The assessment of spectral Doppler parameters in uterine arteries of patients with locally advanced squamous cell cervical cancer

Objectives: Evaluate spectral Doppler parameters peak systolic velocity (PSV), end diastolic velocity (EDV), resistance index (RI) and pulsatility index (PI) in infiltrated and non-infiltrated uterine arteries of patients with locally advanced (stages II B, III B) squamous cell cervical cancer and their changes during treatment.  Material and methods: the study group included 36 patients aged 35–78 years old. At diagnosis, PSV, EDV, RI and PI in uterine arteries were examined and compared with MRI findings. All patients underwent transvaginal doppler ultrasonography prior to the treatment, after external beam radiation therapy and six weeks after the last application of brachytherapy.  Results: The median PSV value in the first examination was higher in infiltrated uterine arteries than compared to non-infiltrated ones (p = 0.001). The PSV values for all vessels decreased between the first and the third observation (p < 0.001). There was a significant difference in PI values between infiltrated and non-infiltrated uterine arteries between the first and the third examination (p = 0.027).  Conclusions: In patients with locally advanced cervical cancer of uterine arteries, assessment of PSV but not EDV, RI or PI can be helpful in differentiating infiltrated from non-infiltrated vessels. In this group of patients, radiotherapy decreases PSV, but not EDV, RI or PI values in uterine arteries. An observation conducted from the onset of radiotherapy to end of the follow-up in uterine arteries reveals that PI, but not RI, PSV or EDV, is different in infiltrated and non-infiltrated vessels

Adnexal tumors after surgical treatment of colorectal cancer

Summary Objective: The risk of metastatic ovarian tumor is significantly higher in case of women with a history of colorectal cancer. Additionally, the possibility of developing ovarian cancer due to congenital mutations in suppressor genes should be assessed. Design: The purpose of the study was to evaluate the clinical presentation and histopathology of adnexal tumors in case of female patients with a history of colorectal adenocarcinoma. Material and methods: A retrospective study on 13 women (each with a history of colorectal carcinoma, operated due to adnexal tumor between 2004 and 2007), has been conducted. Subject characteristics, ultrasound, CT, serum tumor markers levels, histopathology and findings at surgery were analyzed. Results: Time distance between colorectal cancer surgery and ovarian tumor operation – measured in months – was shorter in cases of malignant neoplasms (10.13 +/- 3.98) than in benign tumors (26.2 +/- 19.37). Ultrasound examination showed solid-cystic adnexal tumors in 8 malignant cases, and ovarian cysts in 5 benign conditions. The use of ultrasound with plasma levels of CEA, CA 19.9 and CA 125 improved the validity of the preoperative differentiation of ovarian masses. Total abdominal hysterectomy with bilateral salphingo-oophorectomy was performed in eleven cases. Unilateral adnexectomy only took place in one case of benign tumor and in one case of disseminated neoplasmatic disease. Conclusions: When evaluating a patient with an adnexal tumor, a history of malignancy strongly suggests a metastatic nature. The use of ultrasound associated with plasma levels of Ca 125, Ca 19-9 and CEA, represents a useful method of preoperative assessment of ovarian tumors

Pregnancy-related cervical cancer in the material of the Regional Cancer Centre, Łódź, between 2011 and 2014

Introduction. Pregnancy-related cancer is defined as cancer diagnosed during pregnancy or in the first postpartum year. Cervical cancer affects approximately 1 in 1000 pregnant women and is the most common malignancy affecting pregnancy. We retrospectively analysed the clinical outcome and results of treatment in patients with pregnancy-related cervical cancer. Material and methods. We retrospectively analysed the medical records of nine patients with invasive cervical cancer diagnosed during pregnancy and the postpartum period who had been treated in the Regional Oncological Centre, Łódź, between 2011–2014. Results. Three patients with cervical cancer at stage I were diagnosed between the 14th and 17th week of pregnancy afterwards and underwent radical surgery. Two patients with cervical cancer at stage Ib who were diagnosed in the 19th and 24th week of gestation decided to continue pregnancy until the 30th and 32nd week; then a cesarean section combined with radical surgery was performed. In three patients with inoperative cervical cancer diagnosed between the 26th and 28th week of pregnancy, a cesarean section was performed at week 30–32. In one patient cervical cancer at stage IIb was diagnosed during the post-partum period. All patients were treated using intensity-modulated radiotherapy (IMRT) to a total dose of 44 Gy/2Gy, weekly cisplatin (40 mg/m2) concurrent with radiotherapy and brachytherapy. No toxicity was observed. During follow-up, two patients with inoperable cervical cancer were diagnosed with a recurrence 2 and 10 months after treatment, respectively. Conclusions. The management of pregnancy-related cervical cancer is mainly determined by the week of the pregnancy and the stage of the disease at diagnosis, but also by the patient choice. The general condition and follow-up of newborns from pregnancies complicated by cervical cancer are similar to those of newborns arising from non-complicated pregnancies. Treatment toxicity is similar in cases with pregnancy-related cervical cancer and in non-pregnant women with cervical cancer. The major prognostic factor in pregnancy-related cervical cancer remains the stage of the disease at diagnosis

Prospective analysis of the impact of adjuvant treatment with external beam radiation therapy and vaginal brachytherapy on health-related quality of life in patients with early-stage endometrioid endometrial carcinoma

Objectives: Our study evaluates the impact of adjuvant treatment with external beam radiotherapy (EBRT) combined with vaginal high dose rate brachytherapy (HDR BT) on health related quality of life (HRQL) in patients with early stage endometrioid endometrial carcinoma. Material and methods: From March 2019 to February 2021, 60 patients were enrolled with early stage endometrioid endometrial carcinoma, and qualified to adjuvant treatment after hysterectomy. HRQL was assessed using the EORTC QLQ-C30 questionnaire, with the endometrial cancer-specific HRQL module EORTC QLQ-EN24. Questionnaires were completed in four timepoints during adjuvant radiotherapy. Results: A significant decrease in mean global health status / quality of life (p < 0.001) and role functioning (p = 0.028) was noted, as assessed in EORTC QLQ-C30 scale. Among the EORTC QLQ-C30 symptoms scales, significant differences were noted in the fatigue scale (p = 0.003), pain scale (p = 0.001), constipation scale (p < 0.001) and diarrhea scale (p < 0.001) over time. The EORTC QRQ-EN24 analysis showed significant deterioration in the urological symptoms scale (p < 0.001), gastrointestinal symptoms scale (p < 0.001) and in the mean pain in back and pelvis scale (p = 0.003). Conclusions: Adjuvant radiotherapy in patients with early-stage endometrioid endometrial cancer after hysterectomy is associated with worse quality of life, especially due to the toxicity of the treatment in relation to the gastrointestinal tract and urinary system

The effect of hippocampal sparing during prophylactic cranial irradiation on the preservation of neurocognitive functions in patients with small cell lung cancer: a preliminary study

Summary: Prophylactic cerebral irradiation (PCI) is the standard of care for patients with limited small cell lung cancer (SCLC). Cerebral irradiation is associated with deterioration of patients' quality of life in terms of cognitive function, in which hippocampus plays a critical role. Protection of the hippocampus during PCI aims to reduce the adverse effects of ionizing radiation on neurocognitive function, which may be important for optimal quality of life. To date, subjective psychological tests have been used as a methodical assessment of cognitive function in patients after PCI. In the present study, we attempted to evaluate the effect of hippocampal sparing during PCI on the preservation of cognitive functions in patients with SCLC, using two diagnostic and screening tests: Mini-Mental State Examination (MMSE) Short Scale and Montreal Cognitive Assessment (MoCA) Scale. Assessment was made at three time points: before start of radiation, immediately after completion of irradiation and 3 months after radiation therapy. Our results indicate, that after radiation therapy there is a deterioration in cognitive functions. We additionally found, that the results of both tests after radiation therapy differed significantly according to the gender and education of patients. Following PCI, cognitive functions deteriorate in SCLC patients, even when radiation doses are reduced in the hippocampal area. This trend persists at least 3 months after the end of brain irradiation.Background: Prophylactic cerebral irradiation (PCI) is the standard of care for patients with limited small cell lung cancer (SCLC). Cerebral irradiation is associated with the deterioration of the quality of life in terms of cognitive function, in which the hippocampus plays a critical role. Protection of the hippocampus during PCI aims to reduce the adverse effects of ionizing radiation on neurocognitive function, which may be important for optimal quality of life. To date, subjective psychological tests have been used as a methodical assessment of cognitive function in patients after PCI. Patients and methods: In 20 patients with SCLC, it was attempted to evaluate the effect of hippocampal sparing during PCI on the preservation of cognitive functions in these patients, using two diagnostic and screening tests: Mini-Mental State Examination (MMSE) Short Scale and Montreal Cognitive Assessment (MoCA) Scale. The assessment was made at three time points: before the start of radiation, immediately after completion of irradiation and 3 months after radiation therapy. Results: The results indicate that after radiation therapy there is a deterioration in cognitive functions. Additionally, it was found that the results of both tests after radiation therapy differed significantly according to the gender and education of patients. Conclusions. Following PCI, cognitive functions deteriorate in SCLC patients, even when radiation doses are reduced in the hippocampal area. This trend persists for at least 3 months after the end of brain irradiation

Znaczenie ekspresji antygenu Ki-67 ocenianej metodą mikromacierzy tkankowych dla rokowania u chorych z gruczolakorakiem endometrialnym endometrium

Objectives: To assess the prognostic significance of Ki-67 expression in the tissue microarray method (TMA) for disease free survival (DFS) and overall survival (OS) in endometrioid endometrial cancer (EEC). Material and methods: The study examined 159 consecutive patients aged 37-86 (62.82±9.95) with EEC stages I-III according to FIGO, treated surgically at the Pirogow Memorial Hospital of Lodz between 2000 and 2007. Afterwards they were subsequently treated and examined at the Regional Cancer Center, Copernicus Memorial Hospital of Lodz. Tissue cores 2 mm in size, in duplicate, were taken from the formalin-fixed and paraffin-embedded tissue donor blocks from surgery, and constructed into the TMA recipient blocks. Using TMA method, the relationship between Ki-67 expression, DFS and OS was examined. DFS was defined as a period from primary surgery until relapse. OS was defined as a period from primary surgery until the end of the follow-up (60 months) or until the death of the patient. The study was approved by the Ethics Committee of the Medical University of Lodz (RNN/82/11/KE; KE/1673/12). Results: The follow-up time varied between 3 - 60 months (51.42±15.87). In 31 patients (19.50%) the relapse of was diagnosed 1–59 months (24.97±16.08) after commencement of the treatment. During follow-up 32 patients (20.12%) died. DFS and OS were 80.50% and 79.88%, respectively. The lack of Ki-67 expression was found in 37 cases (23.27%) while in 122 patients (76.73%) the expression was present (p20% was present in 76 cases, 26 cases and 20 cases, respectively. Positive correlation between the expression of Ki-67 and staging was present (r=0.353; pCel pracy: Celem pracy była ocena znaczenia rokowniczego obecności i wielkości ekspresji antygenu Ki-67 ocenianej metodą mikromacierzy tkankowych (TMA) dla przeżycia wolnego od choroby (DFS) oraz przeżycia ogólnego (OS) chorych z gruczolakorakiem endometrialnym endometrium (GEE). Materiał i metody: Grupę badaną stanowiło 159 chorych. Wykorzystując metodę TMA, oceniono zależność między obecnością i wielkością ekspresji Ki-67 a DFS i OS. Wyniki: Okres obserwacji wynosił 3-60 miesięcy (51,42±15,87). DFS i OS wynosiły odpowiednio 80,50% i 79,88%. Brak ekspresji Ki-67 stwierdzono w 37 przypadkach (23,27%), a obecność ekspresji Ki-67 u 122 chorych (76,73%;

Synchronous occurrence of four malignancies in a 55-year-old woman with uterine cervical cancer. Case report and review of literature

Mnogie nowotwory pierwotne przestają być rzadkością w codziennej praktyce klinicznej. Nowoczesne metody leczenia i diagnostyki chorób nowotworowych oraz ogólne wydłużenie średniej długości życia pacjentów spowodowały zwiększoną częstość występowania mnogich nowotworów pierwotnych. Celem pracy jest prezentacja przypadku 55-letniej chorej z rakiem szyjki macicy, rakiem piersi, chłoniakiem/białaczką B-komórkową (CLL/SLL) (Chronic lymphocytic leukemia/Small lymphocytic lymphoma) i oponiakiem występującymi synchronicznie. Opisany przypadek udowadnia, że rozpoznanie raka szyjki macicy nie wyklucza współistnienia innych nowotworów złośliwych. Podkreśla również, że każdy przypadek raka szyjki macicy, o nietypowym obrazie klinicznym powinien być wnikliwie analizowany celem uniknięcia pomyłek diagnostycznych skutkujących pogorszeniem rokowania.Multiple primary malignancies are no longer rare in clinical practice. The incidence of multiple primary malignant neoplasms is the consequence of progress in oncological treatment and diagnostic methods, as well as the higher overall survival rate and life expectancy rate. We present a case of a patient who synchronously developed four malignancies: cervical cancer, breast cancer, chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL/SLL) and an olfactory groove meningioma. This case proves that the diagnosis of the cervical cancer does not exclude the occurrence of other malignancies. It also emphasizes the fact that every case of uterine cervical cancer with atypical clinical presentation should be thoroughly analyzed to avoid diagnostic mistakes, which in turn may worsen the prognosis