This article is given the historical facts of development and evolution for operative approaches within obstetrics and gynecology starting from the first documented steps of ancient scientists till the modern high-tech surgical techniques.
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Country specific incidence and mortality rates were prepared for three types of female genital organs (cervix and corpus, uteri, ovary). World standard population is used for age adjustment to allow international comparisons. Annually in Russia 14,7 thousands of cervix uteri new cases 19,8 thousand of corpus uteri and 13,1 thousand of ovary are registrated. Since 1989 to 2010 year incidence rate (world standard) increased from 12,4 per 100000 female population to 14,3 (for cervix uteri; increase 15,3%), for corpus uteri 9,6 and 15,7 per 100000 (increase 63,5%) and ovary cancer 9,3 and 11,2 per 100000 (increase 20,4%).
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New approaches to prophylactic оf BRCA1, 2-associated breast and ovarian cancers and medico-genetics consulting.
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342 patients with verified locally advanced cervical cancer were included after surgery, 246 pts. in research group ( branch A — 152 pts. after primary surgery, branch B — 94 pts. after surgery with previous taxan-platinum based chemotherapy), 96 pts. — in retrospective control group. In whole, 20 different clinical and morphological parameters were picked out, analyzed with Cox multivariate regressive analyses and compared in two groups as significant factors for tumor progression. It was demonstrated that primary tumor volume over 30см3 (HR 1,64, 95% CI 1,07–2,51, P=0,024); cervical stroma invasion over 1/3 (HR 1,60, 95% CI 1,11–2,31, P=0,011); uterine involvement with myometrium invasion over 5мм (HR 1,38, 95% CI 1,04–1,84, P=0,026); parametrium or vagina involvement (HR 1,86, 95% CI 1,23–2,82, P=0,003); 0-I Grade of therapeutic pathomorphosis after neoadjuvant radiotherapy (HR 1,54, 95% CI 1,03–2,31, P=0,036); positive resection margin (HR 1,81, 95% CI 1,35–2,41, P=0,002); tumor embolus in lymphatic and blood vessels (HR 1,79, 95% CI 1,19–2,68, P=0,005); lymph node metastases (HR 1,86, 95% CI 1,13–3,04, P=0,014); cytoreductive surgery (HR 2,01, 95% CI 1,28–3,16, P=0,002); heavy intraoperative bleeding with persistant anemia II–III (HR 1,49, 95% CI 1,15–1,95, P=0,003) significantly decrease the disease free survival (DFS) rates in control group, after conventional postoperative radiotherapy. The principles of postoperative radiotherapy dose and volume individual choice were formed according to individual predictive factors evaluation. Overall (OS) and DFS rates were evaluated in research group, after modified image-guided radiotherapy, and the significant survival improvement was shown in comparison with control group (60-month OS 74,0±2,9% vs 41,6±5,3%, DFS 71,9±4,6% vs 57,9±4,0% (Р<0,001), with 15% additional survival improvement in neoadjuvant chemotherapy patients. according to cox multivariate analyses in research group, the negative influence of uterine or vagina 2 /3 involvement, positive margin, lymphovascular space invasion and obturator lymph node metastases was successfully overcome by individually planned modified postoperative radiotherapy while parametrium involvement, residual tumor of any size after surgery, ineffective neoadjuvant therapy still significantly decreased DFS rates.
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In this article, we present the results of hormonal treatment applied in 440 patients with endometrial hyperplasia. This type of therapy was effective for all these patients and may be offered to be used as an alternative to surgery in women with endometrial hyperplasia.
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Leiomyomas predominate among benign nonepithelial tumors of the corpus uteri. Leiomyoma is commonly an asymptomatic tumor and detectable in most cases at routine gynecological examinations. However some forms of leiomyomas have a definite metastatic potential and despite its benign morphological signs, may metastasize to the lung. Fatal cases resulting from tumor spread along the postcava to the right atrium are described.
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Proper staging is important for treatment planning and for providing an accurate prognosis there are no reliable data that screening for ovarian cancer is effective in improving length and quality of life in women with ovarian cancer.
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The experience of the use of intraperitoneal chemotherapy counts more than twenty years and nowadays is often used in combination with the cyto-reductive operations which are directed to the prophylaxis and treatment carcinomatosis of peritoneum. The article presents modern ideas about possibility of the use of the combined treatment and its efficiency, as well as our own supervisions.
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Advances in understanding molecular and genetic mechanisms underlying cancer promise an «individualized» management of the disease. Women with a BRCA1 or BRCA2 germ-line mutation are at very high risk of breast and/or ovarian cancer. Because high-quality data are lacking from randomized trials, prevention strategies and treatment of patients with BRCAassociated breast cancer are complex.
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Phyllodes tumors of the breast, having the frequency of not more than 2% of all breast affections, are comparatively rare lesions. Rare occurrence, peculiarities of the clinical course and polymorphism in tumor pathology underlie the lack of uniform principles of diagnosis and treatment of breast phyllodes tumors. The most signifi cant and well-studied molecular and genetic markers of breast tumors are mutations and single-nucleotide polymorphisms, identifi ed in tumor suppressor genes BRCA1/2, PT53.
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Every day in the world in need of pain relief for about 4 million patients suffering for cancer. We present evidence and possible anesthesia.
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