Elizabeth Mussey

Factors influencing survival in Stage I ovarian cancer

Abstract A total of 271 patients with Stage I epithelial cancer of the ovary were treated at the Mayo Clinic from 1950 through 1966. Data related to various forms of treatment show that many factors in addition to the stage of the lesion influence survival. Among these are cell type, grade of malignancy, and gross characteristics of the lesion. These factors should be considered in the selection of the proper treatment of the specific lesion. Such individualized treatment should give a highly satisfactory survival.

Carcinoma in situ of the vagina

Abstract Seven cases of carcinoma in situ of the vagina are reported: in 2 the lesions were primary; in 3 the carcinoma in situ of the vagina was related to the carcinoma in situ of the cervix, and in 2 the carcinoma in situ of the vagina was related to an invasive lesion of the cervix. The prevention, evaluation, and management of carcinoma in situ of the vagina are discussed. The value of estrogen given orally prior to the Schiller test in the postmenopausal woman and of a well-designed vaginal radium applicator are emphasized.Abstract Seven cases of carcinoma in situ of the vagina are reported: in 2 the lesions were primary; in 3 the carcinoma in situ of the vagina was related to the carcinoma in situ of the cervix, and in 2 the carcinoma in situ of the vagina was related to an invasive lesion of the cervix. The prevention, evaluation, and management of carcinoma in situ of the vagina are discussed. The value of estrogen given orally prior to the Schiller test in the postmenopausal woman and of a well-designed vaginal radium applicator are emphasized.

Progestogen treatment of recurrent endometrial carcinoma

Postmenopausal women with recurrent or metastatic adenocarcinoma of the endometrium were treated with Delalutin (17-alpha-hydroxyprogesterone caproate), Depo-Provera (6-methyl-17-alpha-hydroxyprogesterone acetate), or Colprone (6,17-dimethyl-6-dehydroprogesterone). Numbers of patients on each medication were 20, 25, and 30, respectively. The regimens of these progestogens were .5-1.0 gm of Delalutin intramuscularly twice (in 1 case thrice) a week; Depo-Provera intramuscularly 100 mg/day for 10-14 days, then 100 mg 3 times a week for 6 weeks, finally 200 mg/month; and Colprone orally at 100 mg/day for Week 1, 200 mg/day for Week 2, 400 mg/day for Week 3, 800 mg/day for Week 4 on, and, with an objective or equivocal response, 400 mg/day as a maintenance dose. 3 months was considered an adequate trial period. Responses were considered objectively present (positive response), equivocal, or absent. Objective responses were 5 with Delalutin, 6 with Depo-Provera, and 7 with Colprone. Responses were absent in 11 Delalutin, 17 Depo-Provera, and 17 Colprone patients. Objective responses occurred with 3 of 39 pelvic masses, 8 of 22 abdominal masses, 6 of 23 vaginal lesions, and 9 of 21 pulmonary metastatic problems. None of the 5 osseous or central nervous system lesions responded to therapy. Results were especially good in patients who had recurrences 3 or more years after primary (nonprogestogen) therapy, patients with low-grade lesions, and those who had pulmonary metastasis. The progestogens produced an objective response rate of 24%. Use of progestogens is recommended after other measures have failed. In an added discussion, 2 physicians report findings similar to the ones in the main article.

Carcinoma in situ of the cervix

Abstract The past 10 years have witnessed an important advance in the attempt to control cancer of the cervix. This is the acceptance of the fact, first recognized more than 30 years ago, that neoplasia of cervical epithelium can be detected microscopically before its potential invasiveness is manifested. The recent literature reflects increasing agreement on this once controversial point of view but indicates that divergent opinions remain concerning proper methods of diagnosis and treatment. The experience of the Mayo Clinic in the management of carcinoma in situ of the cervix dates from 1932 when the diagnosis was made in one patient and the lesion was controlled by the application of radium. Since that time diverse methods of treatment have been used in an ever-increasing number of cases. This study was undertaken to evaluate the appropriateness and adequacy of treatment as well as to delineate certain features of the disease which may be of clinical or pathologic interest.

Menstrual patterns in myxedema

Abstract The menstrual patterns of 50 premenopausal myxedematous women between 16 and 40 years of age were evaluated. Abnormal menstrual patterns occurred in 56 per per of these patients. More than one form of menstrual irregularity was noted in two cases. Menorrhagia and metrorrhagia, alone or combined, constituted the abnormal patterns in 75 per cent of the patients. Amenorrhea occurs infrequently with myxedema. “Occult” menorrhagia should be considered in the evaluation of the patient with thyroid disease.

Microinvasive carcinoma of the cervix: Late results of operative treatment in 91 cases

Abstract Ninety-one cases of carcinoma of the uterine cervix with stromal invasion of 5 mm. or less were reviewed 5 or more years after operation. Metastasis occurred in 2 cases; one of these patients is alive 5 years after Wertheim hysterectomy and pelvic lymphadenectomy and the other died during the sixth year after vaginal hysterectomy. The data yield only equivocal support for the contention that conservative treatment is adequate for all cases of microinvasive carcinoma of the cervix. Simple hysterectomy cures many of the so-called early lesions, including those exhibiting borderline stromal invasion. This treatment is inadequate for a carcinoma with the metastatic potential implied by the presence of tumor cells in vascular spaces. Of less serious import are lesions with definite but limited (3 mm. or less) invasion of the stroma but no discernible invasion of vessels.

Adjuvant therapy for advanced ovarian malignancy.

Abstract Ninety-one patients with advanced ovarian carcinoma were treated at the Mayo Clinic from February 1961, to July 1965. None of these patients had previously had definitive treatment for their disease. Cyclophosphamide was chosen as the alkylating agent to be used in conjunction with various combinations of radiation therapy. Toxicity was not prohibitive. Prolongation of useful life was noted in many patients. Seventeen patients are alive without evidence of progression of the disease and 15 patients are living with evidence of some progression. Among the latter, control has been re-established in the majority by other modalities.

Cyclophosphamide: Evaluation in recurrent and progressive ovarian cancer☆

Abstract At the Mayo Clinic from May 1960, through December 1965, 138 patients with recurrent and metastatic ovarian cancer were treated with cancer chemotherapy. Of these, 106 patients had tumors that were considered to be unequivocally ovarian in origin. Of the 106 patients, 82 were treated with cyclophosphamide, with and without radiation; 17 of these had objective remission and 8 had arrest of progress of the tumor. Thus, 23.6 per cent obtained significant palliation. Toxicity of the compound was moderate. No cures resulted from the therapy. Continued investigation of treatment regimens and comparison with other compounds are contemplated.

Preliminary observations on carcinoma of the cervix treated with 5-fluorouracil

A D v A N c E D carcinoma of the cervix that is no longer controllable by conventional operative or radiologic techniques presents a therapeutic challenge. This challenge frequently can be met only with analgesics or sedative drugs or with heroic operative measures designed, hopefully, to ameliorate one or another of the intolerable symptoms. Among the most troublesome of these complaints is pain, which is a manifestation of the infiltration of the nerves traversing the posterolateral walls of the pelvis and which usually demands increasing amounts of narcotics for relief. I f the carcinoma is locally uncontrolled, there is profuse and foul vaginal discharge found which is very difhcult to manage by the usual hygienic measures. Neither symptom is amenable to direct operative attack although the occasional patient who is a suitable candidate for spinothalamic tractotomy may obtain gratifying relief of pain by this major operative procedure. Not infrequently, however, little or no benefit results or, which is worse, there is paralysis of the lower extremity or inter-

Intraepithelial carcinoma of the cervix in association with pregnancy

Abstract Ninety-five patients with intraepithelial carcinoma of the cervix and 7 with early invasive carcinoma associated with pregnancy have been observed at the Mayo Clinic from 1932 through 1963. The various forms of investigation and therapy through this transitional period are discussed. The present approach, consisting of conization, vaginal delivery, and suitable follow-up examinations, is outlined. Pregnancy loss from the therapy has been minimal.