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Sentinel node biopsy is an effective option for early-stage cervical cancer May 31, 2009

Posted by patoconnor in cancer, gynecological cancer, ovarian cancer, tubal cancer, uterine cancer, vaginal cancer.
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Sentinel node biopsy is an effective option for early-stage cervical cancer

Published: 31/05/2009

A prospective multicenter study conducted by researchers in France suggests that the majority of women with early-stage cervical cancer can safely undergo sentinel node (SN) biopsy – a technique in which only one to three lymph nodes are removed to determine whether cancer has spread – in lieu of the traditional, more invasive pelvic lymph node removal. This study, presented at the American Society of Clinical Oncology 2009 meeting, showed that SN biopsy was just as useful as full pelvic lymph node removal for identifying even small amounts of cancer cells that spread to lymph nodes in atypical areas of the pelvis.

“Sentinel node biopsy is a good option for women with cervical cancer because it enables us to remove fewer lymph nodes to get information about cancer spread, and could decrease the risk of complications from surgery, such as lymphedema,” said Dr. Fabrice Lecuru, professor at George Pompidou European Hospital in Paris, and the study’s lead author. “Previous studies have shown that sentinel node biopsy can be used to assess cancer spread in usual areas of the pelvis, but our findings add to this growing body of research by showing that this approach is also effective for identifying cancer spread in less common areas of the pelvis and the abdomen. This approach may become a new standard of care for early-stage cervical cancer.”

Ten to 15 per cent of patients with early-stage cervical cancer experience recurrence. Some are due to lymph nodes that were missed during surgery or because of undetected cancer spread to other lymph nodes. During standard surgery, several pelvic lymph nodes are removed and examined for the presence of cancer cells. During SN biopsy, however, a blue dye and radioactive substance that can be traced with imaging techniques are used to locate the first lymph node (the sentinel node) where cancer cells would travel after leaving the cervix. If this node is free of cancer cells, no other lymph nodes should be removed. Since the removal of lymph nodes may impair lymphatic drainage and cause uncomfortable swelling in the legs called lymphedema, doctors have been assessing SN biopsy (which is routinely used for breast cancer and melanoma patients) to see if it can be used to gauge cervical cancer spread.

Prior studies have shown that SN biopsy can be used in cervical cancer patients to predict cancer spread to lymph nodes in the pelvis most likely to contain cancer cells. But in this study, Dr. Lecuru and his colleagues also evaluated the biopsy of sentinel nodes in atypical areas of the pelvis in 128 women with early-stage cervical cancer who also had full pelvic lymph node removal for comparison. They then analysed sentinel nodes for micrometastastic cancer (0.2 to 2 mm in size) and isolated tumour cells as well as areas of cancer greater than 2 mm (macrometastases).

After analysing these nodes, researchers demonstrated that full pelvic lymph node removal and its associated complications could have been avoided in 81.2 per cent of women. Researchers also found that in nearly 40 per cent of women, SN biopsy alone would have provided additional, important information about patients’ disease; for example, SN biopsy was more useful than routine techniques for showing that lymphatic drainage occurred via unusual pathways to less commonly explored areas of the pelvis or of the abdomen, and for detecting micrometastases or isolated tumour cells.

eCancerMedicalScience

Tragic results of suboptimal gynecologic cancer operations. January 4, 2009

Posted by patoconnor in cancer, gynecological cancer, ovarian cancer, tubal cancer, uterine cancer, vaginal cancer.
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Tragic results of suboptimal gynecologic cancer operations.

Eur J Gynaecol Oncol. 2008

Kuyumcuoğlu U, Kale A.
Department of Obstetrics and Gynecology, Dicle University School of Medicine Diyarbakir, Turkey.

OBJECTIVE: The goal of this study was to analyze gynecological cancer patients who underwent suboptimal or failed surgeries with unsatisfactory and undesired results.

STUDY DESIGN: During 1997-2007, 74 women were referred to our gynecological oncology service after suboptimal or failed surgeries for ovarian, cervix, endometrium and vulvar cancers. Medical records were evaluated retrospectively to determine the reasons of suboptimal surgery.

RESULTS: Optimal cytoreduction was achieved in ten women (21.7%), 32 women (69.5%) had suboptimal surgical cytoreduction and four women (8.6%) had failed surgery, Seven patients were recurrences (3 had liver metastasis, 2 had pelvic metastasis, 2 had bladder metastasis); two patients died due to bladder metastasis, one patient died six days after surgery due to a pulmonary embolism in the suboptimal cytoreduction group, and one patient died due to ascites in the failed surgery group. Optimal surgery was achieved in three women (27.2%) and eight women (72.7%) had suboptimal surgery in the cervical cancer population. One patient had a recurrence with pelvic metastasis in the suboptimal group. Suboptimal surgery was achieved in one woman with vulvar cancer. Optimal surgery was achieved in seven women (43.7%) and nine women (56.2%) had suboptimal surgery in the endometrial cancer population. One patient died 11 days after surgery due to sepsis in the optimal surgery group. One patient died 21 months after primary surgery and the other patient had a recurrence with paraaortic lymph nodes, ascites and omental thickening in the suboptimal surgery group. The prognosis of 30 (65.2%) women in the ovarian cancer population, eight (72.7%) women in the cervical cancer group, 11 (68.7%) women in the endometrial cancer group, and one woman (100%) in the vulvar cancer population was unknown. The unknown cases of all genital cancers were missed during followup and we could not reach them using their phone or address information.

CONCLUSION: If a gynecologist does not have enough experience or expertise about gynecological cancer operations, he or she must consider the possible harm that any surgical intervention might do, as the latin phrase “primum non nocere” means and should refer patients to a gynecological oncology center without performing any surgery. Optimal gynecologic surgery can only be carried out correctly when education becomes available throughout the world. Thus postgraduate fellowship programs should be considered urgently to extend the general gynecologists’ surgical experience and expertise in developing and undeveloped countries.

Editor’s Note:

This is critical, especially now that we are seeing such a significant rise in leg swelling (leg lymphedema) amongst gynecologic cancer survivors. One of the earliest documented papers I ran accross was Leg Lymphedema from a Botched Abdominal Surgery – and this was published back in 1963 – Pat O’Connor

PMID: 19115691 [