Cancer screening program in Georgia (results of 2011).

This paper reviews and summarizes the results and epidemiological data of 2011 Cancer Screening Program in Georgia. The first paragraph of paper underlines main results of capacity building of the program and its implementation. The second paragraph is focused on activities conducted within the program on population behaviour change and communication campaign and the final paragraph analyses the data of epidemiological results collected during year 2011 of breast, cervical, prostate and colorectal cancer screening, reviews and summarizes. Implementation of cancer screening programs is of great medical and social importance. Cancer screening, using simple tests that can cover the general population, and also promotes the early diagnosis of cancer and its treatment in a timely manner, increasing life expectancy and reduce mortality.

[Peculiarities of diagnostics and treatment efficiency in uterine sarcoma].

In the department of gynecology of A. Gvamichava National Center of Oncology 43 patients with uterine sarcoma were treated during 2000-2004 years. The youngest woman who visited the Center with uterine sarcoma was diagnosed at 25 years of age and the oldest one was 77 years old. Patients distribution in age groups was as follows: up to 30 years - 1 (20,9%), 30-39 years - 9 (20,9%), 40-49 years - 16 (37,2%), 50-59 years - 15 (34,8%), 60 years and more - 4 (9,3%). Among 4 hystological types of sarcomas, the most prevalent were leiomyosarcoma uteri. Treatment of each patient was started by surgical intervention on uterus and its appendixes, extirpation and further conservative therapy.

[Patogenetic types of body of womb cancer and therapeutic management].

The surgical treatment of body of womb cancer (after surgical hormonotherapy, radiation therapy) was conducted on 353 patients. Of which 264 patients had the first stage of disease; 50-the second stage of disease; 34-the third stage of disease; and 5-the fourth stage of disease. Most women with endometrial carcinoma were 50-59 years old. The youngest patient with body of womb cancer was 25 years old; the oldest patient was 78 years old. The amount of patients over 70 years old reached 5,4%. The research showed that the treatment depends on the stage of the tumour and its histological type, degree of the pathogenetic type of cancer endometrium. At the first stage of the treatment of the two patogenetic types it is enough to perform a radical operation in the field of extirpation of uterine appendages. At the cancer of the second and third stages of the patogenetic type it is necessary hormonotherapy after the operation. And at the second type it is necessary to use radical uterus extirpation in addition with radiation therapy.

[Clinical-morphological parallels of malignant ovarian tumours].

The detection of the malignant ovarian tumor takes place at a later stage because of a symptomless process of the tumor formation at an earlier stage, hence leading to the delayed diagnostics and inefficient treatment. The objective of the research is the development of an efficient treatment of the malignant ovarian tumor patients, finding the most adequate methods and a delineation of the proper tactics for the achievement of the improved long-term results. We have studied the medical cards of the patients checked into A. Gvamichava Gynecological Clinic of the National Oncology Center in 1990-2000. The research has led to the conclusion that the epithelial malignant ovarian tumors outnumber the non-epithelial malignant ovarian tumors by 5 to 2. The most widespread histotype of the epithelial malignant ovarian tumors is the serous carcinoma, most frequently detected among the 50-69 year old patients and diagnosed at the third and the fourth stages. In non-epithelial malignant ovarian tumors, the most widespread histotype is the granule-cellular tumors, most frequently detected in the 50-69 age group, diagnosed at the II and the III stages. In our clinic, the surgical treatment, with a subsequent chemotherapy is preferential.

Clinical prognostic factors and expression of cathepsin D in endometrioid adenocarcinoma.

The aim of our study was to evaluate the association between the expression of cathepsin D and clinical prognostic data in endometrioid adenocarcinoma of different histological grade. We studied 104 postmenopausal women with diagnosis of endometrioid adenocarcinoma. We evaluated the presence of obesity and vaginal bleeding. Surgical specimens were fixed in 10% neutral buffered formalin solution and embedded in paraffin. 4 mm sections were stained by hematoxylin and eosin, von Gieson, and histological type of cancer, metastatic lesion of lymph nodes and depth of myometrial invasion were evaluated. Histological grade of cancer was assessed by FIGO grading system. All samples were analysed by immunohistochemistry for cathepsin D (Dakocytomation). We assessed the number of cathepsin D-positive stromal and tumor cells and degree of positivity (low, moderate, high). Histological study by hematoxylin and eosin showed grade 1 endometrioid carcinoma in 35 cases (33,7%, group 1), grade 2 in 44 cases (42,3%, group 2), grade 3 in 25 cases (24%, grade 3). Our results suggest that the expression of cathepsin D is associated with the higher histological grade of endometrioid adenocarcinoma, depth of myometrial invasion, lymph node positivity, coexistence of obesity and vaginal bleeding. It seems that local invasion and metastatic spread of tumor should be preceeded by the expression of cathepsin D in stromal cells which can be assessed in grade 1 and 2 endometrioid adenocarcinomas. The expression of cathepsin D can be used as a prognostic factor and more aggressive chemothepery regimen should be used.

Optimal variants of treatment of stage I endometrial carcinoma and its choice.

2195 patients affected by endometrial carcinoma were treated at the Tbilisi and the St. Petersburg Oncological Institutes from 1968 to 1987. The incidence of different stages was respectively: I 78.8%; II 11.6%; III 9.0%; IV 0.4%. Adenocarcinoma was the histotype more frequently observed and the grade of differentiation was respectively: G1 39.3%; G2 51.3%; G3 9.4%. The incidence of lymphnodal invasion was equal to 6.2% in I Stage, 12.2% in II Stage and 37.8% in III Stage. In Stage I surgery was the treatment of choice in all cases and in the 70.5% of cases additional treatments were added: in G1, G2 grade endometrial cancer additional hormone therapy, remote irradiation and postoperative hormone therapy were used, whereas in G3 tumours intracavitary irradiation was frequently added in the St. Petersburg Institute. The 5 year survival rate of patients at Stage I was equal to 70.9% in retrospective analysis (1968-1982) and 84.6% in patients followed prospectively (1983-1987).

The methods and results of uterine body cancer: a twenty-year experience of treatments at the Tbilisi Oncological Center.

In the period 1968-1987 at the Oncological Scientific Center of Tbilisi 1100 Endometrial Cancer were observed. All patients were treated surgically and in particular 89.9% cases with total hysterectomy and adnexectomy; 9.8% with hysterectomy, adnexectomy and lymphadenectomy; 0.3% with Wertheim's operation. The Author suggests a pathological staging system with in the first stage (cancer limited to the uterus) in order to better select the treatment and prognosis of patients. According to his classification 5 years survival was 88.1% when tumour was absent in the operative specimen; 82.6% when the tumor was less 2 cm; 67.5% for tumour more than 2 cm; 60.3% when less than half of the myometrium was involved and 40.8% with more than half of the myometrium. The Author confirms the validity of surgical therapy in endometrial cancer eventually associated with hormonal and/or radiotherapy for the cases more at risk.

Management of lymphocysts after cervical carcinoma surgery.

In the Gynecological Clinic of the Oncological National Center of Georgia from 1964 to 1999 1,805 extended hysterectomies due to carcinoma of the cervix uteri were performed. Retroperitoneal lymphocysts were revealed in 4.3% of the cases. Of all stage I disease lymphocysts had developed in 2.8% of cases and in stage II 7.2%. Correlations between lymph node metastatic damage and development of lymphocysts were not found. The peak incidence (6.2-6.4%) of lymphocysts appeared to be in women younger than 30 and in elderly women (over 60 years). Unilateral lymphocysts developed more frequently (left-side in 38.9% in right-side in 33.3%) than bilateral ones (28.3%). In 32.5% of cases the size was less than 5 cm, in 42.3% of cases 6-10 cm and in 25.6% of cases more than 10 cm; 18% of the lymphocysts were asymtomatic and did not need any treatment. High temperature, pain, changes in blood occurring 4-5 days after surgery are indications of parametritis. Lymphocysts usually arise 11-12 days after surgery. Ultrasonography is a highly informative diagnosic method to detect this disease. In 23% of cases, the method of treatment was conservative therapy, 35.8% of patients had punctures, thus micro-drainage was performed and a cocktail injection into the cyst cavity was carried out. In 7.7% of cases lymphocyst resection and drainage was carried out.

The management of cervical cancer in the experience of oncological institute of Tbilisi.

The Authors, after a brief review of epidemiological patterns in the USSR, describe their own experience in the management of cervical cancer. Out of 5116 patients observed in Tbilisi Oncological Center in 26 years (1964-1989), 1289 women (25.7%) underwent radical surgical operation. The other patients received combined Radiotherapy (Brachytherapy plus Teletherapy). In stage I B the best results were obtained with Surgery (5 year survival 86%). Treatment results in stage II (5 year survival rate 68.2%) were obtained with combined Surgery and Radiotherapy. Overall 5 year survival in stage III was 39.3% and treatment results were directly correlated with primary tumour characteristics.

Cervical cuff carcinoma: causes and prevention.

Over an 11-year period (1990-2000) a total of 59 patients with cervical cuff carcinoma were hospitalized (I stage--17; II stage--30; III-IV stage--12 patients). Seventeen patients were subjected to radical extirpation with lymphadenectomy for cervical cuff carcinoma, while 42 patients received combined radiotherapy. In the last 20-year period the patients had undergone supravaginal amputation of the uterus due to uterine fibromyoma, polyposis, and ovarian tumors in various gynecological clinics. In 12 patients the onset of cervical cuff carcinoma occurred within one year after supravaginal amputation of the uterus; in another six patients cancer developed within two years postoperatively, 15 patients in a 3 to 9 year period and 26 developed cancer 10-20 years after surgery. It seems in fact that when cervical cuff carcinoma developed within one year after supravaginal amputation of the uterus the patients had cervical carcinoma which was not identified due to physician negligence. In cases of latent periods up to ten years the patients must have had at least pre-existing disease. To prevent development of cervical cuff carcinoma in the future when operating on the uterus and/or adnexa the scope of surgery (extirpation, amputation) shall be decided based on colposcopic examination of the cervix (target cytology).

Organ preserving method in the management of atypical endometrial hyperplasia.

The problem of organ preservation in the management of atypical endometrial hyperplasia (AEH) comes about especially in patients of reproductive age. Two hundred and fifty-four women with a diagnosis of AEH were hospitalized in our clinic from the period 1991 to 2000. Of those, atypical endometrial hyperplasia with normal uter and appendages was found in 192 women. The remaining 62 patients had diseases of the cervix, corpus uteri, ovaries and oviducts and were subjected to radical hysterectomy. To define the possible sparing tactics of management, 192 women with AEH were divided into two groups. The patients in Group were administered hormonal therapy during a three month period (17alpha OPC - 12.5 g, Depo-Provera - 6 g). If a clinical effect and histological pathomorphism were achieved the patients were subjected to an additional three months of hormonotherapy. Of a total of 96 patients in the first group, 36 (37.5%) who were prescribed hormonotherapy were found to also have mastopathy and endocrine pathology dysfunction of the thyroid gland, and were additionally administered iodine-containing preparations. After completion of the effective hormonotherapy three patients had a normal pregnancy and delivery. Conservative management proved to be effective in 96.4% and ineffective in seven (3.6%) cases. These seven patients were subjected to surgical treatment. All patients in Group 2 were subjected to radical hysterectomy.

Epidemiology and clinical management of endometrial carcinoma in the Republic of Georgia in the last 30 years.

Endometrial carcinoma incidence in Georgia from 1965 to 1992 was 5.3 women per 100,000 and in the structure of gynecological malignant tumors this pathology occupied third place (19.1%). Morbidity incidence varied from 2 to 8 depending on ethnic regions overall a 2.5 times rise in morbidity was observed. Within the period of 1968-1994 1731 patients with uterine carcinoma were subjected to surgical intervention (stage I-81.2%; stage II-9.4%; stage III-9.0%; stage IV-0.3%). Surgical intervention is the optimal method to determine the stage of the disease and planning of adjuvant treatment. Metastases in regional lymph nodes were found in 13.0% (T1-7.7%; T2-20.07%; T3-35.3%). Adenocarcinoma was histologically confirmed in 97.4% (G1-21.3%; G2-57.8%; G3-18.8%). Management of the disease was predominantly started with surgical intervention. In pathogenetic version I (71.4%) total extirpation of the uterine was carried out, while in cases of the pathogenetic version II (28.6%) patients were subjected to the modified extended extirpation. Postoperative management was prescribed based on the peculiarities of the organism and tumor. Highly sensitive classification of endometrial carcinoma of stage I (including 5 subgroups) as well as a synoptic table of optimal management were worked out. As a result, 5 year survival increased by 15%, and 29% of the women operated were spared from additional treatment. On the whole, five-year-survival was observed in 71.0% of women (stage I-77.7%; Early Form-95.5%; stage II-51.5%; stage III-34.2%).

Cervical carcinoma and pregnancy.

Abortion and conization of the cervix is the treatment of choice for patients with preinvasive cervical carcinoma combined with first-term pregnancy. With the second and third term, the pregnancy is led to delivery and a secondary examination is carried out. In case of preienvasive carcinoma only conization of the cervix is performed. In late-term pregnancy the surgical operation starts with a cesarean section. A combination of cervical carcinoma and pregnancy was observed in 31 (44%) of 6,890 patients admitted to the Gynecological Clinic of the National Cancer Center from 1964-2001. Of 1,911 patients with radical hysterectomy (Stage I--58.4%, Stage II--21.8%, Stage III--20%) a combination of cervical carcinoma and pregnancy was diagnosed in 31 women [Stage I--23 (74.2%), Stage II--4 (12.9%), Stage III--4 (12.9%)]; 93.5% of the patients had a first or second term pregnancy. Five-year survival of the patients with surgery only was 83.3%, while with combined therapy--60%. Twenty-nine percent of the patients were 30 and younger. Pregnancy contributed to early manifestation of cervical cancer and did not favor the aggression of malignant tumor growth. The five-year survival rate of patients without staging and those combined with pregnancy was 72.7%; five-year survival rate of patients with early pregnancy was worse compared to those with second or third term pregnancies. Pregnancy is not a contraindication for performance of radical hysterectomy.

[Strategy and results of treatment in trophoblastic disease]. / Taktika i resul'taty lecheniia trofoblasticheskoi bolezni.

The study involved 457 cases of ordinary (261), invasive (75) vesicular mole and choriocarcinoma (121-stage I-51.2; stage II-19.8 and stage III-27.3%). Enhanced chorionic gonadotrophin titer in urine was registered in 67-72%. Choriocarcinoma had no link to pregnancy in 6.6%. It is suggested that cases with a 10-year latency period and longer should be referred to this category of patients. Five-year survival was observed in 98-99% of patients with vesicular mole and in 74.1% with choriocarcinoma in 1977-1989. A special synoptic procedure has been developed for optimal planning the therapy and rehabilitation of cases of trophoblastic disease. Four forms of non-invasive vesicular mole have been identified, and strategies of treatment versus type of tumor and patient's peculiarities worked out. The extent of therapeutic effort has been decreased.