The role of sentinel lymph node detection in vulvar carcinoma and the experiences at the Institute of Oncology Ljubljana Background. Sentinel node biopsy is a promising diagnostic staging procedure ...for vulvar carcinoma and it decreases postoperative morbidity. However, it has not been yet approved as a standard procedure. Patients and methods. From March 2003 to the end of 2006, 35 patients were treated for vulvar carcinoma with the technique of sentinel lymph node dissection. Mean age of the patient was 65.8 years (range 36-88 years). There had 32 patients squamous cell carcinoma, one malignant melanoma, one basal cell carcinoma, and one adeno-squamous cell carcinoma. Before surgery, sentinel node biopsy was made with performing 99mTc static and dynamic lymphoscintigraphy and with intradermal injection of methylene blue dye. Results. With this method we haven't found metastases in 25 patients (71.4%). In 3 cases, we failed and found groin recurrence after 12, 24 and 26 months, respectively. In the first, the reason was probably lack of experience, in the second case, we couldn't detect the second active node seen on the lymphographic scan, and in the third case, the reason was a prior surgical procedure and a scar in the groin region. In the group of SNB negative 22 patients were alive at the end of the year 2007 with no evidence of disease, one died after 45 months (groin recurrence), another one died of other causes. For one patient there is no current data. Patient with melanoma malignum is alive with liver metastases. Conclusions. In order to recognize the value of the obtained knowledge about the new treatment method and to confirm the efficiency or inefficiency of this method, further multicenter research studies need to be performed on larger randomized groups of patients.
The estimated proportion of hereditary breast and ovarian cancers among all breast and ovarian cancer cases is 5-10%. According to the literature, inherited mutations in the BRCA1 and BRCA2 ...tumour-suppressor genes, account for the majority of hereditary breast and ovarian cancer cases. The aim of this report is to present novel mutations that have not yet been described in the literature and pathogenic BRCA1 and BRCA2 mutations which have been detected in HBOC families for the first time in the last three years. In the period between January 2009 and December 2011, 559 individuals from 379 families affected with breast and/or ovarian cancer were screened for mutations in the BRCA1 and BRCA2 genes. Three novel mutations were detected: one in BRCA1 - c.1193C>A (p.Ser398*) and two in BRCA2 - c.5101C>T (p.Gln1701*) and c.5433_5436delGGAA (p.Glu1811Aspfs*3). These novel mutations are located in the exons 11 of BRCA1 or BRCA2 and encode truncated proteins. Two of them are nonsense while one is a frameshift mutation. Also, 11 previously known pathogenic mutations were detected for the first time in the HBOC families studied here (three in BRCA1 and eight in BRCA2). All, except one cause premature formation of stop codons leading to truncation of the respective BRCA1 or BRCA2 proteins.
HPV AND CERVICAL CANCER PREVENTION Marjetka Uršič-Vrščaj; Milan Bašković; Sonja Bebar ...
Zdravniški vestnik (Ljubljana, Slovenia : 1992),
02/2018, Volume:
78
Journal Article
Peer reviewed
Open access
Background: The causal role of human papilloma virus (HPV) in all cancers of the uterine cervix has been firmly established biologically and epidemiologically. HPV types 16 and 18 account for about ...70 % of the cases worldwide. HPV has been recognized as a necessary cause of cervical cancer, meaning that in the absence of the persistent presence of HPV DNA in the cervical cells, cervical cancer will not occur. Thus preventive strategies based on HPV testing in screening programmes or HPV type-specific vaccination are based on solid ground. Most cancers of the vagina and anus are likewise caused by HPV 16, as are a siteable fraction of cancers of the vulva, the penis and the oropharynx. Cervical cancer screening can be a highly effective secondary intervention. In the developing countries these programmes are either not available or are ineffective. HPV vaccination represents the most effective intervention in that scenario. Prophylactic vaccination with human papillomavirus (HPV) virus-like particle (VPL) vaccines against HPV 16 and HPV 18, has transformed our prospects for reducing the in- cidence of cervical cancer on global scale. HPV vaccines are immunogenic, well tolerated and show remarkable efficacy. Screening will have to continue, as two of the 15 oncogenic HPV types are in the vaccines and for two to three decades at least unvaccinated sexually active women still remain at risk for the disease. Conclusions: If vaccination, screening and HPV testing are combined then the virtual elimination of cervical cancer is possible.
Background: Morbidity and mortality caused by cancer persist to be an important health problem world- wide and in the European Union member states as well. In Slovenia, most ovarian cancer cases are ...detected in advanced stages, hence a rather high mortality rate. Aims: The purpose of this research project is to analyze the primary cytoreduction in the patients with advanced ovarian cancer. The main objective of the project is to assess the use of lap- aroscopy in the prediction of optimal cytoreduction in these patients. Applicative research project ‘Estimation of survial in patients with advanced ovarian can- cer based on primary laparoscopical assessment of optimal cytoreduction’ (L3-2371) was approved and has been financed by the Slovene Research Agency and co-financed by the Ministry of Health of RS; Duration: May 1, 2009–April 30, 2012. Methods: The research project will consist of retrospective and prospective study. In all the patients with advanced ovarian cancer managed at the Department of Obstetrics and Gynecol- ogy, University Medical Centre Ljubljana in the years 2003–2008, and in whom optimal primary cytoreduction was made using either laparoscopy or laparotomy, certain clinical and pathomorphological factors will be compared, and the effects of all analyzed factors on the outcome of treatment assessed. In the prospective study, we will aim at assessing the use of laparoscopy in the prediction of optimal cytoreduction in all newly detected cases using a laparoscopy-based score (Fagotti’s scoring system). Conclusions: The standard management of advanced ovarian cancer patients consists of primary surgical optimal and/or suboptimal cytoreduction followed by aggressive cytotoxic chemotherapy. In line with our experience and with that published most recently, laparoscopy seems to be a promising method with which we will attempt to most accurately assess the optimal cytoreduction in surgical treatment of ovarian cancer patients.
Abstract Objective An organized cervical cancer (CC) screening program was introduced in Slovenia in 2003. With the purpose of clinical audit we analyzed the clinicopathological characteristics of CC ...patients for the period between 2003 and 2005. Study design The retrospectively collected data of 450 CC patients were presented at three Advisory Boards of Gynecologic Oncology in Slovenia. They were stratified for stage, tumor characteristics and treatment methods according to gynecologic examination attendance in the last 5 years preceding the diagnosis of CC (attenders vs. nonattenders). Results In the period of observation, 242 women (53.8%) visited their gynecologists in the 5-year period prior to diagnosis of CC. Squamous cell carcinoma was present in 378 women (84.0%), adenocarcinoma in 45 (10.0%), adenosquamous carcinoma in 24 (5.3%) and other types in 3 women (0.7%). Attenders were significantly more frequently diagnosed with squamous cell carcinoma than nonattenders (chi-square = 5.13; P < 0.05). Attenders were significantly more frequently diagnosed in stage IA than in stage IB (chi-square = 22.35; P < 0.01). Similarly, in attenders stage I was significantly more frequent than stage II (chi-square = 18.81; P < 0.01). Pathologic smears of women with CC in the last 5-year period were most frequently evaluated as Pap II in the years 2003 and 2004 (in 39.1 and 26.4% of women, respectively) and as Pap III (in 27.9% of women) in 2005. Surgery was performed in 282 women (62.7%), radiotherapy in 158 (35.1%), symptomatic therapy in 9 (2.0%) and chemotherapy alone in 1 (0.2%) woman. In attenders, surgery alone was the most frequent treatment method (chi-square = 91.18; P < 0.01). Conclusion Only in attenders a significant redistribution of CC stages in favor of early stages is observed, and in these women more conservative and less extensive treatment methods could be applied.
BACKGROUND HT should be considered only when an indication for therapy has been clearly identified,contraindications ruled out, and the potential individual benefits and risks adequatelydiscussed ...with the women so that an informed decision can be made.Breast cancer risk increases with EPT use beyond 5 years. In absolute terms, this increasedrisk are rare in the WHI, being 4 to 6 additional invasive cancers per 10.000 women peryear who used EPT for 5 or more years. Studies have not clarified whether the risk differsbetween continous or sequential use of progestogen. Women in the ET arm of the WHIdemonstrated no increase in risk of breast cancer after an average of 7.1 years of use, with8 fewer cases of invasive breast cancer per 10.000 women per year of ET use. There arelimited observational data suggesting that ET for more than 15 years may increase the riskof breast cancer. There are minimal data reporting any change in breast cancer mortalitywith HT. CONCLUSIONS It should be recognized that even in the absence of HT use, there is a risk of development ofbreast cancer. There are multiple risk factors for breast cancer, including alcohol intake,obesity and lack of exercise. These need to be included during counselling to put the magnitude of risk of HRT into an appropriate perspective
Background: Initial surgical debulking followed by a systemic chemotherapy is the standard treatment sequence for advanced ovarian cancer (AOC) treatment. The purpose of this article is to evaluate ...prognostic factors that impact the success of AOC treatment. Methods: All patients with AOC (FIGO stage III and IV) who were surgically treated at the Division of Gynaecology, University Medical Centre of Ljubljana, in the period from 2003 to 2008 and further received cytotoxic chemotherapy at the Institute of Oncology in Ljubljana were included in this retrospective study. Women with advanced borderline ovarian cancer and patients who initially received neoadjuvant chemotherapy and those whose adjuvant chemotherapy was not platinum-based were excluded from the analysis. Results: A total of 159 women were enrolled in the study, while data were analyzed for 116 patients. Their median age was 59 years (23–80 years) and did not have a significant influence on the treatment outcome. Clear-cell histological type of AOC was an important risk factor for a disease-free interval (DFI) (HR = 2.41, CI 95 % 0.9–5.9; p = 0.08) and overall survival (OS) (HR 4.045; 95.0 % CI 1.5–10.6; p = 0.003). Postoperative residual tumour larger than 2 cm represented a statistically independent risk factor for poor OS. Residual tumour in the upper abdomen did not represent a statistically significant risk factor either for DFI (HR = 1.93; CI 95 % 0.9–4.06; p = 0.08) or for OS (HR = 1.47; 95.0 % CI 0.5–3.8; p = 0.491). Median follow up time was 29.5 months, median DFI 18 months (95 % CI 16– 20) and median OS 32 months (95 % CI 22–42). 74 (63.8 %) patients died. Conclusion: Clear-cell histological type of AOC and residual tumour larger than 2 cm are the most important risk factors for early progress of the disease and poor OS. Hence improvement of surgical treatment is crucial for better treatment outcomes for patients with AOC. The latter can be achieved by an interdisciplinary surgical approach.
BACKGROUND HT should be considered only when an indication for therapy has been clearly identified,contraindications ruled out, and the potential individual benefits and risks adequatelydiscussed ...with the women so that an informed decision can be made.Breast cancer risk increases with EPT use beyond 5 years. In absolute terms, this increasedrisk are rare in the WHI, being 4 to 6 additional invasive cancers per 10.000 women peryear who used EPT for 5 or more years. Studies have not clarified whether the risk differsbetween continous or sequential use of progestogen. Women in the ET arm of the WHIdemonstrated no increase in risk of breast cancer after an average of 7.1 years of use, with8 fewer cases of invasive breast cancer per 10.000 women per year of ET use. There arelimited observational data suggesting that ET for more than 15 years may increase the riskof breast cancer. There are minimal data reporting any change in breast cancer mortalitywith HT. CONCLUSIONS It should be recognized that even in the absence of HT use, there is a risk of development ofbreast cancer. There are multiple risk factors for breast cancer, including alcohol intake,obesity and lack of exercise. These need to be included during counselling to put the magnitude of risk of HRT into an appropriate perspective
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