John Jeffrey

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.

Management of squamous cell cancer of the vulva.

Abstract Objectives To review and make recommendations regarding the management of early and advanced squamous cell cancer of the vulva. Options Radical vulvectomy and groin dissection or more conservative surgery in early squamous cell vulvar cancer; chemotherapy and radiation followed by consideration of surgery in advanced disease. Outcomes Risk of inguinal lymph node metastases, risk of tumour recurrence, patient morbidity, patient survival. Evidence Follows the quality of evidence assessment of the Canadian Task Force on the Periodic Health Examination (Table 1). Recommendations 1.Stage IA lesions (≤ 2cm diameter and≤1mm stromal invasion) can be managed by radical local tumour excision without inguinofemoral node dissection. (II-2B) 2.Stage IB unilateral lesion (≤ 2cm diameter, > 1mm stromal invasion and ≥ 1cm from the midline) is treated by radical wide local excision completed by an ipsilateral inguinofemoral node dissection; a central lesion (within 1cm from the midline) requires bilateral inguinofemoral node dissection. (II-2B) 3.Patients with either three or more micrometastases in the groin with node size>10mm, with extracapsular spread, or with bilateral microscopic groin metastases should receive postoperative bilateral groin and pelvic radiation. (II-2B) 4.Advanced cancer of the vulva should be treated with primary radiation and concomitant chemotherapy, followed by consideration of surgical resection. (II-2B)

Progesterone-Only and Non-Hormonal Contraception in the Breast Cancer Survivor: Joint Review and Committee Opinion of the Society of Obstetricians and Gynaecologists of Canada and the Society of Gynecologic Oncologists of Canada

Objective: To examine the relationship between progestin-only contraception and breast cancer, and to make recommendations regarding contraception for the breast cancer survivor.

No. 109-Hysterectomy

OBJECTIVE To identify the indications for hysterectomy, preoperative assessment, and available alternatives required prior to hysterectomy. Patient self-reported outcomes of hysterectomy have revealed high levels of patient satisfaction. These may be maximized by careful preoperative assessment and discussion of other treatment choices. In most cases hysterectomy is performed to relieve symptoms and improve quality of life. The patients preference regarding treatment alternatives must be considered carefully. OPTIONS The areas of clinical practice considered in formulating this guideline are preoperative assessment including alternative treatments, choice of method for hysterectomy, and evaluation of risks and benefits. The risk-to-benefit ratio must be examined individually by the woman and her health practitioners. OUTCOMES Optimizing the decision-making process of women and their caregivers in proceeding with a hysterectomy having considered the disease process, and available alternative treatments and options, and having reviewed the risks and anticipated benefits. EVIDENCE Using Medline, PubMed, and the Cochrane Database, English language articles were reviewed from 1996 to 2001 as well as the review published in the 1996 SOGC guidelines. The level of evidence has been determined using the criteria described by the Canadian Task Force on the Periodic Health Examination. BENEFITS, HARMS, AND COSTS Hysterectomy is the treatment of choice for certain gynaecologic conditions. The predicted advantages must be carefully weighed against the possible risks of the surgery and other treatment alternatives. In the properly selected patient, the result from the surgery should be an improvement in the quality of life. The cost of the surgery to the health care system and to the patient must be interpreted in the context of the cost of untreated conditions. The approach selected for the hysterectomy will impact on the cost of the surgery. RECOMMENDATIONS Benign Disease Preinvasive Disease Invasive Disease Acute Conditions Other Indications Surgical Approach VALIDATION: Medline searches were performed in preparing this guideline with input from experts in their field across Canada. The guideline was reviewed and accepted by SOGC Council and Executive. SPONSOR The Society of Obstetricians and Gynaecologists of Canada.