An approach to teaching ethical, legal, and psychosocial aspects of gynecologic oncology in a residency program.

An approach to teaching ethical, legal, and psychosocial issues in gynecologic oncology has been integrated into an obstetrics and gynecology residency program. Team-teaching is used, involving gynecologic oncology faculty members and a medical ethicist with experience teaching in the clinical setting of obstetrics and gynecology. The teaching takes place as part of ongoing teaching rounds in the division of gynecologic oncology.

Paclitaxel has moderate activity in squamous cervix cancer. A Gynecologic Oncology Group study.

Purpose: Taxol (paclitaxel; Bristol-Myers Squibb, Princeton, NJ) is a new antineoplastic drug with broad-spectrum activity in solid tumors, including epithelial ovarian cancer, head and neck cancer, esophageal cancer, breast cancer, bladder cancer, and lung cancer. Its unique mechanism of action, polymerization of tubulin monomers, has stimulated both clinical and preclinical research on this agent. As limited drug supplies became more plentiful, a phase II trial of Taxol was initiated in patients with advanced squamous cervix cancer who had received no prior chemotherapy.

Nucleolar organizer regions in adenocarcinoma of the uterine cervix.

Background: Nucleolar organizer regions (AgNORs) are associated with proliferative activity and ploidy in many tumors. The endocervical growth pattern of cervical adenocarcinoma renders tumor volume assessment more difficult, necessitating additional prognostic indicators.

Methods: Thirty-five cases of cervical adenocarcinoma were evaluated by reviewing charts and histologic sections.

Identification of p53 mutations in endometrial adenocarcinoma by polymerase chain reaction-single-strand conformation polymorphism.

Objective: We determined whether mutations in p53 exons 5-6-7-8, as detected in the polymerase chain reaction-single-strand conformation polymorphism (PCR-SSCP) test, might be correlated with stage or grade in endometrial adenocarcinoma.

Methods: We amplified sequences containing exons 5, 6, 7, or 8 in DNA from tumors and controls. Mutation within the amplified sequences was indicated by changes in electrophoretic mobility (band shifts) in the SSCP test.

Surgicopathologic staging of endometrial adenocarcinoma.

In 1988, the International Federation of Gynecologists and Obstetricians' (FIGO) staging criteria for endometrial cancer were changed to require that surgical observations be included in the staging process. Staging now requires thorough intraperitoneal and retroperitoneal search and documentation of metastatic cancer; in addition, direct uterine inspection for tumor invasion and degree of cervical involvement replace length of uterine cavity and endocervical curettage. With change, there have naturally been questions regarding the method, benefit, and risk of surgical staging.

The presentation of adenocarcinoma of the uterine cervix.

Background: Among malignancies of the uterine cervix, the percentage of adenocarcinomas seems to have increased in recent reports.

Methods: The clinical presentation of adenocarcinoma of the uterine cervix during the past 25 years was examined by review of charts and pathologic specimens. The data of a total of 124 patients with cervical adenocarcinoma treated between 1964 and 1988 were evaluated.

Endometrial adenocarcinoma: genetic analysis suggesting heritable site-specific uterine cancer.

Unlabelled: Genetic factors are clearly integral to the etiology of neoplasia. A cancer family syndrome (Lynch syndrome II) consisting of uterine, colon, and ovarian cancer is recognized, but the heritability of isolated endometrial adenocarcinoma has not otherwise been thoroughly investigated. We have performed pedigree studies in index cases with endometrial adenocarcinoma, using spouses as controls.

Ovarian abscess arising within an endometrioma.

Ovarian abscess is a rare gynecologic entity; only 120 cases have been reported in the world literature. In contrast to the more commonly encountered tubo-ovarian abscess, tubal involvement is absent in the ovarian abscess. This report describes a case of an ovarian abscess arising de novo within an endometrioma.

Numerical chromosome abnormalities associated with early clinical stages of gynecologic tumors.

Cytogenetic data are presented for 12 ovarian, three endometrial, and one fallopian tube tumors. In 15 of these, primary tumors were analyzed and in one ascites was studied. All specimens were obtained at the time of diagnostic surgery.

Small cell carcinoma of the cervix: a clinical and flow-cytometric study.

The clinical course of 14 patients diagnosed with small cell carcinoma of the cervix (SCC) was reviewed and compared to that of 37 cases of undifferentiated large cell nonkeratonizing carcinoma (LCNK). We observed the following differences between the two: SCC patients had a higher incidence of pelvic wall involvement and distant metastasis; the development of progressive disease was more frequent in SCC than in LCNK patients; median survival time was 9 months in SCC and 40 months in LCNK patients; flow cytometry revealed aneuploidy in all SCC and in 30% of the LCNK patients; the mean DNA index was 2.24 in SCC, significantly higher than in LCNK (1.

Pipelle endometrial sampling in patients with known endometrial carcinoma.

The purpose of this prospective clinical trial was to determine the reliability of the Pipelle endometrial biopsy instrument in recovering adequate tissue for confirmation of the diagnosis of endometrial cancer in patients with known endometrial carcinoma, and to compare endometrial histology of the sampling specimen with that of the subsequent hysterectomy specimen. Forty patients were enrolled in this study. All biopsies were performed in the office without anesthesia.

Class II radical hysterectomy shows less morbidity and good treatment efficacy compared to class III.

Treatment of 102 patients with cancer of the cervix by class II and III radical hysterectomy was reviewed to compare the operative morbidity and efficacy of class II radical hysterectomy for select cases. Of the 102 patients, 21 had a class II hysterectomy, whereas 81 patients had a class III hysterectomy. The class II operation was performed for those subjects in whom invasive cancer beyond microinvasion could not be excluded after a cone biopsy.

Surgery or radiation for early cervical cancer.

In summary, neither radiation nor surgery is clearly superior. The benefits of surgery include: 1) emotional satisfaction that the tumor has been removed, 2) accuracy of surgical staging, 3) preservation of the ovaries, 4) no secondary uterine cancer (a very uncommon problem), and 5) complications that are more readily correctable. Radiation offers the major advantages of being useful in most patients regardless of age or medical condition and is the choice for large cancers.

Vaginal radiation brachytherapy to reduce central recurrence after radical hysterectomy for cervical carcinoma.

Seventeen (17%) of one hundred and two patients were treated with radiation brachytherapy (without external-beam therapy) to the proximal vagina to reduce the possibility of central pelvic recurrence following radical hysterectomy for cervical carcinoma. The 17 were considered to be at greater risk of developing recurrent cancer in the central pelvis because the cancer invaded halfway through the cervix; however, no lesions extended beyond the cervix, nor were metastases to lymph nodes present or surgical margins involved. The brachytherapy treatment was evaluated for prevention of central pelvis recurrence and for related complications.

Gynecologic Oncology Group experience with ifosfamide.

In July 1985, the Gynecologic Oncology Group initiated a series of phase II trials with ifosfamide/mesna in advanced or recurrent gynecologic malignancies. Previously untreated patients received ifosfamide 1.5 g/m2/d intravenously (IV) for 5 days.

Early phase II Gynecologic Oncology Group experience with ifosfamide/mesna in gynecologic malignancies.

Starting in July 1985, the Gynecologic Oncology Group conducted a series of phase II trials with ifosfamide/mesna in advanced or recurrent gynecologic malignancies. Previously untreated patients received 1.5 g/m2 i.

Phase II trial of ifosfamide and mesna in mixed mesodermal tumors of the uterus (a Gynecologic Oncology Group study).

A phase II trial of ifosfamide (isophosphamide, NSC 109724) and mesna (2-mercaptoethane sodium sulfonate, NSC 113891) in women with advanced or recurrent mixed mullerian tumors of the uterus was conducted by the Gynecologic Oncology Group. The starting dose of ifosfamide was 1.5 gm/m2 daily, intravenously, for 5 days.

Phase II experience with ifosfamide/mesna in gynecologic malignancies: preliminary report of Gynecologic Oncology Group studies.

The Gynecologic Oncology Group initiated a series of phase II trials of ifosfamide/mesna in women with advanced or recurrent gynecologic malignancies in July 1985. Previously untreated patients received ifosfamide, 1.5 g/m2/d, intravenously (IV) for five days.

Cryosurgery for the treatment of cervical intraepithelial neoplasia during the reproductive years.

Cervical intraepithelial neoplasia (CIN) is so rampant that simpler, effective, and less costly methods of therapy are being evaluated to replace the aggressive surgical therapeutic measures of the past. Cryosurgery is one alternative method. A review is presented of 152 patients in the childbearing age group with biopsy confirmation of CIN II (moderate dysplasia) and CIN III (severe dysplasia and carcinoma in situ).

Intestinal anastomoses after radiation therapy by surgical stapling instruments.

The use of automated stapling instruments in 17 patients requiring intestinal surgery following irradiation therapy for gynecologic malignancies has been reviewed. Fifteen of these patients also had other medical problems thought to inhibit optimal anastomotic healing: malnutrition, persistent intraabdominal cancer, uremia, hypoalbuminemia, and recent antineoplastic chemotherapy. Although these conditions severely test a method of intestinal anastomosis, no patient had a complication involving the intestinal anastomosis.

Computerized tomography applied to gynecologic oncology.

Forty patients on the gynecologic oncology service at the University of North Carolina were evaluated with CT scans. Accuracy and clinical benefit of these scans were compared to those of manual clinical examinations. The CT scans were generally superior and had fewer (9) verified errors in the regions of the pelvic wall and para-aortic area than did the manual examinations (17).

Clear cell carcinoma of the endometrium.

The clinical data of 22 patients with clear cell adenocarcinoma of the endometrium treated at the University of North Carolina Memorial Hospital are reported. In addition, the data with particular reference to survival, site of recurrence, and treatment are combined with information from two previous reports of clear cell adenocarcinoma of the endometrium to better define survival. It is noted that the patients with clear cell adenocarcinoma of the endometrium were older and had an overall poorer survival than is reported for adenocarcinoma of the endometrium (nonclear cell).

CT-assisted pelvic and abdominal aspiration biopsies in gynecological malignancy.

Twenty-four CT-directed biopsies were performed in 17 women with proved gynecological malignancy which had been treated previously by surgery, radiotherapy, chemotherapy or a combination of modalities. CT proved superior to ultrasound biopsy in that the presence of gas in the bowel does not hinder imaging and the use of contrast agents to outline bladder and ureters enables identification of pathological masses even in the presence of massive adhesions and anatomical distortion. Even in small lesions, CT can locate the tip of the needle.