2013, Vol 11, No 3
Quality of life of women treated for cervical cancer in Rzeszow
CURR. GYNECOL. ONCOL. 2013, 11 (3), p. 183–190
DOI: 10.15557/CGO.2013.0016

Introduction: In Poland, most cervical cancer cases are reported among women older than 20, however the highest incidence rate concerns the subpopulation of women between the ages of 45 and 60 (60%). Poland has one of the highest mortality rates in cervical cancer in Europe whereas the 5-year survival rate is low. These numbers result from late diagnosis when cancer is advanced. This situation finds a direct reflection in poor quality of life of patients with cervical cancer in Poland. Purpose: Evaluation of quality of life of women treated for cervical cancer. Material and methods: The study group included 59 women receiving therapy in the Gynecologic Oncology Clinic in Rzeszow (January and April 2012). The following standardized measuring tools were used: QLQ-C30, QLQ-CX24 EORTC. An appropriate consent was obtained from the EORTC group. Results: Physical functioning of patients with cervical cancer was quite good. Weakness and nausea were the two most frequent complaints, and their severity increased with the stage of disease. Emotional status of respondents correlated with the presence of symptoms and patient’s marital status. Younger women had significantly poorer perception of their body image. Only 30% of respondents were active sexually. Most patients were afraid of pain during sexual intercourses. Women with better financial status received higher scores when assessing their health status and quality of life. Conclusions: Women with cervical cancer should receive complex and multidisciplinary care from the beginning of therapy so they are prepared for coping with all consequences of their disease.

Keywords: cervical cancer, quality of life, emotional function, physical functioning, body image
The sense of coherence versus life adaptation in women after mastectomy
CURR. GYNECOL. ONCOL. 2013, 11 (3), p. 191–201
DOI: 10.15557/CGO.2013.0017

Introduction: Breast cancer is a medical as well as social problem due to emotional meaning of breasts (attribute of femininity, symbol of motherhood) and fear of the mutilating procedure of mastectomy. One of the factors influencing one’s ability to cope with disease and stress related to it is the sense of coherence (SOC). The level of SOC is an element which explains the relationship between support and health. High SOC level makes people believe in life predictability and order, which in turn motivates them to be healthy and functional. Aim: Defining the relation between the level of coherence and life adaptation in women after mastectomy, as a determinant of returning to optimal health. Material and methods: The study was carried out among 100 women who had their breast amputated with Madden method. The women examined were treated in Oncology Center in Bydgoszcz in Breast Diseases and Reconstructive Surgery wards. The sense of coherence was assessed using Orientation to Life Questionnaire SOC-29 by Antonovsky and adaptation to disease was evaluated on the basis of AIS scale in Juczynski’s adaptation. Results: The examined women presented average level of the sense of coherence. The level of manageability and comprehensibility was higher than the level of the sense of meaningfulness. The group gained an average level of disease acceptance. Those women who got higher results regarding the sense of manageability, comprehensibility and meaningfulness had also better results in disease acceptance. Conclusions: Defining the level of the sense of coherence and the level of life adaptation may serve as a determinant in predicting care for patients going through various stages of cancer disease with particular attention paid to the psychological sphere since it plays a remarkable role. It will enable the compensation of this sphere and will have a positive influence on health.

Keywords: breast cancer, mastectomy, sense of coherence (SOC), disease acceptance, coping with an illness
Psychoneurocybernetic etiopathogenesis of cancers
CURR. GYNECOL. ONCOL. 2013, 11 (3), p. 202–209
DOI: 10.15557/CGO.2013.0018

Multicellular organisms are composed of cells which psychoneurocybernetically match each other in terms of morphology (genetics), information and energy. The most incomprehensible disease, which has been a source of fear for centuries, took its name from crab-like (the word cancer is Latin for crab) or crayfish-like, as in some countries crabs are not found, growths that destroy human body. Cancers develop as a result of a natural and common phenomenon involving the self-organization of so-called dissipative structures from systems (cells) which are to be destroyed due to their thermodynamic insufficiency, referred to as the emergence of negative entropy source. The distinction between physiological and pathological cell metabolism has allowed to separate etiology from the analysis of morphologically and/or biochemically identifiable pathogenic changes underlying disease symptoms and ailments. The thermodynamic etiology of cancerogenesis, which provided new treatment alternatives in the case of standard management insufficiency or failure, is supported by the positive effects of hyperthermia therapy. The development of cybernetics makes it possible to distinguish between precancerous conditions and cancers, and thus enables conscious cancer prevention as well as initiation of causative instead of just symptomatic treatment. Although the existence of societies dependent on legislative, executive and judiciary power is naturally regulated by information, the norms established by people cannot ignore the real natural rights, according to which the public interest is a priority. Life, which is not human-made but passed from generation to generation for the maintenance of the species, is the highest good of a man. This transfer is guaranteed, among other things, by cancers, whose cellular life form is more secure than the affected person. Cancers are only rarely genetically predeterminated, and the self-organization of a cell’s genetic code is an effect, and not the cause of cancerogenesis.

Keywords: cancer etiopathogenesis, self-organization of dissipative structures, medical thermodynamics, cancer therapy, informatonosis, genetic entropy, cancer
Role of splenectomy in surgical treatment of ovarian cancer
CURR. GYNECOL. ONCOL. 2013, 11 (3), p. 210–216
DOI: 10.15557/CGO.2013.0019

In the treatment of ovarian cancer, surgery, chemotherapy or possibly radiotherapy are applied. The scope of surgery is the most significant prognostic factor. Complete cytoreduction is the optimal surgical method. Most frequently, ovarian carcinoma does not involve only the reproductive system, but spreads throughout the peritoneal cavity. In some cases, splenic involvement is found during a surgery. In such cases the surgery should be supplemented with splenectomy – when the spleen is removed as an additional procedure during the operation or as an element of the en bloc removal of the tumor along with the omentum, colon and gastrocolic ligament. Such an extended operation results in only slightly increased number of complications and has no significant impact on the quality of life of ovarian cancer patients. It often enables full cytoreduction. Complications of this part of the operation predominantly include hemorrhage, thromboembolism, infection and, in the case of en bloc operation, anastomotic separation within the gastrointestinal tract. The data available report increased number of intraoperative blood transfusions. The procedure in question is most frequently carried out during a secondary cytoreductive surgery. Despite the lack of recommendations, such procedures should be performed by a surgical team experienced in operations in the upper abdominal cavity. The treatment should be complemented with state-of-the-art chemotherapy. This kind of treatment requires establishing a national network of oncological centers dealing with combined therapies of malignant neoplasms.

Keywords: ovarian cancer, surgery, splenectomy, perioperative complications, complete cytoreduction
Fallopian tube carcinoma – clinical picture, diagnosis, treatment. Case study
CURR. GYNECOL. ONCOL. 2013, 11 (3), p. 217–228
DOI: 10.15557/CGO.2013.0020

Primary fallopian tube carcinoma (PFTC) is a rare tumor diagnosed mainly between the fourth and sixth decade of the patient’s life. The etiology of this cancer remains unknown. Presumably, genetic, hormonal, and reproductive factors like the ones in ovarian cancer may increase the PFTC risk. The germ-line BRCA1 and BRCA2 mutation is the only documented risk factor related to its etiology. Given the rarity of the incidence and diagnostic difficulties concerning the fallopian tube hyperplasic changes in early stages of disease, the diagnosis of PFTC is most often intraoperative and/or happens after the settlement of the final histopathological diagnosis. The pathologic process in early stages is characterized by a stingy or asymptomatic course. The Latzko’s triad, the group of classical symptoms of PFTC, is reported in 15% of cases. It is caused by infilling and decompression of partly blocked oviduct by the pathological process. One of the PFTC signs is the presence of retroperitoneal spread in the endosalpinx before ovaries are involved. The paper presents the case of PFTC treatment in 47-year-old patient diagnosed only intraoperatively, who was subject to conservative treatment 6 months prior to hospitalization – with no result. During this time appropriate diagnosis was not obtained. Combined treatment including surgery and chemotherapy was applied. After obtaining intraoperative positive histopathological exam for fallopian tube neoplastic process, radical surgical treatment was performed. The patient underwent the hysterectomy, adnexectomy, omentectomy, pelvic lymphadenectomy and surgical staging like in ovarian cancer. The adjuvant chemotherapy according to platinum and taxan protocol was administered. The surgical treatment is the base of fallopian tube therapy. In young women in early-stage of the disease, who wish to preserve fertility, conservative treatment is allowed. In other cases hysterectomy, adnexectomy, omentectomy, pelvic and para-aortic lymphadenectomy cytological smears and peritoneum sampling like in ovarian cancer protocol are made. In advanced cases the treatment includes the primary and secondary cytoreduction. In adjuvant therapy the first and the second line chemotherapy is used like in ovarian cancer protocols. At present there are not recommendations for hormonotherapy or adjuvant radiotherapy. The most important prognostic factors are the stage of the disease and the lack of optimal cytoreduction (residual tumor >2 cm). When compared to ovarian cancer, primary fallopian tube cancer more often tends to involve retroperitoneal space and to metastasize distantly. Due to the facts that its clinical symptoms appear earlier, it is diagnosed at earlier stages. A better prognosis regarding the survival in advanced cases points to a different biology of the neoplasm than the one in the ovarian cancer.

Keywords: fallopian tube carcinoma, diagnosis, treatment, prognostic factors, prognosis
Relevance of endocervical cells in Pap smears conducted for prevention of clear cell carcinoma of the cervix – two case presentations
CURR. GYNECOL. ONCOL. 2013, 11 (3), p. 229–237
DOI: 10.15557/CGO.2013.0021

A cervical smear is a test aimed at detecting precancerous lesions and cancer at an early clinical stage. The introduction of a Pap smear as a screening test has reduced the number of newly diagnosed squamous cell carcinomas of the cervix by 42% in 20 years. At the same time, an increase in the incidence of adenocarcinomas originating from glandular, endocervical cells, has been observed. The Bethesda system, which documents the presence or absence of glandular cells of the cervix and defines their pathologies, is currently recommended for evaluation of cervical cytology. Most of the prevention programs recommend to screen every 2–3 years. We report a case of two women with cervical clear cell adenocarcinoma – a rare subtype (5–7%) of adenocarcinomas, diagnosed in stage FIGO IB2 that developed despite regular (every year) cytological screening. The last Pap smears were performed 12 and 13 months before the diagnosis and no abnormalities were found. The results were normal and no endocervical cells were found in the smear. The radical surgical treatment was implemented, followed by an adjuvant therapy. In post-surgical tissues, HPV-18 DNA was detected in both patients. During 24 and 19 months of follow-up, no recurrences were noticed.

Keywords: cervical adenocarcinoma, clear cell carcinoma, Pap smear, endocervical cells, HPV-18
Pelvic actinomycosis with clinical features of an adnexal neoplastic tumor – a case report
CURR. GYNECOL. ONCOL. 2013, 11 (3), p. 238–243
DOI: 10.15557/CGO.2013.0022

Actinomycosis manifesting as a pelvic tumor is a rare complication following a long-term use of a contraceptive intrauterine device (IUD), which constitutes about 3% of all human actinomycosis infections. The most common symptoms include abdominal pain, vaginal discharge, hematuria, and inflammatory bowel disease. A clinical examination reveals an adnexal tumor, and occasionally intraperitoneal abscesses or even an enterovesical fistula. The lack of any typical symptoms makes the diagnostics very difficult, thereby necessitating a laparotomy in most cases. Case report: A 41-year-old woman was admitted to The Gynecologic Oncology Department of The Maria Sklodowska-Curie Memorial Cancer Center in Warsaw with a three-month history of abdominal pain, and a weight loss of 23 kg over the same period. The patient had a contraceptive intrauterine device inserted 17 years earlier. A clinical examination, a transvaginal ultrasound and a computed tomography scan revealed a mass of 170 × 150 × 100 mm in the left lower quadrant of the abdomen and the pelvis, as well as dilated left ureter, and left-side hydronephrosis. Due to the presence of the tumor suspicious for malignancy, the patient was scheduled for a surgical procedure. The surgery included: a total abdominal hysterectomy, a left-side salpingo-oophorectomy, and an omentectomy, followed by a biopsy of the right-side iliac lymph nodes. A histologic examination established pelvic actinomycosis. Conclusion: A diagnosis of pelvic actinomycosis should be considered in patients with a pelvic mass, particularly those with a long-term history of an intrauterine contraceptive device, thereby affecting the choice of the course and the extent of treatment.

Keywords: actinomycosis, pelvic tumor, contraceptive intrauterine device (IUD), suspicion of malignancy, overtreatment