Comparison between gynecologic oncology ultrasound and magnetic resonance imaging in the assessment of early-stage cervical cancer: A local experience in cancer imaging / Philippine Journal of Obstetrics and Gynecology

Objective@#This study aimed to compare the diagnostic accuracy of gynecologic oncology ultrasound and magnetic resonance imaging (MRI) in the assessment of early-stage cervical cancer.@*Methodology@#This was a prospective, cross-sectional study of patients with early-stage cervical cancer eligible for radical hysterectomy in a tertiary government institution from November 25, 2020, to August 2, 2022. Preoperative gynecologic oncology (transabdominal/transvaginal/transrectal) ultrasound and MRI measurements were obtained and compared with histopathologic findings. Sensitivity, specificity, positive predictive value, negative predictive value, and positive likelihood ratio were used to check for the diagnostic accuracy of each modality.@*Results@#A total of 27 patients were enrolled in the study. Four were stage IB1 (14.81%), 10 were stage IB2 (37.03%), nine were stage IB3 (33.33%), two were stage IIA1 (7.40%), and two were stage IIA2 (7.40%). Ultrasound has a comparable diagnostic accuracy with MRI to assess tumor size length, width, and height with an area under the curve of 0.789, 0.753, and 0.806, respectively. Both modalities can predict the absence of parametrial invasion and nodal involvement with a specificity of 100% and a negative predictive value of 88.89% and 81.48%, respectively. The results of the gynecologic oncology ultrasound showed good agreement with MRI.@*Conclusion@#Ultrasound has comparable diagnostic accuracy with MRI in assessing tumor size, parametrial invasion, and nodal involvement in patients with early-stage cervical cancer. It is a good alternative imaging modality to MRI in staging cervical cancer, especially in low- to middle-income countries.

Experience with women having uterine cancer in Eastern India: a hospital based study

Background: The changing lifestyle has led to a rise in obesity, diabetes and hypertension in India which the most important risk factors for developing uterine cancer. The treatment of uterine cancer is evolving and requires proper evaluation and often adjuvant treatment for better survival. The disease being associated with symptoms of abnormal uterine bleeding often ends up being inadequately managed by non-oncologists practicing in a generalist setting in India. The current study was aimed to audit and observe any difference in outcome of patients primarily treated in the oncology set-up of the Chittaranjan National Cancer Institute, which is a regional cancer center in India versus those receiving primary treatment in a non-oncological set-up.Methods: Retrospective data was collected from hospital records after setting inclusion and exclusion criteria for the study.Results: There is poor correlation between the endometrial biopsy and histopathology findings of patients operated in non-oncological setting as compared to that in the institute. The overall survival of patients operated in the institute was superior to those treated outside.Conclusions: Patients having risk factors and symptoms akin to that of uterine carcinoma must be treated in an oncological set-up ideally.

A study of the knowledge, attitude and practices regarding menopause and its treatment among gynecologic oncology patients treated at the Philippine General Hospital / Philippine Journal of Obstetrics and Gynecology

Background@#Menopause is a normal and natural event. It is defined as the final menstrual period and is usually confirmed when a woman has missed her periods for 12 consecutive months. Dealing with issues regarding menopause is just as important in the care of patients afflicted with cancer as it is to the general population undergoing this singular experience. By knowing the patients’ knowledge, attitudes, and practices (KAP) regarding menopause and its treatment, both patients and health care providers will be given a better perspective and useful insights on the matter which, hopefully, will translate to an improved and more holistic patient care. @*Objective@#To determine the knowledge, attitudes, and practices regarding menopause of gynecologic oncology patients treated at the Philippine General Hospital (PGH). Methods: This was a prospective study which employed a KAP survey on menopause using a structured questionnaire designed by the author. The questionnaire was patterned after the Menopause Health Questionnaire of the North American Menopause Society (NAMS) and the Menopause Rating Scale (MRS). Descriptive statistics were employed in the analysis of data using frequency and percentages. @*Results@#There was a total of 100 respondents of the KAP survey conducted at the PGH Cancer Institute Section of Gynecologic Oncology Outpatient Clinic. Majority of the respondents were aware of the more common symptoms of menopause such as irritability (61%) and hot flushes (49%) but had limited knowledge regarding the other symptoms. Majority are not aware of the different treatment modalities available to address menopausal symptoms. Only 13% of the respondents knew about hormonal replacement therapy as a treatment option for menopause. Only a small proportion of the respondents were familiar with the different forms of complementary and alternative medicine. Most of the respondents viewed menopause as a natural event in a woman’s life and needs no treatment. @*Conclusion@#Majority of the gynecologic oncology patients included in the survey do not know about the symptoms of menopause and the treatment options available to address these symptoms. An overwhelming majority of the women included in this survey consider menopause as a normal part of a woman’s life and view menopause in a positive light. Most of the respondents also do not feel that it is a condition that warrants treatment. Although they also experienced some of the symptoms of menopause, majority of the respondents did not avail of any treatment.

Checkpoint-inhibition in ovarian cancer: rising star or just a dream? / 부인종양

The introduction of checkpoint inhibitors revolutionized immuno-oncology. The efficacy of traditional immunotherapeutics, like vaccines and immunostimulants was very limited due to persistent immune-escape strategies of cancer cells. Checkpoint inhibitors target these escape mechanisms and re-direct the immune system to anti-tumor toxicity. Phenomenal results have been reported in entities like melanoma, where no other therapy was able to demonstrate survival benefit, before the introduction of immunotherapeutics. The first experience in ovarian cancer (OC) was reported for nivolumab, a fully human anti-programmed cell death protein 1 (PD1) antibody, in 2015. While the data are extraordinary for a mono-immunotherapeutic agent and very promising, they do not match up to the revolutionary results in entities like melanoma. The key to exceptional treatment response in OC, could be the identification of the most immunogenic patients. We hypothyse that BRCA mutation could be a predictor of improved response in OC. The underlying DNA-repair-deficiancy should result in increased immunogenicity because of higher mutational load and more neoantigen presentation. This hypothesis was not tested to date and should be subject to future trials. The present article gives an overview of the immunologic background of checkpoint inhibition (CI). It presents current data on nivolumab and other checkpoint-inhibitors in solid tumors and OC specifically and depicts important topics in the management of this novel substance group, such as side effect control, diagnostic PD-1/programmed cell death-ligand 1 (PD-L1) expression assessment and management of pseudoprogression.

Screening for Lynch syndrome using risk assessment criteria in patients with ovarian cancer / 부인종양

OBJECTIVE: Lynch syndrome is a cancer predisposition syndrome caused by germline mutation of DNA mismatch repair (MMR) genes. Lynch syndrome only causes about 0.4% of cases of ovarian cancer, which suggests that universal screening may not be cost-efficient. However, the frequency of Lynch syndrome in ovarian cancer is unclear in the Asian population. The goal of the study was to investigate a screening strategy using family history. METHODS: The subjects were 129 patients with ovarian cancer. Clinical and family history were collected using a self-administered questionnaire, and Society of Gynecologic Oncology (SGO) criteria 2007 and PREMM5 were used for risk assessment. Microsatellite instability, immunohistochemistry, and methylation of MMR genes were analyzed. RESULTS: Of the 129 cases, 25 (19.4%) met the SGO criteria, and 4 of these 25 had MSI-high and MMR deficiency. Two cases had loss of MSH2 and MSH6, indicating MSH2 mutation, and the other two had loss of MLH1 and PMS2, including one without MLH1 methylation indicating MLH1 mutation. These results show that screening using family history can detect Lynch syndrome in 12.0% (3/25) of ovarian cancer cases. The 3 cases were positive for PREMM5, but negative for Amsterdam II criteria and revised Bethesda guidelines. Genetic testing in one case with MSH2 and MSH6 deficiency confirmed the diagnosis of Lynch syndrome with MSH2 mutation. CONCLUSION: This is the first study of screening for Lynch syndrome in ovarian cancer using clinical and family history in an Asian population. This approach may be effective for diagnosis in these patients.

Anatomic distribution and clinical target volume of metastatic inguinal nodes in gynecological malignancies / 中华放射肿瘤学杂志

Objective To determine the anatomic distribution of metastatic inguinal nodes in gynecological malignancies,and to explore the delineation of clinical target volume(CTV). Methods A retrospective study was performed among 34 patients with gynecological malignancies and inguinal lymph node metastases. According to the anatomic distribution of metastatic inguinal nodes, CTV covering more than 95% of inguinal lymph nodes and the relationship of inguinal nodes with the femoral vein, greater saphenous vein and its branches, superficial fascia, and deep fascia were analyzed using vascular enhancement images obtained by computed tomography and magnetic resonance imaging as well as 3D reconstruction using the Eclipse Planning System. Results The 34 patients had a total of 145 positive inguinal nodes. In the 131 superficial nodes below the inguinal ligament, 129 were located between the superficial fascia and the deep fascia;the upper group of superficial nodes,containing 25 nodes,was located at 1 cm above the public symphysis and along superficial iliac circumflex vein;the middle group,containing 85 superficial nodes and 11 patients with single superficial node metastasis,was located at the same level of the public symphysis and close to the junction of the saphenous vein and the femoral vein;the lower group, containing 21 superficial nodes,was beneath the public symphysis and along the greater saphenous vein and medial and lateral superficial femoral veins.The 14 deep nodes were located on the medial side of the femoral vein. There were no positive nodes on the posterolateral side of the link between the posterolateral edge of the femoral vein and medial edge of the sartorius muscle. The upper edge of CTV kept 142 lymph nodes beneath the upper edge of the superior pubis ramus and left 3 lymph nodes up to the upper edge of the femoral head. The lower edge of CTV kept 143 lymph nodes above the lower edge of the lesser trochanter and left 2 lymph nodes at 2 cm beneath the lower edge of the lesser trochanter. Conclusions For CTV covering 98% of positive inguinal nodes, the anterior edge is the superficial fascia;the medial edge is composed by the inguinal ligament and the border of medial muscle to the femoral vessels;the posterolateral edge is the link between the posterolateral edge of the femoral vein and the medial edge of the sartorius muscle;the upper edge is the upper border of the femoral head;the lower edge is the lower border of the lesser trochanter.

Application of clinical skills training specification in gynecologic oncology teaching / 基础医学与临床

Clinical skills training is a key factor for improvement of the quality of clinical teaching.Developing highly specific clinical skills training specification is an important step to improve the quality of gynecologic oncology clinical teaching.Based on its importance,a'four steps training strategy,known groups-building specification-train thinking-make a request is developed and used by Dept.of Obsterics and Gynecology,the 3rd Affiliated Hospital,Kunming Medical University.It guides students to achieve the basic theory,basic knowledge and basic skills through a comprehensive way,and it also encourages students with highly learning initiative of gynecologic oncology clinical skills.On the other side,in the clinical skills training will lead teachers to develop their thinking and enhance the enthusiasm of teaching.This method provides a new sight for gynecologic oncology clinical skills training in a new manner.

Sequential chemotherapy and radiotherapy as sandwich therapy for the treatment of high risk endometrial cancer / 부인종양

OBJECTIVE: The purpose of this retrospective study was to assess the tolerability and efficacy of sequential chemotherapy and radiotherapy for the treatment of high risk endometrial cancer. METHODS: We conducted a retrospective study of previously untreated high risk endometrial cancer patients who received sequential chemotherapy and radiotherapy in accordance with the sandwich approach from June 2008 until June 2011. High risk endometrial cancer patients underwent complete surgical staging followed by adjuvant therapy encompassing sequential chemotherapy, radiation therapy and consolidation chemotherapy. RESULTS: The study analysis comprised 32 endometrial cancer patients. All subjects were treated with carboplatin and paclitaxel chemotherapy; currently, 186 cycles have been administered and 94% of patients have completed the planned number of cycles. Grade 3 neutropenia developed in 1 (3.1%) patient; there was no incidence of grade 4 neutropenia. Moreover, we observed grade 3 anemia in four (12.5%) patients and grade 4 anemia in one (3.1%) patient. One (3.1%) patient developed grade 3 thrombocytopenia; grade 4 thrombocytopenia was not observed. Five patients exhibited progressive disease, three of whom have since expired; mean progression free survival and follow-up were 17.4 months and 18.9 months, respectively. CONCLUSION: The preliminary results from our study suggest that the sandwich approach to treating high risk endometrial cancer patients is feasible. Hematologic toxicity was well tolerated and non-hematologic toxicity was mild and easily managed. Further study of this novel regimen in a larger patient population with extended follow-up is necessary.

Major clinical research advances in gynecologic cancer in 2011 / 부인종양

The annual review of 2011 comprised 11 themes of major research achievements in gynecologic oncology including breast cancer. A potential paradigm shift in the management of ovarian cancer was reviewed through comprehensive genomic analyses and a tumor-specific new intraoperative fluorescence imaging technique using folate receptor-alpha targeted agent, which is expected to improve intraoperative staging and more radical cytoreduction. In addition, updates of bevacizumab and poly (ADP-ribose) polymerase inhibitors, risk-reducing salpingo-oophorectomy, and risk evaluation of pelvic mass were discussed. Regarding cervical cancer, this review covered new findings on human papillomavirus vaccines and human papillomavirus tests as well as the current status of clinical trials on locally advanced cervical cancer. The promising role of sentinel lymph node biopsy in the management of early stage endometrial cancer was followed by two notable clinical researches on: exemestane, an aromatase inhibitor, for the prevention of breast cancer and eribulin, a non-taxane microtubule dynamics inhibitor for the treatment of metastatic breast cancer. Lastly, in premenopausal women with breast cancer, the effect of gonadotropin-releasing hormone analogue on the occurrence of chemotherapy-induced early menopause was discussed.

The Role of General Surgeon in Gynecologic Oncology Surgery

PURPOSE: Resection of the bowel or solid organs may be required for pelvic tumor surgery. The present study was performed to assess combined surgical procedures and determine the role of the general surgeon in gynecologic oncology surgery METHODS: We performed a retrospective study of 135 patients with gynecologic malignancy who underwent a combined operation with a general surgeon between January 2000 and December 2005 at Asan Medical Center. The purpose of the combined operation was categorized into 3 groups: a tumor debulking operation, a resolution of intraoperative complications by a gynecologic surgeon, or an intraoperative diagnostic change. RESULTS: The incidence of combined operations for debulking, resolution of intraoperative complications, and intraoperative diagnostic changes were 103 cases (76.3%), 22 cases (16.3%), and 10 cases (7.4%), respectively. Ovarian cancer was the most common gynecologic malignancy (74.1%) and the rate of a combined operation with a general surgeon in ovarian cancer was 18.5% during the time period. Colorectal resection was the most common procedure by a colorectal surgeon (61.5%). Twenty four patients (17.8%) experienced postoperative complications, including ileus, wound infection, pancreas leakage, and stomal necrosis, with no significant differences according to the purpose of combined operation, pathologic diagnosis, or bowel preparation. The rate of a preoperative consultation to a general surgeon by gynecologic surgeons in cases with colorectal or solid organ invasion preoperatively was 53.2%. CONCLUSION: A general surgeon is an important consultant in a debulking operation of gynecologic malignancies, especially ovarian cancer, or treatment of complications. Thorough preoperative evaluation, bowel preparation, and preoperative consultation to a general surgeon is important in gynecologic oncology surgery.

Trocar-site metastasis after laparoscopic gynecologic oncologic surgery / 대한산부인과학회지

OBJECTIVE: The purpose of this study was to evaluate the incidence of abdominal-wall tumor implantation after laparoscopic procedure in patients with gynecologic malignancies. METHODS: The records of 184 patients who had a laparoscopic operations or laparotomy after laparoscopic diagnostic procedures from Aug. 1994 to Aug. 2003 in our hospital were reviewed. The presence of metastasis at trocar site of laparoscopic surgery and incision site of laparotomy was examined. RESULTS: Abdominal-wall tumor implantations were developed at two port site in one patient. This result showed an incidence of 0.24% (2/819), as 2 ones in 819 abdominal trocar sites and 0.5% (1/184), as 1 in 184 procedures. This patient had a FIGO stage III a, grade2 adenocarcinoma of endometrium and underwent laparoscopic modified radical hysterectomy with both pelvic lymphadenectomy. In addition, tumor implantation was occurred at laparotomy skin incision site in one patient, a incidence of 2.2% (1/45), as 1 in 45 laparotomy procedures. This patient had a stage II, squamous cell carcinoma of the vagina, who had received second courses of Ifosfamide-Cisplantin neoadjuvant chemotherapy and open laparotomy with radical hysterectomy with upper vaginectomy was followed by laparoscopic pelvic lymphadenectomy due to fixed grossly metastatic nodes. CONCLUSION: Recently, the use of laparoscopic procedure in oncology was increased, the new complication such as abdominal-wall implantation at trocar site was introduced. The abdominal-wall implantation at trocar site could be prevented by patients selection, intraperitoneal and port-site lavage, surgical modification. And all patients should have careful follow up with special attention to the trocar sites. Port site implantation was rare, but could be occurred in the incidence of 0.5% per procedure.

An analysis of articles published in Korean Journal of Gynecologic Oncology and Colposcopy / 부인종양

OBJECTIVE: We aimed to assess the distribution of research design, type, field and classification for the articles published in Korean Journal of Gynecologic Oncology and Colposcopy during recent 15 years. METHODS: A total of 473 papers published in Korean Journal of Gynecologic Oncology and Colposcopy from 1990 to 2004 were reviewed for retrospective descriptive analysis. First, all papers were analyzed according to the design, type, field of study. Then they were classified again depending on specific topics under the criteria used in science citation index journal, "Gynecologic Oncology". Articles presented at symposia were excluded from this analysis. RESULTS: We observed that distribution in study design showed the inclination toward case series study (71.7%) and case report (26.8%). To the contrary, the numbers of cohort study and randomized controlled trial were five and one, respectively. The distributions of articles were 321 in survey, 6 in experiment, 7 in clinical trial. There were 12 articles belonging to overview of secondary research. Secondary classification based on study field revealed 108 articles in causation, 82 in diagnosis, 73 in therapy as descending order. There were 80 articles of molecular biology including immunology and tumor suppressor genes, 66 articles of cervical cancer, and 36 articles of epithelical ovarian cancer. CONCLUSION: These results suggest that the reports on Korean Journal of Gynecologic Oncology and Colposcopy are mainly converged to case series studies in the design of study and survey in the type of study.