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The conducted analysis for the place and the role of the oncological principles in the gynecological practice shows, that the implementation of the united oncological doctrine has as a task to provide the necessary quality of diagnostics, treatment and follow-up for these localisations. This doctrine is necessary to be valid for the all levels of health system, while the precondition for her realization appears the standards for the good medical practice and the fulfillment of the requirements of the National health insurance company for the relevant clinical pathways.

In the presented methodical scheme, consecutively and systematically are scrutinised the epidemiology, the risk factors, the etiopathogenesis, the histopathology and the clinical signs of the endometrial cancer. The diagnostic possibilities, as well as the staging principles are pointed. The current treatment tactics, therapeutic schemes according to the stage and follow-up corresponding to the requirements of the oncological doctrine are presented.

We tried to evaluate the treatment of borderline ovarian tumours for the period of 1987 till 1999. We analyzed 62 cases as the age varied from 16 till 82 years of age, median 51.2. To most of them was performed surgical treatment, and to some of them immediately second look operation. In 38% of the women under 35 years of age there were, recurrences, as for the all group of border line tumours it was 19% recurrences. The recurrences appeared lately usually after the fifth year. We examined the time of operation, the stage, the histological type, the number of pregnancies, number of recurrences, and the disease free interval. The results showed that the conservative surgery in young women leads to high niveau of pregnancies, and also high level of recurrences. The young patients with unilateral disease stage IA were treated with conservative surgery, with intraoperative staging, without adjuvant chemotherapy. The menopausal women were treated as malignant tumours/Total hysterectomy bilateral salpingo-oophorectomy, omentectomy and appendectomy/ We show the need of active follow up of the treated women especially the young ones who are treated conservatively.

Six cases of primary treated endometrial cancer are included in this research work. Five of these women ended with tumour regression and 2 with pregnancies and deliveries of children. All of the women are still alive without having disease with mean follow-up period of 36.5 months (from 16 to 80 months). We consider that this is very promising method of treatment to offer y conservative treatment with high level of survival and possibility for having y child. Diagnostic and therapeutic data for the patients who are with early endometrial cancer and wish to have y child are analyised in this study. Four of the women were treated with GnRh-analogs-Zoladex and 2 with progestins-high doses.

In our study we present the cases with vaginal cancer treated in the gynaecological clinic of the National Oncological Centre in Sofia for the period from 1989 till 1998. Most of the women were with squamous cell carcinoma of the vagina. Twenty seven patients were examined--19 of them were operated, 18 patients received radiotherapy and 2 chemotherapy. The tumors that were localized in the upper 2/3 of the vagina were operated by radical hysterectomy a modo Wertheim-Meigs and extirpation of the vagina. When the tumor was localized in the lower third of the vagina we performed additionally radical vulvectomy and bilateral inguinofemoral lymph-node dissection. For more advanced cancers we did exenteration anterior and posterior. When there was no possibility for surgical approach or for radiotherapy we did chemotherapy with 5-Fu, methotrexate, cyclophosphamide and vincristin. The prognosis for the vaginal cancers is not good, in 25-30% of the patients survive 5 years. As a whole we assess that we are having the same results, as well as survival rate like other western clinics.

From 1987 till 1997 110 patients with stage-I ovarian malignant tumors were treated and follow-up at the Department of Gynaecological Oncology, National Oncological Center. Papillifery-adenocarcinoma were in 40 cases, serous carcinoma were in 26 cases, mucinous carcinoma were in 15 cases, malignant granulosa cell tumor were in 14 cases, endometrioid carcinoma were in 6 cases, dysgerminoma were in 6 cases, Teilum's tumour were in 2 cases, and 1 case of ovary sarcoma were detected. Radical operated on the first operation were 69 patients (62.8%), and in 37 cases (33.6%) second operation for radicality were performed. In 4 cases only adnexectomy were done. In all cases post operative adjuvant chemotherapy were used. The patients were follow-up by tumour markers, sonography and CT. Follow-up period is from 5 months till 11 years. Alive were 80 patients (73%), and 30 patients (27%) were died. The patients with stage Ic and those nonradical operated in the first operation have worst prognosis then patients with stage Ia and stage Ib. The patients with ovarian tumours must be operated only in the hospitals with possibility of urgent hystological diagnosis for better prognosis in the cases of stage-I malignant ovarian tumours.

The aim of our research work was to assess the transvaginal ultrasonography for measurement of endometrial thickness in women with postmenopausal bleeding, and in this way to determine the less invasive treatment. We wanted to make a grading of endometrial cancer, in order to choose patients who need pelvic and para-aortal lymph dissection. We examined 84 patients by ultrasonography and histological examination of the endometrium. Under 8 mm thickness were not found precancer and cancer lesions. The mean endometrial thickness was 8.25c1.63 mm, while in non pathological lesions was 1.36c1.10 mm. In order to diagnose endometrial pathology we determined border of 5 mm. Over 5 mm the ultrasonography has a 88.6% sensitivity, 90.6% specificity, 4.6% false negatives results--3 polyps, 1 glandular hyperplasia. Nevertheless that we determined border of 5 mm under which with great possibility there is no endometrial cancer, we don't support authors who advise not make a D&C. Future examinations in this field will give more light on this problem.

An attempt was made to examine and compare the abilities of the cytological method, the progesterone test and the uterus sonography for early finding and screening of endometrial cancer in postmenopausal women. There were studied three groups of patients, each group of them consisted of 900 women, for the period of 10 years. The uterus sonography and progesterone test showed the best results. The cytological smears method was found not suitable for screening programme.

An attempt was made to examine the efficiency of the progesterone test and uterus sonography for ten-years period. The progesterone test was used for 621 patients, most of them from the University Obstetrics and Gynaecological Hospital in the town of Varna. Department of Obstetrics and Gynaecology as well as at the National Oncological Centre, Gynaecological Clinic--Sofia during the last few years. There have been found out deep knowledge in epidemiology, etiology and the present possibilities for early diagnostics of the endometrial cancer. All patients of a total number of 621 were in the postmenopausal period and received Progesterone as one-time medical administration. In 44 women bleeding occurred, and 31 of them agreed to undergo abrasio probatoria. 354 out of these 621 patients were examined by ultrasound B-picture after about 6 months to 1 year. 31 cases needed to be cleared-out additionally. The abrasio probatoria done later showed full correspondence to the ultrasound images with the exception of 6 cases. In 15 cases was found polyps endometrial, in 9 cases--atypical glandular hyperplasia, in one case--carcinoma in situ and in 6 cases--early endometrial cancer.

A review on the operative methods for prophylaxis of urological complications (fistulas and strictures) due to radical hysterectomy with systemic dissection of lymph nodes is described. The authors recommend the method of T. H. Green as the most effective method. A new method for protection of the ureter with flaps, formed as a "leg" from omentum majus, is proposed. The modification has been used in 20 patients without postoperative complications. The method is recommended in cases, when postoperative stenosis or strictures of the ureters are expected as well as when postoperative irradiation is forthcoming.

The study was carried out on 106 women with carcinoma of the uterine cervix at the first clinical stage, treated with the operation according to Wertheim (as single treatment and combined with gamma teletherapy of the whole pelvis--preoperative and postoperative). Survival and prognostic value of the examined factors were evaluated by Kaplan-Meier. The five-year survival of the whole population was 85.80%. The prognostic significance of tumourous volume was established: 95.78% of women with initial tumourous lesion survived five years, but 75.30% of women with advanced lesion survived. Pretherapeutic values of erythrocyte sedimentation rate had also prognostic significance--accelerates sedimentation rate was connected with lower survival. However, it was established that accelerated sedimentation rate was connected with larger tumourous volume, therefore its prognostic significance was indirect. Prognostic value with borderline statistical significance showed pretherapeutic value of hemoglobin and the season of operation. Low hemoglobin and spring-summer season of the operation indicated a tendency to a lower survival. Leucocytosis, blood grouping of the patients, time duration of the operation, etc. had no significant effect on the five-year survival.

The authors analysed the results of 225 women with carcinoma of the uterine cervix, treated at the gynecological clinic of the National Oncological Center for a 10-year period. The mean age was 36.7 years. No complaints were found in 206 patients. Cytological Pap 3-5 was established in 221 women. Conformity between histological examination after a colposcopic-directed biopsy, conization or total hysterectomy was found in 117 patients (53.18%). Carcinoma was discovered at 0 degree in 34 patients (11.44%) only just after conization, but in 69 women the tumour was removed during a colposcopic-directed biopsy and was not found in the operation material. Treatment of 217 women was conization, of 3 women--classical total hysterectomy and of 5 patients--intracavitary brachytherapy. In 7 patients the tumour was not removed till healthy tissue, which caused reconization in one woman and total hysterectomy in 6 patients. A relapse of the disease was found in 9 patients up to 2 years after conization (6 cases with carcinoma in situ, 3--with microinvasive carcinoma). Total hysterectomy was performed in all patients. Possibility for discovery of a relapse in the form of invasive carcinoma is ruled out during systemic and continuous observation. It is possible to perform reconization in women with persistent carcinoma in situ in view of preserving their generative function.

Three women with malignant melanocarcinoma of the vulva and one woman with malignant melanocarcinoma of the vagina were treated at the gynecological clinic of the National Oncological Center for the period of 1983-1988. The mean age of the patients was 52 years. In all patients melanocarcinoma was IV-V degree according to Crark as in 2 women it was pigmented, but in 2 women--achromatic. Radical vulvectomy was performed on patients with melanocarcinoma of the vulva as in 2 patients inguino-femoral lymph dissection according to Ducuing was made, but pelvic lymph dissection according to Taussing was performed in 1 woman as well. The operation of Werthaim-Meigs and extirpation of the vagina was performed in the woman with melanocarcinoma of the vagina. Two of the patients died after 13 and 28 months after the primary treatment due to generalization of the process, but 2 of the patients developed a relapse of the disease 10 and 14 months after treatment. Anterior and posterior exenteration of the pelvis was performed in the woman with a relapse of the vaginal melanocarcinoma. Two patients are still alive for a period of 6 and 8 months and chemotherapy continues. A literary review is presented and possibilities for more effective treatment are discussed.