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Gynecologic Oncology

Gynecologic Oncology 2015 #3

Content

FUNDAMENTAL ONCOLOGY
Azhigova R.R., Kuznetsova O.V., Kushlinskiy D.N., Dvorova E.K., Galdava D.E., Kostyleva O.I., Gershtein E.S., Tereshkina I.V., Laktionov K.P., Adamyan L.V.
Features Of Receptor Phenotype In Endometrial Cancer
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The data of the study of epidermal growth factor receptor (EGFR), estrogen (ER), progesterone (PR) in endometrial tumors in 125 patients. EGFR detected in 40% of tumors. The most frequently detected EGFR–RE+RP+tumors (48.8%) and less likely to EGFR+RE+RP+(30.4%). The incidence of EGFR in the tumor is more informative than its level in patients with endometrial cancer and decreased in adverse clinical and morphological signs of the disease.
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BREAST CANCER
Savostikova M.V., Kudaybergenova A.G., Furminskaya E.Yu.
Primary Morphological Diagnosis Of Breast Tumors.
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Objective of the study: to compare the effectiveness of fi ne needle aspiration (FNA) and core biopsies in the pre-operative primary diagnosis of breast tumors.
Materials and Methods: the study examined 519 fi ne needle aspiration biopsies and 439 core biopsies obtained from 432 patients with clinical diagnosis of breast cancer. 368 samples were available for comparison.
Results: Cytological material was assessed as informative — in 412 examinations (79,38%), histological material was informative in 409 (93,16%). Histological examination of core biopsy had diagnostic value by up to 13,78% more frequently. In 98,64% of cases the conclusions of fi ne needle aspiration biopsies (FNAB) and core-biopsies coincided, sensitivity of fi ne needle aspiration biopsy (FNAB) was 97%, specifi city — 92%, sensitivity and specifi city of core biopsy made up 100% and 92% respectively. Among the cases of coincidence benign breast disease made up 5,8%, malignant pathology — 94,2%.
Conclusions: Based on an adequate quality of sampling material cytological examination can be a valuable addition in combination with mammography and clinical investigation in the morphological verifi cation of breast tumors both in primary diagnosis and in the absence of the possibility to perform histological examination. However, a high percent of noninformative (14,62%) material and biopsies that yield little information (6,36%), the presence of false-negative (0,54%) and false-positive (0,82%) results require a standard approach in performing a fi ne needle aspiration biopsy (FNAB), more differentiated morphological assessment of the material and a comprehensive and systematic use of clinical data and mammography data.
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UTERINE CANCER
Nechushkina V.M., Morkhov K.Y., Kuznetsov V.V., Mosina M.V.
Risk Factors For Lymphogenic Metastases Of Endometrial Cancer.
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Regional lymph node involvement is one of most unfavourable prognostic factor in endometrial cancer, that greatly infl uences the treatment strategy of patients.
Objective of the study. To analyze the risk factors of metastasis in regional lymph nodes in endometrial cancer.
Materials and Methods. The study comprised 113 patients with endometrial cancer. 108 patients from 113 (95,5%) had undergone selective pelvic lymphadenectomy, 2 (1,8%) — lumbar, 2 (1,8%) — pelvic and lumbar lymphadenectomy.
Results. Lymphogenic metastases were detected in 37 patients of 113. According to the data of multivariate analysis, the independent risk factors of metastasis in regional lymph nodes in endometrial cancer were detection of enlarged lymph nodes, low or different grade of tumor cell differentiation, stages T1b–T3b and M1 (TNM, 7th revision), as well as the identifi cation of tumor emboli in lymphatic clefts.
Conclusions. The identifi ed independent risk factors of lymphogenic metastasis can be considered as the indications for lymph node dissection for endometrial cancer.
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Novikova S.V., Novikova E.G., Lozovaya Yu.A., Tchulkova O.V., Pronin S.M.
Separate Use Of Hormone Therapy As An Alternative To The Surgical Treatment Of Endometrial Precancer And Early Endometrial Cancer In Patients Of Reproductive Age.
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Objective of the study: To estimate the effectiveness of separate hormone therapy of endometrial cancer and early endometrial cancer in women of reproductive age.
Materials and Methods: The study included 121 patients (56 patients with atypical hyperplasia and 65 patients with early endometrial cancer). Monotherapy using intrauterine device Mirena was conducted in cases of atypical hyperplasia, and in cases of an early endometrial cancer gonadotropin-releasing hormone (GnRH) agonists were used in addition to the insertion of intrauterine device Mirena. The fi rst check-up was conducted three months after. In the absence of atypical endometrial changes hormone therapy was continued for another 3 months. In cases when treatment turned out to be ineffective, surgical treatment or continuation of hormone therapy with an additional oral administration of progestogens were considered. When the results of the treatment showed that cure had been achieved, the patients were recommended to implement their reproductive function within the shortest possible period of time with the use of assisted reproductive technologies (ART) if it is clinically indicated.
Results. The use of monotherapy with intrauterine device Mirena for the period of 6 months resulted in full effect of the treatment in 51/56 patients (91%) with atypical endometrial hyperplasia. The duration of observation was 3–47 months. Recurrences were detected in 8 (16%) patients at period from 8 to 22 months after the treatment. Spontaneous pregnancies (without the use of assisted reproductive technology (ART)) occurred in 8 patients (16%), there was 1 case of spontaneous miscarriage in early pregnancy, in 4 cases pregnancies were carried to full term, three patients are pregnant now. The group of patients with early endometrial cancer (n=65) was examined 6 months after the beginning of hormone therapy and it was diagnosed that the cure had been achieved in 51 cases (78%) of observations. The duration of check-up was 3–47 months (the median — 18 months.), recurrences were detected in 11 (22%) patients at period from 3 to 8 months. Pregnancies occurred in 12 (24%) patients, in two cases — assisted reproductive technology (ART) was used, and in 5 patients pregnancies went on to full term and resulted in live births.
Conclusions. The method of separate hormone therapy of atypical hyperplasia and early endometrial cancer has signifi - cant advantages over traditional surgical treatment as it allows to achieve full cure and to preserve fertility in women of reproductive age. At the same time, the use of hormone therapy is associated with high rate of recurrences and with an increased risk of the development of ovarian cancer.
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OVARIAN CANCER
Bateneva E.I., Filippova M.G., Tyulyandina A.S., Krokhina O.V., Semyanikhina A.V., Petrovskiy A.V., Zhukova L.G., Mescheryakov A.A., Zhordania K.I., Sobolevskiy V.A., Vorotnikov I.K., Trofimov D.Yu., Lyubchenko L.N.
Results Of The Genetic Testing Of Germline Mutations In Genes BRCA1 And BRCA2 In Patients With Breast Cancer And Ovarian Cancer In Russian Population.
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Objective of the study: to evaluate the frequencies of occurrence of twelve known mutations in genes BRCA1 and BRCA2 in unselected patient populations with breast cancer (1091 people) and ovarian cancer (302 people). Materials: whole peripheral blood of patients with breast cancer (1091 people) and patients with ovarian cancer (302 people).
Materials and Methods: genotyping was performed through real-time PCR technology using a set «OncoGenetics BRCA» (LLC «Research and Production Company DNA-Technology», Russia). The operation of testing systems is based on a modifi ed technique of «kissing probes». Polymerase chain reaction was performed using a detecting amplifi er DTprime (LLC «Research and Production Company DNA-Technology», Russia).
Results: mutations in genes BRCA1 and BRCA2 were identifi ed in 5,9% of patients with breast cancer and 20,9% of patients with ovarian cancer. Mutation 5382insC in exon 20 of gene BRCA1 made up 4,0% of patient population with breast cancer and 11,6% of patient population with ovarian cancer. The high frequency of mutation in genes BRCA1 and BRCA2 in patients with ovarian cancer confi rms the necessity to conduct total genetic testing for this patient group. Conclusions: analysis of mutations in genes BRCA1 (185delAG, 4153delA, 5382insC, Cys61Gly, 2080delA, 3819delGTAAA, 3875del- GTCT) and BRCA2 (6174delT) can be recommended for inclusion in the screening programs to detect hereditary cases of breast cancer and ovarian cancer.
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СERVICAL CANCER
Sushinskaya T.V., Zhordania K.I., Payanidi Yu.G.
Analytical Aspects Of Oncological Diseases Of The Female Population Of Russia.
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Statistical data on the incidence of malignant diseases and mortality from them in the different groups of population is the basis for the development and implementation of the regional and national anti-cancer programs.
Cervical cancer is a crucial medical and social issue of female reproductive health in the developed countries. In Russia this type of malignant disease takes the third place in the incidence of reproductive organ diseases of the female population leaving ahead just breast cancer and endometrial cancer. It is estimated that by 2020 the number of new cases of cervical cancer worldwide will have grown by 40%.
Cervical cancer remains relevant for the study up to the present time. This type of malignancy is the third most common cancer worldwide, it is not directly related to the economic level of the country and, most regrettably, doesn’t show any tendency to decline not only in Russia but globally. Despite the fact that its location makes it easily accessible and despite existing real opportunities for its early diagnosis and treatment, cervical cancer is diagnosed with increasing frequency in women of reproductive age and it impacts the nation’s health and the future of every country.
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INTERDISCIPLINARY QUESTIONS
Milkhaylova I.N., Shubina I.Zh.
Chemoimmunotherapy In Oncology.
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Chemoimmunotherapy is a promising approach for treatment of malignant lesions as it mediates induction of immunoregulatory cytokines and specifi c «signals of danger», which appear as a result of cell death due to stimulation of immune cells.
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Tarabrin O.A., Mazurenko А.I.
Hemostasis System Disorders In Oncological Patients.
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Thrombosis and cancer are connected by a bilateral clinical correlation. Thrombosis can be the main clinical sign of unrevealed cancer. On the other side the patients with established malignant tumour at any stage may suffer from thrombotic complications.
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Rogachevsky O.V., Moiseev S.V.
Clinical Significance And Treatment Of Preoperative Anemia.
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Anemia is a common problem in the preoperative setting and is associated with higher risk of death and other postoperative complications. The risk of death was increased in patients with both moderate/severe and mild anemia. Unfavorable prognostic signicance of preoperative anemia did not depend on gender, age and the type of surgery. The use of intravenous iron for correction of iron defi ciency preoperative anemia is preferable as intravenous administration provides more rapid and reliable effect compared to oral intake of iron.
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Abashin S.Yu., Anikeeva O.Yu., Golovin P.S., Ivannikov V.V.
Clinical Aspects Of Pet/Ct Diagnosis Of Tumors Of The Reproductive System.
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Positron Emission Tomography (PET) is a technique used in clinical medicine and biomedical research to create images that show anatomical structure as well as how certain tissues are performing their physiological functions. However, the main emphasis in PET is not on anatomical imaging, as e.g. X-ray or MR imaging. Functional imaging is the major modality.
Radioactive nuclei are introduced to the body as labels on tracer molecules designed to probe physiological processes. These radioactive nuclei emit positrons that annihilate with electrons in the tissue. An annihilation event mostly result in two gamma photons (in some cases also three gamma photons, depending on the angular moment um coupling of the electron and positron)being emitted in almost exactly 180 degrees and with an energy of 511 keV each. The gamma photons are detected in coincidence in a detector ring (or several detector rings) so that two detected gamma photons represent a straight line along which the event took place. An assembly of such lines is gathered and processed with the aid of image processing tools to fi nally produce an image of the activity and thereby of the functionality.
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 NEWS 75
 Invitation to OSORS 76
 ARTICLE SUBMISSION GUIDELINES 78