Gynacological Cancers
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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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Menu: Gynacological Cancers

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).

Ezem BU, Okeudo C, Ukah CO, Anozie UM
Complete hydatidiform mole coexisting with a live fetus.
Niger J Med. 2014 Jan-Mar; 23(1):86-8 [PubMed] Related Publications
Hydatidiform mole co-existing with a normal fetus is very rare. We report a case of a 36 year old woman Para 4+0 who presented with amenorrhoea of twenty four weeks duration, vaginal bleeding, abdominal pain and pre-eclampsia. Ultrasound examination revealed a hydatidiform mole coexisting with a normal living fetus. The patient underwent a caesarean section at twenty eight weeks for maternal distress due to unbearable abdominal pain. The baby died after seven days. Post operatively she had an eclamptic fit and developed oliguria and persistent trophoblastic disease which were all successfully treated.

Related: Breast cancer in pregnancy

Randolph ML, Wu HH, Crabtree WN
Reprocessing unsatisfactory ThinPrep papanicolaou tests using a modified SurePath preparation technique.
Cancer Cytopathol. 2014; 122(5):343-8 [PubMed] Related Publications
BACKGROUND: The frequency of unsatisfactory gynecologic specimens has increased in the study laboratory over the last few years due to the advent of personal lubricants. Similarly, lysed blood, protein, and necrotic debris present a challenge in terms of negative cell transference caused by a clogged filter. In the current study, the authors evaluated the potential use of a modified SurePath reprocessing technique to decrease the frequency of unsatisfactory specimens.
METHODS: An aliquot for human papillomavirus testing was set aside and the remaining specimen in the ThinPrep vial was submitted for sedimentation. A methanol wash was performed using preservative that was added to the remaining sediment. The specimen was vortexed and a protein wash of Tris-buffered deionized water was added before processing. The specimens were stained using the ThinPrep staining protocol. Both the original specimen and the reprocessed specimens were manually reviewed by 1 cytotechnologist and 2 pathologists to determine specimen adequacy.
RESULTS: A total of 1937 ThinPrep Papanicolaou tests were reprocessed and examined. Of these, 1093 (56%) specimens were satisfactory, 624 of which (57%) demonstrated evidence of a transformation zone component. Epithelial cell abnormalities were identified in 116 specimens (10.6%), including 11 high-grade squamous intraepithelial lesion specimens (1.0%); 5 specimens with a classification of atypical squamous cells, cannot rule out a high-grade lesion (0.5%); 21 low-grade squamous intraepithelial lesion specimens (1.9%); and 79 specimens classified as atypical squamous cells of undetermined significance (7.2%).
CONCLUSIONS: The modified SurePath processing technique was adept at handling nearly all of the challenges that biological and environmental conditions (blood, protein, lubricant, etc) present in liquid-based filter preparations. A total of 1093 (56%) of 1937 unsatisfactory ThinPrep Papanicolaou tests were converted to a satisfactory state, resulting in 116 abnormalities (10.6%) being diagnosed that otherwise would have gone undetected

Related: Cervical Cancer

Uterine artery embolisation: an alternative to surgery?
Prescrire Int. 2014; 23(149):133 [PubMed] Related Publications
According to comparative evaluation in about 900 patients, uterine artery embolisation may expose patients to a lower risk of serious complications than surgery. But it reduces fertility.

Bleeding associated with uterine leiomyomas. Tailor treatment to the individual patient.
Prescrire Int. 2014; 23(149):130-5 [PubMed] Related Publications
Uterine leiomyomas are benign, often asymptomatic, tumours of the uterus. When they are symptomatic, the most frequent symptom is heavy, prolonged menstrual bleeding, which stops at menopause. When this blood loss causes iron-deficiency anaemia, iron supplementation is justified. Various treatments aimed at reducing uterine blood loss are proposed for women with leiomyoma-related bleeding. As of late 2013, what is the harm-benefit balance of these treatments? To answer this question, we reviewed the available data using the standard Prescrire methodology. Hysterectomy (removal of the uterus) is the most radical treatment for the clinical manifestations of uterine leiomyomas. Serious complications sometimes occur. Nine randomised trials including a total of 1553 patients found no advantage in leaving the cervix intact. Randomised trials in about 4500 patients showed that the vaginal approach is preferable to an open abdominal or laparoscopic approach: in particular, it resulted in fewer infections and less bleeding. Myomectomy (selective removal of uterine leiomyomas) is another surgical option, especially when the patient wishes to preserve her fertility. Its evaluation is mainly based on noncomparative case series. As with hysterectomy, it exposes patients to the risk of serious complications. Symptoms recur in 4% to 27% of cases.The reintervention rate is 4% to 20%. Injections of the gonadorelin agonists leuprorelin or triptorelin reduce bleeding associated with leiomyomas, according to several randomised trials. They have not been demonstrated to reduce the need for transfusion or to facilitate subsequent surgery for leiomyomas.The harm-benefit balance of prolonged use of these drugs is unfavourable, due to their numerous adverse effects. The oral progesterone receptor antagonist ulipristal reduces excessive bleeding, but has not been demonstrated to facilitate subsequent surgery.The effects on the endometrium of taking ulipristal for more than 3 months are unknown. The progesterone antagonist mifepristone reduced bleeding in small randomised trials, but increased the incidence of endometrial hyperplasia. The levonorgestrel-releasing intrauterine device has mainly been evaluated in non-comparative studies, which suggest that it reduces menstrual bleeding in women with leiomyomas. The risk of expulsion of the device in women with leiomyomas appears to be about 20%. Its main adverse effects are rare cases of acne, depression, headache, weight gain and breast tenderness. Very little evaluation data is available on oral progestins in this situation. A progestin, such as norethisterone, taken from the 5th to the 26th day of the menstrual cycle seems to reduce menstrual blood loss and has a contraceptive effect. Oral progestins expose women to an increased risk of venous thromboembolism and possibly increase the risk of breast cancer. Their harm-benefit balance seems less favourable than that of the levonorgestrel-releasing intrauterine device. The thrombotic risk associated with tranexamic acid is unclear, but deserves serious consideration given the drug's uncertain efficacy. In practice, the treatment should be chosen with the patient, based on various factors, including severity of symptoms, age, desire to preserve fertility or the uterus, characteristics of the leiomyomas, and patient preference. As of late 2013, when drug treatment is considered useful in postponing surgery or while awaiting menopause, the levonorgestrel-releasing intrauterine device is the first choice. Oral progestins are another alternative, although their adverse effects are unclear when taken for several months. It is better to avoid exposing patients to the other available drugs, and to choose iron supplementation for women who develop anaemia.

Rotruck S, Wilson JT, McGuire J
Cytoreductive surgery with hyperthermic intraperitoneal chemotherapy: a case report.
AANA J. 2014; 82(2):140-3 [PubMed] Related Publications
Cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (HIPEC) is a complex procedure used for the treatment of various types of cancer. Specifically, HIPEC has shown success where treatment failure sites (metastases) thrive. A classic example of one such area is the peritoneal surface, which remains a prominent failure site for patients with gynecologic and gastrointestinal cancer. Traditionally, most patients with advanced stages of cancer have undergone palliative procedures as part of their treatment modality or had no surgery at all. With the advent of cytoreductive surgery with HIPEC, patients with peritoneal cancer have shown increased survival rates. Anesthetic complications are common during this procedure with disturbances in hemodynamics, coagulation, and respiratory gas exchange. A knowledge of what to anticipate anesthetically will guide the practitioner to achieve successful management during and after the case. In this case report, a 71-year-old woman was treated for stage Ill peritoneal and ovarian cancer by cytoreductive surgery with HIPEC.

Related: Ovarian Cancer

Nair JJ, Rárová L, Strnad M, et al.
Crinane alkaloids of the amaryllidaceae with cytotoxic effects in human cervical adenocarcinoma (HeLa) cells.
Nat Prod Commun. 2014; 9(4):461-6 [PubMed] Related Publications
The family Amaryllidaceae has a long history of usage in the traditional medicinal practices of the indigenous peoples of South Africa, with three of its species known to be used for cancer treatment. Furthermore, the Amaryllidaceae is widely recognized for its unique alkaloid constituents, several of which exhibit potent and selective cytotoxic activities. In this study, several crinane alkaloids derived from local Amaryllidaceae species were examined for cytotoxic effects against the human cervical adenocarcinoma cell line, of which distichamine was the most potent (IC50 2.2 microM).

Related: Cervical Cancer

Corcoran J, Crowley M
Latinas' attitudes about cervical cancer prevention: a meta-synthesis.
J Cult Divers. 2014; 21(1):15-21 [PubMed] Related Publications
Latina women are almost twice as likely to die from cervical cancer as Caucasian women. In response to this disparity, qualitative study has been devoted to this topic. In order to generalize knowledge, insights gleaned through qualitative research methodology may be integrated through meta-synthesis, a methodology that has developed in nursing and related health sciences. The primary purpose of this meta-synthesis was to obtain information about Latinas' knowledge, attitudes, and perceptions regarding cervical cancer and its screening. After applying inclusion criteria, nine studies were located. Results were organized around four areas of inquiry that cross-cut primary studies: 1) Latina participants' knowledge of cervical cancer and its prevention; 2) barriers for regular cervical cancer screening; 3) facilitators that encouraged such screening; and 4) recommendations on how to provide screening for Latina women. Findings indicated that culturally appropriate education and improving accessibility to health care were the most important overall themes for future efforts to improve screening rates among Latinas in the United States.

Related: USA Cervical Cancer

Steenbergen RD, Snijders PJ, Heideman DA, Meijer CJ
Clinical implications of (epi)genetic changes in HPV-induced cervical precancerous lesions.
Nat Rev Cancer. 2014; 14(6):395-405 [PubMed] Related Publications
Infection of cervical epithelium with high-risk human papilloma virus (hrHPV) might result in productive or transforming cervical intraepithelial neoplasia (CIN) lesions, the morphology of which can overlap. In transforming CIN lesions, aberrations in host cell genes accumulate over time, which is necessary for the ultimate progression to cancer. On the basis of (epi)genetic changes, early and advanced transforming CIN lesions can be distinguished. This paves the way for new molecular tools for cervical screening, diagnosis and management of cervical cancer precursor lesions.

Related: Cervical Cancer

Tomica D, Ramić S, Danolić D, et al.
A correlation between the expression of estrogen receptors and progesterone receptors in cancer cells and in the myometrium and prognostic factors in endometrial cancer.
Coll Antropol. 2014; 38(1):129-34 [PubMed] Related Publications
Endometrial cancer is the most common gynecological malignancy in Croatia. The aim of this study was to determine the immunohistochemical expression of estrogen receptors (ER) and progesterone receptors (PGR) in cancer cells and in the myometrium and to correlate it with prognostic factors of endometrial carcinoma. ER positivity in carcinoma cell nuclei was found in 42 cases (73.7%) and PGR positivity was found in 39 cases (68.4%). Loss of ER in carcinoma cell nuclei correlated with larger tumor size (p = 0.041), poor carcinoma differentiation (p = 0.012), a more aggressive histological type (p < 0.001), lymphovascular space invasion (p = 0.002) and a higher surgical stage (p = 0.037). Loss of PGR in carcinoma cell nuclei correlated with an increased age in patients (p = 0.009), poor tumor differentiation (p = 0.002), a more aggressive histological type (p < 0.001), lymphovascular space invasion (p = 0.002) and a higher surgical stage (p < 0.001). The lower expression of both receptors did not correlate with the depth of myometrial invasion. Regarding the status of receptors in the myometrium, loss of PGR in the myometrium correlated with a more aggressive histological type (p = 0.005) and a lack of ER in the myometrium tended to correlate with tumor growth (p = 0.059). In conclusion, the loss of both hormone receptors in carcinoma cells and loss of PGR in the myometrium was a predictor of a more aggressive type of endometrial cancer and a poor prognosis.

Related: Endometrial (Uterus) Cancer Endometrial Cancer

Wongsena M, Suebsamran P, Panomket P, et al.
Prognostic factors of human papillomavirus genotypes of invasive cervical carcinoma: an analytical cross-sectional study in lower north-east Thailand.
J Med Assoc Thai. 2014; 97 Suppl 4:S12-9 [PubMed] Related Publications
BACKGROUND: Cervical cancer (CXCA) caused by persistent infections by high-risk human papillomavirus (HR-HPV) can lead to multi-step carcinogenesis. The best management strategy and significant prognosis for cervical cancer patients remain unclear.
OBJECTIVE: To investigate the associations of the two most common HR-HPVs with clinical outcomes of progression and recurrence status as well as prognosis outcomes of patients.
MATERIAL AND METHOD: An analytical cross-sectional study of patients registered at Ubon Ratchathani Cancer Hospital was conducted from 2007 to 2010. Clinical data, histopathological features, and clinical outcomes of progression and recurrence status were recorded. HPV type-specific E6/E7 nested multiplex polymerase chain reaction (NMPCR) was performed to identify HR-HPV16 and 18 using extracted deoxyribonucleic acid (DNA) from embedded paraffin. Clinical findings and HPV genotypes were analyzed using Fisher's exact test. Association studies of crucial factors and HR-HPV genotypes were performed using logistic regression analysis (odds ratio [OR]) and 95% confidence interval [CI]). A p-value of less than 0.05 was considered statistically significant.
RESULTS: The study found single HPV16 infection in 57.3%, single HPV18 in 17.3%, mixed HR-HPV16/18 in 13.1%, and non-HPV16, 18, or 16/18 in 12.3%. The findings showed significant association among their genotypes and histopathological types and grading (p < 0.0001 and p = 0.014). Clinical outcomes of progression and recurrence status with increased severity of clinical staging were associated significantly (p = 0.001 and p = 0.002). HPV18 type-specific was shown as a poor prognostic type with its relevance to the severity of disease higher than that of HPV16.
CONCLUSION AND DISCUSSION: HPV16 and 18 remain the major type-specifics especially in relation to invasive CXCA, requiring further therapeutic vaccination study and proper prognosis. HR-HPV type-specific is very important during cervical carcinogenesis but other crucial contributing factors for prognostic outcomes should be further elucidated.

Related: Thailand Cervical Cancer

Baandrup L, Friis S, Dehlendorff C, et al.
Prescription use of paracetamol and risk for ovarian cancer in Denmark.
J Natl Cancer Inst. 2014; 106(6):dju111 [PubMed] Related Publications
It has been suggested that paracetamol reduces the risk for ovarian cancer. We examined the association between prescription use of paracetamol and ovarian cancer risk in a nationwide case-control study nested within the Danish female population. Case patients (n = 3471) were all women with a first diagnosis of epithelial ovarian cancer during the period from 2000 to 2009. Population control subjects (n = 50576) were selected by risk set sampling. Data were derived from prescription and other nationwide registries. Conditional logistic regression was used to estimate odds ratios (ORs) and two-sided 95% confidence intervals (CIs) for ovarian cancer associated with use of paracetamol or nonaspirin nonsteroidal anti-inflammatory drugs (NSAIDs). All statistical tests were two-sided. Use of paracetamol was associated with a reduced odds ratio for ovarian cancer (OR = 0.82; 95% CI = 0.74 to 0.92; P < .001) compared with nonuse, and the odds ratio decreased further with long-term (≥10 years), high-intensity paracetamol use (OR = 0.45; 95% CI = 0.24 to 0.86; P = .02). Use of nonaspirin NSAIDs was not associated with ovarian cancer risk.

Related: Ovarian Cancer

Lee JM, Hays JL, Annunziata CM, et al.
Phase I/Ib study of olaparib and carboplatin in BRCA1 or BRCA2 mutation-associated breast or ovarian cancer with biomarker analyses.
J Natl Cancer Inst. 2014; 106(6):dju089 [PubMed] Article available free on PMC after 01/06/2015 Related Publications
BACKGROUND: Olaparib has single-agent activity against breast/ovarian cancer (BrCa/OvCa) in germline BRCA1 or BRCA2 mutation carriers (gBRCAm). We hypothesized addition of olaparib to carboplatin can be administered safely and yield preliminary clinical activity.
METHODS: Eligible patients had measurable or evaluable disease, gBRCAm, and good end-organ function. A 3 + 3 dose escalation tested daily oral capsule olaparib (100 or 200mg every 12 hours; dose level1 or 2) with carboplatin area under the curve (AUC) on day 8 (AUC3 day 8), then every 21 days. For dose levels 3 to 6, patients were given olaparib days 1 to 7 at 200 and 400 mg every 12 hours, with carboplatin AUC3 to 5 on day 1 or 2 every 21 days; a maximum of eight combination cycles were permitted, after which daily maintenance of olaparib 400mg every12 hours continued until progression. Dose-limiting toxicity was defined in the first two cycles. Peripheral blood mononuclear cells were collected for polymorphism analysis and polyADP-ribose incorporation. Paired tumor biopsies (before/after cycle 1) were obtained for biomarker proteomics and apoptosis endpoints.
RESULTS: Forty-five women (37 OvCa/8 BrCa) were treated. Dose-limiting toxicity was not reached on the intermittent schedule. Expansion proceeded with olaparib 400mg every 12 hours on days 1 to 7/carboplatin AUC5. Grade 3/4 adverse events included neutropenia (42.2%), thrombocytopenia (20.0%), and anemia (15.6%). Responses included 1 complete response (1 BrCa; 23 months) and 21 partial responses (50.0%; 15 OvCa; 6 BrCa; median = 16 [4 to >45] in OvCa and 10 [6 to >40] months in BrCa). Proteomic analysis suggests high pretreatment pS209-eIF4E and FOXO3a correlated with duration of response (two-sided P < .001; Pearson's R (2) = 0.94).
CONCLUSIONS: Olaparib capsules 400mg every 12 hours on days 1 to 7/carboplatin AUC5 is safe and has activity in gBRCAm BrCa/OvCa patients. Exploratory translational studies indicate pretreatment tissue FOXO3a expression may be predictive for response to therapy, requiring prospective validation.

Related: Breast Cancer Carboplatin Ovarian Cancer

Zhou F, Ma M, Tao G, et al.
Detection of circulating methylated opioid binding protein/cell adhesion molecule-like gene as a biomarker for ovarian carcinoma.
Clin Lab. 2014; 60(5):759-65 [PubMed] Related Publications
BACKGROUND: Hypermethylation of the opioid binding protein/cell adhesion molecule-like (OPCML) gene is frequently observed in ovarian carcinoma. We evaluated the detection of circulating hypermethylated OPCML for detecting ovarian carcinoma and assessing its prognosis.
METHODS: We studied 85 tissue samples including 45 ovarian cancer tissues and 40 normal ovarian tissues and blood samples from 45 ovarian cancer patients and 20 healthy individuals. Bisulfite sequencing and methylation-sensitive restriction enzyme-PCR (MSRE-PCR) were used to detect the frequency of OPCML hypermethylation.
RESULTS: We detected that the frequency of OPCML hypermethylation for tissue and serum samples in ovarian carcinoma were 86.7% (39/45) and 80.0% (36/45), respectively, but none was detected in ovarian tissue and serum of healthy individuals. The frequency of OPCML hypermethylation in endometrioid carcinoma, serous cystadenocarcinoma, mucinous cystadenocarcinoma, clear cell carcinoma, and undifferentiated carcinoma were 80.0%, 85.5%, 50.0%, 80.0%, and 100%, respectively (p > 0.05). The frequencies of OPCML hypermethylation in patients were also different in terms of tumor differentiation degree. We detected hypermethylated OPCML in the sera of 50% of well differentiated, 62.5% of moderately differentiated, 93.1% of poorly differentiated tumors (p < 0.05). The frequency of OPCML hypermethylation at FIGO stage I was 42.9%, stage II was 66.7%, stage III was 85.7%, stage IV was 100% (p < 0.05).
CONCLUSIONS: Detection OPCML methylation in the serum is useful for ovarian carcinoma diagnosis.

Related: Ovarian Cancer

Friebel TM, Domchek SM, Rebbeck TR
Modifiers of cancer risk in BRCA1 and BRCA2 mutation carriers: systematic review and meta-analysis.
J Natl Cancer Inst. 2014; 106(6):dju091 [PubMed] Related Publications
BACKGROUND: There is substantial variability in cancer risk in women who have inherited a BRCA1 or BRCA2 (BRCA1/2) mutation. Numerous factors have been hypothesized to modify these risks, but studies are of variable quality, and it remains unclear which of these may be of value in clinical risk assessment.
METHODS: PubMed and Web of Science databases were searched for articles published through September 2013. Fixed effects meta-analysis was done using the hazard ratios and/or odds ratios to estimate the pooled effect estimates (ES) and 95% confidence intervals (CIs) to identify factors that are associated with cancer risk modification in BRCA1/2 mutation carriers.
RESULTS: We identified 44 nonoverlapping studies that met predefined quality criteria. Sufficient evidence is available to make clinically relevant inferences about a number of cancer risk modifiers. The only variable examined that produced a probable association was late age at first live birth, a meta-analysis showed a decrease in the risk of breast cancer in BRCA1 mutation carriers with women aged 30 years or older vs. women younger than 30 years (ES = 0.65; 95% CI =0.42 to 0.99). The same was shown for women aged 25 to 29 years versus those aged less than 25 years (ES = 0.69; 95% CI = 0.48 to 0.99). Breastfeeding and tubal ligation were associated with reduced ovarian cancer risk in BRCA1 mutation carriers; oral contraceptives were associated with reduced risk among BRCA1/2 mutation carriers. Smoking was associated with increased breast cancer risk in BRCA2 mutation carriers only.
CONCLUSIONS: Data assessing many potential risk modifiers are inadequate, and many have not been externally validated. Although additional studies are required to confirm some associations, sufficient information is available for some risk factors to be used in risk counseling or lifestyle modification to minimize cancer risk in BRCA1/2 mutation carriers

Related: Breast Cancer Ovarian Cancer

Rabban JT, Garg K, Crawford B, et al.
Early detection of high-grade tubal serous carcinoma in women at low risk for hereditary breast and ovarian cancer syndrome by systematic examination of fallopian tubes incidentally removed during benign surgery.
Am J Surg Pathol. 2014; 38(6):729-42 [PubMed] Related Publications
Early detection of sporadic pelvic serous carcinoma remains an elusive goal. In women at high risk for hereditary breast and ovarian cancer syndrome who undergo prophylactic salpingectomy, systematic pathologic examination of the fallopian tubes will detect occult tubal cancer, mostly in the fimbriae, of a minority of women. Such tubal cancers are the putative precursor to advanced-stage pelvic cancer. We hypothesized that early tubal cancer detection can also be accomplished in women at low risk using a similar approach. In this study, we performed complete and systematic examination of the fallopian tubes removed during surgery performed for benign indications. Among 522 women, 4 cases of serous tubal intraepithelial carcinoma (STIC) were identified. Three of these cases would have gone undetected using the current standard of care of sampling only a single random section of the tube. The fourth case was accompanied by occult ovarian carcinoma. The fimbriae contained STIC in 3 of the 4 cases and atypical mucosa in 1 case in which the STIC was in the nonfimbriated portion of the tube. The morphologic and immunohistochemical features (aberrant p53 and MIB-1) of these STICs were similar to those expected in high-risk women. All 4 patients with STIC underwent BRCA1 and BRCA2 gene testing; no germline mutations were identified in any patient. An additional 11 specimens contained atypical mucosal proliferations that fell short of morphologic and immunohistochemical criteria for STIC. Two of these 11 fulfilled criteria for a serous tubal intraepithelial lesion, and the remaining atypical proliferations exhibited normal p53 and MIB-1. For most specimens, the fimbriae could be completely submitted in 1 or 2 cassettes per tube. These results demonstrate that systematic examination of the tubal fimbriae can serve as a form of early detection of sporadic tubal cancer without incurring significant labor or cost. We propose that the tubal fimbriae should be completely examined in all patients undergoing benign surgery even if there are no clinical features to suggest risk for hereditary breast and ovarian cancer syndrome.

Related: Cancer Screening and Early Detection Fallopian Tube Cancer MKI67 TP53

Chan KK, Leung TH, Chan DW, et al.
Targeting estrogen receptor subtypes (ERα and ERβ) with selective ER modulators in ovarian cancer.
J Endocrinol. 2014; 221(2):325-36 [PubMed] Related Publications
Ovarian cancer cells express both estrogen receptor α (ERα) and ERβ, and hormonal therapy is an attractive treatment option because of its relatively few side effects. However, estrogen was previously shown to have opposite effects in tumors expressing ERα compared with ERβ, indicating that the two receptor subtypes may have opposing effects. This may explain the modest response to nonselective estrogen inhibition in clinical practice. In this study, we aimed to investigate the effect of selectively targeting each ER subtype on ovarian cancer growth. Ovarian cancer cell lines SKOV3 and OV2008, expressing both ER subtypes, were treated with highly selective ER modulators. Sodium 3'-(1-(phenylaminocarbonyl)-3,4-tetrazolium)-bis(4-methoxy-6-nitro) benzene sulfonic acid hydrate (XTT) assay revealed that treatment with 1,3-bis(4-hydroxyphenyl)-4-methyl-5-[4-(2-piperidinylethoxy)phenol]-1H-pyrazole dihydrochloride (MPP) (ERα antagonist) or 2,3-bis(4-hydroxy-phenyl)-propionitrile (DPN) (ERβ agonist) significantly suppressed cell growth in both cell lines. In contrast, 4,4',4″-(4-propyl-[1H]-pyrazole-1,3,5-triyl) trisphenol (PPT) (ERα agonist) or 4-[2-phenyl-5,7-bis(trifluoromethyl)pyrazolo[1,5-a]-pyrimidin-3-yl]phenol (PHTPP) (ERβ antagonist) significantly enhanced cell growth. These results were confirmed on a xenograft model where SKOV3 cells were injected s.c. into ovariectomized mice. We observed that the average size of xenografts in both the DPN-treated group and the MPP-treated group was significantly smaller than that for the vehicle-treated group. In addition, we found that phospho-AKT expressions in SKOV3 cells were reduced by 80% after treatment with MPP and DPN, indicating that the AKT pathway was involved. The combined treatment with MPP and DPN had a synergistic effect in suppressing ovarian cancer cell growth. Our findings indicate that targeting ER subtypes may enhance the response to hormonal treatment in women with ovarian cancer.

Related: Ovarian Cancer

Geng F, Xing JZ, Chen J, et al.
Pegylated glucose gold nanoparticles for improved in-vivo bio-distribution and enhanced radiotherapy on cervical cancer.
J Biomed Nanotechnol. 2014; 10(7):1205-16 [PubMed] Related Publications
Pharmacokinetics and bio-distribution are crucial factors affecting the performance of an intravenous drug. In this study, we explore the combined use of glucose and polyethylene glycol (PEG) ligands to further improve gold nanoparticle (GNP) pharmacokinetics and bio-distribution, with the aim of using the drug for in-vivo radiotherapy. The inclusion of PEG was found to significantly prolong the half-life period, where PEG-Glu-GNPs achieved 6.17 +/- 3.71 h, compared to 1.23 +/- 0.14 h for Glu-GNPs and 1.07 +/- 0.22 h for uncoated GNPs. Our data indicates that nanoparticle size impacts cell uptake performance, with 20 nm being the optimal diameter for cancer treatment applications. Although PEG-Glu-GNPs mainly distributed in the spleen, liver, lung, and kidneys, the concentration of PEG-Glu-GNPs in tumour tissue was 20 times higher than healthy cells in the uterus and ovaries, reaching 9.22 +/- 2.41 microg/g cancer tissue at 48 h after injection. This difference in uptake holds promise for selective tumor targeting which can in turn lead to more effective radiotherapy through the interaction of X-rays and GNPs. Specifically tumor size after 47 days of treatment had reduced to (769 +/- 92) mm3 compared to (1432 +/- 269) mm3 using X-rays alone and (3514 +/- 1818) mm3 without any treatment. Moreover, the mice remained healthy without statistically significant weight loss. Results of our pharmacokinetic and bio-distribution study as well as therapeutic data for PEG-Glu-GNPs in our tumor bearing animal model demonstrate that PEG-Glu-GNPs provide excellent in-vivo stability, tumor targeting function, and radiotherapeutic enhancement effects, providing useful insights for further clinical studies.

Related: Cervical Cancer

Ward KK, Roncancio AM, Cano MA, Plaxe SC
An ecological analysis of the incidence of invasive squamous cell carcinoma of the cervix in Hispanic women in the United States.
Ethn Dis. 2014; 24(2):243-7 [PubMed] Related Publications
PURPOSE: To evaluate the relationship between county-level characteristics and the incidence of invasive squamous cell carcinoma of the cervix among Hispanic women.
METHODS: The Surveillance, Epidemiology and End Results (SEER) Program's 18 registries from 2000-2009 were queried. Average annual age-adjusted incidence rates for invasive squamous cell carcinoma of the cervix among Hispanic women were calculated. Patients were then stratified by residence in a county with high vs low percent language isolation (LI), income, and education levels.
RESULTS: Among Hispanic women living in high LI, the highest incidence of cervical cancer was found among women residing in counties with low incomes and low education levels (11.3; CI: 10.8-11.8).
CONCLUSIONS: County-level characteristics are associated with cervical cancer incidence in Hispanic women. A more precise understanding of contributing socioeconomic factors such as language may facilitate the design of targeted research studies and interventions, and community-level public policy interventions might be effective in reducing the unequal burden of cervical cancer in Hispanic women in the United States.

Related: USA Cervical Cancer

Leser KA, Francis SA
Mother-child communication about sexual health, HPV and cervical cancer among antenatal clinic attendees in Johannesburg, South Africa.
Afr J Reprod Health. 2014; 18(1):123-6 [PubMed] Related Publications
Parent-child communication about sexual health is considered an effective strategy for encouraging safe sexual practices among youth. This study used a brief survey to examine mother-child communication among 86 antenatal clinic attendees in Johannesburg, South Africa. Eighty-five percent of mothers reported having enough information to discuss HIV/AIDS prevention with their children, while only 36% reported having enough information to discuss HPV/cervical cancer prevention. Thirty-seven percent of mothers who reported being comfortable discussing HIV/sexual health with their child actually discussed these topics with their child; while 58% of mothers who reported being comfortable did not discuss HIV/sexual health with their child. Future research and program planning efforts should focus on identifying the best strategies to educate South African mothers on HPV and cervical cancer, so that mothers can effectively communicate their knowledge about these topics to their children.

Related: Cervical Cancer

Oliver A, Overton C
Detecting ovarian disorders in primary care.
Practitioner. 2014; 258(1769):15-9, 2 [PubMed] Related Publications
Ovarian cysts occur more often in premenopausal than postmenopausal women. Most of these cysts will be benign, with the risk of malignancy increasing with age. The risk of a symptomatic ovarian cyst in a premenopausal female being malignant is approximately 1:1,000 increasing to 3:1,000 at the age of 50. Ovarian cysts may be asymptomatic but presenting symptoms include pelvic pain, pressure symptoms and discomfort and menstrual disturbance. Functional cysts in particular can be linked with irregular vaginal bleeding or menorrhagia. Ovarian torsion is most common in the presence of an ovarian cyst. Dermoid cysts are most likely to tort. Torsion presents with sudden onset of severe colicky unilateral pain radiating from groin to loin. There may be nausea and vomiting. It is often confused with ureteric colic where the pain is similar but radiates loin to groin. Symptoms which may be suggestive of a malignant ovarian cyst, particularly in the over 50 age group, include: weight loss, persistent abdominal distension or bloating, early satiety, pelvic or abdominal pain and increased urinary urgency and frequency. CA125 levels should be checked in women who present with frequent bloating, feeling full quickly, loss of appetite, pelvic or abdominal pain or needing to urinate quickly or urgently. Symptomatic postmenopausal women, those with a cyst > or = 5 cm, or raised CA125 levels, should be referred to secondary care. Functional cysts, particularly when they are < 5 cm diameter, usually resolve spontaneously without the need for intervention. In premenopausal women simple cysts > or = 5 cm are less likely to resolve and need an annual ultrasound assessment as a minimum.

Related: Ovarian Cancer

Cruz-Galarza D, Pérez-Rodríguez O, Laboy-Torres J, Gutiérrez-Rivera S
An unusual case of a borderline Brenner tumor associated with bilateral serous cystadenoma and endometrial carcinoma.
Bol Asoc Med P R. 2014; 106(1):54-6 [PubMed] Related Publications
Brenner tumor accounts for 1.5 to 2.5% of ovarian tumors. Nearly all are benign and 1% malignant. Less than twenty-five cases of borderline Brenner tumor have been reported worldwide. Our case is the first one related to a bilateral ovarian serous cystadenofibroma and endometrioid adenocarcinoma. This unusual case increases the limited data for borderline Brenner tumors.

Related: Breast Cancer Endometrial (Uterus) Cancer Endometrial Cancer Ovarian Cancer

Sneesby L
Home is where I want to die: Kelly's journey.
Contemp Nurse. 2014; 46(2):251-3 [PubMed] Related Publications
The definition of a 'good death' is centred on being peaceful, dignified and pain free. The preferred place of death has also been highlighted as an important concept in defining a good death (Cox, Almack, Pollack, & Seymour, 2011). Seventy percent of Australians express the desire to spend their last days at home. In reality only 16% of people die at home (Preferred Place of Death, 2008). With 10% of Australians dying in residential aged care facilities and approximately 20% in hospices, the rest die in hospitals (Parish et al., 2006). Family support and the family's care giving ability play a major role in determining whether a person is able to die at home. Other factors include the availability of medical and nursing care. This story has been written with the consent of Kelly's husband. All efforts have been made to maintain privacy and confidentiality: Pseudonyms have been used.

Related: Australia Ovarian Cancer

Sinno AK, Saraiya M, Thompson TD, et al.
Human papillomavirus genotype prevalence in invasive vaginal cancer from a registry-based population.
Obstet Gynecol. 2014; 123(4):817-21 [PubMed] Article available free on PMC after 01/04/2015 Related Publications
OBJECTIVE: To describe the human papillomavirus (HPV) genotype distribution in invasive vaginal cancers diagnosed before the introduction of the HPV vaccine and evaluate if survival differed by HPV status.
METHODS: Four population-based registries and three residual tissue repositories provided formalin-fixed, paraffin-embedded tissue from microscopically confirmed primary vaginal cancer cases diagnosed between 1994 and 2005 that were tested by L1 consensus polymerase chain reaction with type-specific hybridization in a central laboratory. Clinical, demographic, and all-cause survival data were assessed by HPV status.
RESULTS: Sixty cases of invasive vaginal cancer were included. Human papillomavirus was detected in 75% (45) and 25% (15) were HPV-negative. HPV 16 was most frequently detected (55% [33/60]) followed by HPV 33 (18.3% [11/60]). Only one case was positive for HPV 18 (1.7%) Multiple types were detected in 15% of the cases. Vaginal cancers in women younger than 60 years were more likely to be HPV 16- or HPV 18-positive (HPV 16 and 18) than older women, 77.3% compared with 44.7% (P=.038). The median age at diagnosis was younger in the HPV 16 and 18 (59 years) group compared with other HPV-positive (68 years) and no HPV (77 years) (P=.003). The HPV distribution did not significantly vary by race or ethnicity or place of residence. The 5-year unadjusted all-cause survival was 57.4% for women with HPV-positive vaginal cancers compared with 35.7% among those with HPV-negative tumors (P=.243).
CONCLUSION: Three fourths of all vaginal cancers in the United States had HPV detected, much higher than previously found, and 57% could be prevented by current HPV vaccines.

Related: Vaginal Cancer

Popovic MD, Banicevic AC, Popovic B, et al.
Treatment of endometrial cancer in patient with malignant obesity.
Med Arch. 2014; 68(1):69-70 [PubMed] Related Publications
Our 60-year-old patient menarche in 13-year, two delivery, last menstruation in 53-year, without uterine bleeding or any kind of symptomatology. The gynecological transvaginal ultrasound examination showed hyperplasio endometrii (20 mm). After curettage, pathological examination was diagnostic polypus carcinomatoides. The patient with HTA and obesity was admitted to and operated on at the Gynecological Department due to endometrial carcinoma (FIGO stage IA1). Because of her giant obesity, BMI - 71.50 kg/m2, weight 219 kg and height 175 cm, surgery by the abdominal approach was very difficult to perform, so vaginal hysterectomy was carried out. The procedure was completed within 127 minutes without any intraoperative complications. Blood loss was less than 100 ml. The patient was discharged on postoperative day 7. The patient was followed up for 6 months after surgery. No complications or recurrence were reported during the 6-month follow up.

Related: Endometrial (Uterus) Cancer Endometrial Cancer

Mojahed S, Karimi Zarchi M, Bokaie M, Salimi T
Attitude and knowledge of Iranian female nurses about human papilomavirus infection and cervical cancer: a cross sectional survey.
J Prev Med Hyg. 2013; 54(3):187-90 [PubMed] Related Publications
BACKGROUND AND AIM: Human Papilomavirus (HPV) is one of the most widespread sexually transmitted diseases is highly related to cervical cancer in women. Cervical cancer's crude incidence rate in Iran is 6-8 per 100,000. The HPV vaccine provides a chance to considerably decrease the transmission of most types of HPV. The aim of this study was to evaluate awareness and knowledge of HPV infection and vaccines and to assess the attitude and approach toward these vaccines among female nurses at Shahid Sadoughi University of Medical Sciences, Yazd, Iran.
MATERIALS AND METHODS: This cross-sectional, descriptive study was performed among 380 female nurses. Data were collected using a questionnaire was consisted in demographic variables and questions on knowledge of participants about HPV infection, HPV vaccine and cervical cancer and also questions on attitude of ourses towards HPV vaccination. The validity and internal consistency of questionnaire was confirmed during experts consents and pilot testing (alpha = 0.79). Data analysis was performed using SPSS15 using chi2-test or Fisher's exact test.
RESULTS: Three hundred and eighty questionnaires were distributed and 357 female nurses completed and returned their questionnaires: Only one hundred and thirty-one of the nurses (36.7%) knew about HPV infection and how it can cause abnormal pap Smear results. about 147 (41.2%) of the nurses stated they would want to be vaccinated. About 146 (40.9%) of respondents supported vaccination of preadolescent girls.
CONCLUSION: The results of this study confirm the lack of knowledge about HPV vaccine and its relation to cervical cancer and also the ways of this cancer prevention. Our study shows an urgent need to design similar studies in other regions of Iran and draw a broad estimation on knowledge of different target groups to make a national program to increase the knowledge of women on this matter and help to decrease the rate of cervical cancer in Iranian population.

Related: Cervical Cancer Human Papillomavirus (HPV), Vaccination, and Cervical Cancer

Hajializadeh K, Ahadi H, Jomehri F, Rahgozar M
Psychosocial predictors of barriers to cervical cancer screening among Iranian women: the role of attachment style and social demographic factors.
J Prev Med Hyg. 2013; 54(4):218-22 [PubMed] Related Publications
OBJECTIVES: Despite advances in screening and treatment during past several Decades, cervical cancer remains a major health problem for Iranian women. Recent researches have focused on factors related to development of health behavior in an effort to design effective early interventions. The current study aimed to investigate the role of attachment styles on cervix cancer screening barriers among women of Bandar Abbas-Iran.
METHODS: In an analytic-cross sectional study, 681 women aged 21-65 referring to health centers were selected randomly and after completing written informed consents were investigated by Revised Adult Attachment Scale (RAAS) (Collins and Read), Pap smear screening barriers and demographic data questionnaire. The data were analyzed by Pearson correlation coefficient, linear regressions and chi-square test.
RESULTS: The results showed significant association between attachment styles and screening barriers. There was a negative significant relation between secure attachment style and screening barriers and there was a positive significant association between insecure attachment style (anxiety and avoidant) and screening barriers. The regression analysis indicated that insecure attachment style (avoidant) were predictors of barriers to the Pap smear screening test in this regard. There was a significant association between age and residential area and participation in Pap smear test.
CONCLUSIONS: Insecure attachment style is associated with hazardous risk behaviors and these results can be useful for health service providers in preventive planning of screening and identification of people susceptible to risk and the design of the intervention.

Related: Cancer Screening and Early Detection Cervical Cancer Cervical Cancer Screening

Masui K, Yoshida K, Takenaka T, et al.
A novel minimally invasive technique of high-dose rate image-based intracavitary brachytherapy for endometrial cancer using a single fine and soft, flexible applicator.
Anticancer Res. 2014; 34(5):2537-40 [PubMed] Related Publications
AIM: We report on a minimally invasive computed tomography (CT)/magnetic resonance imaging (MRI)-based image-guided intracavitary brachytherapy (ICBT) for an elder patient with endometrial cancer, who was unfit for anesthesia, using a fine and soft flexible applicator.
PATIENTS AND METHODS: The patient was an 82-year-old female. She was identified as having T1bN0M0 (stage IB) tumor, and histological findings revealed grade 2 adenocarcinoma. She was contraindicated for surgery because of advanced age and severe pulmonary emphysema; therefore, she was managed with CT/MRI-based ICBT alone. The total treatment dose was 26 Gy (6.5 Gy per fraction). The dose-volume histogram of the gross tumor volume, the clinical target volume, and organs at risk were calculated.
RESULTS: The patient safely completed the ICBT course without pre-medication. Tumor growth was controlled, with complete disappearance after 32 months. No acute or late adverse effects were observed. MRI-guided ICBT can visualize the gross tumor volume in the uterine body, which cannot be detected by CT.
CONCLUSION: We successfully and safely performed minimally invasive CT/MRI-based ICBT without pre-medication in a patient with endometrial cancer with high surgical risks, using a fine and soft, flexible applicator.

Related: Brachytherapy Endometrial (Uterus) Cancer Endometrial Cancer

Tinelli R, Litta P, Meir Y, et al.
Advantages of laparoscopy versus laparotomy in extremely obese women (BMI>35) with early-stage endometrial cancer: a multicenter study.
Anticancer Res. 2014; 34(5):2497-502 [PubMed] Related Publications
BACKGROUND: The aim of the present study was to demonstrate the advantages of laparoscopy versus laparotomy for treatment of extremely obese women with early-stage endometrial cancer.
MATERIALS AND METHODS: Seventy-five extremely obese patients with Body Mass Index >35 kg/m(2) and clinical stage I endometrial cancer underwent hysterectomy and bilateral salpingo-oophorectomy, and in all cases we performed systematic pelvic lymphadenectomy by laparoscopy (mean BMI of 38±7.3 kg/m(2)) or laparotomy (mean BMI of 39±8.1 kg/m(2)).
RESULTS: In two (4.4%) patients of the laparoscopy group we observed a port site haematoma that was resolved without a second surgery. In three patients of the laparotomy-group, we observed dehiscence of the abdominal suture with surgical site infection that was re-sutured.
CONCLUSION: Laparoscopy can be considered a safe and effective therapeutic procedure for managing early-stage endometrial cancer in extremely obese women with a lower complication rate, lower surgical site infection and postoperative hospitalization.

Related: Endometrial (Uterus) Cancer Endometrial Cancer

Tsubamoto H, Sonoda T, Yamasaki M, Inoue K
Impact of combination chemotherapy with itraconazole on survival of patients with refractory ovarian cancer.
Anticancer Res. 2014; 34(5):2481-7 [PubMed] Related Publications
BACKGROUND: After progression during chemotherapy, persistent ovarian cancer rarely responds to cytotoxic agents. We evaluated the use of adjunctive itraconazole for treating refractory ovarian cancer.
PATIENTS AND METHODS: Medical records of patients with ovarian cancer were retrospectively reviewed to select those with a history of platinum and taxane administration, clinical progression within six months of the last platinum administration, continuation of chemotherapy after the first progression during chemotherapy.
RESULTS: Among 55 patients, itraconazole in combination with chemotherapy was administered to 19 patients. The median progression-free survival (PFS) was 103 days and 53 days for chemotherapy with and without itraconazole, respectively (p=0.014). The corresponding median overall survival was 642 days and 139 days, respectively (p=0.006). The hazard ratio for PFS was 0.24 (p=0.002) and for overall survival was 0.27 (p=0.006) for therapy with itraconazole.
CONCLUSION: Adjunctive itraconazole is promising for patients with refractory ovarian cancer.

Related: Carboplatin Ovarian Cancer

Hou MM, Liu X, Wheler J, et al.
Outcomes of patients with metastatic cervical cancer in a phase I clinical trials program.
Anticancer Res. 2014; 34(5):2349-55 [PubMed] Related Publications
BACKGROUND: We evaluated clinical outcomes of patients with metastatic cervical cancer referred to a Phase I Clinical Trials Program.
PATIENTS AND METHODS: We reviewed the electronic medical records of 54 consecutive phase I patients with metastatic cervical cancer over 6.5 years and analyzed the correlation between clinical outcome and potential predictors.
RESULTS: All patients had received at least one systemic therapy for metastatic disease before referral. Only two patients declined phase I trial therapy. The median progression-free (PFS) and overall (OS) survivals were 3.6 and 10.6 months, respectively. Patients harboring phosphatidylinositol-4,5-bisphosphate 3-kinase, catalytic subunit alpha (PIK3CA) mutations or phosphatase and tensin homolog loss, and those with more than two sites of metastasis who received more than one prior systemic chemotherapy before the referral had median PFS of 6.7 and 1.8 months, and median OS of 12.6 and 2.9 months, respectively.
CONCLUSION: Patients with more than two metastatic sites who had received more than one prior system therapy had dismal outcomes. An aberrant PI3K pathway was frequently identified and associated with favorable outcome, providing a promising target.

Related: Cervical Cancer

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