Nejat Ozgul

Cancer Trends and Incidence and Mortality Patterns in Turkey

Cancer incidence and mortality rates have been increasing in Turkey as most of the developing countries. Besides socioeconomic factors, one of the most prominent attributes of developing countries is the dissimilarity of their age-dependent demographic structure. In Turkey, cancer incidence rates rise due to individual and environmental risk factors as well as due to the improvement in the registry system and to increase in access to health services. According to the data retrieved from the Ministry of Health Department of Cancer Control database cancer incidence rates increased between 2002 and 2005. Incidence rates rose from 133.78 per 100 thousand in 2002 to 173.85 per 100 thousand in 2005. Between 2002 and 2005 the average growth rate of increase for men comes about 9.7%, which is higher than 8.6% for women leading to the widening of incidence gap between man and women. First five frequent cancer types in Turkey are lung (30.13), prostate (24.33), skin (18.91), breast (17.96), stomach (9.92) cancer with an incidence of per 100 thousand. Cancer incidence growth rates for men exceed the cancer incidence growth rate for women. This gap is resulting mainly from lung cancer incidence which is much higher for men. Further extension of the nationwide cancer screening and prevention programs will result in improvement of cancer control.

Endometrial stromal sarcoma of the uterus: analysis of 25 patients

OBJECTIVE To analyze the prognostic factors in endometrial stromal sarcoma (ESS). METHODS Prognostic factors and adjuvant treatment of endometrial stromal sarcoma in 25 patients were evaluated retrospectively. RESULTS The mean age of the group was 43. In 58% of the patients, the presenting sign was vaginal bleeding. The median total survival was 55 months while the disease free survival (DFS) was 49 months. Disease recurred in eight patients, in three of whom tumors were confined to the pelvis. Seventeen patients were alive without disease. Four patients died because of the disease. The 5-year survival rate for patients with low-grade (LGESS) disease was 92%, and 85% in high-grade (HGESS) disease. CONCLUSION In multivariate analyzes, tumor grading was the only prognostic factor in endometrial stromal sarcoma (P=0.0026).

A Turkish Gynecologic Oncology Group study of fertility-sparing treatment for early-stage endometrial cancer.

To analyze the results of fertility‐sparing treatment of early‐stage endometrial cancer (EC) in patients treated at Turkish gynecologic oncology centers, and to present a review of the literature.

Accuracy of Frozen Sections for Intraoperative Diagnosis of Complex Atypical Endometrial Hyperplasia

OBJECTIVE The purpose of this study was to correlate the histological diagnosis made during intraoperative frozen section (FS) examination of hysterectomy samples with complex atypical endometrial hyperplasia (CAEH) diagnosed with definitive paraffin block histology. METHODS FS pathology results of 125 patients with a pre- operative biopsy showing CAEH were compared retrospectively with paraffin block pathology findings. RESULTS Paraffin block results were consistent with FS in 78 of 125 patients (62.4%). The FS sensitivity and specificity of detecting cancer were 81.1% and 97.9%, with negative and positive predictive values of 76.7%, and 98.4%, respectively. Paraffin block results were reported as endometrial cancer in 77 of 125 (61.6%) patients. Final pathology was endometrial cancer in 45.3% patients diagnosed at our center and 76.9% for patients who had their diagnosis at other clinics (p=0.018). Paraffin block results were consistent with FS in 62.4% of all cases Consistence was 98.4% in patients who had endometrial cancer in FS. CONCLUSION FS does not exclude the possibility of endometrial cancer in patients with the preoperative diagnosis of CAEH. In addition, sufficient endometrial sampling is important for an accurate diagnosis.

Turkish community-based palliative care model: a unique design

An organized palliative care system was lacking in Turkey before 2010. One of the pillars of Turkish Cancer Control Programme is palliative care. The Pallia-Turk project in this respect has been implemented by the Ministry since 2010. The project is unique since it is population based and organized at the primary level. This means, the whole population (>70 million) will have the quickest and easiest way for access to palliative care. This manuscript briefly summarizes the situation before the project and updates what has been done in last 2 years with the project.

Staining characteristics of p16INK4a: Is there a correlation with lesion grade or high-risk human papilloma virus positivity?

Aim:  The aims of this study were to evaluate the efficiency of p16INK4a in showing cervical lesions and to determine any relationship between lesion grade and high‐risk human papilloma virus (HR‐HPV) infection and p16INK4a staining characteristics.

Opioids for Cancer Pain: Availability, Accessibility, and Regulatory Barriers in Turkey and Pallia-turk Project

Palliative care is an emerging topic in Turkey within recent years. Currently, there are only few number of palliative care services across the country and majority of the centers are pain control units. Morphine consumption rate per capita is low, accessibility and availability of morphine products are also limited. One of the main headings of Turkish Cancer Control Programme 2009-2015 is palliative care and a serial palliative care unit implementation with continuous training programmes is planned to be finalized until 2015. This article reviews the current palliative care situation in Turkey, opioid availability in Turkey and also briefly summarizes Pallia-Turk Project which is unique with respect to many different aspects for implementation, and can be a good model for many other countries that still did not have such an implemented palliative care program.

Prognostic factors and treatment outcomes in surgically-staged non-invasive uterine clear cell carcinoma: a Turkish Gynecologic Oncology Group study

Objective To assess the prognosis of surgically-staged non-invasive uterine clear cell carcinoma (UCCC), and to determine the role of adjuvant therapy. Methods A multicenter, retrospective department database review was performed to identify patients with UCCC who underwent surgical treatment between 1997 and 2016 at 8 Gynecologic Oncology Centers. Demographic, clinicopathological, and survival data were collected. Results A total of 232 women with UCCC were identified. Of these, 53 (22.8%) had surgically-staged non-invasive UCCC. Twelve patients (22.6%) were upstaged at surgical assessment, including a 5.6% rate of lymphatic dissemination (3/53). Of those, 1 had stage IIIA, 1 had stage IIIC1, 1 had stage IIIC2, and 9 had stage IVB disease. Of the 9 women with stage IVB disease, 5 had isolated omental involvement indicating omentum as the most common metastatic site. UCCC limited only to the endometrium with no extra-uterine disease was confirmed in 41 women (73.3%) after surgical staging. Of those, 13 women (32%) were observed without adjuvant treatment whereas 28 patients (68%) underwent adjuvant therapy. The 5-year disease-free survival rates for patients with and without adjuvant treatment were 100.0% vs. 74.1%, respectively (p=0.060). Conclusion Extra-uterine disease may occur in the absence of myometrial invasion (MMI), therefore comprehensive surgical staging including omentectomy should be the standard of care for women with UCCC regardless of the depth of MMI. Larger cohorts are needed in order to clarify the necessity of adjuvant treatment for women with UCCC truly confined to the endometrium.

Clinical and pathological characteristics related to parametrial involvement in clinical early-stage cervical cancer

OBJECTIVES Since parametrial involvement is believed to be a crucial factor in the management of cervical cancer, our study was designed to investigate the clinical and pathological features which predicted parametrial involvement in patients with clinical early-stage cervical cancer. MATERIAL AND METHODS The study included patients with clinical early-stage cervical cancer who underwent radical hys-terectomy with pelvic and para-aortic lymphadenectomy between December 2001 and August 2014, at the Hacettepe University Hospital. The clinical and pathological characteristics of the affected patients were evaluated, including age, histologic subtype, tumor size, depth of cervical stromal invasion, lympho-vascular space invasion (LVSI), and lymph node metastasis. Univariate and multivariate analyses were performed to reveal factors associated with parametrial involvement. RESULTS The study group consisted of 126 patients (mean age: 52.7 years; range: 29-83), including 101 (80.2%) with squamous, 19 (15.1%) with adenocarcinoma, and 6 (4.8%) with adenosquamous histological subtype of cervical cancer. Parametrial involvement and lymph node metastasis were detected in 41 (32.5%) and 46 (36.5%) women, respectively. Univariate analysis showed that deep cervical stromal invasion, LVSI, tumor size > 2 cm and lymph node metastasis were associated with parametrial involvement. Multivariate logistic regression analysis identified the independent risk factors associated with parametrial involvement as LVSI (OR 8.93, 95% CI 1.1-73.5, p = 0.042) and lymph node metastasis (OR 8.8, 95% CI 1.5-9.3, p = 0.004). CONCLUSIONS LVSI, deep cervical stromal invasion, lymph node metastasis and tumor size are significantly associated with parametrial involvement in patients with clinical early-stage cervical cancer.

Hemostatic control of inferior vena cava with tape traction maneuver in the presence of bulky metastatic paraaortic lymph nodes

Paraaortic lymph node metastasis is a frequent finding of advanced ovarian cancer in primary setting [1] or in case of recurrence [2]. Secondary cytoreductive surgery in patients presenting with recurrent nodal disease was found to be relatedwith better oncological outcomes compared with those who had chemotherapy alone [3]. However, resection of these nodesmay result in important intraoperative complications including laceration ofmajor retroperitoneal vessels and increased blood loss [4]. Inferior vena cava (IVC) can be torn easily during dissection of the enlarged nodes and it is of utmost importance to have hemostatic control to prevent torrential bleeding. The aim of this surgical video is to demonstrate the use of tape tractionmaneuver for hemostatic control of IVC. s and Gynecology, Hacettepe rkey. anbasaran@gmail.com an@hacettepe.edu.tr A 39-year-old woman with platinum sensitive ovarian cancer was referred to our unit with suspected recurrence. Computed tomography demonstrated bulky nodal metastasis in the infrarenal interaorticocaval region and splenic hilum. She underwent surgery and intraoperative exploration revealed isolated splenic metastasis and complete peritoneal cleaning was achieved with splenectomy. During retroperitoneal dissection, IVC was suspended by two tapes, one placed under the left renal vein and the other one placed above the iliac bifurcation. A lateral tear in IVC was repaired easily with the help of tape traction maneuver and no transfusion was required. Postoperative period was uneventful. Pathology confirmedmetastatic disease in paraaortic nodes and spleen. Tape tractionmaneuver is an efficientmethod for hemostatic control of IVC. This technique also helps manipulation of IVC for resection of retrocaval nodes. 493 N. Ozgul et al. / Gynecologic Oncology 138 (2015) 492–493 Conflict of interest None. Appendix A. Supplementary data Supplementary data to this article can be found online at http://dx. doi.org/10.1016/j.ygyno.2015.05.012.