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- Volume 7, Issue 1, 2015
Southern African Journal of Gynaecological Oncology - Volume 7, Issue 1, 2015
Volume 7, Issue 1, 2015
Author David AllenSource: Southern African Journal of Gynaecological Oncology 7, pp 2 –3 (2015)More Less
There is much about the management of endometrial cancer that remains controversial. The literature contains very little good evidence to guide our practice on uterine papillary serous cancer (UPSC). UPSC is an aggressive histological subtype of endometrial cancer, accounting for less than 5% of its incidence, but 40% of its mortality. UPSC has a higher propensity for lymphovascular space invasion (LVSI), and intraperitoneal as well as extra-abdominal spread, than the more common endometrioid cancers. Approximately two thirds of women with UPSC have disease outside of the uterus at the time of diagnosis. Recurrence and mortality rates are high for all stages of this disease. Given the poor prognosis, most clinicians argue for adjuvant treatment for early-stage UPSC, but there is no standardised postoperative treatment available. The question which is difficult to answer is: "Does a combination of pelvic radiotherapy and adjuvant chemotherapy improve overall survival in this patient group?"
Author Greta DreyerSource: Southern African Journal of Gynaecological Oncology 7 (2015)More Less
Adjuvant treatment, tumour recurrence and survival rate of uterine serous carcinomas: a single institution review of 62 women.
Retrospective analysis of patients with cancer of the cervix attending a radiotherapy outpatient department.
Living with the late effects of cervical cancer treatment: a descriptive qualitative study.
Pharmacological options for the protection of ovarian function in patients undergoing chemotherapy and/or radiotherapy.
Retrospective analysis of patients with cancer of the cervix attending a radiotherapy outpatient department : experience from a university-based hospital in eastern Uttar Pradesh, India : original researchSource: Southern African Journal of Gynaecological Oncology 7, pp 5 –12 (2015)More Less
Objective: A retrospective analysis of all patients with cancer of the cervix attending a radiotherapy outpatients department in a single unit from January 2005 to December 2006 was carried out to study their epidemiology, stage and status of presentation, compliance with treatment and follow-up, as well as response and complication rates.
Design: This was a retrospective study.
Setting and subjects: Four hundred and ninety-five consecutively registered patients with cancer of the cervix were included in the study, which was carried out between January 2007 and December 2008.
Outcome measures: The epidemiology, stage and status of presentation, compliance with treatment and follow-up, as well as the response and complication rates of the treated patients were the outcome measures.
Results: Most of the patients hailed from the various districts of Uttar Pradesh (58%) and Bihar (32%), India. The majority (> 50%) were aged 40-59 years. Stage information was available for 70% of the patients, of which stage 1 comprised 5%, stage 2, 36%; stage 3, 56%; and stage 4, 3%. Squamous cell carcinoma was the most common reported histopathology (~90%).A significant proportion of the women defaulted after registration, or after undergoing investigations (34%). Of the 65% cases planned for treatment, 50% initiated it, but only 35% completed it, according to protocol. Radical radiotherapy was planned for the majority of women (>90%) with or without chemotherapy. Compliance with follow-up was poor (26%). At the time of the analysis, 63% patients had a complete response, 12% residual disease, 16% progressive disease and 7% locoregional recurrence. Recorded late complications were mostly grade I and II bladder and rectal toxicity.
Conclusion: The outcome of this study will significantly help us to define region-specific strategies needed for the management of cervical cancer in eastern Uttar Pradesh, India.
Adjuvant treatment, tumour recurrence and the survival rate of uterine serous carcinomas : a single-institution review of 62 women : original researchSource: Southern African Journal of Gynaecological Oncology 7, pp 14 –20 (2015)More Less
Objectives: The aim of this study was to assess our department's management of uterine serous carcinoma (USC) and to determine the correlation of the recurrence and survival rates of stage I-IV patients with different adjuvant treatment modalities.
Design: A retrospective, single-institution, observational cohort study was performed.
Subjects and setting: The study participants were women diagnosed with stage I-IV USC between 1996 and 2012 at the Mercy Hospital for Women, Heidelberg, Australia.
Outcome measures: Outcomes measures were tumour recurrence rates, relapse-free survival and overall survival relating to the different adjuvant treatment modalities.
Method: A retrospective, single-institution study on 62 women with stage I-IV USC diagnosed between 1996 and 2012 was performed.
Results: Thirty patients had stage I, 5 stage II, 16 stage III and 11 stage IV, disease. Twenty patients received no adjuvant treatment, 19 patients adjuvant radiotherapy, 13 adjuvant chemotherapy and 10 adjuvant chemoradiation. Thirty-two (52%) patients experienced a recurrence and 32 patients were deceased, of whom 29 deaths were USC related. Recurrence risk correlated with stage (p-value 0.000). Early-stage (I and II) disease was associated with significant better relapse-free survival and overall survival than advanced-stage (III and IV) disease (p-value 0.000 and p-value 0.001, respectively). Adjuvant treatment significantly improved relapse-free survival and overall survival (p-value 0.008 and p-value 0.020, respectively), compared to no adjuvant treatment. Furthermore, a statistically significant improvement in relapse-free survival (p-value 0.035) and a trend towards better overall survival (p-value 0.064) was demonstrated with chemotherapy.
Conclusion: USC has a high recurrence rate and overall prognosis is poor. The stage of disease seems to be the best predictor of prognosis. This study suggests that even patients with early-stage (I and II) disease, i.e. either pure or mixed USC, should receive adjuvant treatment, as all of these women have a significantly high risk of recurrence. Currently, radiotherapy and chemotherapy are the adjuvant therapies used for USC. Prospective studies may help to determine the most effective adjuvant therapies.
Living with the late effects of cervical cancer treatment : a descriptive qualitative study at an academic hospital in Gauteng : original researchSource: Southern African Journal of Gynaecological Oncology 7, pp 21 –26 (2015)More Less
Objective: The late effects of cervical cancer and its treatment are well known. However, qualitative research describing how women experience these effects seems to be unavailable. The purpose of our study was to describe how women experienced the late effects of cervical cancer treatment.
Design: A qualitative descriptive design was used.
Subjects and setting: Purposive sampling was employed to select the participants treated at an academic hospital in Gauteng. Sixteen in-depth interviews were conducted. Data saturation determined the sample size. Thematic analysis was used to analyse the data.
Results: The average age of the sample was 44.1 years, and half of the participants had stage IIB cancer. Most were treated with external beam radiation in combination with brachytherapy. Five themes arose from the data, namely experiencing the physical consequences of the treatment, struggling with the socio-economic implications of the treatment, living with the sexual consequences of the treatment, spiritual issues relating to cervical cancer and facing health system challenges.
Conclusion: The late effects deriving from cervical cancer treatment deprived women of the lives they lived before they were treated for cervical cancer. They were burdened with physical changes which aggravated their already difficult financial situation, and they had to live with unattended healthcare needs. Sexual dysfunction changed their intimate partner relationships, leading to anxiety about the possible loss of their life partners. Despite all this, they were positive about their future owing to their faith. Nurses should assess patients for the late effects of cervical cancer and implement interventions to meet their individual needs.
Pharmacological options for the protection of ovarian function in patients undergoing chemotherapy : reviewAuthor M.H. BothaSource: Southern African Journal of Gynaecological Oncology 7, pp 27 –33 (2015)More Less
Chemotherapy, particularly alkylating agents, can be toxic to germ cells, and may lead to treatment amenorrhoea in young women. The age at which chemotherapy is administered is a strong predictor of subsequent premature ovarian failure, with older patients being at the highest risk. Smaller primordial follicles may survive the insult of chemotherapy better, and the suppression of follicle development may protect the germ cell pool. The suppression of follicle development by gonadotrophin-releasing hormone agonists (or antagonists) or combined oral contraceptives has been reported in the literature. The results are promising, but conflicting reports on the protection makes further studies essential.
Source: Southern African Journal of Gynaecological Oncology 7, pp 34 –36 (2015)More Less
An epithelioid trophoblalstic tumour (ETT) is an extremely rare form of gestational trophoblastic disease (GTD). Usually, patients are of child-bearing age with a prior gestation. The uterus is the most common site for an ETT. This tumour has the same clinical behaviour as that of a placental site trophblastic tumour, but the treatment options may differ. Histologically, an ETT is a distinct neoplasm whose cytological features and growth patterns mimic those of squamous cell carcinoma. An ETT does not appear to be as chemosensitive as other GTDs, making hysterectomy the treatment of choice in patients with disease confined to the uterus. This tumour may present a diagnostic challenge to the pathologist, while clinicians often face problems with treating this tumour because of its rarity. We describe two cases of an ETT occurring in two women, one aged 44 years and the other 42 years.
Psoas abscess : a rare metastatic presentation of asymptomatic carcinoma of the cervix : short reportSource: Southern African Journal of Gynaecological Oncology 7, pp 37 –39 (2015)More Less
Isolated metastasis to the iliopsoas muscle is rare and is often misdiagnosed as psoas abcess, especially when it is the only presenting feature in the absence of a known primary tumour. A 52-year-old woman presented to us with a clinicoradiological diagnosis of psoas abscess. Initially, the patient was managed as a case of tubercular psoas abscess. However, later on, when the disease had not responded to antitubercular therapy, a cytological examination of aspirated material was performed, which confirmed it as being malignant in origin. While searching for primary malignancy, a small growth on the cervix was noticed. A biopsy and histopathological examination confirmed the diagnosis of squamous cell carcinoma of the cervix. A final diagnosis of squamous cell carcinoma of the cervix with isolated iliopsoas muscle metastasis was proposed. This case highlights an unusual site of metastasis in an asymptomatic primary tumour which was diagnosed retrospectively.