An audit of the quality of endometrial cancer care in a specialised unit.

BACKGROUND: Endometrial cancer is the 5th most common female cancer in Scotland and though cure rates are good, 25% of women still die of their disease. Staging has been shown to be poorly performed in Scotland-wide audit and inadequate staging is a predictor of worse outcome. Only 12% of women with endometrial cancer in Scotland are operated upon by a specialist gynaecological oncologist. AIMS: To determine if the quality of staging information in endometrial cancer is improved in a region where all cases are managed by specialist gynaecological oncologists. METHODS: All 108 women diagnosed and treated with endometrial cancer in Grampian in 2002 and 2003 had a retrospective case note assessment of the completeness of staging information. This was compared to previously published Scottish results. RESULTS: Completeness of staging was high. The International Federation of Gynecology and Obstetrics (FIGO) stage was available in 100% of women. Chest X Ray was performed in 85% and peritoneal cytology in 93%. Pelvic lymphadenectomy was performed in 28%. All these results were significantly better than in the Scottish audit. CONCLUSION: Centralisation of women with endometrial cancer results in accurate staging information. However it is not yet known what effect this may have on outcome.

Human papillomavirus 16 infection in adenocarcinoma of the cervix.

The impact of the success of organised cervical screening programme results in a steady decline of the incidence of squamous cell carcinoma of the cervix but a concomitant increase in the incidence of the less common histological subtypes, particularly adenocarcinoma of the cervix (ACC). Although Human papillomavirus (HPV) infection is believed to be a necessary cause of cervical cancer, its role in the pathogenesis of ACC is not well established. Established associations between oncogenic strains of HPV and ACC are based on molecular studies carried out on entire tumour block sections. In this study, the cervical adenocarcinoma cells of a 10-year cohort of women diagnosed with ACC were dissected using the PixCell II Laser Microdissecting System to detect the HPV 16 genome sequence using the real-time quantitative polymerase chain reaction to confirm the presence of HPV DNA within ACC cells. By coupling these two sophisticated techniques, the HPV DNA copy number cell could be calculated to investigate its role. The prevalence of HPV 16 infection in this cohort was 24%, which is significantly higher than the control group (chi(2), P=0.014). Women with ACC also had significantly higher HPV DNA copy number per cell compared to the control group (P=0.00007). Higher HPV DNA copy number is associated with risk of developing ACC.

Human papillomavirus as a form of risk assessment.

There is a huge amount of interest in the use of human papillomavirus testing to improve both the sensitivity and specificity of cervical screening. Although oncogenic human papillomavirus subtypes are recognized to be the most important factor in the development of cervical disease, only a minority of such infections results in invasive cancer. Given our current, albeit limited, knowledge of the natural history of human papillomavirus infection and the development of cervical intra-epithelial neoplasia, it may be possible to identify well-defined high-risk groups of women. Such groups may benefit from intensive surveillance, or indeed new developments in immunoprophylaxis, while allowing low-risk women less screening intervention. Known high-risk groups include those with chronic immunosuppression and previous treatment for high-grade cervical intra-epithelial neoplasia. Lowering the upper age limit for cervical screening is already under consideration because of the low incidence of both human papillomavirus infection and cervical intra-epithelial neoplasia in older women, and human papillomavirus testing could rationalize the screening programme.

Pattern of CIN recurrence following laser ablation treatment: long-term follow-up.

Chew GK, Jandial L, Paraskevaidis E, Kitchener HC. Pattern of CIN recurrence following laser ablation treatment: Long-term follow-up. Our objective was to study the long-term patern of recurrence of cervical intraepithelial neoplasia (CIN) and development of cervical carcinoma in patients who had been treated with laser ablative treatment. The study design consisted of a retrospective analysis of the case records of 2130 patients who received laser ablation treatment for CIN lesions from 1980-1988, with the years 1980 and 1988 inclusive. All of the 2130 women in the cohort have had at least seven years of follow-up. Of the treated population, 79% remain under regular cytological follow-up at the regional laboratory. Nine percent required further treatment, 52% of this within the first year of treatment, 19% within the second year, 4% in the third, 5% in the fourth and fifth years, and 15% over the next five years. These lesions were detected up to ten years after the initial treatment. No recurrent lesions have yet been detected after ten years, and 0.2% of the cohort have developed cervical carcinoma. Long-term follow-up has demonstrated a continuing incidence of recurrent CIN up to ten years after initial treatment. This emphasizes the need for adherence to follow-up protocol if the incidence of cervical carcinoma post-treatment is to be reduced. The data suggest that annual follow-up for 10 years may be advisable to reduce the risk of post-treatment invasive disease.

Marsupial--mouse cell hybrids containing fragments of the marsupial X chromosome.

Hybrids were obtained from fusions of HPRT-deficient mouse fibroblasts and marsupial lymphocytes. These hybrids retained no identifiable marsupial chromosomes, but all expressed the marsupial form of HPRT. Half the clones also expressed marsupial PGK-A, and half of these also marsupial G6PD; no other marsupial allozyme markers were detected. Since G6PD is known to be sex linked in these species, we conclude that Hpt and Pgk-A are also located on the X chromosome and the markers lie in the order Hpt-Pgk-A-Gpd.