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This review aims to present a comprehensive assessment of the current status and impact of robotic-assisted laparoscopy (RAL) in gynecological surgery across various subspecialties, exploring its benefits, applications, and challenges. This included studies evaluating RAL in general gynecology, urogynecology, and gynecological oncology. RAL has emerged as a transformative technology, demonstrating efficacy in procedures ranging from routine gynecologic tasks to complex oncological surgeries. The adoption of RAL has facilitated improved surgical outcomes, reduced learning curves, and enhanced visualization. Superior dexterity, 3D vision, and filtered tremor contribute to its precision. The ergonomic advantages, including intuitive instrument movements and a third assisting arm, further enhance positive outcomes. Notably, RAL has shown promise in managing challenging patient demographics, such as morbidly obese individuals and those with intricate pelvic anatomy. In gynecological oncology, RAL has become integral, manifesting benefits in endometrial, cervical, and ovarian cancer surgeries. Despite challenges like cost considerations, RAL continues to shape the landscape of gynecological surgery, promising improved patient outcomes and contributing to the paradigm shift toward minimally invasive approaches. Ongoing research should focus on long-term cost-effectiveness, patient perspectives, and attitudes toward RAL, ensuring its continued integration into the evolving field of gynecological surgery.
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BACKGROUND: Gynecologic cancers are related of to morbidity and mortality among women globally. The trend and incidence, however, varies according to different geographical settings and demographic differences. The main aim this study was to review the profile of gynecologic cancers managed at a Saint Paul Hospital Millennium Medical College, in Addis Ababa, Ethiopia. METHODS: A retrospective chart review was done for all patients managed at the hospital from 2016 to 2020. The relevant information was retrieved from patient charts and pathology reports; the data was entered and analyzed using SPSS software version 24. RESULT: A total of 768 Gynecologic cancer cases were seen at the hospital and 700 of them were analyzed, the rest were excluded because of chart incompleteness. The most common primary tumor origin was cervix 339 (48.35%) followed by ovarian 194 (27.67%), gestational trophoblastic malignancies (GTN) 90 (12.8%), uterine 46(6.56%), and vulvar 29(4.1%). Most patients with cervical cancer present in a late stage. Only 37.5 % were early stage and surgically operable and the median age was 46 years. The majority of ovarian cancer patients present at advanced stage. CONCLUSION: Cervical cancer emerged as the most common gynecologic cancer in women requiring admission, constituting a substantial cause of cancer-related morbidity. Despite being largely preventable through effective screening programs, cervical cancer remains insufficiently addressed. Awareness creation for people from rural area is essential so that early health seeking behavior will be established
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Humanos , Femenino , Neoplasias Ováricas , Concienciación , Conducta , Neoplasias del Cuello Uterino , Cuello del Útero , Tamizaje Masivo , Informe de Investigación , Centros de Atención TerciariaRESUMEN
Globally, gynecological malignancies are common types of female cancer and the main cause of cancer death among women. Cervical cancer, endometrial cancer and ovarian cancer, which are the main types of gynecological cancers, pose a significant threat to women's health worldwide. Studies have shown that diet plays an important role in the occurrence and development of gynecological cancers such as cervical cancer, endometrial cancer, and ovarian cancer, for which added sugar may be an influencing factor due to its food source characteristic and related biological effect. However, this paper reviewed the research progress on the relationship between consumption of added sugar and gynecological cancers such as endometrial cancer, ovarian cancer and cervical cancer, with a view to providing a reference for the active prevention of gynecological cancer.
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Objective:To investigate the dosimetric effects of prone immobilization devices combined with a belly board (PIDBBs) in the intensity-modulated radiotherapy (IMRT) for gynecologic cancers.Methods:A total of 20 patients with cervical or endometrial cancer treated with radiotherapy in the Third Affiliated Hospital of Sun Yat-sen University from August 2020 to June 2021 were retrospectively analyzed. Two sets of body contours were outlined for each patient. One set of body contours did not contain the immobilization devices, and the other contour set included the immobilization devices. For each patient, doses were calculated for the two sets of contours using the same 7-field IMRT plan and were recorded as Plan without and Plan with. The dosimetric difference caused by the immobilization devices was assessed by comparing the parameter values in the dose-volume histograms (DVHs) and by plan subtraction. The Gafchromic EBT3 film and anthropomorphic phantom were used to verify the calculated doses. Results:The target coverage and average dose of Plan with were lower than those of Plan without. Specifically, the V50 Gy, V49 Gy, and Dmean of planning target volume (PTV) decreased by 19.75%, 7.99%, and 2.54% ( t = 8.96, 10.49, 22.09, P < 0.01), respectively. The V40 Gy, V30 Gy, V20 Gy, V15 Gy, and Dmean of skins increased by 51.79%, 51.05%, 45.72%, 33.63% and 10.80% ( t = -2.54, -5.63, -15.57, -24.06, -13.88, P < 0.01), respectively. Doses to other organs at risk (OARs) showed no significant differences. As indicated by the EBT3 measurements, the doses to skins of the abdomen and pelvis on the anthropomorphic phantom increased by approximately 37.24% ( t = 10.86, P<0.01). Conclusions:Although PIDBBs can effectively reduce the low dose to the small intestine, the radiation attenuation caused by them can reduce the PTV coverage of radiotherapy plans and increase the doses to abdominal and pelvic skins sharply, especially for patients requiring irradiation of the groin and perineum.
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Introduction@#Cancer patients are more susceptible to coronavirus disease-19 (COVID-19) infection because they are immunosuppressed by their disease or therapy, most of them have coexisting medical conditions, and they frequently visit hospitals for treatment and surveillance. @*Objective@#The objective of this study was to determine the prevalence of COVID-19 infection among gynecologic oncology patients receiving treatment in a COVID-19 referral hospital. @*Materials and Methods@#A descriptive, cross-sectional study involving 47 gynecologic cancer patients receiving treatment from June 2020 to December 2020 was performed. All patients underwent SARS-CoV-2 reverse transcription-polymerase chain reaction (RT-PCR) swab test and symptom and exposure assessment before the start of cancer treatment. Patients with negative SARS-CoV-2 RT-PCR swab test results received their planned treatment, and a repeat swab test and triage assessment were done midtreatment and after treatment. @*Results@#Five (10.6%) patients had positive baseline SARS-CoV-2 RT-PCR swab results, but all proceeded with treatment after negative results were obtained. Only 1 (2.13%) patient had a positive SARS-CoV-2 RT-PCR swab test result at midtreatment. All patients had no COVID-19-associated symptoms and none of them tested positive for COVID-19 infection posttreatment. @*Conclusion@#The prevalence of COVID-19 infection among gynecologic cancer patients receiving cancer treatment is 2.13%. All patients who had positive SARS-CoV-2 RT-PCR swab test results at baseline or midtreatment were able to continue and complete treatment. There were no severe clinical events or mortalities among those affected with COVID-19 infection.
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Introducción: La cirugía, en pacientes con obesidad mórbida, como tratamiento del cáncer ginecológico supone un reto para el cirujano y el anestesiólogo, pues se asocia a un incremento de las complicaciones intra y posoperatorias. Objetivo: Describir los principales resultados con la cirugía laparoscópica, en pacientes con obesidad mórbida y adenocarcinoma de endometrio, tratadas en el Instituto Nacional de Oncología y Radiobiología (INOR) de la Habana, Cuba, en el período comprendido enero de 2019 a marzo de 2020. Método: Se realizó un estudio descriptivo, observacional y transversal, en 22 pacientes con índice de masa corporal mayor de 40 kg/m2 y diagnóstico de adenocarcinoma de endometrio, que fueron sometidas a cirugía laparoscópica. El dato primario fue obtenido a través de las historias clínicas, con los que se confeccionó una base de datos en una hoja de Microsoft Excel para sintetizar toda la información. Resultados: Predominó la edad entre 61 a 70 años. El adenocarcinoma endometrioide fue el más frecuente con el 77,27 %. El grado de diferenciación fue el bien diferenciado, infiltrando menos del 50 % del miometrio. El estadiamiento quirúrgico predominante fue el IA (72,72 %). El sangrado transoperatorio fue de 78,9 ± 5,7ml (rango 10 y 200 ml), la media del acto operatorio de 82 min (rango 75-132 min), y la estadía hospitalaria de menos de 24 horas (90,90 %). La conversión quirúrgica se realizó en el 4,54 % de los casos. Conclusiones: Las pacientes con obesidad mórbida pueden beneficiarse del abordaje laparoscópico para el tratamiento y la estatificación quirúrgica laparoscópica del carcinoma endometrial, lo que disminuye la morbilidad y la estadía hospitalaria.
Introduction: Surgery in morbidly obese patients as a treatment for gynecologic cancer is a challenge for surgeons and anesthesiologists, since it is associated with the processes of increasing intraoperative and postoperative complications. Objective: To describe the main results gained with the use of laparoscopic surgery in patients with morbid obesity and endometrial adenocarcinoma treated at the Instituto Nacional de Oncología y Radiobiología (INOR) of Havana, Cuba, from January 2019 to March 2020. Method: A descriptive, observational, cross-sectional study was carried out in 22 patients, with body mass index more than 40 kg/m2 and diagnosis of endometrial adenocarcinoma, who underwent laparoscopic surgery. The primary data was obtained from the medical records, which were used to create a database in a Microsoft Excel spreadsheet to synthesize all the information. Results: The predominant age group was between 61 and 70 years old. Endometrial adenocarcinoma was the most frequent cancer (77.27%). The degree of differentiation was well differentiated, infiltrating less than 50 % of the myometrium. The predominant surgical staging was IA (72.72%). Transoperative bleeding was 78.9 ± 5.7 ml (range between 10 and 200 ml), mean operative time was 82 min (range 75-132 min), and hospital stay was less than 24 hours (90.90%). Surgical conversion was performed in 4.54% of cases. Conclusions: Morbidly obese patients may benefit from the laparoscopic approach for the treatment and laparoscopic surgical staging of endometrial carcinoma, which decreases morbidity and hospital stay.
Introdução: A cirurgia, em pacientes com obesidade mórbida, como tratamento para o câncer ginecológico é um desafio para o cirurgião e para o anestesiologista, pois está associada ao aumento de complicações intra e pós-operatórias. Objetivo: Descrever os principais resultados da cirurgia laparoscópica, em pacientes com obesidade mórbida e adenocarcinoma endometrial, tratados no Instituto Nacional de Oncología y Radiobiología (INOR) em Havana, Cuba, no período de janeiro de 2019 a março de 2020. Método: A estudo descritivo, observacional e transversal realizado em 22 pacientes com índice de massa corporal superior a 40 kg/m2 e diagnóstico de adenocarcinoma de endométrio, submetidas à cirurgia laparoscópica. Os dados primários foram obtidos por meio dos prontuários, com os quais foi criado um banco de dados em uma planilha do Microsoft Excel para sintetizar todas as informações. Resultados: Predominou a idade entre 61 a 70 anos. O adenocarcinoma endometrioide foi o mais frequente com 77,27%. O grau de diferenciação foi bem diferenciado, infiltrando menos de 50% do miométrio. O estadiamento cirúrgico predominante foi IA (72,72%). O sangramento transoperatório foi de 78,9 ± 5,7 ml (variação de 10 e 200 ml), a média do ato cirúrgico foi de 82 min (variação de 75-132 min) e o tempo de internação foi inferior a 24 horas (90,90%). A conversão cirúrgica foi realizada em 4,54% dos casos. Conclusões: Pacientes com obesidade mórbida podem se beneficiar da abordagem laparoscópica para o tratamento e estadiamento cirúrgico laparoscópico do carcinoma endometrial, o que diminui a morbidade e o tempo de internação.
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Resumen INTRODUCCIÓN: El cáncer sincrónico es poco frecuente y de origen incierto. Se caracteriza por diferentes lesiones malignas que afectan dos o más zonas del aparato reproductor al mismo tiempo o en un lapso menor a un año; la combinación ovario y endometrio es la más frecuente. OBJETIVO: Reportar un caso de cáncer ginecológico sincrónico, tumor maligno de células de la granulosa de ovario y carcinoma de células escamosas en la cúpula vaginal; además, revisar la bibliografía al respecto. CASO CLÍNICO: Paciente de 47 años, con histerectomía total por miomatosis y una lesión de gran tamaño que ocupaba el espacio pélvico y comprimía el techo vesical. Acudió a consulta debido a un sangrado genital abundante, pérdida de peso y de orina en forma involuntaria. En el examen físico se evidenció una lesión friable en la cúpula vaginal de 3 cm. Se decidieron la ooforectomía izquierda y la extirpación tumoral. La biopsia y la inmunohistoquímica de las lesiones reportó un tumor maligno de células de la granulosa del adulto localizado en el ovario, y un carcinoma de células escamosas en la cúpula vaginal. Se indicó quimioterapia y en la actualidad la paciente permanece sin recidiva de la enfermedad y en seguimiento oncológico. CONCLUSIÓN: El cáncer sincrónico es poco frecuente, de ahí que se disponga de poca información. Gracias al acierto del diagnóstico y de la conducta terapéutica a seguir, luego de 24 meses la paciente del caso no ha tenido signos de recidiva de la enfermedad; continúa en seguimiento oncológico conforme a los protocolos establecidos.
Abstract INTRODUCTION: Synchronous cancer in gynecology is a rare entity, of uncertain etiology, consisting of different malignant lesions affecting two or more areas of the female reproductive system, at the same time or within a period of less than 1 year, the combination of ovary and endometrium being the most frequent. OBJECTIVE: to report a case of synchronous gynecological cancer, malignant granulosa cell tumor of the ovary and squamous cell carcinoma of the vaginal vault and in view of the infrequency of the case to review the literature. CLINICAL CASE: 47 years old patient, who underwent total hysterectomy for uterine myomatosis plus right oophorectomy for showing ovarian tumor during surgery, the histopathological report reported malignant granulosa cell tumor, abdomino-pelvic tomography was requested, which reported a large pelvic space occupying lesion (LOE) with compression of the bladder roof. She came to our office for the first time due to abundant genital bleeding, weight loss and involuntary urine loss, physical examination revealed a friable lesion in the vaginal vault of 3cm, surgical intervention was decided where a left oophorectomy and tumor pruning were performed, Biopsy and immunohistochemistry of lesions with report of malignant granulosa cell tumor of adult granulosa cells in the ovary and squamous cell carcinoma in the vaginal vault, referred to medical oncology who applied chemotherapy and currently the patient is without recurrence of the disease and in oncological follow-up. CONCLUSION: Synchronous cancer is an infrequent pathology, where much information remains to be investigated to better understand this entity. We present the first reported case of synchronous ovarian granulosa cell tumor cancer with vaginal vault cancer. Fortunately our patient 24 months after completing her treatment shows no signs of recurrence of the disease and will be followed up according to the established oncologic protocols.
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Introducción: las neoplasias intraepiteliales cervicales (NIC) son lesiones precursoras del cáncer de cérvix. Aproximadamente cada año se registran 527,600 nuevos casos, posicionándolo como el segundo cáncer más frecuente y la segunda causa mundial de muerte por cáncer en la mujer. Objetivo: determinar la incidencia de NIC en pacientes que acudieron a una Clínica de Patología de Cérvix de Santo Domingo, República Dominicana. Material y métodos: estudio retrospectivo, descriptivo y transversal en el cual se revisaron las historias médicas de 144 pacientes en riesgo de ser diagnosticadas con NIC durante el periodo. Resultados: la incidencia de NIC fue de 40.97 % (N=144). La NIC I fue el diagnóstico más frecuente con un 93.22 % (N=59), seguido 6.78 % con NIC II (N=59). Hubo una mayor frecuencia de NIC en las edades entre los 30 y 59 años (72.88 %, N=59). 62.71 % (N=59) presentó infección
Introduction: Cervical intraepithelial neoplasia (CIN) are precursor lesions of cervical cancer. Every year there are approximately 527,600 new cases, ranking cervical cancer as the second most frequent cause of cancer and the second cause of cancer deaths in women worldwide. Objective: Determine the incidence of CIN among patients that attend a cervical pathology clinic in Santo Domingo. Methods: Retrospective, descriptive and cross-sectional study in which 144 medical histories of patients in risk of being diagnosed with CIN during the study period were studied. Results: The incidence of CIN was 40.97% (N=144). The majority of cases were diagnosed with CIN I, for a total of 93.22% (N=59), followed by 6.78% diagnosed with CIN II (N=59). A higher frequency of CIN was found between the ages of 30 and 59 (72.88%, N=59). 62.71%
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Humanos , Femenino , Neoplasias del Cuello Uterino , /diagnóstico , Neoplasias de los Genitales Femeninos , Displasia del Cuello del Útero , República Dominicana , Papillomavirus Humano 16RESUMEN
Objective To explore the self-disclosure characteristics of gynecologic cancer patients,and compare psychological distress of each latent class.Methods A total of 177 gynecologic cancer patients from 8 tertiary hospitals were investigated by demographic questionnaire,the Distress Disclosure Index (DDI) and the Distress Thermometer (DT).Results The result showed that 3 latent classes model of self-disclosure was supported,including" High level-willing to disclosure to various people" (39.55%)," Medium level-willing to disclosure to spouse" (20.90%) and " Low level-not willing to disclosure to anyone" (39.55%).Significant differences were found in the effect of residence (x2 =9.341,P<0.05),education level (x2=16.862,P<0.05) and cancer type(P=0.009) on the latent class among these groups.Moreover,the psychological distress scores of the 3 latent classes were 6.61± 1.78,4.59± 1.57 and 3.67± 1.14,and the differences were statistically significant (x2 =83.56,P<0.05).Conclusion The self-disclosure of gynecological cancer patients can be divided into three classes and their psychological distress is different.So the specific intervention methods can be developed to improve the level of self-disclosure and psychological distress of gynecological cancer patients.
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Introdução: A sexualidade é um dos aspectos centrais do ser humano; e a saúde sexual está estritamente relacionada à qualidade de vida. Mulheres com diagnóstico de câncer, além de sofrerem com o estigma da doença, podem vivenciar comprometimento em sua saúde sexual. Para melhor entender essa relação, o presente artigo se propõe a revisar estudos que abordaram saúde sexual em mulheres que tiveram diagnóstico de câncer. Métodos: Revisão bibliográfica através da pesquisa de artigos científicos de revisão ou originais na base de dados PubMed. Resultados: Evidenciou-se uma abordagem pouco efetiva dos profissionais que acompanham pacientes com câncer e que as próprias pacientes não costumam relatar queixas sexuais nas consultas médicas. A dispareunia é a principal queixa e alguns tratamentos estão disponíveis, como lubrificantes, hidratantes vaginais, estrogênio tópico ou laser vaginal. Para disfunções sexuais, a melhor abordagem é a que envolve fármacos associados à terapia sexual. Conclusão: O profissional assistente deve abordar a saúde sexual das suas pacientes com câncer em todas as consultas, esclarecendo dúvidas e orientando, como forma de promover qualidade de vida em uma fase tão delicada na vida dessas pessoas.
Introduction: Sexuality is one of the central aspects of the human being and sexual health strictly related to quality of life. Women diagnosed with cancer, in addition to suffering from the stigma of the disease, may experience impairment in their sexual health. To a better understanding of this relation, the present article proposes to review studies that have addressed sexual health in women diagnosed with cancer. Methods: Bibliographic review by searching for scientific review articles or originals in the PubMed database. Results: Ineffective approach was established among professionals who accompany cancer patients and patients whom do not usually report sexual complaints in medical consultations. Dyspareunia is the main complaint and some treatments are available such as lubricants, vaginal moisturizers, topical estrogen or vaginal laser. For sexual dysfunctions, the best approach is that involving drugs associated with sexual therapy. Conclusion: The professional assistant should address the sexual health of their cancer patients in all consultations, clarifying doubts and guiding, in a way to promote life-quality at such a delicate stage in the lives of these people.
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Sexualidad , Neoplasias , Mujeres , Salud SexualRESUMEN
Fertility preservation plays a central role in cancer care since an increasingly large number of cancer patients are surviving as a result of improvements in diagnostic and therapeutic strategies. Physicians who take part in the initial diagnosis and management of gynecologic cancer should understand the importance of fertility preservation. Since indications for fertility preservation are limited to early-stage gynecologic cancer, a surgeon must carefully consider each indication. Before performing fertility-sparing surgery, health professionals should compare its oncologic and pregnancy outcomes with those of other standard treatments. Individualized treatment strategies should be delivered depending on the patient's situation, and physicians should provide timely information and appropriate counseling.
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Femenino , Humanos , Embarazo , Consejo , Diagnóstico , Preservación de la Fertilidad , Fertilidad , Empleos en Salud , Resultado del EmbarazoRESUMEN
Objective To explore the mutation types and disciplines of STR commonly used in forensic in gynecologic and breast cancerand investigate the application of microdissection in forensic practice involving tumor tissue. Methods DNA of tumor tissues, adjacent normal tissues and peripheral blood from 62 patients with breast cancer, 62 patients with gynecologic cancer and 10 patients with benign gynecologic tumor were amplified by PowerPlex 21 System kit and Argus X-12 kit. Capillary electrophoresis of PCR products was carried out on an ABI 3130 Genetic Analyzer to obtain genotypes. Some tumor tissues with STR variation were microdissected. Results The genotype of peripheral blood in cancer patient was consistent with that of corresponding normal tissue. 4 types of STR variations were found in 46.77% gynecologic cancer tissues, compared with that in benign tumor tissues and breast cancer, the difference of STR variation was significant(P<0.01,P=0.009). The genotype of stromal cells separated by microdissection was consistent with that of corresponding adjacent normal tissue. Conclusion The STR loci detected in the study with poor stability are not suitable for forensic cases involving gynecologic cancer tissues. The genotype of stromal cells separated accurately from tumor tissues by microdissection could represent the normal DNA genotype of the individual with cancer. Microdissection is an effective solution in forensic cases with tumor tissues.
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OBJECTIVE: Brain metastases in gynecologic cancer (ovarian, endometrial, and cervical cancer) patients are rare, and the efficacy of Gamma Knife Radiosurgery (GKRS) to treat these had not been evaluated. We assessed the efficacy of GKRS and prognostic factors for tumor control and survival in brain metastasis from gynecologic cancers. METHODS: This retrospective study was approved by the institutional review board. From May 1995 to October 2012, 26 women (mean age 51.3 years, range 27-70 years) with metastatic brain tumors from gynecologic cancer were treated with GKRS. We reviewed their outcomes, radiological responses, and clinical status. RESULTS: In total 24 patients (59 lesions) were available for follow-up imaging. The median follow-up time was 9 months. The mean treated tumor volume at the time of GKRS was 8185 mm³ (range 10-19500 mm³), and the median dose delivered to the tumor margin was 25 Gy (range, 10-30 Gy). A local tumor control rate was 89.8% (53 of 59 tumors). The median overall survival was 9.5 months after GKRS (range, 1-102 months). Age-associated multivariate analysis indicated that the Karnofsky performance status (KPS), the recursive partitioning analysis (RPA) classification, and the number of treated lesions were significant prognostic factors for overall survival (HR=0.162, p=0.008, HR=0.107, p=0.038, and HR=2.897, p=0.045, respectively). CONCLUSION: GKRS is safe and effective for the management of brain metastasis from gynecologic cancers. The clinical status of the patient is important in determining the overall survival time.
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Femenino , Humanos , Neoplasias Encefálicas , Encéfalo , Clasificación , Comités de Ética en Investigación , Estudios de Seguimiento , Estado de Ejecución de Karnofsky , Análisis Multivariante , Metástasis de la Neoplasia , Radiocirugia , Estudios Retrospectivos , Insuficiencia del Tratamiento , Carga TumoralRESUMEN
Given the growing number of cancer patients and the resulting increase in the administration of chemotherapeutic agents, convenient and effective methods for measuring the symptoms and quality of life associated with the hand-foot syndrome (HFS) are needed. Therefore, the aim of this study was to develop and validate the Korean version of the hand-foot skin reaction and quality of life questionnaire (HF-QoL-K), comprising a 20-item symptom domain and an 18-item daily activity domain. After we developed the HF-QoL-K, 209 Korean patients with gynecologic cancer who were undergoing chemotherapeutic agents relating the HFS were asked to fill in the questionnaire. The content validity, internal consistency reliability, and test-retest reliability were evaluated. The internal validity index, Cronbach’s alpha coefficient, and intra-class correlation coefficient of the HF-QoL-K were 0.90, 0.958, and 0.825 (95% confidence interval [CI], 0.774–0.865), respectively. The scatter plot (Pearson correlation coefficient, 0.826) and the Bland-Altman plot for test-retest reliability were also acceptable. The HF-QoL-K instrument is a valid and reliable questionnaire for the measurement of the symptoms and quality of life in Korean cancer patients suffering HFS.
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Humanos , Quimioterapia , Síndrome Mano-Pie , Calidad de Vida , Reproducibilidad de los Resultados , PielRESUMEN
OBJECTIVE: A number of new techniques have been developed to prevent lymphocele formation after pelvic lymphadenectomy in gynecologic cancers. We assessed whether the electrothermal bipolar vessel sealing device (EBVSD) could decrease the incidence of postoperative lymphocele secondary to pelvic lymphadenectomy. METHODS: A total of 321 patients with gynecologic cancer underwent pelvic lymphadenectomy from 2005 to 2011. Pelvic lymphadenectomy without EBVSD was performed in 134 patients, and pelvic lymphadenectomy with EBVSD was performed in 187 patients. We retrospectively compared the incidence of lymphocele and symptoms between both groups. RESULTS: Four to 8 weeks after operation, 108 cases of lymphocele (34%) were detected by computed tomography scan examination. The incidence of lymphocele after pelvic lymphadenectomy was 56% (75/134) in the tie ligation group, and 18% (33/187) in the EBVSD group. We found a statistically significant difference in the incidence of lymphocele between both groups (p<0.01). To detect the independent risk factor for lymphocele development, we performed multivariate analysis with logistic regression for three variables (device, number of dissected lymph nodes, and operation time). Among these variables, we found a significant difference (p<0.001) for only one device. CONCLUSION: Use of the EBVSD during gynecological cancer operation is useful for preventing the development of lymphocele secondary to pelvic lymphadenectomy.
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Adulto , Femenino , Humanos , Persona de Mediana Edad , Electrocoagulación/instrumentación , Neoplasias de los Genitales Femeninos/patología , Escisión del Ganglio Linfático/efectos adversos , Metástasis Linfática , Linfocele/etiología , Estadificación de Neoplasias , Pelvis , Estudios Retrospectivos , Factores de RiesgoRESUMEN
OBJECTIVE: Compression of the left common iliac vein between the right common iliac artery and the vertebrae is known to be associated with the occurrence of left iliofemoral deep vein thrombosis (DVT). In this study, we described the variability in vascular anatomy of the common iliac veins and evaluated the relationship between the degree of iliac vein compression and the presence of DVT using the data from surgeries for gynecologic cancer. METHODS: The anatomical variations and the degrees of iliac vein compression were determined in 119 patients who underwent systematic para-aortic and pelvic lymphadenectomy during surgery for primary gynecologic cancer. Their medical records were reviewed with respect to patient-, disease-, and surgery-related data. RESULTS: The degrees of common iliac vein compression were classified into three grades: grade A (n=28, 23.5%), with a calculated percentage of 0%-25% compression; grade B (n=47, 39.5%), with a calculated percentage of 26%-50% compression; and grade C (n=44, 37%), with a calculated percentage of more than 50% compression. Seven patients (5.9%) had common iliac veins with anomalous anatomies; three were divided into small caliber vessels, two with a flattened structure, and two had double inferior vena cavae. The presence of DVT was associated with the elevated D-dimer levels but not with the degree of iliac vein compression in this series. CONCLUSION: Although severe compression of the common iliac veins was frequently observed, the degree of compression might not be associated with DVT in surgical patients with gynecologic cancer. Anomalous anatomies of common iliac veins should be considered during systematic para-aortic and pelvic lymphadenectomy in the gynecologic cancer patients.
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Humanos , Arteria Ilíaca , Vena Ilíaca , Escisión del Ganglio Linfático , Registros Médicos , Columna Vertebral , Vena Cava Inferior , Trombosis de la VenaRESUMEN
Gynecologic malignancy during pregnancy is a stressful problem. For the diagnosis and treatment of malignancy during pregnancy, a multidisciplinary approach is needed. Patients should be advised about the benefits and risk of treatment. When selecting a treatment for malignancy during pregnancy, the physiologic changes that occur with the pregnancy should be considered. Various diagnostic procedures that do not harm the fetus can be used. Laparoscopic surgery or laparotomy may be safely performed. The staging approach and treatment should be standard. Systemic chemotherapy during the first trimester should be delayed if possible. Radiation therapy should preferably start postpartum. Although delivery should be delayed preferably until after 35 weeks of gestation, termination of pregnancy may be considered when immediate treatment is required. Subsequent pregnancies do not increase the risk of malignancy recurrence.
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Femenino , Humanos , Embarazo , Feto , Laparoscopía , Laparotomía , Periodo Posparto , Primer Trimestre del Embarazo , RecurrenciaRESUMEN
Introducción: los tumores anexiales representan una patología ginecológica frecuente e importante, de ahí su valor clínico. Objetivo: determinar la presencia de los tumores anexiales teniendo en cuenta algunos aspectos clínicos y epidemiológicos. Métodos: estudio descriptivo longitudinal en el período de tiempo comprendido entre el 1ro. de enero de 2008 al 1ro. de enero de 2010, con un grupo de mujeres con diagnóstico de masa anexial, para valorar algunos aspectos clínicos y epidemiológicos: edad, localización, los antecedentes familiares de cáncer anexial y los antecedentes obstétricos...
Introduction: the adnexal tumors are a frequent and important gynecologic pathology, thus, its clinical value. Objective: to determine the presence of adnexal tumors taking into account some clinical and epidemiological features. Methods: a longitudinal and descriptive study was conducted from January 1, 2008 to January 1, 2010 in a group of women diagnosed with adnexal mass, to assess some clinical and epidemiological features including age, location, and family history of adnexal cancer as well as obstetrics...
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Humanos , Femenino , Adulto , Persona de Mediana Edad , Enfermedades de los Anexos/diagnóstico , Neoplasias de Anexos y Apéndices de Piel/prevención & control , Neoplasias de Anexos y Apéndices de Piel , Epidemiología Descriptiva , Estudios LongitudinalesRESUMEN
PURPOSE: This study was to identify predictors of sexual function in gynecologic cancer patients. METHODS: The participants were 154 patients treated at a university medical center in A city, Korea. The data collection was performed through a structured questionnaire from July to December, 2010. The instruments used in this study were Female Sexual Function Index (FSFI) perceived health status scale, Eastern Cooperative Oncology Group (ECOG) performance status, body image, and depression. Data were analyzed using descriptive statistics, Mann-Whitney test, Kruskal-Wallis test and stepwise multiple regression with the SPSS 18.0. RESULTS: The mean score of perceived health status was 8.42 and sexual function was 8.42. The lowest score among sexual function was lubrication. The scores of sexual function was significantly different by age, job, marital status, period after diagnosis of cancer and diagnosis. There were significant correlations between sexual function, perceived health status, ECOG performance, body image and depression. In multiple regression analysis, predictors were identified as ECOG performance, age, diagnosis and period after diagnosis of cancer (Adj.R2=.28). The most powerful predictor of female sexual function was ECOG performance (19.0%). CONCLUSION: The above findings indicate that it is necessary to develop a more effective and personalized sexual function improvement program for gynecologic cancer patient.
Asunto(s)
Femenino , Humanos , Centros Médicos Académicos , Imagen Corporal , Recolección de Datos , Depresión , Corea (Geográfico) , Lubrificación , Estado Civil , Encuestas y CuestionariosRESUMEN
Oxycodone controlled-release (CR) tablets are used as a first-line opioid analgesic for cancer pain. However, use of oxycodone CR tablets is associated with toxicities such as drowsiness and constipation, leading to deterioration of the quality of life (QOL), especially in patients with gynecologic cancer. In contrast, fentanyl has a superior toxicity profile while still showing a strong analgesic effect. Although fentanyl has been approved for switching from opioid, there have been no Japanese studies of patients with gynecologic cancer who were switched to transdermal fentanyl after experiencing toxicity during therapy with oxycodone CR. More importantly early introduction of palliative therapy for pain has not been adopted routinely in the management of gynecologic cancer. Thus, it appears that treatment for patients with gynecologic cancer remains unsatisfactory at present. We conducted research into improvement of the toxicity profile and pain control with the aim of improving QOL for patients with gynecologic cancer. We showed that pain, drowsiness, and constipation could be significantly improved in gynecologic cancer patients as a result of switching to transdermal fentanyl therapy at an early stage.