Lege Artis Medicinae

[CONTROVERSIAL ISSUES IN THE TREATMENT OF OPERABLE CERVICAL CANCER]

PETE Imre

JULY 20, 2006

Lege Artis Medicinae - 2006;16(07)

[Wertheim hysterectomy as a baseline surgical treatment for patients with FIGO stage 1a2-2a cervical cancer was introduced in 1989 at the National Institute of Oncology, Budapest, Hungary. From then until 2002 when the results were first evaluated 308 such operations were performed. The average 5- and 10-year survival rates were 80% and 75%, respectively. Although these results are comparable to literature data, several issues concerning this group of patients remain to be solved. The participation rate in the Pap test screening programme covered by the national health insurance is only 30%. There is no national database on the current treatment of these patients that could help identify the necessary steps to be taken in order to improve the results. The number of radical hysterectomies performed a year in Hungary, or their outcome, is not known. The treatment scheme varies among the institutes and so does surgical experience. There is no consent regarding treatment policy, preoperative irradiation or chemotherapy, surgical technique, or postoperative management. The improvement of the participation rate in the screening programme, the use of prognostic factors to determine the most appropriate treatment, the role of minimally invasive and fertility-preserving surgery, the preservation of ovaries and the use of neoadjuvant chemotherapy are some of the further issues that need to be discussed. The first step should be data acquisition from all institutes in the country in order to develop and apply uniform treatment guidelines.]

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Lege Artis Medicinae

[NONINVASIVE MECHANICAL VENTILATION IN CHRONIC OBSTRUCTIVE LUNG DISEASES WITH ACUTE OR CHRONIC RESPIRATORY FAILURE]

BALIKÓ Zoltán

[Over the past decade, the use of noninvasive ventilation in the setting of acute exacerbations of chronic obstructive pulmonary disease (COPD) has gained popularity, and is recommended by evidence-based guidelines. The evidence that it should be effective in chronic COPD is much weaker, and large, prospective, randomised, controlled studies that would also provide a guide for the selection of the best candidates, are still lacking. It has bee established, however, that home mechanical ventilation is certainly beneficial for a well-defined subgroup of patients. This includes the so called “blue bloater” patients (with hypercapnia and polyglobulia), other cases with increased hypercapnia, and patients with "overlapping" syndrome (COPD accompanied by sleep apnoe). Also, for patients with acute respiratory failure who refuse intratracheal intubation noninvasive mechanical ventilation remains the only choice. The past years have unequivocally proved the superiority of the positive pressure ventilation mode for either short term or long term use.]

Lege Artis Medicinae

[Interdisciplinary forum of MOTESZ - Budapest, 23-25th March, 2006.]

KRAMER Imre

Lege Artis Medicinae

[ACTINOMYCOSIS MIMICKING LUNG CANCER]

CSERNI Gábor, BORI Rita, BOROSS Gábor, FRANK Emil, LÓRÁND Katalin, SERÉNYI Péter, LENGYEL Mária, KOVÁCS Károly, HALÁSZ Mátyás

[INTRODUCTION - The mortality of lung cancer is high, but with early diagnosis the disease can often be cured. The differential diagnosis of pulmonary carcinoma is widely diverse. CASE REPORT - In a 53-year-old male patient, who had been successfully treated for pneumonia complicated with thoracic empyema, both a CT scan and bronchoscopy raised the suspicion of a malignant tumour. Brush cytology was inconclusive; it raised the possibility of malignancy but was not felt diagnostic of a malignant process, whereas biopsy revealed only inflammatory changes. After right lower lobectomy, actinomycosis was diagnosed by histology. This case is used in the paper as an opportunity to discuss the pseudotumorous presentation of thoracic actinomycosis. CONCLUSION - Pulmonary and thoracic actinomycosis is rare, but due to its ability to simulate tumours, it is an important disease to consider in the differential diagnosis of lung cancer.]

Lege Artis Medicinae

[THE POTENTIAL ROLE OF THE SEMICARBAZIDESENSITIVE AMINE OXIDASE ACTIVITY IN THE DEVELOPMENT OF DIABETIC RETINOPATHY]

DURA Eszter

[Recent data suggest that the copper-containing semicarbazide-sensitive amine oxidase enzyme (SSAO) may play a role in vascular endothelial damage through conversion of certain endogenous monoamines, such as methylamine, into cytotoxic aldehydes, hydrogen peroxide and ammonia. SSAO is present in various human tissues and in the serum. Elevated SSAO activities have been reported in patients with both types of diabetes mellitus. We have demonstrated that the activity of serum SSAO is significantly higher in type 2 diabetic patients with high-risk proliferative diabetic retinopathy compared to those without retinopathy. Our clinical results support the hypothesis that elevated SSAO activity may be involved in the pathogenesis of microvascular diabetic late complications, such as retinopathy. The enzymatic conversion of the endogenous monoamines (e.g. methylamine, aminoacetone) into toxic aldehydes and hydrogenperoxide may be one of the possible mechanisms of the development of microangiopathy. Also, the vascular adhesion protein-1 (VAP-1) function of the molecule can cause leukostasis and leukocyte activation through increased leukocyte adhesion, resulting in worsening of the capillary circulation and hypoxia. Further prospective, larger studies are needed to elucidate the role of the possible association between serum SSAO activity and highrisk proliferative retinopathy in patients with type 2 diabetes. The pharmacological manipulation of SSAO activity might be an interesting new concept for prevention and treatment of diabetic retinopathy.]

Lege Artis Medicinae

[In the focus: periferal vascular diseases - Readers’ questions answered by dr. Éva Meskó]

MESKÓ Éva

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[The relationship between human papilloma virus and cervical cancer]

KOISS Róbert, SIKLÓS Pál

[Worldwide, cervical cancer remains the second most frequent malignancy. The estimated number of new cases is 450,000 per year. Approximately 80% of affected women live in developing countries where access to cervical screening programmes is limited. In Europe, more than 12,800 women die each year from this preventable disease. Human papilloma virus (HPV) infection has been proved to be a potential cause of cervical cancer. Secondary screening decreases the morbidity and mortality of the disease, but does not prevent HPV infection. HPV-DNA can be detected in 90-100% of preinvasive and invasive cervical cancer cases. Trials assessing prophylactic anti-HPV vaccination have confirmed that the vaccination is a suitable method for the primary prevention of precancer lesions and cervical cancer.]

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[Hormesis: the importance of small doses in the modern medicine]

CSABA György

[The hormesis concept contains that high doses of some substances are harmful (toxic or inhibiting), at the same time small doses of these substances are adventageous and stimulating. The pretreatment with small doses helps to neutralize the later harmful or deleterious effects of large doses and this has therapeutical (clinical) importance in case of numerous diseases and treatments. The review use two examples for demonstrating the importance of hormesis: the effect of radiation and the effect to immunity, in addition general, evolutionary aspects are also highlighted. The importance of evolutionary aspects are discussed. It demonstrates the influence of hormesis to the human evolution and calls attention to the expected changes in human diseases (as inevitable consequences of hormesis in our chemically strongly infected world), which are transmitted to the progenies. Hormesis is a therapeutic possibility as well as a challenge for medicine, this means that it is advisable to use it in the therapy and must prepare ourselves to the challenges. ]

LAM Extra for General Practicioners

[THE RELATIONSHIP BETWEEN HUMAN PAPILLOMA VIRUS AND CERVICAL CANCER]

KOISS Róbert, SIKLÓS Pál

[Worldwide, cervical cancer remains the second most frequent malignancy. The estimated number of new cases is 450,000 per year. Approximately 80% of affected women live in developing countries where access to cervical screening programmes is limited. In Europe, more than 12,800 women die each year from this preventable disease. Human papilloma virus (HPV) infection has been proved to be a potential cause of cervical cancer. Secondary screening decreases the morbidity and mortality of the disease, but does not prevent HPV infection. HPV-DNA can be detected in 90-100% of preinvasive and invasive cervical cancer cases. Trials assessing prophylactic anti-HPV vaccination have confirmed that the vaccination is a suitable method for the primary prevention of precancer lesions and cervical cancer.]

Lege Artis Medicinae

[Young men’s knowledge about the human papillomavirus]

BALLA Bettina Claudia, TEREBESSY András, TÓTH Emese, BALÁZS Péter

[Introduction - Nearly the fifth of more than 100 HPV serotypes affect the anogenital region causing genital warts, penile and anal cancer. The incidence of male pathologies is lower than that of females (genital warts, vaginal, vulvar, cervical and anal cancer), however they are equally important in epidemiological terms. Methods - The aim of our questionnaire-based cross-sectional study was to assess the HPV-related knowledge of young men in 19 randomly selected high schools in Budapest. The anonymous questionnaires contained 54 items about socio-demographic and lifestyle factors, HPV-related knowledge and the attitude toward HPV vaccination. Results - We collected 530 completed questionnaires (86.74% response rate). 35.3% of the students knew that HPV was an STD and 3.2% was aware of transmission via skin contact. The majority (52.5%) linked cervical cancer to the viral infection, 7.7% linked HPV to the genital warts of females and 8.3% to the genital warts of males, 9.8% to penile cancer and 4.2% to anal cancer. 44.7% of the young men would have their future children vaccinated, while 24.5% remained uncertain. Conclusions - The young men’s knowledge about HPV was poor and they underestimated the risk of infection. This emphasizes the importance of targeted health education in this population. However, the students were mostly in favour of the HPV vaccination.]

Lege Artis Medicinae

[Analysis of the knowledge on cervical cancer and attendance indicators of cervical screening]

VAJDA Réka, KARAMÁNNÉ Pakai Annamária, ÉLIÁS Zsuzsanna, SÉLLEYNÉ Gyuró Mónika, TAMÁS Péter, VÁRNAGY Ákos, KÍVÉS Zsuzsanna

[OBJECTIVE - The study aims to explore knowledge on cervical cancer and cervical screening among women with 9-14 yearold daughters, and learning the attitudes towards screening, the motivation of attendance at or absence from screening. DATA AND METHODS - A quantitative, cross-sectional study was conducted using our own questionnaire in the town Nagyatád in 2012. Study participants included women who had 9-14 year-old daughters and a registered home address in Nagyatád. We received valid responses from 186 people (response rate: 75.3%). RESULTS - The interviewed women’s knowledge on cervical cancer differed significantly depending on their age, education, marital status, and economic activity. Only 45 women with higher education (p=0.043) were considered to be well informed on the subject. However, their willingness to participate in cancer screening was more favorable than their knowledge, 96.2% of the women claimed to attend an annual cancer screening. The average age of respondents was 20.92 years at first visit. CONCLUSIONS - Although the participation rate was much higher compared with that in previously published studies, it is of great importance to increase the mothers’ knowledge on cervical cancer and the factors that promote its development, so that they can pass their knowledge to their children and strengthen their protection against one of the most common sexually transmitted viral infection and the development of cervical cancer.]