2014, Vol 12, No 4
Ambiguous genitalia or disorders of sex development. Medical and ethical aspects
Curr. Gynecol. Oncol. 2014, 12 (4), p. 259–270
DOI: 10.15557/CGO.2014.0024

Background: Ambiguous genitalia pose significant medical and ethical problems. Information regarding the neonate’s sex is important for upbringing since it has a significant impact on gender identity. Parents should be informed of ambiguous genitalia by obstetric personnel in accordance with medical ethics, in an appropriate, clear, and professional manner. Objective: The authors investigated which medical terms referring to ambiguous genitalia are considered the most appropriate according to the judgement of obstetrics students. Design: Students of obstetrics were presented with diagrams of various genital malformations associated with sexual ambiguity. They were provided with a list of medical terms for each condition and asked to grade them with 0–5 points based on the appropriateness of the term. Setting: Poznan University of Medical Sciences and Vocational State School in Kalisz. Population: 209 medical students specializing in obstetrics. Methods: Students of obstetrics were shown pictures of neonates with genital malformations. They were then asked to select the most appropriate term for ambiguous genitals from the options listed in the ambiguous genitals questionnaire by grading each term with 0–5 points. Main outcome measures: The appropriateness of the medical terms for ambiguous genitalia was assessed on a numerical scale. Results: The analysis revealed which terms referring to ambiguous genitalia were deemed the most appropriate by students. Conclusions: When a child is born with genital abnormalities, interdisciplinary diagnostic procedures must be implemented and counseling for family members should be provided. Moreover, the nomenclature for such anomalies should be reviewed. A proper diagnosis of disorders of sexual development is also important from the oncological point of view – a patient with a “Y” in the karyotype requires prophylactic gonadectomy as part of germinal cancer prevention – for example germinal tumors (dysgerminoma).

Keywords: sex, gynecology, sexology, ambiguous genitalia, neonatology
Dyspareunia and algomenorrhea in women with endometriosis – clinical aspects of dienogest therapy
Curr. Gynecol. Oncol. 2014, 12 (4), p. 271–277
DOI: 10.15557/CGO.2014.0025

Introduction: Dyspareunia is defined as tenderness experienced during sexual intercourse without coexisting shrinkage of the vulva or vagina. Dyspareunia is a common sexual disorder in women and can be caused by endometriosis. Dienogest is an important medicine in the treatment of endometriosis. This study assesses the influence of the type of endometriosis (peritoneal vs. endometrioid cysts) on the prevalence of dyspareunia. Material: The examined group consisted of 28 women with endometrioid ovarian (chocolate) cysts without scattered foci of endometriosis, and 33 patients with peritoneal endometriosis. The control group included 60 women without gynecologic problems. Results: In women with endometriosis, dyspareunia was observed four times as frequently as in healthy women. Moreover, it was five times more frequent in women with peritoneal foci of endometriosis than in patients with endometrioid cysts. Conclusion: A diagnosis of dyspareunia should lead to evaluation for peritoneal endometriosis as a possible cause, given the significant relationship between these conditions. The association between peritoneal endometriosis and dyspareunia suggests that pain upon intercourse could stem from inflammatory mediators or adhesions connected with peritoneal endometriosis.

Keywords: dyspareunia, endometriosis, sexual dysfunction, sexual disorder, sexology
Role of social support and pro-health behaviors in fighting breast cancer
Curr. Gynecol. Oncol. 2014, 12 (4), p. 278–289
DOI: 10.15557/CGO.2014.0026

Introduction: Breast cancer is the most frequent malignant neoplasm in women. This illness often makes women withdraw from their family life and work. They do not believe in a return to health and they cannot accept the fact of being ill. This is why social support is crucial to aid the patient in their struggle with the disease. Aim: The aim of this paper was to show a connection between the level and degree of social support and preferable health behaviors as an indicator of maintaining the optimal health condition. Material and methods: The study was carried out among 105 women with breast cancer treated on the Department of Radiotherapy and Department of Breast Diseases and Reconstructive Surgery of the Oncology Center in Bydgoszcz, Poland. Health behaviors were assessed with the use of the questionnaire of Health Behavior Inventory by Juczyński, and the level of support was evaluated with the Scale of Social Support by Kmiecik-Baran. Results: The examined women show a high level of health behaviors. Proper nutrition obtained the lowest score. The main source of support was their family and friends. The therapeutic team provided mainly information support. Of four types of support, the emotional type was assessed as the most effective, and the tangible one as the least effective. Conclusions: The results of the study may contribute to the deeper understanding of problems and needs of women suffering from breast cancer and enhance their motivation to combat the disease. The results may also influence patients’ health behaviors, which might cause faster convalescence or even help avoid the disease.

Keywords: breast cancer, mastectomy, social support, health behaviors, coping with stress, acceptance of illness
Large endometriosis – case report
Curr. Gynecol. Oncol. 2014, 12 (4), p. 290–293
DOI: 10.15557/CGO.2014.0027

Endometriosis develops in about 10% of women in their fertile age, it is estrogen-dependent and is an important clinical problem. The main symptoms are: chronic pain of the minor pelvis, dysmenorrhea, and dyspareunia, with about 50% of patients being infertile; relapses of the disease are frequent. There are many theories linked to the etiopathogenesis: 1) implantation of the endometrium through salpinges to the abdominal cavity and organs located in the minor pelvis, 2) local immunodeficiency, 3) changes in cellular adhesion and cytokine profile, 4) environmental factors, 5) angiogenesis disorders, 6) genetic predispositions. In our report, we described a case of a patient, age 46, nullipara. The patient’s examination revealed a mass that was palpable in the abdomen and could be felt up to the level of four fingers below the navel. Serum CA-125 was 40.4 U/mL. The ultrasound examination per rectum showed a slightly enlarged uterus with normal endometrium, the right ovary without any pathological changes, and the left ovary changed into a cyst of 15 centimeters in diameter with the superior border not clearly visible. Typical clinical symptoms for endometriosis, like persistent pain in the abdomen, flatulence, bloating, dysmenorrhea, urinary incontinence were not observed in that patient. Surgery was performed in which 1000 mL of fluid were evacuated from the endometrial cyst.

Keywords: endometriosis, cyst, nullipara, abdominal mass, surgery
Challenges in the control of cervical cancer in the developing world
Curr. Gynecol. Oncol. 2014, 12 (4), p. 294–300
DOI: 10.15557/CGO.2014.0028

The incidence and mortality of cervical cancer are both much higher in the developing countries than in the developed world. Furthermore, it is estimated that by the year 2050, there will have been more than 1 million cases of cervical cancer a year, with a majority of them in the developing world. The control of cervical cancer is a real challenge in the developing world as it is related to the cultural and socio-economic conditions, and not only to the scientific aspects. In the developing countries, since the introduction of Pap smear in the mid-20th century and subsequent introduction of colposcopy, the disease has shown a remarkable control. With the addition of HPV testing and introduction of vaccines, it is likely to be further controlled. All these technologies are not available freely to women in the developing world. In India 120 000 women are detected annually and 80 000 die of it due to late diagnosis. At the meeting in Malaysia in May 2013, 70 nations asked for action against cervical cancer by the year 2015 and encouraged the use of vaccines. FIGO’s Comprehensive Cervical Cancer Control needs to be followed. The forum gave clear pathways to this goal. In countries of low income, visual inspection of the cervix with acetic acid is the only method which is feasible for large scale at present. Simultaneously, introduction of HPV testing and use of vaccines must be promoted. Innovative information campaigns to increase awareness shall encourage to such actions. Co-factors for the development of cervical cancer are important contributors. They include high parity, chronic infection, tobacco use, malnutrition and lack of hygiene. Hence, the improvement of social factors like women’s education, alleviation and prevention of poverty need to be attended to. For this to happen, the effort on the part of all governments, international agencies and medical profession needs to be sustained. The introduction of vaccines as an addition to screening gives the hope that there is light at the end of the tunnel.

Keywords: cervical cancer, HPV vaccine, screening
Common approaches to the management of cervical cancer in pregnancy
Curr. Gynecol. Oncol. 2014, 12 (4), p. 301–307
DOI: 10.15557/CGO.2014.0029

Malignancies are rarely diagnosed in pregnant women, yet the increasing age of women getting pregnant contributes to a higher incidence of cancers during this period. Apart from breast cancer, cervical cancer is the most frequently diagnosed malignancy in the said population. The co-occurrence of pregnancy and cancer affects decisions related to diagnostics, treatment, the manner of parturition, the course of the postpartum period and postnatal care. At each stage, the management requires consensus – developed by a multidisciplinary team composed of specialists of different fields: gynecologic oncology, obstetrics, neonatology and oncology. The choice of procedures is also dependent on the patient’s decision regarding the continuation of pregnancy. The majority of reports do not point to any differences in the survival rate between women diagnosed with cervical carcinoma during pregnancy and other women affected by the disease. However, it has been confirmed that pregnancy does not have any effect on the survival time of women affected by invasive cancer. With a broader knowledge of pharmacokinetics of cytostatic drugs administered during pregnancy and new oncologic methods as well as the improvement in the care of a treated mother and fetus, the diagnostic and therapeutic procedures also change. In the case of higher stages of cancer, the latest recommendations suggest the performance of lymphadenectomy in order to assess a high risk of the disease. Is some cases, neoadjuvant chemotherapy is also applied until the fetus reaches its maturity. This paper summarizes the latest scientific reports and recommendations of international expert groups regarding the treatment of cervical cancer during pregnancy.

Keywords: cervical cancer, pregnancy, lymphadenectomy, neoadjuvant chemotherapy, cervical dysplasia
Selected opinions on diagnostic and therapeutic procedures in pregnant patients with particular attention paid to malignant ovarian cancer
Curr. Gynecol. Oncol. 2014, 12 (4), p. 308–317
DOI: 10.15557/CGO.2014.0030

The most common neoplasms in pregnant women are: breast cancer, cancers of the reproductive organ (in particular cervical cancer) and gastrointestinal tract, lymphomas and melanoma. Both diagnosis and treatment of cancer in pregnancy encounter numerous obstacles and therefore they should be conducted by an interdisciplinary team of physicians. The primary aim should always be the protection of life and health of the mother and the lowest possible risk of adverse effects induced by the diagnosis and therapy to the fetus. A surgical procedure is one of the basic methods of oncological treatment, also in pregnant patients. However, its extent depends on the type of cancer, gestational age and fetal development. Radiotherapy of the pelvic and abdominal regions during pregnancy is absolutely contraindicated due to severe (also lethal) consequences to the fetus. Chemotherapy with selected drugs is allowed after organogenesis. The therapy should end approximately three weeks prior to the planned labor. The incidence of malignant ovarian cancers is approximately 1 per 10 000–38 000 pregnancies. In the majority of cases, pregnancy does not affect prognosis. The therapeutic management primarily depends on the clinical advancement of cancer. In early stages, surgical intervention should be limited to unilateral salpingo-oopheorectomy as well as biopsy of the peritoneum and greater omentum. Following the conclusion of pregnancy and postpartum period, a repeated surgery to assess the advancement of the disease should be considered. In advanced diseases, the extent of surgical treatment depends mainly on the patient’s decision to maintain the pregnancy.

Keywords: pregnancy, cancer, ovarian cancer, chemotherapy, radiotherapy