2016, Vol 14, No 1
Electrochemotherapy in breast cancer
Curr Gynecol Oncol 2016, 14 (1), p. 5–12
DOI: 10.15557/CGO.2016.0001

Electrochemotherapy is a local therapy method reserved for cases not subject to surgery in advanced surface-localized cancers in the integuments. It may be applied in treating primary skin neoplasms (cancer and melanoma) as well as metastases of other neoplasms to the skin/hypodermis not qualified for another therapy (e.g. local removal or isolated limb perfusion, radiotherapy), regardless of the histological type of the neoplasm. It is a palliative type of treatment, and its objective is to obtain local control over cancerous lesions deteriorating the quality of life of the patients (infections, hemorrhages, limb function limitation). In selected cases, it is possible to obtain a long-term local control (e.g. in advanced, unresectable or qualifying to an extensive procedure on scalp and neck neoplasms and breast cancers with extensive dermis infiltration, reacting poorly to systemic treatment). Especially local breast cancer recurrence, frequently of large area or multiple with tissue infiltration, persisting despite systemic treatment, may be subject to electrochemotherapy. It especially applies to patients with disseminated cancer. In the paper, the authors are summarizing their experience in the application of that method among patients with breast cancer.

Keywords: electrochemotherapy, breast cancer, local recurrence
Gravida’s knowledge concerning harmful effect of smoking on the fetus and the awareness of HPV infection impact on the development of cervical cancer
Curr Gynecol Oncol 2016, 14 (1), p. 13–22
DOI: 10.15557/CGO.2016.0002

Aim of the paper: The aim of the paper was to evaluate gravida’s knowledge concerning the harmful effect of smoking on the fetus and the awareness concerning the impact of nicotine on the development of cervical cancer in women infected with HPV. Material and method: The study covered 127 women – healthy gravidas provided with a specialist care of K clinic, inhabitants of cities and villages. The study was conducted from March to June 2015 with the utilization of a diagnostic survey. To that end, an author’s questionnaire was drafted, which consisted of 23 questions concerning smoking tobacco and respondent’s knowledge in terms of the HPV infection. Results: Responses of 127 women were evaluated, out of whom 76% had never smoked tobacco, 8% stopped smoking due to pregnancy and 16% limited smoking in that time or moved to “light” cigarettes, or used nicotine patches and limited smoking simultaneously. The majority of gravidas (94%) were aware that smoking is harmful to the child and toxic substances penetrate through the placenta; 76% knew that toxic substances also penetrate to breast milk. The largest group of women (36%) was exposed to passive smoking in own houses, among the closest family. A problem with motivation may be observed in the group of smoking gravidas – it may be necessary to consider obligatory consultations with a psychologist related to motivation and addiction for all the smokers being pregnant or planning their pregnancy. Moreover, the survey proved that young women lack basic knowledge in the field of HPV infection.

Keywords: smoking while pregnant, HPV, cervical cancer, nicotine smoke, passive and active smoking
Inguinal lymphadenectomy in case of vulvar carcinoma – point of view of a surgeon and a pathologist
Curr Gynecol Oncol 2016, 14 (1), p. 23–29
DOI: 10.15557/CGO.2016.0003

Vulvar carcinoma is the fourth most prevalent cancer of genitals in women (accounting for 5% of all neoplasms from this group). Histologically, we differentiate epithelial neoplasms – in 90% of cases we are dealing keratotic squamous cell carcinoma – and non-epithelial ones. The majority of vulvar carcinomas occur at a postmenopausal age and are related to chronic bacterial or viral infection (human papilloma virus). Lymph from the vulva is drained to three groups of inguinal lymph nodes and to iliac lymph nodes. Depending on the location of a neoplastic lesion, vulvar carcinoma metastasizes unilaterally or bilaterally. The basic methods of treatment are surgical removal or inguinal lymphadenectomy – both superficial and deep. This article presents a detailed anatomy of the inguinal-iliac lymphatic system as well as the most widely used surgical techniques and the most common postoperative complications. Cooperation with the clinician is crucial to present a valuable pathology report. In hospitals with an anatomic pathology unit on-site, the surgeon should send a non-fixed material, and optimally – in sterile conditions. In hospitals without an anatomic pathology unit, the specimen must be fixed. For the pathologist’s assessment of pN stage – in accordance with the TNM classification of 2010 – to be reliable, the operative specimen comprising the inguinal lymphatic system must include at least six lymph nodes. Obtaining satisfactory management results requires a good knowledge of anatomy of this area and surgical techniques as well as a proper preparation of the specimen for pathologic examination.

Keywords: vulvar carcinoma, inguinal lymphadenectomy, lymph drainage, metastases, pathologic examination
Is it possible to diagnose endometriosis at the level of endometrium?
Curr Gynecol Oncol 2016, 14 (1), p. 30–38
DOI: 10.15557/CGO.2016.0004

The endometrium of women with endometriosis has a different expression of cytokines, angiogenic and hormonal factors compared to healthy women. Endometriosis is a disease occurring mostly in women at a reproductive age with a frequency of 7–10%. Despite many studies and hypotheses on the pathogenesis of the disease, marker specific to endometriosis has not yet been detected. Thus, laparoscopy remains the gold standard in the diagnosis, particularly in the case of peritoneal form that cannot be visualized by means of an ultrasound test. Other forms of endometriosis – ovarian (chocolate cysts) and deep infiltrating – can be identified in an ultrasound test. Scientists are currently searching for markers that in a specific combination would ensure maximum sensitivity and specificity of the non-invasive detection of endometriosis, even at early stages. The article presents selected factors, such as interleukin 8, vascular endothelial growth factor, platelet-derived growth factor, nerve growth factor, detected in the endometrium, which can be a potential diagnostic target. Diagnoses made at the level of endometrium would facilitate the identification of endometriosis and would significantly reduce costs associated with the necessity to conduct laparoscopy.

Keywords: endometriosis, endometrium IL-8, VEGF, PDGF, NGF
The role of antioxidant vitamins in gynecologic malignancies
Curr Gynecol Oncol 2016, 14 (1), p. 39–52
DOI: 10.15557/CGO.2016.0005

Vitamins D, C, E and A, which belong to antioxidants, exhibit anticancer activity. The mechanism of vitamin D antitumor activity involves the inhibition of cell proliferation, stimulation of apoptosis, inhibition of angiogenesis and an increased activity of metalloproteinases in the extracellular matrix. Vitamin D prevents the development and progression of breast cancer; its lower levels in the serum of premenopausal women are linked to the development of triple negative cancer (E-, PR-, HER2-). Cohort studies on the effects of VDR (vitamin D receptor) polymorphisms and studies related to vitamin D supplementation in postmenopausal women in the context of reduced risk of breast cancer are controversial. Vitamin D exerts a protective effect against ovarian and endometrial cancer. Vitamin C protects cells against the formation of mutagenic nitro compounds, enhances the immune system by promoting the activity of NK, T and B cells. Vitamin C supplementation improves treatment outcomes in disseminated breast cancer; the vitamin acts synergistically with cisplatin, it increases paclitaxel and doxorubicin cytotoxicity and abolishes toxic effects of tamoxifen. Vitamin C combined with chemotherapy in ovarian cancer prolongs patient’s survival. It increases sensitivity to cisplatin. Vitamin E exerts anticancer effects via multiple pathways. Its increased administration reduces the risk of breast cancer and ovarian cancer. The reduction in the incidence of endometrial cancer remains controversial. Vitamin A also exerts antioxidant effects. The compound reduces the incidence of DNA damage in cells exposed to hydrogen peroxide and protects cell organelles (including mitochondria) against the negative impact of lipid peroxidation. It reduces the risk of multiple tumors, including breast and cervical cancer.

Keywords: vitamin D, vitamin C, vitamin E, vitamin A, breast cancer, ovarian cancer, endometrial cancer, cervical cancer
Indications for a non-standard use of thromboprophylaxis in patients with ovarian cancer – two case reports and a literature review
Curr Gynecol Oncol 2016, 14 (1), p. 53–62
DOI: 10.15557/CGO.2016.0006

The authors report two cases of gynecologic malignancy in women receiving different thromboprophylactic regimens. Presently, everyday clinical problems are not always solved based on the well-established standards for the preventive management in venous thromboembolism. The paper presents a review of the literature on the principles for the use of lowmolecular- weight heparins in patients undergoing oncologic surgeries, with particular attention to the aspects of thrombotic risk and suggestions on non-standard management in cases not included in the guidelines. The recommendations of scientific associations, due to their inertia, are released with a delay relative to research, and may present inconsistent views due to the differences in publication timing. This article is to raise readers’ awareness of the scale of the problem and the importance of the effects of thromboembolic complications on prognosis in cancer. The need to assess the risk of these complications at every stage of cancer treatment should be emphasized. Additionally, risk assessment can be used as an opportunity to educate patients in this aspect.

Keywords: cancer, venous thromboembolism, deep vein thrombosis
Late ovarian cancer relapse following conservative surgery in a patient of childbearing age – a case study
Curr Gynecol Oncol 2016, 14 (1), p. 63–68
DOI: 10.15557/CGO.2016.0007

Ovarian cancer is increasingly often diagnosed in women of childbearing age, with the inevitable question arising what course of proceeding to adopt next. In the case of an early-stage cancer, 5-year survival rates range from 75 to 80%. We are presenting here the case of a 21-year-old patient with postoperatively diagnosed early-stage ovarian cancer, who decided to undergo conservative surgical treatment, and was later able to conceive and bear a child. Several years on, she suffered a relapse. Patients of childbearing age with diagnosed ovarian cancer should be tested for BRCA mutation, and receive oncology consultation. As 9–15% of patients suffer relapse after conservative surgery conducted at an early stage of the disease, full resection is essential immediately after the patient’s childbearing plans have been completed.

Keywords: ovarian cancer, conservative operation, FIGO IA, BRCA mutation