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Recommendations of the Polish Gynecological Oncology Society for the diagnosis and treatment of endometrial cancer

Recommendations of the Polish Gynecological Oncology Society for the diagnosis and treatment of vulvar cancer

Recommendations of the Polish Gynecological Oncology Society for the diagnosis and treatment of ovarian cancer

Recommendations of the Polish Gynecological Oncology Society for the diagnosis and treatment of cervical cancer

Wprowadzenie w latach 80. ubiegłego stulecia ablacji jako nowej techniki leczenia zachowawczego krwawień macicznych spowodowanych nieprawidłowym rozrostem endometrium znacząco ograniczyło odsetek histerektomii wykonywanych z tego powodu. Metoda ta zyskuje coraz więcej zwolenników. Ablacja endometrium przy użyciu histeroskopii dotyczy trzech sposobów usuwania endometrium, które są określane jako techniki pierwszej generacji. Są to: przezszyjkowa resekcja endometrium, destrukcja endometrium elektrodą obrotową i destrukcja endometrium przy użyciu lasera. W oparciu o materiał własny histeroskopowej ablacji endometrium, obejmujący 876 przypadków histeroskopowej resekcji endometrium i 51 przypadków destrukcji endometrium przy użyciu elektrody obrotowej, przedstawiono doświadczenia i obserwacje oraz skuteczność tych zabiegów. W latach 90. ubiegłego stulecia zaczęto wprowadzać metody wykorzystujące różne rodzaje energii do destrukcji endometrium, określane jako techniki ablacji drugiej generacji. Są to: termiczne balony śródmaciczne (system therma choice), metoda wodno-termiczna (system hydroterm), wieloelektrodowy system balonowy, metoda mikrofalowa, krioablacja endometrium oraz endometrialna wewnątrzmaciczna terapia laserowa. Warunkiem stosowania tych metod jest wykluczenie atypii endometrium i możliwość następowej kontroli lekarskiej. Najbardziej powszechną metodą ablacji endometrium drugiej generacji jest system therma choice. Mimo że najskuteczniejszą metodą jest histeroskopowa resekcja endometrium, to jednak techniki destrukcyjne są łatwiejsze do wykonania, mniej inwazyjne i powodują mniejszą liczbę powikłań. Introduction of the ablation, in the 1980s, as a new technique of conservative management of metrorrhagia due to endometrial hyperplasia has significantly decreased the percentage of hysterectomies and is gaining more attention. Endometrial ablation with the use of hysteroscopy refers to three methods of endometrial removal, which are defined as the first generation techniques. This group comprises transcervical endometrial resection, endometrial destruction with the revolving electrode and the laser endometrial destruction. Based on our own hysteroscopic endometrial ablation material, which comprises 876 cases of hysteroscopic endometrial resection and 51 cases of endometrial destruction by the revolving electrode, our observations, experience and the efficacy of these procedures have been discussed. In the 1990s new methods using different types of energy for endometrial destruction, known as the second generation techniques, were introduced. This group consists of thermal intracavitary balloons (ThermaChoice System), hydro-thermic method (Hydrotherm System), multielectrode balloon system, microwave method, endometrial cryoablation and endometrial intrauterine laser therapy. These methods may be used provided that endometrial atypia had been excluded and a regular follow-up is possible. The most common method of endometrial ablation is one of the second generation techniques: ThermaChoice System. Although hysteroscopic endometrial resection is the most efficient method, the destructive methods are less invasive, easier to perform and involve fewer complications.

Objective: The aim of the study was to identify barriers in help seeking behaviors among women with urinary incontinence UI. Materials and methods: The study was performed using the method of diagnostic enquiry by means of questionnaireand interview among two groups of patients. The first group of women aged 47-79 years consisted of 80 members of the Association of People with Urinary Incontinence „Uroconti”. The second group included 61 females aged 26-81 years admitted to the Urodynamic Laboratory of Gynecology and Oncology Clinic at the University Hospital in Krakow. Results: Patients with stress urinary incontinence (SUI) reported to the doctor on average after 4 years, patients with urgency urinary incontinence (UUI), after 3 years, patients with a mixed form of urinary incontinence (MUI), after 6 years, and with overflow incontinence, after 10 years from the appearance of first symptoms. Anxiety, shame, the conviction that symptoms of UI are a normal age related state, as well as the conviction that the symptoms are temporary, significantly affected the delay in seeking medical consultation. Most of the surveyed women made the decision to undertake treatment themselves, and their main motive was the escalation of symptoms. The majority (89.4%) of women surveyed alleviated the symptoms of urinary incontinence without the help of a doctor, sometimes using methods detrimental to their health. Conclusion: The identification of help seeking barriers and reaching out to risk groups is essential for early diagnose and effective treatment of women with urinary incontinence.

Knowledge of differences in human papillomavirus (HPV)-type prevalence between high-grade cervical intraepithelial neoplasia (HG-CIN) and invasive cervical cancer (ICC) is crucial for understanding the natural history of HPV-infected cervical lesions and the potential impact of HPV vaccination on cervical cancer prevention. More than 6,000 women diagnosed with HG-CIN or ICC from 17 European countries were enrolled in two parallel cross-sectional studies (108288/108290). Centralised histopathology review and standardised HPV-DNA typing were applied to formalin-fixed paraffin-embedded cervical specimens dated 20012008. The pooled prevalence of individual HPV types was estimated using meta-analytic methods. A total of 3,103 women were diagnosed with HG-CIN and a total of 3,162 with ICC (median ages: 34 and 49 years, respectively), of which 98.5 and 91.8% were HPV-positive, respectively. The most common HPV types in women with HG-CIN were HPV16/33/31 (59.9/10.5/9.0%) and in ICC were HPV16/18/45 (63.3/15.2/5.3%). In squamous cell carcinomas, HPV16/18/33 were most frequent (66.2/10.8/5.3%), and in adenocarcinomas, HPV16/18/45 (54.2/40.4/8.3%). The prevalence of HPV16/18/45 was 1.1/3.5/2.5 times higher in ICC than in HG-CIN. The difference in age at diagnosis between CIN3 and squamous cervical cancer for HPV18 (9 years) was significantly less compared to HPV31/33/other (23/20/17 years), and for HPV45 (1 year) than HPV16/31/33/other (15/23/20/17 years). In Europe, HPV16 predominates in both HG-CIN and ICC, whereas HPV18/45 are associated with a low median age of ICC. HPV18/45 are more frequent in ICC than HG-CIN and associated with a high median age of HG-CIN, with a narrow age interval between HG-CIN and ICC detection. These findings support the need for primary prevention of HPV16/18/45-related cervical lesions.

BACKGROUND: The initial draining lymph node for a primary tumor is referred to as the “sentinel” node. Firstly adopted in the management of patients with cutaneous melanoma and breast cancer, it is now widely tested in cervical cancer. In patients with cervical cancer, lymph node status is the most important prognostic factor for survival. In patients with cervical cancer FIGO stage I and II pelvic lymph node metastases are expected in 0–16 and 24.5-31% and para-aortic lymph node metastases are expected in 0–22 and 11–19% of patients. The removal of pelvic and para-aortic lymph nodes is essential for assessing the biology of the disease. Lymphoscintigraphy enables the visualisation of lymphatic drainage patterns from a great variety of tumour sites prior to surgery. Therefore, the current procedure is to perform the pre-operative mapping of sentinel nodes by static and/or dynamic lymphoscintigraphy, followed by in vivo identification using a gamma detection probe and selective surgical resection. MATERIAL AND METHODS: Between 2001–2003, 37 patients with cervical cancer FIGO stage I-IIa were seemed to be qualified to undergo lymphoscintigraphy. The day before surgery 99mTc-nanocolloid (100 MBq; 0.5–1.0 ml in volume) was applied in each quadrant of the cervix or around the tumor. The static scintigraphic scans were performed after 2 hours p.i. using a dual-head large-field-of-view Siemens gamma-camera equipped with high resolution collimators. SNs were identified intra-operatively using a handheld gamma detection probe (Navigator GPS-Tyco) and intra-operative lymphatic mapping with blue dye. After a resection of the SNs, a standard radical hysterectomy with pelvic and low para-aortic lymph node dissection was performed. Tumor characteristics were compared with sentinel node detection and with the histopathological and immunohistochemical results. RESULTS: The scintigraphy showed a focal uptake in 35 of the 37 patients. In all women one or more sentinel lymph nodes were identified intra-operatively. Of them, 24 patients had those located bilaterally. Histologically positive SNs were found in 5 women (13.5%). CONCLUSIONS: A combination pre-operatively administered radioactively labelled albumin with blue dye allows the successful detection of SN in patient with cervical cancer. This technique will result in a real advance in the less aggressive management of patients with early stage cervical cancer. Sentinel lymph node status may be representative of the pelvic lymph nodes status in cervical cancer and thus could provide important information for further treatment.