Neo-adjuvant treatment of adenocarcinoma and squamous cell carcinoma of the cervix results in significantly different pathological complete response rates

Abstract Background Previous studies on cervical cancer reported a worse outcome for adenocarcinoma (AC) compared with squamous cell carcinoma (SCC). Nevertheless, standard treatment remains identical. Insight in the impact of histological types on biological behavior and pathological complete response rates might result in a treatment paradigm shift. Methods Clinicopathological characteristics, survival rates and relapse patterns were compared between AC (n = 36) and SCC (n = 143) cervical cancer patients. Pathological response to treatment was evaluated in the patient subgroup treated with neo-adjuvant chemoradiation followed by surgery (NA-CRT group; n = 84). Results In the entire cohort, 5y Disease Specific Survival (DSS) was 97.1 and 84% for AC and SCC respectively (p = 0.150). In the NA-CRT group 5y DSS was 100 and 75.5% for AC and SCC respectively (p = 0.059). Relapse patterns did not differ significantly between AC and SCC in the entire cohort, or in the NA-CRT group. Adenocarcinoma patients treated with NA-CRT showed significantly less pathological complete response compared with SCC patients (AC = 7%, SCC = 43%, p = 0.027). Conclusions There were no statistically significant differences regarding relapse and DSS rates between SCC and AC in the entire cohort, or the NA-CRT group. However, a trend to better 5y DSS of AC in the NA-CRT group was observed. This analysis showed significant differences in treatment responses after NA-CRT: patients with AC responded remarkably less to chemoradiation, resulting in a significantly lower pathological complete response rate. These findings imply a need for a paradigm shift in the treatment of cervical AC patients

The rationale of opportunistic bilateral salpingectomies (OBS) during benign gynaecological and obstetric surgery : a consensus text of the Flemish Society of Obstetrics and Gynaecology (VVOG)

Ovarian cancer (OC), is a disease difficult to diagnose in an early stage implicating a poor prognosis. The 5-year overall survival in Belgium has not changed in the last 18 years and remains 44 %. There is no effective screening method (secondary prevention) to detect ovarian cancer at an early stage. Primary prevention of ovarian cancer came in the picture through the paradigm shift that the fallopian tube is often the origin of ovarian cancer and not the ovary itself. Opportunistic bilateral salpingectomy (OBS) during benign gynaecological and obstetric surgery might have the potential to reduce the risk of ovarian cancer by as much as 65 %. Bilateral risk-reducing salpingectomy during a benign procedure is feasible, safe, appears to have no impact on the ovarian function and seems to be cost effective. The key question is whether we should wait for a RCT or implement OBS directly in our daily practice. Guidelines regarding OBS within our societies are therefore urgently needed. Our recommendation is to inform all women without a child wish, undergoing a benign gynaecological or obstetrical surgical procedure about the pro’s and the con’s of OBS and advise a bilateral salpingectomy. Furthermore, there is an urgent need for a prospective registry of OBS. The present article is the consensus text of the Flemish Society of Obstetrics and Gynaecology (VVOG) regarding OBS

Borderline tumors of the ovary: a separate entity

Borderline ovarian tumors (BOT) account for 10% to 20% of all epithelial ovarian tumors. BOT represent a separate entity with pathologic features and biologic behaviour intermediate between distinctly benign and frankly malignant. The misunderstanding of such entity results in over-treatment of BOT both surgically and pharmaceutically. BOT present in the majority of cases as FIGO stage I and are associated with an excellent prognosis. Treatment is mainly surgical and adjuvant therapy is not beneficial

Endometriumcarcinoom, up and coming

In Westerse landen is het endometriumcarcinoom de meest frequente gynaecologische kanker van het kleine bekken. Meteen is het in Europa de vierde meest voorkomende kwaadaardige tumor bij vrouwen, na borst-, long- en colonkanker. De incidentieratio wordt geschat op 24,7 per 100.000 vrouwen. Hij ligt tienmaal hoger in Europa en de Verenigde Staten dan in de ontwikkelingslanden. Het jaarlijkse aantal nieuwe gevallen gaat nog steeds in stijgende lijn, omwille van de toenemende levensverwachting en de heersende ‘epidemie’ van obesitas en lichamelijke inactiviteit

Epidemiological and Economic Impact of Human Papillomavirus Vaccines

Background: Despite screening, cervical cancer (CC) remains a serious health care problem. Because human papillomavirus (HPV) is the necessary cause of CC, the development of 2 new vaccines can have a tremendous impact oil CC and other HPV-related conditions. In this systematic review, the epidemiological and economic impacts of HPV are evaluated. Methods: A literature search was conducted through MEDLINE, Web of Science, Cochrane Library, and Cumulative Index to Nursing and Allied Health Literature. Articles were selected based on inclusion and exclusion criteria. Economic evaluations were submitted to a quality assessment. Results: Sixteen articles were selected to review the epidemiological impact of HPV vaccines, and 11 were selected to review the economic impact. The studies were very heterogeneous because of different assumptions. Nevertheless, a substantial reduction in CC is reported consistently and a (smaller) reduction in precancerous lesions and HPV prevalence. Cost-effectiveness ratios are also very diverse and dependent oil the assumptions made. An HPV vaccine can be profitable if duration of vaccine-related immunity is high, efficacy is high, price is low, screening is reduced, administration is before sexual activity, discount rate is not too high, or if there is herd immunity. Conclusions: Human papillomavirus vaccines have the potential to reduce CC by at least approximately half of its current incidence, and this might be cost-effective if there is high efficacy with a long-lasting immunity

Cervical cancer screening in Belgium and overscreening of adolescents

There has been a marked decrease in the incidence of cervical cancer thanks to cytological screening with the Pap smear test. In Belgium, this screening is rather opportunistic. Over 39% of Belgian women between 25 and 64 years of age are never or only rarely screened by cytological tests. Moreover, there is an excess use of Pap smears because of women who rely on their yearly cervical smear and because many Pap smears are obtained from women beyond the target age range of 25 to 64 years. Sexually active adolescents are increasingly being recognized as a population distinct from adult women. They are at a high risk of acquiring the human papillomavirus (HPV), but most infections and cervical intraepithelial lesions caused by HPV are efficiently cleared by the immune system. We present a description of cervical cancer screening in Belgium using the database of the National Health Insurance Institute (RIZIV/INAMI) and the Belgian Health Care Knowledge Centre (KCE). We describe why elimination of Pap testing in the adolescent population reduces costs and harms without increasing cervical cancer rates. Expectant management, education on the risk factors for cervical cancer and HPV persistence, and HPV vaccination are very important in adolescents and young adults

Borstkanker bij de man

Borstkanker bij de man is een zelden voorkomende ziekte die relatief onbekend is bij de algemene bevolking. Hierdoor wordt de diagnose vaak in een later stadium van de ziekteprogressie gesteld, wat op zijn beurt de prognose beïnvloedt. Na correctie voor de leeftijd en het ziektestadium is de overleving voor mannelijke patiënten dezelfde als voor vrouwelijke. Belangrijke risicofactoren voor mannelijke borstkanker zijn testiculaire afwijkingen (cryptorchidie, orchitis, enz.), het syndroom van Klinefelter en familiale belasting (BRCA2-genmutatie). Wegens de afwezigheid van terminale lobuli is de overgrote meerderheid van de tumoren histopathologisch geclassificeerd als een ductaal carcinoom. De diagnostiek van mannelijke borstkanker loopt parallel met die van vrouwelijke borstkanker (borstonderzoek, beeldvorming en histopathologie). De behandeling van mannelijke borstkanker is in grote lijnen dezelfde als voor vrouwelijke borstkanker. Belangrijke verschillen zijn bij de chirurgische therapie de gemodificeerde radicale mastectomie als standaard en in een adjuvante setting is er heden nog geen plaats voor het gebruik van aromataseremmers