[Clinical-morphological parallels of malignant ovarian tumours].

The detection of the malignant ovarian tumor takes place at a later stage because of a symptomless process of the tumor formation at an earlier stage, hence leading to the delayed diagnostics and inefficient treatment. The objective of the research is the development of an efficient treatment of the malignant ovarian tumor patients, finding the most adequate methods and a delineation of the proper tactics for the achievement of the improved long-term results. We have studied the medical cards of the patients checked into A. Gvamichava Gynecological Clinic of the National Oncology Center in 1990-2000. The research has led to the conclusion that the epithelial malignant ovarian tumors outnumber the non-epithelial malignant ovarian tumors by 5 to 2. The most widespread histotype of the epithelial malignant ovarian tumors is the serous carcinoma, most frequently detected among the 50-69 year old patients and diagnosed at the third and the fourth stages. In non-epithelial malignant ovarian tumors, the most widespread histotype is the granule-cellular tumors, most frequently detected in the 50-69 age group, diagnosed at the II and the III stages. In our clinic, the surgical treatment, with a subsequent chemotherapy is preferential.

[Treatment of malignant ovarian tumours in Georgia in 1990-2000].

The adequate treatment of ovary tumor and the issue of improvement of subsequent results still remain the urgent question of oncology. In 60-80% of diseased the pathology appears at the final--the third and the forth i.e. later stages, while the prolongation of life for the five years period is quite rare--13-47%. Our aim is to study the effectiveness of treatment of malignant ovary tumor based on the data of 1990-2000 provided by A. Gvamichava National Oncological Centre, to develop optimal methods of treatment and select the right tactics in order to improve subsequent results for patients with malignant ovary tumor. The research revealed that the epithelial neoplasm (malignant ovary tumor) is 5.2 times more spread than nonepithelial (malignant ovary tumor). In our clinic the preference is given to the operational method combined with further chemotherapy (ch/t) for treatment of malignant ovary tumor. The advantage is given to the radical surgery (59.4%), amputation of uterine appendages and omentum resection (79.3%). In the case of less radical surgery (23%)--amputation of uterine appendages (63.8%), while for non-radical surgery (17.5%)--ovariectomy, omentum resection (60%). The number of radical surgery of epithelial neoplasm 3 times exceeds less radical surgery and 12 times--non-radical surgery, while in the case of non epithelial neoplasm the number of radical surgery is two times more than less radical surgery and 3 times more than that non radical. In 1990-2000 in the National Oncological Centre ch/t without platinum and audrioblastin (44.8%) had been most frequently used for treatment of ovary tumor. The main schemes were: cyclophosphan + phtoruracyle and cyclophosphan + phtoruracyle +metotrexat.

Clinical characteristics of prognostic factors in uterine endometrioid adenocarcinoma of various grade.

The aim of this study was to compare clinical characteristics of prognostic factors in uterine endometrioid adenocarcinoma of various grades. We have studied 104 postmenopausal women with a histological diagnosis of uterine endometrioid adenocarcinoma. Staging and grading of primary tumor were done according to FIGO system. The following factors were examined: family history of cancer, presence of obesity and vaginal bleeding, recurrence rate within the two years of the study (disease-free periods), vessel permeation, muscle invasion (<1/3, 2/3, >2/3), cervical involvement, lymph node metastasis, ascites cell analysis, parametrium invasion, adnexal metastasis, CA125 pre-surgery values. Histological examination has showed grade 1 endometrioid adenocarcinoma in 35 cases (33,7%, group 1), grade 2 adenocarcinoma in 44 cases (42,3%, group 2), and grade 3 adenocarcinoma in 25 cases (24%, group 3). Most of the factors we have examined seem to be associated with histological grade of uterine endometrioid carcinoma. The analysis of clinicopathological prognostic factors in G1 endometrioid adenocarcinoma cases has showed that about half of these patients are obese, vaginal bleeding is not common, no cervical involvement, parametrium invasion, adnexal metastasis and vessel permeation at the time of diagnosis, no recurrence within two years, pre-surgery value of CA125 is normal, and myometrial invasion is less than 1/3. G3 endometrioid adenocarcinoma cases have showed family history of endometrial cancer, more than half of the patients were obese, with uncommon vaginal bleeding and positive peritoneal cytology, but cervical involvement, parametrium invasion, adnexal metastasis and vessel permeation are present at the time of diagnosis, pre-surgery value of CA125 is high, and myometrial invasion is 2/3 or more than 2/3 in majority of cases, furthermore, in some cases recurrent tumors were developed within two years. G2 endometrioid adenocarcinoma can be considered as an intermediary form which should be managed according to the clinical stage. The results lead to conclude that the histological grade of uterine endometrioid adeno carcinoma seems to be an important independent prognostic indicetor as it is strongly associated with other clinical pathological prognostic factors.

The expression of cadherin e and clinical prognostic factors in uterine endometrioid adenocarcinoma.

The aim of our study was to evaluate the association between the expression of E-cadherin and clinical prognostic factors in uterine endometrioid adenocarcinoma of different histological grade. We have studied 104 postmenopausal women with diagnosis of endometrioid adenocarcinoma. We evaluated the presence of obesity and vaginal bleeding. Surgical specimens were fixed in 10% neutral buffered formalin solution and embedded in paraffin. 4 mm sections were stained by hematoxylin-eosin, von Gieson, and histological type of cancer, metastatic involvement of lymph nodes and depth of myometrial invasion were evaluated. Histological grade of cancer was assessed by FIGO grading system. All samples were analyzed by immunohistochemistry for E-cadherin (Dakocytomation). We assessed the number of E-cadherin-positive and negative tumor cells and degree of positivity (low, moderate, high). Histological study by hematoxylin-eosin has showed grade 1 endometrioid carcinoma in 35 cases (33.7%, group I), grade 2 adenocarcinoma in 44 cases (42.3%, group II), and grade 3 adenocarcinoma in 25 cases (24%, group III). Our results suggest that the loss of E-cadherin expression is associated with a higher histological grade of uterine endometrioid adenocarcinoma, depth of myometrial invasion, lymph node positivity, coexistence of obesity and vaginal bleeding. It seems that local invasion and metastatic spread of tumor should be preceded by the loss of E-cadherin expression in tumor cells, which progressively occurs in carcinogenesis. Therefore, E-cadherin negativity can be used as a poor prognostic factor and more aggressive chemotherapy regimen should be used.

Clinical prognostic factors and expression of cathepsin D in endometrioid adenocarcinoma.

The aim of our study was to evaluate the association between the expression of cathepsin D and clinical prognostic data in endometrioid adenocarcinoma of different histological grade. We studied 104 postmenopausal women with diagnosis of endometrioid adenocarcinoma. We evaluated the presence of obesity and vaginal bleeding. Surgical specimens were fixed in 10% neutral buffered formalin solution and embedded in paraffin. 4 mm sections were stained by hematoxylin and eosin, von Gieson, and histological type of cancer, metastatic lesion of lymph nodes and depth of myometrial invasion were evaluated. Histological grade of cancer was assessed by FIGO grading system. All samples were analysed by immunohistochemistry for cathepsin D (Dakocytomation). We assessed the number of cathepsin D-positive stromal and tumor cells and degree of positivity (low, moderate, high). Histological study by hematoxylin and eosin showed grade 1 endometrioid carcinoma in 35 cases (33,7%, group 1), grade 2 in 44 cases (42,3%, group 2), grade 3 in 25 cases (24%, grade 3). Our results suggest that the expression of cathepsin D is associated with the higher histological grade of endometrioid adenocarcinoma, depth of myometrial invasion, lymph node positivity, coexistence of obesity and vaginal bleeding. It seems that local invasion and metastatic spread of tumor should be preceeded by the expression of cathepsin D in stromal cells which can be assessed in grade 1 and 2 endometrioid adenocarcinomas. The expression of cathepsin D can be used as a prognostic factor and more aggressive chemothepery regimen should be used.

Cervical carcinoma and pregnancy.

Abortion and conization of the cervix is the treatment of choice for patients with preinvasive cervical carcinoma combined with first-term pregnancy. With the second and third term, the pregnancy is led to delivery and a secondary examination is carried out. In case of preienvasive carcinoma only conization of the cervix is performed. In late-term pregnancy the surgical operation starts with a cesarean section. A combination of cervical carcinoma and pregnancy was observed in 31 (44%) of 6,890 patients admitted to the Gynecological Clinic of the National Cancer Center from 1964-2001. Of 1,911 patients with radical hysterectomy (Stage I--58.4%, Stage II--21.8%, Stage III--20%) a combination of cervical carcinoma and pregnancy was diagnosed in 31 women [Stage I--23 (74.2%), Stage II--4 (12.9%), Stage III--4 (12.9%)]; 93.5% of the patients had a first or second term pregnancy. Five-year survival of the patients with surgery only was 83.3%, while with combined therapy--60%. Twenty-nine percent of the patients were 30 and younger. Pregnancy contributed to early manifestation of cervical cancer and did not favor the aggression of malignant tumor growth. The five-year survival rate of patients without staging and those combined with pregnancy was 72.7%; five-year survival rate of patients with early pregnancy was worse compared to those with second or third term pregnancies. Pregnancy is not a contraindication for performance of radical hysterectomy.

Cervical cuff carcinoma: causes and prevention.

Over an 11-year period (1990-2000) a total of 59 patients with cervical cuff carcinoma were hospitalized (I stage--17; II stage--30; III-IV stage--12 patients). Seventeen patients were subjected to radical extirpation with lymphadenectomy for cervical cuff carcinoma, while 42 patients received combined radiotherapy. In the last 20-year period the patients had undergone supravaginal amputation of the uterus due to uterine fibromyoma, polyposis, and ovarian tumors in various gynecological clinics. In 12 patients the onset of cervical cuff carcinoma occurred within one year after supravaginal amputation of the uterus; in another six patients cancer developed within two years postoperatively, 15 patients in a 3 to 9 year period and 26 developed cancer 10-20 years after surgery. It seems in fact that when cervical cuff carcinoma developed within one year after supravaginal amputation of the uterus the patients had cervical carcinoma which was not identified due to physician negligence. In cases of latent periods up to ten years the patients must have had at least pre-existing disease. To prevent development of cervical cuff carcinoma in the future when operating on the uterus and/or adnexa the scope of surgery (extirpation, amputation) shall be decided based on colposcopic examination of the cervix (target cytology).

Organ preserving method in the management of atypical endometrial hyperplasia.

The problem of organ preservation in the management of atypical endometrial hyperplasia (AEH) comes about especially in patients of reproductive age. Two hundred and fifty-four women with a diagnosis of AEH were hospitalized in our clinic from the period 1991 to 2000. Of those, atypical endometrial hyperplasia with normal uter and appendages was found in 192 women. The remaining 62 patients had diseases of the cervix, corpus uteri, ovaries and oviducts and were subjected to radical hysterectomy. To define the possible sparing tactics of management, 192 women with AEH were divided into two groups. The patients in Group were administered hormonal therapy during a three month period (17alpha OPC - 12.5 g, Depo-Provera - 6 g). If a clinical effect and histological pathomorphism were achieved the patients were subjected to an additional three months of hormonotherapy. Of a total of 96 patients in the first group, 36 (37.5%) who were prescribed hormonotherapy were found to also have mastopathy and endocrine pathology dysfunction of the thyroid gland, and were additionally administered iodine-containing preparations. After completion of the effective hormonotherapy three patients had a normal pregnancy and delivery. Conservative management proved to be effective in 96.4% and ineffective in seven (3.6%) cases. These seven patients were subjected to surgical treatment. All patients in Group 2 were subjected to radical hysterectomy.

Management of lymphocysts after cervical carcinoma surgery.

In the Gynecological Clinic of the Oncological National Center of Georgia from 1964 to 1999 1,805 extended hysterectomies due to carcinoma of the cervix uteri were performed. Retroperitoneal lymphocysts were revealed in 4.3% of the cases. Of all stage I disease lymphocysts had developed in 2.8% of cases and in stage II 7.2%. Correlations between lymph node metastatic damage and development of lymphocysts were not found. The peak incidence (6.2-6.4%) of lymphocysts appeared to be in women younger than 30 and in elderly women (over 60 years). Unilateral lymphocysts developed more frequently (left-side in 38.9% in right-side in 33.3%) than bilateral ones (28.3%). In 32.5% of cases the size was less than 5 cm, in 42.3% of cases 6-10 cm and in 25.6% of cases more than 10 cm; 18% of the lymphocysts were asymtomatic and did not need any treatment. High temperature, pain, changes in blood occurring 4-5 days after surgery are indications of parametritis. Lymphocysts usually arise 11-12 days after surgery. Ultrasonography is a highly informative diagnosic method to detect this disease. In 23% of cases, the method of treatment was conservative therapy, 35.8% of patients had punctures, thus micro-drainage was performed and a cocktail injection into the cyst cavity was carried out. In 7.7% of cases lymphocyst resection and drainage was carried out.

[Strategy and results of treatment in trophoblastic disease]. / Taktika i resul'taty lecheniia trofoblasticheskoi bolezni.

The study involved 457 cases of ordinary (261), invasive (75) vesicular mole and choriocarcinoma (121-stage I-51.2; stage II-19.8 and stage III-27.3%). Enhanced chorionic gonadotrophin titer in urine was registered in 67-72%. Choriocarcinoma had no link to pregnancy in 6.6%. It is suggested that cases with a 10-year latency period and longer should be referred to this category of patients. Five-year survival was observed in 98-99% of patients with vesicular mole and in 74.1% with choriocarcinoma in 1977-1989. A special synoptic procedure has been developed for optimal planning the therapy and rehabilitation of cases of trophoblastic disease. Four forms of non-invasive vesicular mole have been identified, and strategies of treatment versus type of tumor and patient's peculiarities worked out. The extent of therapeutic effort has been decreased.

Epidemiology and clinical management of endometrial carcinoma in the Republic of Georgia in the last 30 years.

Endometrial carcinoma incidence in Georgia from 1965 to 1992 was 5.3 women per 100,000 and in the structure of gynecological malignant tumors this pathology occupied third place (19.1%). Morbidity incidence varied from 2 to 8 depending on ethnic regions overall a 2.5 times rise in morbidity was observed. Within the period of 1968-1994 1731 patients with uterine carcinoma were subjected to surgical intervention (stage I-81.2%; stage II-9.4%; stage III-9.0%; stage IV-0.3%). Surgical intervention is the optimal method to determine the stage of the disease and planning of adjuvant treatment. Metastases in regional lymph nodes were found in 13.0% (T1-7.7%; T2-20.07%; T3-35.3%). Adenocarcinoma was histologically confirmed in 97.4% (G1-21.3%; G2-57.8%; G3-18.8%). Management of the disease was predominantly started with surgical intervention. In pathogenetic version I (71.4%) total extirpation of the uterine was carried out, while in cases of the pathogenetic version II (28.6%) patients were subjected to the modified extended extirpation. Postoperative management was prescribed based on the peculiarities of the organism and tumor. Highly sensitive classification of endometrial carcinoma of stage I (including 5 subgroups) as well as a synoptic table of optimal management were worked out. As a result, 5 year survival increased by 15%, and 29% of the women operated were spared from additional treatment. On the whole, five-year-survival was observed in 71.0% of women (stage I-77.7%; Early Form-95.5%; stage II-51.5%; stage III-34.2%).

Continent urinary diversion (Gotsadze Pouch) after pelvic exenteration for gynaecological malignancies.

The problem of urinary diversion is of major importance in patients requiring pelvic exenteration for advanced gynaecological malignancies. Eight patients underwent pelvic exenteration (4-total and 4-anterior) at the Georgian Oncologic Centre, 7 of them for recurrent cervical carcinoma after combined treatment and 1--for primary advanced cervical carcinoma. The original surgical technique for construction of detubalarized ileal reservoir with continent umbilical stoma (Gotsadze Pouch) is described. Six patients underwent this type of urinary diversion with successful results. Urination is patient-controlled via self-catheterization every 5 to 6 hours. The results obtained by operation can be considered as optimal for their functional and rehabilitational properties.

The management of cervical cancer in the experience of oncological institute of Tbilisi.

The Authors, after a brief review of epidemiological patterns in the USSR, describe their own experience in the management of cervical cancer. Out of 5116 patients observed in Tbilisi Oncological Center in 26 years (1964-1989), 1289 women (25.7%) underwent radical surgical operation. The other patients received combined Radiotherapy (Brachytherapy plus Teletherapy). In stage I B the best results were obtained with Surgery (5 year survival 86%). Treatment results in stage II (5 year survival rate 68.2%) were obtained with combined Surgery and Radiotherapy. Overall 5 year survival in stage III was 39.3% and treatment results were directly correlated with primary tumour characteristics.

Optimal version of I and II stages vulvar carcinoma--surgical treatment.

In gynaecological clinic years during 1970-1986, 270 vulval carcinoma patients (I stage 12.6%; II 50.3%; III 29.3%; IV 7.8%) underwent treatment. 34.8% patients age was 60-69, 32.2% 70-79. Average age 66 years. In 70% patients diagnostic epidermoidal, 22.2% low differentiated cancer and 1 case (0.4%) adenocarcinoma. 187 patients underwent total vulvectomy (additional telecurie therapy 18 patients, 2 chemotherapy), 54 total vulvectomy + regional lymphadenectomy, 29 chemo (6), radio (3), symptomatic (20) therapy. 5-year recovery generally equated 40.1% (vulvectomy + lymphadenectomy 58.4%; vulvectomy only 35.8%), at I-II stage 52.1% (vulvectomy + lymphadenectomy 85.7%; vulvectomy 50.0%), at III stage 11.4% (vulvectomy + lymphadenectomy 42.9%; vulvectomy 6.7%), at IV stage 0%. T1 regional lymph nodes involvement, clinical signs (N1, N2, N3) were present in 24.1% patients, T2 36.1%, T3 70.8%. Out of marked 92 patients, lymphadenectomy was performed in 54, mainly with T1 and T2. Histological metastases observed in 48.1%, i.e. no more than 14% T1 and T2 patients. Considering the above raised question rised - it is justifiable in I and II stage patients with negative lymph nodes, regarding advanced age and concomitant diseases, perform protracted traumatic operation. But without histology it's hard to decide lymph nodes condition. Taking into account certain stage characteristic of metastatic spreading, in our clinic from 1985 in T1 and T2 vulval carcinoma without (N0) and/or with (N1, N2) regional lymph nodes involvement signs modified less traumatic one stage extensive vulvectomy with bilateral inguinal lymphadenectomy is performed. Suboperational morphological (cytology, histology) lymph nodes study is conducted. Upon metastases discovery dissection is carried out on femoral lymph nodes as wall.(ABSTRACT TRUNCATED AT 250 WORDS)

[Optimization of the treatment of patients with malignant polyps of the cervix uteri]. / Optimizatsiia lecheniia bol'nykh s malignizirovannymi polipami sheiki matki.

The study was concerned with an analysis of 5-year results of treatment of Ca in situ (II) and invasive cancer (53 patients) arising in cervical polyps. Recurrences were observed in 15.1% of cases undergoing sparing procedures. Conization assures an optimal removal of tissue for Ca in situ. Reproductive patients with invasive carcinoma should also undergo conization. Extirpation of the uterus with appendages should be carried out in menopausal patients and cases of concomitant uterine pathology.

[Optimal treatment modality for patients with stage-I cervical cancer]. / Optimal'nyi variant lecheniia bol'nykh rakom sheiki matki I stadii.

Expansive extirpation of the uterus was performed in 726 cases of stage TIbNXMO cervical cancer. 19.3% of 600 cases of pTIb cancer showed metastatic involvement of lymph nodes. Metastases into regional lymph nodes were found to be resistant to preoperative large-fraction irradiation. The long-term results of treatment of 484 patients with pTIbNOMO cervical cancer receiving 3 different treatment modalities (operation alone, surgery + preoperative irradiation and surgery + postoperative distant irradiation) did not show any significant difference. Complications and relapse were rarer in patients who received surgery only. Therefore, expansive extirpation of the uterus unaccompanied by distant radiotherapy should be a method of choice in treatment of stage I cervical cancer (pTIbNOMO).

[Comparative study of the female genital cancer morbidity in the Georgian SSR, Latvian SSR and Kazakh SSR]. / Sravnitel'noe izuchenie porazharmosti rakom zhenskikh polovykh organov v Gruzinskoi SSR, Latviiskoi SSR i Kazakhskoi SSR

Within a period of 1966-1970 in the three republics according to standardized indices for 100.000 females cancer of the female genitalia was found in 42.32 (in Georgia--29.1; in Kazakhstan--43.02; in Latvia--54.85). Dynamically, there was noted a stabilization of indices on cervial cancer and growth in ovarian and, especially, endometrial cancer incidence. In dynamics there is an "ageing" of cancer of the female gentalia.