D.A. Boyes

Clinical and pathological features and survival of endometrial cancer patients in relation to prior use of estrogens

Abstract Routine clinical histories taken at admission, and confirmed by letters to the referring physician, showed that of 494 patients with newly diagnosed primary endometrial cancer seen between 1968 and 1972 at the major treatment center in British Columbia, 25% had used conjugated estrogens and 2% other forms of estrogens. Compared to nonusers, estrogen users had tumors which were lower staged, less deeply invasive, better differentiated, and more frequently accompanied by hyperplasia or adenomyosis. Estrogen users were younger at diagnosis, of lower parity and lower weight, and of higher socioeconomic status. Menstrual history and presenting symptoms were similar in estrogen users and in nonusers. Estrogen users had a significantly higher survival, 5-year relative survival being 94% in users and 81% in nonusers. This difference is due to the better staging and differentiation in estrogen users. We estimate that due to the improved survival, no increase in mortality from endometrial cancer will be produced unless estrogen users have an incidence rate more than 2.5 times that of nonusers.

Radical hysterectomy in the treatment of cervical cancer

Two hundred and forty-one patients were treated with radical hysterectomy at our institution between 1949 and December, 1978. The corrected 5-year survival rate for all patients with squamous cell carcinoma of the cervix was 73%. Seventeen percent of patients with occult invasive carcinoma had positive lymph nodes at the time of operation. The corrected 5-year survival rate for patients with Stage IB carcinoma who had positive nodes was 66%. Operations for recurrent or persistent disease after radiotherapy resulted in a 5-year survival rate of 54%. Current indications for radical hysterectomy and lymphadenectomy at our center are discussed.

Radiation treatment of carcinoma of the vulva, 1950–1980

A retrospective study of all patients with carcinoma of the vulva treated by radiation therapy at the A. Maxwell Evans Clinic of the Cancer Control Agency of British Columbia, between 1950 and 1980, is reported. Sixty-eight patients, representing 30% of all referred patients with vulvar cancer, were analyzed for survival, recurrence patterns, complications, and clinical features. This group is companion to a series of patients treated with operation reported in 1979. The data confirm a major role for radiation therapy both in palliation and in combined radiotherapy-operation. For 13 cases, radiotherapy with curative intent was used in combination with operation resulting in a 5-year actuarial survival of 92%, with acceptable posttreatment morbidity. The advantages of preoperative radiotherapy, particularly for posterior vulvar lesions, are suggested by the data, and the need for a reappraisal of the role of radiotherapy in vulvar carcinoma is stressed.

Recent results from the British Columbia screening program for cervical cancer

IN THE PROVINCE of British Columbia, there has been a screening program for cervical cancer operating since 1949. It has been slowly increasing its coverage through the years and, in 1974, approximately 440,000 specimens were examined from 775,400 women over 20 years of age. Approximately 2,000 smears per day are now being processed in the one central screening laboratory. Data have been published from the program in the pasF3 and, as there have been many requests for recent data, it was thought appropriate to prepare several tables for publication. Table I shows the incidence of clinical squamous carcinoma in the Province since 1955 in women over 20 years of age. It can be seen that while the population has increased, the number of clinical squamous carcinomas has decreased steadily and is now at 8.6 per 100,000 women over 20 years of age. Approximately one third of the female population in the Province is under 20 years of age. The converted ratio for the female population is approximately 5.7 per 100,000. Table II shows the crude and refined mortality rates, again for women over 20 years of age, for squamous carcinoma of the uterine cervix. The difference between the crude and refined rate is that patients who

COLPOSCOPIC EVALUATION OF PREGNANT PATIENTS WITH ABNORMAL CERVICAL SMEARS

Colposcopic examination and biopsy were used to assess 123 pregnant patients presenting with abnormal cervical smears. Eighty‐seven per cent were 30 years of age or less and 95 (77 per cent) had had one or no previous children. Two patients were found to have microinvasive carcinoma and, in an additional 95 patients, either severe dysplasia or carcinoma in situ was present. Fifty‐five patients (45 per cent) had subsequent conization or hysterectomy and in no instance was the histological diagnosis more serious than that anticipated from the colposcopic evaluation. Only three patients (1·6 per cent) had a cone biopsy during pregnancy; only one minor complication occurred. Colposcopic examination is the choice method of evaluating patients with abnormal cervical smears in pregnancy.

Carcinoma of the cervix in an infant

Abstract 1. 1. The literature pertaining to carcinoma of the cervix occurring in infants under 1 year of age is reviewed. 2. 2. To date it is believed that only 5 cases have been reported. 3. 3. The case history of an 11-month-old infant who had an adenocarcinoma of the cervix is presented. 4. 4. Carcinoma of the cervix in children under 15 years of age has, in all recorded cases, been adenocarcinoma in type.

Experience with Cervical Screening in British Columbia

Abstract The screening project for cervical cancer in the province of British Columbia has been associated with a drop in incidence of clinical squamous carcinoma in women over the age of 20 of 75%, and a drop in mortality of close to 66%. The whole population rates for this disease were approximately 5.1100,000 for incidence and 2.5100,000 for mortality in 1977. It is our view at this time then that the worth of screening for cancer of the cervix by means of Papanicolaou smear has been established. We believe that colposcopy is a useful addition to a screening program, that the service must be set up with great care because of the shift in the responsibility from the pathologist to the colposcopist. The introduction of colposcopy does cause a change in pathological interpretation and in cancer registry data that are significant. In our province, data collected prior to 1974 cannot be collated with data produced after the introduction of colposcopy.

Treatment of early cervical neoplasia: Definition and management of preclinical invasive carcinoma

Abstract The treatment and follow-up of 360 cases of in situ carcinoma of the cervix with microscopi foci of invasion and 390 cases of occult invasion are shown. A significant number of cases have been followed for 15 years. Cases with microscopi foci of invasion have been treated in much the same manner as in situ carcinoma and have about the same prognosis. Cases with occult invasion have a significant mortality and must be treated radically. The presence of lymphatic permeation in the biopsy worsens the prognosis.

Plasma β-subunit human chorionic gonadotropin assay in molar pregnancy and choriocarcinoma

Serum plasma levels of the beta-subunit of human chorionic gonadotropin (HCG-beta) were measured by radioimmunoassay in 24 women with molar pregnancies and five with choriocarcinoma. In the patients with molar pregnancy, plasma HCG-beta concentrations became undetectable within 8 to 173 days. In the patients with choriocarcinoma, plasma HCG-beta levels declined rapidly with appropriate chemotherapy. Serial plasma HCG-beta assay in this series accurately determined remission and detected early recurrences during follow-up. All patients are in remission with a mean follow-up of 22 months for the patients with choriocarcinoma.

Experience with dysgerminomas at the Cancer Control Agency of British Columbia

Abstract Twenty-five cases of ovarian dysgerminoma are reviewed. Most commonly the tumor occurred in the younger age group. Four tumors were found during pregnancy. In seven patients metastases occurred; only two of these have died of dysgerminoma. Corrected 5-year survival is 91%. Treatment consisting of surgery and radiation appears to give best results. Chemotherapy is of benefit in some cases. Results are discussed and current treatment policy at CCABC is presented.