Greg Robertson

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

Thrombocytosis as a prognostic factor in women with cervical cancer

Background. Thrombocytosis (a platelet count >400 × 109/I) is found frequently in association with malignant disease and recently has been suggested to be a poor prognostic indicator in patients with cervical cancer. The authors decided to see if these findings could be verified.

Adjuvant small field pelvic radiation for patients with high risk, Stage IB lymph node negative cervix carcinoma after radical hysterectomy and pelvic lymph node dissection : A pilot study

After radical hysterectomy and pelvic lymph node dissection, an identifiable subgroup of patients with International Federation of Gynecology and Obstetrics Stage IB lymph node negative cervix carcinoma remains at high risk of pelvic recurrence. This study attempted to determine whether postoperative small field of pelvic radiation can improve the disease free survival (DFS) of this high risk group of patients without producing significant morbidity.

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.

Does application of Morsel's solution after loop diathermy excision of the transformation zone reduce post‐operative discharge?

asked about their recollection of post-operative bleeding three months after the event. Therefore, we stand by our claim that our study is the first to document prospectively blood loss following loop diathermy excision of the transformation zone. In the patients in the Monsel’s group we did find a lessening of blood loss in the first 2 days although this was not significant statistically or clinically. We are pleased to note that the unpublished observations mentioned by Lopes et al. concur with our own findings. Finally, we accept that there is inevitably some difficulty in describing post-operative loss, but it is surely a matter of semantics as to where blood loss ends and bloody discharge begins. Mark Doyle Adrian Warwick Charles Redman University of KeelelNorth Staffordshire Health Authority School of PostgraduateMedicine and Biological Sciences North Staffordshire Maternity Hospital Academic Department of Obstetrics and Gynaecology Hilton Road Stoke-on-Trent ST4 6SD Does application of Morsel’s solution after loop diathermy excision of the transformation zone reduce post-operative discharge?

Ketoacidosis in pregnancy: an unusual presentation of diabetes mellitus. Case reports

A previously fit 29-year-old white European gravida 2, para 0, presented at 29 weeks gestation with a 3-day history of nausea, vomiting, polyuria and polydipsia. Since she had had a 16-week incomplete abortion 44 weeks before booking followed by secondary amenorrhoea, the expected date of delivery of her current pregnancy was uncertain. On booking examination there were no abnormal findings and in particular she was normotensive and at her ideal body weight. Ultrasound scan showed a normal fetus whose biparietal diameter and abdominal girth measurements were consistent with 25.5 weeks gestation. Although initial urinalysis with Ames multistix had shown 0.25% glycosuria, subsequent testing by her general practitioner and in the antenatal clinic was negative. There was neither a past nor family history of insulindependent diabetes or risk factors for developing gestational diabetes. On admission she was orientated, apyrexial but dehydrated and ketotic with Kussmaul respiration. Her pulse was 100 beats/min and her supine blood pressure 120/80 mmHg. There were no signs of diabetic retinopathy or neuropathy. Doppler ultrasound confirmed the presence of a fetal heart. The results of biochemical investigations are shown in Table 1.

Management of retroperitoneal lymph nodes in advanced ovarian cancer

Autopsy studies have demonstrated a very high incidence of positive retroperitoneal lymph nodes in patients with advanced ovarian cancer, but the clinical management of these nodes has only recently been investigated. Several institutional studies had suggested an advantage to systematic removal of pelvic and paraaortic nodes in patients whose tumor was optimally cytoreduced in the peritoneal cavity. However, the only randomized prospective study revealed a 7-month benefit in progression-free survival for patients having systematic lymphadenectomy, but no benefit in terms of overall survival. Unless a future randomized trial shows evidence to the contrary, removal of clinically normal nodes should not be considered part of the standard care for patients with advanced ovarian cancer. Bulky nodes should be removed as part of the surgical aim of removing all macroscopic residual disease

Squamous cell carcinoma antigen: pretreatment levels as an indicator of advanced or metastatic disease

Pretreatment values of squamous cell carcinoma antigen (SCC) were obtained in 100 consecutive patients with squamous cell carcinoma of the cervix presenting to the Regional Gynaecological Oncology Centre in Gateshead, UK. Nine patients deemed to have locally advanced disease not suitable for primary surgery had elevated levels. Ninety-one patients were suitable for primary surgery. Sixty-seven had normal SCC levels, two of which had lymph node metastases. Twenty-four had elevated SCC levels, 14 of which had lymph node metastases. Two early recurrences have been detected in the raised SCC group where no lymph node metastases were present. Elevated levels of SCC in the pretreatment assessment indicate a high risk of lymph node metastases and of developing recurrent disease after primary surgery.