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Gestational trophoblastic disease belongs to a spectrum of rare tumors originating from trophoblast. It spreads from the benignant disease uncomplicated partial mole to the most malignant choriocarcinoma in stage IV of disease with brain metastases. Fortunately, with adequate chemotherapy even patients in advanced stage of the disease have significant chances to be cured. In estimating prognosis and adequate therapy of disease, the most significant are clinical factors: serum hCG level, duration of the disease from termination of antecedent pregnancy, prior chemotherapy, brain or liver metastases. hCG is an ideal tumor marker for follow up and early diagnosis of recidivism and metastases. In the Institute of Oncology in Sremska Kamenica 32 patients with gestational trophoblastic disease were treated in the period from 1987 to 2001. All the patients with non-metastatic disease and low risk metastatic disease (stage I-III FIGO) were successfully cured. Five patients died, all in stage IV of the disease (FIGO) with liver and brain metastases; in 4 of them disease occurred after term pregnancy. Overall survival was 85%. Treatment of non-metastatic and low risk metastatic disease was successful in all cases. Treatment failures occurred in advanced disease with brain and liver metastasis Specificity and low incidence of this disease ask for the treatment to be carried out in specialized centers, as it is in developed countries (Trophoblastic Disease Centers).

BACKGROUND: Superficially invasive neoplasias of the uterine cervix are a matter of controversy in terms of their definition, prognostic factors and selection of treatment to minimize the risk of recurrences. METHODS: Forty-three women with invasive cervical carcinoma, operated from 1993 to 2003, were postoperatively staged as IA cervical carcinoma. There were 28 patients who were submitted to class III radical hysterectomy, 9 patients to class II hysterectomy, 2 patients to class I hysterectomy, and 2 patients to abdominal trachelectomy and pelvic lymph node dissection. Mean age of patients was 44 years (range, 27-64 years). RESULTS: Twenty-three patients (56.1%) were stage with IA1 and 18 (43.9%) with stage IA2 disease according to the 1995 FIGO classification. Tumor histology revealed squamous cell carcinoma in 38 (92.6%) cases, adenocarcinoma in 2 (4.8%) cases and glassy cell carcinoma in 1 (2.4%). The average number of examined lymph nodes was 17.4 (2-53). Lymphovascular space invasion was identified in 3 patients. None of the 41 patients had metastasis to the pelvic lymph nodes or developed recurrence of disease. CONCLUSION: The results suggest that patients with cervical cancer stage IA1 have an extremely low risk of pelvic lymph node metastasis and an excellent prognosis, so nonradical management that excludes pelvic lymph node dissection could be as effective as radical surgery in these patients. Stage IA2 invasive squamous carcinoma of the cervix should be treated with radical hysterectomy with lymph node dissection considering the presence of risk factors. The treatment should be individualized and based on an exhaustive pathological evaluation of an adequate cone biopsy specimen.

Borderline ovarian tumors are classified between benign cystadenoma and malignant cystadenocarcinoma. They are characterized as malignant tumors by histopathological features, which make them different from the benign ones. These tumors are commonly diagnosed at the early disease stage. The treatment of these tumors is surgical. The prognosis depends on the stage of disease and histopahtological types. We present 10 patients operated at the Institute of Oncology Sremska Kamenica because of malignant tumors with low malignant oncogenic potential in the period between 2000 and 2005. All patients had surgical treatment with ex tempore diagnostics, hysterectomy and adnexectomy with total omentectomy, or unilaterals adnexectomy. All patients had negative cytoanalytic findings of the small pelvis. Histopathological findings are necessary to confirm the diagnosis of disease. In young patients who had no children fertility can be preserved.

Primary uterine cervical non-Hodgkin's lymphomas (NHL) are rare. Limited experience dictates careful pretherapy evaluation and multidisciplinary approach in treatment planning. A 53-year-old woman presented with postmenopausal bleeding and PAP smear IIIb. Cervical biopsy and endocervical curettage biopsy revealed NHL of the uterine cervix. Abdominal hysterectomy with bilateral adnexectomy was followed by pelvic lymphadenectomy due to lymph node metastasis, 21 months after the primary operation. Subsequently, the patient received postoperative chemotherapy. Seven years after the onset of NHL she is alive with no evidence of disease recurrence.

Objective: Despite the considerable disease burden of ovarian cancer, there were no cost studies in Central and Eastern Europe. This study aimed to describe treatment patterns, health care utilization, and costs associated with treating ovarian cancer in Hungary, Poland, Serbia, and Slovakia., Method: Overall clinical practice for management of epithelial ovarian cancer was investigated through a 3-round Delphi panel. Experts completed a survey based on the chart review (n = 1542). The survey was developed based on clinical guidelines and the International Federation of Gynecology and Obstetrics Annual Report. Means, ranges, and outlier values were discussed with the experts during a telephone interview. Finally, consensus estimates were obtained in face-to-face workshops. Based on these results, overall cost of ovarian cancer was estimated using a Markov model., Results: The patients included in the chart review were followed up from presurgical diagnosis and in each phase of treatment, that is, surgical staging and primary surgery, chemotherapy and chemotherapy monitoring, follow-up, and palliative care. The 5-year overall cost per patient was €14,100 to €16,300 in Hungary, €14,600 to €15,800 in Poland, €7600 to €8100 in Serbia, and €12,400 to €14,500 in Slovakia. The main components were chemotherapy-associated costs (68%-74% of the total cost), followed by cost of primary treatment with surgery (15%-21%) and palliative care (3%-10%)., Conclusions: Patients with ovarian cancer consume considerable health care resources and incur substantial costs in Central and Eastern Europe. These findings may prove useful for clinicians and decision makers in understanding the economic implications of managing ovarian cancer in Central and Eastern Europe and the need for innovative therapies.

Purpose: To compare the presurgically determined FIGO (Federation International Gynaecology Obstetrics) stage of endometrial cancer based on ultrasound (US) and magnetic resonance imaging (MRI) with the surgico-pathological disease stage., Methods: 60 patients with histopathologically proven endometrial cancer were prospectively studied. Prior to surgical treatment, all patients underwent abdominal US and MRI. The imaging results were compared with the surgical histopathological findings., Results: Imaging (US, MRI) staging accuracy for stage I identification was higher than the accuracy of advanced FIGO stages of endometrial cancer. Total accuracy of determination of all disease stages was significantly higher using MRI., Conclusion: US is not adequate for overall presurgical FIGO stage assessment, but does have satisfactory accuracy in determining tumor spread in the uterus itself and can be applied when MRI scanner is not available and when the risk of extrauterine disease expansion is low. MRI examination should be applied in all cases when there is suspicion for extrauterine spread into other pelvic and abdominal organs.

Purpose: Cervical cancer is the leading cause of death in women with gynecological cancers in Vojvodina. Serbia currently holds the leading place in Europe regarding the incidence of cervical carcinoma and comes second in terms of mortality., Methods: Data were retrieved from the Register for malignant neoplasms of the Institute of Oncology Vojvodina for the period 2001-2007. The patients were divided in 3 groups according to the stage of disease based on the FIGO classification for cervical cancer. Data were analysed using linear trend and t-test., Results: The linear trend of the number of registered cases in the group of stage I-IIA patients during 7 years showed no significant change in the prevalence of the disease. In the group of women diagnosed with stage IIB no statistical difference regarding either a rising or a decreasing trend was observed. The observed trend in an advanced disease stage (III and IV) showed a slight decrease in the number of patients, but without statistical significance., Conclusion: The linear trend of the number of patients with cervical carcinoma during a 7-year period points to the fact that the number of newly detected cases of advanced disease stages did not decrease significantly despite the affordable and simple methods of early detection. This result underlines the importance of implementation of a National screening programme in the general population for early detection of cervical neoplasms. The excellent results of National screening programmes in other European countries lend support to this approach.

Treating pregnant patients with a verified malignant disease represents a great clinical problem. Pregnancy-associated invasive cervical cancer is usually diagnosed at an early stage (approximately 70%). A 27-year-old patient was given the diagnosis of a pathohistologically verified cervical carcinoma, International Federation of Gynecology and Obstetrics stage IB1, in the 17th gestational week (GW). A radical abdominal trachelectomy was performed in the 19th GW. The patient was undergoing regular examinations at our institute of oncology while the Clinic of Gynecology and Obstetrics in Novi Sad, Serbia, monitored the pregnancy. In 36th GW, the patient had a cesarean section, with no visible traces of relapse, with good postoperative recovery and normal results in the newborn. The patient was discharged on the fifth postoperative day and advised to have her condition monitored at our institute of oncology. One year after radical trachelectomy, the patient is in the 15th GW of a new pregnancy with a normal Papanicolaou smear result.