Garry V. Krepart

Papillary serous adenocarcinoma of the endometrium.

The clinical outcome of 15 women with papillary serous adenocarcinoma of the endometrium is presented. In 14 instances the diagnosis was made by uterine curettage. Eight cases (53.3%) were clinically understaged based on laparotomy findings. Intraoperative assessment for extrauterine spread of disease was infrequently performed. Recurrent disease developed in 12 patients (80.0%) with ten arising within the abdomen either alone or in conjunction with another site. Eleven patients (73.3%) have died of disease and two of the four alive have been treated for a recurrence. The need to determine appropriate adjuvant therapy for patients with this disease exists. A protocol for patient management is proposed.

Staging laparotomy in early epithelial ovarian carcinoma

It is well known that ovarian carcinoma may have subclinically metastasized at the time of the initial surgical operation when all tumor seemed to be confined to the ovary. A retrospective review of 650 ovarian carcinoma patients from 1976 to 1984 revealed 25 staging laparotomies for early epithelial ovarian carcinoma. Sixteen patients had invasive epithelial ovarian carcinoma, and nine had borderline ovarian carcinomas. Five patients had the stage of their disease changed whereas 20 remained unchanged. Among the staging laparotomy patients, 50% of cases of ovarian carcinoma with ruptured capsules were upstaged as were 33% with those with ascites. Twenty-five percent of cases with invasive epithelial ovarian carcinoma and 12% with borderline ovarian carcinoma were upstaged by a staging laparotomy. As a result of staging laparotomy, 72% of patients were spared treatment. No patient with disease truly confined to the ovaries showed recurrence in spite of receiving no treatment. All patients with disease apparently confined to the ovaries should undergo a staging laparotomy. Only disease remote from the ovary need be treated. If a staging laparotomy is not done, treatment is recommended for apparent Stage I disease.

Ovarian carcinoma of low malignant potential: Staging and treatment

A review of 65 cases of ovarian carcinoma of low malignant potential registered at the Manitoba Cancer Treatment and Research Foundation over a 7 1/2-year period was undertaken. Eighty-four percent of patients presented with Stage I disease, which was confirmed by primary staging laparotomy in 25%. The average age at diagnosis was younger than that commonly found in patients with invasive carcinoma. Fourteen patients received postoperative chemotherapy, of whom 10 were evaluated with second-look laparotomy. No patient with macroscopic residual disease after initial surgery was cured by chemotherapy. This report emphasizes the need for a prospective controlled study to evaluate adjunctive chemotherapy in the treatment of these tumors.

Results of prior cytologic screening in patients with a diagnosis of Stage I carcinoma of the cervix

Cervical carcinoma is a disease which lends itself to prevention and diagnosis by cytologic screening. The results of previous Papanicolaou smears were obtained in 84 patients. Of 197 Papanicolaou smear results obtained prior to diagnosis of Stage I carcinoma, 63 (31%) were positive; and of 51 such smears obtained 1 year prior to diagnosis, 30 (59%) were positive. Possible explanations for negative screening prior to development of carcinoma are given. The need for centralized cytologic screening programs on a provincial basis is stressed.

High-risk surgical stage 1 endometrial cancer: outcomes with vault brachytherapy alone

OBJECTIVE Prior to 1995, in our center, patients with surgically staged endometrial cancer with greater than 50% myoinvasion (FIGO 1C) were treated with vault brachytherapy and whole pelvis (WP) radiotherapy despite negative nodes. After October 1, 1995, these patients were treated with vault brachytherapy alone. The aim of this study was to ensure that the survival and recurrence rate had not changed. METHODS A retrospective review of Cancer Care Manitoba charts was undertaken. All patients diagnosed with endometrioid adenocarcinoma between October 1, 1995, and March 1, 2001, were reviewed. Data for all FIGO surgical stage 1 patients, and a subset of stage 1C patients, were analyzed and compared with those of a historical control group, composed of patient data previously collected in our center (1978 to 1990) [Gynecol. Oncol. 55 (1994), 51]. RESULTS A total of 172 patients had negative selective pelvic lymphadenectomy and FIGO stage 1 disease. Fifty-three stage 1C patients were spared WP radiotherapy. Median follow-up was 32 months. Recurrence rate in FIGO stage 1 disease was 2.3% (4/172) and for the subset 1C was 5.7% (3/53). The recurrence rate was not statistically significantly different from that of the historical control group, 3.6% for stage 1 (P = 0.562) and 7.2% for stage 1C (P = 0.51). Two- and five-year survival rates for stage 1 patients in this study were 97 and 95%, respectively. In the historical group, 2- and 5-year survival rates were 97 and 94%. CONCLUSION Whole pelvis radiotherapy can be safely omitted in patients with FIGO stage 1C endometrial cancer if nodal status is known.

Prognostic significance of positive peritoneal cytology in endometrial carcinoma

A retrospective review of 280 patients with endometrial carcinoma who had peritoneal cytologic examination done at the time of laparotomy was undertaken. A positive cytologic finding was the only manifestation of extrauterine disease in 16 patients (6%). Four (25%) of these patients had a recurrence. Only 13 (5%) of 237 patients with negative cytologic findings had a recurrence. Positive peritoneal cytology is a marker for potential recurrence.

Tubular Krukenberg tumor in pregnancy with virilization

A case of tubular Krukenberg tumor in pregnancy with virilization is presented. The pathology is reviewed. This rare tumor must be distinguished from a Sertoli-Leydig tumor. The index case adds to the previously recorded eight cases. All nine cases reviewed presented with progressive virilization between the third and eighth month of gestation, which regressed after surgery. The fetal outcomes of seven cases have been recorded. The fetuses were all female and of these five were virilized. A gastric primary was found in five cases. A primary breast carcinoma was postulated in another. In the remaining cases either no autopsy was performed or no primary tumor was found.

Adriamycin and cisplatin in the treatment of stage III and IV epithelial ovarian carcinoma

A total of 342 eligible, previously untreated patients with Stage III or IV epithelial ovarian carcinoma were treated with Adriamycin and cisplatin, both at 50 mg/m2, for nine courses. Of the 210 patients who had clinically detectable disease after initial surgery, 85 (41%) had a complete clinical response and 45 (21%) had a partial clinical response. A total of 197 were clinically free of disease at the completion of chemotherapy and 175 of these had a second-look laparotomy; 55 had no macroscopic or microscopic evidence of residual disease after multiple random biopsies were examined histologically (complete surgical/histologic response). The major determinants of complete surgical/histologic response were diameter of largest residual tumor prior to treatment, ECOG performance status, and grade, patients with grade 3 tumors having a higher complete response rate than those with grade 1 or 2 tumors. The major determinants of survival were ECOG performance status and diameter of largest residual tumor prior to treatment. Median survival of the total group was 1.8 years.

Factor analysis of false-negative second-look laparotomy

From January 1976 through December 1987, 155 patients with ovarian epithelial malignancy underwent a second-look laparotomy. Seventy-seven (50%) had a negative second-look. Recurrence after negative second-look occurred in 15 patients (19.5%). Of the factors analyzed, serous histology and residual disease after initial laparotomy were found to be of significance. Grade of tumor, stage, and ascites were not found to be of significance.

Cervical Cancer in the Province of Manitoba: A 30-Year Experience

OBJECTIVES This study was undertaken to analyze trends in cervical cancer incidence by histological type and to track the survival rate in the province of Manitoba over a 30-year period. METHODS Data from the Manitoba Cancer Registry (MCR) relating to all cases of cervical cancer that occurred between 1970 and 1999 in the province of Manitoba were analyzed to calculate incidence and survival rates according to histological subtype. RESULTS Over this 30-year span, invasive cervical cancer was diagnosed in 1927 women, and carcinoma in situ was diagnosed in 10 006 women. Cervical cancer was the fifth most frequent cancer diagnosis for women in 1970, and by 1999 it had become the eleventh most frequent. The incidence rate for cervical cancer decreased from 21.6/100 000 women in 1970 to 8.8/100 000 women in 1999. The mortality rate for women with cervical cancer fell from 7.3/100 000 women in 1970 to 2.8 /100 000 women in 1999. Squamous cell carcinoma (SCC) was the most frequently diagnosed histologic subtype, but its incidence decreased from 1970 to 1999; the proportion of women with adenocarcinoma increased gradually over the same time from 7% to 22%. Survival rates were comparable in women with SCC and adenocarcinoma. In 1999, the incidence of cervical cancer in Manitoba was comparable to the Canadian rate. However, the mortality rate from cervical cancer was higher in Manitoba than in Canada overall. CONCLUSION The incidence of cervical cancer and the incidence of cervical cancer-related deaths in Manitoba both dropped between 1970 and 1999. However, the incidence of cervical carcinoma in situ has increased steadily during the same period. These observations may reflect the effect of screening programs on the detection and treatment of cervical cancer precursors. Squamous cell carcinoma is still the most frequently diagnosed subtype of invasive cervical cancer, but the proportion of women with adenocarcinoma has increased. Deaths from cervical cancer showed a non-significant reduction over the study period.