Michael Friedlander

Biology of Epithelial Ovarian Cancer: Implications for Screening Women at High Genetic Risk

PURPOSEnOur aim was to analyze the clinicopathologic features of screen-detected ovarian cancers identified in women, either at general population risk or high genetic risk of ovarian cancer, who have participated in screening studies.nnnMETHODSnStudies published between 1988 and April 2003 were categorized by the population screened and the primary screening modalities used. Each report was examined with reference to the histologic type, stage, and grade of screen-detected cancers. Reports of studies of prophylactically removed ovaries from women at high risk of ovarian cancer were also reviewed.nnnRESULTSnOf the stage I tumors detected by screening women at population risk, almost half were borderline ovarian tumors, granulosa-cell tumors, or germ-cell tumors, which is disproportionate to their frequency. Furthermore, of the stage I invasive epithelial cancers diagnosed in women at population risk, the majority were endometrioid, clear-cell, and mucinous histologic subtypes. Most ovarian cancers that occur in women at high genetic risk are high-grade serous cancers, and these are infrequently screen detected at an early stage.nnnCONCLUSIONnThe clinicopathologic features of screen-detected ovarian cancers suggest that screening may not reduce mortality in women at increased genetic risk. Prospective screening studies are required in genetically high-risk populations to answer this important question. Women electing surveillance should be aware of the lack of proven benefit and the low likelihood of detecting early stage serous cancers. Bilateral salpingo-oophorectomy appears to be the most effective approach to decrease the risk of ovarian cancer and thereby reduce mortality in high-risk women.

Uterine papillary serous carcinoma. A clinical study

Background. Uterine papillary serous carcinoma (UPSC) is a histologic subtype of endometrial adenocarcinoma that is characterized by its papillary architecture, poor differentiation, and advanced stage at initial presentation. It behaves more aggressively than the more common endometrioid adenocarcinoma of the endometrium.

Current management of epithelial ovarian carcinoma: A review

Epithelial carcinoma of the ovary is the most lethal of gynaecological malignancies and it affects about one in 70 women in developed countries. Over 75% of women with the disease have tumour spread beyond the pelvis at the time of diagnosis, and their treatment requires the appropriate use of surgery and chemotherapy. The strategies used in the treatment of ovarian cancer are constantly evolving. An overview of current treatment regimens and their evolution is provided, with particular emphasis on the interdependence of surgery and chemotherapy in the optimal management of the disease.

Tamoxifen in patients with advanced epithelial ovarian cancer.

Tamoxifen was administered to 30 patients with persistent or recurrent epithelial ovarian cancer following initial plantinum-based chemotherapy. Two complete remissions (lasting 41 months and 12 months, respectively) were documented (6.6%), while 10 patients (33.3%) had stabilization of disease for a mean duration of 11.5 months. Tamoxifen was not associated with any significant toxicity and is a reasonable therapeutic option for patients with persistent or recurrent ovarian cancer, although it is only associated with modest activity. This paper reviews our experience with tamoxifen and summarizes the world literature.

Carboplatin hypersensitivity reactions: re-treatment with cisplatin desensitisation

OBJECTIVEnThis aim of this study was to investigate the feasibility of re-treating patients who had experienced a hypersensitivity reaction to carboplatin with cisplatin following desensitisation.nnnMETHODSnFive patients with recurrent ovarian cancer who had a previous documented hypersensitivity reaction to carboplatin and a good clinical indication for continuing treatment with platinum were retreated following cisplatin desensitisation. All patients were rechallenged with cisplatin following a prolonged desensitisation protocol and the initial four patients then received subsequent cycles with a shortened protocol in an attempt to simplify and shorten the procedure.nnnRESULTSnAll five patients tolerated their first cycle of cisplatin on rechallenge using the full desensitisation protocol with no adverse reactions. Two patients received further treatments (one and three cycles) with a shortened protocol but treatment was terminated due to further adverse hypersensitivity reactions. Two patients received one further cycle with a shortened protocol and did not experience problems with hypersensitivity but treatment was stopped due to evidence of disease progression One patient received a further two cycles using the full desensitisation protocol without problems but treatment was stopped due to evidence of disease progression.nnnCONCLUSIONSnA full cisplatin desensitisation protocol appears to be an effective way to re-treat patients who have previously experienced a hypersensitivity reaction to carboplatin. Attempts to shorten the procedure were associated with further allergic reactions, suggesting that the full protocol should be followed with each treatment.

Hypersensitivity reactions to etoposide. A report of three cases and review of the literature.

Etoposide (VP 16) is an antineoplastic agent that has major activity against a number of tumors, including germ cell neoplasms, small cell lung cancer, and malignant lymphoma. It is a derivative of podophyllin, and acts by inhibiting mitosis (1). Common side effects include bone marrow suppression, alopecia, and gastrointestinal symptoms. Hypersensitivity reactions are uncommon however, and the underlying mechanism is unclear. We report three cases of etoposide hypersensitivity and review the literature.

Risk factors, epidemiology, screening, and prognostic factors in female genital cancer

This review, which due to limitations of space cannot be exhaustive, summarizes the recent literature on risk factors and epidemiology, screening and prognostic factors in a cervical, ovarian, and endometrial cancer. There have been a large number of pertinent publications during this period and this paper summarizes and highlights recent advances in the identification of women at particularly high risk of developing gynecologic cancer, analyzes studies on early detection and screening, and reviews prognostic studies with particular reference to selection of therapy according to risk of relapse and likelihood of benefit.

Stage IB2 adenosquamous cervical cancer diagnosed at 19‐weeks' gestation

Neoadjuvant chemotherapy (NACT) for advanced cervical cancer in pregnancy has been shown to increase operability and be effective against spread of disease. In all reported cases of advanced disease, residual tumour has been found at surgery following NACT. We present a case of a 27‐year old diagnosed with stage IB2 adenosquamous cervical carcinoma at 19‐weeks gestation who was treated with NACT. Following caesarean section and radical hysterectomy, histopathology showed no evidence of residual tumour in the cervix and negative pelvic lymph nodes.