David Ireland

Role of centralization of surgery in stage IB carcinoma of the cervix: A review of 498 cases

A review was undertaken of 498 patients with stage IB carcinoma of the cervix managed over a 15-year period in the Regional Gynaecological Oncology Centre, Gateshead. All but 4 were treated by radical hysterectomy, with adjuvant radiotherapy and/or chemotherapy for those with involved pelvic nodes. The overall 5-year survival in those with negative nodes was 91.4% compared with 50.5% in those with positive nodes (P less than 0.05). Of those dying from the disease, 7 patients only (1.4%) developed central recurrence, the remainder experiencing pelvic side-wall or distant recurrence. There was no difference in survival related to patient age. There were three deaths related to surgery and a fistula rate of only 1.2%. Bladder hypotonia and lymphocyst affected a minority of patients in the long term. The data support the case for radical surgery in stage IB carcinoma of the cervix, managed on a centralized referral basis.

The management of the patient with abnormal vaginal cytology following hysterectomy

Summary. Thirty‐two patients presenting with abnormal vaginal cytology following hysterectomy were studied. Seven (21·8%) had had hysterectomy for benign conditions whilst 25 (78·1%) had cervical intraepithelial neoplasia (CIN) or invasive cervical carcinoma. Twenty‐five patients had partial or total vaginectomy (15 as the primary procedure), and one required laser treatment following vaginectomy. Of 11 (34·3%) patients treated primarily by laser, five subsequently required vaginectomy because of persistent or recurrent cytological abnormality. All four patients treated with topical 5‐fluorouracil or dinitrochlorobenzene subsequently required surgery. Nine of the 32 patients (28·1%) proved to have invasive carcinoma of the vagina on histological examination of the vaginectomy specimen. At the time of writing all patients in the study are well with no evidence of disease.

Is it time for a reconsideration of the criteria for cone biopsy

Between August 1985 and November 1988, 475 laser cone biopsies were performed at the Regional Gynaecological Oncology Unit in Gateshead. Of these, 332 were performed for abnormal cervical cytology and unsatisfactory colposcopy. The negative cone rate in this group was 34%. In those with cytological abnormalities up to and including mild dyskaryosis the figure was 64% and there were no cases of invasive disease. In this group the authors have reconsidered the criteria for cone biopsy and suggested biopsy of the visible ectocervical lesion combined with endocervical curettage or brushing. Those with negative histology or cytological abnormalities less than moderate dyskaryosis should be managed conservatively.

Mucin production in cervical intraepithelial neoplasia and in stage 1b carcinoma of cervix with pelvic lymph node metastases

Sections from cervical intraepithelial neoplasia (CIN 3) and stage 1b carcinoma of the cervix were stained with periodic acid‐Schiff (PAS) and alcian blue to identify the presence of intracellular mucin. One out of seven specimens of CIN 3 demonstrated intracellular mucin. In a series of 33 patients with stage 1b carcinoma of the cervix with pelvic lymph node metastases, PAS demonstrated intracellular mucin staining patterns that were similar in both tumour and lymph node in most patients. In the subgroup of 23 patients classified as having squamous carcinoma, 8 (35%) demonstrated intracellular mucin to some degree and only 2 (25%) of those 8 were alive after 3 years compared with 13 of the other 15 (87%) who did not show any mucin staining (P>0·01).

Surgical management of advanced ovarian cancer.

Surgery is an essential part of the management of patients presenting with ovarian cancer. Diagnosis, staging, and therapy can be carried out at the time of laparotomy. Unfortunately, the disease often presents at an advanced stage and the outlook for patients is poor with an overall 5-year survival rate of 23%. This review focuses on the surgical management of advanced ovarian cancer and focuses on both primary, secondary, and intervention debulking surgery. Target Audience Obstetrics & Gynecologists, Family Physicians Learning Objectives After completion of this article, the reader will be able to explain the influence of primary cytoreductive surgery on survival in patients with ovarian cancer and to list the various options for patients with ovarian cancer.

The Management of the Patient with Abnormal Vaginal Cytology following Hysterectoms

Thirty-two patients presenting with abnormal vaginal cytology following hysterectomy were studied. Seven (21.8%) had had hysterectomy for benign conditions whilst 25 (78.1%) had cervical intraepithelial neoplasia (CIN) or invasive cervical carcinoma. Twenty-five patients had partial or total vaginectomy (15 as the primary procedure), and one required laser treatment following vaginectomy. Of 11 (34.3%) patients treated primarily by laser, five subsequently required vaginectomy because of persistent or recurrent cytological abnormality. All four patients treated with topical 5-fluorouracil or dinitrochlorobenzene subsequently required surgery. Nine of the 32 patients (28.1%) proved to have invasive carcinoma of the vagina on histological examination of the vaginectomy specimen. At the time of writing all patients in the study are well with no evidence of disease.