Ovarian Cysts and Ovarian Cancer

Ovarian cysts and tumours are a relatively common finding among women of many ages, particularly with the wider use of regular physical examinations and ultrasound. Most cysts and tumours in younger women are not malignant and can often be managed entirely within primary care. However, malignant tumours also occur. The average GP will see a new case of ovarian cancer every 4 to 5 years. Ovarian cancer is the second most common cancer of the female genital tract and the leading cause of death due to gynaecological malignancy. Ovarian cancer is frequently diagnosed at a late stage and carries a poor prognosis. Guidance published by the National Institute for Health and Clinical Excellence (NICE) in 2011 recognises this fact and recommends changes to the way in which cases are detected and managed in primary care. This article is a revision of a previous InnovAiT publication, incorporating recent changes to recommended practice

Is conservative treatment for adenocarcinoma in situ of the cervix safe?

Jusque vers 1800, la ville de Mitau est perçue essentiellement comme une cité germanique, sans véritable prise en compte de la diversité des nations qui y vivent, au premier rang desquelles les Lettons. Progressivement, le désintérêt apparent pour les autres peuples fait place à une réflexion concernant la transmission des modes de vie, des mœurs et des langues par la fréquentation quotidienne. Pour les observateurs allemands ou français, le trait typique de la société locale apparaît désormais être le « mélange », dont la définition peut considérablement varier.Bis 1800 wird die Stadt Mitau hauptsächlich als eine deutsche Stadt wahrgenommen, wobei die dort befindlichen Nationen wie ausgeklammert werden, allen voran die Letten. Allmählich wird anstatt des scheinbar mangelnden Interesses für andere Völker die Frage der Vermittlung der Lebensweisen, der Sitten und der Sprachen durch den alltäglichen Umgang thematisiert. Für deutsche und französische Beobachter scheint nun der typische Zug dieser Gesellschaft im « Gemisch » zu liegen, das allerdings unterschiedlich definiert werden kann.Until 1800 the city of Mitau was primarily perceived as a German town, without taking into account the diversity of the nations living there, in particular the Latvians. Progressively, instead of the apparent lack of interest for other people, some reflections begin to be formulated about the transmission of ways of life, habits and languages via everyday life. For German and French observers, the characteristic seemed to be one of “mixing”, the definition of which could vary

Unilateral inguinofemoral lymphadenectomy in patients with early-stage vulvar squamous cell carcinoma and a unilateral metastatic sentinel lymph node is safe

Objective. Optimal management of the contralateral groin in patients with early-stage vulvar squamous cell carcinoma (VSCC) and a metastatic unilateral inguinal sentinel lymph node (SN) is unclear. We analyzed patients who participated in GROINSS-V I or II to determine whether treatment of the contralateral groin can safely be omitted in patients with a unilateral metastatic SN.Methods. We selected the patients with a unilateral metastatic SN from the GROINSS-V I and II databases. We determined the incidence of contralateral additional non-SN metastases in patients with unilateral SN-metastasis who underwent bilateral inguinofemoral lymphadenectomy (IFL). In those who underwent only ipsilateral groin treatment or no further treatment, we determined the incidence of contralateral groin recurrences during follow-up.Results. Of 1912 patients with early-stage VSCC, 366 had a unilateral metastatic SN. Subsequently, 244 had an IFL or no treatment of the contralateral groin. In seven patients (7/244; 2.9% [95% CI: 1.4%-5.8%]) disease was di-agnosed in the contralateral groin: five had contralateral non-SN metastasis at IFL and two developed an isolated contralateral groin recurrence after no further treatment. Five of them had a primary tumor >= 30 mm. Bilateral ra-diotherapy was administered in 122 patients, of whom one (1/122; 0.8% [95% CI: 0.1%-4.5%]) had a contralateral groin recurrence.Conclusion. The risk of contralateral lymph node metastases in patients with early-stage VSCC and a unilateral metastatic SN is low. It appears safe to limit groin treatment to unilateral IFL or inguinofemoral radiotherapy in these cases.(c) 2022 The Authors. Published by Elsevier Inc. This is an open access article under the CC BY license (http:// creativecommons.org/licenses/by/4.0/)

Radiotherapy Versus Inguinofemoral Lymphadenectomy as Treatment for Vulvar Cancer Patients With Micrometastases in the Sentinel Node: Results of GROINSS-V II

PURPOSE The Groningen International Study on Sentinel nodes in Vulvar cancer (GROINSS-V)-II investigated whether inguinofemoral radiotherapy is a safe alternative to inguinofemoral lymphadenectomy (IFL) in vulvar cancer patients with a metastatic sentinel node (SN).METHODS GROINSS-V-II was a prospective multicenter phase-II single-arm treatment trial, including patients with early-stage vulvar cancer (diameter 2 mm and/or extracapsular spread. The protocol was amended so that those with SN macrometastases (> 2 mm) underwent standard of care (IFL), whereas patients with SN micrometastases (<= 2 mm) continued to receive inguinofemoral radiotherapy. Among 160 patients with SN micrometastases, 126 received inguinofemoral radiotherapy, with an ipsilateral isolated groin recurrence rate at 2 years of 1.6%. Among 162 patients with SN macrometastases, the isolated groin recurrence rate at 2 years was 22% in those who underwent radiotherapy, and 6.9% in those who underwent IFL (P = .011). Treatment-related morbidity after radiotherapy was less frequent compared with IFL.CONCLUSION Inguinofemoral radiotherapy is a safe alternative for IFL in patients with SN micrometastases, with minimal morbidity. For patients with SN macrometastasis, radiotherapy with a total dose of 50 Gy resulted in more isolated groin recurrences compared with IFL. (C) 2021 by American Society of Clinical OncologyBiological, physical and clinical aspects of cancer treatment with ionising radiatio