Donald E. Marsden

Outcome and Patterns of Recurrence for International Federation of Gynecology and Obstetrics (FIGO) Stages I and II Squamous Cell Vulvar Cancer

OBJECTIVE: To study patterns of recurrence, to evaluate pathologic features correlating with recurrence, and to estimate the prognostic implications for each different pattern of recurrence in the International Federation of Gynecology and Obstetrics (FIGO) stages I and II squamous cell vulvar cancer. METHODS: This was a retrospective study of 121 cases of vulvar cancer managed at our institution from 1987 to 2005. Time to recurrence, sites of local and distant recurrence, and the type of surgery were recorded. Relapse-free and overall survival were calculated. RESULTS: There was no difference in recurrence rates, time to recurrence, or survival between patients with FIGO stages I or II disease. The 5-year actuarial survival (corrected for competing risks) for stage I disease was 97% compared with 95% for stage II (P=.83). Progression-free survival at 5 years was 86% for stage I and 94% for stage II. In this study, 95.9% of patients were treated with vulvar-conserving surgery without detriment with respect to recurrence or survival. CONCLUSION: Vulvar-conserving surgery, even for large tumors, results in excellent outcomes. Vulvar recurrences have an excellent prognosis, but primary site and remote site vulvar recurrences are biologically different. There is no justification for the FIGO differentiation of node-negative cancers confined to the vulva on the basis of tumor size. LEVEL OF EVIDENCE: III

Current management of epithelial ovarian carcinoma: A review

Epithelial carcinoma of the ovary is the most lethal of gynaecological malignancies and it affects about one in 70 women in developed countries. Over 75% of women with the disease have tumour spread beyond the pelvis at the time of diagnosis, and their treatment requires the appropriate use of surgery and chemotherapy. The strategies used in the treatment of ovarian cancer are constantly evolving. An overview of current treatment regimens and their evolution is provided, with particular emphasis on the interdependence of surgery and chemotherapy in the optimal management of the disease.

Prognostic Importance of Preoperative CA-125 in International Federation of Gynecology and Obstetrics Stage I Epithelial Ovarian Cancer: An Australian Multicenter Study

PURPOSE To evaluate the prognostic significance of preoperative CA-125 levels on overall survival of patients with International Federation of Gynecology and Obstetrics (FIGO) stage I epithelial ovarian cancer (EOC). PATIENTS AND METHODS Data from 518 patients with FIGO stage I EOC treated in seven gynecologic oncology centers throughout Australia between 1990 and 2002 were analyzed. Patients with borderline tumors and nonepithelial ovarian carcinomas were excluded, as were women in whom CA-125 had not been determined preoperatively. Preoperative CA-125 levels were studied in surgically staged and incompletely staged patients and compared with prognostic factors, such as substage, grade, and histologic type. Multivariate Cox models were calculated. RESULTS CA-125 levels more than 30 U/mL were associated with higher grade, substage 1B and 1C, nonmucinous histologic type, and older age. In univariate analysis, higher histologic grade, the absence of surgical staging, and preoperative CA-125 levels more than 30 U/mL were associated with impaired survival. Multivariate analysis identified histologic grade, preoperative CA-125, and surgical staging as independent predictors for survival. In the subgroup of completely surgically staged patients, the 5-year overall survival rate was 82% (95% CI, 76% to 88%) for patients with CA-125 levels more than 30 U/mL and 95% (95% CI, 90% to 99%) for patients with CA-125 levels of 30 U/mL or less (P = .028). In the group of incompletely staged patients, the 5-year survival rates were similar for patients with elevated and normal serum CA-125 levels. CONCLUSION Complete surgical staging, histologic grade, and preoperative serum CA-125 levels are independent prognostic factors and should be included in the decision making for chemotherapy.

Presenting symptoms of epithelial ovarian cancer

Objectives: Epithelial ovarian cancer is a common disease with a high mortality, the latter being frequently attributed to late diagnosis due to failure to recognise symptoms of early disease. This study was designed to determine any differences in symptomatology between patients with early and advanced stage disease.

Triage of ovarian masses

Background: Triage of ovarian masses for appropriate management is important in ensuring the best outcome for patients. The Risk of Malignancy Indices (RMI) seem to represent a low cost and effective tool for triage and management of women with ovarian masses.

CONTEMPORARY MANAGEMENT OF PRIMARY CARCINOMA OF THE VULVA

Over the last 100 years the treatment of vulvar cancer has evolved dramatically. The adoption of radical surgical approaches brought high cure rates, but often with very significant physical and psychosexual morbidity. In the last 20 years, there has been an increasing emphasis on conservative and multimodality treatment. There is, however, good evidence that optimal outcomes are dependent on treatment in specialized multidisciplinary tertiary referral centers.

Squamous carcinoma arising in a grafted donor kidney presenting as high-grade atypia on routine Pap cytology

A discrepancy between abnormal Papanicoloau (Pap) cervical cytology and the histology of colposcopically-directed biopsy occurs in 10–20% of cases. Biopsies less dysplastic than high-grade appearances on cytology predict are most commonly caused by sampling error, although other causes might occur. One important source of error is the presence of a malignant or premalignant lesion remote from the cervix, usually in the vagina. We report a case where abnormal Pap cytology has arisen from the carcinoma of a renal transplant.