Non-blood medical care in gynecologic oncology: a review and update of blood conservation management schemes

This review attempts to outline the alternative measures and interventions used in bloodless surgery in the field of gynecologic oncology and demonstrate their effectiveness. Nowadays, as increasingly more patients are expressing their fears concerning the potential risks accompanying allogenic transfusion of blood products, putting the theory of bloodless surgery into practice seems to gaining greater acceptance. An increasing number of institutions appear to be successfully adopting approaches that minimize blood usage for all patients treated for gynecologic malignancies. Preoperative, intraoperative and postoperative measures are required, such as optimization of red blood cell mass, adequate preoperative plan and invasive hemostatic procedures, assisting anesthetic techniques, individualization of anemia tolerance, autologous blood donation, normovolemic hemodilution, intraoperative cell salvage and pharmacologic agents for controlling blood loss. An individualised management plan of experienced personnel adopting a multidisciplinary team approach should be available to establish non-blood management strategies, and not only on demand of the patient, in the field of gynecologic oncology with the use of drugs, devices and surgical-medical techniques

The importance of intraoperative detection of sentinel node in vulvar cancer

Purpose: To evaluate the detectability and credibility of sentinel lymph node (SLN) in vulvar cancer. Methods: With Tc99m-nanocolloid and methylene blue we identified SLNs in 34 patients. In 27 cases both tracers were used, while in 7 only blue dye completion lymphadenectomy was performed in all patients. SLNs and non-SLNs were sent separately for pathologic evaluation. Results: At least one SLN was identified in all patients. Detection rate per groin was not significantly higher in the combined vs. blue dye only technique (42/50 vs. 10/14, p=0.43) 99m-Tc was not superior to blue dye in detecting SLN (42/50 vs. 50/64, p=0.65). Midline location of the tumor did not seem to negatively affect the procedure. Four false-negatives were observed in 3 patients with tumors >4cm. Negative predictive value of SLN was 100% for grade I tumors ≤4cm in patients ≤71 years. Conclusion: Tc-99m does not seem to be superior to methylene blue in the detection of SLN in vulvar cancer patients of younger age with small, well-differentiated tumors appear to be the most suitable candidates for lymphatic mapping.[…] Σκοπός της μελέτης μας είναι: 1. Η διαπίστωση της αξιοπιστίας μεθόδων που χρησιμοποιούνται για την ανίχνευση του φρουρού λεμφαδένα. 2. Η αξιολόγηση της αρνητικής προγνωστικής αξίας του σε ό,τι αφορά τους μηροβουβωνικούς λεμφαδένες Δηλαδή να διερευνηθεί, αν η ανίχνευση του φρουρού λεμφαδένα και η απουσία διήθησής του κατά την παθολογοανατομική εξέταση είναι αξιόπιστες παράμετροι, σε τέτοιο βαθμό, που να επιτρέπουν στην ομάδα αυτή των ασθενών να παραλείπεται ηβουβωνομηριαία λεμφαδενεκτομή, με τελικό στόχο τη μείωση της νοσηρότητας της επέμβασης. […

Does Cancer Therapy Causes Cancer? A Case Report and Mini Review of the Literature

The subject of whether cancer treatment causes cancer is less widely recognized but obviously not insignificant. Although previous studies have attempted to address the concept of “postradiation carcinoma” there is no direct evidence that these tumors are caused by radiation or simply present incident malignancies in an at-risk population. The risk of second primary cancer in women with cervical cancer in previously irradiated fields remains still unclear. We present an atypical case of endometrial cancer formerly submitted to pelvic irradiation because of cervical carcinoma and we discuss the eventual association of pelvic radiation with a subsequent endometrial carcinoma

Merkel cell carcinoma in pelvic lymph nodes after surgical staging for endometrial cancer: A case report and review of the literature

INTRODUCTION: Merkel cell carcinoma (MCC) is a rare malignant neuroendocrine tumor of the skin. PRESENTATION OF CASE: We present a case of MCC in pelvic lymph nodes, revealed after surgical staging for endometrial cancer. A 54-year-old Caucasian woman presented to our department with a threemonth history of postmenopausal bleeding. After proper preoperative evaluation, the patient underwent total abdominal hysterectomy, bilateral salpingo-ophorectomy and pelvic lymph node dissection. The pathology report confirmed the presence of a small, grade I, endometrioid adenocarcinoma and MCC in the pelvic lymph nodes. Primary site of the disease could not been retrieved. The tumor board decided adjuvant chemotherapy (carboplatin and etoposide) and close follow-up every 2 months. Our patient is alive with no evidence of disease 12 months after surgery. DISCUSSION: It is noteworthy that 19% of the patients with MCC had lymph node metastasis with no apparent primary lesion. The mechanism of this regression remains unclear, although a higher apoptotic activity has been observed in MCC than other skin tumors. In addition, other co-malignancies have also been linked to MCC patients. The explanation for the frequent occurrence of other primary neoplasms in patients with MCC is still unclear. However, a reasonable cause could be an altered genetic profile or an immuno-compromised situation in these patients. CONCLUSION: Further analytic investigations are needed to clarify the role of various factors in the spontaneous regression or not of this neuroendocrine tumor as well as in the simultaneous genesis of other primary carcinomas. © 2012 Surgical Associates Ltd