Search

Only within the last decade we have begun to fully appreciate the natural history and biologic behaviour of borderline tumours in the ovaries. In contradiction to invasive epithelial tumours, most borderline tumours are confined to the ovary(ies) (stage I). Because the prognosis of stage I serous borderline tumours is excellent, with five-year survival rates of almost 100%, some experts are advocating that this subset should be classified as benign. Although the standard treatment for older patients is abdominal hysterectomy and bilateral salpingo-oophorectomy, many young patients who have not completed childbearing can be safely treated with unilateral salpingo-oophorectomy coupled with comprehensive surgical staging, thereby preserving their fertility potential. Another major controversy associated with borderline tumours is the clinical management of patients with advanced-stage disease or peritoneal implants. Many experts strongly believe that surgery is the only effective treatment for borderline tumours. Others routinely employ postoperative chemotherapy for at least some subset of patients with peritoneal implants. Several investigators have focused on DNA ploidy as a predictor of recurrence and survival, but their findings are conflicting.

Background: Ovarian cancer is a common malignant neoplasm in affluent societies. Although the prognosis has continuously improved since the 1950s, it is still poor, with five-year relative survival rates of about 40%., Material and Methods: The paper discusses the potential use of screening for early ovarian cancer detection., Results: The disease is a suitable candidate for screening because the prognosis is strongly dependent on the stage of disease at the time of diagnosis. Ovarian cancer does not, however, meet all the prerequisites for successful screening; there is no preclinical stage that can be detected, and the tests are not sensitive and specific enough to be effective. Furthermore, there is so far no direct evidence that screening would decrease mortality from ovarian cancer, though recent data suggest that screening may increase survival., Interpretation: Screening women at higher risk of developing ovarian cancer might be beneficial.

The prognosis of patients with early stage ovarian borderline tumour and carcinoma is good. In spite of this most patient management has been unnecessarily heavy. DNA ploidy is an independent and the strongest prognostic predictor of survival with an excellent prognosis in patients with diploid tumours, it should be included in the routine evaluation of patients in order to achieve optimal and individual management. Image cytometry is superior to flow cytometry in predicting prognosis.

Ovarian cancer is the most lethal of the gynecological malignancies. One of the aims of the ongoing research in this field is the search for prognostic and/or predictive factors which can contribute to a more individualized patient treatment. All studies performed at The Norwegian Radium Hospital with regard to the prognostic significance of DNA ploidy in borderline, early and advanced ovarian cancer, were reviewed. The conclusions emanating from these studies were compared to the international literature. DNA ploidy analysis is of definite independent prognostic significance in borderline and early (FIGO stage I) ovarian cancer, and is of help in the selection of patients expected to benefit from adjuvant chemotherapy, or in whom a more conservative surgical procedure can be acceptable. DNA ploidy status is also of prognostic significance in advanced ovarian cancer; however, for the time being this information has no direct consequences for patient treatment. We conclude that DNA ploidy analysis should be incorporated in the routine histopathological evaluation of borderline and early (stage I) ovarian cancer.

The International Society of Gynecological Pathologists recently agreed on a classification of endometrial hyperplasia into two main groups; hyperplasias with and without atypia. The lesions were further subdivided into simple and complex hyperplasia. These guidelines were subsequently adopted by the World Health Organization. The disease is a result of oestrogen/gestagen imbalance with oestrogen overexpression. The most important prognostic factor is cellular atypia. Progress to invasive cancer is seen in about 20% of the patients with atypical hyperplasia, and most frequently occurs in postmenopausal women. The treatment of endometrial hyperplasia depends on histologic type, patients' age and whether the hyperplasia is a result of endogenous or exogenous oestrogen overexpression. The risk for progression to invasive cancer is minimal in oestrogen treated patients with simple or complex hyperplasia without atypia. Women under 40 years of age in this group can safely be treated with gestagens. In postmenopausal women with simple or complex hyperplasia with atypia, the recommended treatment is surgery including removal of the uterus and the ovaries.

Screening can be defined as the process of identifying preclinical disease in asymptomatic people. The main objective of screening is to reduce the incidence and the mortality from disease. There are several prerequisites for successful screening, and screening has both beneficial and adverse effects. In Norway only screening for cervical and breast cancer are recommended as nation-wide, organised programmes. Screening for colorectal cancer is planned as a pilot project. Also a study on screening for prostate cancer is planned. Screening for other cancers is not recommended.

Long-term trends in the incidence, prognosis, and mortality of patients with ovarian cancer and borderline tumours in Norway were examined based on data from the population-based Cancer Registry of Norway. The incidence of ovarian cancer rose continuously from the mid-1950s to the mid-1980s. There was also an increasing trend in the incidence of borderline tumours from the early 1970s to the early 1990s. The prognosis for patients with ovarian cancer has improved since the 1950s. In 1989-93 the five-year relative survival rate was 37%. The prognosis for patients with borderline tumours was very favourable, with a five-year relative survival rate of 93% (1970-93). The mortality from ovarian cancer has been almost constant since the 1960s.

The frequency of adenocarcinoma of the uterine cervix is increasing, and accounts for 10-20% of all cervical carcinomas. Adenocarcinoma usually affects women in their fifties and sixties. Mortality is high, with a five-year survival between 49 and 65%. Important prognostic factors are tumour grade, tumour diameter and clinical stage. The prognostic value of histologic subtyping is still under debate. Villoglandular (papillary) adenocarcinoma is a recently described form of well-differentiated adenocarcinoma in the cervix. This lesion apparently affects young women and carries an excellent prognosis. We describe five patients with villoglandular adenocarcinoma in the cervix, clinical stage IB and IIA. Mean age was 34.2 years and mean depth of cervical infiltration was 1.25 cm. Four patients were treated with radical hysterectomy and bilateral pelvic lymphadenectomy and one with simple hysterectomy. All five received postoperative chemotherapy. There is no evidence of recurrent tumour after a follow-up of 18 to 28 months. Cervical conization or simple hysterectomy is probably adequate treatment for this subtype of adenocarcinoma.