2013, Vol 11, No 2
The effect of Cicatridina® preparation on changes in the vagina due to radiotherapy treatment of cervical or endometrial cancer. Observational study
CURR. GYNECOL. ONCOL. 2013, 11 (2), p. 97–102
DOI: 10.15557/CGO.2013.0009

The problem of changes in the vagina after cancer treatment is particularly important in case of patients who have been administered radiotherapy. A high percentage of patients suffer from vaginal changes which significantly deteriorate the quality of their life, and previously used methods fail to prevent them. The aim of this study is to assess the effects of Cicatridina® preparation containing hyaluronic acid on changes in the vagina in 130 women aged 30–78 (the average age of 59), treated surgically or with radiation therapy for cervical cancer or endometrial cancer and who were treated with vaginal globules. The control group consisted of 54 women treated with radiotherapy for cervical or endometrial cancer who were administered a traditional vaginal douching. Studies carried out 3 and 6 months after treatment showed that the vaginal discomfort was less common (after 3 months – 41% and 6 months – 38%) in women treated with Cicatridina® as opposed to women using vaginal douching (78% and 76% respectively, statistically significant differences, observed both in patients suffering from cervical cancer and those with ovarian cancer). Occlusion of the vagina in the treatment group was also less common (9% both after 3 and 6 months) compared to the control group (18% after 3 months and 20% after 6 months). Statistically significant differences were observed in the whole treatment group.

Keywords: Cicatridina®, cervical cancer, endometrial cancer, discomfort in the vagina, occlusion of the vagina
Evaluation of TATI marker assays – the pancreatic trypsin inhibitor – in patients with endometrial cancer with unfavorable predictors
CURR. GYNECOL. ONCOL. 2013, 11 (2), p. 103–114
DOI: 10.15557/CGO.2013.0010

TATI marker (tumor-associated trypsin inhibitor) is most often assessed in patients with ovarian cancer. This paper presents the role and the usefulness of the marker in the evaluation of the treatment results in patients with endometrial cancer. The study was based on the evaluation of TATI marker level in 305 patients suffering from endometrial cancer treated at the Cancer Center between 1994 and1995 in Warsaw. In each patient the TATI marker level was measured from 3 to 7 times in the blood serum after each stage of the adjuvant treatment and in the initial part of the follow-up period. In order to assess the staging a postoperative protocol in force in 1988 (FIGO) was used and in accordance with this protocol, the patients were qualified for the adjuvant therapy, which consisted of the teletherapy, brachytherapy and hormonal therapy. All patients were observed on an outpatient basis after the treatment. The analysis of TATI marker levels in correlation with the features of cancer were carried out after a 17-year-long follow-up period. TATI marker levels have been evaluated in patients with unfavorable predictors identified in the operation protocol and in the histopathological protocol of the removed tumor. It was found that TATI level in the fourth sampling after the treatment was the most important value. TATI level increase in this assay was significantly correlated with the occurrence of local relapse or distant metastasis. The comparison of the results of patients with and without surgical removal of the lymph nodes has shown a significantly longer disease-free period in patients whose lymph nodes were not removed.

Keywords: tumor markers, markers of endometrial cancer, TATI, PSTI, negative predictors of endometrial cancer
Health behaviors and health locus of control in women after mastectomy
CURR. GYNECOL. ONCOL. 2013, 11 (2), p. 115–124
DOI: 10.15557/CGO.2013.0011

Introduction: Health is a significant value in every person’s life. The effectiveness in obeying recommendations regarding health behaviors depends on one’s belief concerning their health locus of control. Aim: To present the relations between preferred health behaviors and health locus of control in women after mastectomy, as a determinant of returning to optimal health. Material and methods: The study was conducted among 98 patients of the Clinical Department of Breast Cancer and Reconstructive Surgery in Oncology Centre in Bydgoszcz. Health behaviors were assessed using the Health Behaviour Inventory by Juczyński and health locus of control was determined using an MHLC questionnaire version B, in the adaptation of Juczyński. Results: The examined women present an average level of health behaviors. The higher their education, the higher level of health behaviors. Among all the dimensions of health locus of control, the highest scores were gained in the dimension of chance and the lowest in the dimension of internal control. The greatest number of high scores was obtained in the dimension of chance and the lowest - in the dimension of influence of others. Conclusions: The obtained results allow for a better recognition of the needs of women with breast cancer. They may serve as educational materials for medical personnel to help to introduce certain modifications in their patients’ lifestyles.

Keywords: breast cancer, mastectomy, health behaviors, health locus of control, acceptance of illness
Modified posterior exenteration in ovarian cancer treatment
CURR. GYNECOL. ONCOL. 2013, 11 (2), p. 125–136
DOI: 10.15557/CGO.2013.0012

The treatment of ovarian cancer is a type of combination treatment consisting of surgery and chemotherapy. Based on numerous studies, one might conclude that the radical nature of the surgical treatment is critical to the survival of the ovarian cancer patient. The aim of the primary procedure is complete cytoreduction, meaning the removal of all macroscopic foci of the cancer. This can be challenging since infiltration of the cancer frequently goes beyond the reproductive organs into the pelvis, involving the rectum, sigmoid colon, and the peritoneum of the lower recess. Therefore, apart from standard procedures, modified posterior exenteration (MPE) should be performed. MPE allows for en bloc resection of the cancerous tumor together with the uterus, adnexa, and parametria, and portions of the vagina, the pelvic peritoneum, the anterior aspect of the rectum, and the sigmoid colon. The next stage of the procedure is colostomy or anastomosis within the region of the gastrointestinal tract followed by lymphadenectomy. A natural consequence of such an extensive intervention is a substantial number of complications. These, however, do not affect the quality of life of patients with ovarian cancer in an appreciable manner and thus have been accepted among gynecologic oncologists. What is important is that this type of surgery has a positive influence on prognosis, tending to prolong patients’ lives. Even when complications do occur, it is still more valuable to go ahead with this type of treatment than to forgo it in the interests of trying to avoid any possible negative consequences. This decision seems even more valid when the progress of medicine, which has enabled the effective treatment of such complications, is taken into consideration. The most common consequences of such a procedure are infection and wound dehiscence while anastomotic dehiscence within the gastrointestinal tract rarely occurs. The data included in the literature has clearly demonstrated that the patient’s preoperative serum albumin level may be connected with the risk of these common consequences and that the experience of the gynecologic oncologist who performs the procedure substantially influences whether such complications occur. It is therefore crucial that we create a nationwide chain of oncologic hospitals where these types of combination treatments of malignant neoplasms can be successfully carried out.

Keywords: ovarian carcinoma, surgical treatment, modified posterior exenteration, rectosigmoid resection, perioperative complications
Clinical and economic aspects of using vaccinating against HPV
CURR. GYNECOL. ONCOL. 2013, 11 (2), p. 137–150
DOI: 10.15557/CGO.2013.0013

Cervical cancer is one of the most common types of cancer in women population in the world and is the cause of majority of deaths among women. Poland is one of the countries with the highest morbidity which is about 3000 cases yearly; major group – of 1301 cases – constitute women aged 45–54. According to National Cancer Registry in years 1999–2010 morbidity and mortality due to cervical cancer remain stable. Key factor leading to cervical cancer is infection with oncogenic types of human papillomavirus (HPV). The most significant are types HPV-16 and HPV-18 which are estimated to be responsible for 73% of cases. Low-oncogenic types HPV-6 and HPV-11 are major cause of warts in areas of cervix, vulva and anus. Vaccinations against HPV represent one of the components of primary prevention. Vaccinations should be supplemented with public education activities focusing on cervical cancer and HPV infections. Secondary prevention should involve regular screening tests among women aged 21–25. Currently two vaccines are registered in Poland: quadrivalent Silgard® against HPV-6, HPV-11, HPV-16 and HPV-18 and bivalent Cervarix® against HPV-16 and HPV-18. Analyses conducted in various countries reported cost-effectiveness of strategies based on vaccinations against HPV infections conducted along with screening tests over strategy based only on screening tests. In Polish settings cost per additional QALY (quality-adjusted life year) in case of vaccinations with Silgard® was estimated for 12 704 PLN. The value is 9 times lower than the official cost-effectiveness threshold of medical technologies in Poland which equals 105 801 PLN/QALY and indicates cost-effectiveness of using and funding quadrivalent vaccine Silgard® in Polish settings.

Keywords: infections, HPV, vaccines, cost-effectiveness, cervical cancer
Pelvic and periaortic lymphadenectomy in the treatment of endometrial cancer
CURR. GYNECOL. ONCOL. 2013, 11 (2), p. 151–158
DOI: 10.15557/CGO.2013.0014

Treatment of endometrial cancer includes surgery, radiotherapy, chemotherapy, and hormonal therapy. Since early 1990s, a matter of much controversy remains the scope of surgery, particularly in the context of excision of lymph nodes. Currently valid surgical classification of clinical stages entails the need to assess the presence of metastases to pelvic and periaortic nodes (FIGO 2009). Technique of mapping sentinel nodes in endometrial cancer is currently being developed and is inherently complicated due to several routes of lymphatic drainage from the uterus. Excision of lymph nodes should be a part of routine surgical staging, as apart from diagnostic-prognostic value, it is of paramount significance for clinical decision-making process. Planning of adjuvant therapy without such an assessment is imprecise. Intraoperative evaluation of extent of the neoplastic process is much more precise than assessment based on imaging studies or clinical criteria of staging, promoted by some centers. An increasing number of centers consider lymphadenectomy as an indispensable component of endometrial cancer management – according to present-day standards, reliable staging of endometrial cancer requires excision and study of lymph nodes. More extensive procedure is not associated with significant increase of complication rate, while reduces number of patients requiring radiotherapy, affecting favorably the patients’ quality of life. Patients undergoing pelvic and periaortic lymphadenectomy benefit from a longer recurrence-free survival and overall survival. Most frequent complication of these procedures is intraoperative bleeding, thromboembolic events and lymphocele. Favorable effects of a more extensive procedure are seen mainly in centers specialized in gynecologic oncology, where median number of excised pelvic and periaortic lymph nodes is significantly higher.

Keywords: endometrial cancer, surgery, lymphadenectomy, postoperative complications, radiotherapy
Ovarian tumors in pregnan
159 CURR. GYNECOL. ONCOL. 2013, 11 (2), p. 159–165
DOI: 10.15557/CGO.2013.0015

Ovarian tumors develop in 2.3–8.8% of pregnant women. Most of them are benign cysts which vanish spontaneously after the 9th or 10th week of gestation. Ultrasound examination and magnetic resonance imaging are helpful diagnostic tools. Computed tomography, however, is contraindicated. The most common benign lesions are teratomas and cystadenomas. Malignant tumors account for 2.15–13% of all ovarian tumors in pregnant patients. Germ cell tumors, followed by borderline tumors and ovarian carcinomas constitute the most common ones. The management in the case of germ cell and borderline tumors involves unilateral adnexectomy and in invasive ovarian carcinomas, the treatment is individualized. In stage 1A G1, the management is similar to the one in borderline tumors and restaging after the delivery may be performed. Additionally, in early stages of carcinoma (stage IA G2 and G3, IB, IC as well as IIA), lymphadenectomy and platinum-based chemotherapy are recommended. In advanced stages, there are numerous possibilities of treatment including radical surgery with termination of pregnancy before the 20th–24th weeks of gestation and adjuvant therapy. Another option is the implementation of neoadjuvant chemotherapy during pregnancy and performance of cytoreduction following the delivery. At the mother’s request, delaying the treatment until after the delivery may be considered. Chemical treatment during pregnancy does not exert negative effects on the fetus provided that it is applied in the second or third trimesters. One of its rare complications is intrauterine growth restriction (IUGR). The survival of patients with ovarian carcinomas diagnosed during pregnancy is not different than in the case of women diagnosed without being pregnant.

Keywords: ovarian tumors, ovarian carcinoma, pregnancy, chemotherapy, laparotomy