Usko Nieminen

Increase of cervical adenocarcinoma: A report of 520 cases of cervical carcinoma including 112 tumors with glandular elements

A total of 520 new cases of cervical carcinoma were treated at the Department of Obstetrics and Gynecology, Helsinki University Central Hospital, in 1976 through 1980. Of these carcinomas, 95 (18.3%) were pure adenocarcinomas and 17 (3.3%) represented adenosquamous tumors. The mean age was 58.9 years (range 23-88 years). The age distribution was similar in patients with and without malignant glandular elements and the peak incidence was in the age group 60-69 years. In patients with adenocarcinoma, stage I was overrepresented (62.1%) whereas epidermoid carcinomas were more evenly distributed among various stages. The overall 5-year survival rate was 63.1%, with the corresponding corrected rate being 69.1%. The survival rate for patients with adenocarcinoma did not differ significantly from that for patients with squamous cell tumor. It is concluded that in our population the increasing frequency of cervical adenocarcinoma has not influenced the favorable results of the 5-year study. This disease, however, deserves more attention since its etiology, pathogenesis, and biology are still largely unresolved.

Malignancy During Pregnancy

The incidence of malignant tumours of different types during pregnancy was studied. Special attention was paid to the presence and treatment of preinvasive and invasive carcinoma of the cervix uteri. The series consisted of 100 malignancies of different types in pregnant patients treated at Departments I and II of Obstetrics and Gynaecology, University Central Hospital, Helsinki, during 1950–69. The total number of pregnant patients admitted during this period was 153 424 and the incidence was thus 0.07%. In 65 cases interruption of pregnancy was the sole intervention as the patient had been or was treated elsewhere. Of these cases, 63 were extragenital malignancies and two were carcinoma in situ of the cervix. The material included another 13 cases of carcinoma in situ of the cervix, making an over‐rule incidence of 0.009%. Invasive carcinoma of the cervix was diagnosed in 17 patients. They were all treated at this clinic. The incidence was 0.01%. Over 5 years have elapsed from the treatment of 9 patients. Eight of these 9 patients were alive after 5 years, but one died after 7 years. The patients treated less than 5 years ago are alive and asymptomatic. In addition, four other malignant tumours of the genital tract and one mediastinal neurinoma that had metastasised into the abdominal cavity were diagnosed.

Endometrial adenocarcinoma: Clinical outcome in 881 patients and analysis of 146 patients whose deaths were due to endometrial cancer

Throughout 1970-1975, 881 patients were treated at Departments I and II of Obstetrics and Gynecology, Helsinki University Central Hospital. They were treated mainly by using surgery and/or radiotherapy combined with adjuvant progestin therapy. The over-all uncorrected 5-year survival rate was 72.2% and corrected rate was 82.1%. In 146 out of 245 cases death was due to endometrial cancer, and this group was analyzed separately.

Stage and Prognosis of Ovarian Cystadenocarcinomas

Abstract. A series of 289 patients with primary ovarian cystadenocarcinomas is presented. Of the tumours, 183 were of the serous and 106 of the pseudomucinous type. The total number includes 41 borderline serous and 18 borderline pseudomucinous cystadenocarcinomas. In this series the survival rates were the same in pseudomucinous and serous cystadenocarcinomas. From the standpoint of survival rates there seemed to be no difference between bilateral and unilateral cases of stage I. No statistically significant difference was observed either, with regard to the survival rates in cases of adherent and nonadherent tumours of stage I, although there seemed to be a tendency towards more favourable results for the non‐adherent carcinomas. On evaluating the results from the standpoint of treatment, irradiation seemed to be of no use in cases in which the tumour was limited to the ovaries. The benefit of radiotherapy is questionable also in those cases where it is sure that the entire tumour has been successfully removed. On the other hand, in cases of widespread carcinoma the value of radiotherapy seems to be indisputable.

Changing pattern of cervical carcinoma: A report of 709 cases of invasive carcinoma treated in 1970–1974

Seven hundred and nine new cases of carcinoma of the uterine cervix were treated by surgery, radiotherapy, or both at Helsinki University Central Hospital between 1970 and 1974. Of these, 241 (34.0%) died of the disease during the 5-year follow-up period. Three hundred and eighty-three (53.9%) of the patients were operated on and in 112 (29.3%) of them the stage of the disease had been underestimated preoperatively. This was mainly due to the undetected lymph node involvement observed first at operation in 72 cases (18.8%). In 237 of the patients carcinoma was confined to the cervix according to findings at operation but in 24 (10.1%) of them a relapse or metastasis was observed within 5 years. Comparison of the results for 1970-1974 with those from the same hospital for 1926-1969 revealed a reversal in the steady improvement in the total 5-year survival rates. It is concluded that, even if the incidence of cervical carcinoma in Finland is to decrease, the prognosis for the disease may become poorer. This is mainly due to a shift in the peak incidence of cervical carcinoma to older age groups. Also a mass screening program is likely to decrease the relative number of slowly growing, less aggressive type of the disease.

Mitotic modifications and aberrations in human cervical cancer

Mitotic modifications and aberrations characteristic of human malignant tumors have been analyzed and illustrated in cervical cancer. Most of them can be explained by assuming that the coordination of the centrosomal and chromosomal mechanisms, typical of normal mitosis, is disturbed. When the spindle mechanism is ahead of the chromosomes, the prophase is relatively shortened. This expresses itself in an increase of the ratio of metaphases to prophases (M/P), which in normal tissues is around 1. With M/P values of 4-6, the first tripolar metaphases are formed, and with higher ratios, divisions having more and more poles appear. The spindle and the chromosomes are out of step in the opposite direction in endocycles, in which the spindle is slowed down or absent. The most common of the endocycles is endoreduplication, followed by endomitosis, which is found in more than half of the cervical cancers. Mitotic abnormalities include lagging chromosomes in metaphase and anaphase and bridges in anaphase, which, when numerous, may lead to restitution. More sporadically occurring are C-mitosis and other abnormalities, including cell and nuclear fusions. There is a wide range of variation in the occurrence and frequency of chromocenters within a tumor, and an even greater variation between tumors. About one-fifth of cervical cancers lack X chromatin bodies. The abnormal chromosome constitutions in cancer are the result of various mitotic modifications and aberrations, as well as chromosome rearrangements. New chromosome combinations are constantly created and selection promotes the fastest dividing ones, which, in turn, become new stem lines of the tumor.

Carcinoma of the uterine cervix stage III: A report of 311 cases

Abstract A series of 311 cases of carcinoma of the uterine cervix stage III treated during 1964–1973 and followed up at least for 5 years is presented. In 1964–1969 (period I), local applications of radium were first given, followed by X-ray treatment of parametria with Mullers apparatus. This therapy was replaced in 1970–1973 (period II) by external megavoltage treatment followed by radium applications. A total of 169 patients were treated in period I and 142 in period II. The 5-year observed survival rate was 28% in the former and 36% in the latter period. The higher survival rate of the latter period was, however, statistically significant only in the first 2 years after treatment. The relative survival rates for the older age groups of patients were better than those for the younger groups, a trend which was statistically highly significant. Megavoltage therapy increased the frequency of transient complications. Severe complications, however, were equally represented in both periods. Fistulas were observed in 12.5% of the patients. In 13% of the series a surgical operation was performed for correction of a complication.

X chromatin, endomitoses, and mitotic abnormalities in human cervical cancer

The incidence of X chromatin bodies and mitotic modifications and aberrations has been analyzed using Feulgen-squash preparations in 47 cervical cancers from Helsinki and 35 from Madison. Sixteen of the 82 tumors did not display any X chromatin bodies, and some others showed a lower than normal frequency, especially in the large nuclei. Different hypotheses to explain the absence of Barr bodies in female tumors have been reviewed. A new observation is that 44/82 tumors contained endomitoses. The metaphase/prophase ratio (M/P) was higher than 1.5 in all but three cases, reaching values as high as 23.0 (Madison) and 34.2 (Helsinki), and in one exceptional case, 51.8. The different types of cells, mitotic, endomitotic, and those with large to giant nuclei, form their own strands or layers. Cervical cancer is diagnosed earlier in Finland than in Madison due to a Pap mass screening program, and consequently, the survival of the patients after 5 years was 27/47 in Helsinki and 6/35 in Madison. No correlation could be established between the M/P (or other mitotic phenomena) or the stage and grade of the tumor, the age of the patient, or survival time.

Results of the Treatment of Carcinoma of the Cervix Uteri

A series of 640 cases of carcinoma of the cervix uteri collected in 1959–63 from the First and Second Departments of Obstetrics and Gynaecology, University Central Hospital, Helsinki, was analysed.

Radical surgery and radiotherapy in the management of 173 cases of carcinoma of cervix uteri.

A total of 173 surgically treated cases of carcinoma of the cervix uteri are presented. Wertheims radical hysterectomy with lymphadenectomy was performed on 137 patients. 158 patients were also given radiotherapy. The 5 year cure rate for the series as a whole was 82.1%. The operative mortality was 0.6%. Fistulae of various types were encountered in 9.8%. During the same period, 467 patients with carcinoma of the uterine cervix were treated by radiotherapy. The 5 year cure rate was distinctly better for the surgically‐treated patients with Stage I carcinoma and slightly better for those with Stage II carcinoma. The incidence of fistula was the same in both groups. Complications of different degrees were more numerous on the whole in ths casss treated by radiotherapy alone.