Adenocarcinoma of the Uterine Cervix and its Precursor Lesion

__Abstract__ More than 2000 years have elapsed since the first description of cervical cancer by Hippocrates. Aretaeus, an ancient Greek physician practicing in the first century before Christ, described uterine cancer as superficial and deep ulcers, which later infiltrate the uterus1 • In 1812 John Clarke described a peculiar degeneration of the cervix, which he called a cauliflower tumor because of it's appearance2• Charles Mansneld Clarke introduced the term carcinoma uteri in 1821 and Hooper identified the cauliflower as a carcinoma of the cervix in 18323. Initia lly there was no distinction between cervical and endometrial carcinoma. Adenoma malignum was used for highly differentiated glandular carcinomas, without distinction in origin. When it became clear that cervical cancer was a separate entity, different types of cervical cancer were described. In German literature Portiokarzinom (karzinom der ektocervix, squamous cell carcinoma origi nating from the portio vaginalis) and Zervixhohlenkarzinom (karzinom der endocervix, adenocarcinoma arizing from the cervical channei)H were dist inguished. Ruge and Veit 1881 and later the school of Schroeder different iated between a portio carcinoma, arising from the connective tissue oft he cervix or from columnar epithelial erosions and cervical carcinoma arising from de cervical glands or from the connective tissue. Treub in 1892 proposed another classification, based on the extension of the different tumor types. He described t he carcinoma of the cervix, also called cancroid or epithelioma as a cancer which originated from the squamous epithelium of the portio vaginalis and the 'Zervixcarcinoma' (cervical cancer) which originated from the cervical glands8 . Today, we speak of cervical carcinoma, without differentiating between portio and cervical cancer

Low preoperative skeletal muscle density is predictive for negative postoperative outcomes in older women with ovarian cancer

Objective. To determine the predictive value of lumbar skeletal muscle mass and density for postoperative outcomes in older women with advanced stage ovarian cancer.Methods. A multicenter, retrospective cohort study was performed in women >= 70 years old receiving surgery for primary, advanced stage ovarian cancer. Skeletal muscle mass and density were assessed in axial CT slices on level L3. Low skeletal muscle mass was defined as skeletal muscle index = 2).Conclusion. Low skeletal muscle density, as a proxy of muscle quality, is associated with poor postoperative outcomes in older patients with advanced stage ovarian cancer. These findings can contribute to postoperative risk assessment and clinical decision making. (C) 2021 The Author(s). Published by Elsevier Inc.Cervix cance

Postoperative outcomes of primary and interval cytoreductive surgery for advanced ovarian cancer registered in the Dutch Gynecological Oncology Audit (DGOA)

Objectives: The challenge when performing cytoreductive surgery (CRS) is to balance the benefits and risks. The aim of this study was to report short term postoperative morbidity and mortality in relation to surgical outcome in patients undergoing primary debulking surgery (PDS) or interval debulking (IDS) surgery in the Netherlands. Methods: The Dutch Gynecological Oncology Audit (DGOA) was used for retrospective analysis. Patients undergoing PDS or IDS between January 1st, 2015 - December 31st, 2018 were included. Outcome was frequency of postoperative complications. Median time to adjuvant chemotherapy and severity of complications were related to outcome of CRS. Complications with Clavien-Dindo ≥3 were analyzed per region and case mix corrected. Statistical analysis was performed with R.Studio. Results: 1027 patients with PDS and 1355 patients with IDS were included. Complications with re-invention were significantly higher in PDS compared to IDS (5.7% vs. 3.6%, p = 0.048). Complete cytoreduction was 69.7% in PDS and 62.1% IDS, p &lt; 0.001. Time to adjuvant chemotherapy was 49 days in patients with complete CRS and a complication with re-intervention. Regional variation for severe complications showed one region outside confidence intervals. Conclusions: Higher complete cytoreduction rate in the PDS group indicates that the correct patients have been selected, but is associated with a higher percentage of complication with re-intervention. As result, time to start adjuvant chemotherapy is longer in this group. Maintaining a balance in aggressiveness of surgery and outcome of the surgical procedure with respect to severe complications is underlined. Bench marked data should be discussed nationally to improve this balance.</p