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Gynacological Cancers

Gynaecological cancers are a group of different malignancies of the female reproductive system. The most common types of gynaecologic malignancies are cervical cancer, ovarian cancer, and endometrial (uterus) cancer. There are other less common gynaecological malignancies including cancer of the vagina, cancer of the vulva, gestational trophoblastic tumours, and fallopian tube cancer. Occasionally skin cancers or sarcomas can also be found in the female genitalia. Generally, most gynaecological cancers are found in women aged over 50, though the incidence rates for younger women have been rising.

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Cervical Cancer
Endometrial (Uterus) Cancer
Fallopian Tube Cancer
Gestational Trophoblastic Cancer
Ovarian Cancer
Vaginal Cancer
Vulva Cancer
Uterine Sarcoma
Gynecologic Oncology (specialty)
General Gynacological Cancer Resources
Latest Research Publications

General Gynacological Cancer Resources (15 links)

Latest Research Publications

This list of publications is regularly updated (Source: PubMed).

Botha MH, van der Merwe FH, Snyman LC, Dreyer G
The vaccine and cervical cancer screen (VACCS) project: acceptance of human papillomavirus vaccination in a school-based programme in two provinces of South Africa.
S Afr Med J. 2015; 105(1):40-3 [PubMed] Related Publications
BACKGROUND: The incidence of cervical cancer in South Africa (SA) remains high, and the current screening programme has had limited success. New approaches to prevention and screening tactics are needed.
OBJECTIVES: To investigate acceptance of school-based human papillomavirus (HPV) vaccination, as well as the information provided, methods of obtaining consent and assent, and completion rates achieved.
METHODS: Information on cervical cancer and HPV vaccination was provided to 19 primary schools in Western Cape and Gauteng provinces participating in the study. Girls with parental consent and child assent were vaccinated during school hours at their schools.
RESULTS: A total of 3 465 girls were invited to receive HPV vaccine, of whom 2 046 provided written parental consent as well as child assent. At least one dose of vaccine was delivered to 2 030 girls (99.2% of the consented cohort), while a total of 1 782 girls received all three doses. Sufficient vaccination was achieved in 91.6% of the vaccinated cohort. Of all invited girls, 56.9% in Gauteng and 50.7% in the Western Cape were sufficiently vaccinated.
CONCLUSION: This implementation project demonstrated that HPV vaccination is practical and safe in SA schools. Political and community acceptance was good, and positive attitudes towards vaccination were encountered. During the study, which mimicked a governmental vaccine roll-out programme, high completion rates were achieved in spite of several challenges encountered.

Silva-Meléndez PE, Escobar PF, Héctor Silva, et al.
Small cell carcinoma of the uterine cervix: a case report and literature review.
Bol Asoc Med P R. 2015 Jan-Mar; 107(1):55-7 [PubMed] Related Publications
Small cell carcinoma of the uterine cervix is a rare and aggressive extra-pulmonary variant of small cell tumors. This carcinoma of the cervix comprises less than 5% of all cervical carcinomas and is know to be highly undifferentiated. It is associated with a poor prognosis and characterized by premature distant nodal involvement. The survival rate at all stages ranges from 17% to 67%. We describe the case of a 41 year old female patient with a rare, and aggressive, clinical stage IB1 small cell neuroendocrine carcinoma of the cervix. The goal of this case report is to describe this rare pathology and contribute information to the scant available data.

Patch AM, Christie EL, Etemadmoghadam D, et al.
Whole-genome characterization of chemoresistant ovarian cancer.
Nature. 2015; 521(7553):489-94 [PubMed] Related Publications
Patients with high-grade serous ovarian cancer (HGSC) have experienced little improvement in overall survival, and standard treatment has not advanced beyond platinum-based combination chemotherapy, during the past 30 years. To understand the drivers of clinical phenotypes better, here we use whole-genome sequencing of tumour and germline DNA samples from 92 patients with primary refractory, resistant, sensitive and matched acquired resistant disease. We show that gene breakage commonly inactivates the tumour suppressors RB1, NF1, RAD51B and PTEN in HGSC, and contributes to acquired chemotherapy resistance. CCNE1 amplification was common in primary resistant and refractory disease. We observed several molecular events associated with acquired resistance, including multiple independent reversions of germline BRCA1 or BRCA2 mutations in individual patients, loss of BRCA1 promoter methylation, an alteration in molecular subtype, and recurrent promoter fusion associated with overexpression of the drug efflux pump MDR1.

Habek D, Akšamija A
Successful acupuncture treatment of uterine myoma.
Acta Clin Croat. 2014; 53(4):487-9 [PubMed] Related Publications
Our case report as the second one in the medical literature demonstrated successful outcome of acupuncture treatment of uterine myoma in terms of tumor size reduction and absence of hypermenorrhea and anemia with successful perinatal outcome with two healthy newborns after previous late miscarriage. Accordingly, acupuncture treatment can be used as an inexpensive, efficient and simple therapeutic option in the management of particular types of myoma.

Cărăuleanu A, Lupaşcu IA, Cărăuleanu DM, et al.
Clinico-epidemiological study of endometrial hyperplasia--a risk factor for the development of endometrial carcinoma?
Rev Med Chir Soc Med Nat Iasi. 2015 Jan-Mar; 119(1):154-61 [PubMed] Related Publications
AIM: Metaplasia is defined as a transformation of an adult epithelial or conjunctive cellular type into another adult cellular type. Endometrial hyperplasia and particularly complex atypical hyperplasia exposes to a high risk of development of the endometrial carcinoma, being considered a lesion precursory to the same. Endometrial hyperplasias are risk factors for the development of endometrial carcinoma and their prophylaxis implies their accurate diagnosis, taking into account that the adenocarcinomas diagnosed in an advanced stage, whose therapeutic context differs from the early stages, have a much lower chance of survival.
MATERIAL AND METHODS: Our study aimed at highlighting objective criteria in establishing the morphological diagnosis and in evaluating the prognostic elements. The studied batch included 875 patients with endometrial hyperplasia and 263 patients with endometrial adenocarcinoma, who were admitted between 2003 and 2007, and the histopathologic diagnosis was obtained by processing the hysterectomy pieces. The presence of this tumour was at its highest level half-way through the study, which was in 2005.
RESULTS: According to the study, there was a higher proportion of patients with endometrial carcinoma from the urban environment (58.2%) than the ones from the rural environment (only 41.8%). Depending on their age, most cases of endometrial adenocarcinoma were diagnosed in 53-year old patients, with an average age of 58.94 years. Our study, made of the two batches of endometrial adenocarcinomas, shows that between the endometrial and non-endometrial adenocarcinoma there are significant differences related to the patients' age, the morphological aspect of the carcinoma, the architectural degree, the nuclear degree of tumours and the invasion in the myometrium.
CONCLUSIONS: Our study proves that endometrial hyperplasia is a frequent diagnosis in peri- and postmenopausal patients and is frequently identified following investigations for an abnormal uterine bleeding. The age of patients with endometrial carcinoma is an important prognostic factor independent of other parameters. The difference between complex hyperplasia with no atypias and complex hyperplasia with atypias is important, because atypical complex hyperplasia is considered the precursor of endometrial adenocarcinoma.

Ilić MB, Jovanović DV, Milosavljević MZ, et al.
Hypercalcemic type of small cell carcinoma of the ovary.
Vojnosanit Pregl. 2015; 72(3):295-8 [PubMed] Related Publications
INTRODUCTION: Extrapulmonary small cell carcinoma is a rare, prognostically bad tumor category. Primary, it can be localized in every organ, even in the ovary, where, due to its clinical specificities, it represents a challenge in diagnosis, as well as in therapy. Small cell ovarian carcinoma (SCOC) is biologically very aggressive malignant tumor of unknown histogenesis. We presented a rare case of SCOC with hypercalcemia of aggressive course and fatal outcome in a postmenopausal woman at International Federation of Gynecology and Obstetrics (FIGO) Ia stage.
CASE REPORT: A 60-year-old woman, Caucasian, came to the doctor because of discomfort in the lower abdomen and pain of greater intensity in last few days. Ultrasound examination and CT scan of the abdomen confirmed the presence of large adnexal masses of cystic-solid appearance with the largest diameter of 13 cm, regular structure of the other gynecological organs, without verifying the existence of metastatic deposits. All the results of laboratory analysis gave normal values, except for calcium, which was elevated. Explorative laparotomy with complete hysterectomy, bilateral salpingo-oophorectomy, dissection of lymph nodes and omentectomy were conducted. Based on pathohistological analysis of the operative material, SCOC at FIGO Ia stage was diag- nosed. No complications were observed in a postsurgery period and after 10 days the patient was discharged in a good condition and with normal calcemia. The treatment was continued with concurrent radiotherapy and chemotherapy. However, in spite of overall treatment, the disease progressed, and the patient died of disseminated metastatic disease, 26 months after the diagnosis.
CONCLUSION: Small cell carcinoma localized in the ovary is generally a tumor category with bad prognosis depending on the stage of the disease.

Beaber EF, Kim JJ, Schapira MM, et al.
Unifying screening processes within the PROSPR consortium: a conceptual model for breast, cervical, and colorectal cancer screening.
J Natl Cancer Inst. 2015; 107(6):djv120 [PubMed] Related Publications
General frameworks of the cancer screening process are available, but none directly compare the process in detail across different organ sites. This limits the ability of medical and public health professionals to develop and evaluate coordinated screening programs that apply resources and population management strategies available for one cancer site to other sites. We present a trans-organ conceptual model that incorporates a single screening episode for breast, cervical, and colorectal cancers into a unified framework based on clinical guidelines and protocols; the model concepts could be expanded to other organ sites. The model covers four types of care in the screening process: risk assessment, detection, diagnosis, and treatment. Interfaces between different provider teams (eg, primary care and specialty care), including communication and transfer of responsibility, may occur when transitioning between types of care. Our model highlights across each organ site similarities and differences in steps, interfaces, and transitions in the screening process and documents the conclusion of a screening episode. This model was developed within the National Cancer Institute-funded consortium Population-based Research Optimizing Screening through Personalized Regimens (PROSPR). PROSPR aims to optimize the screening process for breast, cervical, and colorectal cancer and includes seven research centers and a statistical coordinating center. Given current health care reform initiatives in the United States, this conceptual model can facilitate the development of comprehensive quality metrics for cancer screening and promote trans-organ comparative cancer screening research. PROSPR findings will support the design of interventions that improve screening outcomes across multiple cancer sites.

Wang S, Sun H, Jia Y, et al.
Association of 42 SNPs with genetic risk for cervical cancer: an extensive meta-analysis.
BMC Med Genet. 2015; 16:25 [PubMed] Free Access to Full Article Related Publications
BACKGROUND: A large number of single nucleotide polymorphisms (SNPs) associated with cervical cancer have been identified through candidate gene association studies and genome-wide association studies (GWAs). However, some studies have yielded different results for the same SNP. To obtain a more comprehensive understanding, we performed a meta-analysis on previously published case-control studies involving the SNPs associated with cervical cancer.
METHODS: Electronic searches of PubMed and Embase were conducted for all publications about the association between gene polymorphisms and cervical cancer. One-hundred and sixty-seven association studies were included in our research. For each SNP, three models (the allele, dominant and recessive effect models) were adopted in the meta-analysis. For each model, the effect summary odds ratio (OR) and 95% CI were calculated. Heterogeneity between studies was evaluated by Cochran's Q test. If the p value of Q test was less than 0.01, a random effect model was used; otherwise, a fixed effect model was used.
RESULTS: The results of our meta-analysis showed that: (1) There were 8, 2 and 8 SNPs that were significantly associated with cervical cancer (P < 0.01) in the allele, dominant and recessive effect models, respectively. (2) rs1048943 (CYP1A1 A4889G) showed the strongest association with cervical cancer in the allele effect model (1.83[1.57, 2.13]); in addition, rs1048943 (CYP1A1 A4889G) had a very strong association in the dominant and recessive effect model. (3) 15, 11 and 10 SNPs had high heterogeneity (P < 0.01) in the three models, respectively. (4) There was no published bias for most of the SNPs according to Egger's test (P < 0.01) and Funnel plot analysis. For some SNPs, their association with cervical cancer was only tested in a few studies and, therefore, might have been subjected to published bias. More studies on these loci are required.
CONCLUSION: Our meta-analysis provides a comprehensive evaluation of cervical cancer association studies.

Chacko S
Effect of structured teaching programme on VIA test for early detection and diagnosis of cervical cancer.
Nurs J India. 2014 Sep-Oct; 105(5):221-4 [PubMed] Related Publications
The conceptual framework of the study, undertaken in select health centres of New Delhi, was based on General System Model. The research approach was evaluative with one group pre-test and post-test design. The study population comprised of Community Health Workers working in selected centres in Najafgarh, Delhi. Purposive sampling technique was used to select a sample of 30 Community Health Workers. A structured knowledge questionnaire was developed to assess the knowledge of subjects. A Structured Teaching Programme was developed to enhance the knowledge of Community Health Workers. Pre-test was given on day 1 and Structured Teaching Programme administered on same day. Post-test was conducted on day 7. Most of the Community Health Workers were in the age group of 21-30 years with academic qualification up to Higher Secondary level. Maximum Community Health Workers had professional qualification as ANM/MPHW (female). Majority of the Community Health Workers had experience up to 5 years. Initially there was deficit in scores of knowledge of Community Health Workers regarding Visual Inspection with Acetic Acid (VIA) test. Mean post-test knowledge scores of Community Health Workers were found to be signifi- cantly higher than their mean pre-test knowledge score. The Community Health Workers after expo- sure to Structured Teaching Programme gained a significant positive relationship between post-test knowledge scores. The study reveals the efficacy of Structured Teaching Programme in enhancing the knowledge of Community Health Workers regarding VIA test and a need for conducting a regular and well planned health teaching programme on VIA test for improving their knowledge on VIA test for the early detection and diagnosis of cervical cancer.

Jagielski L, Jelen M, Kobierzycki C, et al.
Increase of nuclear expression of metallothionein I/II in neoplastic transformation of the endomnetrium.
Ginekol Pol. 2015; 86(3):182-7 [PubMed] Related Publications
OBJECTIVES: The aim of our study was to investigate the expression of epidermal growth factor receptor (EGFR), metallothionein (MT) 1/11, and Ki-67 antigen in endometrial cancer We analyzed cytoplasmic (cMT) and nuclear (nMT) metallothionein fractions separately Moreover we evaluated the relationships between expressions of the above mentioned proteins and compared them with clinicopathologic data.
MATERIAL AND METHODS: The study material included paraffin-embedded endometrial cancer samples from 84 patients. The control group consisted of 52 non-neoplastic endometrium samples. Immunohistochemical reactions were performed using monoclonal antibodies against EGFR, MT 1/11 and Ki-67. Expression intensity of the tested proteins was assessed by computer image analysis software. Chi-square, Spearman's correlation, Mann-Whitney and Kruskal-Wallis tests were used for statistical analysis with Statistica 8.0 PL.
RESULTS: Strong expression of nMT was revealed in endometrial cancer cells in relation to benign hyperplasia (p<0.0017) and normal cells (p<0.001) of the endometrium. Statistically significant but weaker expressions in analogous relationships were observed for cMT Moreover higher grade of histological malignancy G was positively associated with increased expression of nMT (p=0.009).
CONCLUSIONS: Expression of nMT remains in distinct correlation with neoplastic transformation of the endometrium and histologic grades. Our results clearly indicate a need for further research on metallothionein expression in tumor cells.

Xia D
Ovarian cancer HO-8910 cell apoptosis induced by crocin in vitro.
Nat Prod Commun. 2015; 10(2):249-52 [PubMed] Related Publications
The effect and mechanism of ovarian cancer HO-8910 cell apoptosis induced by crocin.MTT assay was performed to detect the inhibitory action of crocin on the proliferation of HO-8910 cells. Flow cytometry was used to test the cell cycle distribution and apoptosis rate of ovarian cancer HO-8910 cells. Western blot analysis was utilized to measure the levels of apoptotic proteins such as p53, Fas/APO-1, and Caspase-3. MTT analysis revealed that crocin significantly inhibited the growth of HO-8910 cells. Additionally, flow cytometry illustrated that crocin raised the proportion of HO-8910 cells in the G0/G1 phase and increased their apoptosis rate. Furthermore, Western blot analysis revealed that crocin up-regulated the expression of p53, Fas/APO-1, and Caspase-3. The results of this study showed that crocin can significantly inhibit the growth of HO-8910 cells and arrest them in the G0/G1 phase. Crocin can also promote ovarian cancer HO-8910 cell apoptosis, most likely by increasing p53 and Fas/APO-1 expression, and then activating the apoptotic pathway regulated by Caspase-3.

Núñez-Troconis J, Viloria de Alvarado ME
Syringoma of vulva: an unusual presentation. Clinical, morphological and immunohistochemical aspects.
Invest Clin. 2015; 56(1):60-5 [PubMed] Related Publications
The case of a 34-year-old woman, who consulted because she observed the appearance of numerous yellow-white asymptomatic papules on the vulva, is presented. Clinical diagnosis of syringoma of vulva was established. The pathological and immunohistochemical studies confirmed the diagnosis. Vulvar syringoma usually occurs as a multiple flesh-colored or brownish papules on both sides of labia majora of women in their third decade. Its diagnosis should be considered when the patient complaints of vulvar pruritus and/or sweating.

Bacalbaşa N, Popescu I
Ovarian cancer liver metastases--should we apply the principle of optimal cytoreduction to the liver? A review.
Hepatogastroenterology. 2015 Mar-Apr; 62(138):355-7 [PubMed] Related Publications
Advanced stage ovarian cancer is a common situation at presentation and current medical practice lacks efficient methods of prevention and early diagnosis. Primary maximal cytoreductive surgery followed by adjuvant chemotherapy is currently a generally accepted principle; most patients however undergo recurrence and common therapeutical attitude is secondary cytoreduction based approximately on the same principles as the primary one. Due to the success of liver resections in colorectal metastases and the development of liver surgery in general, different centers worldwide analyzed in the last 20 years liver resections' utility for other primaries, including ovarian tumors.

Gao H, Zhang Z
Sequential chemotherapy and radiotherapy in the sandwich method for advanced endometrial cancer: a meta-analysis.
Medicine (Baltimore). 2015; 94(16):e672 [PubMed] Related Publications
Endometrial cancer is one of the most common gynecological malignancies and the standard treatment modality has not been established.To assess the efficacy and tolerability of a sandwich method consisted of chemotherapy followed by involved field irradiation and additional chemotherapy for the treatment of advanced endometrial cancer.The Medline, Embase, Cochrane, and China National Knowledge Infrastructure (CNKI) Library were searched to identify the relevant literature published between 1970 and September 2014. A meta-analysis was performed to evaluate progression-free survival (PFS), overall survival (OS), and toxicity.A total of 5 articles were subjected to this meta-analysis. The pooled 3-year PFS and OS of patients with advanced endometrial cancer treated with the "sandwich" method was 68% (95% CI: 0.60-0.77) with no heterogeneity (I = 0.00%, P = 0.77) among the studies and 75% (95% CI: 0.61-0.89) with significant heterogeneity (I = 71.8%, P = 0.01), respectively. Pooled analysis of toxicity was not performed because of the substantial heterogeneity.Sequential chemotherapy and radiotherapy in the sandwich method is both efficacious and well tolerated. Large-scale randomized controlled trials (RCTs) are necessary in the future.

Lin Y, Li H, Chen Z, et al.
Correlation of histogram analysis of apparent diffusion coefficient with uterine cervical pathologic finding.
AJR Am J Roentgenol. 2015; 204(5):1125-31 [PubMed] Related Publications
OBJECTIVE: The purpose of this study was to investigate the application of histogram analysis of apparent diffusion coefficient (ADC) in characterizing pathologic features of cervical cancer and benign cervical lesions.
SUBJECTS AND METHODS: This prospective study was approved by the institutional review board, and written informed consent was obtained. Seventy-three patients with cervical cancer (33-69 years old; 35 patients with International Federation of Gynecology and Obstetrics stage IB cervical cancer) and 38 patients (38-61 years old) with normal cervix or cervical benign lesions (control group) were enrolled. All patients underwent 3-T diffusion-weighted imaging (DWI) with b values of 0 and 800 s/mm(2). ADC values of the entire tumor in the patient group and the whole cervix volume in the control group were assessed. Mean ADC, median ADC, 25th and 75th percentiles of ADC, skewness, and kurtosis were calculated. Histogram parameters were compared between different pathologic features, as well as between stage IB cervical cancer and control groups.
RESULTS: Mean ADC, median ADC, and 25th percentile of ADC were significantly higher for adenocarcinoma (p = 0.021, 0.006, and 0.004, respectively), and skewness was significantly higher for squamous cell carcinoma (p = 0.011). Median ADC was statistically significantly higher for well or moderately differentiated tumors (p = 0.044), and skewness was statistically significantly higher for poorly differentiated tumors (p = 0.004). No statistically significant difference of ADC histogram was observed between lymphovascular space invasion subgroups. All histogram parameters differed significantly between stage IB cervical cancer and control groups (p < 0.05).
CONCLUSION: Distribution of ADCs characterized by histogram analysis may help to distinguish early-stage cervical cancer from normal cervix or cervical benign lesions and may be useful for evaluating the different pathologic features of cervical cancer.

Reynaers EA, Ezendam NP, Pijnenborg JM
Comparable outcome between endometrioid and non-endometrioid tumors in patients with early-stage high-grade endometrial cancer.
J Surg Oncol. 2015; 111(6):790-4 [PubMed] Related Publications
BACKGROUND: Approximately 25% of endometrial cancer patients present with high-grade tumors. Unlike the clearly defined work-up for non-endometrioid endometrial cancer, no consensus exists for surgical staging and adjuvant therapy in high-grade endometrioid endometrial cancer. We compared the recurrence rate and disease-related mortality (DRM) after treatment between endometrioid and non-endometrioid endometrial cancer.
METHODS: A total of 123 patients diagnosed with early-stage high-grade endometrial cancer at the Dutch Comprehensive Cancer Centre South (CCCS) between January 2005 and December 2011 were included. All patients underwent abdominal hysterectomy and bilateral salpingo-oophorectomy. Patient and tumor characteristics, primary and adjuvant treatment, and outcome were analyzed.
RESULTS: After a median follow-up of 27.9 months, 27.6% (n = 34) of patients had recurrent disease. Distant recurrence rate was equal among endometrioid (14.5%), papillary serous (14.8%), and clear cell (15.4%) types. The total DRM was 15.4% (n = 19). The 5 year recurrence-free survival was not significantly different between early-stage high-grade endometrioid versus non-endometrioid endometrial cancer (P = 0.72).
CONCLUSION: Distant recurrence and DRM was high in patients with endometrial cancer regardless of histological type, suggesting the need for different therapies in early-stage high-grade non-endometrioid and endometrioid tumors.

Frey MK, Lin JF, Stewart LE, et al.
Comparison of two minimally invasive approaches to endometrial cancer staging: a single-surgeon experience.
J Reprod Med. 2015 Mar-Apr; 60(3-4):127-34 [PubMed] Related Publications
OBJECTIVE: To compare the clinical outcomes of endometrial cancer staging procedures performed by a single surgeon utilizing traditional and robotic-assisted laparoscopic techniques.
STUDY DESIGN: A retrospective review of minimally invasive endometrial cancer staging performed by a single surgeon.
RESULTS: There were no significant differences in operative time, blood loss, surgical complications, or length of hospitalization between laparoscopic (n = 45) and robotic-assisted (n = 77) procedures. On multivariable analysis controlling for surgical chronology, robotic assistance was independently associated with a significantly greater number of lymph nodes (23 vs. 19, p < 0.05; beta 0.163, p < 0.05). When comparing the first chronologic half of robotic-assisted surgeries to the second half, the latter had shorter operative time (208 vs. 246 min, p = 0.01) and a greater number of lymph nodes (27 vs. 19, p = 0.001). Finally, compared to the laparoscopic cases, the second half of robotic-assisted cases had a greater number of total (27 vs. 19, p < 0.001) and pelvic (23 vs. 17, p < 0.001) lymph nodes harvested.
CONCLUSION: There was a learning curve associated with robotic-assisted laparoscopic endometrial cancer staging, with decreased operative time and increased lymph node yield over time. In our study population, robotic assistance was independently associated with a greater lymph node harvest with no increase in operative time or perioperative complications.

Androutsopoulos G, Adonakis G, Terzakis E, et al.
Endometrial cancer in a patient with rheumatoid arthritis.
Eur J Gynaecol Oncol. 2015; 36(1):91-3 [PubMed] Related Publications
BACKGROUND: Rheumatoid arthritis is a chronic, systemic, and autoimmune disease. In patients with rheumatoid arthritis, there is increased risk for site-specific malignancies. The authors present a case of endometrial cancer in a patient with rheumatoid arthritis and a review of the current literature.
CASE: The patient, a 60-year-old, postmenopausal Greek woman suffering from rheumatoid arthritis, presented with a complaint of abnormal uterine bleeding. She underwent total abdominal hysterectomy, bilateral salpingo-oophorectomy, and pelvic and para-aortic lymphadenectomy. Histopathology revealed endometrial cancer. The final diagnosis was Stage Ib endometrial cancer endometrioid type. She underwent postoperative adjuvant radiotherapy. She remains without evidence of disease, 16 months after initial surgery.
CONCLUSION: Although the present patient was diagnosed at early-stage disease and remains well 16 months after initial surgery, she needs a multidisciplinary treatment approach in order to achieve prolonged survival.

Lubin J, Pawałowska M, Markowska A, Bielas A
Small cell carcinoma of the ovary of the hypercalcemic type (SCCOHT)--case report.
Eur J Gynaecol Oncol. 2015; 36(1):88-90 [PubMed] Related Publications
Small cell carcinoma of the ovary of the hypercalcemic type (SCCOHT) is a very rare malignant disease, seen mostly in young women, with a very poor prognosis. There is no standard treatment for patients with this disease and most literature is limited to short series or case reports. This report describes the case of a 34-year-old woman with aggressive course of SCCOHT and poor outcome. What proved difficult was the process of establishing the diagnosis due to non-specific first symptoms of disease and consequently the combined treatment of surgery and chemotherapy with concurrent side effects.

Di Luigi G, D'Alfonso A, Patacchiola F, et al.
Leiomyosarcoma: a rare malignant transformation of a uterine leiomyoma.
Eur J Gynaecol Oncol. 2015; 36(1):84-7 [PubMed] Related Publications
The malignant transformation of a uterine leiomyoma is still debated and, if it occurs, it is very rare. The case of a patient affected by one small leiomyoma is described. Diagnosis was made postoperatively on histopathological examination. The case reported here is meant to underline the need to keep all uterine myomas in check since the transition into leiomyosarcomas (LMSs) may occur with an evolution over a time period which has not been established so far. Specific receptors for luteinizing hormone/human chorionic gonadotropin (LH/hCG) have also been identified in the myometrium of several animal species, including humans. Conventional LMSs express estrogen receptors (ER), progesterone receptors (PR), and androgen receptors (AR) in 30-40% of cases. In comparison with other more common uterine malignancies, uterine LMSs bear some resemblance to type 2 endometrial carcinomas and high-grade serous carcinomas of ovary/fallopian tube origin, based on their genetic instability, frequent p53 abnormalities, aggressive behavior, and resistance to chemotherapy. It could be useful to understand with further researches if hormonal stimulation could be a contributing factor of uterine leiomyoma transformation into LMS. Until today the oncogenic mechanisms underlying the development of uterine LMSs remain elusive.

Yang L, He Z, Huang XY, et al.
Prevalence of human papillomavirus and the correlation of HPV infection with cervical disease in Weihai, China.
Eur J Gynaecol Oncol. 2015; 36(1):73-7 [PubMed] Related Publications
OBJECTIVE: This study investigates the human papillomavirus (HPV) infection rate in female genital tracts, as well as the HPV genotype distribution and HPV correlation with cervical disease in Weihai, Shandong Province, China.
MATERIALS AND METHODS: A random sample of 9,460 volunteers was simultaneously screened using gene chips and examined by ThinPrep liquid-based cytology test (TCT). Cervical biopsy samples were collected from women with positive HPV-DNA and abnormal TCT for pathological diagnosis.
RESULTS: The overall HPV prevalence was 6.93% (656 of 9,460). A total of 753 subjects were infected with HPV subtypes (including multiple HPV infections). Of those with infections, 688 were infected with high-risk (HR) types (91.37%), and 65 were infected with low-risk subtypes (8.63%). The single-infection rate was 63.1%.The prevalence rates of HPV in women aged 20 to 39 years and 40 to 59 years were 7.29% and 6.71%, respectively. The most common genotype was HPV16. The HR genotypes were associated with cervical diseases such as atypical squamous cells of undetermined significance (ASCUS) (37.9%), atypical squamous cells high grade (ASC-H) (42.5%), low grade squamous intraepithelial lesion (LSIL) (50%), and high grade squamous intraepithelial lesion HSIL (66.7%). Cervical biopsy results show that the HPV detection rate increased in the following biopsy samples: cervical intraepithelial neoplasia (CIN) I (74.11%), CIN II (84.31%), CIN III (90.32%), and squamous-cell carcinoma (SCC) (100%).
CONCLUSIONS: The HPV infection rate with associated cervical disease in Weihai is equal to those in foreign countries but is lower than the average rate in China. The prevalence of HPV was higher in young people. The most common HPV genotype was 16, followed by 52 and 58. HR HPV is the most probable infection factor for cervical diseases.

Tanda ET, Budroni M, Cesaraccio R, et al.
Epidemiology of ovarian cancer in North Sardinia, Italy, during the period 1992-2010.
Eur J Gynaecol Oncol. 2015; 36(1):69-72 [PubMed] Related Publications
INTRODUCTION: The aim of this study was to analyze and describe the incidence and mortality trends of ovarian cancer in North Sardinia, Italy, in the period 1992-2010.
MATERIALS AND METHODS: Data were obtained from the tumor registry of Sassari province which makes part of a wider registry web, coordinated today by the Italian Association for Tumor Registries.
RESULTS: The overall number of ovarian cancer cases registered in the period under investigation was 600. The mean age of the patients was 62 years. The standardized incidence and mortality rates were 11.2/100,000 and 5.1/100,000 respectively. A substantially stable trend in incidence and mortality of ovarian cancer was evidenced. Relative survival at five years from diagnosis was 44.2%.
CONCLUSIONS: The incidence and mortality trends of ovarian cancer in North Sardinia remained relatively stable in the last decades, while prognosis remains relatively poor.

Zhou WQ, Sheng QY, Sheng YH, et al.
Expressions of survivin, P16(INK4a), COX-2, and Ki-67 in cervical cancer progression reveal the potential clinical application.
Eur J Gynaecol Oncol. 2015; 36(1):62-8 [PubMed] Related Publications
PURPOSE OF INVESTIGATION: To explore the significance of survivin, P16(INK4a), COX-2, and Ki-67 expressions for prediction of cervical cancer progression.
MATERIALS AND METHODS: A retrospective study was performed in 129 cases including 24 squamous carcinoma of the cervix (SCC), 70 cervical intraepithelial neoplasias (CIN), 15 cervical condyloma acuminatum (CCA), ten chronic cervicitis (CC), and ten normal cervix (NC). Protein expressions were evaluated using immunohistochemistry.
RESULTS: Survivin, P16(INK4a); COX-2, and Ki-67 were highly expressed in SCC and CIN compared with others. Their expression rates were gradually increased in CIN I, CIN II, CIN III, and SCC groups, showing 72.00%, 88.00%, 90.00%, and 95.83% for P16(INK4a), 68.00%, 84.00%, 95.00% and 100.00% for COX-2, 76.00%, 96.00%, 100.00%, and 100.00 for Ki-67, respectively. There were significant correlations between survivin and P16(INK4a), COX-2, Ki-67, as well as P16(INK4a) and Ki-67.
CONCLUSION: Survivin, P16(INK4a), COX-2 and Ki-67 play critical roles for development and progression of cervical cancer.

Kerimoglu OS, Pekin A, Yilmaz SA, et al.
Pyometra in elderly post-menopausal women: a sign of malignity.
Eur J Gynaecol Oncol. 2015; 36(1):59-61 [PubMed] Related Publications
PURPOSE: To describe the clinical and histopathological characteristics of 12 patients with pyometra and highlight the increased incidence of gynecological malignancy in these patients.
MATERIALS AND METHODS: The authors examined the medical records of 12 patients with pyometra, who were treated between 2009 and 2013.
RESULTS: All patients were post-menopausal, and their mean age was 70.83 ± 6.978 years (min = 61, max = 82). To remove purulent fluid via dilation and because of the probability of malignancy, three patients (25%) underwent cervical biopsy and endometrial curettage; the other nine patients (75%) underwent curettage alone, with suitable antibiotic therapy. Of the 12 patients, nine (75%) had gynecologic malignancy [(endometrial cancer, n = 5, 41.6%), (cervical cancer, n = 3, 25%), (uterine leiomyosarcoma, n = 1, 8.3%)]. In three (25%) patients, the cause of pyometra was benign pathologies, among which the most common were leiomyomas (n = 2, 66.6%).
CONCLUSION: Pyometra diagnosed during the post-menopausal period should be considered a complication caused by gynecological malignancy until proven otherwise.

Li Y, Wang X, Li J, Ding W
Combination therapy of liposomal paclitaxel and cisplatin as neoadjuvant chemotherapy in locally advanced cervical cancer.
Eur J Gynaecol Oncol. 2015; 36(1):54-8 [PubMed] Related Publications
OBJECTIVES: To investigate the efficacy and toxicities of combination therapy of liposomal paclitaxel and cisplatin as neoadjuvant chemotherapy (NACT) in locally advanced cervical cancer.
MATERIALS AND METHODS: The authors retrospectively reviewed the clinical records of patients with cervical cancer who received NACT with liposomal paclitaxel and cisplatin at Sun Yat-sen University Cancer Center from April 1, 2008 to December 31, 2012. Liposomal paclitaxel and cisplatin was administrated intravenously at a dose of 175 mg/m2 and 75 mg/m2, respectively.
RESULTS: The total response rate was 86.1% (62/72) including a complete response and partial response rate of 27.8% (20/72) and 58.3% (42/72), respectively. Stable disease was observed in 12.5% (9/72) of patients and progressive disease in 1.4% (1/72). Hematological toxicities were the major dose-limiting toxicities. Grade 3/4 neutropenia and anemia developed in 18.1% (13/72) and 6.9% (5/72) of patients, respectively. Peripheral neuropathy occurred in 6.9% (5/72) of patients (all grade 1).
CONCLUSION: The study findings support further evaluation of liposomal paclitaxel with cisplatin as an additional chemotherapy regimen which may be efficacious and tolerable in the NACT of cervical cancer.

Fukuda T, Imai K, Yamauchi M, et al.
Primary peritoneal cancer: study of 14 cases and comparison with epithelial ovarian cancer.
Eur J Gynaecol Oncol. 2015; 36(1):49-53 [PubMed] Related Publications
PURPOSE OF INVESTIGATION: Primary peritoneal carcinoma (PPC) is histologically similar to ovarian serous carcinoma, but its biochemical features remain obscure. The authors investigated and compared clinical findings, treatments, and outcomes of patients with PPS and those with epithelial ovarian cancer (EOC) patients.
MATERIALS AND METHODS: The authors retrospectively reviewed data from 14 patients with PPC and 219 patients with EOC treated at the present hospital from January 2005 to December 2012, including demographic data, pathologic findings, treatments, and outcomes.
RESULTS: Patients with PPC were significantly older (62.6 ± 8.4 years) than those with EOC (56.3 ± 11.3 years) (p = 0.045). There was no significant difference in serum CA-125 levels. The five-year survival rates did not differ significantly between patients with PPC (61.1%) and those with EOC (60.3%; p = 0.78); nor between patients with PPC and those with Stage III serous EOC (43.8%; p = 0.40).
CONCLUSIONS: Treatment strategies for EOC applied to PPC apparently led to similar survival patterns among the two patient groups. Cytoreductive surgery combined with pre/postoperative platinum-containing chemotherapy may be effective for PPC patients.

Xiao YT, Luo LM, Zhang R
Effect of lentivirus mediated cyclooxygenase-2 gene shorthairpinRNA on invasiveness of endometrial carcinoma.
Eur J Gynaecol Oncol. 2015; 36(1):44-8 [PubMed] Related Publications
OBJECTIVE: This study aims to explore the effects of lentivirus mediated cyclooxygenase-2 gene shorthairpinRNA (COX-2-shRNA) on invasiveness of endometrial carcinoma HEC-1B cells.
MATERIALS AND METHODS: Double-stranded DNA oligonucleotide of COX-2-shRNA was designed and synthesized, and the recombinant lentiviral vector COX-2-ShRNA (LV-COX-2-ShRNA) was constructed. LV-COX-2-ShRNA, pHelper 1, and pHelper 2 were transferred into 293T cells, followed by lentiviral packaging. The virus titer was tested according to expression level of GFP in 293T cells. HEC-1B cells were infected with recombinant lentivirus. The silencing of COX-2 gene was assessed by real-time PCR and western-blot, and the in vivo invasiveness of HEC-1B cells was analyzed by transwell invasion assay.
RESULTS: Recombinant lentiviral vector expressing siRNA targeting COX-2 gene was successfully constructed to harvest the recombinant lentivirus with the concentrated virus suspension titer of 5 x 10(7)Tu/ml. Compared with control group, the inhibitory rate of COX-2 expression in HEC-1B cells in siRNA group were 61.87% and 67.48% at mRNA and protein level, respectively. The mean number of cells penetrating matrigel was 16.6, which was significantly less than the control group 50.2 and non-specific siRNA infection group 47.2, the invasion inhibition rate being 64.8% (p < 0.01).
CONCLUSION: RNA interference can inhibit the invasiveness of HEC-in cells.

Andrikopoulou M, Salakos N, Deligeoroglou E, et al.
The role of mTOR signaling pathway in premalignant and malignant cervical lesions.
Eur J Gynaecol Oncol. 2015; 36(1):36-43 [PubMed] Related Publications
PURPOSE OF THE STUDY: Aberrant activation of the Akt/mTOR/pS6 signaling pathway has been identified in various types of cancer and is under investigation in cervical cancer. The purpose of this study was to assess the expression of the phosphorylated/activated forms of Akt (upstream molecule), 4E-BP1 and pS6 (downstream molecules) in biopsy samples of cervical low grade squamous intraepithelial lesions (LSIL), high grade squamous intraepithelial lesions (HSIL), and squamous cell carcinoma (Ca) compared to normal cervical epithelium.
MATERIAL AND METHODS: The study included 38 cases diagnosed as LSIL, 31 cases as HSIL, 29 cases as Ca, and eight control cases from normal cervix. Immunohistochemistry was used to assess the expression of pAkt, p4E-BP1 and pS6.
RESULTS: Statistical analysis revealed significant differences between HSIL and Ca groups compared to controls regarding intensity, positivity, and total scores for all three molecules (p < 0.001). A trend for higher expression with increasing grade of dysplasia was demonstrated.
CONCLUSION: These results strongly support the view that the mTOR signaling pathway is involved in cervical carcinogenesis.

Cho SH, Lim JY, Kim SN, et al.
The prognostic significance of pretreatment [18F]FDG-PET/CT imaging in patients with uterine cervical cancer: preliminary results.
Eur J Gynaecol Oncol. 2015; 36(1):30-5 [PubMed] Related Publications
PURPOSE OF INVESTIGATION: To evaluate the prognostic significance of positron emission tomography/computed tomography (PET/CT) in patients diagnosed with cervical cancer.
MATERIALS AND METHODS: Patients with cervical cancer in FIGO Stages IB1 to IVB were imaged with PET/CT prior to treatment during one of the staging work-ups. The patients were observed for a median of 31.4 months (range, six to 89 months) after the initial treatment. The standardized uptake value (SUV) max of the primary cervical tumor mass was compared with the prognostic factors. RESULTs: A total of 81 patients who were primarily treated with radical hysterectomy (RH, n = 45) or concurrent chemoradiation (CCRT, n = 36) were analyzed. Multivariate analysis indicated that larger tumor size (> 4 cm, OR 8.694, 95% CI, 1.638-46.146), deep stromal invasion (≥ 1 cm, OR 7.249, 95% CI, 1.141-46.039) by the primary tumor, and pathologically confirmed pelvic lymph node involvement (positive, OR 14.586, 95% CI, 2.072-102.674) were significantly associated with recurrence after treatment. However, pretreatment SUVmax was not a significant independent predictor of disease recurrence (OR 1.058, 95% CI, 0.255-4.398).
CONCLUSION: [18F]Fluorodeoxyglucose (FDG) uptake by the primary tumor showed a significant association with several risk factors that have been identified as treatment predictors. However, a high pretreatment SUVmax was not predictive of recurrence in uter- ine cervical cancer patients.

Shou H, Chen Y, Chen Z, et al.
Laparoscopic ovarian transposition in young women with cervical squamous cell carcinoma treated by primary pelvic irradiation.
Eur J Gynaecol Oncol. 2015; 36(1):25-9 [PubMed] Related Publications
OBJECTIVE: To report the authors' experience with laparoscopic ovarian transposition and ovarian function preservation in young women with cervical squamous cell carcinoma treated by primary pelvic irradiation.
MATERIALS AND METHODS: Twenty-seven premenopausal patients were treated with radiotherapy for a cervical squamous cell carcinoma. Laparoscopic ovarian transposition to paracolic gutters with uterine conservation with pelvic common iliac lymph node and para-aortic lymph node sampling were performed in ten patients at the same time of laparoscopic ovarian transposition. Preservation of ovarian function was assessed by patients' symptoms and serum follicle-stimulating hormone level.
RESULTS: Bilateral or unilateral laparoscopic ovarian transposition was performed in 27 patients: 22 cases Stage IIB, one case Stage IIIA, and four cases Stage IIIB. No immediate intraoperative or postoperative complications were observed. Two of the ten patients were confirmed by lymph node metastases. One patient was lost to follow-up. Ovarian preservation was achieved in 18 (69.2%) of 26 patients. No patient was detected with ovarian metastasis at follow-up.
CONCLUSIONS: Laparoscopic ovarian transposition is a safe and effective procedure for preserving ovarian function. This procedure may be considered in premenopausal women who need to undergo pelvic irradiation for cervical squamous cell carcinoma, especially for those less than 40 years of age. Otherwise, para-aortic lymph node or common iliac lymph nods sampling at the same time of laparoscopic ovarian transposition may preferably guide radiation therapy.

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