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PubMed1999

[Gynecologic neoplasms in pregnancy].

Cancer in pregnancy represents a complicated scenario and a unique challenge to the pregnant patient, her family and the physicians. Extraordinary decisions are forced upon the woman and all participants involved with her care. They must address medical, religions, social, ethical and emotional concerns of the mother and her family. Because of the low incidence of malignant disease in pregnancy it is not possible to develop a large personal experience. The most common malignancies in pregnancy are cancers of the cervix and the breast, followed by melanomas and ovarian cancer. After stratification for stage all gynaecological malignancies have a similar prognosis as cancers in nonpregnant patients, provided they are treated correctly. The general principle is to treat the cancer and to allow the pregnancy to proceed until adequate foetal maturity has been achieved. In cervical cancer a delay in therapy of several weeks revealed no adverse effects on treatment outcome. Generally caesarean section should be the delivery method of choice. In breast cancer diagnoses is typically delayed for 5 to 7 months for various reasons. Therefore work-up of a mass discovered during pregnancy has to be as strict and complete as outside pregnancy. Breast-conservation therapy remains an option even in pregnancy but adjuvant radiotherapy should be started after the child has been born. Even chemotherapy is possible although the first trimester is the most critical time resulting in a 10-20% malformation rate as compared with a rate of 3% in the general population. Chemotherapy in the second and third trimester may result in intrauterine growth restriction. Breast feeding is contraindicated in women receiving chemotherapy. Therapeutic abortion does not improve survival. Most ovarian cancers diagnosed in pregnancy are of low grade and early stage (Stage I). Work-up and treatment involving surgery and chemotherapy follows the same guidelines as in the nonpregnant woman. In order to arrive at the optimal decision, the patient and her family have to be optimally informed.

Adult↗
PubMed1990

[Pain therapy in gynecologic neoplasms].

A great number of patients with gynaecological malignant diseases suffer from severe pain, caused, for example, by bone metastases of breast cancer or tumour infiltration of the pelvis and the lumbar plexus in uterine cancer. Several methods of treatment are available depending upon the origin of pain. It is possible to achieve pain relief by radiotherapy or by cytostatic therapy. Sometimes, anaesthesiological and neurosurgical measures are successful, but the most important method is treatment with analgesics. Strong opioids are given, if pain relief is insufficient under treatment with non-narcotic drugs or weak opioids, like codeine. Morphine and other strong opioids are not reserved for pain control only in terminally sick women, as they can be administered successfully for long periods without severe side effects. If possible, the oral route should be selected. If vomiting occurs, or if patients are unable to take oral medication, morphine can be given peridurally, intrathecally or by infusion. Often, an additional treatment is necessary with different medicaments like tricyclic antidepressants and corticosteroids.

Analgesics↗
PubMed1990

[Immunohistochemistry in the diagnosis of gynecologic neoplasms].

This survey presents the practical application of immunohistochemistry additional to clinical anamnesis and histology (HE staining) in the differential diagnosis of morphologically similar lesions. First of all, the algorithmic approach for immunohistological diagnosis of undifferentiated or non-classifiable malignant neoplasias of the female genital tract is described and the significance of immunohistochemistry for the differential diagnostic discrimination and the histogenesis of organ-specific gynaecological neoplasias is re-assessed.

Biomarkers, Tumor↗
PubMed1988

[Hydronephrosis as a late complication in gynecologic neoplasms: current possibilities for sensible urinary drainage].

By means of new endourological techniques supravesical urinary drainage is possible with minimal invasiveness. In 10 patients suffering from hydronephroses caused by gynaecological malignancies a worthwhile prolongation of lifetime was achieved by palliative urinary drainage (mean follow-up: 9.1 months). Four cases with fistulas and consecutive incontinence were treated successfully by percutaneous ureteral occlusion (3x), inner stenting respectively (1x). The very low invasiveness of the methods described should encourage the decision towards palliative supravesical urinary drainage.

Aged↗
PubMed2002

Unexpected gynecologic neoplasms in patients with proven or suspected BRCA-1 or -2 mutations: implications for gross examination, cytology, and clinical follow-up.

Identification of inheritable mutations associated with the development of malignancy has led to prophylactic surgeries to remove tissues at risk. We report seven unrelated patients with family histories of breast and/or ovarian cancer, five of whom underwent prophylactic salpingo-oophorectomy with hysterectomy. Four had proven BRCA-1 or -2 mutations. Malignant cells were found unexpectedly in the peritoneal washings of two patients, leading to the discovery of early-stage fallopian tube carcinoma. After changing the sampling technique at our institution, two more cases of unexpected fallopian tube carcinoma in situ were discovered. Another patient had a significant family history and underwent hysterectomy for uterine fibroids, leading to the discovery of fallopian tube carcinoma. Another patient with BRCA-1 mutation had unexpected widespread primary peritoneal papillary serous adenocarcinoma. The final patient had a borderline malignant clear cell adenofibroma. These cases underscore the importance of peritoneal cytology and thorough sampling in the management of patients undergoing hysterectomy with a family history of breast/ovarian cancer and/or known BRCA-1/BRCA-2 mutations. As prophylactic surgeries are becoming more common secondary to advances in molecular diagnostics, pathologists need to be aware that surgical specimens from these patients may require more rigorous examination to uncover early neoplastic changes.

Adenocarcinoma↗
PubMed1987

A study of cytoplasmic and nuclear estrogen and progestin receptors in gynecologic neoplasms.

A rapid method for simultaneous preparation of cytosol and nuclear estrogen (E) and progestin (P) receptors and their in vitro determination is described. The method was applied to several uterine or ovarian surgical specimens to evaluate their steroid hormone "dependence". The results suggest that low cytoplasmic E receptor levels (ERc) are associated with higher nuclear E receptor (ERn) levels but no apparent correlation was observed between PRc and ERn levels. The method appeared to be suitable for screening steroid hormone receptor content in tumor tissues and may provide better estimation of steroid dependence since both cytoplasmic and nuclear compartments can be studied simultaneously.

Adult↗