2014, Vol 12, No 3
Hypofractionation in hemostatic radiotherapy in advanced vaginal and cervical cancer. Our experience and review of literature
Curr. Gynecol. Oncol. 2014, 12 (3), p. 190–196
DOI: 10.15557/CGO.2014.0016

In gynecologic oncology – despite the existence of proven methods of prevention – more than 60% of patients consult the doctor only at the advanced clinical stage of the disease. The first symptom of advanced cervical and vaginal cancer is often heavy bleeding, due to the considerable fragility of the tumor. The aim of the study was to evaluate the impact of dose fractionation method on the effect of palliative hemostatic radiotherapy. In the years 2001–2012, 67 patients with a diagnosis of advanced cervical and vaginal cancer were treated using this method in the Department of Gynecologic Oncology, Marie Skłodowska-Curie Memorial Cancer Center and Institute of Oncology in Warsaw. Because of the massive bleeding, eight patients with cervical cancer required ligation of the illiac vessels by means of laparotomy or laparoscopy. The study group consisted of 63 patients with cervical cancer and four patients with vaginal cancer. A direct hemostatic effect, as measured by complete cessation of vaginal bleeding after radiotherapy, was obtained in 57 (85%) cases. As a result of recurrent bleeding, 16 patients required the second stage of radiotherapy, which was followed by resolution of the above-mentioned symptom. In the analyzed material, no impact of dose fractionation method on the hemostatic effect was observed. A partial response (cessation of bleeding) after the first stage of radiotherapy was mainly achieved in patients with low hemoglobin levels (less than 9 g/dL) and invasive type of tumor growth. In the case of eight patients – due to a marked regression of tumors – it was decided to implement a radical treatment. In all patients, the treatment was well tolerated. None of them had early acute radiation reactions in the bladder or intestines.

Keywords: cervical cancer, vaginal cancer, radiotherapy, hemostatic effect, hypofractionation
siRNA preparations in gene therapy of ovarian cancer
Curr. Gynecol. Oncol. 2014, 12 (3), p. 197–205
DOI: 10.15557/CGO.2014.0017

According to statistics, ovarian cancer is the fourth cause of death due to gynecologic cancer. It results from late diagnosis of the disease, caused by the lack of characteristic symptoms, as well as from unsatisfactory treatment methods due to e.g. cell resistance to chemotherapy. The search for new therapies is still in progress. It is believed that preparations whose activity is based on RNA interference, i.e. gene silencing with the use of siRNA, are a promising group of new antineoplastic medications. Fire et al. were awarded the Nobel Prize for discovering this phenomenon. The phenomenon of siRNA interference in healthy cells is a natural protective mechanism. Genes are silenced in the cytoplasm with the use of the Dicer enzyme. siRNA gene preparations are delivered into cells with the use of viral methods such as AAV or adenoviruses, as well as non-viral methods e.g. with the use of liposomes. Clinical trials concerning siRNA preparations are now in the first phase. They are conducted on two gene preparations: CALAA-01 and siRNA nanomolecule directed against PLK1. In this paper attention was drawn to the therapeutic meaning of siRNA sequences in relation to the following genes: MDR1, VEGF, MMP, CD44, HER2, SHH, STAT. Both experimental and clinical studies give hope for the use of the described mechanisms in fight with ovarian cancer in the future.

Keywords: siRNA, ovarian cancer, gene therapy, clinical research, chemoresistance
Sense of coherence in relation to health behaviors among women in menopausal period
Curr. Gynecol. Oncol. 2014, 12 (3), p. 206–215
DOI: 10.15557/CGO.2014.0018

Introduction: Menopause is a condition, which significantly affects woman’s life in many aspects. Accepting this new situation is a complicated, multi-stage process. Sense of coherence developed over lifetime appears to be a predictor of dealing with menopause. Aim: The aim of the study is to assess the correlation between sense of coherence and healthy behaviors among women in menopausal period as a decisive factor for optimal health maintenance. Material and methods: The study was performed on one hundred women in menopausal period treated in the local Health Centre in Iława (Warmia and Mazury province). In order to assess the sense of coherence, respondents were questioned using the Life Orientation Questionnaire (SOC-29) and healthy behaviors were evaluated with Health Behavior Inventory (IZZ). Results: The study group of menopausal women is characterized by average level of sense of coherence as well as average level of healthy behaviors. Research shows a relationship between global SOC score and healthy behaviors. It was proven that women with high SOC level reached a higher preferred level of healthy behaviors and they overcome symptoms of menopause period with greater ease. Moreover, the extent of healthy behaviors is correlated with social and demographic variables. Women under 50 years old and those who had received tertiary education also achieved higher scores on IZZ questionnaire. Conclusions: The level of sense of coherence significantly influences the extent of healthy behaviors in the menopausal period. Women with a strong sense of coherence are characterized by a greater level of healthy behaviors. Educating women in a professional way requires recognition of individual conditions of each patient.

Keywords: sense of coherence (SOC), healthy behaviors, menopause, coping with stress, acceptance condition
Professional liability of physicians
Curr. Gynecol. Oncol. 2014, 12 (3), p. 216–224
DOI: 10.15557/CGO.2014.0019

This paper discusses the responsibility of physicians for medical malpractice based on legislative acts. The profession of a physician has been subjected to evaluation since the ancient ages, which contributed to various laws, decrees and norms. It was Hippocrates who included the ethical norms of medical practice in his ethical works. They are well-known today as the Hippocratic Oath which is taken by each physician upon the conclusion of their education. This oath was probably created between 420 and 400 BC and includes ethical, not legal, principles concerning the profession of a physician. Contemporary conduct of physicians is not devoid of negligence, harming and even hurting patients. Therefore, a system of investigation proceedings has appeared – accused physicians are evaluated by physicians-screeners and judged by physicians-judges. This paper presents principles on which the work of screeners for professional liability and judges is based on the territory of the Republic of Poland. Moreover, the entire Hippocratic Oath is quoted. At present, when we are observing such considerable changes in the manners of treatment, in creating new drugs or when comfort of the healthy is forcing physicians to perform euthanasia or abortion, it is worth referring to the ethos of our profession in order to perform our work in accordance with moral principles.

Keywords: Hippocratic Oath, ethics of a physician, medical judgment, professional liability of physicians
Partial resection of the sixth segment of the liver in a young woman with recurrent ovarian cancer – case report
Curr. Gynecol. Oncol. 2014, 12 (3), p. 225–232
DOI: 10.15557/CGO.2014.0020

Ovarian cancer and its course are still one of the most important issues in gynecologic oncology. Understanding the biology of this disease and the possibility of using many adjuvant treatment options to the basic chemotherapy has transformed the disease from a previously lethal into a chronic condition. The mainstay of treatment of advanced stage (FIGO III/IV) ovarian cancer includes currently without a doubt a radical operative procedure involving not only the minor pelvis, but also the abdomen, especially upper abdominal surgery. The above mentioned new insight into the biology of this neoplasm and multicentered studies have led to the improvement of many operative protocols, with a requirement to excise the mass up to the point of macroscopically invisible “remnants of the disease” (T = 0 cm). One of the more common locations of recurrence in patients with advanced ovarian cancer is the liver. Due to the recent development of the approach to liver resection, especially with regard to metaplastic tumors, doctors of various specialties dealing with oncological surgery, including gynecologic oncologists, have been performing this procedure more and more frequently. This is a component of therapy which has a statistically significant impact on patient survival rates. This study presented a case of a 34-year-old female patient, who was operated on at the Department of Gynecology and Gynecologic Oncology of the Medical University in Bialystok for a recurrence of ovarian cancer – the patient underwent partial resection of the liver.

Keywords: ovarian cancer, recurrence of neoplastic disease, partial resection of the liver, radical procedure, surgery of the upper abdomen
Squamous cell vaginal cancer in a patient with complete pelvic organ prolapse – case report
Curr. Gynecol. Oncol. 2014, 12 (3), p. 233–238
DOI: 10.15557/CGO.2014.0021

Vaginal cancer is one of the least common reproductive tumors in women; in Poland it constitutes only 1–4% of them. It is found primarily in elderly patients with the mean age at diagnosis of approximately 70 years. Because of a similar clinical presentation and histological structure, vaginal cancer can be mistaken in its early stages for infiltrating cervical cancer. The incidence of vaginal cancer has been increasing at an alarming pace in recent years, due to the aging of the surveyed populations. In this article we analyzed the comorbidity of squamous cell vaginal cancer and complete pelvic organ prolapse. In order to employ proper cancer treatment, we had to restore the normal anatomy of the reproductive organs prior to brachytherapy. Following unsuccessful attempts to reduce the prolapse using a conservative approach, a two-stage surgical treatment was performed to enable brachytherapy. Initially, we excised the uterus with its adnexa and removed (with a rim of healthy tissue) the tumor in the pouch of Douglas. Subsequently, in collaboration with a surgical team, we reconstructed the vaginal ligaments with the use of a U-shaped polypropylene mesh, which was fixed to the sacral bone. Simultaneously, we reconstructed the rectovaginal septum. In connection with this case report we reviewed the current methods of surgical and systemic treatment of vaginal cancer.

Keywords: virginal squamous-cell cancer, enterocele, U-shaped polypropylene mesh, vaginal stub suspension, cancer recurrence
Glandular cancer of the cervix or endometrial cancer – difficulties in diagnostics
Curr. Gynecol. Oncol. 2014, 12 (3), p. 239–244
DOI: 10.15557/CGO.2014.0022

According to the epidemiological data, a tendency for rising cervical adenocarcinoma morbidity, especially among young women, has recently been observed. The efficacy of routinely used screening methods in detecting glandular precancerous lesions is significantly lower than in planoepithelial lesions. Many authors emphasize a worse outcome in cervical adenocarcinoma patients when compared with the patients with squamous cell cancer. Endometrial cancer is one of the most common gynecologic malignancies in Poland – affecting menopausal women. An early symptom of this cancer is an abnormal bleeding pattern in women of childbearing age or bleeding after menopause. The selection of the type and methods of endometrial cancer treatment are crucial factors influencing the final effectiveness of treatment. The article presents a case report – patient (age 31) who after cervical conization was diagnosed with cervical adenocarcinoma. Based on the diagnosis, the patient was qualified to Wertheim’s operation (radical hysterectomy with pelvic lymphadenectomy with paracervical tissue). There were no complications during or after surgery. The final histopathological report proved endometrial clearcell adenocarcinoma. We discussed diagnostic difficulties and the recommended treatment for both types of cancer. We should also remember that the final pathology report determines postoperative treatment.

Keywords: endometrial clear-cell carcinoma, adenocarcinoma of cervix, HPV virus, cervical intraepithelial neoplasia, radical hysterectomy
Granulation tissue of large size in the vagina after Manchester operation
Curr. Gynecol. Oncol. 2014, 12 (3), p. 245–248
DOI: 10.15557/CGO.2014.0023

We reported on a case of granulation tissue of large size in the vagina after Manchester operation. A 71-year-old patient was admitted with a tumor of 7 cm in diameter in the vagina. The patient had undergone Manchester operation a year before. Granulation of tissues in the vagina are an often complication after hysterectomy. Clinical symptoms are mucous or blood secretion and mild coital bleeding. In some cases it might also be asymptomatic. It was found that in more than 30% of women after hysterectomy there is granulation tissue in the vagina. It was observed that in more than 60% it is ≤5 mm in size and that it regresses more often than in cases where it is of >5 mm (72% and 33%, respectively). Granulation tissue of >10 mm is very rare. Double biopsies of the 7-centimeter tumor did not provide sufficient information on the tumor origin. There are different therapeutic options for granulation tissue depending on its size – from observation to laser and surgical treatment. In the presented case the only possible option was according to us cautious removal of the tumor from the anterior wall of the vagina to prevent bladder damage. Tumor excision was performed – immunohistochemical staining methods revealed granulation tissue.

Keywords: Manchester operation, Fothergill operation, granulation tissue, wound healing, surgery