Cancer Of Female Genital Tract Research Articles

Model for the molecular genetic diagnosis of endometrial cancer using K-ras mutation analysis.

Model for the molecular genetic diagnosis of endometrial cancer using K-ras mutation analysis.

The epidemiology of female genital tract cancers

Endometrial, ovarian and cervical cancer are among the leading causes of death in women. The role of unopposed estrogens in endometrial carcinogenesis is well established. Any factor that increases the exposure of the endometrium to unopposed estrogen, such as menopausal replacement treatment, obesity, or irregular menstrual cycles tends to raise the risk of the disease, while factors that lower exposure to estrogens or increase progesterone levels, such as oral contraceptives (OC) or smoking, decrease the risk. These well-established risk factors can have different effects at different ages, particularly in pre- and postmenopausal women: more generally, the interaction between various factors is still not totally defined. With reference to ovarian cancer, OC and parity, late menopause and lifelong regular menstrual periods increase the risk of the disease. In terms of biologic mechanisms, these factors are thought to act on ovarian cancer risk by affecting lifetime number of ovulations. Along this line, ‘incessant ovulation’ could be the relevant exposure that defines the incidence of the neoplasm. Among the factors other than reproductive or hormonal, diet is likely to be the most relevant, but it is still. however, poorly quantified. There is now consistent evidence that Human Papillomavirus (HPV) has a causal role in the ethiology of cervical cancer and that sexual habits and reproductive/hormonal factors are associated with the risk of invasive cervical cancer. Less clear is the role of smoking and dietary habits, but recent studies have shown a direct relationship between smoking and the risk of invasive cervical cancer and an inverse one between selected vitamin intake and risk of the disease. In this paper we review and discuss these evidences.

Risk of second malignant neoplasms following female genital tract cancers in New South Wales (Australia), 1972-91

Data from the New South Wales (NSW) Central Cancer Registry for 1972-91 were examined to determine the risk of a second primary cancer following an initial invasive cancer of the cervix uteri (ICD-9 180), corpus uteri (ICD-9 182), ovary (ICD-9 183) or 'other female genital organs' (ICD-9 184). Expected numbers of cancers were obtained by assuming that women with a cancer of the female genital tract experienced the same cancer incidence as the female population of NSW as a whole. The relative risk (RR) of a second primary cancer was the ratio of observed to expected numbers of second cancers, excluding those of the female genital tract. Following cervical cancer, significantly increased risks were found for cancer of the larynx (RR= 7.43), lung (RR = 3.64), bladder (RR = 3.36) and for all tobacco-related sites (excluding cervix and bladder) grouped together (RR = 2.54). A nonsignificant excess of anal cancer (RR = 4.23) was also seen. After an initial cancer of the corpus uteri significantly increased risks were found for colorectal (RR = 1.35), breast (RR = 1.36) and bladder cancers (RR = 1.95). The excess of colorectal cancer bordered on significance (RR = 1.43) but there was no increased risk of breast cancer (RR = 1.02) after ovarian cancer. The data illustrate the need for surveillance of women with cervical cancer for further tobacco-related cancers, and the risk of treatment-initiated neoplasms.

Risk of second malignant neoplasms following female genital tract cancers in New South Wales (Australia), 1972-91

Data from the New South Wales (NSW) Central Cancer Registry for 1972-91 were examined to determine the risk of a second primary cancer following an initial invasive cancer of the cervix uteri (ICD-9 180), corpus uteri (ICD-9 182), ovary (ICD-9 183) or 9other female genital organs9 (ICD-9 184). Expected numbers of cancers were obtained by assuming that women with a cancer of the female genital tract experienced the same cancer incidence as the female population of NSW as a whole. The relative risk (RR) of a second primary cancer was the ratio of observed to expected numbers of second cancers, excluding those of the female genital tract. Following cervical cancer, significantly increased risks were found for cancer of the larynx (RR= 7.43), lung (RR = 3.64), bladder (RR = 3.36) and for all tobacco-related sites (excluding cervix and bladder) grouped together (RR = 2.54). A nonsignificant excess of anal cancer (RR = 4.23) was also seen. After an initial cancer of the corpus uteri significantly increased risks were found for colorectal (RR = 1.35), breast (RR = 1.36) and bladder cancers (RR = 1.95). The excess of colorectal cancer bordered on significance (RR = 1.43) but there was no increased risk of breast cancer (RR = 1.02) after ovarian cancer. The data illustrate the need for surveillance of women with cervical cancer for further tobacco-related cancers, and the risk of treatment-initiated neoplasms.

Cancers of the female genital tract in Ragusa, Sicily.

A descriptive study of cancers of the female genital tract (cervix, endometrium, ovary, labia, vulva and vagina) in the province of Ragusa (Sicily) was carried out using incidence and mortality data of the Ragusa Cancer Registry, covering the years 1981-1987. Corpus uteri was the most frequent site of cancer, followed by cervix utery and ovary; the highest mortality rates were exhibited by ovary cancer, whose survival at five years was 18.1 percent. A comparison of incidence and mortality rates with those observed by Italian and European registries shows that while in Ragusa rates for cancers of all sites were lower, female genital tract cancers, particularly of the uterus, were more frequent in Ragusa than in other Italian and European areas. In contrast with what has been reported by cancer registries of most developed countries, incidence of cervix cancer in Ragusa has apparently not decreased between 1981 and 1987, while mortality has increased.

Female genital tract cancer

Site-specific cancer frequencies and incidence rates are reported regularly by the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) program, but not by histologic type within site. This report reviews data for 160,977 histologically or cytologically confirmed invasive and in situ cancers of the female genital tract. Data were supplied by the SEER program for histologically confirmed cases of uterine corpus, uterine cervix, ovary, vulva, vagina, fallopian tube, and placental cancers diagnosed between 1973 and 1987. Histologic types were reviewed for race, age at diagnosis, incidence, stage, and survival. There were 89,943 invasive and 71,034 in situ neoplasms. Squamous carcinoma was the most common invasive malignancy of the cervix (77.1%), vulva (74.4%), and vagina (70.8%). Adenocarcinoma was the most frequent malignancy in the uterine corpus (81.5%) and ovary (86.6%), with these percentages reaching 91.6% for corpus and 86.9% for ovary if adenosquamous carcinoma and adenocarcinoma with squamous metaplasia are included. Cervical carcinoma in situ accounted for 91.0% of all in situ cancers. In situ cancers made up 78.5% of all cervical cancers, 35.1% of vaginal cancers, and 50.4% of vulvar cancers. There are dominant histologic groups in each female genital tract site that are largely responsible for incidence and survival statistics. Within the groups, however, there are subtypes with differing features. Epidemiologic studies may provide more definite information by considering the effect of these subtypes in examining risk factors.

Hormonal therapy following female genital tract cancer.

Following treatment of genital tract cancer, women are often left in an estrogen-deficient state suffering both short- and long-term effects which markedly reduce the quality of life. In the belief that sex hormones may induce an adverse effect on all these women, attending physicians often refuse to prescribe hormonal replacement therapy (HRT). In an attempt to introduce a rational approach to this problem the effect of sex hormones on genital tract cancer growth is reviewed and some general guidelines for administering sex hormones to women following treatment for genital tract cancer are developed. A plea is made to improve the well-being of patients following cancer treatment by considering the judicious use of appropriate hormonal therapy, including estrogens.

Relationship between Quetelet's index and cancer of breast and female genital tract in 47,000 women followed for 25 years

The relationship between Quetelet's index and subsequent risk for cancer of endocrine target organs was studied in a cohort of 47,003 women, examined for height and weight in the years 1963-65, and followed up in the Swedish Cancer Register until 1987. High Quetelet's index was associated with a decreased risk for breast cancer among women less than 55 years of age at risk, while a high Quetelet's index predicted an increased risk among older women. Among women > or = 55 years of age, the excess relative risk for breast cancer associated with high Quetelet's index declined significantly during the follow-up period. Cancer of the ovaries and the uterine cervix were not significantly related to Quetelet's index in any age group. In women > or = 55 years of age, the relative risk for cancer of the uterine corpus associated to Quetelet's index was higher than that for breast cancer, and this association persisted during the entire follow-up period of more than 20 years. In spite of the fact that endometrial cancer is less common than breast cancer, because of the stronger relation between overweight and endometrial cancer, more endometrial cancer would be attributable to obesity than breast cancer.

Mutagenic and recombinagenic effects of diethylstilbestrol quinone

Estrogens are believed to be major contributors to many cancers of the human female genital tract, but the mechanism of their carcinogenic action is not well-understood. While a tumor-promoting role for estrogens is well-supported, whether they also act as tumor initiators has remained controversial. Here, we have sought to examine the mutagenic potential of diethylstilbestrol, a synthetic estrogen that is a powerful carcinogen in hamsters, and is suspected to be a human carcinogen. Phage M13 single-stranded DNA was treated in vitro with diethylstilbestrol quinone (DES Q; 1.25 mM) and transfected into Escherichia coli cells. DES Q treatment resulted in an apparent enhancement of mutagenesis in the LacZ(α) gene segment. DNA sequence analysis of LacZ(α) mutants obtained by transfection of DES Q-treated DNA revealed that the major effect of DES Q treatment has been a 6-fold elevation of recombination between the phage-borne LacZ(α) sequence and the LacZΔM15 sequence on the E. coli fertility plasmid F. To confirm whether DES Q treatment is recombinagenic, we used an experimental system that allows the detection of recombination between a defective E. coli chromosomal LacY gene and a normal counterpart borne on a plasmid. Transfection of DES Q (0.06–12 mM) treated plasmid DNA showed significant enhancement (2-100-fold) in recombination, but not in mutagenesis. These results raise the possibility that estrogen quinones may induce recombinagenic DNA damage.

Anaerobic bacteremia in a cancer center.

Seventy-five episodes of clinically relevant anaerobic bacterial bacteremia observed in cancer patients were reviewed. Gastrointestinal (22.7%), hematological (22.7%) and female genital tract (18.6%) cancers were the most common underlying malignant diseases. Among 84 strains of strict anaerobic bacteria recovered in the 75 patients, gram-negative rods were isolated in 49 patients (58.3%), gram-positive rods in 29 patients (34.5%) and gram-positive cocci in 6 patients (8%). Bacteroides spp. and Clostridium spp. were the most frequent pathogens (85.7%). Twenty-one episodes of bacteremia were polymicrobial, aerobic gram-positive cocci being the most frequently associated pathogens. When identified, the primary sites were the gastrointestinal tract (40%), the female genital tract (17.3%), skin and soft tissue (14.6%), the oropharynx (12%) and the lower respiratory tract (6.7%). The source remained unknown in 7 cases (9.3%). The overall survival (evaluated 10 days after the occurrence of bacteremia) was 82.5%. There was no difference in mortality between patients with monomicrobial and polymicrobial bacteremia. Pulmonary complications were more frequent in patients with fatal outcome in comparison to patients who survived. The mortality rate of the patients adequately treated was 10.3% compared to 41% for the patients not treated or treated inadequately (P = 0.016, chi 2).

Prevalence of non-specific vaginitis and correlation with isolation of Gardnerella vaginalis in Italian outpatients.

Among all subjects attending a Center for prevention of female genital tract cancer Gardnerella vaginalis was isolated from 57 out of 171 women affected by non-specific vaginitis (NSV), from 15 of 703 non-NSV vaginitis patients and from 10 of 338 healthy adults. Postmenopausal women showed an increased rate of asymptomatic carriage of G. vaginalis. The data suggest a relatively weak association between clinical diagnosis of NSV and isolation of G. vaginalis.

Book reviews

This multi-author book, edited by Nori and Hilaris, draws many of its contributors from the Memorial Sloan-Kettering Cancer Centre in New York. Its American origins are evident in that a short section on the treatment of breast cancer is included in a text otherwise exclusively concerned with the treatment of female genital tract cancer, reflecting the wider scope of the gynaecologist in the US. The book aims to be of interest to all doctors concerned in the care of women with gynaecological cancer and is organized into three sections of General Principles, Clinical Applications and Special Topics.

Photodynamic Therapy for Cancer of the Lower Female Genital Tract

A new and conservative approach to the management of severe dysplasia and carcinoma in situ of the lower female genital tract was attempted. A total of seven patients who had failed all conventional modalities for cancer of the vulva, vagina, or perianal region were treated with photodynamic therapy (PDT). PDT is an experimental cancer therapy that involves a combination of a tumor-localizing photosensitizer and photoactivating red light, usually from an argon-dye laser system. Of the 45 sites that were treated, 34 were disease-free (76%) as evidenced by negative biopsies at 3 months. Adverse reactions to PDT included a transient cutaneous photosensitivity, due to retention of the photosensitizer in the skin, that usually persisted for 45 to 60 days. Edema, erythema, and necrosis, accompanied by varying levels of pain, occurred in treated sites within 12 to 48 hours of treatment. Based on these initial clinical results, the future of PDT as a modality for cancer of the lower female genital tract appears promising.

Evaluation of hospital screening for breast and female genital tract cancer.

Evaluation of hospital screening for breast and female genital tract cancer.

Evaluation of hospital screening for breast and female genital tract cancer

Evaluation of hospital screening for breast and female genital tract cancer

DNA repair protects against cutaneous and internal neoplasia: evidence from xeroderma pigmentosum.

Xeroderma pigmentosum (XP), is a rare, autosomal recessive disease with sun sensitivity and multiple neoplasms in association with reduced DNA repair. As a reflection of the clinical consequences of deficient DNA repair, XP serves as a model for determining the effects of proficient DNA repair. To estimate the risk of developing neoplasms in XP, we abstracted reports of 726 XP patients (from 41 countries) published from 1874 to 1982. Despite limitations of a literature survey, the XP patients under age 20 years had an estimated 2000-fold increase in frequency of basal cell and squamous cell carcinoma of the skin, of cutaneous melanoma, of cancer of the anterior eye, and of cancer of the anterior tongue, in comparison to the general population. These sites are all potentially exposed to u.v. radiation, a strong carcinogen which produces DNA damage that is poorly repaired by XP cells. XP patients under age 20 years also had an estimated 12-fold increase in occurrence of neoplasms in sites not exposed to u.v. radiation. Among the XP patients under age 40 years with internal cancer, there was a disproportionate representation of malignant neoplasms of the brain (especially sarcomas), and oral cavity (excluding tongue) compared to US whites under age 40 years. These internal neoplasms may be related to exposure to chemical environmental carcinogens that cause DNA damage which, like u.v.-induced damage, is poorly repaired by XP cells. These reports provide no evidence of an increase in XP of common lethal neoplasms such as lymphomas, or female genital tract or endocrine system cancers. These findings suggest that DNA repair plays a role in protection against u.v.-induced neoplasia and in protection against some internal neoplasms in the general population.

Carcinoembryonic antigen in gynecologic cancers. Immunohistochemical localization and serum levels.

The presence of carcinoembryonic antigen (CEA)-dependent fluorescence was observed in almost 89% of female genital tract cancers irrespective of their histologic type. Anti-CEA serum was free of antibody to normal cross-reacting antigen. The high percentage of positive fluorescence tests did not correlate with the preoperative serum CEA levels. Double immunodiffusion tests showed different content of CEA and normal cross-reacting antigen in individual specimens of genital tract cancers.

Cancer of the genital tract among the Ibo women in Nigeria.

An analysis of female genital tract cancer among the Ibos of Nigeria has proven to be preponderantly cervical cancer. It is therefore obvious that the practice of ritual circumcision among the Ibo men does not protect the women from cervical cancer. The most important etiological factors contributing to cervical cancer among the Ibo women are early marriage, early age of coitus, and grand multiparity. Corpus cancer is relatively rare among the Ibo women.

Cancer family syndrome

A familial cancer syndrome is reported in which a high incidence of colonic and female genital tract cancers occur at unusually early ages in the absence of polyps and other predisposing factors. A family is reported and the literature reviewed.

Cell‐mediated Immunity: Effect of Female Genital Tract Cancer, Pregnancy and Immunosuppressive Drugs

Summary: Cell‐mediated immune response was measured by the uptake of tritiated thymidine by lymphocytes cultured in serum‐free medium. Five groups were studied: healthy young women, age‐matched controls, pregnant patients, women with genital tract cancer, and patients who were receiving long‐term treatment with prednisolone and azathioprine. A quantitative assessment of the thymus‐derived “T” lymphocyte was made by its mitogenic response to different doses of phytohaemagglutinin (PHA). There was no significant change in resting lymphocyte activity in any of the above groups. With PHA stimulation, the 3 test groups gave responses significantly below those of healthy controls and age‐matched hospital patients. In pregnancy, depression of response was noted at 20 μg PHA whilst, in cancer and during immunosuppressive therapy, depression was more marked and occurred at 5 μg, 20 μg and 100 μg PHA. The results indicate a disturbance of the “T” lymphocyte function in the 3 conditions studied.