摘要:

AbstractObjective:Most patients with endometrial carcinoma present with stage I disease and it is this group of patients in which prognostic factors have been studied, so that therapy can be tailored to the risks for recurrence. The papillary serous endometrial cancer and clear cell cancers have a poor prognosis but these comprise only a small proportion of endometrial cancer patients. The current surgical staging system for endometrial cancer is based on previously identified intra and extra‐uterine factors that influence the prognosis. However, much of the information regarding prognosis, such as histologic type and grade, evidence of disease beyond the uterus and receptor‐status can be gleaned from careful preoperative assessment of these patients. Information regarding ploidy and receptor status is available from curettage specimens and, with increasing use of hysteroscopy and/or vaginal ultrasound a more precise assessment of the extent of the disease in the uterine cavity and involvement of the cervix may be possible, although the uterine extent of the disease does not play the prognostic role that was anticipated formerly. A major concern regarding surgical staging has been the fact that many of these patients are elderly and obese with significant medical problems. There is the imminent risk that the pelvic and para‐aortic node dissection (rather than sampling) may increase morbidity. More studies have shown that this might not be a factor with sampling. But does it suffice? Similarly, concerns have been expressed regarding those patients who may require postoperative radiation which may be compromised by postoperative adhesions, bladder, intestine and ureteral problems. It is yet to be demonstrated that in diseases extending outside the pelvis, the currently available treatment affects survival. Undoubtedly, recurrence patterns will be affected but clear demonstration of survival advantage is not available, eventually will never be. The concepts of treatment of advanced disease with spread outside the pelvis should undergo rethinking in the way that control of the existing disease rather than eradicating it by all means might offer better chances for life quality, life expectancy albeit limited, in cancer patients.

ISSN:0020-6695    

DOI:10.1016/0020-7292(95)02403-Y

出版商:Wiley    

年代:2000

数据来源: WILEY

摘要:

AbstractOvarian carcinoma can arise directly from the ovarian surface epithelium or its intraparenchymal inclusions or from pre‐existing benign ovarian lesions such as endometriosis and epithelial tumors.

ISSN:0020-6695    

DOI:10.1016/0020-7292(95)02404-Z

出版商:Wiley    

年代:2000

数据来源: WILEY

摘要:

AbstractConflicting evidence on the prognostic influence of some of the clinical and histopathological variables in cervical cancer of the HPV status and type and chemotherapeutic response prompted a number of reviews from nearly 40 years experience in a tertiary referral centre. The collation and analyses of these data with those from recent literature allow some proposals to be made. The disease is more prevalent in the young in women in whom, in many centers, the mortality is also higher; the latter may be related to the reported increase in both small cell types and adeno and adenosquamous carcinoma — a finding more marked in the young. Lymph node metastases, related to increasing grade, size, stage and lymph space invasion, are unequivocally associated with a worse prognosis. Resolution of the exact nature of the intimate association of this disease with the human papilloma virus remains to be resovled as does the influence on prognosis of the tumor HPV status and that of the different oncogenic types. Reports on the efficiency of neoadjuvant platinum based combination chemotherapy are generally promising but vary considerably depending on the regimen used. Its value will not be determined without properly conducted large randomized studies.

ISSN:0020-6695    

DOI:10.1016/0020-7292(95)02405-2

出版商:Wiley    

年代:2000

数据来源: WILEY

摘要:

AbstractA monoclonal antibody was generated against an ovarian cancer cell line, OC‐3‐VGH and was shown to recognize a unique tumor‐associated antigen, COX‐1 found in ovarian or cervical tumors. COX‐1 can be detected in the cultured shed medium of several ovarian/cervical cancer cell lines, and in the sera of ovarian or cervical cancer patients when assayed by a sandwich immunoassay kit employing this monoclonal antibody. Multi‐medical centers clinical trials have been conducted since 1989 to evaluate the efficacy of using this immunoassay procedure for the cancer monitoring. In the case of ovarian cancer, COX‐1 immunoassay kit has the sensitivity of 68% as compared to 71% for the corresponding CA 125 kit. When both COX‐1 and CA 125 kits were combined for the simultaneous monitoring of cancer patients, the sensitivity could be increased to as high as 87%. Further analysis revealed that serum COX‐1 levels in cancer patients are correlated with stages of tumor progression. Following the surgical removal of tumors, greater than 50% of the cancer patients showed dramatic and significant decrease of serum levels of COX‐1 antigen. The results of these multi‐center clinical studies clearly suggested that COX‐1 is a suitable marker for the monitoring and diagnosis of ovarian cancer patients, when used alone or in combination with CA 125.

ISSN:0020-6695    

DOI:10.1016/0020-7292(95)02406-3

出版商:Wiley    

年代:2000

数据来源: WILEY

摘要:

AbstractRadioimmunodetection (RAID) is more sensitive and specific than conventional diagnostic methods. In this study, a monoclonal antibody against cervical carcinoma antigen, MAb Cx‐99, was labeled with111Indium (111In). This immunoconjugate was intravenously injected into athymic nude mice bearing cervical squamous cell carcinoma (SCC) xenografts. The tissue distribution study showed that the xenograft tumor had higher binding activity than most other tissues after 48 h from injection, demonstrated by localization ratio of tumor or tissues (c.p.m./g) against blood (c.p.m./g). However, this localization ratio was also high in the liver, spleen and kidney. The imaging study by immunoscintigraphy also showed that the tumor and liver were distinct from other background tissues 2 days after injection. This preliminary study showed that111In‐labeled MAb Cx‐99 may have potential for RAID of cervical cancer, especially for tumors in the pelvis.

ISSN:0020-6695    

DOI:10.1016/0020-7292(95)02407-4

出版商:Wiley    

年代:2000

数据来源: WILEY

摘要:

AbstractDuring a 20‐year time period, 117 patients with various histologic types of cancer underwent pelvic exentereation. Six of the 107 patients who needed anterior exenteration with urinary diversion received partial excision of the urinary bladder and modification surgery, of which three had uretero‐cystostomy, two had mobilization of bladder and uretero‐cystostomy and one had uretero‐uterostomy. These six patients, except for two, died of disease in 1 year. Two patients are alive and happy, with quality of life because they can urinate normally. We suggest that anterior exenteration should be modified whenever possible to preserve the bladder and not to do an urinary diversion.

ISSN:0020-6695    

DOI:10.1016/0020-7292(95)02408-5

出版商:Wiley    

年代:2000

数据来源: WILEY

摘要:

AbstractSuccessful research outcomes in the treatment of genuine stress incontinence depend upon correct preoperative urodynamic evaluation. These procedures and how they are used for diagnosis and the selection of the correct surgical procedure are discussed.

ISSN:0020-6695    

DOI:10.1016/0020-7292(95)02409-6

出版商:Wiley    

年代:2000

数据来源: WILEY

摘要:

AbstractBy employing neoadjuvent chemotherapy (NCT) before radical hysterectomy (RS) and pelvic radiotherapy (RT) in bulky locally advanced cervical cancer (IB, IIA, IIB), the study was focused to update the results of the author's therapeutic experience with multimodal treatment by observing tumor free survivals along with related prognostic factors in different treatment modalities with NCT. The chemotherapy regimen for induction is composed of Vinblastin, Bleomycin and cis‐Platin regimen (VBP). The effect of neoadjuvent chemotherapy was evaluated by the WHO definition of clinical response (CR, PR, ST, PG). As a result of NCT study in the stage IA, IIA, and IIB cervical cancer patients recurrence occurred in 50 out of 138 patients (35.5%) treated with radical hysterectomy only (RS) compared with 17 out of 92 patients (18.5%) treated with NCT followed by radical surgery. In conjunction with the NCT study in the cervical cancer, another two groups of patients who were treated by neoadjuvent chemotherapy followed by radical hysterectomy (NCST) and adjuvent radiation (NCSRT) were evaluated in the high‐risk patients of cervical cancer with stage IB, IIA, and IIB. Primary responses in the NCST group (n= 61) were CR (68.9%), PR (22.9%), ST (4.9%) and PG (3.3%) respectively, while the chemoresponse of the NCSRT group (n= 101) were CR (65.3%), PR (18.9%), ST (4.9%) and PG (10.9%), respectively. The survival rates of the NCSRT group (n= 101) were 100% in all 1–5 years in CR group, while the rate of the NCST group was 100% at 1 year and 98.5% at 5 years in the CR group of patients. In contrast to CR, the patients who showed PR patients showed 40.1% of 5‐year survival rate in NCST group, and 12.6% in NCRST group. Tumor size, lymphnode metastasis and primary chemoresponse pattern were correlated to each other, but 5‐year survival rate of the CR group was much higher in the same stages IB, IIA and IIB of cervical cancer. In the multivariate analysis of known risk factors, the response pattern to primary chemotherapy, the responsiveness revealed the highest value (R.R. = 3.26) as a survival predictor in the patient treated with a multimodal approach.

ISSN:0020-6695    

DOI:10.1016/0020-7292(95)02410-E

出版商:Wiley    

年代:2000

数据来源: WILEY

摘要:

AbstractCertain human papaillomavirus (HPV) types are major risk factors for the development of cervical neoplasia. The value of HPV DNA testing in the management of patients with disease and in population screening is a subject of controversy. Since the introduction of molecular biology into the HPV field, there have been rapid advances and improvements in HPV diagnosis. The various molecular diagnostic methods for detection of HPV DNA (dot blot hybridization, Southern blot hybridization, in situ hybridization, Hybrid Capture Test, and polymerase chain reaction; PCR) could be selected by taking into consideration some factors such as characteristics of sample, sensitivity of HPV test and expenses. The HPV DNA testing would be a clinically useful diagnostic method, when used in conjunction with the Pap smear in population screening or in conjunction with cytology and colposcopy to identify the women infected with high‐risk HPVs or women who had equivocal cervical lesions. Despite the confusion, a multitude of reports demonstrate that HPV DNA testing has the clinical utility, and future investigations should be directed at more accurately delineating its role in human health care.

ISSN:0020-6695    

DOI:10.1016/0020-7292(95)02411-5

出版商:Wiley    

年代:2000

数据来源: WILEY

摘要:

AbstractRadiation therapy is an effective treatment modality for various gynecologic malignancies. In spite of advances in radiotherapy equipment and techniques over the years, the gastrointestinal and urinary tracts have remained a considerable problem with radiotherapy of the pelvis and abdomen. Clinical presentation of intestinal complications, current concepts of pathophysiology and principles of medical and surgical management are reviewed.

ISSN:0020-6695    

DOI:10.1016/0020-7292(95)02412-6

出版商:Wiley    

年代:2000

数据来源: WILEY