Microinvasive carcinoma of the cervix

BACKGROUND: Superficially invasive neoplasias of the uterine cervix are a matter of controversy in terms of their definition, prognostic factors and selection of treatment to minimize the risk of recurrences. METHODS: Forty-three women with invasive cervical carcinoma, operated from 1993 to 2003, were postoperatively staged as IA cervical carcinoma. There were 28 patients who were submitted to class III radical hysterectomy, 9 patients to class II hysterectomy, 2 patients to class I hysterectomy, and 2 patients to abdominal trachelectomy and pelvic lymph node dissection. Mean age of patients was 44 years (range, 27-64 years). RESULTS: Twenty-three patients (56.1%) were stage with IA1 and 18 (43.9%) with stage IA2 disease according to the 1995 FIGO classification. Tumor histology revealed squamous cell carcinoma in 38 (92.6%) cases, adenocarcinoma in 2 (4.8%) cases and glassy cell carcinoma in 1 (2.4%). The average number of examined lymph nodes was 17.4 (2-53). Lymphovascular space invasion was identified in 3 patients. None of the 41 patients had metastasis to the pelvic lymph nodes or developed recurrence of disease. CONCLUSION: The results suggest that patients with cervical cancer stage IA1 have an extremely low risk of pelvic lymph node metastasis and an excellent prognosis, so nonradical management that excludes pelvic lymph node dissection could be as effective as radical surgery in these patients. Stage IA2 invasive squamous carcinoma of the cervix should be treated with radical hysterectomy with lymph node dissection considering the presence of risk factors. The treatment should be individualized and based on an exhaustive pathological evaluation of an adequate cone biopsy specimen

Aljoa MANDIÆ

Postmenopausal vaginal bleeding (PMB) is the leading symptom of endometrial cancer. More than 70 % of patients with endometrial cancer are postmenopausal. Despite PMB as a leading symptom in diagnosis of endometrial cancer, PMB could be caused by some benign processes in endometrium such as hyperplasia and focal endometrial disease, such as a polyp. The golden standard for histological evaluation of the endometrium is curettage. Transvaginal ultrasound (TVS) and measurement of endometrium thickness is also one of the favored methods in the last decade. Sonographic imaging of the endometrium can be extremely helpful, because endometrial cancer is nearly always associated with thickening and heterogeneity of the endometrium except in case of atrophy-associated adenocarcinoma of the endometrium, which is not associated with thickening. Hysteroscopy found place as a favored method in diagnosis of focal endometrial lesions. Saline infusion sonohysterography (SIS) is a relatively new imaging procedure. The SIS will show whether the endometrium is diffusely thickened, in which case curettage would be the next step, or focally thickened, in which case hysteroscopy with biopsy would be the next step. Combination of some diagnostic procedures, such as TVS, SIS, hysteroscopy, endometrial biopsy, and curettage, should decrease false positive and false negative results, which may affect the correct diagnosis and treatment

Review article UDC: 611.664:616-006:577.21 Archive of Oncology 2002;10(2):79-81. Tumor angiogenesis and endometrial cancer

Increasing importance is given to the clinical significance of the new formation of vessels (angiogenesis) in the course of physiological, inflammatory and neoplastic processes. Angiogenesis is best studied in the growth of malignant tumors, since cancer may be regarded as the most important angiogenesis-dependent disease. Vascular endothelial cell proliferation, migration, and capillary formation are stimulated by angiogenic growth factors, which include the proteins vascular endothelial growth factor (VEGF), basic fibroblast growth factor (bFGF), and transforming growth factor, and eicosanoids synthesized from n-6 fatty acids. Angiogenesis plays an important role in physiological proliferation of the endometrium and formation of corpus luteum in the second half of menstrual cycle. The present study showed that microvessel counts affect prognosis of patients with endometrial cancer. Analysis of angiogenesis in endometrial cancer may be a useful biologic parameter and additional study of neovascularization is required. Tumor angiogenesis is regulated by the balance of stimulators (e.g., VEGF, bFGF) and inhibitors of angiogenesis (e.g., angiostatin, endostatin, angiostatic steroids). Measuring angiogenesis (blood vessel density) and/or its main regulators such as VEGF and bFGF in solid tumors, or the levels of these growth factors in the serum or urine provides new and sensitive markers for tumor progression, metastasis and prognosis

Montenegro

BACKGROUND: Superficially invasive neoplasias of the uterine cervix are a matter of controversy in terms of their definition, prognostic factors and selection of treatment to minimize the risk of recurrences. METHODS: Forty-three women with invasive cervical carcinoma, operated from 1993 to 2003, were postoperatively staged as IA cervical carcinoma. There were 28 patients who were submitted to class III radical hysterectomy, 9 patients to class II hysterectomy, 2 patients to class I hysterectomy, and 2 patients to abdominal trachelectomy and pelvic lymph node dissection. Mean age of patients was 44 years (range, 27-64 years). RESULTS: Twenty-three patients (56.1%) were stage with IA 1 and 18 (43.9%) with stage IA 2 disease according to the 1995 FIGO classification. Tumor histology revealed squamous cell carcinoma in 38 (92.6%) cases, adenocarcinoma in 2 (4.8%) cases and glassy cell carcinoma in 1 (2.4%). The average number of examined lymph nodes was 17.4 (2-53). Lymphovascular space invasion was identified in 3 patients. None of the 41 patients had metastasis to the pelvic lymph nodes or developed recurrence of disease. CONCLUSION: The results suggest that patients with cervical cancer stage IA 1 have an extremely low risk of pelvic lymph node metastasis and an excellent prognosis, so nonradical management tha

Actual problem UDC:612.818:616-006:615-085 Archive of Oncology 2002;10(2):71-5.

Gestational trophoblastic disease belongs to a spectrum of rare tumors originating from trophoblast. It spreads from the benignant disease- uncomplicated partial mole to the most malignant choriocarcinoma in stage IV of disease with brain metastases. Fortunately, with adequate chemotherapy, even patients in advanced stage of the disease have significant chances to be cured. In estimating prognosis and adequate therapy of disease, the most significant are clinical factors: serum bhCG level, duration of the disease from termination of antecedent pregnancy, prior chemotherapy, brain or liver metastases. bhCG is an ideal tumor marker for follow up and early diagnosis of recidivism and metastases. In the Institute of Oncology in Sremska Kamenica 32 patients with gestational trophoblastic disease were treated in the period from 1987 to 2001. All the patients with non-metastatic disease and low risk metastatic disease (stage I-III FIGO) were successfully cured. Five patients died, all in stage IV of the disease (FIGO) with liver and brain metastases; in 4 of them disease occurred after term pregnancy. Overall survival was 85%. Treatment of non-metastatic and low risk metastatic disease was successful in all cases. Treatment failures occurred in advanced disease with brain and liver metastasis. Specificity and low incidence of this disease ask for the treatment to be carried out in specialized centers, as it is in developed countries (Trophoblastic Disease Centers)

Gestational trophoblastic disease

Gestational trophoblastic disease belongs to a spectrum of rare tumors originating from trophoblast. It spreads from the benignant disease uncomplicated partial mole to the most malignant choriocarcinoma in stage IV of disease with brain metastases. Fortunately, with adequate chemotherapy even patients in advanced stage of the disease have significant chances to be cured. In estimating prognosis and adequate therapy of disease, the most significant are clinical factors: serum hCG level, duration of the disease from termination of antecedent pregnancy, prior chemotherapy, brain or liver metastases. hCG is an ideal tumor marker for follow up and early diagnosis of recidivism and metastases. In the Institute of Oncology in Sremska Kamenica 32 patients with gestational trophoblastic disease were treated in the period from 1987 to 2001. All the patients with non-metastatic disease and low risk metastatic disease (stage I-III FIGO) were successfully cured. Five patients died, all in stage IV of the disease (FIGO) with liver and brain metastases; in 4 of them disease occurred after term pregnancy. Overall survival was 85%. Treatment of non-metastatic and low risk metastatic disease was successful in all cases. Treatment failures occurred in advanced disease with brain and liver metastasis Specificity and low incidence of this disease ask for the treatment to be carried out in specialized centers, as it is in developed countries (Trophoblastic Disease Centers)

Unmet oral health needs among persons with intellectual disability

The aim of this study was to examine the factors affecting oral health status among intellectually disabled individuals in Serbia. The sample population was categorized according to age, sex, living arrangements, general health and the level of intellectual disability (ID). The diagnosis of dental caries was performed using the DMFT/dmft criteria. The oral hygiene and gingival health were assessed with the plaque index (Silness&Loe) and gingival index (Life&Silness), respectively. Descriptive analysis, step-wise and logistic regression were performed to analyze related influential factors for caries presence, number of extracted teeth, teeth restored, the oral hygiene level and the extent of gingival inflammation. Odds ratios for caries were significantly higher among adult persons with ID, in persons with co-occurring developmental disorders (DDS) and increased with the level of ID. Group with DDS was associated with a 1.6 times greater odds of untreated decay, while the institutionalization was associated with 2.4 times greater odds of untreated decay. Institutionalization and co-occurring disabilities have been found to be significantly associated with a higher probability of developing gingivitis. Targeting oral health services to individuals with ID are encouraged and may help to reduce overall negative effect on oral and general health associated with delayed treatments, chronic dental pain, emergency dental care, tooth loss and advanced periodontal disease

Primary non-Hodgkin's lymphoma of the uterine cervix: A case report

Primary uterine cervical non-Hodgkin's lymphomas (NHL) are rare. Limited experience dictates careful pretherapy evaluation and multidisciplinary approach in treatment planning. A 53-year-old woman presented with postmenopausal bleeding and PAP smear IIIb. Cervical biopsy and endocervical curettage biopsy revealed NHL of the uterine cervix. Abdominal hysterectomy with bilateral adnexectomy was followed by pelvic lymphadenectomy due to lymph node metastasis, 21 months after the primary operation. Subsequently, the patient received postoperative chemotherapy. Seven years after the onset of NHL she is alive with no evidence of disease recurrence

Montenegro

Primary non-Hodgkin's lymphoma of the uterine cervix: A case repor