Fallopian tube cancer: radical surgery, extended field radiation and chemotherapy in 24 personal cases treated with "intent to cure".

This may be the largest personal experience of this rare cancer reported to date. Results with an aggressive multi-modality approach exceed results in low stage disease compared to recently reported series. Of the total of 53 personal cases treated, this report focuses on the 24 where, irrespective of clinical stage, all gross disease could be excised, and therapy then added for occult disease control.

Endometrial cancer and surgical staging: a personal assessment.

In 1998, FIGO introduced a new staging system for endometrial cancer that is now surgical rather than clinical. The addition of extensive lymph node surgery, either formal lymphadenectomy or liberal sampling of the pelvic and aortic lymph nodes, represents the most significant and controversial component of this system. The yield of metastatic nodes is relatively low.

The bulky 6-cm barrel-shaped lesion of the cervix: primary surgery and postoperative chemoradiation.

Objective: The purpose of this report is to detail what appears to be the largest reported experience of primary radical hysterectomy for bulky barrel-shaped cervical cancers of 6 cm or greater in diameter, followed in all instances by radiation therapy and chemotherapy.

Methods: Twenty-two unselected cases were operated primarily. One had unresectable aortic node disease.

Death of the Papanicolaou smear? A tale of three reasons.

The Papanicolaou smear is arguably the most cost-effective cancer screening test ever devised. Yet future availability of this low-cost test is seriously threatened by increasing litigation, huge awards, and the implied linkage between "error" and "negligence." The expectation of a 0 error standard, even for a screening test, is central in the current medical-legal climate.

Should whole pelvic radiation therapy become past history? A case for the routine use of extended field therapy and multimodality therapy.

Total pelvis radiation therapy as refined over the past 40 years has impacted positively on gynecologic cancer management. Improved overall results on a worldwide basis reflect a broader application of contemporary radiation treatment plans. Individual clinical stages of disease and subsets have not seen improvement in several decades.

Advances in diagnosis, staging, and management of cervical and endometrial cancer, stages I and II.

The majority of patients with low stage cervical and endometrial cancer are cured. Results obtained in the past only in the categorical cancer centers are currently being achieved more broadly. This reflects the work of formally trained gynecologic oncologists often in collaboration with formally trained radiation therapists distributing themselves in a horizontal fashion to more and more university medical centers, teaching hospitals, and quality tertiary hospitals in the private sector.

Combined therapy as an alternative to exenteration for locally advanced vulvovaginal cancer. II. Results, complications, and dosimetric and surgical considerations.

We have introduced a therapeutic alternative to exenteration for locally advanced vulvovaginal cancer using surgery for the vulvar (external genital) phase of this disease presentation, combined with radiotherapy for the internal genital phase (with adequate overlap of fields to protect surgical margins). The rationale is that this approach treats the cancer and its dual regional spread patterns, while at the same time preserving the bladder and/or rectum, and should be associated with less morbidity and mortality than exenterative surgery. This report updates our experience with a total of 48 treated cases (37 primary cases and 11 cases of recurrent disease).

Risk factors and recurrent patterns in Stage I endometrial cancer.

Clinical Stage I carcinoma of the endometrium was evaluated in 222 patients. Twenty-five percent of patients were found to have pathologic findings thought to require postoperative external irradiation; of these, 20 of 57 (35%) had recurrence. During the 36- to 72-month follow-up period, only 14 of 165 (8.

Presidential panel. The gynecologic oncologist in academic departments.

Now that the subspecialty of gynecologic oncology is well established within the specialty of obstetrics and gynecology, it seems timely to evaluate the pros and cons, the strengths and weaknesses of such a program as it interrelates with other programs in an academic department. A survey is presented which reflects the beliefs of both members and candidate members of the Society of Gynecologic Oncologists on such issues as gynecologic oncologists as chairmen of departments; teaching demands; time commitments to patient care and research in an academic institution; and surgical privileges for gastro-intestinal and urologic procedures in various hospitals. Financial and budgetary items are also discussed.

Surgical staging in endometrial cancer: clinical-pathologic findings of a prospective study.

The pathologic features of a prospective study of FIGO stage I endometrial cancer is presented. The uterus, tubes, ovaries, and pelvic lymph nodes of 222 cases and aortic nodes of 157 cases have been analyzed. The surgical-pathologic specimen would suggest a negligible risk for lymph node metastasis if: cancer is confined to the endometrium irrespective of grade, invasion is superficial for grades 1 and 2 tumor, the intermediate third of the myometrium is invaded for grade 1 tumor only, and occult disease is not present in the cervix and/or adnexa.

Combined therapy as an alternative to exenteration for locally advanced vulvo-vaginal cancer: rationale and results.

Locally advanced vulvo-vaginal cancer is a difficult therapeutic problem complicated by the fact that it is an uncommon clinical entity. Surgery for the vulvar (external genital) phase of this disease presentation was combined with radiotherapy for the internal genital phase (with adequate overlap of fields to protect surgical margins). The rationale is that this approach treats the cancer and its dual regional spread patterns, while at the same time preserves the bladder and/or rectum, and should be associated with less morbidity and mortality than exenterative surgery, especially in this predominantly geriatric patient population.