RESUMO
Cancer in pregnancy requires the careful consideration of multiple complex issues to achieve the most favorable outcome for mother and fetus. Presented are the principles of surgery, radiation, and chemotherapy as they pertain to pregnancy, and a discussion of site-specific cancers.
Assuntos
Neoplasias dos Genitais Femininos/terapia , Complicações Neoplásicas na Gravidez/terapia , Neoplasias da Mama/terapia , Carcinoma/terapia , Feminino , Feto/efeitos dos fármacos , Feto/efeitos da radiação , Neoplasias Gastrointestinais/terapia , Neoplasias dos Genitais Femininos/tratamento farmacológico , Neoplasias dos Genitais Femininos/radioterapia , Neoplasias dos Genitais Femininos/cirurgia , Humanos , Leucemia/terapia , Linfoma/terapia , Neoplasias Ovarianas/terapia , Gravidez , Complicações Neoplásicas na Gravidez/tratamento farmacológico , Complicações Neoplásicas na Gravidez/radioterapia , Complicações Neoplásicas na Gravidez/cirurgia , Resultado da Gravidez , Neoplasias da Glândula Tireoide/terapia , Resultado do Tratamento , Neoplasias do Colo do Útero/terapiaRESUMO
Details of surgical removal of invasive breast cancer do not govern survival or cure. They do, however, control local recurrence rates and regional recurrence risk. The surgeon's role in breast cancer in the new millennium is to produce a cosmetic and functional result that is as good as possibly can be achieved while minimizing recurrence. Guidelines for incision placement, tissue volume removal, and nodal removal are critical determinants of cosmetic and functional outcome and need to be appreciated by surgeons.
Assuntos
Neoplasias da Mama/cirurgia , Mastectomia/métodos , Papel do Médico , Biópsia/métodos , Neoplasias da Mama/mortalidade , Análise Custo-Benefício , Feminino , Humanos , Mastectomia/efeitos adversos , Mastectomia/economia , Mastectomia/normas , Guias de Prática Clínica como Assunto , Radioterapia Adjuvante/economia , Radioterapia Adjuvante/normas , Análise de Sobrevida , Resultado do TratamentoRESUMO
The Breast Health Center, a component of the program in Women's Oncology at Women & Infants Hospital, is a multidisciplinary center devoted to the treatment and study of benign and malignant breast diseases. The philosophy, structure, and function of The Breast Health Center are described along with its specific components. The Breast Health Center's three fundamental missions of patient care, education, and research are discussed.
Assuntos
Doenças Mamárias/terapia , Neoplasias da Mama , Hospitais Especializados/organização & administração , Serviço Hospitalar de Oncologia/organização & administração , Política Organizacional , Serviços de Saúde da Mulher/organização & administração , Biópsia , Doenças Mamárias/diagnóstico , Neoplasias da Mama/diagnóstico , Neoplasias da Mama/prevenção & controle , Neoplasias da Mama/terapia , Feminino , Hospitais Pediátricos/organização & administração , Humanos , Guias de Prática Clínica como Assunto , Rhode Island , Fatores de Risco , TelemedicinaRESUMO
OBJECTIVE: To analyze a group of 22 patients with synchronous endometrioid tumors of the ovary and endometrium. STUDY DESIGN: A retrospective chart review was undertaken and information collected on patient age, parity, tumor grade and stage, presence of coexisting endometriosis and survival. Flow cytometry was determined from archival samples of the endometrial and ovarian tumors. RESULTS: The mean age at diagnosis was 52.8 years (range 36-71); mean parity was 1.05. With regard to the endometrial component, 68.2% were grade 1, 63.6% were stage I and, by flow cytometry, 62.5% were aneuploid. With regard to the ovarian lesions, 68.2% were grade 1, 68.2% were stage I, and 71.4% were aneuploid by flow cytometry. Twelve (54.5%) of 22 patients had pathologic evidence of coexisting endometriosis. Overall, three-year survival was 75%. All 11 patients with stage I disease at both sites were alive, without disease, at a mean follow-up of 34.9 months. CONCLUSION: Patients with synchronous endometrioid tumors of the endometrium and ovary are generally younger than reported for either endometrial adenocarcinomas or ovarian epithelial adenocarcinomas. They tend to be low grade and early stage and are frequently associated with endometriosis. Our data suggest that the survival of patients with synchronous primaries correlates with the stage of the individual tumors and that a second, synchronous primary does not adversely affect prognosis.
Assuntos
Adenocarcinoma/patologia , Adenoma/patologia , Neoplasias do Endométrio/patologia , Neoplasias Ovarianas/patologia , Adenocarcinoma/epidemiologia , Adenocarcinoma/mortalidade , Adenoma/epidemiologia , Adenoma/mortalidade , Adulto , Idoso , DNA de Neoplasias/análise , Neoplasias do Endométrio/epidemiologia , Neoplasias do Endométrio/etiologia , Endometriose/complicações , Feminino , Citometria de Fluxo , Humanos , Incidência , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Neoplasias Ovarianas/epidemiologia , Neoplasias Ovarianas/etiologia , Prognóstico , Estudos Retrospectivos , Taxa de Sobrevida , Fatores de TempoRESUMO
BACKGROUND: Ureteroarterial fistula (UAF) is a rare occurrence. It can be difficult to diagnose with a high mortality. We report a case of a recurrent UAF. CASE: A 38-year-old women diagnosed with cervical cancer had undergone pelvic exenteration for severe radiation-induced necrosis with a vesicovaginal and rectovaginal fistula after primary radiation therapy. Hemorrhage into the urinary tract necessitated surgical intervention and vascular repair with a femoral-femoral bypass. Although these measures were effective, the patient died 6 months later following an acute hemorrhage into her conduit. Arteriogram revealed a second UAF. CONCLUSION: When urinary tract bleeding occurs in patients previously diagnosed with a gynecologic malignancy and treated with radiation therapy and extensive surgery with urinary diversion, UAF should be considered in the differential diagnoses.
Assuntos
Carcinoma de Células Escamosas/cirurgia , Artéria Ilíaca/patologia , Exenteração Pélvica/efeitos adversos , Doenças Ureterais/etiologia , Fístula Urinária/etiologia , Neoplasias do Colo do Útero/cirurgia , Adulto , Carcinoma de Células Escamosas/radioterapia , Evolução Fatal , Feminino , Humanos , Artéria Ilíaca/diagnóstico por imagem , Necrose , Recidiva Local de Neoplasia , Lesões por Radiação/cirurgia , Radiografia , Doenças Ureterais/diagnóstico por imagem , Fístula Urinária/diagnóstico por imagem , Neoplasias do Colo do Útero/radioterapiaRESUMO
This study was undertaken to examine the incidence and conditions under which lymph node metastases are present and patterns of recurrence in women with uterine leiomyosarcoma (LMS) and endometrial stromal sarcoma (ESS), excluding malignant mixed mesodermal tumors. From 1981 through 1991, 21 women with LMS and 10 women with ESS were treated. Retroperitoneal lymph node dissections were performed in 15 women with LMS and 7 women with ESS. In the women with LMS, 4/15 (26.7%) had lymph node metastases; in each there was disseminated intra-abdominal disease. In the 7 women with ESS, there were no lymph node metastases present. Ten women (47%) with LMS developed recurrences, and 3 (14%) had persistent disease. In the 10 women with ESS, 3 (30%) had recurrences, and 1 (10%) had persistent disease. In total, recurrences involved the lung in 84% of cases. Of the 13 women with recurrences, 7 had undergone lymph node sampling, and all were negative; 4 additional women had no evidence of adenopathy on abdominal-pelvic CT scan. Lymph node metastases were found only with extrauterine disease, and in all of these cases there was rapid progression of the sarcoma. Women without extrauterine disease did not have lymph node metastases detected; however, there was still a high rate (40%) of distant failure. Knowledge of lymph node status had minimal impact on the clinical management of women with uterine LMS and ESS.
Assuntos
Neoplasias do Endométrio/patologia , Leiomiossarcoma/patologia , Metástase Linfática , Recidiva Local de Neoplasia , Sarcoma/patologia , Neoplasias Uterinas/patologia , Adulto , Idoso , Neoplasias do Endométrio/terapia , Feminino , Humanos , Leiomiossarcoma/terapia , Linfonodos/patologia , Pessoa de Meia-Idade , Prognóstico , Sarcoma/terapia , Neoplasias Uterinas/terapiaRESUMO
OBJECTIVE: Our aim was to determine the value of the S-phase fraction, p53, and HER-2/neu status as predictors of inguinal nodal metastasis in early vulvar cancer. METHODS: The charts of 100 consecutive patients with invasive squamous cell cancer of the vulva were reviewed and a cohort of patients with clinical stage I or II disease treated primarily with radical surgery and inguinal node dissection was identified. Within this cohort, all node-positive patients were matched with node-negative controls by depth of invasion. Tumor from the 13 node-positive patients and 26 controls was then analyzed by flow cytometry and immunohistochemistry. RESULTS: The median value of the S-phase fraction was higher in tumor from patients with inguinal nodal metastasis (median, 18.2; 25th-75th percentile: 13.9-28.3) than in node-negative patients (median, 8.9; 25th-75th percentile: 5.4-15.6) (P = 0.01). The presence of the HER-2/neu immunopositivity was also found to be associated with nodal metastasis (OR 4.05, 95% CI 1.0-16.6), but we found no evidence that DNA index or the presence of p53 immunopositivity was associated with nodal metastasis. CONCLUSION: Early vulvar cancer patients with inguinal node metastasis have a significantly higher S-phase fraction and are more likely to have HER-2/neu immunopositivity when compared to those without nodal metastasis.