Gynecologic malignancies

Ovarian cancer constitutes one of the most lethal gynecologic malignancies for females. Currently, early detection strategies and therapeutic options for ovarian cancer are far from satisfactory, leading to high diagnosis rates at late stages and disease relapses. New avenues of therapy are needed that target key processes in ovarian cancer progression.

20p vimichaelfaraday 25-03-2022 16 1   Download

Tuyển tập báo cáo các nghiên cứu khoa học quốc tế ngành hóa học dành cho các bạn yêu hóa học tham khảo đề tài: CGB and GNRH1 expression analysis as a method of tumor cells metastatic spread detection in patients with gynecological malignances

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Tuyển tập báo cáo các nghiên cứu khoa học quốc tế ngành hóa học dành cho các bạn yêu hóa học tham khảo đề tài: Effects of pegylated G-CSF on immune cell number and function in patients with gynecological malignancies

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Ovarian cancer is the leading cause of death among women with gynecologic malignancies in the United States. Advanced ovarian cancers are difficult to cure with the current available chemotherapy, which has many associated systemic side effects. Doxorubicin is one such chemotherapeutic agent that can cause cardiotoxicity. Novel methods of delivering chemotherapy without significant side effects are therefore of critical need.

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Clinical Presentation Molar pregnancies are generally associated with first-trimester bleeding and excessive uterine size. About 45% of patients have ovarian theca-lutein cysts present on ultrasound. The β-hCG levels are generally markedly elevated. Fetal parts and heart sounds are not present. The diagnosis is generally made by the passage of grapelike clusters from the uterus, but ultrasound demonstration of the hydropic mole can be diagnostic. Patients suspected of a molar pregnancy require a chest film, careful pelvic examinations, and weekly serial monitoring of β-hCG levels.

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Clinical Presentation and Staging Patients with cervix cancer generally are asymptomatic, and the disease is detected on routine pelvic examination. Others present with abnormal bleeding or postcoital spotting that may increase to intermenstrual or prominent menstrual bleeding. Yellowish vaginal discharge, lumbosacral back pain, lower-extremity edema, and urinary symptoms may be present. The staging of cervical carcinoma is clinical and generally completed with a pelvic examination under anesthesia with cystoscopy and proctoscopy.

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Patients with stage IV disease (outside the abdomen or invading the bladder or rectum) are treated palliatively with irradiation, surgery, and platinum-based chemotherapy. Progestational agents produce responses in ~10–20% of patients. Well-differentiated tumors respond most frequently, and response can be correlated with the level of progesterone receptor expression in the tumor.

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Malignant germ cell tumors are usually large (median—16 cm). Bilateral disease is rare except in dysgerminoma (10–15% bilaterality). Abdominal or pelvic pain in young women is the usual presenting symptom. Serum human chorionic gonadotropin (β-hCG) and α fetoprotein levels are useful in the diagnosis and management of these patients. Before the advent of chemotherapy, extensive surgery was routine, but it has now been replaced by careful evaluation of extent of spread, followed by resection of bulky disease and preservation of one ovary, the uterus, and the cervix, if feasible.

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Uterine Cancer Incidence and Epidemiology Carcinoma of the endometrium is the most common female pelvic malignancy. Approximately 39,080 new cases are diagnosed yearly, although in most (75%), tumor is confined to the uterine corpus at diagnosis, and therefore most can be cured. The 7400 deaths yearly make uterine cancer only the eighth leading cause of cancer death in females.

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Patients with stage I disease, no residual tumor, and well or moderately differentiated tumors need no adjuvant therapy after definitive surgery, and 5-year survival exceeds 95%. For all other patients with early disease and those stage I patients with poor prognosis histologic grade, adjuvant platinum-based therapy is warranted. Large prospective randomized trials have demonstrated that adjuvant therapy improves disease-free and overall survival by 8% (82% vs. 74%, p = .008).

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Table 93-1 Staging and Survival in Gynecologic Malignancies St age Ovarian -Year 5 trial Endome 5 -Year x Surviv al, % Cervi -Year 5 Surviv al, % Surviv al, % 0 — — Carcin oma in situ 00 1 I Confined 9 Confine 8 Confin 8 to ovary 0 d tocorpus 9 ed to uterus 5 II Confined to pelvis 0 7 corpus cervix Involves and 0 8 s Invade beyond 5 6 uterus but not to pelvic wall III Intraabdo minal spread 5–20 1 Extends outside the 0 3 Exten 3 ds to pelvic 5 wall and/or uterus but not outside the true pelvis lower third of vagina, or hydronephros is IV Sp...

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Screening In contrast to patients who present with advanced disease, patients with early ovarian cancers (stages I and II) are commonly curable with conventional therapy. Thus, effective screening procedures would improve the cure rate in this disease. Although pelvic examination and CA-125 can occasionally detect early disease, these are relatively insensitive screening procedures. Transvaginal sonography is often used, but significant false-positive results are noted, particularly in premenopausal women.

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Harrison's Internal Medicine Chapter 93. Gynecologic Malignancies Ovarian Cancer Incidence and Epidemiology Ovarian cancer can develop from three distinctive cell types (germ cells, stromal cells, and epithelial cells), and each of these presents with distinctive features and outcomes and requires widely different management approaches. Epithelial ovarian cancer is the most common of the three and the leading cause of death from gynecologic cancer in the United States. In 2007, 22,430 new cases were diagnosed, and 15,280 women died from ovarian cancer.

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