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Cervical cancer (CC) ranks fourth for cancer incidences in women after breast cancer, colorectal cancer and lung cancer. There is a steady increase in the incidence of invasive forms of CC in Russia. Over the past quarter of a century, the mortality rate of reproductive age group women with cervical cancer has increased by 2 times. The standard treatment options for cervical cancer progression were the regime of paclitaxel plus cisplatin (carboplatin). The addition of an antiangiogenic therapy (bevacizumab) to the standard chemotherapy regimen increases overall survival of only 4%. The response to other lines of chemotherapy does not exceed 10% after the therapy using the combination of paclitaxel + carboplatin + bevacizumab. The results of KEYNOTE-158 trial demonstrated objective responses in 91% of CC patients lasting for more than 6 months in case of application of pembrolizumab 200 mg every 3 weeks in cases of PD-L1 expression (CPS1) with acceptable toxicity. The presented clinical case of successful treatment using pembrolizumab in women with PD-L1 expression in metastatic CC has a beneficial effect on further accumulation of experience and could help to choose the right treatment options in order to increase the efficacy of the therapy and to increase the survival rates for this category of patients.

Insufficient diagnosis of ovarian tumors during pregnancy and decreased oncological alertness constitute huge problems that can subsequently have an unfavorable outcome for both the pregnant woman and the fetus. The difficulties of diagnosing and treating ovarian cancer during pregnancy were demonstrated on the following clinical case example. In pregnant patient A. at 19-20 weeks of pregnancy, a lesion was found in the area of the right appendages (100.9 55.4 93.4 mm, V = 273 cm3), with many tissue partitions and parietal tissue inclusions. The growth of the neoplasm was noted (CA-125 884 U / ml) and the pain syndrome occurred in the patient at 23-24 weeks of pregnancy. Magnetic resonance imaging revealed a solid-cystic neoplasm of the right ovary (cystadenoma?) and surgery was performed in November 2019. Based on the results of histological examination, a high-grade serous ovarian cancer was diagnosed without signs of microsatellite instability MSI-H/dMMR (in the right ovary, in the biopsy of the left fallopian tube). The patient. received two cycles of polychemotherapy (TC scheme). The treatment was tolerated satisfactorily (CA-125 287.3 U / ml). At a gestational age of 34 6/7 weeks (January 2020), a simultaneous operation was performed, including a lower midline laparotomy, a lower uterine segment caesarean section, extirpation of the uterus with appendages, and an omentectomy. A boy was born (weight 2280 g, height 44 cm) with the Apgar score of 7/7 points, with no complications noticed in the postpartum period. Postoperative histological examination showed metastasis of carcinoma in the left ovary with signs of therapeutic pathomorphosis. The treatment was completed in March 2020 after six cycles of polychemotherapy.

The article provides an overview of the possible causes of bleeding from the genital tract in peri- and postmenopausal women. The correct approach to patients with abnormal uterine bleeding during menopausal hormone therapy is described. A modern analysis of data on the diagnosis and treatment of postmenopausal vaginal bleeding against the background of menopausal hormone therapy was carried out. The modern possibilities of endometrial diagnostics and treatment are shown.

Aim. To analyze and systematize the available information on pathogenetic mechanisms of hormonal carcinogenesis. Materials and methods. The review includes data from foreign articles published in PubMed and Medline and national works posted on elibrary.ru over the past 20 years. Results. Currently, the term estrogen is often used in the context of hormonal carcinogenesis. According to most researchers, it should not fit into the narrow framework of receptor-mediated proliferation induced by estrogens in target tissues. The concept of estrobiome as a combination of all mechanisms providing the realization of estrogen effects should include not only hormones and native receptors themselves, but also the enzymes involved in their synthesis, estrogen metabolites, intestinal microbiota, as well as genetic and epigenetic factors. Conclusions. When analyzing cancer risk, it is necessary to comprehensively assess contributing factors and hormonal-metabolic preconditions for neoplastic process.

Ovarian cancer mortality rates hold a leading position among women’s cancer, which is primarily associated with the pathogenetic features of ovarian cancer, the heterogeneity of the disease, the lack of effective screening and diagnostic methods for early cancer detection. The causes of most ovarian tumors remain unknown. Ovarian benign tumors and tumor-like formations are not among the risk factors of ovarian cancer. The purpose of this literature review is to highlight the latest data from world expert organizations on the possibilities of ovarian neoplasm diagnosis and treatment.

Currently endometrial cancer remains a pressing issue for public health worldwide. Every year there is a steady increase in morbidity rates, which is associated with an increase in the prevalence of risk factors for the disease among which “non-steroid triad” is prevalent: obesity, diabetes, metabolic syndrome. Other significant risk factors for endometrial cancer include the long-term use of tamoxifen and the presence of Lynch syndrome, which makes it possible to carry out selective screening of the disease in these groups of patients. Endometrial cancer is a symptomatic disease, the main clinical manifestation of which is the bleeding from the genital tract on the background of postmenopause. In this case, with timely diagnostic measures, the disease is diagnosed in more than 80% of cases in the early stages of the tumor process, in which the results of treatment are satisfactory. However, despite years of research, questions remain about the relevance and feasibility of population and selective screening for uterine cancer, the ultimate goal of which is to reduce mortality from this disease in a population. Endometrial biopsy and ultrasound of the pelvic organs are considered as the main screening methods, however, the effectiveness of these methods as a population screening is limited. Unreasonable tests lead to overdiagnosis of the disease, invasive interventions increase the risk of the development of predictable complications. This review of the literature contains current information on factors that increase and decrease the risk of endometrial cancer and the results of scientific research on endometrial cancer screening. This information will allow the doctor to choose a rational tactic for managing each particular patient with various risk factors for endometrial cancer and to avoid unnecessary invasive interventions.

Aim. To carry out a systematic analysis of available researches data on a possibility of using menopausal hormone therapy (MHT) in patients who successfully completed a treatment for malignant neoplasms of different localization. Materials and methods. The review includes data of foreign articles published in PubMed and Medline and domestic articles published in Elibrary.ru over the past 20 years. Results. The data obtained allow us to extend indications range for MHT in patients with history of malignant neoplasms in different organs. This study is one of the few attempts of clinicians to justify the use of MHT as one of the tools for the still imperfect rehabilitation of cancer patients. Conclusion. Patients who successfully completed a treatment for malignant tumors of any localization require special conditions of rehabilitation in order to keep their health and quality of life. A reasonable MHT use in these patients will allow to avoid complications caused by estrogen deficiency followed surgery, radiation with or without systemic (cytostatic) treatment methods.

Hypothesis/aims of study. The current analysis was undertaken to assess the incidence of malignant diseases in patients with endometriosis. Study design, materials and methods. This is a cohort study of women with surgically verified endometriosis retrieved from the Saint Petersburg 122 Clinical Hospital Discharge Register 1996–2006 (n = 1551). Data were linked to the Saint Petersburg Cancer Agency to identify cases of malignancy. Results. Malignant diseases were identified in 6.3% (n = 98) of cases. The median follow-up was 12.2 (7.5) years. Breast cancer (n = 29), ovarian cancer (n = 7), endometrial cancer (n = 7), thyroid cancer (n = 7), colorectal cancer (n = 6), melanoma (n = 6), non-Hodgkin’s lymphoma (n = 4), and glioblastoma (n = 3) were prevalent. Conclusion. The incidence of cancer in patients with endometriosis is low. Women with endometriosis have an increased risk of some malignancies, particularly ovarian cancer.

Currently, tamoxifen is the gold standard in the treatment of hormone receptor-positive breast cancer, which reduces recurrent tumor risk by more than 40%. Tamoxifen, which belongs to selective estrogen receptor modulators, can cause endometrial changes in women of different age groups and increase the risk of hyperplasia and endometrial cancer by several times. In clinical practice, the occurrence of various endometrial alterations during tamoxifen treatment often leads to groundless drug withdrawal. Oncology, gynecology and radiology community knowledge related to optimal methods and criteria for diagnosing different tamoxifen-induced endometrial conditions, as well as in choosing the optimal treatment tactics, will be instrumental in the unified and correct approach to managing patients with hormone receptor-positive breast cancer and maintaining tamoxifen therapy due to its high effectiveness.

The aim of the work is to conduct a systematic analysis of the available research results on the possibility of using menopausal hormone therapy (MHT) in patients who successfully completed the treatment of endometrial cancer (EC). Materials and methods. The review includes data from foreign articles published in PubMed and Medline, and domestic works published on elibrary.ru over the past 40 years. Results. The results obtained allow us to consider MHT as an independent method of medical rehabilitation for women who have undergone EC. A clear patient profile should be established, allowing the use of this method, with strict adherence to health monitoring. Conclusion Patients who have successfully completed the treatment of EC require the creation of special rehabilitation conditions in the interests of maintaining health and quality of life and should be under the close attention of the doctor. Argumented approaches to the appointment of MHT in such patients will avoid complications associated with estrogen deficiency after surgery, radiation with or without systemic (cytostatic) treatment methods.

5-fluorouracil (5-FU) has remained the treatment of choice in the adjuvant and palliative setting of colon cancer (CC).The purpose of this study was to evaluate the expression of the thymidine phosphorylase (TP), thymidylate synthase (TS) and dihydropyrimidine dehydrogenase (DPYD)in CC patients treated with 5-fluorouracil (5-FU) to determine their predictive and prognostic significance. Immunohistochemistry (IHC) analysis of the expression of proteins was performed on tumour tissue of 104 patients with stage IV colon cancer. All patient was treated withfluoropyrimidine/antifolate-based therapy (FOLFOX, De Gramont, FOLFIRI). Usedmultivariate logistic regression analyses we found the level of expression of proteins thymidine phosphorylase (TP), thymidylate synthase (TS) as predictors efficiency 5 - fluoropyrimidine with adenocarcinoma of the colon. The value of expression of TP and TS has a statistically significant effect (p = 0,006 and p = 0.0036) on time to disease progression, respectively.Our data demonstrated the efficacy of the 5-fluoropyrimidine chemotherapy colon adenocarcinoma may be utilized evaluation of expression of TS and TP.

The article describes the review of literature risk factors for fibrocystic disease (FCD), the role and place of individual risk factors such as mammographic density and cyclic mastalgia. The evaluation of significant clinical symptoms as a risk factor for breast cancer (BC) was made. The modern possibilities of diagnostics of FCD are considered. The modern recommendations on medical tactics are given. The pathogenetic treatment of FCD aimed at preventing breast cancer is described; The use of a Progestogel® drug for the treatment of FCD and breast cancer prophylaxis.

Use of the method liquid-based cytology with next immunocytochemical study of endometrium is expedient for the differential diagnosis of endometrial pathology processes. The level of the gene PTEN and steroid receptors expression is higher in cases of simple hyperplasia and hyperplasia without atypia. Increase of the markers p53 and Ki67 expression was found only by atypical endometrial hyperplasia. Positive reaction on CD138 determines the inflammatory process.

The paper considers modern approaches to the study of the method of cytological changes of Dysplastic squamous epithelium of the cervix, definition of pathogenetic treatment with the aim of preventing invasive cervical cancer: reducing morbidity and mortality