BACKGROUND: The aim of the study was to compare health-related quality of life (QoL) and oncological outcome between gynaecological cancer patients undergoing pelvic exenteration (PE) and extended pelvic exenteration (EPE). EPEs were defined as extensive procedures including, in addition to standard PE extent, the resection of internal, external, or common iliac vessels; pelvic side-wall muscles; large pelvic nerves (sciatic or femoral); and/or pelvic bones. METHODS: Data from 74 patients who underwent PE (42) or EPE (32) between 2004 and 2019 at a single tertiary gynae-oncology centre in Prague were analysed. QoL assessment was performed using EORTC QLQ-C30, EORTC CX-24, and QOLPEX questionnaires specifically developed for patients after (E)PE. RESULTS: No significant differences in survival were observed between the groups (P > 0.999), with median overall and disease-specific survival in the whole cohort of 45 and 49 months, respectively. Thirty-one survivors participated in the QoL surveys (20 PE, 11 EPE). No significant differences were observed in global health status (P = 0.951) or in any of the functional scales. The groups were not differing in therapy satisfaction (P = 0.502), and both expressed similar, high willingness to undergo treatment again if they were to decide again (P = 0.317). CONCLUSIONS: EPEs had post-treatment QoL and oncological outcome comparable to traditional PE. These procedures offer a potentially curative treatment option for patients with persistent or recurrent pelvic tumour invading into pelvic wall structures without further compromise of patients´ QoL.
- Klíčová slova
- Gynaecological cancer, Health-related quality of life, LEER, Out-of-box procedures, Pelvic exenteration,
- MeSH
- exenterace pánve * metody MeSH
- kvalita života MeSH
- lidé MeSH
- nádory pánve * chirurgie MeSH
- průzkumy a dotazníky MeSH
- retrospektivní studie MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
OBJECTIVES: To compare the performance of transvaginal and transabdominal ultrasound with that of the first-line staging method (contrast-enhanced computed tomography (CT)) and a novel technique, whole-body magnetic resonance imaging with diffusion-weighted sequence (WB-DWI/MRI), in the assessment of peritoneal involvement (carcinomatosis), lymph-node staging and prediction of non-resectability in patients with suspected ovarian cancer. METHODS: Between March 2016 and October 2017, all consecutive patients with suspicion of ovarian cancer and surgery planned at a gynecological oncology center underwent preoperative staging and prediction of non-resectability with ultrasound, CT and WB-DWI/MRI. The evaluation followed a single, predefined protocol, assessing peritoneal spread at 19 sites and lymph-node metastasis at eight sites. The prediction of non-resectability was based on abdominal markers. Findings were compared to the reference standard (surgical findings and outcome and histopathological evaluation). RESULTS: Sixty-seven patients with confirmed ovarian cancer were analyzed. Among them, 51 (76%) had advanced-stage and 16 (24%) had early-stage ovarian cancer. Diagnostic laparoscopy only was performed in 16% (11/67) of the cases and laparotomy in 84% (56/67), with no residual disease at the end of surgery in 68% (38/56), residual disease ≤ 1 cm in 16% (9/56) and residual disease > 1 cm in 16% (9/56). Ultrasound and WB-DWI/MRI performed better than did CT in the assessment of overall peritoneal carcinomatosis (area under the receiver-operating-characteristics curve (AUC), 0.87, 0.86 and 0.77, respectively). Ultrasound was not inferior to CT (P = 0.002). For assessment of retroperitoneal lymph-node staging (AUC, 0.72-0.76) and prediction of non-resectability in the abdomen (AUC, 0.74-0.80), all three methods performed similarly. In general, ultrasound had higher or identical specificity to WB-DWI/MRI and CT at each of the 19 peritoneal sites evaluated, but lower or equal sensitivity in the abdomen. Compared with WB-DWI/MRI and CT, transvaginal ultrasound had higher accuracy (94% vs 91% and 85%, respectively) and sensitivity (94% vs 91% and 89%, respectively) in the detection of carcinomatosis in the pelvis. Better accuracy and sensitivity of ultrasound (93% and 100%) than WB-DWI/MRI (83% and 75%) and CT (84% and 88%) in the evaluation of deep rectosigmoid wall infiltration, in particular, supports the potential role of ultrasound in planning rectosigmoid resection. In contrast, for the bowel serosal and mesenterial assessment, abdominal ultrasound had the lowest accuracy (70%, 78% and 79%, respectively) and sensitivity (42%, 65% and 65%, respectively). CONCLUSIONS: This is the first prospective study to document that, in experienced hands, ultrasound may be an alternative to WB-DWI/MRI and CT in ovarian cancer staging, including peritoneal and lymph-node evaluation and prediction of non-resectability based on abdominal markers of non-resectability. © 2021 International Society of Ultrasound in Obstetrics and Gynecology.
- Klíčová slova
- abdominal cavity, computed tomography, laparoscopy, laparotomy, lymph node, magnetic resonance imaging, ovarian neoplasm, pelvis, ultrasonography,
- MeSH
- celotělové zobrazování statistika a číselné údaje MeSH
- difuzní magnetická rezonance statistika a číselné údaje MeSH
- dospělí MeSH
- epiteliální ovariální karcinom diagnostické zobrazování patologie MeSH
- invazivní růst nádoru MeSH
- lidé středního věku MeSH
- lidé MeSH
- lymfatické uzliny patologie MeSH
- magnetická rezonanční tomografie statistika a číselné údaje MeSH
- nádory vaječníků diagnostické zobrazování patologie MeSH
- peritoneální nádory diagnostické zobrazování patologie MeSH
- prospektivní studie MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
AIM: To summarize the current knowledge about the care of pregnant women after fertility-preserving operations for cervical cancer. STUDY TYPE: Review article. SETTING: Department of Gynecology and Obstetrics, 1st Faculty of Medicine, Charles University and General University Hospital, Prague. METHODOLOGY: Search of published literature on a given topic using the PubMed database. RESULTS: Pregnant women after fertility-sparing surgery for cervical cancer can benefit from screening and treatment for asymptomatic bacteriuria, cervical incompetence screening, and progressive cervical shortening by transvaginal ultrasonography. Tests to determine the presence of biomarkers of preterm birth in cervicovaginal fluid improve the prediction of preterm birth. Vaginal progesterone supplementation should be the primary prevention of preterm birth in all women after trachelectomy. Women with a history of preterm birth or late abortion may benefit from cerclage. The preferred mode of delivery is the cesarean section after 37 weeks of gestation. CONCLUSION: Due to the lack of data, pregnancy management in women who have undergone fertility-sparing surgery for early cervical cancer is inconsistent. An increasing number of pregnancies after fertility-sparing surgery will likely prompt clinical research in this field.
- Klíčová slova
- cerclage, fertility-sparing surgery, fetal fibronectin, prediction, preterm birth, preterm premature rupture of membranes, trachelectomy,
- MeSH
- císařský řez MeSH
- inkompetence hrdla děložního * MeSH
- lidé MeSH
- nádory děložního čípku * chirurgie MeSH
- novorozenec MeSH
- předčasný porod * MeSH
- prenatální péče MeSH
- těhotenství MeSH
- Check Tag
- lidé MeSH
- novorozenec MeSH
- těhotenství MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- přehledy MeSH
OBJECTIVE: The study evaluates results of 2-years follow-up of patients in ages 35-36 and 45-46, who are participating in the project LIBUSE, that deals with efficacy of HPV DNA and Pap smear co-testing and p16/Ki67 dual staining in the Czech national cervical screening. DESIGN: Prospective observational study. SETTING: Department of Obstetrics and Gynecology, General University Hospital and 1st Medical Faculty, Charles University, Prague. MATERIALS AND METHODS: Out of all women enrolled in the project LIBUSE only those who were at the beginning of the study 35-36 and 45-46 years old were sellected. Conventional Pap smear and HPV DNA test (Cobas 4800, Roche Diagnostics) had been collected at the baseline. Women were stratified according to their results in the three risk groups: 1. low-risk, 2. high-risk and 3. intermediate risk, who subsequently underwent p16/Ki67 dual staining. All high-risk patients and those with positive result of dual staing were refered to the expert colposcopy. The cases with biopsy proven precancers or cancers were considered as „positive findings“. RESULTS: Altogether 352 women meet the age requirements. In 26 (7.6%) women had been proven HPV DNA positivity and out of the them 9 cases were HPV 16/18 positive. Severe cytological abnormality was found only in one patient (0.3%), who was simultaneously HPV positive. Ten women (2.8%) were classified as high-risk and directly refered to colposcopy. Another 18 patients underwent p16/Ki67 dual staining and 4 positive cases were refered to colposcopy too. After one year further 9 patients were classified as intermediate risk and 6 more were identified after two years of follow-up. Within two years 9 more patient were refered to colposcopy. After the entire period of follow-up in 10 patients biopsy confirmed precancer lesions, none of them had invasive cancer. CONCLUSIONS: Addition of HPV DNA testing with selective HPV 16/18 genotyping to the cytology based screening significantly increases sensitivity and safety of our cervical screening program.
- Klíčová slova
- HPV test, cervical cancer, cervical uterine cancer, mass screening, p16/Ki67, precancer lesion, screening,
- MeSH
- analýza dat MeSH
- antigen Ki-67 analýza MeSH
- barvení a značení MeSH
- časná detekce nádoru MeSH
- DNA MeSH
- dospělí MeSH
- imunohistochemie MeSH
- infekce papilomavirem * diagnóza MeSH
- inhibitor p16 cyklin-dependentní kinasy MeSH
- lidé středního věku MeSH
- lidé MeSH
- lidský papilomavirus 16 MeSH
- lidský papilomavirus 18 genetika MeSH
- nádory děložního čípku * diagnóza MeSH
- Papillomaviridae genetika MeSH
- senzitivita a specificita MeSH
- těhotenství MeSH
- třídění pacientů MeSH
- vaginální stěr MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- těhotenství MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- pozorovací studie MeSH
- Názvy látek
- antigen Ki-67 MeSH
- DNA MeSH
- inhibitor p16 cyklin-dependentní kinasy MeSH
INTRODUCTION: The main aim of organized national cervical cancer screening programs is to decrease incidence and mortality of this malignancy. A total of 770 cases of cervical cancer and 354 deaths from the disease were noticed in the Czech Republic in 2017 which means the incidence 14,5 new cases per 100 000 women. The Czech national cervical cancer screening program is based on cytology (Pap smear) testing in asymptomatic women once a year. OBJECTIVE: To provide an overview of new possibilities and potential tools in cervical cancer screening worldwide and in the Czech Republic. SETTING: Gynecologic Oncology Center, Department of Gynecology and Obstetrics, Hospital Na Bulovce and 1st Medical School of Charles University, Prague; Gynecologic Oncology Center, Department of Gynecology and Obstetrics, General Faculty Hospital and 1st Medical School of Charles University, Prague. METHODS: For this review, we have used the results of studies, review articles, and guidelines of national cervical cancer screening programs published in English. We summarize the current knowledge of molecular genetic methods being applied in the screening of cervical carcinoma. CONCLUSION: The knowledge that persistent human papillomavirus (HPV) infection is the main cause of cervical cancer has resulted in the development of new possibilities of cervical cancer screening worldwide. HPV testing use for cervical cancer screening is now a reality with a quite lot of countries. Nevertheless, HPV testing is mainly used in the stratification of patients with unclear results of a cytological (PAP smear) result in the Czech Republic. While there is a wide and growing consensus that HPV molecular testing is the most accurate and cost-effective method of primary screening, there is a comparative lack of consensus regarding the optimal stratification of patients with proven HPV infections. Biomarkers, such a p16/Ki67 dual immunostaining, a methylation of viral DNA, a detection of E6/E7 mRNA, and others have been proposed for triage of HPV positive women. New possibilities and approaches in strategy of cervical cancer screening are discussed.
- Klíčová slova
- E6/E7 mRNA, HPV test, Methylation, cervical cancer, cervical uterine cancer, mass screening, molecular methods, p16/Ki67, screening,
- MeSH
- časná detekce nádoru MeSH
- infekce papilomavirem * diagnóza MeSH
- lidé MeSH
- nádory děložního čípku * diagnóza MeSH
- Papillomaviridae * genetika MeSH
- plošný screening MeSH
- těhotenství MeSH
- Check Tag
- lidé MeSH
- těhotenství MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- přehledy MeSH
- Geografické názvy
- Česká republika epidemiologie MeSH
BACKGROUND: Here, we present a review of the revised FIGO (International Federation of Gynecology and Obstetrics) staging system for carcinoma of the cervix uteri, explaining the reasons for the changes and summarizing suitable diagnostic methods and treatment options for particular stages of disease according to current guidelines. AIM: The FIGO staging system has been revised as follows. Measurement of lateral extension has been removed from stage IA; the only criterion is a measurement for the deepest invasion of < 5.0 mm. Stage IB has been divided into three subgroups: IB1, tumors with a largest diameter measuring 5 mm and < 2 cm; IB2, tumors measuring 2-4 cm; IB3, tumors measuring 4 cm. Stage IIIC includes an assessment of retroperitoneal lymph nodes: IIIC1 if only pelvic lymph nodes are involved, and IIIC2 if para-aortic nodes are infiltrated. The revised staging system does not mandate the use of a specific imaging method or surgical assessment of the extent of the tumor. The method used to assign a stage should be recorded and reported. The European Society of Gynaecological Oncology, the European Society for Radiotherapy and Oncology, and the European Society of Pathology have developed clinically relevant and evidence-based guidelines to improve the quality of care for women with cervical cancer. These guidelines cover comprehensive staging, management, and follow-up for patients with cervical cancer. The guidelines are intended for use by gynaecologic oncologists, general gynaecologists, surgeons, radiation oncologists, pathologists, clinical oncologists, radiologists, general practitioners, palliative care experts, and other health professionals. CONCLUSION: We summarize the new FIGO classification system, including diagnostic methods and treatments for particular stages. We also discuss the main changes and their clinical impact. This work was supported by the Charles University project UNCE 204065. The authors declare they have no potential conflicts of interest concerning drugs, products, or services used in the study. The Editorial Board declares that the manuscript met the ICMJE recommendation for biomedical papers.
- Klíčová slova
- FIGO staging, cancer of the cervix uteri, cancer staging, guidelines, gynecological cancer,
- MeSH
- lidé MeSH
- lymfatické uzliny patologie MeSH
- nádory děložního čípku patologie MeSH
- směrnice pro lékařskou praxi jako téma MeSH
- staging nádorů * MeSH
- Check Tag
- lidé MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
INTRODUCTION: The carcinoma of the cervix uteri is the fourth most common cancer in women worldwide and more than 85% of these cases occur in developing countries. Altogether 822 new cases were found in the Czech Republic during 2016 which means the incidence 15,3 new diseases/100,000 women. OBJECTIVE: To provide an overview of changes in FIGO (International Federation of Gynecology and Obstetrics) staging for carcinoma of the cervix uteri with an incorporation of possible imaging methods and/or pathological findings, and clinical assessment of tumor size and extent. SETTINGS: Gynecologic Oncology Center, Department of Gynecology and Obstetrics, Hospital Na Bulovce and 1st Medical School of Charles University, Prague; Gynecologic Oncology Center, Department of Gynecology and Obstetrics, General Faculty Hospital and 1st Medical School of Charles University, Prague; Institute of Radiation Oncology, Hospital Na Bulovce, Prague. METHODS: For this review, we have used the results of studies, review articles, and guidelines of oncogynecologic organisations on the cervical cancer published in English. They were identified through a search of literature using PubMed, MEDLINE-Ovid, Scopus and Cochrane Library with the keywords. We summarize the new classification, main changes compared to the former one and their clinical impact. CONCLUSION: Lateral extension measurement is removed in the stage IA, the only criterion is the measured deepest invasion.
- Klíčová slova
- ESGO, FIGO, carcinoma, cervix uteri, staging,
- MeSH
- cervix uteri patologie MeSH
- gynekologie MeSH
- karcinom diagnostické zobrazování patologie MeSH
- lidé MeSH
- lymfatické metastázy diagnostické zobrazování patologie MeSH
- nádory děložního čípku diagnostické zobrazování patologie MeSH
- staging nádorů trendy MeSH
- Check Tag
- lidé MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- přehledy MeSH
- Geografické názvy
- Česká republika MeSH
OBJECTIVE: To summarize current knowledge of the relationship of genital and oral HPV infection in women. DESIGN: Review article. SETTING: Gynecologic Oncology Center, Department of Gynecology and Obstetrics, Hospital Na Bulovce and 1st Medical School of Charles University, Prague; Gynecologic Oncology Center, Department of Gynecology and Obstetrics, General Faculty Hospital and 1st Medical School of Charles University, Prague; ENT Department, Hospital Na Bulovce, Prague. METHODS AND RESULTS: The infection of human papillomavirus (HPV) is strongly associated with the development of anogenital cancers and of a subset of head and neck squamous cell cancers, yet a quite little is known about the interrelationship between oral and cervicovaginal HPV infections. A key issue in oral HPV infection is whether it can be brought about a genital HPV infection, through sexual or other contact and by autoinoculation, or whether it can be considered a fully independent event. Pertinent to this issue is the frequency of oral HPV infection in women with a cervical HPV infection. Some studies show that females with genital HPV infection are at higher risk for oral infection and HPV genotype-concordance with genital infection are more prevalent than could be expected by chance. However, more data are needed to better understand the natural history of HPV infection at each anatomic site. CONCLUSION: The relationship of oral to cervicovaginal HPV infection remains unclear. Nevertheless, published data suggest that HPV infections at these two sites are not entirely independent, although genotype-specific concordance is low.
- Klíčová slova
- cervicovaginal HPV infection oral HPV infection., genital HPV infection, human papillomavirus,
- MeSH
- infekce papilomavirem diagnóza etiologie terapie MeSH
- lidé MeSH
- Papillomaviridae MeSH
- rizikové faktory MeSH
- ústa * MeSH
- ženské pohlavní orgány * MeSH
- Check Tag
- lidé MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- přehledy MeSH
OBJECTIVE: Overview of available information on current vaccination options against HPV and possibilities for further development. DESIGN: Review article. SETTINGS: Clinic of Gynecology and Obstetrics, University Hospital in Ostrava; Clinic of Gynecology and Obstetrics, General University Hospital in Prague. METHODS AND RESULTS: Three prophylactic vaccines have been developed against HPV infection and are all now avaliable in Czech Repulbic; nonavalent (Gardasil 9), quadrivalent vaccine (Silgard) and bivalent vaccine (Cervarix). Therapeutic vaccines, designed to induce regression of existing HPV-associated lesions, are in development and not yet clinically available. CONCLUSION: All three avaliable prophylactic vaccines show high efficacy in prevention of vaccine-specific HPV-type infection. The highest degree of protection is achieved in the population of HPV-naive women.
- Klíčová slova
- HPV vaccination, bivalent HPV vaccine, cervical cancer, human papillomavirus, nonavalent HPV vaccine, quadrivalent HPV vaccine, quadrivalent HPV vaccine nonavalent HPV vaccine.,
- MeSH
- infekce papilomavirem prevence a kontrola MeSH
- lidé MeSH
- nádory děložního čípku prevence a kontrola MeSH
- těhotenství MeSH
- vakcinace MeSH
- vakcíny proti papilomavirům aplikace a dávkování MeSH
- Check Tag
- lidé MeSH
- těhotenství MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- přehledy MeSH
- Názvy látek
- vakcíny proti papilomavirům MeSH
