No abstract

67 breast cancers with a maximum diameter of up to 10 mm on the histological section were retrospectively analysed according to the primary situation for medical consultation and the way to cancer diagnosis. 46 women presented themselves with clinical signs. 19 women had an anamnestical risk, whereas only two women were without any risks or symptoms. 34 tumourspecific clinical signs are followed by 25 tumourspecific mammograms. Eight small invasive carcinomas were detected only under the microscope, two of them in mastectomy specimens. Even small cancers, therefore, are mostly diagnosed from the patients themselves. The contribution of mammography is tremendous. Intensified systematic histological examination of biopsies and mastectomy specimens is mandatory especially in high risk patients.

In a review of the most important examination methods for diagnosis of endometrial carcinoma so far published the efficacy of each of the individual methods is assessed according to uniform criteria. Only the specimens diagnosed as positive were taken as a basis for the rate of correct diagnosis, in order to facilitate comparison of the efficacy of the methods with one another. The validity of the methods is briefly outlined. Cytological diagnosis of endometrial carcinoma is appreciably less reliable than that of cervical carcinoma, regardless of the method used. The cytodiagnostic problems are different, depending whether exfoliative cytology or endouterine biopsy techniques have been used. Cancers of highly differentiated tumor cells are most seldom identified by the conventional smear techniques. Taking the endometrial carcinoma and endometrial hyperplasia patients at Erlangen University Gynecological Clinic between 1963 and 1981 as a basis, and limiting the scope of the study to high-risk adipose patients aged over 45, one-fifth of the carcinomas and one-fourth of the precancerous patients would not be included in a program based on risk factors. Of the Erlangen patients, a 5-year survival probability of 95% and more was calculated for women with tumors from cytologically highly differentiated cancer cells in histological stage I. It is particularly difficult to identify these patients cytologically, and the prognosis for them can hardly be improved further. Cytological nucleus grading proved a reliable prognosis factor, in particular for histologically undifferentiated tumors.(ABSTRACT TRUNCATED AT 250 WORDS)

Historical data, histological parameters and follow-up findings were reviewed both in 75 "prophylaxis failures" and in 255 cases of clinical cervical carcinoma treated surgically (Wertheim's procedure); all of these cases were diagnosed between 1974 and 1980. In 29.5% of the patients preventive care or respectively gynaecological examination failed. The many and varied causes of errors are discussed. Neither the histological tumour type, nor the lymph-node metastasis rate, nor the frequency of recurrence, nor the mortality figures are indicative of a more aggressive type of tumour in the "prophylaxis failures". Mortality among the latter is 13.3%, as opposed to 15.3% in the entire patient collective, the lymph-node metastasis rate 25.3% as compared to 31.8% overall, and the recurrence rate 18.1% as compared to 18.8% overall. As expected, cases with obviously delayed diagnosis have the highest mortality rate, i.e., 25% as against 15.3% overall. There is not a single case in which cancer can be shown to have developed without a preceding precancerous stage. It is suspected that mistakes made while obtaining smears are the principal cause of failure of prophylaxis, followed by errors of evaluation, in histology, and in therapeutic measures taken after histological confirmation of cervical neoplasm. These results do not in any way exclude an aggressive type of tumour in rare individual cases; however, the occurrence of such a tumour would be an exception.

The careful cleansing of the vagina with physiologic saline and 96% ethyl alcohol, the insert of a big, dry swab for two minutes in front of the portio vaginalis cervicis and the cleansing once more again with a dry swab are an effective prophylaxis against tumor implantation from a carcinoma of the endometrium or of the cervix. This could be confirmed not only by cytology prior to operation and by cytology antecedent to cleansing the vagina immediately prior to the removal of the uterus from the vagina but also by the follow-up study of 517 surgically treated cancers of the endometrium and 241 cervical cancers.