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G J Photopulos

Publications and source records attributed to G J Photopulos.

16 recordsLinked to original sources
PubMed1997

An approach to teaching ethical, legal, and psychosocial aspects of gynecologic oncology in a residency program.

An approach to teaching ethical, legal, and psychosocial issues in gynecologic oncology has been integrated into an obstetrics and gynecology residency program. Team-teaching is used, involving gynecologic oncology faculty members and a medical ethicist with experience teaching in the clinical setting of obstetrics and gynecology. The teaching takes place as part of ongoing teaching rounds in the division of gynecologic oncology. Articles from clinical journals are used to inform and stimulate discussion of clinical ethical, legal, and psychosocial issues. Integrating the teaching of ethical and legal aspects of gynecologic oncology into residency education is challenging, given the competing demands on the residents' time and the need for teaching to be clinically relevant. The program described in this article illustrates that such teaching can be carried out in a manner that covers main issues and has practical value for residents.

Curriculum↗
PubMed1994

Surgicopathologic staging of endometrial adenocarcinoma.

In 1988, the International Federation of Gynecologists and Obstetricians' (FIGO) staging criteria for endometrial cancer were changed to require that surgical observations be included in the staging process. Staging now requires thorough intraperitoneal and retroperitoneal search and documentation of metastatic cancer; in addition, direct uterine inspection for tumor invasion and degree of cervical involvement replace length of uterine cavity and endocervical curettage. With change, there have naturally been questions regarding the method, benefit, and risk of surgical staging. The major concerns include: do all patients require surgical staging? what are the risk factors of endometrial cancer? what is gained from preoperative evaluation? what is the technique of surgical staging? what are the hazards to the patient? how is staging incorporated into treatment? and, what is the current experience with surgical staging? These questions are addressed in this review.

Adenocarcinoma↗
PubMed1992

Endometrial adenocarcinoma: genetic analysis suggesting heritable site-specific uterine cancer.

UNLABELLED: Genetic factors are clearly integral to the etiology of neoplasia. A cancer family syndrome (Lynch syndrome II) consisting of uterine, colon, and ovarian cancer is recognized, but the heritability of isolated endometrial adenocarcinoma has not otherwise been thoroughly investigated. We have performed pedigree studies in index cases with endometrial adenocarcinoma, using spouses as controls. Preliminary results from 64 probands showed four families in which endometrial adenocarcinoma was diagnosed in at least one first-degree relative of the proband (mother, daughter, sister); none showed relatives with colon or ovarian cancer. In none of the 34 control pedigrees did either a mother or sister have endometrial adenocarcinoma. In four other families, multiple first- and second-degree relatives of probands had adenocarcinoma of the uterus, colon, or ovary, presumably representing a cancer family syndrome (Lynch syndrome II). CONCLUSION: Our preliminary data not only show familial and probably heritable tendencies for endometrial adenocarcinoma, but further suggest that there are at least two distinct forms: (1) the previously described Lynch syndrome II (cancer family syndrome), and (2) a heretofore unemphasized entity characterized by a tendency to endometrial adenocarcinoma alone.

Adenocarcinoma↗
PubMed1991

Class II radical hysterectomy shows less morbidity and good treatment efficacy compared to class III.

Treatment of 102 patients with cancer of the cervix by class II and III radical hysterectomy was reviewed to compare the operative morbidity and efficacy of class II radical hysterectomy for select cases. Of the 102 patients, 21 had a class II hysterectomy, whereas 81 patients had a class III hysterectomy. The class II operation was performed for those subjects in whom invasive cancer beyond microinvasion could not be excluded after a cone biopsy. The mean age and weight of women having class II and III radical hysterectomies were nearly identical (41.1 and 40.6 years, respectively, and 66 and 65 kg, respectively). However, the mean operative time (3.8 and 4.7 hr, respectively; P = 0.001) and postoperative hospital stay (7.3 and 9.2 days, respectively; P = 0.001) were lower for class II than for class III hysterectomies. No fistulas or recurrent cancer developed following class II hysterectomy, and no patients had metastatic cancer in the nodes or parametrium. Among the 81 women undergoing class III hysterectomy, there were 3 fistulae and 3 recurrences. We conclude that the lesser morbidity, including shorter operative time and shorter postoperative hospital stay and excellent cancer control of the class II radical hysterectomy and lymphadenectomy, recommend the operation for selected early cancers of the cervix especially when a question concerning depth of invasion exists after cone biopsy.

Adult↗
PubMed1991

Ovarian abscess arising within an endometrioma.

Ovarian abscess is a rare gynecologic entity; only 120 cases have been reported in the world literature. In contrast to the more commonly encountered tubo-ovarian abscess, tubal involvement is absent in the ovarian abscess. This report describes a case of an ovarian abscess arising de novo within an endometrioma. The woman presented with a 20-cm pelvic-abdominal mass with paracaval adenopathy and bilateral ureteral obstruction. Treatment with broad-spectrum antibiotics was unsuccessful. The surgical specimen revealed endometrial glands, stroma, hemosiderin-laden macrophages, and evidence of abscess formation.

Abscess↗
PubMed1991

Pipelle endometrial sampling in patients with known endometrial carcinoma.

The purpose of this prospective clinical trial was to determine the reliability of the Pipelle endometrial biopsy instrument in recovering adequate tissue for confirmation of the diagnosis of endometrial cancer in patients with known endometrial carcinoma, and to compare endometrial histology of the sampling specimen with that of the subsequent hysterectomy specimen. Forty patients were enrolled in this study. All biopsies were performed in the office without anesthesia. The patients had a median age of 62 years (range 40-83). Discomfort was reported by the patient as mild, moderate, or severe; only two patients (5.0%) reported severe pain. There were no complications experienced with endometrial sampling. Thirty-nine of 40 specimens (97.5%) confirmed endometrial carcinoma; therefore, this study yielded a 97.5% sensitivity for the Pipelle endometrial sampling device. Comparing Pipelle and hysterectomy histology for individual patients, the histologic grade was the same in 29 (74.4%), while the Pipelle demonstrated a more advanced degree of differentiation in five (12.8%) and a lesser degree in five (12.8%). There was no residual tumor identified in one hysterectomy specimen (2.5%). Among the 12 patients who had a D&C for diagnostic purposes before referral, the Pipelle biopsy correlated with the D&C histology in ten of 12 (83.3%) and revealed a more advanced grade of tumor in one (8.3%) and a more differentiated grade in one (8.3%). In one patient, the D&C histology was adenocarcinoma grade 1, with the Pipelle demonstrating atypical hyperplasia and the hysterectomy specimen interpreted as endometrial adenocarcinoma in situ. This study demonstrates the Pipelle to be an accurate device for endometrial sampling in patients with endometrial carcinoma.

Adult↗
PubMed1990

Vaginal radiation brachytherapy to reduce central recurrence after radical hysterectomy for cervical carcinoma.

Seventeen (17%) of one hundred and two patients were treated with radiation brachytherapy (without external-beam therapy) to the proximal vagina to reduce the possibility of central pelvic recurrence following radical hysterectomy for cervical carcinoma. The 17 were considered to be at greater risk of developing recurrent cancer in the central pelvis because the cancer invaded halfway through the cervix; however, no lesions extended beyond the cervix, nor were metastases to lymph nodes present or surgical margins involved. The brachytherapy treatment was evaluated for prevention of central pelvis recurrence and for related complications. The 17 women treated with radiation brachytherapy were also compared with 74 patients who did not receive brachytherapy after radical hysterectomy because their cancers were smaller and did not invade halfway through the cervix. Both groups were similar with respect to age (41 and 40 years, respectively), weight (69.5 and 65.9 kg), operative characteristics, and the proportions of squamous cell carcinoma and adenocarcinoma. Recurrences have not been observed among the patients treated with brachytherapy during a mean follow-up of 39 months (range, 9-92 months). No complications were attributed to the brachytherapy. However, two patients with large tumors refused adjuvant brachytherapy and suffered central pelvic recurrences. Brachytherapy in selected patients following radical hysterectomy was safely administered and appeared to reduce the risk of central pelvic recurrence.

Adenocarcinoma↗
PubMed1990

Surgery or radiation for early cervical cancer.

In summary, neither radiation nor surgery is clearly superior. The benefits of surgery include: 1) emotional satisfaction that the tumor has been removed, 2) accuracy of surgical staging, 3) preservation of the ovaries, 4) no secondary uterine cancer (a very uncommon problem), and 5) complications that are more readily correctable. Radiation offers the major advantages of being useful in most patients regardless of age or medical condition and is the choice for large cancers. Because stage IB cervical cancer is a very diverse pathological entity with a number of potential prognostic factors (including cell type, depth of invasion, tumor volume, lymphatic space involvement, and occult lymph node metastases), and because patients present with a number of other conditions (including excess weight, advanced age, prior pelvic surgery or infection, and severe medical illness), we are fortunate to have two good methods for treating cervical cancer. Prospective randomized studies will be necessary in the future to better define specific advantages in the various clinical settings. But, in general, the following have proven most expedient: 1) class I hysterectomy, for microinvasive cancer of 3 mm invasion or less without lymphatic space involvement, 2) modified, extended hysterectomy (class II) and pelvic lymphadenectomy for lesions of 3 mm and lymph vascular space involvement or when the lesion seems to just exceed 3 mm and for very early adenocarcinoma, 3) an extended hysterectomy (class III) and pelvic lymphadenectomy for larger IA2, IB, and IIA lesions that are less than 4 cm, particularly for the pregnant or younger patient, and when ovarian conservation is desired, 4) radiation therapy is used for lesions over 4 cm and for women with severe medical illness making extended hysterectomy too hazardous, 5) combination therapy and chemotherapy are now reserved for study in poor prognosis patients with very large lesions (greater than 6 cm), occult metastases, and unfavorable histologic criteria (Table 2).

Combined Modality Therapy↗
PubMed1980

Cryosurgery for the treatment of cervical intraepithelial neoplasia during the reproductive years.

Cervical intraepithelial neoplasia (CIN) is so rampant that simpler, effective, and less costly methods of therapy are being evaluated to replace the aggressive surgical therapeutic measures of the past. Cryosurgery is one alternative method. A review is presented of 152 patients in the childbearing age group with biopsy confirmation of CIN II (moderate dysplasia) and CIN III (severe dysplasia and carcinoma in situ). The persistence of CIN 3 months after therapy was deemed a treatment failure. Initial failure rates (24.2% for CIN II and 31.6% for CIN III) were high by this stringent definition. However, follow-up smears, further treatment, and a review of the literature definition of "treatment failure" lowered the failure rate to acceptable levels such that cryosurgery should be utilized in the therapy of cervical intraepithelial neoplasia.

Carcinoma in Situ↗
PubMed1979

Computerized tomography applied to gynecologic oncology.

Forty patients on the gynecologic oncology service at the University of North Carolina were evaluated with CT scans. Accuracy and clinical benefit of these scans were compared to those of manual clinical examinations. The CT scans were generally superior and had fewer (9) verified errors in the regions of the pelvic wall and para-aortic area than did the manual examinations (17). Both the CT and bimanual examinations had the same number of verified errors (3) in the central pelvic region. The authors found the CT scans to be beneficial in evaluation of pelvic wall and para-aortic regions for treatment planning of either primary or recurrent cancer.

Diagnosis, Differential↗
PubMed1979

Clear cell carcinoma of the endometrium.

The clinical data of 22 patients with clear cell adenocarcinoma of the endometrium treated at the University of North Carolina Memorial Hospital are reported. In addition, the data with particular reference to survival, site of recurrence, and treatment are combined with information from two previous reports of clear cell adenocarcinoma of the endometrium to better define survival. It is noted that the patients with clear cell adenocarcinoma of the endometrium were older and had an overall poorer survival than is reported for adenocarcinoma of the endometrium (nonclear cell). Patients with Stage I clear cell carcinoma of the endometrium, however, had a similar five-year survival to Stage I adenocarcinoma of the endometrium. The paper also examines treatment methods and correlates these with site of recurrence as well as survival.

Adenocarcinoma↗
PubMed1979

Intestinal anastomoses after radiation therapy by surgical stapling instruments.

The use of automated stapling instruments in 17 patients requiring intestinal surgery following irradiation therapy for gynecologic malignancies has been reviewed. Fifteen of these patients also had other medical problems thought to inhibit optimal anastomotic healing: malnutrition, persistent intraabdominal cancer, uremia, hypoalbuminemia, and recent antineoplastic chemotherapy. Although these conditions severely test a method of intestinal anastomosis, no patient had a complication involving the intestinal anastomosis. The use of these stapling instruments reduced both the operating time and the contamination of the peritoneal surfaces by bowel content, thereby improving the postoperative recovery of these patients. The favorable results and the secure anastomoses justify the continued use of stapling instruments in gynecologic oncology patients with prior irradiation therapy.

Female↗
PubMed1978

Adenoid cystic carcinoma of the Cervix. Report of 9 cases and a reappraisal.

The clinical and pathologic findings of 9 patients with adenoid cystic carcinoma of the cervix are presented. A review of the literature identified an additional 29 cases. The tumor was usually associated with adenocarcinoma or squamous cell carcinoma of the cervix. Adenoid cystic carcinoma of the cervix appears to be an aggressive type of tumor; of the 38 cases reported in the literature lung metastases have occurred in 18 (47.4%), and of these, 14 patients are known to have died of the cancer.

Aged↗
PubMed1977

Evaluation of conventional diagnostic tests for detection of recurrent carcinoma of the cervix.

The use of routine diagnostic tests to evaluate patients periodically after treatment for carcinoma of the cervix has been reviewed. Of 169 patients treated at Brooke Army Medical Center for carcinoma of the cervix, 73 were evaluated after their treatment by a group of six diagnostic tests referred to collectively as an oncologic survey. The survey consisted of an intravenous pyelogram (IVP), chest roentgenogram, barium enema, cystoscopy, proctoscopy, and bone scan. Although 16 patients developed recurrent tumor, the oncologic survey detected only three recurrences that had not already been suspected by physical examination. Only the IVP and chest roentgenogram were of sufficient benefit to suggest their routine use for the detection of recurrent cancer. The other tests included in the oncologic survey were not beneficial when used routinely and should be reserved to evaluate patients otherwise suspected of recurrent cancer.

Barium Sulfate↗