2017, Vol 15, No 4
The impact of treatment exposure on diabetes biomarkers among Jordanian breast cancer women: a connection through FBG, C-peptide and HOMA-IR
Curr Gynecol Oncol 2017, 15 (4), p. 231–238
DOI: 10.15557/CGO.2017.0022

Background: Breast cancer is the most frequently occurring and life-threatening malignant tumor in women. The evidence that associates diabetes’ biomarkers with breast cancer is highly controversial. Aims: To evaluate diabetes’ biomarkers in breast cancer patients according to type of treatment exposure, breast cancer severity and menopausal status. Material and methods: A total of 396 breast cancer patients aged between 25 and 65 years attending breast cancer clinics were evaluated. The experimental design permitted to include 134 newly-diagnosed breast cancer patients who were not exposed to any type of interventions and 262 recently diagnosed breast cancer patients (up to three months). Recently, group members were subdivided in two subgroups to control exposure to therapy specially chemotherapy. The patients were further divided according to breast cancer stages and postmenopausal status. Diabetes biomarkers consisted of fasting blood glucose (FBG), C-peptide and HOMA-IR. Results: The high FBG was more prevalent in advance (24.1%) than early (10.6%) stage breast cancer. Compared with premenopausal breast cancer patients, postmenopausal breast cancer patients had higher prevalence of abnormal FBG (21.0% vs. 11.1%). The differences were also significant in the mean of FBG (103.0 ± 1.5 vs. 89.0 ± 0.0 mg/dL). In postmenopausal breast cancer patients, FBG was higher in the recently diagnosed whom expose to treatments including chemotherapy (106.5 ± 1.7 mg/dL vs. 126.2 ± 1.2 mm Hg) compared to the newly-diagnosed group whom not yet expose to any kind of treatment interventions. Conclusion: Diabetes was prevalent among breast cancer patients and it was higher in postmenopausal and advanced stage breast cancer women. The burden of diabetes on treatment expose breast cancer women tend to be high and warrants closer attention by health care provider to improved outcomes after diagnosis and treatment exposure.

Keywords: breast cancer stage, C-peptide, fasting blood glucose, menopausal status, treatment exposure
Determinants of pelvic and para-aortic lymph node metastasis in endometrial cancer and its role in tailoring lymphadenectomy
Curr Gynecol Oncol 2017, 15 (4), p. 239–245
DOI: 10.15557/CGO.2017.0023

Background: The International Federation of Gynecology and Obstetrics (FIGO) decided to adopt surgical staging for endometrial cancer including systemic pelvic and para-aortic lymph node dissection in 1988; however, the extent of an optimal lymphadenectomy and which subgroup of patients would benefit are still debatable issues. The purpose of this study was to evaluate the incidence and distribution of pelvic and aortic lymph node metastases in endometrial cancer and to study various clinicopathologic variables affecting lymph node metastasis in endometrial cancer and their role in tailoring lymphadenectomy. Methods: This retrospective study included patients with endometrial cancer that were admitted to the Obstetrics and Gynecology Department of Shinshu University Hospital, Japan, and South Egypt Cancer Institute, Assiut University, Egypt, between June 2005 and May 2014. All patients underwent pelvic lymph node and para-aortic lymph node dissection as part of the primary surgery during the study period. Demographic and clinicopathological data were collected and analyzed in relation to pelvic lymph node and para-aortic lymph node metastasis. Results: Seventy-eight patients (35 patients from Japan and 43 patients from Egypt) with endometrial cancer with FIGO stage I–IV and with all histopathological cell types and tumor grades were included. Pelvic lymph node metastases were significantly correlated with advanced disease (stage III and IV), endometroid carcinoma, myometrial invasion >1/2, adnexal involvement and lymphovascular space invasion. Para-aortic lymph node metastases were significantly correlated with advanced disease (stage III and IV), myometrial invasion >1/2, adnexal involvement and lymphovascular space invasion. Conclusion: Our study concluded that lymphadenectomy in patients with endometrial cancer can be tailored according to risk stratification for lymph node metastasis. So, in low risk patients lymphadenectomy can be omitted to avoid operative complications.

Keywords: retrospective studies, incidence, endometrial neoplasms, lymph node excision, lymphadenectomy
A comparative analysis of outcomes of preventive screening for early detection of cervical cancer in patients from two diff erent regions in the Lubusz Province (Poland)
Curr Gynecol Oncol 2017, 15 (4), p. 246–262
DOI: 10.15557/CGO.2017.0024

Introduction: Cervical cancer is one of the most commonly diagnosed gynecologic malignancies in Poland. Due to effective prevention and increasing health awareness among women, the incidence of cervical cancer is dropping in many European countries. In Poland, morbidity and mortality due to cervical cancer vary depending on the region. Unfortunately, the Lubusz Province has had one of the highest rates of morbidity and mortality from cervical cancer for the last 10 years. HPV infection is a necessary, but may not be sufficient for the initiation of neoplastic processes in the cervix. Other factors include chronic vaginitis, early sexual initiation, multiparity, age, tobacco smoking, immune deficiencies and low socioeconomic status of women. The aim of the study was to compare cytological findings in patients from Lubusz Province, from two regions different in terms of the socioeconomic status of inhabitants – Słubice County (borderland) and Zielona Góra (a city). Material and methods: Cytological findings from the Cytodiagnostic Laboratory of the Zdrojowa Clinic in Zielona Góra from years 2010–2013 were used in the study. Results: Comparative analysis of cytological findings showed a significantly higher number of high-grade lesions in patients from Słubice County vs. Zielona Góra. Conclusions: The risk of pathological cervical lesions was higher among young women from borderland. The risk of high-grade intraepithelial lesions and cervical cancer is determined by the socioeconomic status.

Keywords: cervical cancer, cytology, preventive screening
New strategies for the prevention and treatment of cervical cancer
Curr Gynecol Oncol 2017, 15 (4), p. 263–267
DOI: 10.15557/CGO.2017.0025

Advanced cervical cancer continues to be a major issue in female health, particularly in less economically advanced countries. In cases of locally advanced or metastatic disease standard treatment is often unsuccessful; new preventive approaches and novel treatment methods, which use therapeutic vaccines and synergistic strategies involving chemotherapy and immunotherapy, are implemented. Vaccination against highly oncogenic HPV strains is an established preventive method against precancerous conditions and invasive cervical cancer. Third phase results of the VIVIANE clinical trial confirmed the efficacy of such an approach: a nine-valent HPV vaccine reduced the risk of cervical cancer by more than 70%. Phase II clinical trials showed that a therapeutic vaccine based on a modified bacterium Listeria monocytogenes is a promising treatment option for women with metastatic and recurrent cervical cancer. Although immunotherapy involving the use of tumour infiltrating T cells in cervical cancer is also promising, further studies are needed. Phase III trials confirmed the efficacy of anti-angiogenic bevacizumab in parallel with cytostatic drugs in advanced cervical cancer. The final evaluation of GOG 240 findings demonstrated improved progression-free survival and overall survival. Nanotherapy represents a system of delivering therapeutic substances to cancerous cells using nanostructures 10–100 nm in size as vectors. The nanoparticles are mainly lipids (e.g. liposomes), polymers, micelles or noble metals. This procedure is currently assessed using established cell lines of cervical cancer and animal models. It seems effective and devoid of cytotoxic effects on healthy cells. It is likely that nanotherapy will be applied in the near future in women with cervical cancer.

Keywords: cervical cancer, HPV, immunotherapy, antiangiogenic therapy, nanotherapy
Positron emission tomography – role in gynecology
Curr Gynecol Oncol 2017, 15 (4), p. 268–276
DOI: 10.15557/CGO.2017.0026

Positron emission tomography records radiation emitted during the annihilation of positrons. This method is applied in neurology, cardiology, oncology and for locating inflammation foci; it also has an important role in gynecology. The paper presents the application of positron emission tomography for the diagnosis of ovarian and breast cancer and in cervical cancer. Breast cancer is the most common cancer among women. Endometrial, ovarian and cervical carcinoma are the fourth, fifth and sixth most prevalent cancers, respectively. These diseases are the second (breast cancer), fourth (ovarian cancer), seventh (cervical cancer) and tenth (endometrial cancer) cause of death due to cancer among women. Positron emission tomography combined with computed tomography (PET/CT) using 18F-fluorodeoxyglucose, which is increasingly widely available, allows for disease staging during one scan. In the case of breast cancer PET/CT with 18F-fluorodeoxyglucose is characterized by high sensitivity mainly in triple-negative cancer and in inflammatory cancer. Other forms of breast cancer are characterized by lower glucose metabolism and can give false-negative results. PET/CT ensures higher accuracy in the diagnosis of recurrent breast cancer than other imaging methods. PET/CT is also of high utility for the staging of cervical cancer and detection of its recurrence and, in particular, for radiotherapy planning. The procedure is highly sensitive in the detection of metastatic lymph nodes both in cervical and endometrial cancer. This method is very effective in the assessment of ovarian cancer recurrence with increased tumor marker levels. PET/CT scan results affect therapeutic decisions in a substantial proportion of patients with ovarian cancer.

Keywords: diagnosis, gynecology, positron emission tomography
Does obesity increase the risk of ovarian cancer? A literature review
Curr Gynecol Oncol 2017, 15 (4), p. 277–283
DOI: 10.15557/CGO.2017.0027

Obesity is one of the twenty-first century civilization diseases, which has been long linked to an increased risk of cardiovascular diseases, diabetes and cancer. Epidemiological data show that a slim body (body mass index, BMI 21–23 kg/m2) allows to avoid 20% of cancers related to excess fat tissue. Increased body weight (BMI >25 kg/m2) is associated with approximately 1.5-fold higher risk of cancer compared to the risk with normal BMI. There is growing evidence that high BMI may also increase the risk of cancer recurrence and mortality as well as reduce the efficacy of chemotherapy. While the relationship between obesity and numerous cancers, such as colon cancer, esophageal adenocarcinoma, breast cancer, endometrial cancer, kidney and pancreatic cancer, has been scientifically proven, studies assessing the relationship between ovarian cancer and obesity remain inconclusive. Some studies confirm the increased risk of cancer in obese women, whereas other authors do not show this correlation or even point to higher survival rates among obese patients with ovarian cancer, which is known as the obesity paradox. A variety of research methodologies may be found in the literature. Perhaps this is the reason for the significant divergence of results obtained in different studies. The aim of the paper was to describe selected substances produced by the adipose tissue, which play a crucial role in the induction of inflammation. We also present literature data on the relationship between obesity and ovarian cancer.

Keywords: ovarian cancer, obesity, BMI, inflammation
Lipoleiomyoma of the ovary – a case report and a literature review
Curr Gynecol Oncol 2017, 15 (4), p. 284–292
DOI: 10.15557/CGO.2017.0028

Leiomyoma belongs to rare benign ovarian tumors. Cellular leiomyoma (8892/0) and lipoleiomyoma (8890/0) are histological variants of leiomyoma (8890/3), which is the most common benign tumor in women. Cellular leiomyoma is found in about 5% of uterine leiomyoma cases. Histologically, it presents as a highly cellular tissue with increased cellular density compared to myometrium. The cells are usually small, spindle-shaped, without atypia, with low mitotic activity (<5 mitotic figures per 10 HPF) and scarce connective tissue component. Lipoleiomyoma is composed of adipocytes, smooth muscle cells and fibrous tissue. Only single cases of ovarian lipoleiomyoma are documented in the available English-language literature. We present a case of a 51-year-old patient qualified for laparotomy due to right ovarian tumor. A tumor about 70 mm in diameter was excised followed by hysterectomy with bilateral salpingo-oophorectomy. Postoperative histopathological evaluation revealed right ovarian tumor (lipoleiomyoma cellulare oedematosum); in the uterine corpus – leiomyomata intramuralia partim cellularia et leiomyoma submucosum corporis uteri. So far, there have been no case reports of cellular lipoleiomyoma of the ovary (lipoleiomyoma cellulare) in the literature. Patients after surgical procedures due to rare histological subtypes of ovarian leiomyoma should remain under long-term clinical surveillance.

Keywords: ovarian lipoleiomyoma, cellular lipoleiomyoma of the ovary, benign ovarian tumors