Objective of the study. To conduct a systematic review of the data available in modern literature on diffuse benign breast conditions for the purpose of choosing an adequate optimal complex of methods for breast examination, treatment tactics and the intervals of monitoring.
Materials and Methods. The overview includes the data of articles found in Pubmed that have been published on this subject in Russia and abroad over the last 10 years.
Results. The article presents the modern concepts on the characteristics and peculiarities of different forms of mastopathy, their clinical course, their radiological, sonographic and pathomorphologic manifestations. The work also provides evidence for the pathogenetic mechanisms of the treatment of various types of mastopathy. Advantages of modern techniques used for the treatment of breast diseases are demonstrated. Various tactics for the treatment of the syndrome of diffuse changes in the breast are considered.
Conclusion. It is necessary to conduct further investigations as regards to an early diagnosis of breast diseases targeted at raising knowledge of physicians who specialize in various fi elds of medicine — in breast diseases and breast surgery, gynecology and obstetrics, oncology and general practice as well.
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Objective of the study. To study the clinical and genetic associations of the tumors in female patients with multiple primary malignant tumors of reproductive system organs and of the colon.
Materials and Methods. The study involved patients with multiple primary malignant neoplasms of reproductive organs (n = 635) who underwent treatment in the Federal State Budgetary Institution «N.N. Blokhin Russian Cancer Research Center» from 1990 to 2013, as well as 2318 their fi rst-grade relatives over 20 years of age (residents of Moscow and Moscow region). The analysis was carried out using both the standard statistical procedures and specifi c methods of genetic testing. Also DNA-testing of mutations in genes of repair system MLH1, MSH2, MSH6 was performed using a method of electrophoresis and polymerase chain reaction (PCR) sequencing of aberrant site in 35 patients with multiple primary malignant tumors of reproductive system and the colon.
Results and Discussion. From 5520 women with colon cancer who underwent treatment at the Federal State Budgetary Institution «N.N. Blokhin Russian Cancer Research Center» over the last 20 years multiple primary malignant tumors were detected in 2% of all observations. In total, 233 cases of multiple primary malignant tumors were identifi ed, of those 122 (52,4% cases were synchronous, 66 (28,3%) — combined, and 45 (19,3%) — metachronous. In cases of metachronous multiple primary cancer of the cervix and the colon colorectal cancer developed in 85,6% of observations after radiation treatment conducted for cervical cancer. In cases of multiple primary endometrial cancer and colon cancer in 84,0% of observations colon cancer progression was detected after radiation therapy performed for endometrial cancer as well. Moreover, all patients developed colon cancer in 8 years or later after the radiation therapy of the fi rst tumor. The molecular genetic research that had been conducted showed that congenital disorders of repair system of unpaired DNA bases (MSH2, MLH1 and MSH6) were discovered in 37% of observation with patients with multiple primary cancer of reproductive system and the colon.
Conclusions. Multiple primary malignant tumors of reproductive organs and the colon are a rare pathology. Thus, the risk of the development of multiple primary malignant tumors in women considerably increases when congenital defects of repair system of unpaired DNA bases (MSH2, MLH1 and MSH6) exist. Therefore, it is necessary to identify these mutations in the families of patients with multiple primary colon, endometrial and/or ovarian cancers, as well as in cases of aggregation of solitary tumors of above listed localization in one family.
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Objective of the study — is the optimization of the diagnosis and treatment of hyperplastic processes of the endometrium and the evaluation of long term results of hysteroscopic endometrial destruction using resectoscopic techniques.
Materials and Methods. 300 patients with recurrent hyperplastic processes of the endometrium were examined and underwent treatment using novel techniques (hysteroscopic and resectoscopic technologies). The criterion of the effectiveness was radical removal of pathologically altered tissues and absence of recurrence.
Results. The growth of endometrium after ablation was observed in cases of cystic glandular hyperplasia and glandular hyperplasia. Endometrial regeneration processes didn’t occur in glandular fi brous polyps and fi brous polyps. Six months after surgery amenorrhea was detected in 235 patients (78,3%), hypomenorrhea — in 35 patients (11,6%). Minor changes in menstrual function or its absence were identifi ed in 30 patients examined (10,11%).
Conclusions. Hysteroscopic and resectoscopic technologies provide an opportunity to affect hyperplastic processes of the endometrium under direct visual control, simultaneously ensuring the effectiveness and safety of the treatment. These are organ-preserving surgeries which enable faster recovery of patients, absence of the risk of complications related to prolonged anesthesia.
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Objective of the study: To analyze the prevalence and incidence rates of ovarian cancer taking into account the data of genotyping for BRCA1/2-status in the Russian female population, to construct a clinical-statistical model, which would allow to predict the prevalence rate of hereditary ovarian cancer considering the stage of the disease. Also the objective is to identify the demand in the introduction of screening programmes, which would contribute to detect hypothetical patients (fi rst-second degree relatives of ovarian cancer patients), who are considered to be at risk of developing ovarian cancer and are subject to undergo mandatory testing.
Materials and Methods: An information retrieval search of the data regarding the prevalence and incidence of ovarian cancer in the Russian Federation, including patients with BRCA1/2 gene mutations, of clinical recommendations relating to the course and outcomes of the disease in different clinical groups of patients was conducted.
Results: Considering the probabilities introduced into the model it was established that if the number of newly detected patients with ovarian cancer and BRCA1/2 gene mutations at an early stage may make up from 326 to 486 people, then with advanced cancer — from 1197 to 1437 people. If we consider the whole population of patients with a proven diagnosis of ovarian cancer who are registered at the cancer centers and institutes of the Russian Federation, the number of patients with BRCA1/2 gene mutation at present is from 13 206 до 14 329 people. An expert-based evaluation demonstrates that 1683–1762 relatives of patients will be identifi ed as BRCA1/2 gene mutation carriers, and 673–705 individuals will develop ovarian cancer in the lifetime (the risk of the development of this subtype of ovarian cancer is 0,4). The survival rate in a «test group» is 2,4 times higher compared to the group of relatives who haven’t been tested.
Conclusions: It is feasible to perform the testing on BRCA1/2 gene mutation in all ovarian cancer patients regardless of family medical history that is stipulated by both clinical and clinical-economic indicators. The identifi cation of a sub-group of patients with BRCA1/2 — associated cancer, relatives — who are the carriers of BRCA mutations will provide an opportunity to avoid a burden on state budget in social service sector, as well as on the budgets of healthcare sector of different levels in connection with the optimization of existing treatment regimens.
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Objective of the study. To determine the possibilities of the use of tumor –associated markers CEA, CA 125, CA 19.9, CA 15.3 in the diagnosis and monitoring of patients with pseudomyxoma and peritoneal mesothelioma.
Materials and Methods. The levels of tumor markers CEA, CA 125, CA 19.9, CA15.3 were measured in 30 patients with pseudomyxoma and peritoneal mesothelioma before and after treatment for the period from 2007 to 2014.
Results. The markers CA 125 — 10/18 (55.5%) and CA 15.3 — 8/18 (44.4%) were found to have the highest basic diagnostic sensitivity for mesothelioma; CA 125 — 21/30 (70%), CA 19.9 — 19/30 (63%) and CEA — 20/30 (67%) — for pseudomyxoma. The correlation between the level of tumor markers and the volume of cytoreduction was identifi ed, furthermore after the optimal removal of tumor (CC = 0, completeness of cytoreduction) the normalization of the level of elevated markers was achieved in all the patients. Moreover, the factors that contributed to the monitoring of the correlation between the initially elevated marker level and the prognosis of the disease were revealed. These factors are: poor tumor differentiation, presence of ascites, РЗ disseminations, non optimal cytoreductive surgery.
Conclusions. It is necessary to include the analysis of the level of tumor markers into the algorithm of the examination and dynamic testing after the treatment for all patients with peritoneal mesothelioma and pseudomyxoma, despite its limited diagnostic value and low specifi city. With initially elevated levels of tumor markers this uncomplicated diagnostic test allows to determine the effectiveness of treatment.
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Objective of the study: to examine the material obtained from the uterine cavity of patients diagnosed with ovarian cancer of different morphological types, which enables to identify the factors indicating the potential role of some hyperplastic processes of the endometrium in the development of ovarian cancer and the possibility of their use in the diagnosis of malignant ovarian tumors.
Materials and Methods: 79 cytological and 218 immunocytochemical studies of uterine lavages samples obtained from uterine cavity of 39 patients with ovarian cancer of different histological type of tumor, were performed. All those patients underwent treatment in the Federal State Budgetary Institution «N.N. Blokhin Russian Cancer Research Center» of the Ministry of Healthcare of the Russian Federation in the period from 2013 to 2016. The control group included 16 practically healthy volunteers. Liquid-based cytospin monolayer preparations of the Cytospin system were made for the cytology tests of the collected material and for performing of immunocytochemical reactions. Immunocytochemical analyses were conducted using monoclonal antibodies (MAbs) against antigens: p53, CA125, WT1, Ki67.
Results: immunocytochemical analysis of the sample material obtained from uterine cavity of patients with a clinical diagnosis of ovarian cancer detected the co-expression of protein p53, WT1, CA125, Ki67 in cells in 79% (31 of 39) of observations. When using a traditional cytologic diagnostic method combined with immunocytochemical technique the cells of ovarian carcinoma were identifi ed in the uterine cavity in 82% (32 of 39) of observations. Moreover, malignant cells were not detected in the traditional cytologic evaluation of the cell samples from uterine cavity obtained from 12 patients with benign ovarian tumors, however, immunohistochemical analysis revealed weak and moderate focal p53 protein expression in separate cells of the endometrium in 2 cases of observations (serous and mucinous cystadenoma). CA125 and Ki67 don’t have diagnostic signifi cance as their values vary widely.
Conclusions: Our fi ndings testify that immunocytological analysis, based on the expression of molecular genetic markers of the cells, obtained from lavage of the uterine cavity provides a high enough effi ciency in ovarian cancer diagnosis. It will allow to acknowledge the fact, that a considerably greater part of so called «ovarian cancer» than previously recognized, are in fact metastatic tumors with the localization of primary tumor in the uterus.
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Objective of the study. To identify the trends in determining initial disability in adult population as a result of malignant tumors of female genital organs in Belgorod Region.
Materials and Methods. The analysis of the levels, structure and trends of disability determination in adult population of Belgorod region due to malignant neoplasms of female internal genital organs in dynamics for period 2005–2013 was performed. The study was conducted by a continuous method. The analysis that investigated the rate at which the indicators of primary disability changed was carried out using the parameters received as a result of comparing the levels of population growth rate or a rate of population decline per 10 thousand of female population.
Results. It was estimated that the proportion of malignant tumors of female internal genital organs in the nosological structure of establishing initial disability due to cancer diseases in Belgorod region is signifi cant. Among the contingent of people who were approved for disability the fi rst time they applied the share of persons of young age prevailed in the group of people with cervical cancer, of middle age and of retirement age prevailed in the group of individuals with ovarian cancer, and the group of people who had endometrial cancer was predominated by individuals of retirement age. These observations show negative tendency to the increase of the proportion of the above stated age groups in the overall number of people whose initial disability claims were approved. In the contingent of people who were approved for disability due to malignant neoplasms of female genital organs the fi rst time they applied the persons with grade 2 of disability are prevalent with an evidential trend to a decrease of their proportion among the persons with endometrial cancer. The disability of the severest grade 1 is more common for the people with ovarian cancer and has a tendency to inconsiderable decrease of its share.
Conclusions. The levels, age structure and major trends in the dynamics of the indicators of initial medical determination of disability as a consequence of malignant diseases of female genital organs can be used as information database for the development of the programs of prevention of incidence of cancer and reducing disability of population caused by malignant diseases.
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Objective of the study: to conduct a systematic analysis of the data available in current literature on the role of narcotic analgesics in the therapy of chronic pain syndrome in cancer patients.
Materials and Methods: The review covers the data obtained from both international and domestic publications found in Pubmed on the subject which have been published over the past 10 years.
Results: The article describes potential mechanisms of pain syndrome relief and management in cancer patients and specifi cally using narcotic analgesics.
Conclusion: It is necessary to carry out further research in this regard. It is of particular importance to improve the principles of pain management with predominant use of non-invasive forms of narcotic analgesics, that can bring relief to a patient and some «peace and comfort» to his/her family.
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Objective of the study. To analyze the data, available in modern literature, on the peculiarities of the course of cancer in pregnant women.
Materials and Methods. The review introduces the fi ndings of the foreign authors on the problem under study over the last 20 years, as well as the results of the research conducted by the expert group «Cancer during pregnancy» of the European Society of Gynecologic oncology (ESGO).
Results. The experts worked out the principal recommendations on the management of pregnant patients with gynecologic cancers.
Conclusion. It is necessary to continue the research in this area. In particular, when choosing the tactics of treatment of pregnant patient with gynecologic cancer it is essential to take into consideration all the concerns related both to mother and fetal health and development, and that commonly raises opposing points of views.
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Objective of the study. To evaluate the effectiveness and safety of the use of low molecular weight heparins for the prevention and treatment of thrombosis in patients with gynecologic cancers.
Materials and Methods. The effect of Clexane (Enoxaparin sodium) and Fraxiparine (Nadroparin calcium) on the hemostatic system and the incidence of thrombotic complications in 500 patients with gynecologic cancers who had undergone surgery, was studied.
Results and Discussion. Low molecular weight heparins (LMWH) are the basis of the specifi c prevention of thromboembolic complications in cancer patients. An adequate prevention and treatment of thrombotic complications in patients with gynecologic cancers before and after surgery, as well as during chemotherapy, reduce an intensity of intravascular blood coagulation, decrease the incidence of venous thrombosis and prevent lethal complication of thromboembolism which provide more opportunities for anticancer treatment and improve quality of life of these patients.
Conclusion. Patients with gynecologic cancer belong to a group of high risk for developing thromboembolic complications and they need a preventive treatment using adequate doses of low molecular weight heparins (LMWH). In cases of high risk for venous thrombosis low molecular weight heparins are prescribed and the dose is adjusted individually depending on body weight, additional clinical and hemostasiological factors.
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