Analysis of invasive cervical cancer cases in Latvia

Background: The aim of the study is to evaluate the cervical cancer screening programme in Latvia and to determine how early cervical cancer diagnostics can be improved and the burden of the disease can be reduced.Methods: All cervical cancer cases diagnosed in 2014 and treated in Oncology Centre of Latvia were included in the retrospective cross-sectional study. Cervical cancer cases were classified according to the cytological sampling interval: a “short” (5 years) interval.Results: There were 189 patients identified during the study period. Information was obtained from 130 (68.7%) patients. 49.2% (n=64) of all patients had had a cytological examination within the last three years. For 11.6% (n=15) women, the screening interval was regular, while 21.5% (n=28) had had their last cytological examination more than five years before. 17.7% (n=23) had never had cytological examination. A tendency for more frequent early stage cervical cancer detection in the group of cytological sampling interval less than three years compared to a 3–5 years interval (71.9% vs. 53.3%, p=0.003) was observed.Conclusions: In Latvia, cervical cancer is an unresolved healthcare issue for women. Despite the fact that lack of a quality management system, diagnostic imperfections and non-attendance in the organized, cytology-based screening programme remain the main barrier of cervical cancer control, introduction of a more sensitive test, such as primary testing for oncogenic human papilloma virus types, could significantly reduce the burden of the disease

Urinary concentrations of human epidydimis secretory protein 4 (He4) in the diagnosis of ovarian cancer : A case-control study

Objective: To analyze differential diagnostic accuracy of urinary human epidydimis secretory protein 4 (HE4)in patients with ovarian tumors. Materials and methods: In the case-control study 23 patients with ovarian cancer, 37 patients with benign ovarian tumors and 18 women in the control group were included. Serum CA125 values and urinary concentrations of HE4were assessed quantitatively. Urinary creatinine concentrations and glomerular filtration rate were also determined and used to calculate ratios to HE4. Results: Higher urinary HE4 concentrations were observed in patients with late stage ovarian cancer (p=0.001) and also in patients with early stage ovarian cancer when compared to patients with benign ovarian tumors (p=0.044). On analysis where all ovarian cancer patients were included, higher diagnostic accuracy was observed with calculated ratio of HE4 to glomerular filtration rate (GFR) to unchanged urinary HE4 concentrations -AUC 0.861 vs. 0.858. When discriminatory accuracy was calculated for urinary HE4/GFR ratio and unchanged urinary HE4 concentrations, the last demonstrated a higher area under the curve - 0.701 vs. 0.602. The urinary HE4/creatinine ratio had lower discriminatory characteristics than unchanged concentrations of urinary HE4. However, HE4 serum concentration was more accurate for discrimination of patients with benign and malignant ovarian tumors when compared to urinary HE4 and CA125 in sera (AUCs were 0.868 for serum HE4 and 0.856 and 0.653 for urinary HE4 and CA125, respectively). Conclusions: Ovarian cancer patients have higher urinary concentrations of human epidydimis secretory protein 4 than patients with benign ovarian tumors. Urinary HE4 has comparable discriminatory accuracy with serum HE4 for benign and malignant ovarian tumors and can be recommended as a non-invasive ovarian cancer riskassessment method.publishersversionPeer reviewe

Midline involvement as a risk factor for vulvar cancer recurrence

Objective: This observational study was to identify risk factors for vulvar cancer recurrence. Materials and Methods: In the study 107 patients with primary vulvar cancer were analyzed. Surgical treatment consisted of radical excision of the primary tumor in combination with unilateral or bilateral superficial and deep inguinofemoral lymphadenectomy through separate incisions. Patients with deeper tumor invasion >1 mm or wider than 2 cm and/or groin lymphnode metastases were referred for adjuvant radiotherapy. Those with large privary vulvar tumors received neoadjuvant radiotherapy of 30Gy followed by surgical treatment and adjuvant radiotherapy. Results: Most of patients had only primary radiotherapy to the vulva and inguinal lymph nodes and only 34.5% of patients were eligible for surgical treatment. In 5 year follow-up period 25.2% (27) patients were alive without the disease, 15.0% (16) were alive with the disease and 59.8% (64) were dead. 60.7% (65) patients experienced local recurrence and 2.8% (3) patients had distant metastases. Median survival for patients without recurrent disease was 38.9±3.2 months and 36.0±2.6 months with no statistically significant difference. Patients with early stage vulvar cancer had longer mean survival rates-for stage I 53.1±3.4 months, 38.4±4.4 months for stage II and 33.4±2.6 and 15.6±5.2 months for patients with stage III and stage IV vulvar cancer, respectively. The only signifficant prognostic factor predicting vulvar cancer recurrence was involvement of the midline. Conclusions: Patients having midline involvement of vulvar cancer has lower recurrence risk, probably because of receiving more aggressive treatment. There is a tendency for lower vulvar cancer recurrence risk for patients over 70 years of age and patients who are receiving radiotherapy as an only treatment without surgery, but tendency for higher risk of recurrence in patients with multifocal vulvar cancer.publishersversionPeer reviewe

The Influence of Adjuvant Radiotherapy on Physical Symptoms and Quality of Life In IB1 Stage Cervical Cancer Patients

Cervical cancer is the fourth most common cancer affecting women worldwide. Radical hysterectomy with pelvic lymphadenectomy with or without adjuvant radiation therapy is used as primary therapy for IB stage carcinoma of the cervix. The aim of this study was to compare the complications and quality of life of patients with stage IB1 cervical carcinoma treated by surgery or combined surgery and adjuvant radiotherapy. In a prospective case-control study 49 patients diagnosed with a cervical cancer were included - 37 patients receiving adjuvant radiotherapy in the study group and 12 patients without radiotherapy in the control group that were undergoing surgical treatment in Riga Eastern Clinical university hospital between January 2011 and December 2012. Mean age was higher in patients who received adjuvant radiotherapy in comparison to patients who received only surgical treatmen

Prognostic factors in uterine adenosarcoma: subanalysis of the SARCUT study

ObjectiveThe purpose of the study was to analyse the role of prognostic factors on the risk of recurrence and overall survival of patients with uterine adenosarcoma.MethodsA retrospective international multicentre study involving 46 centres collected 32 cases of uterine adenosarcoma, and these cases were included in the present subanalysis. Clinical and demographic features and tumour characteristics were gathered, as well as information on treatment and relapse. Disease-free and overall survival were analysed.ResultsThe 5-year disease-free survival (DFS) was 85.3% and the 5-year overall survival (OS) rate was 89.5%. The risk factors significantly associated with overall survival were age (HR 1.09, 95% CI 1.03–1.15; p = 0.004) and FIGO stage II–III (HR 17.75, 95% CI 2.87–109.93; p = 0.002). Patients who experienced early relapse (within 12 months) had a tumour size >30 mm and advanced stage. The majority of recurred cases were treated with radiotherapy or surgery and obtained a good response rate.ConclusionThe most significant prognostic factors in uterine adenosarcoma were age and FIGO stage and, indirectly, tumour size at diagnosis. The use of secondary surgery and/or radiotherapy could help in prolonging the disease-free status of the patients

Subspecialty training in Europe:a report by the European Network of Young Gynaecological Oncologists

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Analysis of invasive cervical cancer cases in Latvia

Background: The aim of the study is to evaluate the cervical cancer screening programme in Latvia and to determine how early cervical cancer diagnostics can be improved and the burden of the disease can be reduced.Methods: All cervical cancer cases diagnosed in 2014 and treated in Oncology Centre of Latvia were included in the retrospective cross-sectional study. Cervical cancer cases were classified according to the cytological sampling interval: a “short” (<3 years), a “regular” (3–5 years) or a “long” (>5 years) interval.Results: There were 189 patients identified during the study period. Information was obtained from 130 (68.7%) patients. 49.2% (n=64) of all patients had had a cytological examination within the last three years. For 11.6% (n=15) women, the screening interval was regular, while 21.5% (n=28) had had their last cytological examination more than five years before. 17.7% (n=23) had never had cytological examination. A tendency for more frequent early stage cervical cancer detection in the group of cytological sampling interval less than three years compared to a 3–5 years interval (71.9% vs. 53.3%, p=0.003) was observed.Conclusions: In Latvia, cervical cancer is an unresolved healthcare issue for women. Despite the fact that lack of a quality management system, diagnostic imperfections and non-attendance in the organized, cytology-based screening programme remain the main barrier of cervical cancer control, introduction of a more sensitive test, such as primary testing for oncogenic human papilloma virus types, could significantly reduce the burden of the disease

Malign intraperitoneal mezotelioma - başkent üniversitesi deneyimi

Objective: To evaluate diagnostic and treatment results of malignant intraperitoneal mesothelioma in one setting. Materials and Method: 12 patients treated for malignant peritoneal mesothelioma from January 2007 to June 2009 in Başkent University Ankara Hospital, Department of Gynaecology and Obstetrics were evaluated. In a retrospective observational study design tumour stage, grade, differentiation, time from first symptoms, pleural involvement, peritoneal cancer index, surgical cytoreduction, chemotherapeutic regimen, number of cycles, disease free survival and overall survival were evaluated. Disease free survival, overall survival, time until first symptoms were researched. Results: The main presenting symptom was abdominal distension. Primary cytoreductive surgery followed by chemotherapy was performed in 9 patients. In 6 patients completeness of cytoreductive score below 2 was achieved. As a first line chemotherapy the most often used was cisplatin in combination with pemetrexed. Themean time from first symptoms until the diagnosis was 1.9 months. Disease free survival of 4.4±1.0 months after completing particular treatment and overall 1-year survival of 85.7% was observed. No correlations between first symptoms (0.27, p=0.52), time until the diagnosis (-0.29, p=0.44) and overall survival were observed. Similarly, correlations between peritoneal cancer index (0.25, p=0.67), prior surgical score (-.45, p=0.37), completeness of cytoreduction score (0.61, p=0.27) and overall survival were not observed. Conclusions: Because of the low number of patients and different treatment approaches data from a particular patient setting are inconclusive, but from the literature there is evidence that patients with malignant intraperitoneal mesothelioma should undergo optimal cytoreduction and receive a combination of cisplatin and pemetrexed as a first line chemotherapy for intravenous or cisplatin in different chemotherapy regimens using the intraperitoneal administration route, if accessible, with even higher overall survival rates.publishersversionPeer reviewe