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Endometrial cancer is one of the most frequent gynaecological cancers in Danish women. The staging of the cancer is done surgically in accordance with guidelines from the International Federation of Gynaecology and Obstetrics. The method has proven insufficient and unsuitable because treatment is frequently decided during surgery and the final staging is done by the pathologist when examining the specimen. Too many patients are over- or under-treated and there is a high demand for new diagnostic tools for preoperative staging of endometrial cancer. We have reviewed recent literature on the subject.

In October 2007, the Danish government and regions made an agreement comprising acute treatment of ovarian cancer (OC) patients. The acute OC-package includes the tumour marker cancer antigen 125 (CA125) as an essential factor. This marker is yet not optimal due to too low sensitivity/specificity. There is therefore a need for new or supplementary markers to improve the treatment. As the agreement will be influencing all diagnostic procedures, there is, furthermore, a need for information about OC and tumor markers. In this article we review the literature and illustrate future challenges and opportunities in OC marker diagnostics.

New non-invasive diagnostic tests for detection of ovarian cancer in early stages can improve survival. One approach is the proteomic analysis of serum or urine, which may be the technology needed. Preliminary proteomic analyses of serum and urine have shown a higher positive predictive value than that of the combination of serum CA125 and ultrasound examination, which actually is used preoperatively for the ovarian cancer diagnosis (RMI index). Identification of new ovarian cancer biomarkers will optimally be usable as an ovarian cancer-screening tool.

A new plasma protein, tetranectin, was discovered in 1986. It is composed of four non-covalently linked identical peptide chains, each with a molecular weight of 20 kDa. The protein structure is known and it has been found to bind to plasminogen, Ca++ and sulphated polysaccharides. All normal epithelial and mesenchymal cells contain tetranectin in their cytoplasm, but tetranectin is not seen in normal extracellular matrix. The concentration of tetranectin in blood from healthy individuals is about 10 mg/1 with slight sex and age variations. The biological function of the protein is still unknown. The amount of tetranectin in the blood is reduced in patients with various cancer diseases. The degree of tetranectin reduction in the blood from patients with ovarian carcinoma and metastasizing breast carcinoma correlates with survival. While tetranectin is absent in normal extracellular matrix, it is found extracellulary in granulation tissues and in some carcinomas of the breast and the ovary. Lifetables of patients with ovarian carcinoma show that high concentrations of extracellular tetranectin is associated with a poor prognosis. Tetranectin may be a new prognostic marker which should be included in future clinical studies evaluating the prognosis for cancer patients.

A longitudinal interview study of 360 mothers was carried out to investigate: 1) utilization of maternity leave by the parents, 2) mothers' resumption of occupation after delivery and 3) duration of breast feeding seen in correlation with the mothers' resumption of work. 1) 95% of the families utilized the entire maternity leave. In 92% of the families, the mothers utilized all 24 weeks and, in 3% of the families, the fathers took part in the maternity leave. Only 46% of the fathers utilized the right to take leave in connection with delivery and 14% employed their holiday but were at home for a significantly shorter period. 2) Only one fourth of the mothers had resumed work 24 weeks after the delivery. 44% of the mothers prolonged the maternity leave with their holiday and 32% prolonged the maternity leave even longer. One year after delivery, significantly more mothers were housewives than previously. 3) A significantly positive correlation was found between the time for maternal return to work and the duration of breast feeding. We conclude that almost all of the families utilized the maternity leave and that prolongation of maternity leave (which is 24 weeks after delivery at present) might be necessary.

A longitudinal prospective study was performed to investigate the total duration of breast-feeding. Three hundred and sixty six mothers were followed-up until three years after delivery. At three months, 73% were breast-feeding, at six months 52%, at one year 20% and 1% breast-fed more than three years. Correlations were found between duration of breast-feeding and maternal age, education and social class. Mature mothers who lived under good socioeconomic conditions breast-fed for longer periods than those who were less fortunate in these respects. Mothers who had breast-fed an older child usually breast-fed the next child for a similar period. Breast-feeding has become popular: only 1% did not want to breast-feed at all and 89% of mothers intended to breast-feed their children for six months or more. Solid food was most frequently introduced when the infants were four months old. At six months 4% were still exclusively breast-fed. Even though the mothers now breast-feed longer than previously, only 39% succeeded in breast-feeding for as long as or longer than they had intended.

Postpartum atony with haemorrhage is a life-threatening condition which may necessitate surgical intervention with ligation of the ascending arterial branches or hysterectomy. On the basis of the literature, recent medical treatment with the prostaglandins F2 alpha and E2 is reviewed. When this treatment was employed, surgical intervention could be avoided in 60-100% of the cases which did not respond to ordinary treatment for atony. The forms of administration, which may be intravenous, intramuscular, intravaginal or injection into the myometrium, are discussed. In addition, the dosage, choice of prostaglandin and the contraindications of treatment are reviewed. It is concluded that prostaglandin treatment should be considered prior to surgical treatment and that the possibilities of obtaining prostaglandin rapidly should be present in all maternity departments.