Surgical approaches towards fertility preservation in young patients with early invasive cervical carcinoma.

Cervical cancer still remains one of the major problems in developing countries. The last decade of 20th century has seen a trend towards more conservative surgical approaches in the treatment of early-stage disease in young patients. The trend of delaying childbearing, nowadays, increases preservation of fertility, and reproductive function is a major concern when counseling these young women with regard to the effects of treatment for cervical cancer. Radical trachelectomy, either with abdominal or vaginal surgical approach, showed promise as treatment option in young patients with early cervical cancer. The basic principle of such a surgical approach is an operation aiming at preserving the uterine body and removing the cervix, parametrium, with bilateral pelvic lymphadenectomy, and creating a utero-vaginal anastomosis, either laparoscopically or by laparotomy. Both surgical approaches are evaluated after a search of the relevant literature in Pub Med or Medline.

Linear trend analysis of patients with cervical cancer treated at the Institute of Oncology Vojvodina in 2001-2007.

PURPOSE: Cervical cancer is the leading cause of death in women with gynecological cancers in Vojvodina. Serbia currently holds the leading place in Europe regarding the incidence of cervical carcinoma and comes second in terms of mortality. METHODS: Data were retrieved from the Register for malignant neoplasms of the Institute of Oncology Vojvodina for the period 2001-2007. The patients were divided in 3 groups according to the stage of disease based on the FIGO classification for cervical cancer. Data were analysed using linear trend and t-test. RESULTS: The linear trend of the number of registered cases in the group of stage I-IIA patients during 7 years showed no significant change in the prevalence of the disease. In the group of women diagnosed with stage IIB no statistical difference regarding either a rising or a decreasing trend was observed. The observed trend in an advanced disease stage (III and IV) showed a slight decrease in the number of patients, but without statistical significance. CONCLUSION: The linear trend of the number of patients with cervical carcinoma during a 7-year period points to the fact that the number of newly detected cases of advanced disease stages did not decrease significantly despite the affordable and simple methods of early detection. This result underlines the importance of implementation of a National screening programme in the general population for early detection of cervical neoplasms. The excellent results of National screening programmes in other European countries lend support to this approach.

Clinical-sonographic scoring system in noninvasive diagnosis of endometrial cancer.

PURPOSE: In 90% of all endometrial cancers vaginal bleeding is the leading clinical symptom. Nowadays, scoring systems have become acceptable in medicine as less invasive, adequate, diagnostic methods. The main goal of this study was to examine the clinical-sonographic scoring system as a noninvasive diagnostic method for endometrial cancer. PATIENTS AND METHODS: The study included 122 patients with postmenopausal bleeding (PMB). Transvaginal sonography was performed before curettage. Patients were divided in two groups (A and B). In group A included were patients without endometrial malignancy and in group B were patients with endometrial cancer. A clinical-sonographic scoring system named ONCO 1 was created. Each patient got her own score based on anamnesis, clinical examination, and transvaginal ultrasonography. Evaluations of the clinical-sonographic scoring system were performed by using the test for diagnostic accuracy and receiver operating characteristic (ROC) curve. RESULTS: Patients with endometrial cancer were older (median age in group B 64.49 years vs. 58.81 in group A), the length of corpus uteri was longer (6.41 cm in group B vs. 5.25 cm in group A), and the postmenopausal period was longer (13.67 years median in group B vs. 9.11 in group A). All parameters were statistically significant. The average value of clinical-sonographic scoring system ONCO 1 in group A was 7.13, +/-3.07 SD and in group B it was 9.14, +/-2.32 SD. The difference was statistically significant. CONCLUSION: Postmenopausal bleeding caused by endometrial cancer is usually diagnosed in older patients. It was possible to distinguish high-risk patients with neoplasia from those with benign changes of the endometrium using the clinical-sonographic systems ONCO 1. Nevertheless, histopathological examination is still unavoidable for the final diagnosis of endometrial cancer.

Stage IB2 cervical cancer: brachytherapy followed by radical hysterectomy.

PURPOSE: Stage IB2 squamous cell cervical cancer can be treated by radiation therapy alone or by radical hysterectomy and lymphadenectomy (pelvic-/+para-aortic). Preoperative radiation therapy followed by extrafascial hysterectomy has been recommended as an effective combined treatment method. PATIENTS AND METHODS: During the period January 1994-January 2004, 114 patients with stage IB2 cervical cancer were treated with preoperative brachytherapy followed by radical hysterectomy (Piver class III) with pelvic lymphadenectomy. RESULTS: Histology showed that 56 (49%) patients were without cervical malignant disease. Positive lymph nodes were found in 5 (9%) of them and negative in 51 (91%). In 58 (51%) patients cervical cancer still existed after brachytherapy and among them 26 (45%) were with lymph node metastasis. Patients with residual cervical carcinoma and positive lymph nodes after brachytherapy were older than those with no residual carcinoma and negative lymph nodes. CONCLUSION: Women with stage IB2 squamous cell cervical cancer primarily treated with brachytherapy must be assessed by appropriate diagnostic procedures to evaluate local effects of brachytherapy and the status outside the pelvis. Negative local findings with positive lymph nodes point to further treatment of patients, while positive local findings point to radical surgery which may increase recurrence-free interval.