子宫内膜癌与结直肠癌双原发癌40例临床分析

目的 探讨子宫内膜癌与结直肠癌双原发癌患者的临床病理特征、预后及影响因素.方法 采用查阅病例、电话、门诊随访等方式回顾性分析2001年12月至2017年4月在北京大学肿瘤医院收治的子宫内膜癌与结直肠癌双原发癌患者共40例.结果 40例患者的中位随访时间为49(5～264)个月.2年生存率为91.9％,3年生存率为86....     

Impact of contraception on gynecologic cancers

In considering the appropriate contraceptive method for a particular woman, the potential effect of that method on her risk of developing cancer of the breast, cervix, endometrium, or ovary is crucial. Among the most closely studied of the risk factors for gynecologic neoplasm has been the potential role of contraceptives, especially oral contraceptives, intrauterine devices, and injectable progestins. Physicians need to consider the potential impact of these agents on the disease process, therapy for the disease, future fertility, and the health of the fetus. Although much of the epidemiologic data is inconsistent and difficult to interpret, most studies find no association between oral contraceptive use and increased risk of breast cancer, except possibly in younger women (< 45 years of age) with prolonged use. Oral contraceptive use may also protect against benign breast disease. Data concerning oral contraceptive use and cervical neoplasm are confounded by several interacting variables, the most important of which is that oral contraceptive users tend to have more Papanicolaou smears than nonusers. Some studies have indicated an increased risk of two- to fourfold after 10 years of use. Oral contraceptive use provides clear protection against endometrial and ovarian cancer, an effect that persists for years after discontinuation. Less data have been collected regarding the relationship between intrauterine devices and injectable hormonal preparations and various types of cancer. No evidence suggests that the intrauterine device predisposes to the development of preneoplastic conditions of the cervix, nor to endometrial or ovarian cancer. A reliable form of contraception is indicated in women with cancer of any kind that may require chemotherapy or radiation, because these treatments can have adverse effects on the fetus, especially if given during the first trimester. (Am J Obstet Gynecol 1993;168:1980-5.)     

Gynaecologic challenging issues in the management of BRCA mutation carriers: oral contraceptives,prophylactic salpingo-oophorectomy and hormone replacement therapy

BRCA1 and BRCA2 mutation carriers have a 54–85% and 45% lifetime risk of developing breast cancer, respectively, and a 18–60% and 11–27% lifetime risk of developing ovarian cancer, respectively. Oral contraceptives (OCs) significantly reduce the risk of ovarian cancer also in BRCA1/BRCA2 mutation carriers. The association between OC use and breast cancer risk in these women is controversial. Some studies showed a modestly increased risk especially among BRCA1 mutation carriers. The risk appears to be greater for women who took OCs for at least 5 years and who took OCs before the age of 30 years. Other studies reported that duration of use before first full-term pregnancy has a positive association with breast cancer risk. Salpingo-oophorectomy reduces the risk of coelomic epithelial cancer of 80–95% and the risk of breast cancer of approximately 50%. BRCA1 and BRCA2 mutation carriers should be encouraged to undergo prophylactic bilateral salpingo-oophorectomy at the age of 35–40 years or when childbearing is complete. Short-term use of hormone replacement therapy may relieve menopausal symptoms and does not appear to affect the breast cancer risk reduction obtained with salpingo-oophorectomy.     

RNA干扰技术治疗妇科恶性肿瘤

RNA干扰（RNAi）是双链RNA诱导细胞内特定基因沉默的现象。随着对RNAi技术研究的不断深入,其作用机制正在被逐步阐明,RNAi技术也日趋完善和成熟,已广泛应用于许多研究领域,如功能基因学,微生物学,基因表达调控机制研究等领域。在肿瘤方面,更取得突破性进展,为肿瘤的基因治疗开辟了新的有效途径。就RNAi技术在妇科恶性肿瘤方面的应用进展综述。     

The epidemiology of female genital tract cancers

Endometrial, ovarian and cervical cancer are among the leading causes of death in women. The role of unopposed estrogens in endometrial carcinogenesis is well established. Any factor that increases the exposure of the endometrium to unopposed estrogen, such as menopausal replacement treatment, obesity, or irregular menstrual cycles tends to raise the risk of the disease, while factors that lower exposure to estrogens or increase progesterone levels, such as oral contraceptives (OC) or smoking, decrease the risk. These well-established risk factors can have different effects at different ages, particularly in pre- and postmenopausal women: more generally, the interaction between various factors is still not totally defined. With reference to ovarian cancer, OC and parity, late menopause and lifelong regular menstrual periods increase the risk of the disease. In terms of biologic mechanisms, these factors are thought to act on ovarian cancer risk by affecting lifetime number of ovulations. Along this line, 'incessant ovulation' could be the relevant exposure that defines the incidence of the neoplasm. Among the factors other than reproductive or hormonal, diet is likely to be the most relevant, but it is still. however, poorly quantified. There is now consistent evidence that Human Papillomavirus (HPV) has a causal role in the ethiology of cervical cancer and that sexual habits and reproductive/hormonal factors are associated with the risk of invasive cervical cancer. Less clear is the role of smoking and dietary habits, but recent studies have shown a direct relationship between smoking and the risk of invasive cervical cancer and an inverse one between selected vitamin intake and risk of the disease. In this paper we review and discuss these evidences.     

Cancer risk in young women at risk of hereditary nonpolyposis colorectal cancer: implications for gynecologic surveillance

OBJECTIVES: The lifetime risk of endometrial and ovarian cancers in hereditary nonpolyposis colorectal cancer (HNPCC) is up to 60 and 12%, respectively, in addition to the high risk of colorectal cancer. International guidelines recommend surveillance of those at risk with colonoscopy every 1--2 years from age 20--25 years and annual gynecologic surveillance from 25--35 years for women. We reviewed our own experience to see whether these recommendations were appropriate. METHODS: Pedigrees of 120 HNPCC families registered with the Familial Bowel Cancer Service at The Royal Melbourne Hospital were reviewed. Ninety families met our criteria for HNPCC and were included in the study. Pedigrees were analyzed to identify early-age onset colorectal and gynecologic cancers and to calculate cumulative incidence of both cancer types for at-risk women (HNPCC-affected and first-degree female relatives of affected family members) for comparison with the general population. RESULTS: Colorectal cancer occurred in 434 individuals, endometrial cancer in 43, and ovarian cancer in 24. Gynecologic and colorectal cancers were diagnosed at similar ages (mean 49.3 versus 51.8 years; P = 0.25), with 5 (7.1%) gynecologic cancers diagnosed by 35 years. Cumulative incidences of gynecologic and colorectal cancers to ages 25, 30, 35, and 40 years were substantially higher among at-risk women than in the general population. CONCLUSIONS: Consideration should be given to offering gynecologic cancer surveillance from the age of 25 years, as for colorectal cancer. However, this approach should be individualized as it has yet to be demonstrated that surveillance reduces the mortality of gynecologic cancer in HNPCC.     

RNA干扰技术治疗妇科恶性肿瘤

RNA干扰（RNAi）是双链RNA诱导细胞内特定基因沉默的现象。随着对RNAi技术研究的不断深入,其作用机制正在被逐步阐明,RNAi技术也日趋完善和成熟,已广泛应用于许多研究领域,如功能基因学,微生物学,基因表达调控机制研究等领域。在肿瘤方面,更取得突破性进展,为肿瘤的基因治疗开辟了新的有效途径。就RNAi技术在妇科恶性肿瘤方面的应用进展综述。     

Oncological repercussions of polycystic ovary syndrome

Polycystic ovary syndrome (PCOS) is a highly prevalent endocrine disorder that has been associated with insulin resistance and metabolic syndrome. Evidence has suggested that PCOS may be associated with the appearance of certain types of cancer, particularly endometrial, ovarian and breast cancer. The objective of this review was to collect further evidence of these correlations and to identify their possible mechanisms.     

Posttreatment surveillance and diagnosis of recurrence in women with gynecologic malignancies: Society of Gynecologic Oncologists recommendations

Although gynecologic cancers account for only 10% of all new cancer cases in women, these cancers account for 20% of all female cancer survivors. Improvements in cancer care have resulted in almost 10 million cancer survivors, and this number is expected to grow. Therefore, determining the most cost-effective clinical surveillance for detection of recurrence is critical. Unfortunately, there has been a paucity of research in what are the most cost-effective strategies for surveillance once patients have achieved a complete response. Currently, most recommendations are based on retrospective studies and expert opinion. Taking a thorough history, performing a thorough examination, and educating cancer survivors about concerning symptoms is the most effective method for the detection of most gynecologic cancer recurrences. There is very little evidence that routine cytologic procedures or imaging improves the ability to detect gynecologic cancer recurrence at a stage that will impact cure or response rates to salvage therapy. This article will review the most recent data on surveillance for gynecologic cancer recurrence in women who have had a complete response to primary cancer therapy.     

Squamous cell cancer of the cervix: prognostic factors related to survival

Seven hundred and fifty-three patients with invasive squamous cell cancer of the cervix treated at the University of Michigan from 1970–1985 are reported. These included stage IA 43, stage IB 345, stage IIA 27, stage IIB 163, stage IIIA 4, stage IIIB 113, stage IVA 32, stage IVB 26. The age ranged from 18 to 92 years with a mean of 49.9 years. Clinical characteristics included: nulliparity 11%, married 93%, obese 41%, hypertensive 37%, diabetes 10%, smoking 50%, bleeding 76%. The cumulative five-year survival for all patients was 67% and this was influenced by the stage of disease: stage IA 98%, stage IB 89%, stage IIA 72%, stage IIB 62%, stage III 37%, stage IVA 14%, stage IVB 4%. Patients with a well-differentiated tumor had an 85% survival rate while those with a poorly differentiated tumor had a 57% survival rate. The probability of metastatic disease to lymph nodes corresponded to the stage of disease; stage I 17%, stage II 55%, stage III 70%, stage IV 81%. When lymph nodes were negative, the survival rate for all patients was 86% while those with positive nodes had a 33% survival rate. Factors which influenced survival in the univariate analysis included stage, node status, tumor grade, age, interval from previous pelvic examination, diabetes. Only stage, node status and tumor grade maintained significance in the multiple proportion hazard analysis.     

Phase II trial of weekly paclitaxel (80 mg/m2) in platinum and paclitaxel-resistant ovarian and primary peritoneal cancers: a Gynecologic Oncology Group study

OBJECTIVE: To evaluate the activity of single agent weekly paclitaxel in patients with both platinum and paclitaxel (delivered every 3 weeks)-resistant ovarian cancer. METHODS: Forty-eight patients with platinum and paclitaxel-resistant ovarian cancer (defined as progression during, or recurrence < 6 months following, their prior treatment with both agents) received single agent weekly paclitaxel (80 mg/m2/week) until disease progression (assuming acceptable toxicity). Following the initial 12 weekly doses, treatment could be given for 3 weeks, with a 1 week break. RESULTS: In this chemoresistant population, the objective response rate was 20.9%. Serious adverse events were relatively uncommon (neuropathy-grade 2: 21%; grade 3: 4%; and grade 3 fatigue: 8%). CONCLUSION: The weekly administration of paclitaxel can be a useful management approach in women with both platinum and paclitaxel (given every 3 weeks)-resistant ovarian cancer. It would be appropriate to directly compare weekly to every 3-week paclitaxel delivery in the setting of primary chemotherapy of advanced ovarian cancer.     

Effect of statin on risk of gynecologic cancers: A meta-analysis of observational studies and randomized controlled trials

Objective. Epidemiologic and clinical findings are inconsistent concerning the risk for gynecologic cancers associated with statin use. We conducted a detailed meta-analysis of all relevant original studies to evaluate the effects of statin on the risk of gynecologic cancers.     

Screening for familial ovarian cancer—management and outcome of women with moderate to high risk of developing ovarian cancer

Abstract.   Rieck GC, Lim K, Rogers MT, France E, Gray JR, Amso N, Evans AS, Howells RH, & Fiander AN. Screening for familial ovarian cancer—management and outcome of women with moderate to high risk of developing ovarian cancer. Int J Gynecol Cancer 2006; 16(Suppl. 1): 86–91.
Five percent to ten percent of ovarian cancers are hereditary. Individual genetic risk of developing ovarian malignancy is discussed in women. Currently, prophylactic surgery is advised to women with a moderate to high risk of developing ovarian cancer. Workload and outcome of the multidisciplinary familial ovarian screening clinic in South Wales were assessed. This was an observational study of 145 women registered with the Familial Ovarian Screening Clinic between January 1998 and December 2003. The data were retrieved from the medical notes. Yearly follow-ups were investigated with a transvaginal scan and CA125 level. Post-surgery women were followed up with yearly CA125 estimations: 46.9% fell into moderate-risk and 50.3% into high-risk category. The median age was 42 (SD 10.4), 71.7% were pre menopausal, and 10.3% had a personal history of breast cancer and 1.4% colon cancer. Whereas 36.5% opted for surgery, the remaining women (but two) opted for annual follow-up. Histology of the women who had surgery showed three cases of malignancies (fallopian tube carcinoma, atypical ovarian epithelial cells, and metastatic breast cancer). Seven women developed breast cancer during the observation period. The follow-up period is too short to come to a final conclusion as to the benefits of yearly screening in this group of women. In our series, a significant number of patients developed malignancies, despite prophylactic surgery.     

卵巢癌干细胞及卵巢癌治疗

卵巢癌干细胞在卵巢癌发生、化疗耐药和复发过程中起重要作用。传统治疗对减小肿瘤体积有效,但是治疗后留下的卵巢癌干细胞成为卵巢癌复发和难治的根源。兼顾卵巢癌干细胞和普通肿瘤细胞的治疗策略才能真正有效治疗卵巢癌。对卵巢癌干细胞生物学特性和调控机制的了解是研究卵巢癌干细胞靶向治疗的基础。     

肿瘤干细胞在妇科肿瘤中的研究进展

恶性肿瘤是严重威胁女性健康的疾病。转移与复发是妇科肿瘤治疗面临的两大难题。肿瘤干细胞学说认为,肿瘤组织中也存在少量具有干细胞性质的肿瘤干细胞,肿瘤干细胞是肿瘤发生、转移和复发的关键。肿瘤干细胞学说的提出,使通过靶向性杀伤肿瘤干细胞从而根治肿瘤成为可能。肿瘤干细胞和妇科肿瘤的相关研究进展综述。     

Gynaecological malignancies in pregnancy: a review

Gynaecological malignancies frequently occur in women of reproductive age and are estimated to complicate approximately one in 1000 pregnancies. The incidence of gynaecological malignancies during pregnancy is expected to rise as more women delay childbearing into their later reproductive years, and maternal age is the most powerful predictor of cancer risk. Pregnancy-associated malignancies present significant challenges as a result of the conflict between optimal maternal therapy and fetal well-being. The lack of prospective randomised treatment studies has prevented the development of clinical guidelines for most of the issues complicating the management. In the present review, recent diagnostic and treatment strategies for cervical, ovarian, vulvar and endometrial carcinomas during pregnancy are presented.     

An analysis of the association between statin use and risk of endometrial and ovarian cancers in the Women's Health Initiative

Background

Statins have anti proliferative activity in vitro against endometrial and ovarian cancer and can affect levels of reproductive hormones. We analyzed data from the Women's Health Initiative (WHI) to assess whether statins are associated with risk of endometrial and ovarian cancer.

Age at menarche and menopause of uterine cancer patients.

An investigation was undertaken of the ages at menarche and at menopause of cervical and endometrial cancer patients for the years 1950-55 and 1960-65. Analysis of the ages at menarche in relation to the year of birth did not show a difference between the uterine cancer groups, whereas the age at menopause did show such a difference. The menopause occurred later in the endometrial than in the cervical cancer group. There was an earlier mean age at menarche and a later mean age at menopause per decade. Therefore, the menopause seems a constitutional factor involved in the development of endometrial cancer and perhaps also cervical cancer.