INTRODUCTION Ovarian cancer is the leading cause of mortality from gynecologic malignancies in the industrialized countries and is responsible for
|
|
- Amice Walton
- 5 years ago
- Views:
Transcription
1 INTRODUCTION Ovarian cancer is the leading cause of mortality from gynecologic malignancies in the industrialized countries and is responsible for more deaths than both cervical and endometrial tumours. The tumour biology of epithelial ovarian cancer differs from that of most other epithelial tumours, because of the intraperitoneal spreading leading to exfoliation of cancer cells into the peritoneal fluid. The prognostic factors can be used to predict the future course of the malignancy and may identify a subgroup of patients with high-risk disease. The prognostic factors of ovarian tumours can be classified into clinico-pathological and molecular markers. Clinico-pathological factors include patient-, tumour- and therapy-related characteristics. For prognostic purposes more and more molecular markers are are currently under evaluation to define the category of risk to which an individual patient can be assigned. Six different groups of molecular markers are known. Developments in molecular techniques have resulted this new generation of prognostic factors. In my thesis, I deal separately with the molecular and clinico-pathological prognostic factors. To estimatate the future course of ovarian carcinoma and to optimize the most appropriate treatment, the knowledge of different prognostic factors is essential. In my thesis I examined the following clinico-pathological factors: Ovarian cancer may occur at any age but is most common between years of age. Patients younger than 60 usually have better prognosis than patients older than 60. The stage of the tumour is the most important prognostical factor. The relationship between the histology and the prognosis is not unambiguos. The most common - serous - tumours are usually considered to be agressive, as opposed to endomerioid and mucinous tumours. Clear-cell carcinomas are also thought to be agressive. The classification of the degree of differentation of ovarian carcinoma is based on the Federation International d Gynecology et Obstetrique (FIGO), the Gynecology Oncology Group (GOG) and the World Health Organization (WHO). However, these grading systems are not perfect, but grading is considered to be a prognostic factor. Ascites or tumour cells in peritoneal washing are adverse prognostic factors. The residual tumour volume and the employed surgical procedure are the most important treatment related prognostic factors.
2 In my thesis, I examined two members of the metastasis-cascade. First, I analyzed fibronectin which is an adhesion molecule and may have an important prognostic role in ovarian cancer. The second examined molecular marker was the matrix metalloproteinase-2/9, which belongs to proteolytic enzymes produced by both connective tissue and tumour cells and could degrade components of the the extracellular matrix (ECM). Of special importance to epithelial ovarian cancer spread are the type IV gelatinases, Mr 72,000 (MMP-2, gelatinase A) and Mr 92,000 (MMP-9, gelatinase B) enzymes, because of their preference to degrade type IV collagen which is the major component of basement membranes. This degradation is an essential step in tumour invasion. There is evidence from studies with epithelial ovarian cancer that MMP-2 and MMP-9 activity play an important role in the invasion and metastasis of epithelial ovarian cancer. There is evidence from studies with ovarian cancer cell lines that fibronectin activates MMP-9 secretion via the MEK1-MAPK and the PI3K-Akt pathways in ovarian cancer cells. Fibronectin produced by mesothel cells of the peritoneum stimulates MMP-9 expression of ovarian cancer cells and thus probably invasion and dissemination. Fibronectin was identified in ascites of advanced ovarian cancer patients. Cancer cells are transformed cells in which DNA-synthesis is considerably elevated compared to that of normal cells. There are high activities of purine and pyrimidine biosynthetic enzymes involving both de novo and salvage biosynthetic pathways. The most important enzyme in the de novo biosynthetic pathyway is the ribonucleotid reductase. However, most tissue can synthesize both purine and pyrimidine in the salvage pathway. In this respect, pyrimidine synthesis may continue through both the de novo pathway, in which the key enzyme is the thymidylate synthase (TS) and through the salvage pathway in which the key enzyme is the thymidine kinase (TK). Both enzyme s activities lead to production of thymidine-three phosphate. Thymidine kinase is located in the cytoplasm and its activity depends on the cell cycle, because in the S-phase, the TK activity is ten times higher than in the G1-phase. The DNA-synthesis through the salvage pathway in tumour cells may continue even if the de novo pathway is blocked. This indicates that pyrimidine synthesis may continue through both the de novo pathway, where the key enzyme is the thymidylate synthase (TS) and through the salvage pathway where the key enzyme is the thymidine kinase (TK).
3 OBJECTIVES I chose the topic because I have several times seen that the outcome of apparently similar cases of epithelial ovarian cancers is highly variable, and the traditional prognostic factors often would not predict disease outcome in a clinically useful manner. To examine this problem I analyzed in detail the following topics: 1. To examine the survival and clinico-pathological prognostic factors of patients treated at the 1 st. Department of Obsterics and Gynecology Semmelweis University Faculty of Medicine between Are these prognostic factors useful to predict disease outcome and survival of ovarian malignancies? 2. To compare the survival with the similar data of the twenty-fifth Annual Report on the Results of Treatment in Gynecological Cancer of FIGO in order to evaluate the efficiency of the treatment. 3. To analyze the prevalence, clinical course and molecular markers of ovarian tumours of low malignant potential (LMP). To review our experience with the fertility-sparing surgery in the treatment of LMP ovarian tumours of patients younger than To assess the prognostic value of MMP-2 and MMP-9 activities and fibronectin expression in ovarian cancer patients. 5. To compare the usefulness of traditional clinico-pathological prognostic factors to the examined molecular markers during the disease course. 6. To examine the activity and thermostability one of the key enzymes of the salvage DNA-synthesis in ovarian cancer and in normal ovaries. To fulfill these objectives I employed experimental and mathematical-statistical methods. MATERIAL AND METHODS Between 1993 and 2003, 155 patients with epithelial ovarian carcinomas and 47 patients with ovarian tumours of low malignant potential had been treated at the 1 st. Department of Obsterics and Gynecology Semmelweis University Faculty of Medicine. Those patients who have previous underwent chemotherapy or radiation therapy were excluded from the study. Collaborative research was started in 2002 between the oncological division of the I st. Department of Obstetrics and Gynecology and I st. Department of Pathology and Experimental Cancer Research of Semmelweis University. We asked for and received permission from the Regional and Institutional Committee of Science and Research Ethics of Semmleweis University. The goal was to investigate the relationship between the course of ovarian carcinoma to the mutual effect on the tumor cells and extracellular matrix. I examined the role
4 of molecular markers in the prognosis of ovarian tumours by employing molecular pathological procedures. The samples were collected from the operating rooms of the I st. Department of Obstetrics and Gynecology. The prognosis of epithelial ovarian cancer is considered better in young patients. To test this theory, I divided the patients into two groups according to their age. Those patients who were younger than 60 years of age at the time of diagnosis created the first group and those who were older created the second group. Comprehensive surgical staging was done based on the FIGO-classification. The histological examination was performed in the Histopathological Laboratory of the I st Department of Gynecology and Obstetrics. In cases where the tumour was questionable, a second-opinion was asked from either the I st Department of Pathology and Experimental Cancer Research or from the Oncopathological Laboratory of the National Oncological Institute. Samples were collected from ascites in every case and the volume was measured. If the volume was greater than 1000 ml, it was considered and classified as large quantity. Based on the measured diameter of residual tumor mass, the surgical procedure was considered optimal if it was less than 1 cm, otherwise it was considered suboptimal. I analyzed the role of prognostic factors in the patient survival rate. I also examined the possibility of employing fertility-sparing surgery in the treatment of borderline ovarian tumours. For those patients with low malignancy ovarian tumours who were older than 40, transabdominal hysterectomy and bilateral salpingoophorectomy was offered. I compared the survival with the similar data of the twenty-fifth Annual Report on the Results of Treatment in Gynecological Cancer of FIGO in order to evaluate the efficacy of the treatment. In order to investigate tumours with molecular markers, the serum and ascites of 22 patients with histologically verified ovarian tumours were analyzed. In the serum and ascites, matriolytic activity was detected in the surgically removed tumours by means of gelatin zymography. The samples were transported into the pathological laboratory under 4 C, where it was pulverized in the mortar and frozen immediately in liquid nitrogen. Proteolysis was detected as a white zone in a dark field and quantitative assessment was performed by using densitometric scanning with an Eagle Eye II (Stratagene, CA, USA). Each gel was scanned twice, and a standard curve was set up for every zymogram in relation to the gelatinolytic activity of recombinant MMP-2 and MMP-9. MMP-2 and MMP-9
5 gelatinolytic activity present in the ovarian tissues was compared with this curve. MMP-2 and MMP-9 activity was expressed in arbitrary units (U) per microgram of ovarian cancer tissue. Fibronectin content was identified by immunotechnique blot analysis and its quantity was estimated by densitometer analysis. The fibronectin concentration was determined using densitometric scanning with an Eagle Eye II, taking into account the intensity and the width of the band. Each gel was scanned twice, and a standard curve set up for every zymogram in relation to the fibronectin expression present in the ovarian tissues was compared with this curve. Fibronectin concentration was expressed in arbitrary units (U) per microgram of ovarian cancer tissue. The results were correlated to the clinico-pathological parameters, disease recurrence and patient survival, with a median follow-up period of 30 months. Thymidine kinase activity ( 14 C TdR + ATP TK 14 C-dTMP + ADP) was measured by the PEI cellulose plate method. TK activity was calculated in nmol substrate metabolised per hour per mg protein. Because of our interest to analyze thermostablity of TK, samples were incubated at 37 o C for three hours and TK activity measured every l5 minutes. We calculated the percent of TK activity in the presence of ATP and CTP, and estimated the relative contributions of TK isoenzymes to total TK activity in 7 ovarian cancers and in 9 normal ovaries. Statistical Analysis Different biostatistical methods were employed to analyze the data. Survival data was calculated begining the date of surgery. Treatment and survival data were supplemented from medical record reviews and from the Population Register Office. In order to compare different prognostic factors, a multvariate Cox proportional regression analysis was performed. A p value of <0.05 was considered to be significant. To compare activity of thymidine kinase, Student s t test was employed. Variances between MMP-2/9 activities and fibronectin expression were analyzed with ANOVA and differences between groups were evaluated using Student s t test. A p value of <0.05 was considered to be significant. RESULTS The morbidity of epithelial ovarian cancer increases with age. The most affected age group was between years of age in regard to carcinoma and between years in regard to
6 borderline tumours. The number of cancer patients with stage I and stage II tumors is about the same, however, 79% of patients were diagnosed in stage III. Disseminated malignancy was verified in about 10% of the patients. Approximately two thirds of the carcinomas were of serous histology. Surprisingly, most carcinomas were anaplastic. Ascites was presented in almost all patients with carcinoma and the volume of the ascites correlated to the stage of the disease. Optimal surgical procedure was done in more than half of the patients, however in 13% of the patients, only explorative laparotomy could be done. Twenty-eight percent of the patients with borderline ovarian tumours were younger than 40. Of them, 10 patients who wished to have children underwent fertility-sparing surgery. Half of them became pregnant and had healthy children. The 5-year survival of ovarian tumours with low malignant potential was 90%, and of epithelial ovarian cancers was 30,9%, respectively. Multivariate analysis identified adverse prognostic factors, including advanced age (>60 years) and stage, high grade and suboptimal operation with residual macroscopic disease and the presence of ascites. By examining the Kaplar-Meier-curves, the adverse survival was most strongly influenced by advanced stage. The relationship between the survival and age showed that those patients who were 60 years or older had twice the risk of dying from ovarian cancer compared to those who were younger. Histological type was not identified to be an adverse prognostic factor in this study, however mucinous and clear-cell types had a more favourable prognosis than serous types. Poorly differentiated carcinomas were associated with significantly decreased survival, since the mean survival time was approximately six times shorter for ovarian cancer patients with anaplastic tumours. There was no significant difference in regard to survival between well and moderately differentiated carcinomas. The patients whose carcinomas lacked ascites showed a survival time twice as long as those with ascites. In those patients who had more than 1000 ml ascites, the 5-year survival was less than 10%. The second strongest predictor of survival was the type of surgical procedure and the measured diameter of the residual tumour volume. The 5-year survival of patients who had an optimal operation was approximately ten times higher than patients who had a suboptimal operation.
7 No correlation could be seen between the histology of the ovarian tumours and the elevation of MMP-2/9 activity and fibronectin expression. I did not measured MMP-2/9 activity in normal ovaries, however I did find MMP-2/9 activity in ovarian tumours. Although the fibronectin concentration was particularly elevated in epithelial ovarian cancers, there was no statistically significant difference between fibronectin concentration in benign, borderline, and malignant ovarian tumours. Fibronectin expression was lower in early stage carcinomas compared to advanced stage tumours. However, the fibronectin concentration was significantly higher in patients who died because of ovarian cancer. The significantly elevated MMP-9 activity in ovarian cancer patients with recurrence may improve the theory that MMP-9 as opposed to MMP-2 is important not only in proliferation but also the dissemination of epithelial ovarian cancer. It is also possible that those ovarian cancer cells which have higher MMP-9 activity and fibronectin concentration may be more resistant to chemotherapy. There was no differences between the clinical-pathological parameters of recurrent and non-recurrent ovarian cancers. However, expression of MMP-9 and fibronectin concentration in recurrent ovarian cancer patients was significantly higher. In addition, the fibronectin concentration in the serum and ascites of recurrent ovarian cancer patients was also higher, though not significantly. MMP-9 activities in the serum and ascites of recurrent ovarian carcinomas were also higher, but only the MMP-9 activity elevation in the ascites was significant. MMP-2 activity was moderately but not significantly higher in recurrent ovarian carcinomas. Thymidine kinase activity was significantly higher in ovarian carcinoma extracts in contrast to normal ovaries, indicating elevated proliferation and mitotic activity. Thymidine kinase-2 isoenzyme can also be found in normal ovaries, which is produced by mitochondria and is more stable to thermal activity. The thymidine kinase-1 isoenzyme, which is found predominantly in the cytosol, is capable of dividing cells such as ovarian carcinoma cells and is thermally unstable and more subject to inactivation by thermal effect than the normal ovarian extracts. The TK-2 isoenzyme could usually only be revealed in the S-phase. I have found a notable difference between the thermostability of TK isoenzymes, which indicates clearly their different characteristics. CONCLUSIONS Oldaltörés 1. Multivariate analysis identified adverse prognostic factors including advanced age
8 (>60 years) and stage, high grade and suboptimal operation with residual macroscopic disease, and the presence of ascites. However, the histological type was not identified to be an adverse prognostic factor in this study. 2. The 5-year survival of patients with early stage ovarian carcinoma at Semmelweis University s 1 st Department of Obstetrics and Gynecology is similar to the survival of patients in the twenty-fifth Annual Report on the Results of Treatment in Gynecological Cancer of FIGO. However, 5-year survival for advanced stage ovarian cancer patients in 1 st Dept. of Obstetrics and Gynecology of Semmelweis University is 6% lower in regard to stage III carcinomas, and 13% lower in respect to stage IV carcinoma patients respectively. The reason may be that taxol treatment had been introduced later in the chemotherapy of ovarian cancer in Hungary than most countries in the FIGO-survey. 3. The prevalence, clinical course, and recovery of ovarian tumour patients with low malignant potential at the 1 st Dept. of Obstetrics and Gynecology of Semmelweis University was similar to patients of the twenty-fifth Annual Report on the Results of Treatment in Gynecological Cancer of FIGO. The fertility-sparing surgical procedure should be offered to young patients with early stage, low malignant potential ovarian tumours. In this study, half of those patients who had undergone fertility-sparing surgical procedure became pregnant and had a healthy newborn. 4. No correlation could be seen between the histology of the ovarian tumours and the elevation of MMP-2/9 activity and fibronectin expression. There was no statistically significant difference between MMP-2/9 activity and fibronectin concentration in ovarian carcinomas compared to normal ovaries so these molecular factors are not candidate markers for screening of ovarian carcinomas. 5. I previously stated that activated forms of MMP-9, MMP-2, and fibronectin concentration corresponded with the clinical course of epithelial ovarian carcinomas. The expression of these molecular markers in recurrent ovarian carcinomas was significantly higher compared to ovarian cancers without recurrence. MMP-9 activity and fibronectin concentration could be an appropriate molecular markers which may point out the high-risk subtype of epithelial ovarian carcinoma. 6. Thymidine kinas-1 isoenzyme activity was significantly higher in ovarian carcinoma extracts than in normal ovaries, indicating elevated proliferation and mitotic activity in the S-phase. Thymidine kinase is a potentially promising goal to the enzyme-pattern targeted chemotherapy
9 Oldaltörés
Borderline Ovarian Tumours. Andreas Obermair Brisbane
Borderline Ovarian Tumours Andreas Obermair Brisbane Definition First described in 1929 Cellular features of malignancy Cellular atypia Mitotic activity No stromal invasion An entity per se??? (or precursor
More informationPDF hosted at the Radboud Repository of the Radboud University Nijmegen
PDF hosted at the Radboud Repository of the Radboud University Nijmegen The following full text is a publisher's version. For additional information about this publication click this link. http://hdl.handle.net/2066/24096
More informationIntroduction to REMARK: Reporting tumour marker prognostic studies
Introduction to REMARK: Reporting tumour marker prognostic studies Doug Altman The EQUATOR Network Centre for Statistics in Medicine, Oxford, UK C 1 S M Reliable research Reliability is determined by proper
More informationChapter 2: Initial treatment for endometrial cancer (including histologic variant type)
Chapter 2: Initial treatment for endometrial cancer (including histologic variant type) CQ01 Which surgical techniques for hysterectomy are recommended for patients considered to be stage I preoperatively?
More informationProf. Dr. Aydın ÖZSARAN
Prof. Dr. Aydın ÖZSARAN Adenocarcinomas of the endometrium Most common gynecologic malignancy in developed countries Second most common in developing countries. Adenocarcinomas, grade 1 and 2 endometrioid
More informationStudy on the expression of MMP-9 and NF-κB proteins in epithelial ovarian cancer tissue and their clinical value
Study on the expression of MMP-9 and NF-κB proteins in epithelial ovarian cancer tissue and their clinical value Shen Wei 1,a, Chen Juan 2, Li Xiurong 1 and Yin Jie 1 1 Department of Obstetrics and Gynecology,
More informationRole of peritoneal washing cytology in ovarian malignancies: correlation with histopathological parameters
Naz et al. World Journal of Surgical Oncology (2015) 13:315 DOI 10.1186/s12957-015-0732-1 WORLD JOURNAL OF SURGICAL ONCOLOGY RESEARCH Open Access Role of peritoneal washing in ovarian malignancies: correlation
More informationMPH Quiz. 1. How many primaries are present based on this pathology report? 2. What rule is this based on?
MPH Quiz Case 1 Surgical Pathology from hysterectomy performed July 11, 2007 Final Diagnosis: Uterus, resection: Endometrioid adenocarcinoma, Grade 1 involving most of endometrium, myometrial invasion
More informationAnnual report of Gynecologic Oncology Committee, Japan Society of Obstetrics and Gynecology, 2013
bs_bs_banner doi:10.1111/jog.12360 J. Obstet. Gynaecol. Res. Vol. 40, No. 2: 338 348, February 2014 Annual report of Gynecologic Oncology Committee, Japan Society of Obstetrics and Gynecology, 2013 Daisuke
More informationOne of the commonest gynecological cancers,especially in white Americans.
Gynaecology Dr. Rozhan Lecture 6 CARCINOMA OF THE ENDOMETRIUM One of the commonest gynecological cancers,especially in white Americans. It is a disease of postmenopausal women with a peak incidence in
More informationRisk group criteria for tailoring adjuvant treatment in patients with endometrial cancer : a validation study of the GOG criteria
Risk group criteria for tailoring adjuvant treatment in patients with endometrial cancer : a validation study of the GOG criteria Suk-Joon Chang, MD, Hee-Sug Ryu MD Gynecologic Cancer Center Department
More informationSignificance of Ovarian Endometriosis on the Prognosis of Ovarian Clear Cell Carcinoma
ORIGINAL STUDY Significance of Ovarian Endometriosis on the Prognosis of Ovarian Clear Cell Carcinoma Jeong-Yeol Park, MD, PhD, Dae-Yeon Kim, MD, PhD, Dae-Shik Suh, MD, PhD, Jong-Hyeok Kim, MD, PhD, Yong-Man
More informationSurvival Analysis and Prognosis for Patients with Serous and Mucinous Borderline Ovarian Tumors: 14-Year Experience from a Tertiary Center in Iran
ORIGINAL ARTICLE Survival Analysis and Prognosis for Patients with Serous and Mucinous Borderline Ovarian Tumors: 14-Year Experience from a Tertiary Center in Iran Katayoun Ziari, Ebrahim Soleymani, and
More informationTrial record 1 of 1 for:
Find Studies About Studies Submit Studies Resources About Site Trial record 1 of 1 for: YO39523 Previous Study Return to List Next Study A Study of Atezolizumab Versus Placebo in Combination With Paclitaxel,
More informationHitting the High Points Gynecologic Oncology Review
Hitting the High Points is designed to cover exam-based material, from preinvasive neoplasms of the female genital tract to the presentation, diagnosis and treatment, including surgery, chemotherapy, and
More informationبسم هللا الرحمن الرحيم. Prof soha Talaat
بسم هللا الرحمن الرحيم Ovarian tumors The leading indication for gynecologic surgery. Preoperative characterization of complex solid and cystic adnexal masses is crucial for informing patients about possible
More informationAnnual report of the Committee on Gynecologic Oncology, the Japan Society of Obstetrics and Gynecology
bs_bs_banner doi:10.1111/jog.12596 J. Obstet. Gynaecol. Res. Vol. 41, No. 2: 167 177, February 2015 Annual report of the Committee on Gynecologic Oncology, the Japan Society of Obstetrics and Gynecology
More informationChapter 8 Adenocarcinoma
Page 80 Chapter 8 Adenocarcinoma Overview In Japan, the proportion of squamous cell carcinoma among all cervical cancers has been declining every year. In a recent survey, non-squamous cell carcinoma accounted
More informationTriage of Ovarian Masses. Andreas Obermair Brisbane
Triage of Ovarian Masses Andreas Obermair Brisbane Why Triage? In ovarian cancer, best outcomes for patients can be achieved when patients are treated in tertiary centres by a multidisciplinary team led
More informationThe impact of clinicopathologic and surgical factors on relapse and pregnancy in young patients ( 40 years old) with borderline ovarian tumors
Fang et al. BMC Cancer (2018) 18:1147 https://doi.org/10.1186/s12885-018-4932-2 RESEARCH ARTICLE Open Access The impact of clinicopathologic and surgical factors on relapse and pregnancy in young patients
More informationClinical outcome of cystectomy compared with unilateral salpingo-oophorectomy as fertility-sparing treatment of borderline ovarian tumors
REPRODUCTIVE SURGERY Clinical outcome of cystectomy compared with unilateral salpingo-oophorectomy as fertility-sparing treatment of borderline ovarian tumors Yoav Yinon, M.D., Mario E. Beiner, M.D., Walter
More informationHuman epididymal protein 4 The role of HE4 in the management of patients presenting with pelvic mass Publication abstracts
Human epididymal protein 4 The role of HE4 in the management of patients presenting with pelvic mass Publication abstracts Ovarian cancer is diagnosed annually in more than 200,000 women worldwide, with
More informationEffect of a nutrient mixture on the localization of extracellular matrix proteins in HeLa human cervical cancer xenografts in female nude mice
Effect of a nutrient mixture on the localization of extracellular matrix proteins in HeLa human cervical cancer xenografts in female nude mice Publication from the Dr. Rath Research Institute Experimental
More informationPractice of Medicine-1 Ovarian Cancer Clinical Correlation
Practice of Medicine-1 Ovarian Cancer Clinical Correlation Amir A. Jazaeri, M.D. Assistant Professor, Division of Gynecologic Oncology American Cancer Society Female Cancers 2000 Statistics Reprinted by
More informationImproving quality of care for patients with ovarian and endometrial cancer Eggink, Florine
University of Groningen Improving quality of care for patients with ovarian and endometrial cancer Eggink, Florine IMPORTANT NOTE: You are advised to consult the publisher's version (publisher's PDF) if
More informationA holistic approach to targeting breast cancer part II: Micronutrient synergy. Presented by: Dr. Neha Shanker DRRI
A holistic approach to targeting breast cancer part II: Micronutrient synergy Presented by: Dr. Neha Shanker DRRI Overview of the previous webinar In the last presentation we talked about: Increase in
More informationThe clinical relevance of circulating, cell-free and exosomal micrornas as biomarkers for gynecological tumors
Department of Tumor Biology The clinical relevance of circulating, cell-free and exosomal micrornas as biomarkers for gynecological tumors cfdna Copenhagen April 6-7, 2017 Heidi Schwarzenbach, PhD Tumor
More informationThe role of neoadjuvant chemotherapy in patients with advanced (stage IIIC) epithelial ovarian cancer
Radiology and Oncology Ljubljana Slovenia www.radioloncol.com research article 341 The role of neoadjuvant chemotherapy in patients with advanced (stage IIIC) epithelial ovarian cancer Erik Škof 1, Sebastjan
More informationPre-operative assessment of patients for cytoreduction and HIPEC
Pre-operative assessment of patients for cytoreduction and HIPEC Washington Hospital Center Washington, DC, USA Ovarian Cancer Surgery New Strategies Bergamo, Italy May 5, 2011 Background Cytoreductive
More informationDiabetes Mellitus and Breast Cancer
Masur K, Thévenod F, Zänker KS (eds): Diabetes and Cancer. Epidemiological Evidence and Molecular Links. Front Diabetes. Basel, Karger, 2008, vol 19, pp 97 113 Diabetes Mellitus and Breast Cancer Ido Wolf
More informationImpact of Surgery Extent on Survival and Recurrence Rate of Stage ⅠEndometrial Adenocarcinoma
Hou et al. / Cancer Cell Research 3 (2014) 65-69 Cancer Cell Research Available at http:// http://www.cancercellresearch.org/ ISSN 2161-2609 Impact of Surgery Extent on Survival and Recurrence Rate of
More informationAn Example of Business Analytics in Healthcare
An Example of Business Analytics in Healthcare Colleen McGahan Biostatistical Lead Cancer Surveillance & Outcomes BC Cancer Agency cmcgahan@bccancer.bc.ca Improve Ovarian Cancer Outcomes Business relevancy
More informationQuantitative Data Analysis Assignment Sample Newessays.co.uk
Absorbance Quantitative Data Analysis Assignment Sample Newessays.co.uk Part A: Results of the Study Is there a difference of curve profile between the MTT assay and the cell number? What do the different
More informationRosekeila Simões Nomelini, 1 Taísa Morete da Silva, 1 Beatriz Martins Tavares Murta, 2 and Eddie Fernando Candido Murta 1. 1.
International Scholarly Research Network ISRN Oncology Volume 2012, Article ID 947831, 5 pages doi:10.5402/2012/947831 Clinical Study Parameters of Blood Count and Tumor Markers in Patients with Borderline
More informationClaudin-4 Expression in Triple Negative Breast Cancer: Correlation with Androgen Receptors and Ki-67 Expression
Claudin-4 Expression in Triple Negative Breast Cancer: Correlation with Androgen Receptors and Ki-67 Expression Mona A. Abd-Elazeem, Marwa A. Abd- Elazeem Pathology department, Faculty of Medicine, Tanta
More informationFast Facts: Ovarian Cancer
Fast Facts Fast Facts: Ovarian Cancer Christina Fotopoulou MD PhD Consultant Gynaecological Oncologist Queen Charlotte s and Chelsea Hospital London, UK Thomas J Herzog MD Professor of Obstetrics and Gynecology
More informationreceive adjuvant chemotherapy
Women with high h risk early stage endometrial cancer should receive adjuvant chemotherapy Michael Friedlander The Prince of Wales Cancer Centre and Royal Hospital for Women The Prince of Wales Cancer
More informationSee the latest estimates for new cases of ovarian cancer and deaths in the US and what research is currently being done.
About Ovarian Cancer Overview and Types If you have been diagnosed with ovarian cancer or are worried about it, you likely have a lot of questions. Learning some basics is a good place to start. What Is
More informationEDUCATIONAL COMMENTARY CA 125. Learning Outcomes
EDUCATIONAL COMMENTARY CA 125 Learning Outcomes Upon completion of this exercise, participants will be able to: discuss the use of CA 125 levels in monitoring patients undergoing treatment for ovarian
More informationThe Expression of Tumor-Derived and Stromal-Derived Matrix Metalloproteinase 2 Predicted Prognosis of Ovarian Cancer
ORIGINAL STUDY The Expression of Tumor-Derived and Stromal-Derived Matrix Metalloproteinase 2 Predicted Prognosis of Ovarian Cancer Ziyi Fu, MD,* Sujuan Xu, MD,Þ Ye Xu, MD,Þ Jiehua Ma, MD,* Jingyun Li,
More informationLow-grade serous neoplasia. Robert A. Soslow, MD
Low-grade serous neoplasia Robert A. Soslow, MD soslowr@mskcc.org Outline Orientation Ovarian tumor overview Non serous borderline tumors Serous borderline tumors Clinical summary Morphologic description
More informationClinical statistics of gynecologic cancers in Japan
J Gynecol Oncol. 2017 Mar;28(2):e32 pissn 2005-0380 eissn 2005-0399 Review Article Clinical statistics of gynecologic cancers in Japan Wataru Yamagami, 1,7 Satoru Nagase, 2,7 Fumiaki Takahashi, 3 Kazuhiko
More informationFocus on... Ovarian cancer. HE4 & ROMA score
Focus on... Ovarian cancer HE4 & ROMA score Ovarian cancer in the world* Accounting for around 4% of all cancers diagnosed in women The estimated World age-standardised incidence rate for the more developed
More informationJoseph Misdraji, M.D. GI pathology Unit Massachusetts General Hospital
Joseph Misdraji, M.D. GI pathology Unit Massachusetts General Hospital jmisdraji@partners.org Low-grade appendiceal mucinous neoplasm (LAMN) High-grade appendiceal mucinous neoplasm (HAMN) Adenocarcinoma
More informationGCIG Rare Tumour Brainstorming Day
GCIG Rare Tumour Brainstorming Day Relatively (Not So) Rare Tumours Adenocarcinoma of Cervix Keiichi Fujiwara, Ros Glasspool Benedicte Votan, Jim Paul Aim of the Day To develop at least one clinical trial
More informationClear cell carcinoma arising from abdominal wall endometriosis: a unique case with bladder and lymph node metastasis
Liu et al. World Journal of Surgical Oncology 2014, 12:51 WORLD JOURNAL OF SURGICAL ONCOLOGY CASE REPORT Open Access Clear cell carcinoma arising from abdominal wall endometriosis: a unique case with bladder
More informationUNIVERSITY OF MEDICINE AND PHARMACY CRAIOVA PhD SCHOOL. PhD THESIS
UNIVERSITY OF MEDICINE AND PHARMACY CRAIOVA PhD SCHOOL PhD THESIS THE IMPORTANCE OF TUMOR ANGIOGENESIS IN CEREBRAL TUMOR DIAGNOSIS AND THERAPY ABSTRACT PhD COORDINATOR: Prof. univ. dr. DRICU Anica PhD
More informationRisk of Malignancy Index in the Preoperative Evaluation of Patients with Adnexal Masses among Women of Perimenopausal and Postmenopausal Age Group
IOSR Journal of Dental and Medical Sciences (IOSR-JDMS) e-issn: 2279-0853, p-issn: 2279-0861.Volume 17, Issue 9 Ver. 8 (September. 2018), PP 20-25 www.iosrjournals.org Risk of Malignancy Index in the Preoperative
More informationSurgical management and neoadjuvant chemotherapy for stage III-IV ovarian cancer
Ovarian cancer Surgical management and neoadjuvant chemotherapy for stage III-IV ovarian cancer JM. Classe, R. Rouzier, O.Glehen, P.Meeus, L.Gladieff, JM. Bereder, F Lécuru Suitable candidates for neo-adjuvant
More informationClinical guideline Published: 27 April 2011 nice.org.uk/guidance/cg122
Ovarian cancer: recognition and initial management Clinical guideline Published: 27 April 2011 nice.org.uk/guidance/cg122 NICE 2018. All rights reserved. Subject to Notice of rights (https://www.nice.org.uk/terms-and-conditions#notice-ofrights).
More informationPRINCESS MARGARET CANCER CENTRE CLINICAL PRACTICE GUIDELINES GYNECOLOGIC CANCER CERVIX
PRINCESS MARGARET CANCER CENTRE CLINICAL PRACTICE GUIDELINES GYNECOLOGIC CANCER CERVIX Site Group: Gynecology Cervix Author: Dr. Stephane Laframboise 1. INTRODUCTION 3 2. PREVENTION 3 3. SCREENING AND
More informationInternational Society of Gynecological Pathologists Symposium 2007
International Society of Gynecological Pathologists Symposium 2007 Anais Malpica, M.D. Department of Pathology The University of Texas M.D. Anderson Cancer Center Grading of Ovarian Cancer Histologic grade
More informationInvited Re vie W. Molecular genetics of ovarian carcinomas. Histology and Histo pathology
Histol Histopathol (1 999) 14: 269-277 http://www.ehu.es/histol-histopathol Histology and Histo pathology Invited Re vie W Molecular genetics of ovarian carcinomas J. Diebold Pathological Institute, Ludwig-Maximilians-University
More information2007 Cancer Committee
2007 Cancer Committee Ovarian Cancer Study Stage III & IV Albert Bonebrake, MD Rosie Netzer, RHIT, CTR Joanne Schahuber, R.T.(R)(T)(M)(QM) Table of Contents Table of Contents... 1 Ovarian Cancer Facts:...
More informationAnalysis of Prognosis and Prognostic Factors of Cervical Adenocarcinoma and Adenosqumous Carcinoma of the Cervix
DOI 10.1007/s11805-009-0133-8 133 Analysis of rognosis and rognostic Factors of Cervical Adenocarcinoma and Adenosqumous Carcinoma of the Cervix Guangwen Yuan Lingying Wu Xiaoguang Li Manni Huang Department
More informationInstitute of Pathology First Faculty of Medicine Charles University. Ovary
Ovary Barrett esophagus ph in vagina between 3.8 and 4.5 ph of stomach varies from 1-2 (hydrochloric acid) up to 4-5 BE probably results from upward migration of columnar cells from gastroesophageal junction
More informationDOCTORAL THESIS SUMMARY
UNIVERSITY OF MEDICINE AND PHARMACY CRAIOVA FACULTY OF MEDICINE DOCTORAL THESIS SUMMARY CLINICO-IMAGING STUDY OF INVASIVE DUCTAL BREAST CARCINOMAS CORRELATED TO HORMONAL RECEPTORS AND HER2/NEU ONCOPROTEIN
More informationGynecologic Oncology update
Gynecologic Oncology update Park City Utah Postgraduate Course in the Department of Obstetrics and Gynecology University of Utah/Huntsman Cancer Institute Andrew P. Soisson, MD Division of Gynecologic
More informationFDG-PET/CT in Gynaecologic Cancers
Friday, August 31, 2012 Session 6, 9:00-9:30 FDG-PET/CT in Gynaecologic Cancers (Uterine) cervical cancer Endometrial cancer & Uterine sarcomas Ovarian cancer Little mermaid (Edvard Eriksen 1913) honoring
More informationAdjuvant Therapies in Endometrial Cancer. Emma Hudson
Adjuvant Therapies in Endometrial Cancer Emma Hudson Endometrial Cancer Most common gynaecological cancer Incidence increasing in Western world 1-2% cancer deaths 75% patients postmenopausal 97% epithelial
More informationCase 1. Gynaecology Case Presentation. Objectives. Disclosures 22/10/ year old female Clinical history: Assess right ovarian cyst
Gynaecology Case Presentation Organ Imaging 2016 University of Toronto Sarah Johnson 39 year old female Clinical history: Assess right ovarian cyst Clinically diagnosed endometriosis Started fertility
More informationIntroduction: 年 Fas signal-mediated apoptosis. PI3K/Akt
Fas-ligand (CD95-L; Fas-L) Fas (CD95) Fas (apoptosis) 年 了 不 度 Fas Fas-L 力 不 Fas/Fas-L T IL-10Fas/Fas-L 不 年 Fas signal-mediated apoptosis 度降 不 不 力 U-118, HeLa, A549, Huh-7 MCF-7, HepG2. PI3K/Akt FasPI3K/Akt
More informationRESEARCH COMMUNICATION
RESEARCH COMMUNICATION Clinicopathologic Analysis of Women with Synchronous Primary Carcinomas of the Endometrium and Ovary: 10- Year Experience from Chiang Mai University Hospital Jiraprapa Natee 1 *,
More informationRecurrence of sex cord tumor with annular tubules in young patient with Peutz-Jeghers syndrome
Slimane et al. 74 CASE REPORT PEER REVIEWED OPEN ACCESS Recurrence of sex cord tumor with annular tubules in young patient with Peutz-Jeghers syndrome Meher Slimane, Selma Gadria, Manel Hadidane, Houyem
More informationCan the Ovaries be preserved in Selected Cases of Endometrial Cancer?
Can the Ovaries be preserved in Selected Cases of Endometrial Cancer? Parekh C D 1*, Desai A D 2, Patel B M 3, Patel S M 4, Mankad M H 5 1 Assistant Professor,Department of Gynaecologic Oncology, Gujarat
More informationPROGNOSTIC FACTORS AND FIRST LINE CHEMOTHERAPY IN AOC
PROGNOSTIC FACTORS AND FIRST LINE CHEMOTHERAPY IN AOC Giorgia Mangili RUF ginecologia oncologica medica IRCCS San Raffaele Milano mangili.giorgia@hsr.it STANDARD CHEMOTHERAPY The standard chemotherapy
More informationSetting The setting was secondary care. The economic study was carried out in Belgium.
Cost effectiveness of paclitaxel/cisplatin compared with cyclophosphamide/cisplatin in the treatment of advanced ovarian cancer in Belgium Neymark N, Gorlia T, Adriaenssen I, Baron B, Piccart M Record
More informationClinicopathologic Characteristics and Prognosis of Gastric Cancer in Young Patients
Yonago Acta medica 2012;55:57 61 Clinicopathologic Characteristics and Prognosis of Gastric Cancer in Young Patients Hiroaki Saito, Seigo Takaya, Yoji Fukumoto, Tomohiro Osaki, Shigeru Tatebe and Masahide
More informationWinship Cancer Institute of Emory University Optimizing First Line Treatment of Advanced Ovarian Cancer
Winship Cancer Institute of Emory University Optimizing First Line Treatment of Advanced Ovarian Cancer Ira R. Horowitz, MD, SM, FACOG, FACS John D. Thompson Professor and Chairman Department of Gynecology
More informationGestione dei tumori borderline iniziali e avanzati nelle donne in età fertile
Gestione dei tumori borderline iniziali e avanzati nelle donne in età fertile Pierandrea De Iaco pierandrea.deiaco@aosp.bo.it SSD ONCOLOGIA GINECOLOGICA AOU SANT ORSOLA-MALPIGHI BOLOGNA Borderline ovarian
More informationCase 1. Pathology of gynecological cancer. What do we need to know (Case 1) Luca Mazzucchelli Istituto cantonale di patologia Locarno
Case 1 Pathology of gynecological cancer. What do we need to know (Case 1) Luca Mazzucchelli Istituto cantonale di patologia Locarno SAMO Interdisciplinary Workshop on Gynecological Tumors Lucern, October
More informationCytyc Corporation - Case Presentation Archive - October 2001
ThinPrep Pap Test History: 82 Year Old Female Specimen Type: Peritoneal Washings Case provided by Dr. Berle Stratton, Southwest Washington Medical Center, Vancouver, Washington. *The images, analysis and
More informationNorth of Scotland Cancer Network Clinical Management Guideline for Cancer of the Ovary
North of Scotland Cancer Network Cancer of the Ovary Based on WOSCAN CMG with further extensive consultation within NOSCAN UNCONTROLLED WHEN PRINTED DOCUMENT CONTROL Prepared by NOSCAN Gynaecology Cancer
More informationStage IIIC transitional cell carcinoma and serous carcinoma of the ovary have similar outcomes when treated with platinum-based chemotherapy
Original Investigation 33 Stage IIIC transitional cell carcinoma and serous carcinoma of the ovary have similar outcomes when treated with platinum-based chemotherapy Gökhan Boyraz, Derman Başaran, Mehmet
More informationNeoplasia 2018 Lecture 2. Dr Heyam Awad MD, FRCPath
Neoplasia 2018 Lecture 2 Dr Heyam Awad MD, FRCPath ILOS 1. List the differences between benign and malignant tumors. 2. Recognize the histological features of malignancy. 3. Define dysplasia and understand
More informationNovel Biomarkers (Kallikreins) for Prognosis and Therapy Response in Ovarian cancer
Novel Biomarkers (Kallikreins) for Prognosis and Therapy Response in Ovarian cancer Eleftherios P. Diamandis, M.D., Ph.D., FRCP(C) EORTC-NCI-ASCO Meeting,November 16, 2007 Yousef GM, Diamandis EP. Endocr.
More informationHistopathological analysis of neoplastic and non neoplastic lesions of ovary: A study of one hundred cases
Orginal Article Histopathological analysis of neoplastic and non neoplastic lesions of ovary: A study of one hundred cases 2 G Prathima, Srikanth Shastry 2 Consultant Pathologist, Image Diagnostics, Kadapa,
More informationACCME/Disclosures. Risk of Gyne Ca in HBOC. Molecular basis of HBOC. Hereditary Ovarian and Breast Cancer Syndrome
Hereditary Ovarian and Breast Cancer Syndrome C. Blake Gilks, MD Dept of Pathology Vancouver General Hospital University of British Columbia Blake.gilks@vch.ca The USCAP requires that anyone in a position
More informationACRIN Gynecologic Committee
ACRIN Gynecologic Committee Fall Meeting 2010 ACRIN Abdominal Committee Biomarkers & Endpoints in Ovarian Cancer Trials Robert L. Coleman, MD Professor and Vice Chair, Clinical Research Department of Gynecologic
More informationTest Bank for Robbins and Cotran Pathologic Basis of Disease 9th Edition by Kumar
Link full download:https://getbooksolutions.com/download/test-bank-for-robbinsand-cotran-pathologic-basis-of-disease-9th-edition-by-kumar Test Bank for Robbins and Cotran Pathologic Basis of Disease 9th
More informationThe legally binding text is the original French version TRANSPARENCY COMMITTEE OPINION. 16 December 2009
The legally binding text is the original French version TRANSPARENCY COMMITTEE OPINION 16 December 2009 REMOVAB 10 microgram concentrate for infusion solution Carton containing 1 pre-filled syringe (CIP:
More informationEpithelial Ovarian Cancer
Epithelial Ovarian Cancer GYNE/ONC Practice Guideline Dr. Alex Hammond Dr. Ian Kerr Dr. Akira Sugimoto Dr. Stephen Welch Kay Faroni Christine Gawlik Kerri Thornton Approval Date: This guideline is a statement
More informationRecent advances in breast cancers
Recent advances in breast cancers Breast cancer is a hetrogenous disease due to distinct genetic alterations. Similar morphological subtypes show variation in clinical behaviour especially in response
More informationImmunohistochemistry on Fluid Specimens: Technical Considerations
Immunohistochemistry on Fluid Specimens: Technical Considerations Blake Gilks Dept of Pathology University of British Columbia, Vancouver, BC, Canada Disclosures None Learning Objectives At the end of
More informationIndex. B Bilateral salpingo-oophorectomy (BSO), 69
A Advanced stage endometrial cancer diagnosis, 92 lymph node metastasis, 92 multivariate analysis, 92 myometrial invasion, 92 prognostic factors FIGO stage, 94 histological grade, 94, 95 histologic cell
More informationCase Scenario 1. History
History Case Scenario 1 A 53 year old white female presented to her primary care physician with post-menopausal vaginal bleeding. The patient is not a smoker and does not use alcohol. She has no family
More informationPort-Site Metastases After Robotic Surgery for Gynecologic Malignancy
SCIENTIFIC PAPER Port-Site Metastases After Robotic Surgery for Gynecologic Malignancy Noah Rindos, MD, Christine L. Curry, MD, PhD, Rami Tabbarah, MD, Valena Wright, MD ABSTRACT Background and Objectives:
More informationCancer cells in vitro
Supplementary Figure S1 Cancer cells in vitro Pretreatment with Control IgG (18h) Pretreatment with anti-u-par (18h) Acid Wash/Pretreatment with Control IgG (18h) Acid Wash/Pretreatment with anti-u-par
More informationHow to Recognize Gynecologic Cancer Cells from Pelvic Washing and Ascetic Specimens
How to Recognize Gynecologic Cancer Cells from Pelvic Washing and Ascetic Specimens Wenxin Zheng, M.D. Professor of Pathology and Gynecology University of Arizona zhengw@email.arizona.edu http://www.zheng.gynpath.medicine.arizona.edu/index.html
More informationBACKGROUND. The objective of this study was to determine the impact of malignant
1397 The Clinical Significance of Malignant Pleural Effusions in Patients with Optimally Debulked Ovarian Carcinoma Ram Eitan, M.D. Douglas A. Levine, M.D. Nadeem Abu-Rustum, M.D. Yukio Sonoda, M.D. Jae
More informationClinicopathologic Features of Ovarian Mixed Mesodermal Tumors and Carcinosarcomas
GYNECOLOGIC ONCOLOGY 2, 228--22 (989) Clinicopathologic Features of Ovarian Mixed Mesodermal Tumors and Carcinosarcomas KEITH Y. TERADA, M.D., TERRI L. JOHNSON, M.D., MICHAEL HOPKINS, M.D., AND JAMES A.
More informationNorth of Scotland Cancer Network Clinical Management Guideline for Endometrial Cancer
THIS DOCUMENT North of Scotland Cancer Network Clinical Management Guideline for Endometrial Cancer Based on WOSCAN CMG with further extensive consultation within NOSCAN UNCONTROLLED WHEN PRINTED DOCUMENT
More informationInteractive Staging Bee
Interactive Staging Bee ROBIN BILLET, MA, CTR GA/SC REGIONAL CONFERENCE NOVEMBER 6, 2018? Clinical Staging includes any information obtained about the extent of cancer obtained before initiation of treatment
More informationRandomized Phase III Trials of Intravenous vs. Intraperitoneal Therapy in Optimal Ovarian Cancer
Randomized Phase III Trials of Intravenous vs. Intraperitoneal Therapy in Optimal Ovarian Cancer Deborah K. Armstrong, M.D. Associate Professor of Oncology, Gynecology and Obstetrics Development of Intraperitoneal
More informationDebulking Surgery and HIPC to Treat Ovarian Cancer
Transcript Details This is a transcript of an educational program accessible on the ReachMD network. Details about the program and additional media formats for the program are accessible by visiting: https://reachmd.com/programs/clinicians-roundtable/debulking-surgery-and-hipc-to-treat-ovariancancer/3690/
More informationLaparoscopy as the primary modality for the treatment of women with endometrial carcinoma Eltabbakh G H, Shamonki M I, Moody J M, Garafano L L
Laparoscopy as the primary modality for the treatment of women with endometrial carcinoma Eltabbakh G H, Shamonki M I, Moody J M, Garafano L L Record Status This is a critical abstract of an economic evaluation
More informationOvarian Clear Cell Carcinoma
Ovarian Clear Cell Carcinoma Rouba Ali-Fehmi, MD Professor of Pathology The Karmanos Cancer Institute, Wayne State University School of Medicine 50 year old woman with chief complaint of shortness of breath
More informationMalignant transformation in benign cystic teratomas, dermoids of the ovary
European JournalofObstetrics& Gynecology andreproductivebiology, 29 (1988) 197-206 197 Elsevier EJO 00716 Malignant transformation in benign cystic teratomas, dermoids of the ovary S. Chadha 1 and A. Schaberg
More informationWhat is endometrial cancer?
Uterine cancer What is endometrial cancer? Endometrial cancer is the growth of abnormal cells in the lining of the uterus. The lining is called the endometrium. Endometrial cancer usually occurs in women
More informationDefinition Endometriosis is the presence of functioning endometrial tissue outside the cavity of the uterus.
Dept. of Obstetrics t and Gynecology Faculty of Medicine University of Sumatera Utara Endometriosis Definition Endometriosis is the presence of functioning endometrial tissue outside the cavity of the
More information