Cancer during pregnancy: 10-year experience at a regional cancer reference center in Mexico.

INTRODUCTION: Cancer during pregnancy is uncommon. However, recent trends in the prolongation of the childbearing age have made cancer-associated pregnancies more frequent. The objective of our study was to describe the frequency, types of cancer, and treatment with this association in our institution. MATERIAL AND METHODS: The clinical records of 36 patients who presented to a regional reference center in Mexico over 10 years were reviewed collecting demographics, pregnancy characteristics and outcomes, type of cancer, clinical stage, treatment, and oncological outcome. RESULTS: The following tumors were observed: Uterine cervix (20), breast (7), ovary (3), non-Hodgkin Lymphoma (2), and other malignancies (4). The mean age of the patients was 30 (range 20-39) years. Mean follow up was 17.8 (range 1-74) months. The pregnancies were synchronous in 23 cases and 13 were diagnosed in the following 12 months after birth. Mean gestational age of the product was of 37.4 weeks, resulting in 15 deliveries with healthy products, four abortions and four deaths. The majority of patients had advanced clinical stages. Overall survival was 36.4%. DISCUSSION: Cancer during pregnancy appears to have a worse outcome when compared to the results reported in the literature of non-pregnant women with the same conditions. This may be related to the advanced clinical stages we found. Cancer during pregnancy requires specialized attention to improve both fetal and maternal outcomes.

Cancer during pregnancy: 10-year experience at a regional cancer reference center in Mexico.

INTRODUCTION: Cancer during pregnancy is uncommon. However, recent trends in the prolongation of the childbearing age have made cancer-associated pregnancies more frequent. The objective of our study was to describe the frequency, types of cancer, and treatment with this association in our institution. MATERIAL AND METHODS: The clinical records of 36 patients, who presented to a regional reference center in Mexico over 10 years were reviewed collecting demographics, pregnancy characteristics and outcomes, type of cancer, clinical stage, treatment, and oncological outcome. RESULTS: The following tumors were observed: Uterine cervix (20), breast (7), ovary (3), non-Hodgkin Lymphoma (2), and other malignancies (4). The mean age of the patients was 30 (range 20-39) years. Mean follow up was 17.8 (range 1-74) months. The pregnancies were synchronous in 23 cases and 13 were diagnosed in the following 12 months after birth. Mean gestational age of the product was of 37.4 weeks, resulting in 15 deliveries with healthy products, four abortions, and four deaths. The majority of patients had advanced clinical stages. Overall survival was 36.4%. DISCUSSION: Cancer during pregnancy appears to have a worse outcome when compared to the results reported in the literature of non-pregnant women with the same conditions. This may be related to the advanced clinical stages we found. Cancer during pregnancy requires specialized attention to improve both fetal and maternal outcomes.

Pelvic exenteration for recurrent or persistent cervical cancer: experience of five years at the National Cancer Institute in Mexico.

Cervical cancer constitutes a major health problem in Mexico and other developing countries. The purpose of our study was to assess the experience of a comprehensive national oncological reference center on pelvic exenteration for post-radiotherapy recurrent or persistent cervical cancer, describing the prognostic value of time to recurrence, procedure complications, and survival. Medical records from 42 patients with post-radiotherapy recurrent or persistent cervical cancer who underwent a pelvic exenteration with curative purposes from 1984 to 1989 were retrospectively reviewed. Histological diagnoses were squamous cell carcinoma (32 patients), adenosquamous carcinoma (9 patients), and adenocarcinoma (1 patient). Average follow up was of 56.3 mo after the procedure and global survival at 5 yr was 65.8%. Survival for patients with early recurrence was 56.9% vs 78% for patients with late recurrence (p = 0.05). Complications were observed in 65.3% of the cases with a surgical mortality of 4.8%. Pelvic exenteration is a surgical procedure with high morbidity in spite of the recent medical advances. Pelvic exenteration should not be indicated with palliative purposes owing to the high rate of complications. Patients with tumor persistence or early recurrence have a worse prognosis. In well-selected cases, exenteration may provide a survival benefit.

A descriptive study of second primary malignancies associated to breast cancer in a mexican Hispanic population.

Breast cancer is the second most frequent tumor in Mexico. Patients diagnosed with this cancer have a higher risk of developing a second malignancy. The objective of our study was to see the frequency, types of second cancers, and its impact on survival, in order to be able to deliver a proper and efficient follow up to these patients, because our patients differ from the population of breast cancer in the rest of the world. Our patients are younger and therefore at higher risk. The clinical records of breast cancer patients treated at the Instituto Nacional de Cancerologia Mexico from 1983 to 1992 were reviewed. In 1370 evaluable patients, 77 (5.6%) developed a second neoplasm, of those, 56 (72.7%) in the contralateral breast and 21 in other sites (27.3%), thyroid was the most frequent followed by ovary and endometrium. Mean age of the patients was 51.5 yr, 45.5 for the other breast and 55.5 for other malignancies (p = 0.01). Median survival for all the group was of 180 mo (3-238). Patients were significantly younger in the contralateral breast group, although all our breast cancer patients are younger. The most frequent second malignancy after the other breast, was thyroid followed by ovary and endometrium with similar survival for both groups.

Membrane proteins in neoplasic and normal uterine cervix.

Tumor cells exhibit phenotypic and genotypic differences in comparison to normal cells. These differences can be used to identify proteins important for tumor growth and, therefore, potentially used in the diagnosis and follow-up of patients. The objective of this work was to investigate the electrophoretic pattern of cytoplasm membrane proteins from normal and malignant cervix using polyacrylamide-SDS gels. A highly reproducible protein pattern was found in the 29 samples of normal cervix whereas three well-defined patterns of protein bands were observed in the 48 tumor specimens (pattern I: 25%, pattern II: 29.2% and pattern III: 45.8%). A low concentration or absence of high molecular weight proteins was observed (p<0.5) in tumor samples. None of the tumor protein patterns correlated with the clinicopathologic characteristics of patients. Nine out of 11 patients (82%) showing the pattern III had a complete clinical response whereas only 55% (11 out of 20) of those with patterns I and II showed a complete response. However, this difference was non-significant (p=0.1247). In conclusion, we demonstrate that there is a gain and loss of cytoplasmic membrane proteins in tumors, shown as different protein band patterns. These findings could have clinical and biological significance that must be further evaluated.

Helicobacter pylori and lymphoid follicles in primary gastric MALT-lymphoma in Mexico.

We reviewed our cases of gastric MALT-lymphomas over a 12-year period at a national oncological referral center, the Instituto Nacional de Cancerología in Mexico City, looking for morphological evidence of Helicobacter pylori infection near the primary neoplasia. H pylori as well as lymphoid follicles and chronic active gastritis were carefully searched for in the adjacent mucosa. There were 23 (85%) low-grade and four (15%) high-grade MALT-lymphomas. H pylori microorganisms were found adjacent to the neoplasia in 23 cases (85%; CI 95% = 72-99%) but the lymphoid follicles were seen in 15 of 23 (65%; CI = 56-74%). Chronic active gastritis was present in 25 cases (93%; Cl = 90-95%). There was a close association between H pylori and gastric MALT-lymphoma. Lymphoid follicles were a reliable indicator of infection and the claimed pathophysiological substrate for MALT-lymphoma. We conclude that patients in whom gastric lymphoid follicles are detected, must remain under clinical follow-up since H pylori is a plausible promoter of neoplastic transformation.

[Expression of cathepsin D in breast cancer and its clinical and histopathological correlations]. / Expresión de catepsina D en carcinoma mamario y sus correlaciones clínicas e histopatológicas.

BACKGROUND: Cathepsin D is a lysosomal protease which is overexpressed in some cases of breast cancer. Several studies done in tumor cytosol have shown that high levels of cathepsin D are associated with poor prognosis in patients with breast cancer but the results are not conclusive using immunohistochemistry methods to assay cathepsin D. OBJECTIVE: To evaluate if cathepsin D, assayed by a immunohistochemical technique using a polyclonal antibody, can be considered an independent prognostic factor in breast cancer. PATIENTS AND METHODS: Paraffine embedded sections of 68 tumor specimens from breast cancer patients in stages I to IV seen at the Instituto Nacional de Cancerologia during the period from 1985 to 1986. RESULTS: From the 68 patients, 35 (51%) had an intense positive staining for cathepsin D, 19 (28%) han mild staining and 14 (21%) were negative. Ten patients with mild staining had artifacts due to deficiencies in the tissue fixation technique. Cathepsin D expression did not have a prognostic value nor association with other clinical and histopathological prognostic factors well established in breast cancer. CONCLUSION: Cathepsin D determined by immunohistochemistry has no prognostic value in breast cancer.

[Prognostic factors in breast cancer with contralateral supraclavicular or axillary lymphatic metastases]. / Factores pronósticos en cáncer de mama con metástasis a ganglios supraclaviculares o axila contralateral.

OBJECTIVE: To evaluate prognostic factor differences between surviving and decreased breast cancer patients in clinical stage IV with supraclavicular or contralateral axilla metastasis when first seen. METHODS: From the clinical records of 13 years (1975-88) two groups of ten patients each were obtained. Group 1 were women alive and free of disease for more than five years. Group 2 had similar characteristics but had died of the disease. In both groups clinical data were evaluated (age, menstrual status and survival); from slides the histologic factors like tumor size, nodal status, fibrosis percentage, inflammatory infiltrate, nuclear grade and necrosis were evaluated; immunohistochemistry of CD34 for angiogenesis, cathepsin D, p53 antioncogen, c-erb-B2 oncogen, epidermic growth factor, estrogen and progesterone receptors and cellular kinetics were performed; Kaplan Meier survival curves were constructed for the factors showing intergroup differences. RESULTS: The factors associated to the living patients were: low inflammatory infiltrate (p = 0.001), low fibrosis (p = 0.007), lower p53 expression (p = 0.03) and positive estrogen receptor (p = 0.03); other factors were marginally associated: positive progesterone receptor (p = 0.07) and having less than 6 positive lymph nodes (p = 0.07).

Intraoperative touch imprint cytology of sentinel lymph nodes in breast cancer: experience at a tertiary care center in Mexico.

BACKGROUND: Sentinel lymph node (SLN) biopsy in patients with breast cancer has emerged as a conservative and promising procedure. One of the most important issues is the intraoperative evaluation of the SLN with a high degree of accuracy by frozen section and/or imprint cytology. The objective of this study was to test the ability of intraoperative touch imprint cytology (ITIC) to predict metastasis on SLN. METHODS: SLNs were freshly examined, bisected in <0.5 cm or serially sectioned at 2 mm intervals on the long axis. Each surface of the section was touched on the glass slide, and stained. Results of ITIC were compared with permanent sections. Sensitivity (Se), specificity (Sp), positive predictive value (PPV), negative predictive value (NPV), and accuracy (Acc) were calculated. False negatives were reviewed. RESULTS: We analyzed 179 SLN from 110 patients. The comparison between ITIC and final results of the SLN showed 139 (77.6%) true negative imprints, and 28 (15.6%) true positive. There were 12 (6.70%) false negative (FN) imprints which included 6 macrometastases, 3 micrometastases, and 3 isolated tumor cells. Re-screening after the definitive results of false negative imprints showed again 10 negative imprints, one with two groups of cells and one with multiple groups of cells. The overall Se was 70% (73.6% for micro/macrometastases and 82.3% for macrometastases), Sp and PPV were 100% in all cases. NPV was 92.1% overall (93.4% micro/macrometastases and 96% in macrometastases).Global accuracy was 93.3% (94.4% for micro/macrometastases and 96% for in macrometastases). CONCLUSIONS: ITIC is excellent to detect macrometastases, however, it fails to detect micrometastases. False negative imprints for macrometastases are mainly due to sampling error. The immediate availability, low cost, high Sp, PPV, preservation of the lymph node for histopathologic examination, avoiding of a second surgery are the major advantages of intraoperative evaluation of SLN.