Gynecologic oncology
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Gynecologic oncology · Sep 2011
ReviewAdjuvant treatment for stage IIIC endometrial cancer: options and controversies.
Endometrial cancer is the most common gynecologic malignancy. Locally advanced and high risk endometrial cancer encompasses a heterogeneous group of patients and optimal treatment for various sub-groups of these patients remains controversial. ⋯ Areas of controversy are also discussed to assist clinicians in identifying the most effective adjuvant treatment regimens for patients with locally advanced disease. On-going randomized trials are briefly discussed.
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Gynecologic oncology · Sep 2011
Proteomic biomarkers apolipoprotein A1, truncated transthyretin and connective tissue activating protein III enhance the sensitivity of CA125 for detecting early stage epithelial ovarian cancer.
The low prevalence of ovarian cancer demands both high sensitivity (>75%) and specificity (99.6%) to achieve a positive predictive value of 10% for successful early detection. Utilizing a two stage strategy where serum marker(s) prompt the performance of transvaginal sonography (TVS) in a limited number (2%) of women could reduce the requisite specificity for serum markers to 98%. We have attempted to improve sensitivity by combining CA125 with proteomic markers. ⋯ Combining a panel of proteomic markers with CA125 could provide a first step in a sequential two-stage strategy with TVS for early detection of ovarian cancer.
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Gynecologic oncology · Sep 2011
Risk factors for lymph node metastasis in apparent early-stage epithelial ovarian cancer: implications for surgical staging.
The extent of lymphadenectomy to be performed in apparent early-stage epithelial ovarian cancer (EOC) is not well defined. We evaluated the patterns of lymphatic spread in apparent early-stage EOC and risk factors for lymph node metastasis, as these have potential implications for clinical decision making. ⋯ Complete surgical staging in EOC patients with gross disease confined to the ovaries and pelvis should include bilateral pelvic and paraaortic lymphadenectomy. Even in patients with unilateral lesions, lymph node metastases are commonly bilateral. Bilateral ovarian lesions, positive cytology, presence of ascites, high grade histology, and serous histology are risk factors for lymph node involvement. This information may be helpful in counseling patients presenting for consideration of re-staging after unexpected findings of malignancy.
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Gynecologic oncology · Jun 2011
Cost-consequences evaluation between bivalent and quadrivalent HPV vaccines in Italy: the potential impact of different cross-protection profiles.
Two human papillomavirus (HPV) vaccines are currently available: a bivalent HPV-16/18 and a quadrivalent HPV-6/11/16/18 vaccine. The vaccines may have different sustained- and cross-protection levels against non-vaccine oncogenic HPV-types. This study investigated the potential difference in clinical and economic impacts provided by two HPV vaccines in Italy. ⋯ Our model suggests that, in the Italian setting, the bivalent vaccine would prevent more precancerous and CC lesions than the quadrivalent vaccine. This translates into a greater cost averted for the bivalent vaccine, which could completely offset savings in GW-related costs associated with the quadrivalent vaccine.
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Gynecologic oncology · Apr 2011
Incidence and timing of venous thromboembolism after surgery for gynecological cancer.
This study aims to determine the incidence, timing, and risk factors of clinical venous thromboembolism. ⋯ In gynecologic cancer patients, over 75% of VTE are detected more than 7 days after surgery. Patients with ovarian cancer, prolonged hospitalization, or a history of VTE are at highest risk of developing clinical VTE. Such patients would be optimal candidates for clinical trials evaluating extended VTE prophylaxis.