Uterine Cancer
Immune response in cervical dysplasia induced by human papillomavirus: the influence of human immunodeficiency virus-1 co-infection -- review.
Nicol AF, Fernandes AT, Bonecini-Almeida Mda G.
Departamento de Microbiologia, Imunologia e Parasitologia, Instituto de Pesquisa Clinica Evandro Chagas-Fiocruz, Av. Brasil 4365, 21040-900 Rio de Janeiro, RJ, Brazil.
Human immunodeficiency virus (HIV-1) has become an important risk factor for human papillomavirus (HPV) infection and the development of HPV associated lesions in the female genital tract. HIV-1 may also increase the oncogenicity of high risk HPV types and the activation of low risk types. The Center for Disease Control and Prevention declared invasive cervical cancer an acquired immunodeficiency virus (AIDS) defining illness in HIV positive women. Furthermore, cervical cancer happens to be the second most common female cancer worldwide. The host's local immune response plays a critical factor in controlling these conditions, as well as in changes in the number of professional antigen-presenting cells, cytokine, and MHC molecules expression. Also, the production of cytokines may determine which arm of the immune response will be stimulated and may influence the magnitude of immune protection. Although there are many studies describing the inflammatory response in HPV infection, few data are available to demonstrate the influence of the HIV infection and several questions regarding the cervical immune response are still unknown. In this review we present a brief account of the current understanding of HIV/HPV co-infection, emphasizing cervical immune response.
PMID: 15867955 [PubMed - indexed for MEDLINE]
Clinical pathway for the evaluation of postmenopausal bleeding with an emphasis on endometrial cancer detection.
Moodley M, Roberts C.
Department of Obstetrics and Gynaecology, Nelson R. Mandela School of Medicine, Congella, Durban 4000, South Africa.
Postmenopausal bleeding (PMB) accounts for about 5% of all office gynaecology visits. The causes of PMB are varied. Many women with endometrial cancer present with this symptom. Although many investigations are described, the most appropriate approach is often unclear. In a patient with no obvious local cause, the emphasis should be on uterine and adnexal evaluation. Based on a literature review, the evidence favours a conservative approach if the endometrial thickness (ET) is < 4mm, unless there are risk factors. All patients with ET 4 mm should have outpatient endometrial sampling. If this is unsuccessful, then outpatient hysteroscopy with directed biopsy or inpatient hysteroscopy is favoured. The role of ancillary investigations are described.
PMID: 15763777 [PubMed - indexed for MEDLINE]
Minimal invasive surgery in gynaecology
Article in German
Steiner RA, Fehr PM.
Kantonales Frauenspital Fontana, Spitaler Chur AG, Chur.
In Gynaecology there have been many innovative developments towards minimal invasive surgery. Today patients can profit of these new techniques in all fields of gynaecological surgery, some of which are described: The treatment of benign adnexal pathology including ectopic pregnancy is a domain of laparoscopy. Also symptomatic myomas can be enucleated by laparoscopy with favourable pregnancy outcome. The role of endoscopy in malignant disease has still to be defined though pelvic and paraaortal lymphonodectomy and even radical hysterectomy have been shown to be feasible. Pathology of the uterine cavity (myomas, polyps, septae) is routinely treated by hysteroscopy. The concept of operative treatment of stress urinary incontinence has changed since the minimal invasive TVT procedure has shown to be as successful as the classic colposuspension. For patients with breast cancer there has been a change from (ultra-) radical surgery to breast conserving treatment. Furthermore with the concept of the sentinel lymphnode a reduction of the morbidity of the classical lymphonodectomy is achieved without loss of information about the axillary lymphnode status.
PMID: 15756923 [PubMed - indexed for MEDLINE]
Diagnostic significance of tumor markers for gynecologic malignancies
Aoki D, Hirasawa A, Susumu N.
Dept of Obstetrics & Gynecology, School of Medicine, Keio University, Tokyo, Japan.
Gynecologic malignancies include ovarian cancer, uterine cervical cancer, endometrial cancer, and trophoblastic neoplasms. With ovarian tumors, due to their location within the abdominal cavity, it is difficult to make a preoperative pathological diagnosis of cancer without laparotomy. From this point of view, the use of tumor markers that consist of carbohydrate antigens, such as CA 125, in addition to diagnostic imaging are useful in the diagnosis of ovarian cancer. SCC antigen, a marker for squamous cell carcinoma, is clinically useful in the management of advanced cervical cancer. At present, there are no useful tumor markers for endometrial cancer that exhibit both high sensitivity and specificity, although CA 125 is often used in clinical practice. Finally, human chorionic gonadotropin (hCG) serves as an ideal tumor marker for trophoblastic disease; however, the incidence of trophoblastic neoplasms has decreased dramatically with the incorporation of strict clinical management of post-molar disease as well as with the overall decrease in the number of pregnancies.
PMID: 15791829 [PubMed - indexed for MEDLINE]
