Management of endometrial cancer with suspected cervical involvement

Article Abstract:

Endometrial cancer is cancer of the endometrial cells lining the inside of the uterus. In some cases, the cervix, which is the neck of the uterus, may also be involved. The stage of the disease is determined by assessing the depth of cancer invasion into the lining of the uterus and the sites to which the cancer has spread, or metastasized. Women with endometrial cancer and cervical involvement, which is considered to be stage II disease, are often treated with radiation therapy followed by total abdominal hysterectomy and removal of the ovaries. However, radiation therapy used before surgery has a tendency to distort tissue. This complicates disease staging, obscures variables used to determine the disease prognosis, and limits subsequent application of radiation therapy. The new staging system adopted in 1989 requires that the stage be determined based on operative (surgical) assessment, and not before. The effectiveness of an initial operation before specifying disease staging was assessed in 70 women with endometrial cancer and suspected cervical involvement. The patients were treated with initial hysterectomy and in some cases lymph node removal, followed by tailored radiation and/or chemotherapy. Surgery confirmed the presence of stage II disease in only 37 percent of the patients. Cancer therapy following surgery depended on how much of the cervix was involved, how deeply the cancer had invaded the layers of the uterus, the cancer cell type, the tumor grade, and the amount of cancer spread. The risk status was evaluated for each patient using these factors. The 21 patients considered at low risk for cancer recurrence did not receive any postoperative therapy; they had a five-year survival rate of 90 percent. There were 38 patients who were considered at high risk for cancer recurrence who received postoperative pelvic radiation therapy; they had a 65 percent five-year survival. The 11 patients at very high risk received chemotherapy and extended radiation therapy; there were no women in this group who survived for five years. Initial surgery can define the extent of uterine, cervical and metastatic involvement in patients with endometrial cancer and suspected cervical involvement. This allows accurate disease staging and is useful in deciding which patients would benefit from radiation therapy; specifically, radiation can be avoided in patients whose cancer is less extensive than predicted from preoperative examinations. (Consumer Summary produced by Reliance Medical Information, Inc.)

Care and treatment, Methods, Surgery, Cervical cancer, Endometrial cancer, Cancer invasiveness, Tumor staging, Cancer staging, Uterus

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CA 125 regression: a model for epithelial ovarian cancer response

Article Abstract:

Cancer of the ovary ranks fourth as a cause of death among women in the US. Surgical removal of the tumor and treatment with the anticancer agent cisplatin have increased the survival time of women with ovarian cancer. CA 125 is a substance released by the epithelial form of ovarian cancer and can be used to assess the progression of disease and response to treatment. Increased levels of CA 125 suggest progression of the cancer or lack of response to chemotherapy. However, in most cases, the effectiveness of chemotherapy is assessed by surgery, in which the abdomen is examined for any residual cancer cells following treatment. Measurement of CA 125 levels before repeat surgery is not very effective in predicting disease progression in advanced cases of epithelial ovarian cancer. However, CA 125 levels may be useful in evaluating the initial response of tumor cells to chemotherapy and to compare the effectiveness of different drug regimens. A model was developed in which CA 125 levels decline with decreasing numbers of tumor cells. The average time for initial CA 125 levels to decrease by 50 percent following surgery to remove the tumor was 10.4 days. It was predicted that the response of tumor cells to drug therapy was greater with high doses of cisplatin compared with lower doses. This initial response of tumor cells as indicated by CA 125 may be used to predict the outcome of repeat surgery and overall survival. (Consumer Summary produced by Reliance Medical Information, Inc.)

Measurement, Development and progression, Ovarian cancer, Chemotherapy, Tumor markers

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Primary invasive carcinoma of the vagina

Article Abstract:

In the past, survival from cancer originating in the vagina was poor, but improved treatment has led to better prognoses. To further improve prevention and treatment of this disease, 53 women with carcinoma of the vagina were evaluated. Their average age was 64 years. No particular risk factors, such as pessary use, uterine prolapse, or number of pregnancies, were identified. Patients who were diagnosed with vaginal cancer during routine examination, before symptom development, survived longer. Two-year survival, corrected for other diseases, was 69 percent. Patients who had undergone previous hysterectomy tended to be diagnosed after symptoms of vaginal cancer developed. These symptoms included vaginal bleeding, unusual vaginal discharge, and pelvic pain. A total of 70 percent of patients were treated with radiation, while 26 percent were treated with surgery with or without radiation. Thirty-four percent of patients required hospitalization for complications such as intestinal obstruction or abscess, and of 10 patients who required surgery for these complications, 9 had been treated with radiation, which probably led to the development of adhesions. These findings suggest that women of all ages, including those who have had hysterectomies, should continue to have annual gynecologic examinations to screen for cancer. (Consumer Summary produced by Reliance Medical Information, Inc.)

Health aspects, Standards, Women, Prognosis, Diseases, Medical screening, Health screening, Gynecologic examination, Vaginal cancer

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