[Menopausal hormonal therapy and breast cancer.]

The most common treatment for menopausal syndrome is menopausal hormone therapy (MHT), however, the safety of MHT, due to the risk of developing and recurrent breast cancer (BC), is still a matter of debate. The review presents the results of randomized cohort studies of this issue. It has been shown that MHT increases the risk of developing of breast cancer and disease recurrence after treatment. Risk of breast cancer developing in women getting MHT, depends on body mass index (BMI), duration of hormone use and dose of drugs, and is greater in thin women comparing with women with increased BMI, and also greater in estrogen-progestin combined MHT users comparing with estrogen-only users. It was found that in women using MHT hormone-dependent forms of cancer developed more often, but by the time of diagnosis, disease was found in more advanced stage and metastases in lymph nodes were found more often comparing with patients who did not use MHT. Risk of breast cancer recurrence is less with the use of low doses of vaginal estrogen. An alternative option for the relief of menopausal disorders in breast cancer patients during and after treatment is using of pineal gland hormone melatonin, since, along with its anti-aging properties, it is able to suppress cancer at the stages of initiation, progression and metastasis and has the ability to reduce the toxic effects of anticancer drugs while increasing their effectiveness.

[Pre-surgical hormonal-metabolic state in endometrial cancer patients who underwent laparoscopy or laparotomy].

73 randomly selected from the entire array menopausal endometrial cancer patients (34 of whom were subjected to further surgery by laparotomy and 39 - by laparoscopic ap- proach) were examined 48-72 hours before surgery. Patients passed anthropometry, their medical history was collected, and in the blood serum, taken on an empty stomach, glucose, gly- cated hemoglobin, lipid fractions, insulin, thyrotropin, estradiol and testosterone levels were measured while insulin resistance index was calculated. Although patients who later went through laparoscopic surgery were characterized by somewhat higher body mass and waist circumference, other investigated pa- rameters did not differ between laparoscopy and laparotomy groups. Moreover a frequency of so called "metabolically healthy" obesity appeared to be even higher in laparoscopic group. Taken together this confirms the fact that the overweight should not be considered as contraindication for videosurgery in patients with endometrial cancer. At the same time it is desirable to compare distant oncological results with individual characteristics of pre-surgical hormonal-metabolic status of pa- tients depending on the surgery type and obesity phenotype.

[Endovideosurgery (minimally invasive surgery) in treatment for malignant tumors of female genital organs: a 5-year experience of the clinic of the N.N.Petrov Research Institute of Oncology].

During the period of 2010-2015 laparoscopic surgery was performed in 1263 patients: 1113 with endometrial cancer (588 hysterectomies, 509 hysterectomies with pelvic lymphadenectomy, among them 16 with sentinel lymph node (SLN) mapping with Indocyanine green (ICG)); 86 with cervical cancer (80 nerve-sparing radical hysterectomies (NSRH), among them 15 with SLN mapping, 6 radical vaginal trachelectomies with endovideoassisted lymphadenectomy); 64 with ovarian malignancies. The average operating time in the group of hysterectomies was 101 minutes, in the group of hysterectomies with pelvic lymphadenectomy - 184 minutes, in the group of NSRH - 230 minutes. Average blood loss was less than 50 ml. No intraoperative complications were registered. Asymptomatic lymph cysts were observed in 122 cases. Symptomatic lymph cysts requiring surgical treatment were registered in 9 cases. Inconsistencies of vaginal sutures after radical hysterectomy were in two cases, ureterovaginal fistulas - in two cases. During a 3-year follow-up period twelve recurrences were observed in endometrial cancer patients (12/443; 2,7%), four patients (0,9%) died from disease. After NSRH two local recurrences (2,5%) were registered in patients with cervical cancer, after radical trachelectomy -two local recurrences (33%). One patient became pregnant in the group of vaginal trachelectomies. Therefore laparoscopic approach in treatment of female genital malignacies allows performing an adequate volume of surgery with minimal risk of intra- and postoperative complications, favorable course of the rehabilitation period, and oncological safety.

Possibilities of estimating the prognosis for development of preinvasive cervical neoplasia by the latest molecular biology methods.

Secondary prevention of cervical cancer is the identification and treatment for preinvasive forms of the disease, which include cervical intraepithelial neoplasia (CIN). The traditional method of identification of CIN is cytological however the sensitivity and specificity of this method is limited. The efficacy of a test for human papillomavirus as well as new molecular-biological methods for assessing the prognosis of development of dysplasia and choice of appropriate treatment tactics are still in the process of discussion. The article contains information about different possibilities of using molecular-biological methods for assessing the prognosis of development of CIN and cervical cancer.

[Obesity and characteristics of endometrial cancer: are there any changes over several decades?].

It is shown that endometrial cancer features (including expression of the PTEN and HER-2/neu proteins) are connected dissimilarly with body mass index and with the belonging of the patients to the groups with standard, SO and metabolically healthy obesity, MHO. In the course of the last half-century an increases are discovered in the height and weight of the females with endometrial cancer that moves in the opposite direction with a reduction of the share of MHO cases among obese patients. This conclusion should be taken into account when one considers the means for contemporary prevention of both obesity and cancer of uterine body.

[RESULTS OF LAPAROSCOPIC SURGERY FOR ENDOMETRIAL CANCER: EXPERIENCE OF THE N. N. PETROV RESEARCH INSTITUTE OF ONCOLOGY].

For the period from September 2010 to September 2014 there were operated 513 patients with endometrial cancer using laparoscopic installation the Karl Storz company. 304 patients (59.2%) underwent hysterectomy with appendages, 209 (40.8%)--hysterectomy with appendages and pelvic lymphadenectomy, including 11 patients (2.2%) with the addition of omentectomy in serous and serous-papillary forms of endometrial cancer. The average age of patients was 58.4 years (44-75 years). Body mass index over 25.0 was determined in 456 patients (88.9%), of whom 183 patients (35.6%) had an excess of body weight, in 159 (31.0%)--obesity of I degree, in 79 (15.5%)--obesity of II degree and in 35 patients (6.8%)--obesity of III degree. There were no reported complications during surgery. The postoperative period in the majority of patients was characterized by the minimal complications and absence of contraindications for adjuvant radiotherapy. During follow-up period there were registered 4 relapses: in 1 patient with serous--papillary form of endometrial cancer during the first year after surgery--in the form of dissemination of tumor in the abdomen and pelvis; in 3 patients--in the form of a cytological detection of glandular cancer cells in vaginal stump. As a result, regardless of age and comorbidities, laparoscopy allows performing to endometrial cancer patients the entire volume of planned radical surgery with minimum damage and with minimal risk of intra- and postoperative complications, favorable and accelerated rehabilitation period.

[LAPAROSCOPIC NERVE-SPARING RADICAL HYSTERECTOMY IN CERVICAL CANCER].

Cervical cancer is the most common cancer of the female reproductive system up to 20% of malignant tumors of the female genital organs. Surgery is the main method in treatment for local cervical cancer but postoperative complications often are associated with dysfunction of the pelvic organs. Some researchers focus their attention on the preservation of the pelvic innervation without loss of surgery's radicalism, which is represented in this survey. The paper presents the results of comparative analysis of 54 cases of surgical treatment for invasive cervical cancer.

[LAPAROSCOPIC SURGERY FOR ENDOMETRIAL CANCER IN PATIENTS OVER 70 YEARS OF AGE].

Surgery is the main method in treatment for endometrial cancer. The complexity of treatment of endometrial cancer patients in elderly age is a result of a large number of comorbidities and, as a consequence, the potential possibility of a large number of intra--and postoperative complications. The article presents the international data and the analysis of own results of a use of laparoscopy in surgical treatment of these patients. A comparison with a group of operations performed by laparotomy is carried out as well as it is evaluated the main intra--and perioperative parameters and also complications, and immediate outcomes of patients treated at the Oncogynecology Department of the N.N.Petrov Research Institute of Oncology.

[INDOCYANINE GREEN (ICG) IN THE DETECTION OF SENTINEL LYMPH NODES IN ENDOMETRIAL AND CERVIX CANCER].

We analyzed the international and our own experience of using different dyes in the identification of sentinel lymph nodes in oncogynecological practice. We evaluated the possibility of using indocyanine green (ICG) in the detection of sentinel lymph nodes in patients with endometrial and cervical cancer. The first results of the use of ICG at the Oncogynecology Department of the N.N.Petrov Research Institute of Oncology are presented.

[CHEMOPERFUSION TECHNOLOGIES IN TREATMENT FOR MALIGNANT TUMORS].

The data of literature on possibility of the use of perfusion technologies in combined treatment for malignant tumors of different sites are presented. Possible complications during hyperthermic chemoperfusion are discussed and the effectiveness of this method is analyzed.

[PERSONALIZATION OF TREATMENT FOR CERVICAL CANCER DURING PREGNANCY].

The paper presents a clinical case of a patient of 29 years old with a diagnosis of cervical cancer sIIA1 stage with the modern therapeutic approach: as a diagnostic and treatment phase there was performed videoendoscopic pelvic lymph node dissection at a 16-week pregnancy, excluded lymphogenous spread of tumor and on the basis of which it was decided to prolong pregnancy, given the strong desire of the patient to keep the baby. At a 19-week and a 23-week pregnancy there were two courses of neoadjuvant chemotherapy and at a 34-week--Cesarean delivery with simultaneous radical hysterectomy and ovarian transposition followed by a course of adjuvant distant radiotherapy. The final diagnosis was as pT2aN0M0. The observation was during 7 months: the patient is alive without recurrence, the child develops without physical and psychomotor abnormalities.

[Possibilities of cryopreservation of ovarian tissue for fertility preservation in cancer patients].

One of the effective methods of fertility preservation is an autologous transplantation of cryopreserved ovarian tissue. Currently, according to the world literature, after orthotopic autotransplantation of ovarian tissue 37 healthy children were born. In 2014 at the North-West Federal Medical Research Center it was established Cryobank of ovarian tissue, which is now kept 50 samples of ovarian tissue of man. Cryoconservation is performed by standard slow freezing. Autotransplantation of cryopreserved ovarian tissue has unique advantages over other methods of fertility preservation. This method does not lead to the postponement of anticancer therapy, safe for hormone-dependent cancer and can be performed regardless of the day of menstrual cycle and it is the only option for fertility preservation in prepubertal girls. The use of this method in clinical practice leads to restoration of endocrine function of the ovaries as well as of fertility in the future.

[Possibilities of antiviral and immunomodulatory therapy for patients with preinvasive cervical neoplasia].

Secondary prevention of cervical cancer is the identification and treatment of preinvasive forms of the disease, which include dysplasia or cervical intraepithelial neoplasia. Traditional surgical treatment of preinvasive neoplasia does not always result in elimination of the virus that, in its turn, cannot completely exclude the possibility of recurrence. The article presents references and own observations on possibilities of drug therapy in complex treatment for cervical neoplasia.

[Cervical intraepithelial neoplasia combined in pregnancy: diagnosis, management, outcomes].

Cervical cancer is the leading gynecological tumor associated with pregnancy accounting for 1.2-4.5 cases per 10,000 births. Precancerous diseases of the cervix, which include cervical intraepithelial neoplasia of high severity (H-SIL) combined with pregnancy, are even more relevant since the frequency of their occurrence can achieve 5.0%. Besides the peak of dysplastic cervical changes occurs in the mean age at delivery in the Russian Federation (28 years). The features of diagnosis and management of these patients during pregnancy, delivery and postpartum require a multidisciplinary approach from doctors of different specialties.

[Laparoscopic radical hysterectomy with pelvic lymph node dissection for endometrial cancer in obese patients].

The results of treatment of 61 endometrial cancer patients with various forms of obesity are presented. Two groups of patients were compared: the first group comprised 26 patients who had undergone the laparoscopic surgery; the second group included 35 patients who had open surgery. Te laparoscopic approach improved the results of surgical treatment of endometrial cancer in patients with obesity. This technique allowed to reduce intraoperative blood loss, to diminish the duration of analgesics' administration, to shorten the period of bowel function recovery, 3 times to reduce the incidence of postoperative complications.

[Neoadjuvant chemoradiotherapy in the combined treatment of patients with stage IB2-III cervical cancer].

There are provided own observations on the use of cisplatin and capecitabine in schemes of combined treatment of patients with cervical cancer. Their efficiency as radiosensitizing agents is showed. There are discussed possible indications for the use of cisplatin and capecitabine in cervical cancer patients with metastatic lymph nodes.

[Experience of use of synthetic cellular implants for correction of genitals prolapse].

The results of extraperitoneal pelvic floor reconstruction using synthetic prostheses implanted Prolift of 86 patients with genital prolapse III-IV(POP-Q; ICS, 1996) are presented. Analysis of treatment, intraoperative and postoperative complications, factors influencing the choice of a rational method of surgical intervention is performed. The results show the high efficiency of the method--no recurrence genital prolapse in 97.7% of patients in the observation period from 6 months to 6 years. However, in 27.9% of cases, surgery is accompanied by complications of varying severity, which requires a comprehensive assessment and balanced approach to the choice of method of surgical treatment.

[The role of laparoscopic interventions in diagnosis and treatment of patients with locally advanced cervical cancer].

The efficiency of laparoscopic para-aortic lymphadenectomy and radiodiagnostic methods in pre-treatment clarification of tumor lesion extent in stage IB2-III cervical cancer patients was compared. The Magnetic Resonance or sonographic imaging data was found to be inferior to lymph nodes morphological investigation followed by morphological study of distant lymph nodes. The results demonstrate the adequacy of surgical staging by laparoscopic para-aortic lymphadenectomy in patients with locally advanced cervical cancer for therapy tactics decision making.

[Laparoscopic surgery for treatment of endometrial cancer].

Surgery is the cornerstone of the treatment of endometrial cancer. With introduction of new technologies the laparoscopic intervention becomes increasingly popular for treatment of endometrial cancers. Forty five patients with endometrial cancer were operated in N.N. Petrov Research Institute of Oncology from September 2011 to March 2011. Laparoscopic hysterectomy with appendages was performed in 30 patients (66.7%), in 14 (66.7%) patients was also performed pelvic lymphadenectomy and in 1 (2.2%) case additional omentectomy was required. There were no intraoperative complications. The postoperative period was characterized by early mobilization, satisfactory intestinal peristaltic in the first 24 hours, minimal complication rate and absence of contraindications for adjuvant radiotherapy.