ISSN:1040-872X    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

This review explores the recent experience with, and the basis for, the use of selective estrogen receptor modulators to treat and prevent breast cancer. As new agents are unveiled, they will continue to be tested against tamoxifen. A number of new selective estrogen receptor modulators are in clinical development in an attempt to decrease the unwanted effects of tamoxifen. Raloxifene holds the promise of treating osteoporosis with the beneficial side effect of breast cancer prevention. Additionally, two different classes of hormonal agents, the aromatase inhibitors and estrogen receptor down-regulators, which have no estrogen-like properties at any site, appear to be promising new treatments for advanced breast cancer.

ISSN:1040-872X    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

This paper reports on recent advances on the relation between diet, other environmental factors and breast and gynaecological cancers. Despite considerable research the issue remains still unsettled. The protective effect of a diet rich in vegetables and fruit, and thus selected (antioxidant) micronutrients, is not consistently reported in various studies. The possible relationship between fats and breast and female genital tract neoplasms also remains unconfirmed, while the potential benefits of physical activity remains unquantified. Alcohol appears to be related to the risk of breast cancer and overweight is associated with post-menopausal breast cancer and is strongly related to the risk of endometrial cancer.

ISSN:1040-872X    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

Genetic testing for susceptibility to ovarian cancer is rapidly becoming integrated into the clinical practice of oncology. Genetic testing for BRCA1 and BRCA2 is now recommended to most women with invasive ovarian cancer. Approximately 10% of these women will have a positive test, including 4% of women without a family history of cancer. Currently, the treatment of hereditary ovarian cancer is the same as for non-hereditary ovarian cancer. It appears that women with ovarian cancer and a BRCA mutation experience better survival than women without a mutation, possibly due to enhanced susceptibility to chemotherapy. Strategies for prevention of ovarian cancer among carriers include oral contraceptives, tubal ligation and prophylactic oophorectomy.

ISSN:1040-872X    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

The management of fallopian tube carcinoma is similar to that of ovarian carcinoma. Surgery should consist of bilateral salpingo-oophorectomy, total abdominal hysterectomy, comprehensive surgical staging also including a systematic pelvic and para-aortic lymphadenectomy, and aggressive debulking in patients with advanced tumour. Patients with apparently early stage low-risk fallopian tube carcinoma, not submitted to complete surgical staging, as well as those with early stage high-risk disease should receive adjuvant single-agent carboplatin. Patients with advanced disease should undergo paclitaxel- plus carboplatin-based chemotherapy. Second-line treatment for persistent/recurrent disease should be mainly based on the platinum-free interval, whereas secondary cytoreduction should be considered only for highly selected patients with localized, late relapse.

ISSN:1040-872X    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

Gestational trophoblastic diseases comprise a rare spectrum of disorders in which the normal regulatory mechanisms controlling the behaviour of trophoblastic tissue are lost. They vary from the benign complete and partial hydatidiform moles to the frankly malignant choriocarcinoma and placental site trophoblastic tumours. The majority will be cured by suction curettage, followed by human chorionic gonadotrophin screening, but some will go on to need chemotherapy. The majority of patients will be cured even despite the presence of metastatic disease. Patients should have their treatment stratified according to various prognostic factors in order to ensure firstly their disease is eliminated and secondly to reduce the incidence of long-term treatment complications.

ISSN:1040-872X    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

The incidence of human papilloma virus-related vulvar intraepithelial neoplasia is increasing worldwide. This is associated with an increasing incidence of invasive vulvar cancer in young women. Undifferentiated vulvar intraepithelial neoplasia has an invasive potential; a subset of very young patients with pigmented lesions and spontaneous regression has been described. Differentiated vulvar intraepithelial neoplasia is human papilloma virus negative and affects older women, who are at risk of invasive cancer. Chromosomal changes and angiogenesis may play a role in carcinogenesis. Immunocompromised women bear a substantial risk of vulvar intraepithelial neoplasia. These facts demand the awareness of both women and physicians, because there is evidence of diagnostic delays in patients with vulvar cancer. The standard treatment is surgical excision, which may be combined with laser treatment in extensive disease. Preliminary results of topical antiviral agents and photodynamic therapy are available, but remain to be confirmed by prospective, placebo-controlled studies.

ISSN:1040-872X    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

Breast cancer surgery continues to become more conservative. Supporting this conservatism are (1) earlier diagnosis through mammographic screening, (2) an increasing role for diagnostic ultrasound and magnetic resonance imaging, (3) the further development of image-guided core-needle biopsy, and (4) the advent of sentinel lymph node biopsy as an alternative to conventional axillary dissection. For patients with duct carcinomain situ, the addition of radiotherapy and tamoxifen to surgical excision reduces local recurrence but has not yet improved survival over the rate observed with excision alone. There may be low-risk subgroups of duct carcinomain situpatients for whom conservative surgery alone is adequate treatment. For patients with invasive cancer, breast conservation remains underutilized. A small survival benefit from post-mastectomy adjuvant radiotherapy is offset by an increased incidence of cardiovascular mortality, a phenomenon which has not yet been demonstrated for radiotherapy following breast conservation. Sentinel lymph node biopsy represents a new standard of care for axillary lymph node staging in the large majority of breast cancer patients with high-risk duct carcinomain situand stage I-II invasive cancers. The procedure is feasible, accurate, and works best with a combination of blue dye and radioisotope mapping. After proper validation studies, patients with negative sentinel lymph nodes do not require axillary dissection. The prognostic significance of sentinel lymph node micrometastases identified by enhanced pathologic techniques remains a matter of debate. Prophylactic mastectomy reduces breast cancer incidence and mortality among those with a high-risk family history, and mutations ofBRCA1-2, but has significant adverse psychosocial sequelae for a small and unpredictable fraction of patients and should not be undertaken lightly. Prophylactic oophorectomy should be offered to all women withBRCA1-2mutations, especially those beyond the years of childbearing.

ISSN:1040-872X    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

The incidence of glandular neoplasms of the uterine cervix has been steadily increasing over the past two decades. Given the fact that these lesions are more difficult to diagnosis and are relatively infrequent, less is known about them compared with their squamous counterparts. In addition, because these lesions tend to arise in women of childbearing age, there is a particular need to understand whether the in-situ and early invasive forms of adenocarcinoma are amenable to conservative treatment measures that spare fertility like their squamous counterparts. Recent publications have addressed the underlying causes of the increasing incidence, the pros and cons of conservative management, and the difficulties in definitively identifying each glandular subtype. The most difficult diagnostic lesions are adenocarcinomain situcases and early invasive adenocarcinomas.

ISSN:1040-872X    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

Several recent advances have been made in our understanding of the pathogenesis of endometrial tumours, particularly endometrioid endometrial carcinoma (EEC). Mutations in thePTENgene and microsatellite instability (MSI) are common genetic abnormalities in EECs, and distinguish these lesions from other histological subtypes of endometrial carcinoma. Endometrial precancers are monoclonal lesions that share a common genetic lineage with invasive EEC, includingPTENmutations and MSI. Mutations of thePTENtumour suppressor gene have been identified in histologically normal-appearing endometrium exposed to oestrogen, 18-55% of endometrial precancers and 26-80% of EECs.PTENhas been shown to play several roles in tumour suppression, including cell cycle arrest and promotion of apoptosis. Loss ofPTENfunction predisposes endometrial cells to neoplastic transformation, particularly in high-oestrogenic states. MSI is another common alteration seen in EECs and endometrial precancers, and some studies have reported an association between MSI andPTENmutations. The replication error that results in MSI may facilitate the development ofPTENmutations in some, but not all, cases of EEC. The prognostic significance ofPTENgene mutations and MSI in endometrial carcinoma is controversial. Further study is needed to delineate the different pathogenetic pathways of EEC and their natural history.

ISSN:1040-872X    

出版商:OVID    

年代:2002

数据来源: OVID