2018, Vol 16, No 4
A patient with vulvar cancer – current treatment trends based on the analysis of own material
Curr Gynecol Oncol 2018, 16 (4), p. 208–215
DOI: 10.15557/CGO.2018.0024

Aim: The objective of the study was to analyze risk factors, treatment protocols and outcomes in patients with vulvar tumor, vulvar cancer in particular. Material and methods: This was a retrospective observational study; a total of 86 patients receiving surgical treatment due to vulvar tumors in the Clinic of Gynecological Surgery and Oncology of the Medical University of Lodz between 2010 and 2016 were included in the study. Nine patients were excluded from the study due to the lack of key data. The data were analyzed statistically using Statistica 13 in two groups – a group with benign lesions (B) and a group with malignancies (M). Analysis of variance was used for intergroup comparisons, and Pearson correlation coefficient was used to measure the correlation between continuous variables. Results: Out of 77 patients, 33 were diagnosed with malignant tumors (42.86%). The patients in the M group were statistically significantly older (60.12 vs. 70.6, p > 0.001), while no significant differences regarding body mass index, parity (p = 0.9), mode of delivery (p = 0.26), the time of menopause onset and smoking tobacco were found between the two groups. Vulvar intraepithelial neoplasia was statistically significantly more common in group B (30% vs. 3% in group M; p < 0.01). No correlation was found between the age at diagnosis and the size of vulvar tumor. A weak positive relationship was observed between age and the length of postoperative hospitalization. A long-term follow-up response was obtained in 32% of patients from the M group. Five-year survival was observed in 67% of women – all patients received surgical treatment in the early stage of the disease. Conclusions: The incidence of vulvar cancer was significantly higher among postmenopausal vs. premenopausal patients. The coexistence of vulvar intraepithelial neoplasia and vulvar cancer was not reported in the analyzed group. Surgical treatment, which is the best choice in the early stage of the disease, ensures high rates of 5-year survival.

Keywords: vulvar cancer, vulvar intrapepithelial neoplasia (VIN), vulvar dysplasia
Pelvic exenteration in modern gynecologic oncology – own experiences
Curr Gynecol Oncol 2018, 16 (4), p. 216–223
DOI: 10.15557/CGO.2018.0025

Aim: Analysis of indications for the procedure of exenteration, and intra- and postoperative complications, based on cases from a single gynecologic oncology center over the past 5 years. Material and methods: Detailed review of medical records of female patients who underwent pelvic exenteration surgery over the last 5 years (2014–2018). The review excluded cases of exenteration for ovarian cancer. The analysis included indications for the procedure, age of operated patients, location and histological type of tumor, prior treatment history, performance status and comorbidities, purpose and type of procedure, duration of operation, early and late complications according to the Clavien–Dindo classification, method of urinary diversion, and achieved surgical margins. Results: A total of 8 pelvic exenteration procedures were performed between early 2014 and mid-2018, including 5 procedures with the intention to cure, and 3 palliative procedures. Half of the cases involved patients with recurrence of vulvar cancer. The mean duration of the procedure was 315 minutes, while the mean duration of stay in the hospital ward was 24.38 days. Early postoperative complications of varying severity occurred in each operated case, with severe complications (grades IIIb–V based on the Clavien-Dindo classification) observed in 5 women (62.5%). There were no deaths in the early postoperative period. Late complications were observed in a total of 6 women (75.0%), including one death 11 months after palliative exenteration. Conclusions: Despite advances in perioperative care, pelvic exenteration is associated with a high risk of complications which are often life-threatening. The eligibility of patients for this radical surgical approach should be assessed on a case-by-case basis, and the procedure itself should be carried out in a medical center with properly trained staff and medical equipment.

Keywords: pelvic exenteration, gynecologic cancer recurrence, complications, urinary diversion
Complete blood count and selected clinical factors: are they related to the grade and stage of endometrial cancer?
Curr Gynecol Oncol 2018, 16 (4), p. 224–233
DOI: 10.15557/CGO.2018.0026

Endometrial carcinoma is the most common gynecologic cancer. The method of therapy depends on the histological type, grade and stage of cancer. The primary treatment is surgery: total hysterectomy with bilateral salpingo-oophorectomy in stage IA G1/G2, additionally with pelvic lymph node dissection in stage IB and higher and in every case of G3 cancer. Pelvic lymphadenectomy is associated with the risk of multiple complications. The aim of this study was to assess if preoperative complete blood count results are associated with the stage and grade of endometrioid type of endometrial cancer and if they can be used in the preoperative decision making process, for example whether or not to perform lymphadenectomy. This retrospective study included the data of 283 patients with endometrial cancer, treated primarily with surgery at the Department of Gynecology, Obstetrics and Gynecologic Oncology of the Medical University of Silesia in 2008–2014. The relationship between such factors as age, body mass index, hemoglobin level, hematocrit, PLT, MPV, diabetes, arterial hypertension, nulliparity and endometrial cancer stage and grade was analyzed. The study group was divided into two subgroups: a good prognosis group: IA G1 and IA G2 cancers and a poor prognosis group: IA G3, IB, II, III, IV cancers. Subsequently, the study group was divided based on histopathological grade into G1, G2 and G3 groups. Statistical analysis was performed with the use of the Student’s t-test, a z-test, the Mann–Whitney U-test, the Kolmogorov–Smirnov test and the ROC curve. No statistically significant differences were demonstrated for the factors mentioned above between the good and poor prognosis groups. Logistic regression analysis showed that the factors which increase the risk of G2 cancer include MPV: from 9% to 43% and age: up to 6.6% (p < 0.05). The ROC curve was used to determine cut-off points: over 8.9 fL for MPV and over 62 years for age. An MPV of over 9.8 fL increases the risk of G2 cancer nearly twice. Complete blood count results are not useful for preoperative endometrial cancer staging and assessment for lymphadenectomy, while cancer grade correlates with age and MPV. The results of the study show the possibility to use MPV in preoperative prediction of endometrial cancer grading.

Keywords: endometrial cancer, grading, MPV
Tobacco smoking and HPV – silent killers
Curr Gynecol Oncol 2018, 16 (4), p. 234–244
DOI: 10.15557/CGO.2018.0027

Introduction: Cervical cancer is one of few cancers for which effective early diagnostic workup has been developed. A free program for early detection of cervical cancer has been introduced for the group of the most vulnerable women in the whole Poland. Despite these measures, five women die of cervical cancer each day in Poland due to a low screening rate and inadequate knowledge among women about the causes of this cancer. Material and method: The knowledge about modifiable risk factors of cervical cancer was analyzed in 570 women. Data were collected over a period of nine years, from 2009 to 2017, by means of direct contact with 100 subjects at outpatient clinics and 70 patients treated for cervical cancer at Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, and from 400 Internet responders. Results: In 2009, the greatest knowledge about the impact of HPV infection on the incidence of cervical cancer was noted in women treated for cervical cancer (98% of the respondents) and in 85% of healthy women. In 2012 and 2017, a substantially lower number of the respondents (30% and 46%, respectively) knew about the influence of HPV on cancer incidence. Knowledge about the influence of smoking on the risk of the disease was low in the entire studied group: throughout the 9-year period from 2009 to 2017, it was declared by 33%, 35%, 5% and 14% of the respondents, respectively. The magnitude of the influence of HPV infection coexisting with tobacco smoking could be assessed mainly by women undergoing treatment (87%). Only 7–8% of the subjects recognized this relationship as the most significant in the pathogenesis of cervical cancer. The study also demonstrated how low the contribution of nurses and midwives is in providing women with knowledge about modifiable risk factors of cervical cancer. Conclusions: 1) The study showed that it is necessary to undertake better educational activities in the field of modifiable risk factors for cervical cancer, which include smoking tobacco. 2) It seems that policy makers in the field of health care should verify whether the funds absorbed by the National Program of Early Cervical Cancer Detection should also be transferred for HPV vaccination of the young generation as this virus is the cause of many cancers, not only cervical cancer. Data on the decline of cervical cancer incidence in countries that vaccinate young people should be a strong argument for the introduction of vaccinations in Poland.

Keywords: cervical cancer, HPV infection, modifiable risk factors
Molecular characteristics of endometrial cancer and their potential effect on clinical management
Curr Gynecol Oncol 2018, 16 (4), p. 245–250
DOI: 10.15557/CGO.2018.0028

Endometrial cancer is the most common malignancy of the female genital tract in highly developed countries. Over the past few decades, there has been a population-wide increase in the incidence of this type of cancer. Current treatment standards and scope of management are based primarily on the histopathological type of the tumor, the degree of differentiation and clinical staging. However, this approach does not fully reflect contemporary requirements and the need for personalized treatment in this challenging group of patients, and given the development of molecular medicine, it seems fairly outdated. Advanced age, obesity and multiple coexisting diseases are among potential reasons for deciding against very radical surgical treatment or extensive adjuvant therapy. On the other hand, the extent of necessary treatment may be underestimated in cases with primary suspected low-grade disease. New diagnostic methods based on the genomic analysis of malignant endometrial tumors used to be inaccessible for general use because of high costs associated primarily with the need to employ specialized equipment for the molecular evaluation of tumors. However, as this area of medicine developed, evidence emerged for the benefits of using, at least to a partial extent, markedly cheaper immunohistochemical methods as an alternative to DNA sequencing, which offers a possibility to implement this diagnostic modality in a large number of clinical treatment centers. Molecular diagnostics of endometrial cancer raises hope for the identification of groups of patients who will be offered a more personalized therapeutic approach.

Keywords: endometrial cancer, molecular changes, polymerase ε (POLE), new prognostic methods