Fujimoto I

Increasing incidence of endometrial carcinoma in Japan

Abstract Incidence of corpus cancer has been increasing in the Gynecology Clinic of the Cancer Institute Hospital, Tokyo, in recent years, and this tendency has become very marked since 1966. This tendency for increased incidence of corpus cancer has been observed among relatively young age groups. There was no evidence that the age of outpatients was getting higher in recent years or that the number of outpatients with higher risk age for corpus cancer was increasing. Increased incidence of corpus cancer could not be correlated to the improvement in diagnostic technique or to increase in the number of endometrial biopsy. Correlation between increased incidence of corpus cancer and socioeconomic factors must await further detailed examinations. Precancerous changes responsible for corpus cancer may have been on the increase in recent years.

Clinical study of primary carcinoma of the fallopian tube: Experience with 15 cases

Between 1950 and 1986, fifteen cases of primary carcinoma of the fallopian tube were diagnosed and treated at the Cancer Institute Hospital, Tokyo. These cases constituted 0.14% of the total number of gynecologic malignancies at the hospital during that period. The average age of the 15 patients was 55.7 years. The most frequent symptom was atypical genital bleeding, seen in 12 cases (80%). Massive watery discharge was seen in 4 cases (27%). In preoperative cytologic examination, 6 cases (40%) were positive for cancer. All cases underwent operation as therapy. Postoperative irradiation, adjuvant chemotherapy, and/or second- or third-look operations were also performed. Histopathologically, all materials were found to be adenocarcinoma. Four cases were well differentiated, eight were moderately differentiated, and three were poorly differentiated. As for the prognosis, 7 patients were followed more than 5 years postoperatively. The 5-year survival rate was 57% (4/7). In stage I cancers, the 5-year survival rate was 80% (4/5). The prognosis of stage I cancer patients was estimated to be rather good.

Lymph node metastasis and prognosis of endometrial carcinoma

Abstract Recently there has been much discussion about the choice of surgical treatment for carcinoma of the body of the uterus. From the study of the literature, it is concluded that there is a high incidence of lymphatic metastases in cases with cervical involvement, so Wertheims hysterectomy with pelvic lymphadenectomy has been carried out for such cases. Deep myometrial infiltration and involvement of lymphatic vessels within myometrium are also very important factors for pelvic lymph node involvement, but it is quite impossible to examine these two factors preoperatively. As to the sites of spread, paraaortic lymph node involvement seems not so important as was said in the literature. In the case with cervical involvement, the external iliac lymph node is the most often affected, just as in the case of cervical carcinoma. Without cervical involvement, the obturator lymph node and hypogastric lymph node seem to be a primary site for lymphatic spread. The prognosis is poor in patients with involvement of the pelvic lymph node. Radical hysterectomy should be carried out as the general condition permits.

Use of angio computed tomography to evaluate extent of endometrial carcinoma

Patients with endometrial carcinoma underwent angio computed tomography (CT) prior to surgery to evaluate the extent of the carcinoma. The subjects of the study were 87 patients operated on at the Cancer Institute Hospital during the period 1983 to 1986. After preoperative bilateral internal iliac angiography, angio CT was performed using the already inserted catheters. Although the intact uterine wall was enhanced by the angio CT, the cancerous lesion was not, which permitted easy recognition of the cancerous lesion as a low-density area. To evaluate the degree of myometrial invasion, the minimal thickness of intact uterine wall was measured in the CT image, and was compared later with findings from the operative materials. The comparison showed that for all the patients, the minimal thickness of the intact uterine wall as shown in the CT image was comparable to the actual minimal thickness of the operative materials. Because depth of myometrial invasion is known as an important prognostic factor, measurement of the minimal thickness of the intact uterine wall as shown in the CT image is useful as an objective prognostic factor. Angio CT facilitates recognition of myometrial invasion preoperatively.