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1.
Wiad Lek ; 74(8): 1984-1987, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34537754

RESUMO

We review the current research literature on treatment behaviour for neoplasms of the female genital tract during pregnancy. Guidelines for clinical management of cervical cancer, ovarian tumours, and vulvar cancer are presented both regarding gynaecological oncologic treatment and obstetrics. Cervical cancer is the most common malignant tumour of the female genitalia during pregnancy due to the high incidence of this neoplasm in developing countries, including Bulgaria, on the one hand, and on the other, it affects women of reproductive age. Treatment algorithms depending on various factors - gestational age, stage of the disease, tumour lesion size, and presence of pelvic lymph node metastases, are presented. Ovarian tumours are classified into benign, borderline malignant, and malignant tumours. The latter, in turn, are divided into early and advanced stages, as well as epithelial and non-epithelial tumours, which can be detected at different stages of pregnancy.


Assuntos
Neoplasias dos Genitais Femininos , Neoplasias Ovarianas , Neoplasias do Colo do Útero , Feminino , Neoplasias dos Genitais Femininos/epidemiologia , Neoplasias dos Genitais Femininos/terapia , Humanos , Linfonodos , Metástase Linfática , Neoplasias Ovarianas/terapia , Gravidez , Neoplasias do Colo do Útero/terapia
2.
Bull Cancer ; 108(9): 806-812, 2021 Sep.
Artigo em Francês | MEDLINE | ID: mdl-34217437

RESUMO

OBJECTIVE: In France, we are lacking an identified pathway for training in gynaecological cancer surgery. The four competent French learned societies: the SFOG, the CNGOF, the SFCO and the SCGP supported by the CNU of Obstetrics & Gynaecology, and UNICANCER agreed to materialize this course and attest it by a certification awarded by a national jury. MATERIAL AND METHODS: The national committee of certification in gynaecological oncology made up of ten members, representing the 6 concerned organizations, set itself five objectives: the definition of the eligibility criteria for training centres; the determination of a check-list to be filled by the candidate; the determination of a targeted curriculum for the training in gynecological oncological surgery; the determination of the assets necessary for the certification of a candidate already in practice; and the practical organization of the certification. RESULTS: Criteria for approval of centres for training included 150 gynaecological cancer cases per year, among which 100 excisional surgeries, including twenty advanced-stage ovarian cancers. For certification of candidate who followed the curriculum established by the committee or by validation of prior experience for an actual practitioner, a candidate must validate a logbook and fill out a checklist including four parts: theoretical and practical training; research and publications; teaching and subscription to a continuing education program. The accomplished elements of the logbook and the checklist will be evaluated by a score. The first certification session is planned for the end of 2021.


Assuntos
Institutos de Câncer/normas , Certificação/normas , Competência Clínica , Neoplasias dos Genitais Femininos/cirurgia , Ginecologia/educação , Comitês Consultivos/organização & administração , Institutos de Câncer/estatística & dados numéricos , Certificação/organização & administração , Lista de Checagem , Currículo , Educação Médica Continuada , Feminino , França , Neoplasias dos Genitais Femininos/epidemiologia , Procedimentos Cirúrgicos em Ginecologia/educação , Ginecologia/normas , Hospitais de Ensino/normas , Hospitais de Ensino/estatística & dados numéricos , Humanos , Neoplasias Ovarianas/patologia , Neoplasias Ovarianas/cirurgia , Editoração/estatística & dados numéricos , Pesquisa/estatística & dados numéricos , Sociedades Médicas , Ensino
3.
Arch Gynecol Obstet ; 304(3): 679-686, 2021 09.
Artigo em Inglês | MEDLINE | ID: mdl-34059957

RESUMO

PURPOSE: COVID-19 has captured the world. We hypothesized that this pandemic reduced referral of other non-COVID-19 patients to the hospitals or clinics, including gynecological and perinatological referrals. Women can be at risk in limited use of health services. METHODS: In this retrospective study, referrals from gynecologic oncology, perinatology, and gynecology clinics in a large teaching hospital of Tehran University of Medical Sciences (TUMS) were compared from February 20 to May 20, 2020, with the same period in 2019. Finally, referral trends in 2020 were compared with the COVID-19 admission pattern. RESULTS: Total admissions to all three clinics declined 63% in 2020 compared to 2019. There was a significant relationship between the number of visits to three clinics during these2  years (p < 0.001). The reduction in referrals to the gynecology clinic was more than gynecologic oncology and perinatology. The COVID-19 referral pattern was conversely linked to gynecology-related admissions. CONCLUSION: As the pandemic situation makes patients hesitant to go to the hospitals or not, health policymakers should consider other non-COVID issues, including maternal and fetal concerns. Providing safe places for other patients to visit is a goal that can be achieved through developing guidelines for nosocomial hygiene and training informed healthcare staff. Moreover, non-urgent visits should be avoided or postponed. This issue calls for new strategies, including telemedicine in situations similar to the current pandemic to both identify and manage such conditions.


Assuntos
COVID-19/psicologia , Parto Obstétrico/estatística & dados numéricos , Neoplasias dos Genitais Femininos/epidemiologia , Ginecologia/estatística & dados numéricos , Perinatologia , Adulto , COVID-19/epidemiologia , Feminino , Maternidades/estatística & dados numéricos , Humanos , Irã (Geográfico)/epidemiologia , Obstetrícia/estatística & dados numéricos , Pandemias , Estudos Retrospectivos , SARS-CoV-2
4.
BMC Infect Dis ; 21(1): 554, 2021 Jun 11.
Artigo em Inglês | MEDLINE | ID: mdl-34116658

RESUMO

BACKGROUND: Multicentric intraepithelial lesions of the lower genital tract (multicentric lesions) were defined as intraepithelial lesions of two or three sites within cervix, vagina, and vulva occurring synchronously or sequentially. The characteristics of multicentric lesions has been poorly understood. This study aimed to evaluate the risk factors for multicentric lesions, including specific HPV genotypes. METHODS: A retrospective case-control study was performed involving patients histologically diagnosed with multicentric lesions between January 2018 and October 2019. Controls were patients histologically diagnosed with single cervical intraepithelial neoplasia (CIN) and admitted during the same period. Univariable and multivariable analyses were used to assess the risk factors for multicentric lesions. RESULTS: Of 307 patients with multicentric lesions, the median age was 50 years (interquartile range: 43-55.5), and they were older than patients with single CIN (median age: 43 years, interquartile range: 36-50). In the multicentric lesion group, the proportions of cytologic abnormalities, HPV positivity, and multiple HPV infections were 68.9, 97.0, and 36.5%, respectively. In the multivariable analysis, menopause, a history of malignant tumors beyond the lower genital tract and multiple HPV infections were associated with the incidence of multicentric lesions (Odd ratio (OR) = 3.14, 95% confidence interval (CI) 2.24-4.41; OR = 9.58, 95% CI 1.02-89.84; OR = 1.47, 95% CI 1.03-2.10). The common HPV genotypes were HPV16, HPV53, HPV58, HPV52, HPV51, HPV56 and HPV18 in patients with multicentric lesions. The proportion of HPV16 infection was higher in high-grade lesions group than that in low-grade lesions group (OR = 2.54, 95% CI 1.34-4.83). The OR for multicentric lesions, adjusted for menopause, smoking, gravidity, parity, a history of malignant tumor beyond the lower genital tract and multiple HPV infection, was 1.97 (95% CI 1.04-3.75) in patients with HPV51 infection. CONCLUSIONS: Multicentric lesions were associated with menopause, a history of malignant tumors and multiple HPV infections. HPV16 was the most common genotype, especially in high grade multicentric lesions and HPV51 infection was found to be a risk factor for detecting multicentric lesions.


Assuntos
Neoplasias dos Genitais Femininos , Papillomaviridae/genética , Infecções por Papillomavirus , Infecções do Sistema Genital , Adulto , Estudos de Casos e Controles , Feminino , Neoplasias dos Genitais Femininos/epidemiologia , Neoplasias dos Genitais Femininos/virologia , Humanos , Pessoa de Meia-Idade , Infecções por Papillomavirus/epidemiologia , Infecções por Papillomavirus/virologia , Infecções do Sistema Genital/epidemiologia , Infecções do Sistema Genital/virologia , Estudos Retrospectivos , Fatores de Risco
6.
Curr Opin Obstet Gynecol ; 33(4): 355-359, 2021 08 01.
Artigo em Inglês | MEDLINE | ID: mdl-34183551

RESUMO

PURPOSE OF REVIEW: To summarize the most recent evidence on gynecologic cancer disparities and to describe studies investigating the social determinants of health and receipt of evidence-based care and potential interventions to address inequities in care. RECENT FINDINGS: Significant disparities in disease-specific survival by race/ethnicity, socioeconomic status, and payer status have persisted in women with gynecologic cancers. Compared with white women, black women have an increased likelihood of disease-specific mortality for endometrial cancer and are less likely to receive guideline-adherent care for ovarian cancer. The Covid-19 pandemic has brought significant attention to the structural barriers that contribute to persistent health disparities and how community-based partnerships with a focus on policy interventions are needed for equitable gynecologic cancer outcomes. SUMMARY: In this review, we discuss structural barriers contributing to racial inequities, the role of Medicaid payer status and receipt of quality cancer care, gender, and racial workforce diversity, and community-based partnerships to create evidence-based interventions to address disparities.


Assuntos
Afro-Americanos , Neoplasias dos Genitais Femininos/epidemiologia , Disparidades em Assistência à Saúde , Grupos Minoritários , Feminino , Humanos , Medicaid , Qualidade da Assistência à Saúde , Estados Unidos/epidemiologia
7.
J Urol ; 206(3): 577-585, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-33872050

RESUMO

PURPOSE: According to the American Urological Association/American Society of Clinical Oncology/American Society for Radiation Oncology/Society of Urologic Oncology Guideline on treatment of nonmetastatic muscle invasive bladder cancer (MIBC), females requiring radical cystectomy (RC) should undergo concomitant anterior pelvic exenteration despite low rates of malignant involvement of gynecologic organs. We present the clinicopathological characteristics of patients with MIBC treated with neoadjuvant chemotherapy (NAC) and evaluate the impact of NAC on gynecologic organ involvement. MATERIALS AND METHODS: An institutional review board approved review of patients with cT2-T3 MIBC treated with RC at our institution between 2005 and 2018 was performed. Patients were stratified by receipt of NAC. RESULTS: A total of 186 females with cT2-T3 MIBC underwent RC during the study period, of whom 67.7% received NAC prior to RC. Patients who received NAC were more likely to have cT3 disease, preoperative hydronephrosis, and variant histology on transurethral resection (p <0.001, p=0.004, p=0.029, respectively). Rates of recurrence or metastasis were similar between groups (27.0% vs 26.7%, p=0.964). No patients had isolated genitourinary organ recurrence (median followup 32.1 months). Nine patients (5.7%) had gynecologic organ involvement (6 NAC vs 3 no NAC, p=0.978). Among those who underwent hysterectomy, 2 patients (3.1%) who received NAC had uterine involvement compared to none in the no NAC cohort (p=0.551). Rates of vaginal involvement were similar between the groups (4 NAC vs 3 no NAC, p=0.402). Additionally, 1 patient who received NAC had incidentally diagnosed localized endometrial cancer. No women had fallopian tube or ovarian involvement. CONCLUSIONS: Even among high risk patients with MIBC, gynecologic organ involvement of MIBC is rare, and organ preservation, especially of the ovaries, is likely safe.


Assuntos
Cistectomia , Neoplasias dos Genitais Femininos/epidemiologia , Terapia Neoadjuvante , Recidiva Local de Neoplasia/epidemiologia , Neoplasias da Bexiga Urinária/patologia , Idoso , Quimioterapia Adjuvante , Feminino , Seguimentos , Neoplasias dos Genitais Femininos/secundário , Humanos , Histerectomia , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/prevenção & controle , Estudos Retrospectivos , Bexiga Urinária/patologia , Bexiga Urinária/cirurgia , Neoplasias da Bexiga Urinária/terapia , Útero/patologia , Útero/cirurgia , Vagina/patologia , Vagina/cirurgia
8.
J Obstet Gynaecol Res ; 47(5): 1643-1650, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-33650217

RESUMO

Since the outbreak of COVID-19, there have already been over 26 million people being infected and it is expected that the pandemic will not end in near future. Not only the daily activities and lifestyles of individuals have been affected, the medical practice has also been modified to cope with this emergency catastrophe. In particular, the cancer services have faced an unprecedented challenge. While the services may have been cut by the national authorities or hospitals due to shortage of manpower and resources, the medical need of cancer patients has increased. Cancer patients who are receiving active treatment may develop various kinds of complications especially immunosuppression from chemotherapy, and they and their carers will need additional protection against COVID-19. Besides, there is also evidence that cancer patients are more prone to deteriorate from COVID-19 if they contract the viral infection. Therefore, it is crucial to establish guidelines so that healthcare providers can triage their resources to take care of the most needed patients, reduce less important hospitalization and visit, and to avoid potential complications from treatment. The Asia and Oceania Federation of Obstetrics and Gynecology (AOFOG) hereby issued this opinion statement on the management of gynecological cancer patients during the COVID-19.


Assuntos
COVID-19 , Neoplasias dos Genitais Femininos , Ginecologia , Obstetrícia , Ásia/epidemiologia , Feminino , Neoplasias dos Genitais Femininos/epidemiologia , Neoplasias dos Genitais Femininos/terapia , Humanos , Oceania , Gravidez , SARS-CoV-2
9.
J Gynecol Obstet Hum Reprod ; 50(8): 102133, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-33789183

RESUMO

INTRODUCTION: The coronavirus SARS-CoV-2 (COVID-19) pandemic has put tremendous pressure on the French healthcare system. Almost all hospital departments have had to profoundly modify their activity to cope with the crisis. In this context, the surgical management of cancers has been a topic of debate as care strategies were tailored to avoid any delay in treatment that could be detrimental to patient wellbeing while being careful not to overload intensive care units. The primary objective of this study was to observe changes in the surgical management of pelvic cancers during the COVID-19 pandemic in France. MATERIAL AND METHODS: This study analyzed data from the prospective multi-center cohort study conducted by the French Society for Pelvic and Gynecological Surgery (SCGP) with methodological support from the French (FRANCOGYN) Group. All members of the SCGP received by e-mail a link allowing them to include patients who were scheduled to undergo gynecological carcinologic surgery between March 16th 2020 and May 11th 2020. Demographic data, the characteristics of cancers and the impact of the crisis in terms of changes to the usual recommended coarse of care were collected. RESULTS: A total of 181 patients with a median age 63 years were included in the cohort. In total, 31 patients had cervical cancer, 76 patients had endometrial cancer, 52 patients had ovarian or tubal cancer, 5 patients had a borderline tumor of the ovary, and 17 patients had vulvar cancer. During the study period, the care strategy was changed for 49 (27%) patients with postponed for 35 (19.3%) patients, and canceled for 7 (3.9%) patients. Surgical treatment was maintained for 139 (76.8%) patients. Management with neoadjuvant chemotherapy was offered to 19 (10,5%) patients and a change in surgical choice was made for 5 (2,8%) patients. In total, 8 (4,4%) patients tested positive for COVID-19. Data also shows a greater number of therapeutic changes in cases of ovarian cancer as well as a cancelation of a lumbo-aortic lymphadenectomy in one patient with cervical cancer. Hospital consultants estimated a direct detrimental impact of the COVID-19 pandemic for 39 patients, representing 22% of gynecological cancers. CONCLUSION: This study provided observational data of the impact of the COVID-19 health crisis on the surgical management of gynecological cancers.


Assuntos
COVID-19/epidemiologia , Neoplasias dos Genitais Femininos/cirurgia , Procedimentos Cirúrgicos em Ginecologia/estatística & dados numéricos , Idoso , COVID-19/prevenção & controle , Estudos de Coortes , Controle de Doenças Transmissíveis , Bases de Dados Factuais , Feminino , França/epidemiologia , Neoplasias dos Genitais Femininos/classificação , Neoplasias dos Genitais Femininos/epidemiologia , Neoplasias dos Genitais Femininos/patologia , História do Século XXI , Humanos , Pessoa de Meia-Idade , Pandemias , Quarentena , SARS-CoV-2
10.
Nursing ; 51(3): 58-62, 2021 Mar 01.
Artigo em Inglês | MEDLINE | ID: mdl-33674538

RESUMO

ABSTRACT: Lesbian and bisexual women may be at an increased risk for gynecologic infections and breast cancer due to a higher prevalence of factors such as obesity, smoking, and lower pregnancy rates. This article discusses the role of healthcare professionals in preventive screening for breast and gynecologic cancers and promoting healthy living in these patients by avoiding smoking, maintaining an ideal body weight, and limiting alcohol consumption.


Assuntos
Bissexualidade , Neoplasias da Mama/enfermagem , Detecção Precoce de Câncer/enfermagem , Neoplasias dos Genitais Femininos/enfermagem , Homossexualidade Feminina , Neoplasias da Mama/epidemiologia , Feminino , Neoplasias dos Genitais Femininos/epidemiologia , Humanos , Medição de Risco , Fatores de Risco
11.
BMC Cancer ; 21(1): 232, 2021 Mar 06.
Artigo em Inglês | MEDLINE | ID: mdl-33676451

RESUMO

BACKGROUND: There is currently a lack of information on full anogenital evaluation of women with a previous history of anogenital neoplasia. METHODS: Retrospective analysis of the Homerton Anogenital Neoplasia Service records from January 2012 to March 2017, to identify all new referrals of women with previous anogenital neoplasia, who had had at least one complete examination of all anogenital sites. Multizonal anogenital disease (MZD) was defined as the presence of high-grade squamous intraepithelial lesions (HSIL)/carcinoma concurrently at two or more of the following sites/zones: perianus, anal canal, vulva, vagina or cervix. RESULTS: 253 women were included, mean age was 47 (SD=15) years and median duration of follow-up was 12 (IQR=21) months. Fifty-six women (22%) were diagnosed with MZD at first assessment and/or during follow-up. Current smokers (RR=1.84, 95% CI 1.21-2.79, p=0.004) and women on immunodulators/immunosuppressive drugs (RR=2.57, 95% CI 1.72-3.86, p<0.001) had an increased risk for MZD. The risk was lower for women without a previous history of anogenital high-grade lesions/cancer compared to those with this history (RR=0.06, 95% CI 0.01-0.45, p=0.006). CONCLUSIONS: Multizonal assessment was important to diagnose occult areas of disease and should be especially considered in current smokers, pharmacologically immunocompromised and those with a previous history of anogenital HSIL/cancer.


Assuntos
Neoplasias do Ânus/diagnóstico , Carcinoma de Células Escamosas/diagnóstico , Neoplasias dos Genitais Femininos/diagnóstico , Segunda Neoplasia Primária/diagnóstico , Infecções por Papillomavirus/diagnóstico , Adulto , Canal Anal/diagnóstico por imagem , Canal Anal/patologia , Canal Anal/virologia , Neoplasias do Ânus/epidemiologia , Neoplasias do Ânus/patologia , Neoplasias do Ânus/virologia , Biópsia , Carcinoma de Células Escamosas/epidemiologia , Carcinoma de Células Escamosas/patologia , Carcinoma de Células Escamosas/virologia , Colo do Útero/diagnóstico por imagem , Colo do Útero/patologia , Colo do Útero/virologia , Colposcopia , Feminino , Seguimentos , Neoplasias dos Genitais Femininos/epidemiologia , Neoplasias dos Genitais Femininos/patologia , Neoplasias dos Genitais Femininos/virologia , Humanos , Pessoa de Meia-Idade , Gradação de Tumores , Segunda Neoplasia Primária/epidemiologia , Segunda Neoplasia Primária/patologia , Segunda Neoplasia Primária/virologia , Infecções por Papillomavirus/epidemiologia , Infecções por Papillomavirus/patologia , Infecções por Papillomavirus/virologia , Estudos Retrospectivos , Centros de Atenção Terciária/estatística & dados numéricos , Vagina/diagnóstico por imagem , Vagina/patologia , Vagina/virologia , Vulva/diagnóstico por imagem , Vulva/patologia , Vulva/virologia
12.
J Obstet Gynaecol Res ; 47(5): 1631-1642, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-33631867

RESUMO

AIM: To provide information including the trend of gynecological malignancies in Japan, we hereby present the Annual Patient Report for 2017 and the Annual Treatment Report for 2012, on the outcomes of patients who started treatment in 2012. METHODS: The Japan Society of Obstetrics and Gynecology maintains an annual tumor registry, where information on gynecological malignancies from various participating institutions is gathered. The data of patients whose treatment with gynecologic malignancies was initiated in 2017 were analyzed retrospectively. Survival of the patients who started treatment with cervical, endometrial and ovarian cancer in 2012 was analyzed by using the Kaplan-Meier, log-rank and Wilcoxon tests. RESULTS: Treatment was initiated in 2017 for 7710 patients with cervical cancer; 11 120 with endometrial cancer; 7029 with ovarian, tubal and peritoneal cancer; 2164 with ovarian borderline tumors; and with the others (213 vulvar cancer, 139 vaginal cancer, 366 uterine sarcoma, 41 uterine adenosarcoma and 131 trophoblastic diseases). This clinicopathological information was summarized as the patient annual report. The 5-year survival rates of the patients with cervical cancer were 92.9, 75.5, 58.2 and 26.7% for stages I, II, III and IV, respectively. The 5-year survival rates for the patients with endometrial cancer were 93.6, 85.6, 72.6 and 27.3% for stages I, II, III and IV, respectively. The 5-year survival rates for the patients with ovarian cancer (surface epithelial-stromal tumors) were 92.5, 83.5, 49.5 and 30.8% for stages I, II, III and IV, respectively. CONCLUSION: The annual tumor report is an important survey that provides knowledge on gynecological malignancy trends in Japan.


Assuntos
Neoplasias dos Genitais Femininos , Ginecologia , Obstetrícia , Neoplasias Ovarianas , Neoplasias do Colo do Útero , Feminino , Neoplasias dos Genitais Femininos/epidemiologia , Neoplasias dos Genitais Femininos/terapia , Humanos , Japão/epidemiologia , Estudos Retrospectivos
13.
Gynecol Oncol ; 161(2): 595-600, 2021 05.
Artigo em Inglês | MEDLINE | ID: mdl-33551197

RESUMO

OBJECTIVE: To utilize a novel crowdsourcing method to measure financial toxicity and its effects among a national cohort of gynecologic cancer patients. METHODS: Crowdsourcing methods were used to administer an online survey to women in the United States with gynecologic cancers. We used the Comprehensive Score for Financial Toxicity (COST) tool to measure financial toxicity and the EQ-5D-3L to measure quality of life (QOL). Based on prior work, we defined high financial toxicity as a COST score ≤ 23. We assessed correlation of COST scores with QOL. We used log-binomial regression to examine associations between high financial toxicity and cost-coping strategies. RESULTS: Among the final study sample of 334 respondents, 87% were white, median age at diagnosis was 55 (interquartile range 47-63), 52% had stage III or IV disease and 90% had private insurance or Medicare. Median COST score was 24 (interquartile range 15-32) and 49% of respondents reported high financial toxicity. Greater financial toxicity was correlated with worse QOL (p < 0.001). Participants reporting high financial toxicity were more likely to use cost-coping strategies, including spending less on basic goods (RR: 3.3; 95% CI: 2.1-5.1), borrowing money or applying for financial assistance (RR: 4.0; 95% CI: 2.4-6.9), and delaying or avoiding care (RR: 5.6; 95% CI: 2.6-12.1). CONCLUSIONS: Crowdsourcing is an effective tool to measure financial toxicity. Nearly half of respondents reported high financial toxicity, which was significantly associated with worse QOL, utilization of cost-coping strategies and delays or avoidance of care.


Assuntos
Crowdsourcing/estatística & dados numéricos , Estresse Financeiro/epidemiologia , Neoplasias dos Genitais Femininos/economia , Efeitos Psicossociais da Doença , Estudos Transversais , Crowdsourcing/economia , Crowdsourcing/métodos , Feminino , Estresse Financeiro/etiologia , Neoplasias dos Genitais Femininos/epidemiologia , Gastos em Saúde/estatística & dados numéricos , Humanos , Pessoa de Meia-Idade , Mídias Sociais , Estados Unidos/epidemiologia
14.
Int J Cancer ; 148(12): 2915-2923, 2021 06 15.
Artigo em Inglês | MEDLINE | ID: mdl-33506540

RESUMO

Twin studies suggest a familial aggregation of bladder cancer, but elements of this increased familial risk of bladder cancer are not well understood. To characterize familial risk of bladder cancer, we examined the relationship between family history of bladder and other types of cancer among first-degree relatives and risk of bladder cancer in 1193 bladder cancer cases and 1418 controls in a large population-based case-control study. Multivariate logistic regression was used to estimate odds ratios (ORs) and 95% confidence intervals (CIs) for the association between family history of bladder cancer (defined as at least one first-degree family member with bladder cancer or a cancer of any other site). We also evaluated cancer aggregation of specific sites in family members. Participants with a first-degree relative with bladder cancer had nearly double the risk of bladder cancer (OR = 1.8, 95% CI 1.2-2.9) as those without a family history of bladder cancer. Risk was increased for having a sibling with bladder cancer (OR = 2.6, 95% CI 1.3-5.3) compared to no siblings with cancer. Bladder cancer risk was elevated when participants reported a first-degree relative with a history of female genital cancer (OR = 1.5, 95% CI 1.1-2.1), melanoma (OR = 1.9, 95% CI 1.02-3.6), and tobacco-associated cancer (OR = 1.3, 95% CI 1.06-1.6). These findings add to evidence of a familial predisposition to bladder cancer. Clarification of the aggregation of bladder cancer in families and with other cancer sites will be of interest as many loci and common polymorphisms related to bladder cancer have yet to be identified in large genomic studies.


Assuntos
Neoplasias dos Genitais Femininos/epidemiologia , Melanoma/epidemiologia , Fumar/epidemiologia , Neoplasias da Bexiga Urinária/epidemiologia , Adulto , Idoso , Estudos de Casos e Controles , Feminino , Humanos , Maine/epidemiologia , Masculino , Pessoa de Meia-Idade , New Hampshire/epidemiologia , Linhagem , Medição de Risco , Fumar/efeitos adversos , Estudos em Gêmeos como Assunto , Vermont/epidemiologia
15.
J Obstet Gynaecol ; 41(2): 298-304, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33448228

RESUMO

The aim of the present study was to determine the incidence of unexpected gynaecological malignancies in patients undergoing hysterectomy for benign indications and to evaluate their clinical characteristics. Data from 6448 cases who had undergone hysterectomy for benign indications between the dates of 01.01.2008-01.01.2018 were recorded retrospectively from the database of the institution. The mean age of the cases with malignancy was 59.2 ± 9.66 (45-80) and 76,31% were (29/38) postmenopausal. The mean gravidity was 3.94 ± 1.73 and parity was 3.31 ± 1.45. Their mean BMI was 29.6 ± 4.26 kg/m2 (22.4-41.9 kg/m2 range). These patients were followed for a mean duration of 60.68 ± 37.66 months and during this period death associated with malignancy occurred in 4/38 (%10.52) cases, all of whom had leiomyosarcoma. The benign indications of procedure were as follows: myoma uteri (2675, 41.48%), abnormal uterine bleeding (1508, 23.38%), uterine prolapsus (793, 12.29%), ovarian cyst (619, 9.59%), endometriosis (303, 4.69%), endometrial polyp (264, 4.09%), pelvic pain (238, 3.69%) and other benign causes (48, 0.74%). Unexpected gynaecological malignancy was found in 20 cases (0.31%) with endometrial cancer, in eight cases (0.12%) with uterine sarcoma, in seven cases (0.10%) with ovarian cancer, in one case (0.01%) with tubal cancer and in two (0.03%) with cervical cancer. Gynaecological malignancy was found in 38 of 6648 cases who underwent hysterectomy for benign indications, yielding an incidence rate of 0.58%.IMPACT STATEMENTWhat is already known on this subject? Hysterectomy is the most common gynaecological surgery in the world and although most are performed for benign indications, unexpected gynaecological malignancy is possible in the final pathology results.Although there are available publications investigating unexpected gynaecological malignancy incidences after hysterectomies for benign reasons, the incidence is still not clear. We aimed to contribute to the existing literature with this study, which includes a large number of cases.What do the results of this study add? Our study adds new findings to the body of the knowledge on the incidence of unexpected gynaecological malignancies in hysterectomies for benign indications. Gynaecological malignancy was found in 38 of 6648 cases who underwent hysterectomy for benign indications, yielding an incidence rate of 0.58%.What are the implications of these findings for clinical practice and/or further research? There is an unexpected possibility of gynaecological malignancy even in cases where it is expected to be benign with current diagnostic methods. In cases that are expected to be benign, detailed preoperative evaluation should be performed in all patients to prevent unexpected gynaecological malignancies. More sensitive screening methods should be developed especially in the preoperative differential diagnosis of leiomyoma and leiomyosarcoma.


Assuntos
Doenças dos Genitais Femininos/cirurgia , Neoplasias dos Genitais Femininos , Histerectomia , Achados Incidentais , Índice de Massa Corporal , Bases de Dados Factuais/estatística & dados numéricos , Feminino , Doenças dos Genitais Femininos/epidemiologia , Neoplasias dos Genitais Femininos/classificação , Neoplasias dos Genitais Femininos/diagnóstico , Neoplasias dos Genitais Femininos/epidemiologia , Humanos , Histerectomia/métodos , Histerectomia/estatística & dados numéricos , Incidência , Pessoa de Meia-Idade , História Reprodutiva , Estudos Retrospectivos , Turquia/epidemiologia
16.
Gynecol Oncol ; 161(1): 291-296, 2021 04.
Artigo em Inglês | MEDLINE | ID: mdl-33514482

RESUMO

OBJECTIVE: To assess the cancer risk in a cohort of women with newly diagnosed endometriosis. METHODS: This retrospective, nationwide, population-based cohort study utilized data from the 10-year claims database of the Korean National Health Insurance from January 2008 to December 2018. Patients diagnosed with endometriosis between 2010 and 2013 were included; those who underwent appendectomy but were not diagnosed with endometriosis during the study period served as controls. No participant was diagnosed with cancer before enrollment. Cancer diagnoses according to the International Classification of Diseases, 10th revision, were compared between the two groups. Cancer occurrence in both groups was identified according to the diagnostic codes for different organ sites. RESULTS: Altogether, 179,865 patients with endometriosis and 87,408 controls were analyzed, and the incidence rates of cancer were 644.3 and 543.8 per 100,000 person-years, respectively. Patients with endometriosis had a significantly increased overall cancer risk (hazard ratio [HR], 1.34; 95% confidence interval [CI], 1.28-1.40; p < 0.001) than controls after adjusting for age, insurance type, and comorbidities. They had significantly increased uterine (HR, 4.59; 95% CI, 3.56-5.91; p < 0.001), ovarian (HR, 2.51; 95% CI, 1.99-3.16; p < 0.001), cervical (HR, 1.84; 95% CI, 1.49-2.28; p < 0.001), breast (HR, 1.44; 95% CI, 1.31-1.58; p < 0.001), and thyroid cancer (HR, 1.34; 95% CI, 1.24-1.45; p < 0.001) risk. Median age at diagnosis was <50 years for all cancer types. CONCLUSIONS: Endometriosis was associated with an increased cancer risk, specifically uterine, ovarian, cervical, breast, and thyroid cancers, suggesting that effective cancer screening for early detection of malignancies in women should be implemented in those with endometriosis.


Assuntos
Endometriose/epidemiologia , Neoplasias/epidemiologia , Adulto , Neoplasias da Mama/epidemiologia , Estudos de Coortes , Feminino , Neoplasias dos Genitais Femininos/epidemiologia , Humanos , Incidência , Pessoa de Meia-Idade , República da Coreia/epidemiologia , Estudos Retrospectivos , Risco , Neoplasias da Glândula Tireoide/epidemiologia , Adulto Jovem
17.
JAMA Netw Open ; 4(1): e2031661, 2021 01 04.
Artigo em Inglês | MEDLINE | ID: mdl-33416884

RESUMO

Importance: Radiotherapy is a common treatment for rectal cancer, yet the risk of second gynecological malignant neoplasms (SGMNs) in patients with rectal cancer undergoing radiotherapy have not been adequately studied. Objective: To investigate the association between radiotherapy and the risk of individual types of SGMN in patients with rectal cancer and assess survival outcomes. Design, Setting, and Participants: A large population-based cohort study was designed to identify the risk of SGMNs in patients with rectal cancer diagnosed from January 1973 to December 2015. The statistical analysis was conducted from September 2019 to April 2020. The study was based on the 9 cancer registries of Surveillance, Epidemiology, and End Results database. A total of 20 142 female patients with rectal cancer in localized and regional stage were included. Exposure: Receipt of neoadjuvant radiotherapy for rectal cancer. Main Outcomes and Measures: The development of an SGMN defined as any type of GMN occurring more than 5 years after the diagnosis of rectal cancer. The cumulative incidence of SGMNs was estimated by Fine-Gray competing risk regression. Poisson regression was used to evaluate the radiotherapy-associated risk for SGMNs in patients undergoing radiotherapy vs patients not undergoing radiotherapy. The Kaplan-Meier method was used to assess the survival outcomes of patients with SGMNs. Results: Of 20 142 patients, 16 802 patients (83.4%) were White and the median age was 65 years (interquartile range, 54-74 years). A total of 5310 (34.3%) patients were treated with surgery and radiotherapy, and 14 832 (65.7%) patients were treated with surgery alone. The cumulative incidence of SGMNs during 30 years of follow-up was 4.53% among patients who received radiotherapy and 1.53% among patients who did not. In competing risk regression analysis, undergoing radiotherapy was associated with a higher risk of developing cancer of the uterine corpus (adjusted hazard ratio, 3.06; 95% CI, 2.14-4.37; P < .001) and ovarian cancer (adjusted hazard ratio, 2.08; 95% CI, 1.22-3.56; P = .007) compared with those who did not receive radiotherapy. The dynamic radiotherapy-associated risks (RR) for cancer of the uterine corpus significantly increased with increasing age at rectal cancer diagnosis (aged 20-49 years: adjusted RR, 0.79; 95% CI, 0.35-1.79; P = .57; aged 50-69 years: adjusted RR, 3.74; 95% CI, 2.63-5.32; P < .001; aged ≥70 years: adjusted RR, 5.13; 95% CI, 2.64-9.97; P < .001) and decreased with increasing latency since rectal cancer diagnosis (60-119 months: adjusted RR, 3.22; 95% CI, 2.12-4.87; P < .001; 120-239 months: adjusted RR, 2.72; 95% CI, 1.75-4.24; P < .001; 240-360 months: adjusted RR, 1.95; 95% CI, 0.67-5.66; P = .22), but the dynamic RR for ovarian cancer increased with increasing latency since rectal cancer diagnosis (60-119 months: adjusted RR, 0.70; 95% CI, 0.26-1.89; P = .48; 120-239 months: adjusted RR, 2.26; 95% CI, 1.09-4.70; P = .03; 240-360 months: adjusted RR, 11.84; 95% CI, 2.18-64.33; P = .004). The 10-year overall survival among patients with radiotherapy-associated cancer of the uterine corpus was significantly lower than that among matched patients with primary cancer of the uterine corpus (21.5% vs 33.6%; P = .01). Conclusions and Relevance: Radiotherapy for rectal cancer was associated with an increased risk of cancer of the uterine corpus and ovarian cancer. Special attention should be paid to reduce radiotherapy-associated SGMNs and improve their prognosis.


Assuntos
Neoplasias dos Genitais Femininos/epidemiologia , Segunda Neoplasia Primária/epidemiologia , Neoplasias Retais/epidemiologia , Neoplasias Retais/radioterapia , Idoso , Estudos de Coortes , Feminino , Seguimentos , Neoplasias dos Genitais Femininos/etiologia , Humanos , Incidência , Pessoa de Meia-Idade , Terapia Neoadjuvante/estatística & dados numéricos , Segunda Neoplasia Primária/etiologia , Segunda Neoplasia Primária/patologia , Neoplasias Retais/patologia , Programa de SEER , Estados Unidos/epidemiologia
18.
Sci Rep ; 11(1): 1441, 2021 01 14.
Artigo em Inglês | MEDLINE | ID: mdl-33446912

RESUMO

After pelvic lymphadenectomy (PLA), pelvic vessels, nerve, and ureter are skeletonized. Internal hernias beneath the skeletonized pelvic structure following pelvic lymphadenectomy (IBSPP) are a rare complication following PLA. To the best of our knowledge, only 12 IBSPP cases have been reported and clinical details on such hernias remain unknown. The aim of the study was to investigate the incident and etiology of IBSPP. 1313 patients who underwent open or laparoscopic pelvic lymphadenectomy were identified from our database. A retrospective review was performed. Mean follow-up period was 33.9 months. A total of 12 patients had IBSPP. Multivariate analysis of laparoscopic surgeries group as compared to open surgeries group, para-aortic lymphadenectomy rate, number of dissected lymph nodes by PLA, antiadhesive material use rate, and blood loss were lower in laparoscopic surgeries group: odd ratio (OR) = 0.13 [95% confidence interval (CI) 0.08-0.19], and OR = 0.70 [95% CI 0.50-0.99], OR = 0.17 [95% CI 0.10-0.28], OR = 0.93 [95% CI 0.92-0.94]. However, no significant difference was observed in the incidence of IBSPP between laparoscopic surgery (1.0%) and open surgery (0.8%). All IBSPP occurred in the right pelvic space. These findings may contribute to the development of prevention methods for this disease.


Assuntos
Neoplasias dos Genitais Femininos , Hérnia , Intestino Delgado , Laparoscopia/efeitos adversos , Excisão de Linfonodo/efeitos adversos , Complicações Pós-Operatórias/epidemiologia , Adulto , Feminino , Seguimentos , Neoplasias dos Genitais Femininos/epidemiologia , Neoplasias dos Genitais Femininos/cirurgia , Hérnia/epidemiologia , Hérnia/etiologia , Humanos , Pessoa de Meia-Idade , Estudos Retrospectivos
19.
J Minim Invasive Gynecol ; 28(3): 475-480, 2021 03.
Artigo em Inglês | MEDLINE | ID: mdl-32702513

RESUMO

OBJECTIVE: To provide a perspective on nerve-sparing (NS) surgery in gynecology. DATA SOURCES: Literature review, English language. METHODS OF STUDY SELECTION: Systematic reviews and meta-analyses studies were selected for review for oncology; comparative studies were selected for endometriosis, and 1 comparative and 1 prospective study were chosen for sacrocolpopexy. TABULATION, INTEGRATION, AND RESULTS: Two tables summarize the results of systematic reviews and meta-analyses in oncology. Oncology, endometriosis, and urogynecology sections. Primary benefit of NS technique is decreased bladder dysfunction, and, to a lesser degree, vaginal and rectal dysfunc. CONCLUSION: NS is preferable to conventional surgery for benign and malignant conditions to reduce postoperative bladder, rectal, and vaginal dysfunction.


Assuntos
Procedimentos Cirúrgicos em Ginecologia/métodos , Tecido Nervoso/cirurgia , Tratamentos com Preservação do Órgão/métodos , Endometriose/epidemiologia , Endometriose/patologia , Endometriose/cirurgia , Feminino , Doenças Urogenitais Femininas/epidemiologia , Doenças Urogenitais Femininas/patologia , Doenças Urogenitais Femininas/cirurgia , Neoplasias dos Genitais Femininos/epidemiologia , Neoplasias dos Genitais Femininos/patologia , Neoplasias dos Genitais Femininos/cirurgia , Procedimentos Cirúrgicos em Ginecologia/efeitos adversos , Procedimentos Cirúrgicos em Ginecologia/estatística & dados numéricos , Humanos , Histerectomia/métodos , Metanálise como Assunto , Tecido Nervoso/patologia , Tratamentos com Preservação do Órgão/efeitos adversos , Tratamentos com Preservação do Órgão/estatística & dados numéricos , Período Pós-Operatório , Estudos Prospectivos , Revisões Sistemáticas como Assunto
20.
Int J Gynecol Cancer ; 31(6): 914-919, 2021 06.
Artigo em Inglês | MEDLINE | ID: mdl-33020205

RESUMO

The SARS-CoV-2 (COVID-19) pandemic has significantly impacted the management of patients with gynecologic cancers. Many centers have reduced access to routine visits to avoid crowded waiting areas and specially to reduce the infection risk for oncologic patients. The goal of this review is to propose a surveillance algorithm for patients with gynecologic cancers during the COVID-19 pandemic based on existing evidence and established guidelines. It is time to consider strategies based on telemedicine and to adapt protocols in this new era. We hereby propose a strategy for routine surveillance both during and beyond the pandemic.


Assuntos
COVID-19/epidemiologia , Neoplasias dos Genitais Femininos/epidemiologia , Telemedicina/métodos , Algoritmos , Feminino , Neoplasias dos Genitais Femininos/diagnóstico , Neoplasias dos Genitais Femininos/terapia , Humanos , SARS-CoV-2/isolamento & purificação
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