, remarkably for those resident in countries with initially low survival.ConclusionsDespite increases over time, survival for women’s cancers remained poor in Eastern Europe, likely due to advanced stage at diagnosis and/or suboptimum access to adequate care. Low survival for women living in Ireland/UK and Denmark could indicate late detection, possibly related also to referral delay. Poor survival for ovarian cancer across the continent and over time suggests the need for a major research effort to improve prognosis for this common cancer.     

Late injury of cancer therapy on the female reproductive tract

The purpose of this article is to review the late effects of cancer therapy on the female reproductive tract. The anatomic sites detailed are the vulva, vagina, cervix, uterus, fallopian tubes, and ovaries. The available pathophysiology is discussed. Clinical syndromes are presented. Tolerance doses of irradiation for late effects are rarely presented in the literature and are reviewed where available. Management strategies for surgical, radiotherapeutic, and chemotherapeutic late effects are discussed. Endpoints for evaluation of therapeutic late effects have been formulated utilizing the symptons, objective, management, and analytic (SOMA) format. Late effects on the female reproductive tract from cancer therapy should be recognized and managed appropriately. A grading system for these effects is presented. Endpoints for late effects and tolls for the evaluation need to be further developed.     

Emerging clinical importance of the cancer biomarkers kallikrein-related peptidases (KLK) in female and male reproductive organ malignancies

Background

Tumor tissue-associated KLKs (kallikrein-related peptidases) are clinically important biomarkers that may allow prognosis of the cancer disease and/or prediction of response/failure of cancer patients to cancer-directed drugs. Regarding the female/male reproductive tract, remarkably, all of the fifteen KLKs are expressed in the normal prostate, breast, cervix uteri, and the testis, whereas the uterus/endometrium and the ovary are expressing a limited number of KLKs only.

Conclusions

Most of the information regarding elevated expression of KLKs in tumor-affected organs is available for ovarian cancer; depicting them as valuable biomarkers in the cancerous phenotype. In contrast, for breast cancer, a series of KLKs was found to be downregulated. However, in breast cancer, KLK4 is elevated which is also true for ovarian and prostate cancer. In such cases, selective synthetic KLK inhibitors that aim at blocking the proteolytic activities of certain KLKs may serve as future candidate therapeutic drugs to interfere with tumor progression and metastasis.     

Thirteen-week oral toxicity study of difluoromethylornithine in combination with tamoxifen citrate in female dogs

Purpose: Cancer chemoprevention is the use of pharmacologic or natural agents to inhibit the development of cancer. Difluoromethylornithine (DFMO) is an irreversible inhibitor of ornithine decarboxylase, the rate-limiting enzyme in the biosynthesis of polyamines. DFMO has demonstrated chemopreventive efficacy in animal models of tumorigenesis. Tamoxifen (TAM), a nonsteroidal antiestrogen, is approved for use in the treatment of estrogen receptor-positive breast carcinoma and has demonstrated efficacy in chemoprevention of breast cancer in women at high risk for the disease. The administration of TAM with DFMO is being considered for development by the National Cancer Institute as a potential drug regimen for the chemoprevention of breast carcinoma. Methods: The toxicity of DFMO in combination with TAM was evaluated in female Beagle dogs following 13 weeks of daily oral administration by capsule. Dose levels in milligrams per kilogram body weight per day were: 0 (vehicle control), 100 DFMO, 0.1 TAM, 1.0 TAM, 0.1 TAM + 100 DFMO and 1.0 TAM + 100 DFMO. Results: No mortalities occurred. Diarrhea was produced by TAM and vaginal discharge, due to reproductive tract lesions, was produced by both DFMO and TAM, either alone or in combination. DFMO decreased reticulocyte counts and TAM increased counts of mature neutrophils. DFMO alone resulted in lesions to the intestines and ovaries, and cornified epithelium of vagina and cervix. TAM produced cornified epithelium of vagina and cervix, and numerous lesions in the ovaries, fallopian tube, uterus, cervix and vagina which were likely due to an estrogen agonist effect. Coadministration of DFMO increased the incidence and/or severity of these reproductive tract lesions. Each compound alone produced ovarian atrophy, and antral follicles and corpora lutea were completely absent in the 1.0 TAM + 100 DFMO group. Conclusions: Coadministration of DFMO and TAM resulted in additive toxicity involving the female reproductive system. Received: 1 July 1998 / Accepted: 25 September 1998     

Cancer in the Parsi community of Bombay

A study of the distribution of cancer in the Parsi community has brought to light certain important differences existing between this community and other communities of Western India. Such variations may be due to the habits and customs of the Parsis and perhaps in a small measure to ethnic characteristics. There is a striking preponderance of cancer at certain sites such as the anterior two-thirds of the tongue, the female breast and the uterus. In contrast, the disease is far less frequent in the buccal mucosa, base of the tongue, cervix and lung than in other communities.     

Relative frequency and survival results of cancer seen at a county hospital

The relative frequency of cancer cases (percentage of total malignancies) admitted to Los Angeles County-University of Southern California (LAC-USC) Medical Center from 1942 to 1974 was studied (basal cell and epidermoid carcinoma of the skin were excluded). Among cancers of the digestive system, the relative frequency of cancer of the stomach has definitely declined from a high of 9.5% before 1946 to a low of 2% in 1972. Carcinoma of the colorectum has shown a downward trend in the last decade. Among cancers of the respiratory system, cancer of the lung continues its steady increase from a relative frequency of 7% before 1946 to a high of 20% in 1974. The percentages of malignant lesions of the female organs (breast, uterine body, ovaries) have stayed relatively constant. Cancers of the central nervous system and malignancy of unknown primary site showed an increasing trend over the last 15 years. The 8 most common cancers according to their relative frequency at Los Angeles County Hospital in 1974 are: colon (10%), rectum (5%), breast (15%), lung (13%), prostate (7%), cervix uteri (6%), stomach (3%), and pancreas (3%). In general, survival results of patients in the California Tumor Registry are comparable with those reported in the national study, and survival rates of patients seen at the Los Angeles County Hospital are lower. But 5 year survival rates have improved by more than 3 percentage points for patients with all stages of cancer of the colon, breast, prostate, and cervix uteri diagnosed at the Los Angeles County Hospital in recent years.     

Primary-multiple malignant tumors of the colon, uterus and breast

A study of 94 case histories of primary multiple tumors of the large bowel, uterus and breast showed relative risk of development of uterine body cancer in patients with colonic cancer to be 37 times that for a general population of healthy females over 40 years of age. Post-treatment risk of breast cancer in cases of large bowel cancer increases 17-fold, uterine body--15-fold and cervix uteri--10-fold. Risk for large bowel cancer increases 179-fold in patients treated for uterine body tumors. On the whole, it serves as a confirmation of a possible role of endocrine-metabolic disorders played in the pathogenesis of primary multiple tumors of the large bowel and uterus. Radiation is the key factor of induction of rectal and rectosigmoidal tumors as a result of radiotherapy for cancer of the uterus. The results of the study make the case for timely diagnosis of primary multiple tumors of the large bowel, uterus and breast and adequate follow-up, no matter at what site the first tumor was found.     

Women ﾕ s Awareness,Knowledge and Perceived Magnitude Regarding Common Female Cancers in Yangon,Myanmar

Early detection and diagnosis can greatly increases the chances for successful treatment particularly relevantfor common female cancers like cancer breast and cervix. Increased awareness of the possible warning signs ofthese cancers among general public is a necessity. A community-based, cross-sectional study was conductedwith the objectives of assessing the women’s awareness and knowledge on common female cancers and estimatingthe perceived magnitude and survival of these cancers. A total of 400 women were interviewed using a pretested,structured questionnaire. Mean age of women was 48.4 years and majority were married, dependent andprimary school passed. Almost all (99.3%) were aware of breast cancer and only (69.5%) were aware of cervicalcancer. Breast lump was considered as a condition that will later develop into cancer by (38.8%) and (41.5%)mentioned that it was painless in early stage. Abnormal bleeding per vagina and white discharge were mentionedas main symptoms of cervical cancer (76.3%, 63.3%). Regarding the risk of cervical cancer, female hygiene wasindicated by (88.5%) and number of sexual partners by (77.0%). Almost all of them said that both diseases canbe cured at early stage. Cancer breast, uterus and cervix were mentioned as the most common female cancersaccording to their perceived magnitude. Although cervical and breast cancer were perceived as common femalecancers, health education activities regarding risk factors and early warning signs of these cancer still need tobe promoted.     

Cervical Adenocarcinoma and Squamous Cell CarcinomaIncidence Trends among Tunisian Women

Introduction: Uterine cervix cancer is an important public health problem in Tunisia. In this study, we reporttrends in the incidence of adenocarcinoma and squamous cell carcinoma of the cervix uteri in the central regionof Tunisia during 1993-2006. Design: Data were obtained from the Cancer Registry of the Center of Tunisiawhich registers invasive cancer cases by active methods. Five-year age-specific rates, crude incidence rates (CR),world age-standardized rates (ASR), percent change (PC) and annual percent change (APC) were calculatedusing annual population data. Results: Among all women cancers, cervix uteri cancer accounted for 5.9% andranked the fourth during the study period with an ASR of 6.9 per 100,000. The ASRs decreased notably with anAPC of -6.7% over the whole period. However, incidence rates of adenocarcinomas have increased during thelast years (APC: +14.4%). Conclusion: The introduction of cytological screening programs has led to a markeddecrease of the incidence rates of cervix uteri cancer among Tunisian women. The data underline the fact thatthe population-based cancer registry is an indispensable tool for providing data for planning and evaluation ofprograms for cancer control.     

不同分期局部进展期宫颈癌子宫位移与膀胱状态的相关性

目的:分析不同分期局部进展期宫颈癌子宫位移与膀胱状态的相关性.方法:20例宫颈癌分别在膀胱空虚和充盈状态行模拟定位CT和MRI扫描,并行图像融合.CT图像确定测量基线,MRI图像测量子宫不同部位位移以及与分期的关系.结果:宫颈和宫颈管位移以前后和头脚方向为主,宫体和宫底位移以头脚方向为主,子宫不同部位左右方向位移均较小.Ⅱ期宫颈癌位移明显,Ⅲ期和IV期位移相对较小(P<0.05).结论:子宫位置受膀胱状态影响,分期不同位移有差异.     

2017年广西肿瘤登记地区恶性肿瘤流行特征及疾病负担分析

目的 分析2017年广西肿瘤登记地区恶性肿瘤的流行特征及其造成的疾病负担,为广西恶性肿瘤防治提供参考。方法 根据2017年广西33个肿瘤登记地区上报的肿瘤发病和死亡数据,计算发病率、死亡率及其中国人口和世界人口标化率（简称中标发病率/死亡率和世标发病率/死亡率）等指标分析恶性肿瘤的流行特征;采用伤残损失寿命年（years of lived with disability,YLDs）、过早死亡损失寿命年（years of life lost,YLLs）和伤残调整寿命年（disability?adjusted life years,DALYs）等指标评价恶性肿瘤疾病负担。结果 2017年广西肿瘤登记地区恶性肿瘤共报告新发病例34 105例,粗发病率为243.67/10万,中标发病率为201.71/10万,世标发病率为196.51/10万;共报告死亡例数20 709例,粗死亡率为147.96/10万,中标死亡率为117.81/10万,世标死亡率为116.26/10万。恶性肿瘤发病前10位分别是肺癌、肝癌、女性乳腺癌、结直肠癌、子宫颈癌、胃癌、鼻咽癌、子宫体癌、前列腺癌和卵巢癌,占全部恶性肿瘤发病的74.0%;死亡前10位分别为肝癌、肺癌、结直肠癌、胃癌、女性乳腺癌、子宫颈癌、鼻咽癌、食管癌、白血病和脑癌,占全部恶性肿瘤死亡的82.0%。2017年广西恶性肿瘤合计损失的DALYs为301 738.20人年,DALYs率为2 155.86/10万人年,DALYs率前10位癌种分别为肝癌、肺癌、女性乳腺癌、结直肠癌、胃癌、子宫颈癌、鼻咽癌、白血病、脑癌和食管癌。结论 2017年广西恶性肿瘤发病率、死亡率和DALYs率均处较高水平,肺癌、肝癌、结直肠癌、鼻咽癌、女性乳腺癌、子宫颈癌等是广西重点防治的恶性肿瘤。