Increased diversity of a cervical microbiome associates with cervical cancer.

The cervical microbiome (CM) is a complex ecosystem that can change in response to gynecological cancers. We aimed to evaluate changes in the CM of patients who underwent chemoradiation (CRT) therapy for locally advanced cervical cancer. Before and after CRT, cervical swab samples were collected from 16 patients with squamous cell carcinoma of the cervix, and 30 healthy women. All samples were subjected to 16s rRNA-Seq analysis. In healthy premenopausal women the CM comprised mostly Lactobacillus (>90%); the CM community in samples from both pre- and postmenopausal pre-treatment cancer patients was heterogeneous, with a low proportion of Lactobacillus in younger cases. On the genus level, 27 and 11 taxa differentiated healthy controls from cancer patients in pre- and postmenopausal age groups, while 31 and 2 genera differentiated pre- and post-radiation samples and pre-radiation and the follow-up samples, respectively. Microbiome diversity was significantly higher in pre-treatment patients than in healthy controls. The results reveal significant alterations in the CM of cervical cancer patients relative to that in healthy controls; these changes were more striking after CRT. However, further research is needed to determine whether alteration of the CM offers new therapeutic options.

[Merkel cell carcinoma of the vulva - case report and the literature review]. / Rak sromu z komórek Merkla - opis przypadku i przeglad pismiennictwa.

UNLABELLED: Merkel cell carcinoma (MCC) is a rare malignant neoplasm, mostly affecting the skin (97% of cases). It is usually found in elderly people, in the sun-exposed areas of the skin. About 50-60% of MCC cases are located on the head and the neck, less often on the extremities and the torso, and extremely rarely in the genital area. Ultraviolet radiation may be the main factor responsible for the development of the tumors but viral etiology is also debated. Due to extremely rare incidence of MCC in the area of the vulva, proper management remains a challenging task. AIM: To present a case of an aggressive MCC of the vulva and a review of the literature. MATERIAL AND METHODS: A previously healthy 72-year-old patient presented at the Oncology Center of the Maria Sklodowska-Curie Institute, Warsaw, in June 2010. Four months previously the patient noticed a painless lump in the vestibular region of the vagina. She received anti-inflammatory treatment at her local gynecological clinic, with no success. In February the patient underwent removal of the vulvar tumor Histopathological examination confirmed anaplastic carcinoma. Microscopic evaluation revealed the tumor diameter to be 15mm. Surgical margins were free of neoplastic infiltration. The patient did not receive adjuvant therapy due to the results from the histopathological protocol. The disease recurred after three months. Radical vulvectomy and bilateral inguinal femoral lymphadenectomy were performed in May 2010. Histopathological examination confirmed microcellular carcinoma with no metastases to the lymph nodes and complete resection of the tumor (RO). The disease recurred in the next two months: a 50-mm tumor was found in the right inguinal lymph nodes. The decision to verify all histopathological material obtained during all procedures performed so far was made. Immunohistochemical evaluation confirmed MCC. Adjuvant radiotherapy was recommended. The area of the vulva, pelvic and inguinal lymph nodes were irradiated. One month after therapy completion the patient complained of pain in the lumbar area. An ultrasound examination of the abdomen revealed a tumor (9 cm in diameter) in the para-aortic region but it was not histopathologically verified due to extremely poor overall condition of the patient. As the condition of the woman deteriorated systematically the patient was referred to a hospice facility where she died 9 months since the primary diagnosis. CONCLUSIONS: MCC of the vulva is a rare neoplasm with an aggressive course. Clinical and histopathological diagnostic difficulties and consequently lack of standardized management, result in low survival rates.

[Influence of tumor diameter on treatment results in cervical cancer patients]. / Wplyw wielkosci guza nowotworowego na wyniki leczenia chorych na raka szyjki macicy.

UNLABELLED: The impact of the tumor size on treatment outcomes in cervical cancer patients remains a subject of controversy OBJECTIVES: The assessment of prognostic value of pretreatment tumor size in cervical cancer patients. MATERIALS AND METHODS: Patients of Maria Sklodowska - Curie Memorial Cancer Centre in Warsaw, treated between January 1996 and December 2000, were included into the retrospective study. 242 patients were diagnosed with a histologically confirmed squamous cell carcinoma and 42 with adenocarcinoma, FIGO staged IB-IVA, having undergone the clinical assessment and USG examination of the tumor treated with curative intent with surgery and/ or radiotherapy. The widest tumor diameter was adopted as the tumor size. In most cases of adenocarcinoma, the tumors were described as endocervical and the tumor measurement was connected with the risk of mistake, therefore, the analysis of the squamous cell cancer patients only was performed. A multivariate analysis of 242 patients with regard to overall survival (OS) and disease-free survival (DFS), depending on the selected clinico-pathological factors, was performed. The mean potential follow-up time for surviving patients was 50 months (range 8.7-62). The 5-year overall survival (OS) rate was 62%. RESULTS: As the result of the multivariate analysis, the impact of FIGO stage (p=0.002), hemoglobin pretreatment concentration (p=0.031) and tumor size before treatment (p = 0.044) on OS, and FIGO stage (p=0.001), hemoglobin level before treatment (p=0.019) on DFS, was demonstrated. CONCLUSIONS: Tumor diameter before treatment in squamous cell cervical cancer patients provides important prognostic information, regardless of other prognostic factors.

[Prognostic value of histopathology in cervical cancer patients]. / Rokownicze znaczenie utkania histopatologicznego u chorych na raka szyjki macicy.

UNLABELLED: Cervical cancer is the sixth cause of cancer morbidity and the seventh cause of cancer death among women in Poland. The rising tendency of cervical adenocarcinoma morbidity and the decrease of cervical squamous cell carcinoma have been observed. Many authors emphasize the worse outcome of cervical adenocarcinoma patients, when compared with the squamous cell cancer. OBJECTIVES: The assessment of prognostic value of histopathology in cervical cancer patients. MATERIAL AND METHODS: The retrospective analysis of 142 cervical adenocarcinoma and 242 squamous cell cancer patients, treated between January 1989 and December 1999, at Gynecological Oncology Department of Maria Sklodowska-Curie Memorial Cancer Center in Warsaw, has been performed, In each case, the clinical diagnosis was histologically confirmed. All patients were treated with surgery and/or radiotherapy The above methods were used as the routine therapeutic modalities, during the analyzed period. The analysis of the overall survival (OS) and the disease-free survival (DFS), in dependence on the selected clinico-pathological factors, was performed. RESULTS: The percentage of the 5-year OS for cervical adenocarcinoma patients amounted to 45.0%, whereas for squamous cell cancer to 62.5%. The difference was statistically significant (p = 0.05). In spite of higher percentage of cervical adenocarcinoma, diagnosed at early stage, when compared with squamous cell cancer the outcome of the whole adenocarcinoma group was worse. CONCLUSIONS: Regardless of the other clinico-pathological factors, adenocarcinoma was associated with poorer survival Identification of women who are at risk and different treatment modalities for both types of tumor should be the subject of future studies.

[Cutaneous melanoma during pregnancy at the Cancer Center-Institute in Warsaw]. / Czerniak skóry rozpoznany podczas ciazy w materiale Centrum Onkologii--Instytutu w Warszawie.

Malignant melanoma is a neoplasm which frequency has been increasing rapidly in Poland. The paper describes five cases of patients with cutaneous melanoma coexisting with pregnancy, who have been recently treated in the Department of Soft Tissue/Bone Tumors of M. Sklodowska-Curie Memorial Cancer--Institute of Oncology, Warsaw. All patients presented clinically advanced primary lesions with poor prognosis. In paper recommendations for treatment of women with suspicious cutaneous lesions before or during pregnancy and patients with melanoma planning a pregnancy are presented. The suspicion of melanoma is indication for immediate excisional biopsy by local anesthesia. Further treatment should be performed in tertiary oncological centres. There is no evident clinical data that pregnancy has a significant impact on progression of melanoma. The most important factor influencing prognosis of melanoma is the stage of the disease at the diagnosis. There are no grounds for abortion in pregnant women with melanoma in I/II/III stages.

[Hydronephrosis as a prognostic factor for patients of figo IIIB cervical cancer]. / Zastój moczu jako czynnik prognostyczny u chorych na raka szyjki macicy w IIIB stopniu klinicznego zaawansowania.

OBJECTIVE: The aim of this study was to assess whether hydronephrosis is a prognostic factor for patients of FIGO stage III B cervical cancer. MATERIAL AND METHODS: A retrospective review of 145 stage III B cervical cancer patients treated with radiotherapy between 1989-1993 at Maria Sklodowska-Curie Memorial Cancer Center in Warsaw was performed. Radiotherapy consisted of External Beam Irradiation (EBI) and Brachytherapy (BT) or EBI alone. RESULTS: Multivariate analysis revealed that hydronephrosis and Brachytherapy following EBI as the second part of the treatment were statistically significant factors in survival of FIGO stage III B cervical cancer patients. The five-year survival rate was 36% for patients without hydronephrosis treated with EBI and BT, compared to the group with hydronephrosis treated with EBI alone (no regression or too slow regression of the tumor to use BT), in which the survival rate was only 17 months. CONCLUSION: FIGO III b cervical cancer patients with hydronephrosis are treated only with palliative intent.