Objective of the study is to carry out a systematic analysis of the data, accumulated in current literature to evaluate how genetic screening on the presence of pathogenic mutations in the genes, responsible for ovarian cancer predisposition, can affect treatment strategy, risk prediction and preventive measures for patients and their families.
Materials and Methods. The review comprises the data of foreign and Russian scholarly articles found in PubMed on the subject, published over the past 10 years.
Results. For decades hereditary breast cancer and/or ovarian cancer were thought to be associated only with mutations in BRCA1 and BRCA2 genes. However, it has been established recently, that other rare alleles (ATM; BRIP1; MRE11; NBN; PALB2; RAD50; RAD51; STIC) are also related to a high or moderate risk of developing this syndrome. The fallopian tubes of women with hereditary ovarian cancer mutations provide signifi cant information about the early stages of carcinogenesis and the process of malignant transformation. While surgical removal of the fallopian tubes and ovaries reduces the risk of developing ovarian cancer in carriers of BRCA1 and BRCA2 gene mutations, the benefi ts and advantages of such intervention in preventing this disease is unclear in cases of inherited mutations.
Conclusions. It is necessary to conduct further research in this area.
Keywords: ATM; BRCA1; BRCA2; BRIP1; MRE11; NBN; PALB2; RAD50; RAD51; STIC; carcinogenesis; hereditary syndrome of breast cancer and/or ovarian cancer
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Currently, oncogynecological diseases remain one of the serious medico-social problems. Among them, a group of border line tumors is distinguished, morphologically similar to ovarian adenocarcinoma. However, the difference between these diseases lies in the absence of stromal invasion in borderline tumors, except in cases of microinvasion. This feature of the disease course allows us to speak of a favorable development of these tumors and classify them as a borderline position between benign and malignant ovarian formations. This nosology is also characterized by a long remission period with a favorable prognosis, which is an important determining factor for the realization of patients’ reproductive plans. This article provides a review of literary data from recent studies by domestic and foreign authors on this issue.
Objectives: To conduct a review of modern literary data on borderline ovarian tumors (BOT) in women of reproductive age, including epidemiology, risk factors, pathogenesis, clinical picture, and diagnosis. The authors emphasize the relevance of the topic in connection with medical and social aspects, preservation of fertility, and differential diagnosis from malignant ovarian neoplasms (MON). Special attention is paid to the role of surgical treatment in preserving patients’ reproductive plans.
Materials and Methods: The article is a literature review based on the analysis of publications by domestic and foreign authors in recent years (including WHO, FIGO, Rosstat RF data, and studies from the 1970s to 2023). Materials include epidemiological data, clinical cases, results of molecular-biological, laboratory, and instrumental studies (ultrasound, MRI, CT, pathomorphology). Analysis methods — systematization and comparison of data from sources such as PubMed, Rosstat, studies in Japan, China, Denmark, etc., without conducting an original experiment. The authors used TNM classifications (8th edition), FIGO (2016), and WHO for staging and typing BOT.
Results: As a result of the review, it was revealed that BOT account for 15–20 % of epithelial ovarian neoplasms, are most often diagnosed at the age of 40–45 years (10 years younger than MON). Common histological types: serous (53 %) and mucinous (43 %). Risk factors include mutations in BRAF, KRAS, BRCA1/2 genes, cyclic ovulations, infertility, and IVF. The clinical picture is often asymptomatic, with complaints of pelvic pain, infertility, or ascites (rarely). Diagnosis is based on ul trasound (cystic-solid formations with papillary growths), MRI/CT (for differentiation from MON), tumor markers (CA-125, HE4, ROMA, CEA, CA19–9), and pathomorphology (absence of stromal invasion). Treatment is predominantly surgical (laparoscopy with fertility preservation); chemotherapy is ineffective. The prognosis is favorable, relapses — 15 % at stage I.
Conclusion: BOT are intermediate neoplasms between benign and malignant ovarian tumors, with a favorable prognosis and the possibility of fertility preservation. Early diagnosis and a multidisciplinary approach (ultrasound, MRI, pathomorphology) are critically important to avoid over- or under-diagnosis, prevent radical operations, and implement reproductive plans. Further research into pathogenesis and the infl uence of pregnancy on relapses is necessary.
Keywords: borderline ovarian tumors (serous and mucinous), epidemiology of borderline tumors, risk factors and pathogenesis, clinical picture, diagnosis of borderline ovarian tumors, fertility, pregnancy
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Purpose. To analyze scientifi c research on surgical methods of cancer recurrence treatment to consider possible surgical interventions, to determine the indications and contraindications to them, as well as to refl ect the factors infl uencing the outcome in such patients.
Materials and Methods. The literature review includes data from foreign and domestic studies.
Results. In patients who received radiation therapy at the initial stage, with the development of relapse, surgical intervention for therapeutic purposes can be performed in the absence of distant metastases and intraperitoneal spread of the tumor process. With the central nature of the recurrence, pelvic exenteration is optimal; with lateral exenteration involving the lateral wall of the pelvis, lateral exenteration is optimal. However, for this intervention, the integrity of the sciatic nerve is required. An indication for performing a hysterectomy may be the small size of a recurrent tumor (up to 2 cm) or FIGO IB-IIA at the initial stage of diagnosis of cervical cancer in combination with a recurrence size of less than 4 cm. Targeted removal of the recurrence is possible with isolated inguinal recurrence and/or with a prolonged relapse-free period.
Conclusion. Surgical methods for the treatment of recurrent cervical cancer can be used for therapeutic purposes in certain categories of patients.
Keywords: cervical cancer, recurrence of cervical cancer, surgical treatment, pelvic exenteration, radical hysterectomy
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Objective of the study: Optimization of management of patients with HPV-associated cervical lesions to reduce the rate of recurrence after surgical treatment.
Materials and Methods: The study evaluated the long-term outcomes of the treatment of 109 patients who had undergone conization of the cervix by the loop electrosurgical excision procedure (LEEP) for recurrence of cervical intraepithelial neoplasia (CIN).
Results: Among 109 patients with cervical intraepithelial neoplasia (CIN) relapse the vast majority (78,9 %) had CIN 3. High viral load was detected in 50 % of patients, very high viral load — in 43,3 %. Only 6,7 % of patients had low viral load. High viral load (> 5 lg copies/105 cells) is associated with early relapses. Positive surgical resection margin is an additional prediction factor of early recurrence.
Conclusion: High and very high viral loads were identifi ed in 93,3 % of patients with relapses. The level of viral load and surgical resection margin status are signifi cant prognostic factors of recurrence timing. The most aggressive course with early recurrence is observed in patients with a viral load of > 5 lg copies/105 cells.
Keywords: cervical cancer, human papillomavirus (HPV), cervical intraepithelial neoplasia (CIN), conization, recurrence
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Rezume: Lymphangioleiomyomatosis (LAM) is a systemic disease, most common in women of reproductive age, which is characterized by proliferation of smooth muscle cells in the lungs, lymph nodes and other organs. Extrapulmonary types of lymphangioleiomyomatosis (LAM) are extremely rare, and, therefore, the mechanisms, underlying the pathogenesis, have not been suffi ciently studied and the clinical picture may remain unrecognized for a long time. This article presents a rare clinical case of extrapulmonary lymphangioleiomyomatosis (LAM) with isolated lesions of the pelvic and retroperitoneal lymph nodes in a 49–year–old patient.
Keywords: lymphangioleiomyomatosis (LAM), extrapulmonary lymphangioleiomyomatosis (LAM), mTOR inhibitors, tube rous sclerosis, estrogen receptor antagonists
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Relevance. To date, the diagnosis and treatment of functional disorders of the lower genitourinary tract are underdeveloped and inconsistent. The objective of this literature review is to analyze the prevalence of such disorders among the adult population of Russia and to present current methods of medical rehabilitation used as a part of comprehensive treatment of this pathology.
Methods. A systematic search of the data in PubMed, e-Library bases for the following key words: “urinary incontinence”, “sexual dysfunction”, “erectile dysfunction”, “psychological distress”, “cervical cancer”, “ovarian cancer”, “prostate cancer” was carried out for the periods 2005-2025.
Results. Dysfunction of urogenital system is common both in general population and among cancer patients who completed their anti-tumor treatment. Cancer patients, in addition to urinary disorders, may suffer from functional status disorders, specifi c for them (lymphostasis, peripheral polyneuropathy, etc.). To provide effective care, a comprehensive examination, including urodynamic testing, and psychological trainings should be carried out.
Conclusions. Increased awareness and availability of treatment are cornerstones to successful therapy for genitourinary disorders. Innovative developments and inventions, additional studies are required to optimize treatment outcomes and to ensure patient safety.
Keywords: urinary incontinence, sexual dysfunction, erectile dysfunction, psychological distress, cervical cancer, endometrial cancer, ovarian cancer, prostate cancer
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Objective of the study is to conduct a systematic analysis of the data, accumulated in current literature, to assess the benefi ts and risks of menopausal hormone therapy for the carriers of BRCA 1/2 gene mutations after prophylactic adnexectomy.
Materials and Methods. The review comprises the data of foreign and Russian scholarly articles found in PubMed on the subject, published over the past 10 years.
Results. Numerous international studies have confi rmed that women with BRCA 1/2 gene mutations have an increased risk of developing ovarian and breast cancer in their lifetime compared to the general population and, therefore, they should undergo prophylactic adnexectomy to reduce their cancer risk. Menopausal hormone therapy (MHT) after prophylactic surgery in these patients does not appear to have an adverse effect and doesn’t undermine the breast cancer risk reduction associated with prophylactic adnexectomy. An adequate menopausal hormone therapy (MHT) should be offered to women after prophylactic surgery to avoid postmenopausal symptoms and chronic diseases associated with low estrogen levels, such as osteoporosis and heart attack. However, all indication for menopausal hormone therapy (MHT) should have clear medical grounds, and patients should be informed about the limited amount of data on oncological safety.
Conclusion. Further research is needed in this regard.
Keywords: menopausal hormone therapy (MHT), carriers of BRCA 1/2 gene mutations, prophylactic adnexectomy, breast cancer
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