2015, Vol 13, No 2
An assessment of the urinary function and the comfort of life in patients after endometrial cancer combined treatment
Curr Gynecol Oncol 2015, 13 (2), p. 78–84
DOI: 10.15557/CGO.2015.0009

Endometrial cancer is currently the most common form of female reproductive tract tumors. The efficacy of treatment, which involves surgery, radiotherapy and systemic therapy, is increasing and the assessment of the quality of life of patients is subject to careful analysis. Difficulty in urination represents a major factor reducing the quality of life of patients. The aim of the study was to collect data on the urinary functioning and the quality of life in endometrial cancer patients considered cured after a combined treatment compared to patients after non-oncological hysterectomy. A total of 46 females divided into two groups were included in the study. Group I (study group) included 23 endometrial cancer patients (stage IA, G1–G2) after combined treatment, who received surgical treatment and adjuvant brachytherapy; group II (control group) included 23 patients after non-oncological hysterectomy and uterine appendage removal. The patients were assessed once, between month 6 and 12 after treatment termination. Medical history, gynecologic examination, urodynamic testing and life quality assessment were performed in all patients. Statistical analysis showed a significant difference between the two groups in terms of urogynecologic outcomes (p = 0.0193). The proportion of women without any disturbances was definitely higher in the control group (only 22%) vs. study group. Stress urinary incontinence, mixed incontinence and overactive bladder were more common in the study group compared to controls. Furthermore, a significant difference in the quality of life was shown between the compared groups of patients (p = 0.0270). Reduced quality of life was significantly more common in the study group (57% vs. 26% of controls). Improvement of life quality was less common in the study group (13%) compared to controls (28%). Brachytherapy increases the severity of genitourinary disorders, which adversely affects the quality of life in patients after cancer therapy.

Keywords: endometrial cancer, brachytherapy, stress urinary incontinence, urodynamic testing, overactive bladder, mixed incontinence
Histology of endometriosis-associated ovarian carcinomas
Curr Gynecol Oncol 2015, 13 (2), p. 85–92
DOI: 10.15557/CGO.2015.0010

Objective: The objective of this study was to demonstrate the histological diversity of endometriosis-associated ovarian carcinoma. Material and methods: Using record linkage techniques, we have conducted histopathological assessment in patients with endometriosis-associated ovarian cancer who received surgical treatment between 2004–2010 in the Oncology Centre in Bydgoszcz. Endometriosis and cervical carcinoma were confirmed in one tissue specimen in 62 patients. Results: Endometriosis seemed to promote the development of specific histologic types of ovarian cancer. Of 62 subjects, 53.22% (33/62) had endometrioid adenocarcinoma, 25.8% (16/62) had clear-cell carcinoma, 19.35% (12/62) had serous adenocarcinoma, and 1.61% (1/62) had mucinous adenocarcinoma. Our results support the hypothesis that coexistent endometriosis is more often associated with endometrioid and clear-cell carcinomas than other histologic subtypes as well as that clear-cell variant is the most common cancer developing in the abdominal wall scar from a previous laparotomy. Among patients with endometriosis-associated ovarian carcinoma in the abdominal scar, three (75%) had clear-cell carcinoma and one had papillary serous adenocarcinoma. Conclusions: According to Sampson’s criteria, endometrioid carcinoma of the ovary was the most common histological diagnosis in patients with endometriosis-associated ovarian carcinoma. The clear-cell variant of cancer was the most common type in patients with endometriosis-associated ovarian carcinoma in the abdominal scar after laparotomy.

Keywords: endometriosis, ovarian cancer, histopathology
The prognostic value of the WHO status in cervical cancer patients
Curr Gynecol Oncol 2015, 13 (2), p. 93–98
DOI: 10.15557/CGO.2015.0011

Background/Aims: The pretreatment World Health Organization performance status in cervical cancer patients is very often underestimated. The aim of this study was to assess the World Health Organization performance status as a prognostic factor in patients with cervical cancer. Methods: A total of 142 cervical adenocarcinoma and 242 squamous cell cancer patients with FIGO stage I–IV were included in the retrospective analysis. All patients received surgical treatment and complementary radiotherapy or radiotherapy alone between January 1989 and December 1999. The multivariate Cox analysis, taking into account the clinical and histological factors, was performed. Results: The median age of patients was 54 years (range 25–85 years); the median follow-up time was 52 months (range 9–174 months). Regardless of other factors, the World Health Organization status (1–3 vs. 0) showed statistically significant association with the overall survival [HR= 2.5 (1.4, 4.5), p = 0.002] and the disease free survival [HR = 2.1 (1.2, 3.5), p = 0.005] in adenocarcinoma patients. No impact of the performance status on treatment outcomes was observed in patients with cervical squamous cell cancer. Conclusion: The World Health Organization performance status in cervical adenocarcinoma patients seems to be an important prognostic factor which may prove helpful in the qualification for an appropriate treatment.

Keywords: cervical cancer, general condition, treatment outcomes
The extent of lymphadenectomy in endometrial cancer and its effect on blood loss and procedure duration
Curr Gynecol Oncol 2015, 13 (2), p. 99–105
DOI: 10.15557/CGO.2015.0012

The clinical staging of endometrial cancer is performed based on surgical-pathological criteria. The extent of lymph node dissection represents a clinical problem. The study was performed in order to assess the occurrence of metastases in iliac and para-aortic lymph nodes as well as to compare selected surgical risk factors in the case of extending the surgery with the dissection of these lymph nodes. The control group included 27 patients undergoing hysterectomy with iliac lymph node dissection; the study group included 30 patients after iliac and para-aortic lymph node removal. The incidence of metastases was assessed as well as the duration of procedure and intraoperative blood loss were compared. Metastases to lymph nodes were found in 10 (17.5%) females. Iliac lymph node metastases were detected in four patients (14.8%) in group I. In group II, metastases were detected in six (20%) patients: isolated para-aortic metastases in two patients (6.67%), para-aortic and iliac metastases in four (13.33%) patients. Statistically significant difference (p = 0.0035) was found in the duration of procedures: the median was 102.5 minutes for iliac lymphadenectomy, and 132.5 minutes for iliac/para-aortic lymphadenectomy; the maximum duration of iliac/para-aortic lymphadenectomy was 20 minutes longer. There was no statistically significant difference in blood loss (p = 0.4980). However, significantly higher maximum blood loss volume was noticeable in the study group. It is necessary to adjust the para-aortic lymphadenectomy in endometrial cancer to patient’s health status as well as to make maximum use of preoperative diagnostics. The procedure should be performed by a specialist experienced in gynecologic oncology to minimize the surgical risk. Information on lymph node status is the most important prognostic factor in endometrial cancer, which allows for a proper qualification for adjuvant therapy.

Keywords: endometrial cancer, surgical treatment, para-aortic lymph nodes, pelvic lymph nodes, lymphadenectomy
What are the perspectives for sentinel lymph node biopsy?
Curr Gynecol Oncol 2015, 13 (2), p. 106–112
DOI: 10.15557/CGO.2015.0013

Local staging of malignancy, introduced in the past few decades into clinical practice, is based on the identification of the lymph node in which metastasis is most likely to occur (sentinel node biopsy). This is a standard of care for breast cancer, melanoma and Merkel-cell carcinoma. Potential changes in the clinical practice of sentinel node biopsy can be assigned to three areas: identification of sentinel lymph node, evaluation of nodal metastases and the therapeutic consequences of the outcomes. In the future, gradual reduction in the invasiveness of sentinel node identification may be expected. Also, the use of radioisotope and blue dye will probably be abandoned. Molecular probes prepared individually for each patient, based on the molecular characteristics of the tumor and conjugated to molecules enabling transcutaneous visualization will allow for an effective, reliable and non-invasive evaluation of the sentinel lymph node. Adjuvant local treatment (surgery or irradiation) will be abandoned in the distant future, even in the case of a confirmed presence of metastasis in sentinel lymph node due to the development of molecularly targeted and very effective methods of individualized conservative treatment. According to the current guidelines on the treatment of early-stage breast cancer, the need for complementary axillary lymphadenectomy may be eliminated in certain circumstances. Sentinel lymph node biopsy will continue to play an important role in staging and therapeutic qualification of patients with early-stage malignant tumors of different histological types and different locations. At the same time, the use of non-invasive methods will increase – both in identification and evaluation of sentinel lymph nodes.

Keywords: sentinel lymph node biopsy, perspectives, development trends
Gonadal tumors of the ovary with particular emphasis on sclerosing stromal tumors. The importance of early diagnosis in ovarian tumors
Curr Gynecol Oncol 2015, 13 (2), p. 113–122
DOI: 10.15557/CGO.2015.0014

Despite the dynamic advances in medicine, ovarian tumors still remain a serious diagnostic and therapeutic issue. There is an ongoing search for an ideal method of early detection of ovarian malignancy. Although malignant lesions are most common in adult women, they may also occur in teenage girls (e.g. germ cell tumors). It is estimated that gonadal tumors account for about 7% of ovarian malignancies, therefore they are considered rare. Tumors belonging to this specific group develop both from female and male gonad components as well as from stromal cells and fibroblasts. Granulosa cell tumors account for as much as 70% of malignant gonadal tumors: 95% in the mature form and 5% in the juvenile form. Gonadal tumors further include thecomas and fibromas, Sertoli–Leydig cell tumors as well as very rare tumors, such as gynandroblastoma, sex cord tumors with annular tubules and sclerosing stromal tumors. The histological structure of sclerosing stromal tumors shows male and female gonadal endocrine cells. For this reason, these tumors often show hormonal activity, as reflected in the clinical course of the disease. Sclerosing stromal tumor of the ovary is an extremely rare cancer belonging to the theca cell-fibrous group. The paper presents macro- and microscopic characteristics, diagnostics, symptomatology and therapeutic methods in sclerosing stromal tumor patients. The importance of early ovarian malignancy detection was emphasized.

Keywords: ovary, cancer, sclerosing stromal tumor
Properties and clinical application of human amniotic epithelial cells (HAEC)
Curr Gynecol Oncol 2015, 13 (2), p. 123–135
DOI: 10.15557/CGO.2015.0015

In the contemporary medicine, undifferentiated progenitor cells of various origin and various degree of plasticity have become highly promising. Their most abundant, renewable and uncontroversial sources are placental tissues and umbilical blood. The only epithelial cells in this group come from the amnion which is used as a whole as an allogenic biological dressing. They have a range of unusual properties, such as the relative lack of histocompatibility antigens, plasticity (enabling their differentiation into a number of epithelial and mesenchymal cells) and the lack of neoplastic capacity. Amniotic epithelial cells are the only epithelial cells of the placenta. It is believed that they retain their progenitor (pluripotent) properties even in term pregnancies. This probably results from the fact that they omit the differentiation that accompanies gastrulation. Such features are typical of all placental cells which differ from amniotic epithelial cells only in their non-epithelial origin. In culture conditions, amniotic epithelial cells are characterized by a considerable plasticity: they can be stimulated to differentiate into adipocytes, chondrocytes, osteocytes, myocytes, cardiomyocytes, neurocytes, pancreatic cells and hepatocytes. To date, however, the attempts to direct their development towards the epidermis have not been successful. Obtaining multilayer epidermis in amniotic epithelial culture would be of considerable importance for tissue engineering of biological dressings. Amniotic membranes have been used for this purpose for many years, but because of their complex structure and metabolic requirements, they do not heal but dry up when applied to the wound. Some reports, however, indicate that the epithelium isolated from the amnion could be able to heal thus being suitable for allogenic grafts.

Keywords: amniotic epithelial cells, amniotic membrane, tissue engineering, cell culture, biological dressing