Clinical value of new techniques of gynecological tumor assessment

The histopathological diagnosis and treatment of borderline epithelial tumors of the ovary (BTO) still pose problems to both pathologists and gynecologists. BTO is a disease of younger, fertile females and generally has an excellent prognosis. A minority of patients, however, succumb to this disease. A review of the literature is given addressing aspects of epidemiology, histology, treatment and prognosis, resulting in a proposal for the management of serous and mucinous borderline tumors of the ovary.

Section: Histopathologymentioning

confidence: 99%

“…However, a large series by Kaern et al revealed only a 60% survival rate for stage III (both serous and mucinous) BTO (15) . Pseudomyxoma peritonei is associated with a more aggressive biological tumor (96) .…”

Section: Survivalmentioning

confidence: 99%

The management of borderline epithelial tumors of the ovary

Burger¹,

Prinssen²,

Baak³

et al. 2000

“…Changes in expression of certain oncogenes and suppressor genes and the presence of some growth and proliferating factors may adversely affect prognosis. For example, overexpression or amplification of the c‐ myc or c‐erbB‐2 oncogenes correlates with more aggressive tumor behavior and poor prognosis in cervical, endometrial and ovarian carcinoma in some studies (7) . Tumor behavior may hence be determined early in the histogenesis process of malignancies.…”

mentioning

confidence: 99%

Diagnosis and treatment delay in gynecological malignancies. Does it affect outcome?

Menczer¹

2000

Delay of diagnosis and treatment of malignant tumors is perceived as unfavorably affecting outcome. However, tumor behavior may be determined early in the histogenesis process and the outcome may be more a function of the biologic properties of the tumor than of our ability to make an early diagnosis. The objective of the present review is to evaluate data concerning the effect of diagnosis and treatment delay on outcome in gynecological malignancies. A medline search including the terms diagnosis delay, treatment delay, outcome, vulvar carcinoma, cervical carcinoma, endometrial carcinoma and ovarian carcinoma was conducted and all pertinent articles in the English language were included. Relatively few investigations deal with the effect of diagnosis and treatment delay on prognostic factors and on outcome in invasive gynecological malignancies. The reviewed data do not seem to indicate an unequivocal deleterious effect of a delay of several weeks or even several months in patients with some gynecological malignancies. Intentional delay of diagnosis or treatment of gynecologic malignancies is unjustified; however, the data presented should encourage a closer scrutiny and possibly a revision of the concept of "early" diagnosis and of the notion that delay of any duration has a definite, unfavorable effect on outcome.

“…Therefore only risk factors which are well established as being independent of others in multi‐variate analysis or in a tree structured survival analysis ( 5 –7 ) are used to select for adjuvant therapy. At the same time the number of prognostic factors in cervical cancer being explored is growing as attention has been given recently to various oncogenes and growth factors ( 8 ) .…”

mentioning

confidence: 99%

The prognostic significance of p53, mdm2, c-erbB-2, cathepsin D, and thrombocytosis in stage IB cervical cancer treated by primary radical hysterectomy

Jonge

Viljoen²,

Lindeque

et al. 1999

The objective of this study was to evaluate the value of platelet count, p53, MDM2, c-erbB-2, and cathepsin D immunoreactivity as predictors of lymph node metastasis (LNM) as well as their prognostic significance in patients with stage IB cervical cancer treated by radical hysterectomy between 1991 through 1995. We also report on the outcome of a protocol considering lymph-vascular space invasion (LVSI) in addition to LNM as a strong motivation for adjuvant radiotherapy. A total of 93 patients were the subject of this retrospective study. The incidence of positive nodes was high (30.1%). Thrombocytosis (>/= 400.000/mm3) was present in 6.7% of patients. Positive immunostaining was found for p53 (50.6%), MDM2 (21.7%), c-erbB-2 (14.5%), and cathepsin D (45.8%), but none of them was able to predict LNM. Only thrombocytosis was associated with an unfavorable prognosis: a statistically significant association was shown with relapse-free and overall survival in an univariate analysis (P = 0.0431 and P = 0.0012, respectively) with a tendency to significance in multivariate analysis (P = 0.079 and P = 0.0882, respectively). We postulate that thrombocytosis in early stage cervical cancer could be a marker for subclinical tumor burden. LVSI, regarded as an indication for adjuvant radiotherapy, was no longer associated with poor relapse-free or overall survival, but resulted in a 41% postoperative irradiation rate. Further research is needed to establish the value of LVSI in postoperative radiotherapy decision making.