Gynecologic Cancers

Dr. Grigsby has done a masterful job of summarizing current information on the use of radiation in the management of patients with endometrial carcinoma. In the summary, he offers clear recommendations as to the appropriate management of various subsets of patients-recommendations that are based, at least to some extent, on the data reviewed. Such decision-making based on often incomplete information is necessary in the absence of appropriately designed randomized trials addressing the specific clinical situation. It is important, however, to understand clearly what we actually know and what we deduce from bits and pieces of data.

Dr. Grigsby does an excellent job of summarizing the accepted, stage-by-stage treatment recommendations as well as the controversies surrounding the treatment of endometrial carcinoma. This review is both important and timely, as we have seen the incidence of endometrial cancer increase over the past few years to the point where it is now the most common gynecologic malignancy.

The best clinical outcomes for patients with endometrial cancer seem to be achieved with either surgery alone or a combination of surgery and radiation therapy. Although once administered preoperatively, irradiation is now

Topoisomerase inhibitors have been widely studied for the treatment of refractory or recurrent cervical cancer. Various schedules have been used, with response rates ranging from 13% to 20%. The combination of cisplatin and irinotecan (CPT-11, Camptosar) is being studied in cervical cancer.

WASHINGTON-Health and Human Services Secretary Tommy Thompson has given nine more states the go-ahead to extend Medicaid benefits to uninsured women diagnosed with cancer under the federal Breast and Cervical Cancer Prevention and Treatment Act of 2000.

HOUSTON, Texas-Irinotecan (Camptosar) is active in platinum-refractory cervical cancer and should be tested with cisplatin (Platinol) in randomized trials, declared Claire F. Verschraegen, MD. The use of irinotecan might enable clinicians in developing countries (where radiotherapy equipment is in short supply) to downsize many cervical cancers to resectable size, Dr. Verschraegen added. She is assistant professor in the Division of Cancer Medicine Section of Gynecologic and Medical Therapeutics at the University of Texas M. D. Anderson Cancer Center in Houston, Texas.

CHICAGO-Cisplatin-based chemoradiotherapy has greater efficacy than previous regimens in treating cervical cancer, but toxicity needs to be reduced, stated William Small, Jr., MD. He is assistant professor of radiology, Division of Radiation Oncology, at Northwestern University’s Robert H. Lurie Comprehensive Cancer Center in Chicago.

The diagnosis and management of cancer in older women is becoming an increasingly common and challenging issue. Women who reach age 65 can expect to live an additional 17 years.[1] Age is an important risk factor for developing cancer. Epidemiologic data from 1992 to 1994 reveal that invasive cancer develops in 1 of 5 women aged 60 to 79 years.[2]

WASHINGTON-A new analysis of data from the National Breast and Cervical Cancer Early Detection Program (NBCCEDP) shows that among women who received their first NBCCEDP Pap test between 1991 and 1998, American Indian and Alaskan Native (AI/AN) women had the highest proportion of abnormal Pap tests, while white women had the highest rate of serious cervical lesions detected by biopsy.

Congress finally passed a bill (H.R. 4386/S. 662) that allows states to provide medical treatment for women with breast and cervical cancer. At their option (there is no requirement), states can treat women who have tested positive in a screening

WASHINGTON-President Clinton has signed the Breast and Cervical Cancer Prevention and Treatment Act of 2000 into law. The Act provides $990 million over 10 years to expand the treatment options for uninsured, low-income women diagnosed with breast or cervical cancer in a nationwide program run by the Centers for Disease Control and Prevention (CDC).

Although the causes and natural histories of breast and cervical cancer are different, the public health responses to these diseases have been similar. Early detection of breast cancer and primary prevention of cervical cancer are possible through community-based screening programs; however, early detection of both breast and cervical cancer is less common among low-income women (defined as up to 250% of poverty level, depending on family size). This report presents morbidity and mortality data regarding breast and cervical cancer, screening recommendations, an update on the National Breast and Cervical Cancer Early Detection Program (NBCCEDP), and recommended priority activities for the NBCCEDP. The NBCCEDP is a major public health effort to increase breast and cervical cancer screening among uninsured, low-income women.

NEW YORK-A randomized trial enrolling 150,000 women and funded by the US National Cancer Institute is underway in India to screen for breast and cervical cancer using simple methods.

CHICAGO-Every hour, approximately 10 women in the United States will be diagnosed with a cancer of the reproductive organs-ovarian, cervical, uterine, vaginal, vulvar, or tubal cancer. In response to this sobering statistic, the Gynecologic Cancer Foundation is educating women on the importance of early detection and prevention throughout Gynecologic Cancer Awareness Month (GCAM) in September.

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]