Radical abdominal trachelectomy in the 19th gestation week in patients with early invasive cervical carcinoma: case study and overview of literature.

Treating pregnant patients with a verified malignant disease represents a great clinical problem. Pregnancy-associated invasive cervical cancer is usually diagnosed at an early stage (approximately 70%). A 27-year-old patient was given the diagnosis of a pathohistologically verified cervical carcinoma, International Federation of Gynecology and Obstetrics stage IB1, in the 17th gestational week (GW). A radical abdominal trachelectomy was performed in the 19th GW. The patient was undergoing regular examinations at our institute of oncology while the Clinic of Gynecology and Obstetrics in Novi Sad, Serbia, monitored the pregnancy. In 36th GW, the patient had a cesarean section, with no visible traces of relapse, with good postoperative recovery and normal results in the newborn. The patient was discharged on the fifth postoperative day and advised to have her condition monitored at our institute of oncology. One year after radical trachelectomy, the patient is in the 15th GW of a new pregnancy with a normal Papanicolaou smear result.

Effects of folate deficiency on gene expression in the apoptosis and cancer pathways in colon cancer cells.

Folate is a B vitamin, deficiency of which appears to increase the risk of developing several malignancies including colorectal cancer. In contrast to the cancer-promoting effect of folate deficiency in normal tissues, several lines of evidence indicate that folate depletion suppresses the progression of existing neoplasms and enhance the sensitivity of cancer cells to chemotherapy. Folate mediates the transfer of one-carbon necessary for the de novo biosynthesis of purines and thymidylate, and hence is an essential factor for DNA synthesis and repair, and the maintenance of DNA integrity and stability. Folate deficiency induces DNA strand breaks, increases uracil misincorporation into DNA, impairs DNA repair and appears to induce apoptosis. Although the effects of folate depletion on DNA integrity and apoptosis and on subsequent cancer development, progression and treatment in colonic epithelial cells have been well characterized, it is largely unknown at present how folate depletion modulates specific upstream genes in apoptosis and cancer pathways that regulate these processes. We therefore investigated the effects of folate depletion on expression of genes involved in apoptosis and cancer pathways in four human colon adenocarcinoma cell lines in an in vitro model of folate deficiency. Apoptosis and cancer pathway-specific mini-microarray were used to screen for differentially expressed genes in response to folate deficiency, and the expression of seven most notably and consistently affected genes was confirmed by real time RT-PCR. Our data suggest that folate deficiency affects the expression of key genes that are related to cell cycle control, DNA repair, apoptosis and angiogenesis in a cell-specific manner. Cell-specificity in gene expression changes in response to folate deficiency is likely due to significant differences in molecular and phenotypic characteristics, growth rates and intracellular folate concentrations among the four cell lines.

The role of laparoscopy in gynecologic oncology.

In some patients and when performed by a skillful surgeon, gynecologic oncologist familiar with advanced laparoscopic techniques, laparoscopy results with less surgical trauma, reduced blood loss and hospitalization, and faster recovery. The complication rate has been found to increase as the complexity of the operation rises, but it is not higher than in open surgery. Preliminary studies show that recurrence and survival rates are comparable to those reported for patients treated by a standard abdominal approach. Future randomised trials are necessary to deal with long term recurrences and survival data and benefits of laparoscopy in management of gynecologic malignancies. At our institution 97 cancer patients underwent laparoscopic procedures, without complications: explorative and staging laparoscopies with biopsies of ovaries, peritoneal biopsies, retroperitoneal and mesenteric tumours; second look laparoscopy, ovariectomy, laparoscopic assisted vaginal hysterectomy (LAVH). Advanced ovarian cancer was found in 3 patients and laparotomy was performed. No complications were established.

[Treatment protocol for cervical carcinoma]. / Protokol lecenja karcinoma grlica materice.

INTRODUCTION: Cervical cancer is the second most common cancer in women worldwide and the second cause of cancer death among women. About 95% (90% in developed countries) of invasive carcinomas are of squamous types, and 5% (10% in developed countries) are adenocarcinomas. FIGO classification of cervical carcinomas, based on clinical staging and prognostic factor dictate therapeutic procedures and help in designing treatment protocols. THERAPEUTIC MODALITIES: Surgical therapy includes conization, radical hysterectomy with pelvic lymphadenectomy and palliative operation--urinary diversion and colostomy. Radiotherapy, brachytherapy and teletherapy are most recently combined with chemotherapy as concurrent chemoradiation. DISCUSSION AND CONCLUSION: No change in therapeutic modalities will ever decrease mortality rate of cervical carcinoma as much as education, prevention and early screening. The 5-year survival for locally advanced disease has not improved during the last 40 years as a result of failure to deliver therapy to the paraaortic region. Paraaortic lymph nodes should be evaluated before therapy planning by different imaging procedures, or more exactly by surgical staging: laparoscopy or laparotomy. Radical operations of cervical carcinoma should be performed by experienced surgeons, educated for this type of operation, with sufficient number of cases.