Linear trend analysis of patients with cervical cancer treated at the Institute of Oncology Vojvodina in 2001-2007.

PURPOSE: Cervical cancer is the leading cause of death in women with gynecological cancers in Vojvodina. Serbia currently holds the leading place in Europe regarding the incidence of cervical carcinoma and comes second in terms of mortality. METHODS: Data were retrieved from the Register for malignant neoplasms of the Institute of Oncology Vojvodina for the period 2001-2007. The patients were divided in 3 groups according to the stage of disease based on the FIGO classification for cervical cancer. Data were analysed using linear trend and t-test. RESULTS: The linear trend of the number of registered cases in the group of stage I-IIA patients during 7 years showed no significant change in the prevalence of the disease. In the group of women diagnosed with stage IIB no statistical difference regarding either a rising or a decreasing trend was observed. The observed trend in an advanced disease stage (III and IV) showed a slight decrease in the number of patients, but without statistical significance. CONCLUSION: The linear trend of the number of patients with cervical carcinoma during a 7-year period points to the fact that the number of newly detected cases of advanced disease stages did not decrease significantly despite the affordable and simple methods of early detection. This result underlines the importance of implementation of a National screening programme in the general population for early detection of cervical neoplasms. The excellent results of National screening programmes in other European countries lend support to this approach.

Clinical staging and histopathological findings after radical hysterectomy in FIGO stage IIB cervical cancer.

PURPOSE: Advanced cervical cancer still represents a major health care challenge in the developing world. According to standard protocols the treatment of choice for stage IIB cervical cancer is cisplatin-based chemoradiotherapy. However, in some European countries, and especially in Japan, patients with stage IIB cervical cancer are generally treated with radical hysterectomy as initial treatment. The aim of this study was to compare clinical stage with pathological findings, and also to correlate any relationship between parametrial infiltration and nodal status. PATIENTS AND METHODS: From 1997 to 2006, 26 patients with FIGO stage IIB cervical cancer were radically operated (Piver class III operation). Preoperative clinical findings were compared with the pathological findings of the surgical material. The correlation between infiltration of the parametria and lymph node status was also examined. Fisher's exact test was used to examine statistical significance. RESULTS: The patients' median age was 48.3 years (range 36-61). The median number of removed lymph nodes was 16 (range 8-40). The histopathological types of cervical tumors were: squamous cell carcinoma 80%, adenosquamous carcinoma 15% and adenocarcinoma 5%. In 50% of the patients the parametria were infiltrated, suggesting that 50% of the patients were clinically overstaged. Positive lymph nodes were found in 69% of patients with positive parametria and 15% in patients with negative parametria (p <0.05). Patients with positive lymph nodes received adjuvant chemoradiotherapy. CONCLUSION: Adequate preoperative staging such as clinical examination under anesthesia or nuclear magnetic resonance could help to exclude parametrial involvement in equivocal cases. Parametrial invasion presents an important risk factor for lymph nodes metastases.

Benign and malignant struma ovarii: report of three cases and review of the literature.

Struma ovarii belongs to the group of monodermal and highly specialized teratomas and comprises less than 5% of mature teratomas. Thyroid tissue is present exclusively or predominantly. Malignant transformation in struma ovarii is uncommon, and when present, it exhibits a follicular pattern most of the times. Three patients with the diagnosis of struma ovarii are presented herein. Two of them had a unilateral adnexal mass with ascites in one case. Total abdominal hysterectomy with bilateral salpingo-oophorectomy and omentectomy were carried out in both patients. In both patients thyroid hormonal status was normal pre and postoperatively. The third patient had a histology compatible with follicular carcinoma of the thyroid tissue of struma ovarii; strumal carcinoid was also present. Postoperatively monochemotherapy with etoposide was administered for 6 cycles every 3 weeks. Thyroid hormones and thyroid ultrasonography (US) were also normal in this patient. Surgical management is the treatment of choice for struma ovarii which also represents a preventive measure for possible future malignant transformation.

Radical hysterectomy for stage IB1 cervical carcinoma: lymph node metastasis as a prognostic factor.

PURPOSE: Lymph node metastasis is one of the most important factors influencing prognosis and further therapy in patients with cervical carcinoma. The aim of this study was to confirm the impact of nodal metastasis od disease-free interval in women with stage IB1 cancer of the uterine cervix. PATIENTS AND METHODS: From June 1986 to December 1999 269 patients with stage IB1 cervical carcinoma were operated on. Two hundred thirty-six (87.84%) patients had class III and 33 (12.16%) class II radical hysterectomy, according to Piver's classification. RESULTS: The median number of the removed lymph nodes was 21. Positive lymph nodes were found in 71 (25.28%) patients. All patients with positive lymph nodes received postoperative adjuvant external beam radiotherapy. Patients with bulky nodal disease received also chemotherapy.Overall 5-year disease-free interval in 212 patients was 80%. Five-year disease-free interval for patients without lymph node metastasis was 91%, while it was 40% in those with lymph node metastasis (p < 0.0001). CONCLUSION: Surgical staging of cervical cancer, which includes pelvic and para-aortic lymphadenectomy,together with pathological data, can provide potentially useful information for the radiation oncologist and precise analysis of survival and prognostic risk factors.