Genezen van voorstadium maar toch cervixcarcinoom

Patients with histologically confirmed cervical intraepithelial neoplasia (CIN) grade 1-3 who have completed a 2-year follow-up period with three negative cytological test results show an incidence of invasive carcinoma of 35.1 per 100,000 women years. Their risk for invasive cancer is 4-fold the risk in healthy women who had a negative primary test result. It has been proposed that this group should be kept in long-term, frequent follow-up. The author argues that if cervical cancer develops in these women, the treatment and diagnostics of CIN might have been incorrect. If the thickness of the electrosurgically excised tissue strips is insufficient, more deeply situated parts of the cervical crypts may be left behind in the stroma. After healing, cervical carcinoma may develop beneath a normal surface if these parts of the crypts contain intraepithelial neoplastic cells. This carcinoma is not amenable to early diagnosis. Before deciding on a more intense follow-up, we have to investigate the quality of the diagnostics and treatment in this group of wome

Complications after surgery for the relief of dyspareunia in women with lichen sclerosus: a case series

IntroductionThe objective of this study was to analyse complications after surgical intervention on the vulva, especially with grafting of the vaginal epithelium, for the relief of dyspareunia in women with lichen sclerosus. Material and methodsA case series of 23 women with histologically confirmed lichen sclerosus who underwent vulvar surgery because of disabling sexual dysfunction. Surgical care was provided in a university hospital (tertiary referral center) between 2008 and 2012. The interventions were posterior vestibuloplasty (perineoplasty), dehooding of the glans clitoridis and anterior vestibuloplasty with grafts of vaginal epithelium. ResultsA posterior vestibuloplasty was performed in all 23 women. Short-term complications included postoperative infection with subtotal dehiscence of the advanced vaginal epithelium (n = 1), and reactivation of lichen sclerosus with the formation of bullae due to the postoperative discontinuation of dermatosteroid use (n = 1). The long-term complications included localized pain (n = 3); although the relation with the surgical intervention was unclear. Four women underwent dehooding of the glans clitoridis, all without complications. Anterior vestibuloplasty with a free full-thickness graft of vaginal mucosa was performed in five women. One woman underwent a second operation because of contraction and keratinization of the graft. The importance of estrogens for the condition of the graft was unclear. ConclusionsAfter reconstructive vulvar surgery in women with lichen sclerosus, issues such as infection, reactivation of the disease and pain require attention. The use of vaginal grafts in the repair of the anterior vestibule is a novel approach and deserves further exploratio

Regional and temporal variation in hysterectomy rates and surgical routes for benign diseases in the Netherlands

Objective. To provide descriptive statistics on hysterectomy for benign gynecological conditions in the Netherlands and to analyze regional and temporal variations in hysterectomy rates and surgical routes. Design. Retrospective cohort study. Setting. Dutch hospitals. Population. All women with a hysterectomy for benign gynecological conditions in the Netherlands in 19952005. Methods. This study is based on an analysis of the Dutch registry of hospital admissions for 19952005. Main outcome measures. The age-adjusted hysterectomy rate and age- and diagnosis-adjusted proportion of vaginal hysterectomies for each Dutch healthcare region and time period. Results. The average annual crude hysterectomy rate for benign disease only, was 17.2 per 10 similar to 000 women of all ages. The vaginal route was chosen for 50.8% of the patients. During the study period, the number of hysterectomies for bleeding disorders declined almost 25%. Among 27 Dutch healthcare regions, the age-adjusted hysterectomy rates for bleeding disorders and pelvic organ prolapse varied 2.2- and 2.3-fold, respectively. The average annual age- and diagnosis-adjusted proportion of vaginal hysterectomies varied from 43.4 to 63.8%. The regional differences with regard to rate and proportion declined slightly over time. Conclusions. The Netherlands is among the countries with the lowest hysterectomy rates and the highest proportion of vaginal hysterectomies. The regional differences indicate that a further decrease in the hysterectomy rates and an increase in the proportion of vaginal hysterectomies are possibl

The impact of performance status on survival in patients of 80 years and older with vulvar cancer

Objective. There are no data available on the impact of performance status on outcome in patients with vulvar cancer. It was the objective of this study to determine the impact of performance status on survival in a group of elderly patients. Methods. A retrospective review of records of patients with vulvar cancer aged 80 years or greater and treated in a gynecological referral center was performed. Multiple clinical and pathological variables together with performance status were assessed and the impact on overall survival was determined both by univariate and multivariate analysis. Results. Of 75 patients aged 80 years or older, 57 (76%) had standard treatment. The patients who had standard treatment were characterized by an earlier clinical stage and a better performance status compared with patients who had nonstandard treatment. When preoperatively available parameters of all patients were assessed in relation to survival in the total group, Eastern Cooperative Oncology Group (ECOG) performance status was the only independent prognostic indicator for survival. When all clinical and histopathological variables were assessed in the subgroup who had standard treatment, both ECOG performance status and extracapsular lymph node involvement were independent prognostic variables for overall survival. Age was not a significant prognostic variable. Conclusions. ECOG performance status is the only available pretreatment variable with independent prognostic value for survival in this group of elderly patients with vulvar cancer. These data show the importance of individualizing the treatment of patients with vulvar cancer. Performance status takes a more important place than age in the management process of these patients. (C) 2002 Elsevier Science (USA

Renal ultrasound to detect hydronephrosis: A need for routine imaging after radical hysterectomy?

Background. Hydronephrosis can be a side effect of radical hysterectomy for cervical cancer. The incidence of clinically relevant hydronephrosis has not been studied in a large sample and the benefit of early detection of hydronephrosis is not clear. Objective. To assess the incidence of hydronephrosis, following radical hysterectomy and evaluate the usefulness of routine renal ultrasound (RH). Methods. Retrospective study, January 1998 and December 2008. Cervical cancer patients (FIGO stage IBI-IIA), treated with radical hysterectomy and pelvic lymph node dissection with or without adjuvant radiotherapy, without surgical lesion of the ureter, followed-up 6 months in the Academic Medical Center Amsterdam. Routine renal ultrasound was performed four weeks after RH, and in some on indication before or after the routine ultrasound. We documented which interventions for hydronephrosis were performed and evaluated the profile of patients at risk for hydronephrosis. Results. 281 patients were included: 252 (90%) underwent routine renal ultrasound and 29 (10%) underwent imaging on indication before routine ultrasound. The overall incidence of hydronephrosis was 12%. In symptomatic patients, the incidence was 21% and 9% in asymptomatic women undergoing routine ultrasound. Four patients were invasively treated for hydronephrosis (1% of the total group) after imaging for clinical suspicion of hydronephrosis. Patients with hydronephrosis were significantly more often treated with radiotherapy than patients without (43% versus 25% (p = 0.03). Conclusion. There is no place for routine renal ultrasound following radical hysterectomy. Patients should be instructed about the symptoms that may be related to hydronephrosis, to allow for renal ultrasound on indication. (C) 2011 Elsevier Inc. All rights reserve

Severe Pelvic Floor Symptoms After Cervical Cancer Treatment Are Predominantly Associated With Mental and Physical Well-Being and Body Image A Cross-Sectional Study

Objective: To identify associations between demographic, disease-related, and psychological variables and severe distress from pelvic floor symptoms (PFSs) after cervical cancer treatment. Methods: This study was cross-sectional and questionnaire based. We included patients with cervical cancer treated between 1997 and 2007 in the Academic Medical Center, Amsterdam. Pelvic floor symptoms were assessed with urogenital distress inventory and defecatory distress inventory. Scores were dichotomized into severe (>90th percentile) versus nonsevere distress. Disease-related variables were extracted from medical files. Psychological factors included mental and physical well-being, optimism, and body image, which were assessed with standardized questionnaires. Univariate and multivariate logistic regression analyses were performed. Results: A total of 282 patients were included: 148 were treated with radical hysterectomy and pelvic lymph node dissection, 61 patients were treated with surgery and adjuvant radiotherapy, and 73 patients were treated with primary radiotherapy. Demographic: Multivariate analyses showed no significant relation between demographic variables and symptoms. Disease-related: None of these variables were significantly associated in multivariate analyses. Psychosocial: In all treatment groups, multivariate associations were found. In general, better mental and physical well-being was associated with nonsevere PFSs. Increased body image disturbance was associated with severe defecation symptoms. Conclusions: Few associations were found between demographic and disease-related variables and distress from PFS after cervical cancer treatment. However, better mental and physical well-being is associated with nonsevere distress from urogenital and defecation symptoms and more body image disturbance with severe PFSs. Improving these factors might reduce distress from PFSs and should be a focus of future researc

Long-term sexual function in survivors of vulvar cancer: A cross-sectional study

Objectives. To assess sexual function of vulvar cancer survivors who received extensive and less extensive treatment. To explore associations between sexual function and patient, disease, treatment, and psychological variables. Methods. Sexual function (Female Sexual Function Index, FSFI), mental and physical well-being (SF36 Health Survey), body image (Body Image Scale), and optimism (Life Orientation Test) were assessed in vulvar cancer survivors treated in the period January 1997-January 2007. Demographic, disease and treatment characteristics were collected from medical files. Radical local excision with inguinal lymph node dissection and radical vulvectomy were considered extensive treatments; radical local excision, with or without sentinel node dissection, was considered less extensive treatment. Univariate and multivariate linear regression analyses were performed. Results. Of 120 eligible patients, 76 (63%) responded. Eighteen women with a male partner (43%) reported having sexual intercourse. FSFI domain scores did not differ between extensively and less extensively treated women. Age was negatively associated with "Arousal" and "Desire", having a partner was positively associated with "Satisfaction", and optimism and physical well-being were positively associated with "Desire" and "Orgasm". Adjuvant inguinal radiotherapy was negatively associated with "Orgasm". One woman reported having better sexual function after than before treatment, 50% reported a similar sexual function, and 42% a worse sexual function. Conclusions. 43% of women who survived vulvar cancer and who had a male partner were sexually active. Treatment-related variables had a limited influence on long-term sexual function in these patients. Having a partner, good physical well-being, and being optimistic were positively associated with sexual function. (c) 2012 Elsevier Inc. All rights reserve

Prognostic Value of Bilateral Positive Nodes in Squamous Cell Cancer of the Vulva

Objectives: The aim of the current study was, first, to determine whether laterality of lymph node metastases has prognostic significance, independent of the number of lymph node metastases. Second was to determine the prognostic significance of extracapsular spread irrespective of the number of lymph node metastases. Methods: Data on 134 patients with stage III/IVA vulva cancer from 1982 till 2004 and treated with curative intent in either the Academic Medical Centre in Amsterdam or the Mercy Hospital for Women in Melbourne were reviewed. The impact of the number of lymph node metastases, extracapsular spread, and bilateral existence of lymph node metastases on survival was determined. Results: The bilateral presence of lymph node metastases is not a significant predictor for survival if a correction is made for the number of lymph node metastases (hazards ratio, 1.3 1; 95% confidence interval, 0.68-2.51; P = 0.420). If extracapsular spread is put into the model as well, this is the only parameter of prognostic significance in multivariate analysis (hazards ratio, 5.27; 95% confidence interval, 2.60-10.67; P <0.001). The five-year survival of patients with extracapsular spread is only 31%, which is considerably lower than the 80% survival of patients with only intracapsular metastases. Conclusions: In conclusion, there is growing evidence that bilateral existence of lymph node metastases is not a sufficient variable to qualify stage. Extracapsular spread, however, seems to be the most valuable lymph node-associated prognostic factor for surviva

Validation of existing prognostic models in patients with early-stage cervical cancer

Objective. Models that predict survival and recurrence in patients with early-stage cervical cancer are important tools in patient management, We validated 12 existing prognostic models in an independent population of patients with early-stage cervical cancer. Materials and Methods. We searched the literature for prognostic models in patients with surgically treated early-stage cervical cancer. The prognostic performance of these models was assessed in a consecutive group Of Surgically treated patients with early-stage cervical cancer treated in our hospital between 1982 and 2004. The performance of the models was visually assessed with calibration plots, which display the relation between the predicted and observed survival. Results. Twelve published prognostic models met the inclusion criteria. The models categorized the patients into two to four risk groups. Prognostic factors most frequently used in these models were depth of invasion, lymph node metastasis, vascu/vascular space involvement, and tumor size. The models were validated in 563 consecutive patients with early-stage cervical cancer. All of the models underestimated the recurrence-free Survival or disease-specific survival in our patients. Only two models performed reasonably well in our population. The use of more than three prognostic categories in the models was not meaningful. Conclusion. In general, the models underestimated the survival. Only 2 of the 12 prognostic models for patients with early-stage cervical cancer were valid for the prediction of the recurrence-free or disease-specific Survival in our patient Population. (C) 2009 Elsevier Inc. All rights reserve

Prognostic Model for Survival in Patients With Early Stage Cervical Cancer

BACKGROUND: In the management of early stage cervical cancer, knowledge about the prognosis is critical. Although many factors have an impact on survival, their relative importance remains controversial. This study aims to develop a prognostic model for survival in early stage cervical cancer patients and to reconsider grounds for adjuvant treatment. METHODS: A multivariate Cox regression model was used to identify the prognostic weight of clinical and histological factors for disease-specific survival (DSS) in 710 consecutive patients who had surgery for early stage cervical cancer (FIGO [International Federation of Gynecology and Obstetrics] stage IA2-IIA). Prognostic scores were derived by converting the regression coefficients for each prognostic marker and used in a score chart. The discriminative capacity was expressed as the area under the curve (AUC) of the receiver operating characteristic. RESULTS: The 5-year DSS was 92%. Tumor diameter, histological type, lymph node metastasis, depth of stromal invasion, lymph vascular space invasion, and parametrial extension were independently associated with DSS and were included in a Cox regression model. This prognostic model, corrected for the 9% overfit shown by internal validation, showed a fair discriminative capacity (AUC, 0.73). The derived score chart predicting 5-year DSS showed a good discriminative capacity (AUC, 0.85). CONCLUSIONS: In patients with early stage cervical cancer, DSS can be predicted with a statistical model. Models, such as that presented here, should be used in clinical trials on the effects of adjuvant treatments in high-risk early cervical cancer patients, both to stratify and to include patients. Cancer 2011;117:768-76. (C) 2010 American Cancer Societ