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

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

Rak szyjki macicy związany z ciążą w materiale Regionalnego Ośrodka Onkologicznego w Łodzi z lat 2011–2014

Wstęp. Choroba nowotworowa związana z ciążą definiowana jest jako rozpoznanie nowotworu w trakcie trwania ciąży lub w ciągu jednego roku od porodu. Rak szyjki macicy jest najczęściej rozpoznawanym nowotworem podczas ciąży i dotyczy 1:1000 ciężarnych. Celem pracy była analiza kliniczna i ocena wyników leczenia chorych na raka szyjki macicy związanego z ciążą. Materiał i metody. Retrospektywnej analizie poddano dziewięć chorych z rakiem szyjki macicy rozpoznanym w trakcie trwania ciąży lub połogu, leczonych w Regionalnym Ośrodku Onkologicznym w Łodzi w latach 2011–2014. Wyniki. U trzech chorych rozpoznano raka szyjki macicy w I stopniu zaawansowania pomiędzy 14–17 tygodniem ciąży i wykonano radykalny zabieg operacyjny. U dwóch chorych rozpoznano raka szyjki macicy w stopniu IB w 19 i 24 tygodniu ciąży. Ciąże te kontynuowano i w 30–32 tygodniu ciąży wykonano cięcie cesarskie z operacją radykalną. U trzech chorych z nieoperacyjnym rakiem szyjki macicy rozpoznanym pomiędzy 26–28 tygodniem ciąży wykonano cięcie cesarskie w 30–32 tygodniu ciąży. U jednej chorej nieoperacyjny rak szyjki macicy w stopniu zaawansowania IIB został rozpoznany w połogu. W leczeniu wszystkich chorych stosowano teleradioterapię konformalną IMRT do dawki 44 Gy/2 Gy w połączeniu z iniekcjami cisplatyny w dawce 40 mg/m2 jeden raz w tygodniu oraz brachyterapię HDR. Nie obserwowano powikłań wymagających przerwania leczenia. W okresie obserwacji u dwóch chorych stwierdzono wznowę nowotworu, odpowiednio po 2 i 10 miesiącach od zakończenia leczenia. Wnioski. Zaawansowanie raka szyjki macicy, okres ciąży, w którym rozpoznano nowotwór, oraz decyzja chorej wa­runkują strategię leczenia. Stan ogólny i przebieg okresu adaptacyjnego noworodków urodzonych z tych ciąż nie różnią się od stanu noworodków urodzonych z ciąż bez tego powikłania. Tolerancja radiochemioterapii u chorych na raka szyjki macicy związanego z ciążą nie różni się od tolerancji leczenia chorych z nowotworem rozpoznanym u nieciężarnych. Podstawowym czynnikiem decydującym o rokowaniu w tych przypadkach pozostaje stopień za­awansowania nowotworu w momencie rozpoznania choroby

Endometrioid endometrial cancer – the prognostic value of selected clinical and pathological parameters

Objectives: to assess the relationship between selected clinical and pathological factors and disease free survival (DFS) and overall survival (OS) in endometrioid endometrial cancer patients. Material and methods: A retrospective review of 262 patients aged 37-86 (6.0±9.0) was performed. Selected clinical and pathological data were correlated with DFS and OS. Results: Follow-up was 8-123 months (64.9±27.1). In 4 patients (1.5%) clinical progression was diagnosed during the treatment. In 43 patients (16.4%) relapse was diagnosed 2-61 months (23.9±15.7) after commencing treatment. DFS and OS were 82.1% and 81.3% respectively. In univariate analysis worse DFS was related to older patients (p=0.007) and non-radical surgery (

Does obesity hinder radiotherapy in endometrial cancer patients? The implementation of new techniques in adjuvant radiotherapy – focus on obese patients

The increasing incidence of obesity in Poland and its relation to endometrioid endometrial cancer (EEC) is resulting in the increasing necessity of treating obese women. Treatment of an overweight patient with EEC may impede not only the surgical procedures but also radiotherapy, especially external beam radiotherapy (EBRT). The problems arise both during treatment planning and when delivering each fraction due to the difficulty of positioning such a patient – it implies the danger of underdosing targets and overdosing organs at risk. Willingness to use dynamic techniques in radiation oncology has increased for patients with EEC, even those who are obese. During EBRT careful daily verification is necessary for both safety and treatment accuracy. The most accurate method of verification is cone beam computed tomography (CBCT) with soft tissue assessment, although it is time consuming and often requires a radiation oncologist. In order to improve the quality of such treatment, the authors present the practical aspects of planning and treatment itself by means of dynamic techniques in EBRT. The authors indicate the advantages and disadvantages of different types of on-board imaging (OBI) verification images. Considering the scanty amount of literature in this field, it is necessary to conduct further research in order to highlight proper planning and treatment of obese endometrial cancer patients. The review of the literature shows that all centres that wish to use EBRT for gynaecological tumours should develop their own protocols on qualification, planning the treatment and methods of verifying the patients’ positioning

Czy zamienne stosowanie klasyfikacji zaawansowania nowotworów endometrium według Międzynarodowej Federacji Ginekologów i Położników z 1988 roku i z 2009 roku może prowadzić do istotnych pomyłek klinicznych?

Introduction: Since 2009 the new FIGO Staging System of endometrial cancer, which changed the previousFIGO 1988 Staging System, has been present. Unfortunately, parallel use of both classifications is observed.Aim of study: to assess whether parallel use of the 2009 and the 1988 FIGO staging systems can causesignificant therapeutic mistakes in patients with endometrioid endometrial cancer.Material and methods: We analysed 262 patients with endometrioid endometrial cancer. The endometrialcancers were staged in both classifications. We analysed possible therapeutic mistakes caused by diverse nomenclature.Results: The patients at low risk, intermediate risk, and high risk for relapse were presented in: 110 (41.6%),109 (42.0%) and 43 (16.4%) cases, respectively. The possibility of inappropriate qualification for adjuvant treatmentoccurred in 102 patients (38.9%) if they were staged in the FIGO 1988 classification and interpreted as theFIGO 2009 classification, and similarly, in 65 patients (24.8%) if they were staged in the FIGO 2009 classificationand interpreted as the FIGO 1988 classification. The risk of a decision mistake in terms of the adjuvant treatmentdue to diverse nomenclature was observed commonly in 167 patients (63.7%).Conclusions: The common use of both FIGO staging systems for endometrioid endometrial cancer cancause significant therapeutic mistakes in terms of the adjuvant treatment. There is a need to use only the newFIGO 2009 Staging System for endometrial cancer and stop using the FIGO 1988 Staging System to avoid therapeuticmistakes