Anca C. Ansink

Recurrent Stage IB cervical carcinoma: evaluation of the effectiveness of routine follow up surveillance

Objective To study the effectiveness of follow up surveillance in detecting recurrent disease following radical hysterectomy for Stage IB cervical carcinoma.

Recurrent cervical cancer: detection and prognosis

Background.u2003 Only a small proportion of cervical cancer recurrences is detected during routine follow‐up. We investigated which percentage of recurrences is detected during follow‐up, which diagnostic tools are helpful to detect recurrent disease and which factors are of prognostic significance once recurrent disease has been established in patients treated for cervical cancer stage IB–IVA.

The hormonal receptor status of uterine carcinosarcomas (mixed müllerian tumours): an immunohistochemical study.

AIM: To investigate the role of oestrogen and progesterone receptor status in uterine carcinosarcomas (mixed Müllerian tumours) to see whether the receptors were identifiable, and if so whether they were of significance clinically. METHODS: 11 cases of uterine carcinosarcoma were identified from clinical and pathology records. An immunohistochemical method was used to demonstrate oestrogen and progesterone hormone receptors on paraffin embedded material, with suitable tissue controls, staining being recorded. RESULTS: 10 of 11 cases showed staining for one or both hormone receptors in normal tissue adjacent to tumour. In four carcinosarcoma cases, staining for one or both receptors was shown within the epithelial component (appearing to correlate with the degree of epithelial differentiation); two of these cases had staining within sarcomatous areas. Two of the three patients still alive had epithelial hormone receptor positivity. CONCLUSIONS: Receptors for oestrogen and progesterone were found in four of 11 cases of uterine carcinosarcoma, using paraffin embedded material. There may be an association between hormone receptor positivity and clinical outcome.

Outcome, complications and follow-up in surgically treated squamous cell carcinoma of the vulva 1956–1982

Between 1956 and 1982, 139 patients were surgically treated in the Netherlands Cancer Institute because of a squamous cell carcinoma of the vulva. Eighty-nine of these patients underwent radical vulvectomy and inguinal lymph-node dissection. Five-year survival rates were 91% for stage I, 85% for stage II, 64% for stage III and 33% in stage IV cases. The fact that 5 year survival rates between the group of patients with a more extensive surgical treatment (i.e., inguinal lymph node dissection) and the group of patients only being treated by a vulvar operation were equal, is a remarkable result. Postoperative complication rates were, in conformity with results found elsewhere, high. Only 25% of the patients did not have any early complication at all. The most important early complication was found to be wound infection (52%). Late complications were mostly miction problems (24%) and pelvic relaxation, resulting in cystocele, rectocele and/or descensus uteri (26%). Patients who were treated only by a vulvar operation had significantly less late complications (P = 0.027). The majority of recurrences were observed in the first 2 postoperative years. Patients with a pelvic relapse or with distant metastases could in no case be treated successfully. Inguinal relapses, however, could only be treated with success when primary treatment of the groin had not been given before. Complete remissions were very often accomplished in case of vulvar relapse and second, third, or fourth relapses on the vulva. Ten percent of all the patients still alive 5 years after primary treatment had a relapse as yet, or more likely, a second vulvar carcinoma.(ABSTRACT TRUNCATED AT 250 WORDS)

Cytokeratin subtypes and involucrin in squamous cell carcinoma of the vulva. An immunohistochemical study of 41 cases

Background. Histologic grade seems to be of limited prognostic significance in patients with vulvar carcinoma. However, the study of cytokeratin expression is of potential interest because it allows a more precise evaluation of the degree of squamous differentiation. This study was was conducted to investigate whether differences in cytokeratin expression exist between normal vulvar epithelium and vulvar carcinoma and whether these differences are prognostically significant.

Optimal treatment of premature ovarian failure after treatment for Hodgkin's lymphoma is often withheld.

Background. The purpose of this study is to determine: 1. the effect of treatment for Hodgkins lymphoma on ovarian function, and 2. the interventions to relieve postmenopausal symptoms. Methods. Seventy‐seven consecutive patients treated between 1989 and 2003 in the Rotterdam region for Hodgkins lymphoma stages I and II were approached for this study. A questionnaire consisting of 45 questions was carried out to evaluate premature menopausal symptoms, hormonal replacement therapy and use of contraception, menstrual cycle, and subsequent pregnancies. Results. After informed consent 67 patients were willing to participate in the study and 66 patients filled in a questionnaire. After antitumor treatment 13 patients developed treatment‐related premature ovarian failure, 35 patients had a spontaneous cycle, and 18 patients could not be classified as they used hormonal contraception. Women who developed treatment‐related premature ovarian failure had a significantly higher mean age at the start of treatment for Hodgkins lymphoma than women who remained premenopausal (p<0.002). Only 6 of these 13 women (46%) received hormonal substitution. In all, 21 women conceived after antitumor treatment, and 28 children were born. All pregnancies were the result of spontaneous conception. Conclusions. The effect of antitumor treatment for Hodgkins lymphoma on ovarian function is age dependent (odds ratio of 1.18 per year). There is a striking inconsistency regarding the management of ovarian protection before and during antitumor treatment. Premenopausal women who undergo therapy for Hodgkins lymphoma should be offered hormonal substitution therapy after loss of ovarian function.