Gynecologic Cancers

Intestinal obstruction in the patient with ovarian cancer is a difficult situation for both patient and physician. In women presenting with ovarian cancer, obstruction is almost never complete.

Drs. Randall and Rubin address three subjects important to all patients with advanced-stage epithelial ovarian cancer: (1) the incidence and annual mortality associated with the disease, (2) the use of intestinal surgery at the time of initial surgery, and (3) the use of surgery for intestinal obstruction in patients with recurrent (or progressive) ovarian cancer. I believe that progress in all three areas has been made, albeit slowly.

In their excellent review of intestinal obstruction in women with advanced and recurrent ovarian cancer, Drs. Randall and Rubin indicate that median survivals and quality of life for these patients have improved substantially. Data from the International Federation of Obstetrics and Gynecology (FIGO)[1] and the National Cancer Institute’s Survival, Epidemiology, and End Results (SEER) program[2] indicate that the 5-year disease-free survival for advanced-stage disease has risen over the past several decades from approximately 5% to 20%. Therefore, the palliation of intestinal obstruction secondary to metastatic ovarian cancer has become a more urgent issue. The management of recurrent or chronic intestinal obstruction is often complex, and the authors have carefully substantiated issues related to this complication of the malignancy.

Authors Thomas Randall, MD, and Stephen Rubin, MD, provide a thoughtful, state-of-the-art discussion on current controversies in the management of intestinal obstruction in patients with ovarian cancer.

SAN DIEGO-AIDS experts have long worried that human immunodeficiency virus (HIV) infection might increase a woman’s risk of cervical cancer, particularly in the presence of concurrent human papillomavirus (HPV) infection.

SAN DIEGO-Preliminary data show that a new outcomes measurement tool developed by the Society of Gynecologic Oncologists (SGO) Outcomes Task Force is a reliable method for demonstrating quality of care to third parties. Lead author Alexander W. Kennedy, MD, of the Department of Gynecology and Obstetrics, Cleveland Clinic Foundation, reported on behalf of the task force at the SGO’s 31st Annual Meeting.

The borderline category of ovarian tumors is one of the most controversial topics in gynecologic oncology and pathology, and is confusing to both clinicians and patients. Although numerous reviews have appeared in the literature, most of them rehash the prevailing views on borderline tumors without critically evaluating the published data that allegedly validate some rather puzzling and perplexing notions. For example, although these tumors are considered to be a subset of carcinoma, most patients are cured even when they have “metastatic” disease that has been inadequately treated. In addition, reports cite recurrence and death as late as 39 years after the diagnosis of tumors that appear histologically bland and noninvasive.

Ovarian tumors of low malignant potential (LMP) would benefit from a new name, not to mention a deeper understanding of their biology, effective treatment, and a framework within which they can be studied. Fortunately, for a pathologic entity that is poorly understood and also is unresponsive to current therapy, most LMP ovarian tumors carry a benign prognosis.

Low malignant potential (LMP) ovarian tumors represent a small subset of epithelial ovarian cancers that were first identified 70 years ago but were recognized in a systematic way only within the last 30 years. These lesions

SAN DIEGO-Estrogen replacement therapy (ERT) does not increase the risk of recurrence in patients who have had endometrial cancer and should not be categorically ruled out in these women, according to research presented at the 31st Annual Meeting of the Society of Gynecologic Oncologists (SGO).

SAN DIEGO-Black women with cancer have generally worse outcomes than white cancer patients, and some cancer experts suspect underlying differ-ences in cancer susceptibility or progression. US military medical researchers suggest that, at least for cervical cancer, they are looking in the wrong place.

At the recent annual meeting of the Society of Gynecologic Oncologists (SGO), researchers announced findings suggesting that the putative tumor-suppressor gene-the fragile histidine triad (FHIT) gene-may be central to the development of

Research presented recently at the Society of Gynecologic Oncologists (SGO) annual meeting found that survival rates of African-American women with advanced-stage endometrial cancers are significantly worse than those of Caucasian women.

Although endometrial cancer is the most common gynecologic malignancy diagnosed in US women, it has not received the same attention from health care professionals and the lay public as has its more lethal counterpart in the female gonad-epithelial ovarian cancer.

Cervical cancer has a high incidence and is a rapidly progressive illness among human immunodeficiency virus (HIV)-infected women. This cancer has received increasing attention since 1993 following its addition to the list of AIDS-defining illnesses monitored by the Centers for Disease Control and Prevention (CDC).[1] With increased heterosexual transmission of HIV and frequent co-infection with the human papillomavirus (HPV),[1] invasive cervical cancers will appear more often among HIV-infected women.

Endometrial carcinoma is the most common gynecologic malignancy in the United States. Most cases are diagnosed at an early stage. However, the outcome for women diagnosed with advanced-stage disease remains poor. The etiology of most endometrial carcinomas stems from the effects of excess estrogen, whether this comes from exogenous or endogenous sources. Differences in epidemiology and presentation suggest the existence of two forms of endometrial cancer: those related to and those unrelated to hormonal stimulation. Most women with endometrial cancer present with abnormal uterine bleeding; endometrial sampling is essential to exclude endometrial carcinoma in such patients. Endometrial cancer is surgically staged, and staging usually includes a hysterectomy and bilateral salpingo-oophorectomy. Lymphadenectomy also should be performed in selective cases to better assess disease spread and to evaluate the need for adjuvant therapy. Adjuvant treatment may include the use of radiation, progestins, or cytotoxic chemotherapeutic agents. Several clinical trials are underway to compare these treatment modalities, as well as to determine the optimal combination of active chemotherapeutic agents, such as doxorubicin, platinum agents, and paclitaxel (Taxol). [ONCOLOGY 13(12):1665-1675, 1999]

We commend Chen et al for their comprehensive review of the evaluation and treatment of endometrial cancer. As the authors state, endometrial cancer is the most common gynecologic malignancy in the United States. Fortunately, it is also one of the most curable. The majority of women with endometrial cancer are treated by surgery alone; primary radiation therapy is generally reserved for patients with unacceptable risks of surgical morbidity. In this commentary, we will address several areas of current controversy.

Endometrial cancer is the fifth leading cause of cancer in women worldwide, with approximately 150,000 cases diagnosed each year, and is the most common malignancy of the female genital tract in the United States. Dr. Chen and colleagues provide an excellent review of current clinical investigations focusing on the evaluation and treatment of this carcinoma.

The Gynecologic Cancer Foundation, along with the American Hospital Association, has declared September 1999 the first annual Gynecologic Cancer Awareness Month. Each year, 82,000 women in the United States (ie, 1 in every 25 women) are

Standard radiation therapy for patients with latestage cervical cancer (stage IIIB) should be adjusted so that each patient receives moderate doses of external-beam radiation therapy plus radioactive implants, according to a study led by Dr. Mark

SAN FRANCISCO-A single-visit cervical cancer screening program conducted before and after church services may help extend the benefits of early diagnosis and treatment to underserved populations, according to research presented at the 30th annual meeting of the Society of Gynecologic Oncologists.

Laparoscopy dates back to 1901 when Kelling inspected a dog’s abdominal cavity with a cystoscope introduced transcutaneously. This technique was subsequently applied to humans in 1923.[1] Jacobaeus, in 1910, developed instruments

Dr. Chi very nicely reviews the history of operative laparoscopy in gynecologic oncology and covers most of the applications currently considered to be useful.

Minimally invasive surgery is simply the use of small incisions with specialized equipment to accomplish surgical objectives that would otherwise be completed through larger incisions with conventional equipment. A priority of gyne-cologic oncologists

One of the cornerstones of gynecologic cancer surgery is the assessment and removal of the retroperitoneal lymph nodes. Numerous reports have demonstrated that, when performed by highly skilled individuals, laparoscopic