Background: Surgery has been considered the cornerstone in the management of endometrial cancer, especially in its early stages. The use of minimally invasive surgeries in patients with endometrial cancers has been widely adopted worldwide. In this study, we discuss the outcomes of type I endometrial cancer patients who underwent laparoscopic hysterectomy at our center. Results: The patients were categorized into two groups: open surgery group (59 patients) and laparoscopy group (60 patients). There was no significant difference between both groups as regards the epidemiologic and clinicopathologic parameters. There was no statistical difference between the two groups in the FIGO stage (International Federation of Gynecology and Obstetrics). Operative time was significantly longer in the laparoscopy group compared to the open surgery group (p < 0.0001). No significant difference was found between both groups as regards the type of operation and blood loss. The rate of intraoperative complications was nearly similar in both groups. There was no significant statistical difference between the numbers of lymph node yield in both groups. Conclusion: The results in this study support the use of laparoscopy in early stage type I endometrial cancers without compromising the oncological outcomes regarding the disease-free and overall survival. We encourage further prospective multicenter randomized trials to consolidate these results.
Introduction: Proper design of the operative plan for patients with ovarian masses is a must to avoid unnecessary surgical steps, the need for another surgery or empirical chemotherapy. We investigated the role of frozen section examination in this design. Methods: This was a prospective study in which 64 complex adnexal masses with normal tumor markers underwent frozen section examination. The patients were divided into two parallel groups: group A in which the decision whether to proceed for complete staging or not was built on the result of the examination, and group B in which the patients underwent panhysterectomy at baseline regardless of their frozen section examination result. Postoperative stay, estimated blood loss and the incidence of complications were compared. Results: When comparing the two groups, including patients with tumors that turned out to be benign, there were no significant differences in postoperative complications, but there were for the operative time (60 vs. 120 minutes, p = 0.004) and blood loss, which were significantly lower in group A (50 vs. 100 mL, p = 0.001), and hospital stay, which was statistically insignificantly shorter than in group B (1 day vs. 2 days, p = 0.062). The sensitivity of frozen section examination for benign, borderline, and malignant ovarian masses was 91.9%, 76.9%, 53.3%, respectively, while the specificity was 85.2%, 87.5%, 95.9% and the overall diagnostic accuracy was 89.6%, 85.2%, 85.9%, respectively. Conclusion: The use of frozen section examination in the assessment of complex ovarian masses in patients with normal tumor markers offers an acceptable accuracy with a significant decrease of the operative time, blood loss as well as hospital stay.
Ovarian cancer, like breast cancer, may either develop spontaneously or as a result of a family history. BRCA1 and BRCA2 mutations significantly increase the risk of both cancers at all ages. It is estimated that 3–5% of women are BRCA mutation carriers. BRCA1 mutation carriers have a 65% risk of breast cancer and 39% risk of ovarian cancer. These risks are lower among BRCA2 mutation carriers, i.e. 45% and 11% for breast and ovarian cancer, respectively. In breast and ovarian cancer with BRCA mutations, blocking the function of poly(ADP-ribose) polymerase (PARP) enzymes, including PARP1 and PARP2, causes an accumulation of DNA damage that ultimately leads to cancer cell death. Based on this mechanism, PARP inhibitors have been used in the treatment of hereditary neoplasms, in which the proper functioning of DNA damage repair systems is disturbed. In clinical trials to date, PARP inhibitors significantly extended the progression-free survival in patients with confirmed BRCA mutations. Similar results have been obtained for patients without confirmed genetic background. Currently, PARP inhibitors are increasingly approved for use in the treatment of ovarian and breast cancer. From May 2021, the Ministry of Health has reimbursed maintenance therapy with PARP inhibitors in patients with known BRCA mutation status.
Lymphoepithelioma-like carcinoma (LELC) of the uterine cervix is a rare type of cervical cancer. The etiopathogenesis of cervical LELC involves consideration of the human papillomavirus (HPV) and Epstein–Barr virus infection. We present the case of a 57-year-old female diagnosed with a unique HPV-59 with the absence of Epstein–Barr virus, which is characteristic for European women. The treatment included a radical hysterectomy with nerve-sparing radical hysterectomy, which has not been used in patients with LELC so far. Complementary treatment included combined radiotherapy and cisplatin infusion.
Magnetic resonance imaging-guided radiotherapy can accurately irradiate moving targets such as cervical cancer. An 82-year-old woman with locally advanced cervical cancer was referred for palliative radiotherapy. She had refused chemotherapy and brachytherapy, so she was treated with external beam radiotherapy to control her uterine bleeding and to alleviate pubic pain. Since her cervical cancer had no metastases, and she was expected to survive for a long time, curative doses of radiation (70–80 Gy/28 fractions) were administered by magnetic resonance imaging-guided planned adaptive intensity-modulated radiation therapy. Six months after intensity-modulated radiation therapy, the tumor disappeared without adverse events, and her symptoms were relieved. To the best of our knowledge, this is the first report of locally advanced cervical cancer treated with high-dose magnetic resonance imaging-guided adaptive intensity-modulated radiation therapy.
