Raynaud’s phenomenom as a first manifestation of high grade serosus carcinoma – case report

Cilj: Prikazati slučaj pacijentice s Raynaudovim fenomenom kao prvom manifestacijom seroznog karcinoma visokog gradusa te dijagnostički i terapijski postupak. Prikaz slučaja: Pacijentica stara 47 godina upućena je na Odjel za reumatologiju i kliničku imunologiju zbog pozitivnih antinuklearnih antitijela i Raynaudova fenomena. Kliničkim pregledom i laboratorijskom obradom isključena je sistemska bolest vezivnog tkiva. Ultrazvukom abdomena uočena je cistična tvorba u području zdjelice. Tumorski markeri CA-125, HE-4 bili su povišeni. PET/CT analizom (pozitronska emisijska tomografija / kompjutorizirana tomografija) uočeno je pojačano nakupljanje radiofarmaka u supra/retroklavikularnim limfnim čvorovima, zdjelično i paraaortalno. Citološka punkcija limfnog čvora na vratu upućivala je na metastatski slabodiferencirani adenokarcinom. Učinjena je laparoskopija desnog i lijevog jajnika, obostrana salpingektomija te zdjelična limfadenektomija. Patohistološka analiza potvrdila je da se radi o intraepitelnom seroznom karcinomu visokog gradusa jajovoda. Nakon dijagnostičke obrade provedeno je 6 ciklusa kemoterapije (Paklitaksel i Carboplatina). Na kontrolnom CT-u nije bilo znakova diseminacije osnovne bolesti. Pacijentica je trenutno dobrog općeg stanja i liječi se Olaparibom. Raynaudov fenomen je u značajnom poboljšanju. Zaključak: Serozni karcinom visokog gradusa može se prezentirati na atipičan način. Iznenadna pojava Raynaudova fenomena kod mlađih osoba treba pobuditi sumnju na moguću malignu bolest.Aim: To present a case of a patient with Raynaud’s phenomenom as the first manifestation of a high grade serosus carcinoma. Case report: A 47-year-old female has been referred to the Department of Rheumatology and Clinical Immunology due to the positive antinuclear antibodies and Raynaud’s phenomena. Both clinical examination and laboratory treatment excluded systemic connective tissue disease. Abdominal ultrasound revealed cystic formation in the pelvis area. Tumor markers CA-125, HE-4 were elevated. PET / CT analysis (positron emission tomography/computed tomography) observed increased radiotracer uptake involving supra/retroclavicular lymph nodes, pelvic and paraortal. The cytology of the lymph node at the neck indicated a metastatic weak-bound adenocarcinoma. Left and right ovarian laparoscopy, double salpingectomy and pelvic lymphadenectomy were performed. The pathological analysis confirmed that it was intraepithelial serous high grade fallopian tube cancer. The patient went to 6 cycles of chemotherapy (Paclitaxel and Carboplatin). Follow up CT didn’t show any signs of dissemination of the underlying disease. The patient is currently in a good general condition and treated with Olaparib. Raynaud’s phenomenon is significantly improved. Conclusion: Serous high-grade cancer can be presented in an atipic manner. The sudden occurrence of Raynaud’s phenomena in younger people should raise doubts about possible malignancy

Effectiveness and Safety of Immune Checkpoint Inhibitors in Older Cancer Patients

Background: The development of immunotherapy checkpoint inhibitors (ICIs) has revolutionized cancer care. However, old patients are underrepresented in most clinical trials, although they represent a significant proportion of real-world patients. We aimed to evaluate the effectiveness and safety of ICIs in patients older than the age of 70. Methods: We performed a retrospective chart review of 145 patients aged 70 or older treated with ICIs for metastatic or unresectable cancer. Results: Median progression-free survival (PFS) was 10.4 months (95% CI 8.6–13.7), with no differences between octogenarians and septuagenarians (p = 0.41). Female gender (p = 0.04) and first-line treatment setting (p 0.005). Patients treated with ICIs in the first-line setting reported longer OS compared to treatment in the second-line setting (p < 0.001). Discontinuation of ICIs due to adverse effects was associated with both shorter PFS (p = 0.0005) and OS (p < 0.0001). Conclusion: The effectiveness of ICIs in older cancer patients primarily depends on the line of treatment and treatment discontinuation. Octogenarians experienced similar treatment responses, PFS, OS, and adverse effects compared to septuagenarians

CLINICAL RECOMMENDATIONS FOR DIAGNOSING, TREATMENT AND MONITORING OF PATIENTS WITH ENDOMETRIAL CANCER – CROATIAN ONCOLOGY SOCIETY AND CROATIAN SOCIETY FOR GYNECOLOGY AND OBSTETRICS AS CROATIAN MEDICAL ASSOCIATION UNITS AND CROATIAN SOCIETY OF GYNECOLOGICAL ONCOLOGY

Rak trupa maternice javlja se u većini slučajeva u poslijemenopauzalnih žena, a najčešće se očituje ginekološkim krvarenjem. Nakon raka jajnika i vrata maternice treći je uzrok smrti žena od raka spolnog sustava. Dijagnoza se postavlja patohistološkim pregledom kiretmana ili bioptata, a definitivni stadij bolesti utvrđuje se analizom uzoraka dobivenih histerektomijom i obostranom salpingoovariektomijom sa zdjeličnom i paraaortalnom limfadenektomijom. U tekstu koji slijedi sadržane su kliničke upute s ciljem standardizacije postupaka i kriterija postavljanja dijagnoze, liječenja i praćenja bolesnica s rakom trupa maternice u Republici Hrvatskoj.Uterine cancer occurs mainly in postmenopausal women, usually as vaginal bleeding. Following ovarian and cervical cancer it is the third most common cause of female reproductive system cancer death. Diagnosis is set by analyzing samples obtained via hysterectomy with salpingo-oophorectomy and pelvic / paraaortal lymphadenectomy. The following text presents the clinical guidelines in order to standardize the procedures and criteria for the diagnosis, treatment and monitoring of patients with uterine cancer in the Republic of Croatia

CLINICAL RECOMMENDATIONS FOR DIAGNOSING, TREATMENT AND MONITORING OF PATIENTS WITH ENDOMETRIAL CANCER – CROATIAN ONCOLOGY SOCIETY AND CROATIAN SOCIETY FOR GYNECOLOGY AND OBSTETRICS AS CROATIAN MEDICAL ASSOCIATION UNITS AND CROATIAN SOCIETY OF GYNECOLOGICAL ONCOLOGY

Rak trupa maternice javlja se u većini slučajeva u poslijemenopauzalnih žena, a najčešće se očituje ginekološkim krvarenjem. Nakon raka jajnika i vrata maternice treći je uzrok smrti žena od raka spolnog sustava. Dijagnoza se postavlja patohistološkim pregledom kiretmana ili bioptata, a definitivni stadij bolesti utvrđuje se analizom uzoraka dobivenih histerektomijom i obostranom salpingoovariektomijom sa zdjeličnom i paraaortalnom limfadenektomijom. U tekstu koji slijedi sadržane su kliničke upute s ciljem standardizacije postupaka i kriterija postavljanja dijagnoze, liječenja i praćenja bolesnica s rakom trupa maternice u Republici Hrvatskoj.Uterine cancer occurs mainly in postmenopausal women, usually as vaginal bleeding. Following ovarian and cervical cancer it is the third most common cause of female reproductive system cancer death. Diagnosis is set by analyzing samples obtained via hysterectomy with salpingo-oophorectomy and pelvic / paraaortal lymphadenectomy. The following text presents the clinical guidelines in order to standardize the procedures and criteria for the diagnosis, treatment and monitoring of patients with uterine cancer in the Republic of Croatia

Clinical guidelines for diagnosis, treatment and monitoring of patients with malignant tumors of uterine corpus

Rak tijela maternice, prema zadnjim podatcima Registra za rak iz 2017. godine u Republici Hrvatskoj, nalazi se na četvrtom mjestu po učestalosti, a na osmom mjestu po smrtnosti. Najčešće se dijagnosticira u postmenopauzalnih žena, većinom u dobi od 50. do 79. godine života. Dijagnoza karcinoma endometrija utvrđuje se patohistološkom analizom kiretmana ili bioptata sluznice maternice, a stupanj proširenosti bolesti primjenom slikovnih metoda. U većine bolesnica bolest se otkriva u lokaliziranom stadiju te se uspješno liječi operativno, a ovisno o patohistološkom nalazu i primjenom odgovarajuće adjuvantne terapije. Lokalno uznapredovala bolest najčešće se liječi operativno uz adjuvantnu terapiju, a metastatska primjenom kemoterapije ili hormonske terapije. Mezenhimalni tumori tijela maternice liječe se operativno uz dodatak sistemske terapije adjuvantno ili samo sistemskom terapijom u slučaju diseminirane bolesti. Ove kliničke upute pisane su u cilju postizanja najviših standarda i ujednačenja postupaka u dijagnosticiranju, liječenju i praćenju bolesnica sa zloćudnim tumorima tijela maternice u Republici Hrvatskoj.Uterine cancer, according to the latest data from the 2017 Croatian Cancer Registry, is the fourth most common cancer in women in Croatia and ranking eighth in mortality. Most commonly, it is diagnosed in postmenopausal women at the age 50–79. Endometrial cancer diagnosis is determined by pathohistological analysis of curettage or biopsy and the stage of the disease by radiological imaging. In most patients, the disease is diagnosed in the localized stage and is successfully treated surgically; depending on the pathohistological finding, appropriate adjuvant therapy could be applied. Locally advanced disease is most commonly treated surgically with adjuvant therapy, and metastatic with chemotherapy or hormone therapy. Mesenchymal tumors of the uterine body are treated surgically with the addition of systemic adjuvant therapy, or only systemic therapy in the case of metastatic disease. The following manuscript presents clinical guidelines to standardise procedures for the diagnosis, treatment and follow-up of patients with malignant tumors of the uterus in the Republic of Croatia

Clinical guidelines for diagnosis, treatment and monitoring of patients with cervical cancer

Rak vrata maternice, u odnosu na novotvorine drugih ginekoloških sijela, bolest je žena mlađe životne dobi koja se može prevenirati zdravstvenim odgojem i cijepljenjem adolescentske populacije te preventivnim i redovitim ginekološkim pregledima, a u ranim stadijima bolesti i učinkovito liječiti. Metode liječenja uključuju kirurgiju, radioterapiju i sistemnu terapiju, ovisno o stadiju bolesti i općem stanju bolesnica. Odluku o liječenju donosi multidisciplinarni tim u koji trebaju biti uključeni ginekolozi, radiolozi, klinički onkolozi, patolozi, citolozi i po potrebi kirurzi i urolozi. Uspjeh liječenja uvelike ovisi o njihovoj međusobnoj suradnji i kvalitetnoj komunikaciji u razmjeni iskustava i nalaza. S obzirom na važnost ove bolesti i posljedice koje ostavlja na obitelj i društvo potrebno je definirati i provoditi standardizirani pristup u dijagnostici, liječenju i praćenju ovih bolesnica. U tekstu koji slijedi iznesene su obnovljene i nadopunjene kliničke smjernice s ciljem implementacije standardiziranih postupaka u radu s bolesnicama s rakom vrata maternice u Republici Hrvatskoj.Cervical cancer, in comparison with other gynecological malignancies, mainly affects younger women. It can be prevented through educational programs, vaccination, screening and early detection. In early stages it can also be effectively treated. Treatment modalities include surgery, radiotherapy and systemic therapy according to stage of the disease and patient condition. Treatment decisions should be made through multidisciplinary team meetings that consist of gynecologists, radiologists, clinical oncologists, pathologists, cytologists and if necessary surgeons and urologists. The success rate of the treatment depends significantly on their good and thorough communication and cooperation. Due to the significance and impact of this disease it is important to define and implement a standardized algorithm and approach for diagnostics, treatment and monitoring. The following text presents up-dated and supplemented clinical guidelines for the standardization of the diagnostic criteria, management, treatment and monitoring of patients with uterine cervical cancer in the Republic of Croatia