2018, Vol 16, No 1
DNA content evaluation for epithelial ovarian cancer identification
Curr Gynecol Oncol 2018, 16 (1), p. 3–10
DOI: 10.15557/CGO.2018.0001

Objective: To assess the cellular DNA status of epithelial ovarian cancer cells for clinical stage identification and its effect on survival. Methods: Sixty-two patients treated by primary surgery and six courses of platinum-based chemotherapy were enrolled. The surgical stage was analyzed in correlation with DNA ploidy, S-phase fraction and DNA index. DNA analysis was performed via image cytometry. Results: From the 62 cases, 38 were International Federation of Gynecology and Obstetrics (Fédération Internationale de Gynécologie et d’Obstétrique, FIGO) stage I and II, 24 – stage III and IV. In the DNA histograms obtained, the DNA index ranged from 0.85 to 3.02. Sixteen were classified as diploid and 46 as aneuploid (18 multiploid). S-phase fraction ranged from 9.8 to 51%. The aneuploid cells with DNA content above 5C ranged from 0.0 to 77.2%. Patients diagnosed with FIGO III and IV (vs. I and II) were 3.3 times more likely to die. Only in FIGO stage I and II the survival differed significantly for the different groups of ploidy. The risk of death for the multiploid (vs. diploid) group is 6.4 times and for aneuploid (vs. diploid) 2.3 times. Overall survival was better in the group with low DNA index. The low percentage compared with a high percentage of 5C cells ploidy groups showed association with mortality. The death hazard for the S-phase >33 median group is 4.9 times the hazard in relation to the S-phase <33. Conclusions: DNA ploidy, DNA index, S-phase, and 5C cells are important prognosticators for epithelial ovarian cancer mainly in early stages.

Keywords: DNA content, epithelial ovarian cancer, prognosis
Urological injury during surgery for malignant cancer
Curr Gynecol Oncol 2018, 16 (1), p. 11–29
DOI: 10.15557/CGO.2018.0002

Aim: This study was performed to analyze causes and types of urological injuries secondary to surgery for malignant cancer in a group of gynecological patients. Material and methods: From 1998 to 2017, 40 cases of urological injury secondary to gynecological operations were noted at the Department of Gynecology and Obstetrics of the Specialist Hospital in Radom, Poland. This group included 16 cases of injuries detected during and after surgery for malignant cancer (a total number of operations carrying a risk of urological injury: 851). Medical records of these patients were retrospectively analyzed. Results: Surgeries that led to urological injury were: hysterectomy with lymphadenectomy (4 cases, all after oncological surgery), hysterectomy (15 cases, 9 cases after oncological surgery), uterine body amputation (8 cases, 1 after oncological surgery), removal of ovarian tumor/rumors (4 cases, 2 after oncological surgery) and urogynecological surgery (9 cases). The following injuries occurred during gynecological surgery: ureteral and urinary bladder injury in 1 case (during oncological surgery), unilateral ureteral injury in 12 cases (8 during oncological surgery) and bladder injury in 18 cases (7 during oncological surgery). In urogynecological surgery, there were 8 cases of bladder wall injury and 1 case of urethral incision. In 1 case, it was required to remove the left kidney because of excision of a fragment of the ureter during hysterectomy with left salpingo-oophorectomy conducted due to ovarian cancer. In the remaining cases, the final outcomes of injury correction were favorable. Injuries that occurred in major gynecological procedures constituted the majority of urological injuries (27 cases, 67.5%). In this group, most of the surgeries (14, 51.9%) were conducted due to malignant genital cancer. Conclusions: Urological injury usually occurs during major gynecological surgery. In the group of oncological surgeries, ureteral injury with concomitant urinary bladder injury was the most common complication, observed in 1.06% of operated women. Patients at risk of urological complications, particularly those facing hysterectomy with salpingo-oophorectomy due to genital malignancy, should be adequately early referred to a reference center with resources to provide multidisciplinary medical care.

Keywords: gynecological surgery, urological injury, vesicovaginal fistula
Radiodiagnosis and radiotherapy in pregnancy – facts without myths
Curr Gynecol Oncol 2018, 16 (1), p. 30–41
DOI: 10.15557/CGO.2018.0003

Cancer in pregnancy is an increasingly common phenomenon faced by oncologist. This is a consequence of postponed motherhood until a later age and high rates of malignant tumors in the group of adolescents and young adults (20–44 years). The most common diseases diagnosed in pregnant women are breast cancer and hematological malignancies. Both, diagnosis and later treatment require the use of radiation. Irradiation of a pregnant woman is perceived as fetal exposure to irreversible damage and even death. There are no studies describing the actual effect of different doses and types of radiation on the fetus. Furthermore, due to anxiety and stereotypes pointing to the harmfulness of radiation, women requiring radiation are offered pregnancy termination before initiation of cancer therapy. However, the increasing data based on a review of literature from different parts of the world show that such management is not in line with the current medical knowledge in the field of radiodiagnosis and radiotherapy. This article presents data based on a literature review devoted to the assessment of the impact of radiation on living organisms and the use of radiation for diagnostic and therapeutic purposes in pregnant women. The data clearly indicate that both diagnostic and therapeutic ionizing radiation can be safely used also in pregnant women.

Keywords: cancer in pregnancy, radiotherapy in pregnancy, radiodiagnosis in pregnancy
Intraperitoneal vs. systemic chemotherapy in ovarian cancer
Curr Gynecol Oncol 2018, 16 (1), p. 42–45
DOI: 10.15557/CGO.2018.0004

Intraperitoneal therapy (IP) has been used in the treatment of ovarian cancer for over twenty years. The principal strategy of intraperitoneal therapy is based on increased local cytostatic drug concentration in the peritoneal cavity and extended tissue exposure to the drug. Based on the results obtained in three phase III clinical trials conducted between 1996 and 2006, indicating extended total survival in IP therapy, the National Cancer Institute in the USA considered the use of this therapy as justified. The inclusion criterion was ovarian cancer with optimum cytoreduction (≤1 cm of residual disease). Retrospective analyses conducted in 2015 confirmed longer median survival by more than 10 months as compared to systemic intravenous therapy. Promising results were also reported for heated intraperitoneal chemotherapy (HIPEC) in patients with recurrent ovarian cancer. Other intraperitoneal therapies have recently been introduced: PIPAC (pressurized intraperitoneal aerosol chemotherapy) and HINAT (hyperthermic intracavitary nanoaerosol therapy). These trials are, however, highly experimental, requiring further clinical studies.

Keywords: ovarian cancer, IP, HIPEC, PIPAC, HINAT
Metformin in cancer treatment
Curr Gynecol Oncol 2018, 16 (1), p. 46–49
DOI: 10.15557/CGO.2018.0005

Diabetes and obesity are associated with an augmented manifestation of malignant tumors of various localizations. Metformin is commonly used in patients with diabetes type 2, particularly those classed as obese. It has been shown to reduce both incidence of malignant tumors and respective mortality. The action of metformin involves a pleiotropic mechanism: it activates the LKB1/AMP pathway (liver kinase B1/adenosine monophosphate) which inhibits the mTOR pathway and blocks cell division also by its effect on cyclins. Additionally, metformin promotes apoptosis and cellular autophagy, inhibits the activity of metalloproteinases and activates the immune system. Metformin reduces the incidence of lung, pancreas, liver and large intestine cancers. It also reduces the percentage of triple-negative breast cancers and improves response to neoadjuvant chemotherapy in this disease. In endometrial cancer, metformin increases the positive influence of gestagens, potentiates the effects of paclitaxel and improves survival. In cervical cancer, metformin extends time to relapse, and in ovarian cancer, it extends time to progression and improves overall survival. Studies indicate that a destructive effect on cancer stem cells may be its additional mechanism of action.

Keywords: metformin, ovarian cancer, endometrial cancer, breast cancer, cancer stem cells
An outline of sexual problems in patients with breast cancer
Curr Gynecol Oncol 2018, 16 (1), p. 50–56
DOI: 10.15557/CGO.2018.0006

Clinical practice points to the need for an individual approach to the sexuality of women affected by breast cancer, which is the most common female malignancy. Patients with breast cancer who undergo mastectomy are burdened with many bad experiences related both to the somatic and mental sphere, which usually results in distress. The latest treatment modalities have contributed to improved comfort of life in women with breast cancer. Importantly, the sexual life of patients is now also taken into account. Due to the advances in diagnostic methods, surgical treatment and adjuvant therapy of gynecological cancers, it is increasingly possible to achieve long-term survival and cure. Functional changes caused by the disease and the therapy used are related to the individual characteristics of women and have a multifactorial etiology. Medical personnel should address these issues during conversations with patients in an appropriate way, i.e. emphatically, respecting patient’s intimacy and dignity. Gynecological and sexological care deals with the most intimate problems and requires particular sensitivity and professional approach in women with breast cancer.

Keywords: breast cancer, sexology, oncology, gynecology
Eosinophilic ascites: a case report and literature review
Curr Gynecol Oncol 2018, 16 (1), p. 57–63
DOI: 10.15557/CGO.2018.0007

Ascites with elevated serum CA-125 but without suspicious adnexal masses is a diagnostic challenge. The differential diagnosis of patients aged 20–50 years old presenting with ascites should account for rare etiologies, such as the hypereosinophilic syndrome. A 37-year-old patient was referred to the Gynecologic Oncology Outpatient Clinic of the University Hospital in Krakow due to rapidly progressing ascites with serum CA-125 above the normal limit. Thorough imaging studies showed no evidence of malignant ascites, whilst hypereosinophilia was detected in laboratory tests. After ruling out other causes of primary and reactive hypereosinophilia, the diagnosis of the hypereosinophilic syndrome was made. After the administration of oral corticosteroid therapy, complete resolution of symptoms (including ascites) was achieved, and CA-125 level returned to normal. Currently, the patient is asymptomatic and is followed up at the Autoimmune Diseases Outpatient Clinic.

Keywords: ascites, hypereosinophilia, CA-125, hypereosinophilic syndrome