Preoperative imaging of primary intra-abdominal gynaecological malignancies. Diagnostic accuracy of CT-scan and MRI. A Greek cohort study.

OBJECTIVES: To determine the radiological modalities that provide at the initial workout the most accurate information regarding the operability and the type of operation for patients with primary cervical, endometrial, and ovarian carcinomas. PATIENTS AND METHODS: The medical records of 611 patients with gynaecological cancer were reviewed. The preoperative radiological findings were compared with the intraoperative and pathological ones. The diagnostic accuracy of CT and MRI at various sites was evaluated for all three kinds of carcinoma in combination. RESULTS: MRI was more accurate than CT in determining cervical enlargement (82% vs 73%), parametrial invasion (91% vs 74%) and the only examination that could evaluate cervical tumour size as well as cervical stromal and myometrial infiltration. Regarding lymph node involvement their results were similar (86% vs 88%). Both methods were comparably accurate in evaluating ovarian tumours (82% vs 84%), ascites (82% vs 81%), omental (73% vs 77%) and mesenterial infiltration (88% vs 93%). They also proved to be highly accurate (100% vs 98%) in the evaluation of solid abdominal organs. CONCLUSIONS: Non-enchanced MRI should only be used for the preoperative evaluation of a patient with cervical carcinoma, while CT with intravenous and per os contrast media for one with ovarian cancer. Regarding patients with endometrial cancer, no high-resolution method is required for endometrioid grade I tumours, while contrast-enchanced MRI should be employed for all other cases.

Prognostic significance of factors affecting disease free interval and overall survival for Stage II breast cancer in Greece. A multivariate cohort study.

BACKGROUND: Univariate analysis evaluates the impact of a prognostic factor on survival rates, either disease free (DFI) or overall (OS). Since many of the factors are interrelated, it is difficult to predict the prognosis of an individual patient. Multivariate analysis is therefore required in order to allow factors act together thus ending in the best possible combined predicting result. METHODS: A step-up procedure (Cox's Proportional Hazards Regression model) was used to include various prognostic parameters, relating to patients themselves, to the pathology of their tumours and to the treatment schedule followed. Two hundred and sixty-nine Stage II breast cancer Greek patients, treated from 1981 until 1991 and with a median 12-year of follow-up are studied. RESULTS: Five factors were found to be significant for patients DFI. In order of relevant importance, these were the number of infiltrated nodes, tumour size, postoperative radiotherapy, adjuvant chemotherapy and patients age. Regarding patients OS, tumour size, number of positive nodes, patients' age at entry and ER/PR status were the most important ones. CONCLUSION: Our long-term (12-year), single institution, single area results, suggest that, the prognostic factors for patients DFI and OS are the same with those of series from Europe and USA. Additionally, they remain unchanged after long-term follow-up, compared to a previously reported short-term national-wide study from this country.

Adjuvant tamoxifen versus tamoxifen plus CMF in the treatment of early breast cancer in Greece. Fifteen-year results of a randomised prospective trial and the potential risks of the antioestrogen.

BACKGROUND: CMF and Tamoxifen are the most commonly administered drugs for the adjuvant treatment of early-stage breast cancer. We present the 15-year follow-up of our 250-patient series and evaluate the oestrogenic side-effect of Tamoxifen on the endometrium. PATIENTS AND METHODS: 250 women entered this prospective study from 1981-1986. They had all undergone modified radical mastectomyl and were randomly assigned to receive either Tamoxifen only for 4 years or combination of Tamoxifen with 6 cycles of standard CMF. Abdominal sonogram was used to determine endometrial thickness, with 6 mm as cut-off limit for endometrial biopsy. RESULTS: After 15.6 years of follow-up DFS and OS rates were better for the CMF + Tamoxifen, group (52.8% vs 39.2%--p = 0.043 and 57.6% vs 40.8%--p = 0.006 respectively). Only patients with more than 4 infiltrated nodes did not significantly benefit from adjuvant CMF. Postmenopausal women suffered more proliferative endometria compared to premenopausal ones (40.3% vs 15.6%), while life-threatening lesions (cancer and atypias) were found in 3.3% of the postmenopausal patients only. CONCLUSION: CMF + Tamoxifen combination offers better long-term results for early-stage breast cancer patients. Dose reduction must be avoided if maximum results are to be achieved. More than 4 positive nodes seem to require additional chemotherapeutic manipulation. Tamoxifen's oestrogenic side-effect on the endometrium is quite common, but life-threatening lesions are rare, thus proving the drug's safety.

Emotional support of cancer patients: the nursing approach.

The present study attempts to classify cancer patients' psychologic responses in order of importance, and to identify the role of the oncology nursing staff in the moral support of these patients. We want to emphasize the significant role of the nursing staff because until 1990, Greece had no specialization in the field of oncology nursing. After the initial diagnosis of cancer, the patient was considered as emotionally depressed. Our sample consisted of 120 cancer patients from the southwestern regions of Greece. From our research, we concluded that the factors generally characterizing cancer patients, in order of priority, are (a) moral support from family and friends (p < 0.0001), (b) psychologic reactions after some months (p < 0.0001), (c) sex (p = 0.0006), (d) age (p < 0.0001), (e) marital status (p < 0.0001), and (f) psychologic reactions during the first days following diagnosis (p = 0.018) because of the shock experienced. More specifically, we wish to stress the absence of the consulting role on the part of the nursing staff. This finding is worth the keen attention of consultants on health matters. Nurses have a great deal to contribute to the emotional care of cancer patients, and are puzzled about the reasons why they are not asked to participate in this important function.