2015, Vol 13, No 1
Type I and II endometrial cancer – a new look at the etiology and clinical course
Curr Gynecol Oncol 2015, 13 (1), p. 5–10
DOI: 10.15557/CGO.2015.0001

Endometrial cancer is the most frequent malignancy of female genital organs in more developed countries. It is a heterogeneous tumor with variable risk factors, precancerous conditions, clinical course and prognosis. The majority of cases are sporadic, however endometrial cancer develops in around 8–12% of women with Lynch syndrome, who are at increased risk of this disease. MLH1, MSH2 and MSH6 mutations are observed with equal frequency. Recent molecular studies on endometrial cancer indicate that the classic division into two types according to Bokhman is insufficient, particularly with respect to type II which is less common, and which includes both serous carcinomas and clear-cell carcinomas. Endometrial intraepithelial carcinoma is considered a precursor lesion for uterine serous carcinoma. In immunohistochemical tests (p53, Ki67, ER and PR) it resembles a precursor lesion for ovarian serous carcinoma, possibly indicating the clonal origin of both carcinomas. It is possible that cells from the foci of endometrial intraepithelial carcinoma migrate to the fallopian tube and lead to the peritoneal spread of the disease. Differential diagnosis of uterine serous carcinoma and ovarian serous carcinoma is difficult; testing ER and PR profiles and evaluation of WT1 expression can prove helpful. In recent years, it has been found that uterine serous carcinoma can be associated with the carrier state of mutated BRCA1. These studies are significant since in carriers of mutated BRCA1, apart from prophylactic adnexectomy, hysterectomy should be considered as well. Another important aspect in such cases is therapy with PARP inhibitors.

Keywords: endometrial cancer, molecular background, signaling pathways
Current problems in diagnostic management and surgical treatment of breast cancer patients – a review of selected clinical issues
Curr Gynecol Oncol 2015, 13 (1), p. 11–19
DOI: 10.15557/CGO.2015.0002

Breast cancer is the most common malignancy in women in Poland and other developed countries. It refers especially to those in peri- and postmenopausal age. Poland is characterized by a dynamic increase in the number of new cases of breast cancer. Namely, in 2010, the number of new diagnosed cases was more than 30% higher than 10 years before. As suggested by epidemiological forecasts for Poland, the trend is expected to be maintained. Surgical treatment is the main prerequisite for a permanent and positive outcome of breast cancer treatment. The percentage of surgeries performed in Poland has increased significantly in recent years from 77% in 2004 to 90% in 2010. The most important prognostic factor affecting longterm treatment outcomes in cancer patients is the clinical grading of the disease. Early detection of breast cancer, preferably at the asymptomatic stage, may significantly determine both the selection of available treatment options and the final treatment outcome. The objective of this study was to discuss current problems related to preoperative diagnostics and surgical treatment of breast cancer patients. Issues concerning mammography screening program were subjected to analysis. The part concerning surgical treatment features new trends regarding procedures of conservative treatment of breast cancer. It is also important to emphasize the necessity of the use of conclusions from the Z0011 trial and personalized oncoplastic surgery techniques in everyday clinical practice.

Keywords: breast cancer, diagnosis and treatment, sentinel lymph node biopsy, lymphatic system imaging methods, surgical treatment
Sexually transmitted diseases in adolescents
Curr Gynecol Oncol 2015, 13 (1), p. 20–26
DOI: 10.15557/CGO.2015.0003

Although the body is protected by the immune system, only a small proportion of people do not experience inflammatory problems in their lives. For girls, preventive Babeş–Pap smear tests are necessary, and vaccination against oncogenic HPV strains must be considered. The treatment of symptoms and effects of these ailments without removing their causes make them sometimes change into diseases of disastrous consequences leading to a tragedy of many women and their families. It is therefore important to prevent diseases by prophylactic checkups and treatment of diagnosed pathological conditions. The most certain methods enabling sexually transmitted diseases to be avoided are refraining from sexual activity (vaginal, anal or oral) or remaining in a long-term monogamous relationship with an uninfected partner. Prior to the initiation of sexual activity, it is recommended to perform tests for sexually transmitted diseases, including HIV infection. According to numerous reports, about one million people a day are infected with a sexually transmitted disease. The WHO (World Health Organization) reports that recent changes and new trends in the epidemiology are as follows: 340 million new cases each year (an increase by 50% since 1990), including more than 50% of patients at the age <25. According to the WHO, 41% of patients <25 years old have unprotected sex. The estimated number of new cases of sexually transmitted infections in the US is 9.1 million infections per year among persons <25 years old; 88% of them being HPV (human papillomavirus), NG (Neisseria gonorrhoeae), TV (Trichomonas vaginalis) or CT (Chlamydia trachomatis) infection. In Eastern Europe a 37-fold increase in syphilis has been noted in the past 10 years. Demographic and educational changes as well as behavioral factors are important and affect the incidence of sexually transmitted diseases.

Keywords: girls, oncology, viral infections, sexually transmitted diseases, disease prevention
The clinical course of cancer and mental adjustment
Curr Gynecol Oncol 2015, 13 (1), p. 27–43
DOI: 10.15557/CGO.2015.0004
The aim of the article is to present the basic aspects of psychological functioning in the situation when an individual struggles with the diagnosis and treatment of cancer. The article discusses issues of distress experienced by cancer patients and factors predisposing to more severe distress. Moreover, the problems affecting the level of adjustment to the situation of disease and treatment are discussed and presented in three dimensions: as factors associated with the patient as an individual, with the disease itself and with the context of patient’s life. Attention is paid to anticancer treatment, which is a huge burden for patients and, in many cases, adjustment to such a burden is a considerable challenge. The awareness of the specificity of psychological reactions to individual stages of the disease is significant for people who work with such patients or relatives who accompany them through their disease. The paper provides a characteristics of a psychological reaction to the diagnosis of cancer and presents the specific character of the remission period as well as a possible recurrence. Moreover, it discusses the advanced and terminal phases of the disease. The aforementioned stages are presented based on personal relevance of a given stage to the individual patient. Furthermore, the most common emotions are described and the psychological tasks with which patients struggle in the given stages of cancer are discussed. The last part of the paper concerns patients’ need for information. The quality and level of communication of the patient with the therapeutic team considerably affects the way they cope with the disease and therapy. The paper also discusses the most commonly mentioned needs of patients and/or their families at individual stages of the disease and phases of treatment.
Keywords: psychological reactions to diagnosis and treatment of cancer, distress, adjustment to cancer, stages of disease, information needs
Systemic treatment of borderline ovarian tumors – case report and literature review
Curr Gynecol Oncol 2015, 13 (1), p. 44–50
DOI: 10.15557/CGO.2015.0005

In the classification of the World Health Organization from 1973, borderline tumors were classified as a separate group of epithelial ovarian tumors. The most important characteristics of such tumors include: the absence of destructive stromal invasion and a buildup of epithelial cells as well as moderate mitotic activity and nuclear atypia. Surgery, which can be fertility-sparing in younger women who plan pregnancy, is the basic treatment of borderline tumors. Adjuvant therapy is, however, a debatable issue. In selected cases, chemotherapy is implemented but treatment protocols are not uniform and vary in different centers. The indications for adjuvant treatment and the number of cycles are determined by the experience of an oncological center. Doubts usually concern patients with invasive implants and advanced forms of the disease. The aim of the paper was to present a rather special case of a 25-year-old patient with bilateral borderline ovarian tumors with invasive implants in the peritoneum and greater omentum. The patient underwent a sparing surgery, due to her decision to retain fertility, followed by chemotherapy. The patient has not presented any signs of relapse for two years. The article also presents a review of available literature on adjuvant treatment of borderline tumors and new recommendations of experts and oncological societies. Most of the studies indicate that systemic treatment is ineffective. In the case presented, however, a remission was achieved after six cycles of chemotherapy, which suggests the need for individualizing treatment in certain cases.

Keywords: borderline ovarian tumors, fertility-sparing treatment, chemotherapy, indications, follow-up
Rhabdomyosarcoma alveolare in the urogenital region – a case report and literature review
Curr Gynecol Oncol 2015, 13 (1), p. 51–58
DOI: 10.15557/CGO.2015.0006

Introduction: Soft tissue sarcoma accounts for 1% of malignant neoplasms detected in adult patients in Poland. Their primary localization in the urogenital system is rare. Aim of the paper: To present a case of rhabdomyosarcoma alveolare of the urogenital region in a 40-year-old female patient and conduct a literature review. Material and methods: The retrospective analysis involved medical records of the patient hospitalized in the Oncology Center in Krakow. The available literature on soft tissue sarcoma in the urogenital region was reviewed. Results: A 40-year-old patient presented at the Oncology Center with a lesion in the area of the external opening of the urethra. The histopathological examination of the specimen confirmed the presence of rhabdomyosarcoma alveolare. Since the surgical procedure was not radical, postoperative brachytherapy was conducted. Thirteen months later, a local relapse was diagnosed and removed together with a fragment of the urethra. In the edges of surgical cuts, neoplastic tissue was detected. Postoperative chemo- and teleradiotherapy were started. The literature review demonstrated few case reports of alveolar rhabdomyosarcoma of the urogenital region in adult women. Discussion: Rhabdomyosarcoma is a childhood sarcoma. The results of retrospective studies indicate poor prognosis in adult patients, and the alveolar type is characterized by an aggressive course. This case report confirms the tendency of the neoplasm to recur locally. Conclusions: Rhabdomyosarcoma alveolare of the urogenital region in adult women is a very rare and highly aggressive neoplasm that tends to recur. The rare occurrence of this disease indicates that it should be diagnosed and treated in specialized centers. The urogenital localization does not allow radical surgical treatment and limits postoperative radiotherapy. Individualized combined treatment is therefore necessary.

Keywords: rhabdomyosarcoma, alveolar rhabdomyosarcoma, rhabdomyosarcoma alveolare of the urogenital region, rhabdomyosarcoma in adults, soft tissue sarcoma in adults
Placental site trophoblastic tumor – case report
Curr Gynecol Oncol 2015, 13 (1), p. 59–65
DOI: 10.15557/CGO.2015.0007

Placental site trophoblastic tumor is the rarest and most difficult to diagnose forms of gestational trophoblastic disease. It constitutes 1–2% of gestational trophoblastic disease cases. The most common symptom of placental site trophoblastic tumor is abnormal vaginal bleeding with enlargement of the uterus. Symptoms related to the location of the metastases may occur as well. Placental site trophoblastic tumor may develop in women of any age after pregnancy as well as a long time after menopause. Placental site trophoblastic tumor mostly follows normal delivery, then molar pregnancy, spontaneous abortion, termination of pregnancy or ectopic pregnancy. Placental site trophoblastic tumor etiology is not entirely known. Inactivation and disregulation of TP53 gene as well as upregulation of EGFR and MIB-1 are thought to be the leading factors in the pathogenesis of this tumor. The tumor histologically arises from the intermediate trophoblast cells, which are present at fetus implantation. The majority of placental site trophoblastic tumor behave in a benign fashion and approximately 10–15% are clinically malignant. Placental site trophoblastic tumor can metastasize. The most common site of metastasis are the lungs and vagina. Placental site trophoblastic tumor is characterized by high human placental lactogen levels and high or normal human chorionic gonadotropin levels. The diagnosis of placental site trophoblastic tumor is confirmed by a histopathological and immunohistochemical report. Placental site trophoblastic tumor is usually resistant to chemotherapy. For this reason, placental site trophoblastic tumor is mostly treated surgically, including hysterectomy with or without adnexectomy and subsequent chemotherapy is administered. The first-line chemotherapy regimen is EMA-CO. For EMA-CO refractory cases, second-line chemotherapy is EMA-EP. Radiation is reported to be useful. In post-treatment monitoring, the chorionic gonadotropin and placental lactogen concentration in the blood is observed, as well as performing imaging examinations such as ultrasound, magnetic resonance imaging and positron emission tomography. The chance of recovery depends on the tumor advancement, time passed from the previous pregnancy and pregnancy duration as well as mitotic index of the tumor cells. In cases when placental site trophoblastic tumor is limited to the uterus, the prognosis is relatively good, providing hysterectomy has been carried out. Some cases of long-term remission have been reported with multiagent therapy.

Keywords: placental site trophoblastic tumor, human chorionic gonadotropin, human placental lactogen, surgical treatment, EMA-CO
45th Annual Meeting on Women’s Cancer – Tampa, USA
Curr Gynecol Oncol 2015, 13 (1), p. 66–67
DOI: 10.15557/CGO.2015.0008