Advanced Ovarian Cancer As a Risks of Primary Multiple Malignant Tumors After the Treatment

Р Е З Ю М Е Т А

ADVANCED OVARIAN CANCER AS A RISKS OF PRIMARY MULTIPLE MALIGNANT TUMORS AFTER THE TREATMENT OF EXTRA GENITAL CANCER.

G. CHAKALOVA

Int. J. Gynecol. Cancer, vol. 23, Suppl 1, 2013, p.163.

Department of Gynecological Oncology, NationalOncologyHospital, Sofia, Bulgaria.

From 1987 till 2011, 2319 patients with ovarian cancer were treated at our Department, in 101 cases (4,4%) ovarian cancer was a part of combination of primary multiple malignant tumors. In 93 cases the combination was between 2 tumors. In 25 cases the tumor combination was genital (14 endometrial, 8 cervical, 3 uterine sarcomas) and in 68 was extra genital (51 breast, 9 rectum, 3 thyroid, 1 MM, 1 skin, 1 lymphoma, 1 larynx and 1 renal). In 8 cases the combination was between 3 tumors (5 breast, 3 rectum, 3 endometrial, 2 cervical, 1 thyroid, 1 MM, 1 larynx). All cases of primary extra genital tumor were early diagnosed and treated. From 101 ovarian cancer, 85 cases were advanced – Stage III and IV. Our results show that ovarian cancer is late diagnosed in cases with PMMT. In follow-up of the primary extra genital tumor especially in cases of breast and rectum cancers an algorithms for early detection of the ovary cancer is recommended: vaginal and rectal examination, laboratory analyses: WBC, biochemical analyses including check for renal function, Hb, Ca 125, HE4, imaging: chest X-ray, abdominal and pelvic ultrasound. Optional investigation are: pelvic NMR, CT of the abdomen (PET/CT if possible), cystoscopy, rectoscopy, IVU or sonographic renal examination. Recommended follow-up: every 3 months after completed therapy during the first year, every 6 months up to 5 years. Annually afterwards. Investigations in addition to gynecological examination should be performed depending on symptoms, local findings and general condition of the patient.

AGE DISTRIBUTION IN CASES OF CERVICAL CANCER IN BULGAIA

GALINA CHAKALOVA

ResearchGate, 2013.

Department of Gynecological Oncology,

National Oncological Center, Sofia, Bulgaria

ABSTRACT

The study of age distribution and median age in cases of 3869 patients with cervical cancer, treated from 1982 till 2009, were presented. Stage I were 1550 patients, Stage II were 1280 patients, Stage III were 1000 patients and Stage IV were 39 patients. In cases of Stage I median age were 43,3 years, in Stage II were 46,7 years, Stage III- 52 years, and Stage IV- 47,1 years. In cases of Stage I, depended of depth of invasion the median age is from 38,9 years (in cases of invasion till 1000 мm) and till 47,7 years (in cases of invasion more than 4 cm). In all stages is sown that median age increased in correlation of the stage. A comparison with date of the National Cancer Registry is performed. We detect that screening programs will be most important in women till 40 years.

Key words: cervical cancer, median age, age distribution.

BREAST AND GYNECOLOGICAL CANCER INCIDENCE OF FAMILIAL CANCER AND MULTIPLE PRIMARY MALIGNANT TUMORS.

PROF. G. CHAKALOVA

Journal of BUON, 13, Supll. 1, 2008, 48, PP-160.

Head Clinic of Gynecological Oncology, National Oncologic Hospital, Sofia, Bulgaria

SUMMARY

Purpose: A prospective study of the incidence of familial breast-gynecological cancer and primary multiple breast-gynecological cancer is presented. Materials: From 1982 till 2006 in our Department were treated 9575 patients with gynecological malignancies. Results: In 14 cases (0,14%) familial breast-gynecological cancer were detected. In 5 cases the familial cancer were breast-ovarian cancer, in 6 cases familial breast-endometrial cancer, and in 3 cases familial breast-cervical cancer were found. The most frequent were the combination of mother-daughter and sister-sister. The incidence if primary malignant breast-gynecologic cancer were detected in 140 cases (1,46%). The most frequent combination was breast-endometrial cancer-62 cases (44,3%). In 39 cases (27,9%) breast-ovarian cancer, in 38 cases ( 27,1%) breast-cervical cancer, and 1 case (0,7%) breast-vulva cancer were found. The breast cancer was a first tumor in 91 cases (65%), and gynecologic tumor was a first tumor in 49 cases (35%). The second tumor was found in advanced stage (stage II and stage III) in 80 cases (57,1%). The high risk for appearing the second tumors is first 5 year after the treatment of the first one. Conclusion: Our results suggest that is s strong relation between breast and gynecological cancer and a strictly post treatment control is necessary for a early detection of the secondary malignancies. The breast and gynecological examination is very important for the relatives of the patients with malignancies for early detection of familial cancer.

Cancer burden of breast and gynecological cancers in Bulgaria: epidemiology andclinical aspects

G. Chakalova (1), N. Dimitrova(2), I. Gavrilov (3), Z. Valerianova (2)

. J BUON18, 2013 (inpress)

(1) Department of Gynecological Oncology; (2) Bulgarian National Cancer Registry; (3) Thoracic surgery department; National Oncology Hospital, Sofia, Bulgaria

Background: In Bulgaria, there are over 3700 cases diagnosed with breast cancer annually and over 3300 - with gynecological cancers.

The objective was to estimate the burden of breast and gynecological cancers in Bulgaria, analyzing trends of incidence, mortality and survival for the past two decades.

Materials and methods: Data from the Bulgarian National Cancer Registry for women diagnosed with cancer of breast (C50, ICD10), cervix uteri (C53), corpus uteri (C54) and ovary (C56) during the period 1993 – 2009 were analyzed. Age-standardized incidence and mortality rates (ASR) per 100,000 persons were calculated using the world standard population. Average annual percent changes (AAPC) for the period 1993-2009 were estimated by Joinpoint regression. Observed survival was analyzed with Life table method for two periods – 1993-1997 and 2005-2009.

Results: Incidence rates of the most frequent cancers among Bulgarian women are increasing – from 1.7% to 2.6% annually. Mortality rates are decreasing significantly for breast (with -0.8% annually) and increasing of corpus uteri cancers (with 4.9% annually). Survival for all sites increased from 3 to 8% over the study period. We observe greater proportion of cases diagnosed at first stage in 2009 than in 1993, for the four sites.

Conclusion: The results indicate some differences in trends in incidence and mortality of the reviewed sites, compared with other European countries, highlighting the need for more strict adherence to integrated treatment standards and the necessity of introduction of population screening programs.

CERVICAL CANCER INCIDENCE IN LAST 30 YEARS: PROBLEMS WITH EARLY DETECTION AND HEALTH POLITIC IN BULGARIA

Int. J. Gynecol. Cancer, vol. 23, Suppl 1, 2013, p.54.

G. CHAKALOVA

For the last 30 years (1982-2011), 4142 patients with invasive cervical cancer and 1085 patients with carcinoma in situ were treated in our department. The period was separated in 3 decades. In the first period from 1048 patients with invasive cancer, Stage I was in 44%, Stage II-32%, Stage III-23%, and Stage IV -1%. Carcinoma in situ was in 227 cases (21%) of all cases of cervical diseases. During the second period 1837 patients with invasive cancer, Stage I was in 37%, Stage II-35%, Stage III-27% and Stage IV- 1%. Carcinoma in situ was in 425 cases (19%) of all cases of cervical diseases. In the last period 1257 patients with invasive cancer, Stage I was in 42%, Stage II-30%, Stage III-27% and Stage IV- 1%. Carcinoma in situ was in 383 cases (23%) of all cases of cervical diseases. Treatment was in correlation with the stage of the disease. In cases of carcinoma in situ and invasive cervical carcinoma a significant rejuvenationwas detected and peak was found in 30-34 and 45-49 years of age respectively. Our results show that in last 20 years changes in health politic and absence of a national screening program, were worst for early detection of cervical cancer. In the end of the period a detection of carcinoma in situ was better, but a high level of advanced cervical cancer is persisted. An urgent introduction of cervical screening in Bulgaria and improvement of performance ofgeneral practitioner and gynecologistsoutside the hospital is recommended.

Chakalova G., G. Gancev. Detection of most frequent HPV infection after treatment of CIN and prevention of recurrences with Interferоn-alfa.ResearchGate,2013.

ABSTRACT Objective: The aim of the present study was to investigate the persistent HPV infection after treatment for CIN and the efficacy the topical Interferon-alfa for prevention of recurrences.
Materials and Methods: In 175 cases with CIN II-III after the treatment a cytological test were performed and Pap IIID were found. HPV DNA was examined by the PCR. Interferon-alfa was injected locally tree-times per week- 3 Mio UI for a total of 10 administrations.
Results: The most frequent types was HPV 16 (101 cases), HPV 31 in 50 cases, and HPV 18 in 24 cases were found. After 10 applications cytologically Pap I-II were detected in all cases.
Conclusion: Combined HPV testing and cytology seems to be sufficient to detect post-treatment HPV. Topical Interferon-alfa treatment is an effective therapeutic method for persistent HPV infection (types 16, 18 and 31) after the treatment of CIN II-III, and total dose of 30 MIU are the optimal dose for prevention of CIN.
Key Words: HPV; CIN; Interferon-alfa

DETECTION OF MULTIPLE PRIMARY MALIGNANT TUMORS: BREAST AND GYNECOLOGICAL CANCER

Prof. G. Chakalova,

National Oncologic Hospital, Sofia, Bulgaria

. Int.J. Cancer Suppl., 2008, p.68,

Background: Double and triple primary malignant neoplasms of breast and gynecological cancers is a common event. However, synchronous triple primary neoplasms in women is an extremely rare event.

Objective: The aim of this study is to detect double and triple breast and gynecological cancer.

Materials and methods: A prospective study for 20-years period (1987-2006) was held. At the Clinic of Gynecological Oncology in our hospital 10000 patients were treated.

Results: Multiple primary malignant tumors were detected in 252 patients. Double tumors were in 241 cases and triple tumors were detected in 11 cases. A various combination of 515 (5,1%) malignancies were found. At last one of the tumors has been treated in our clinic. Synchronous tumors were in 52 patients (20%), and metachronous were in 200 patients (80%). The most frequent other site of neoplasms was the breast. The combination of breast and endometrial cancer was found in 62 cases (24%), breast and ovarian cancer - in 39 cases (15,5%) and breast and cervical cancer - in 38 cases (15,1%). The combination of ovarian and endometrial cancer was detected in 24 cases (9,5%) and multiple cervical, vulva or vagina cancer - in 21 cases (8,3%). Colorectal cancer in patients with gynecological cancer was found in 15 cases (6%) and combination of thyroid cancer and gynecological malignancies was found in 8 cases (3,2%). The rest were various combinations of gynecological malignancies and other localization: lymphoma, leukemia, malignant melanoma, sarcoma, cancer of the pancreas, stomach, bladder, kidney, skin and etc. A various combinations of 33 malignancies were detected in 11 patients with triple tumors. Triple tumors were in combination with ovarian cancer in 8 cases, with endometrial cancer in 4 and with cervical cancer in 3 cases. Breast cancer was found in 7 cases of triple combination. In 25 cases (75%) the combination of breast, ovary, endometrial, colon and thyroid cancer was found. Synchronous tumors were found in 3 patients and metachronous were found in 8 patients. Analyzing the stage distribution of the all 252 patients with multiple malignancies detected that the second and third malignancies usually were in Stage II and Stage III. In most cases the cause of death was the second and the third cancer. More frequently the second cancer was gynecological.

Conclusions: We conclude that gynecological malignancies are often associated with primary cancers elsewhere, especially in the breast, colon-rectum and thyroid. A patient presenting with a gynecological malignancy should be thoroughly examined for second and third cancer, as should patients be followed-up after treatment for genital tract cancer.

ENDOMETRIAL CANCER IN CASES OF PRIMARY MULTIPLE MALIGNANT TUMORS- ALGORITHMS FOR EARLY DETECTION AND FOLLOW-UP.

G. CHAKALOVA

Int. J. Gynecol. Cancer, vol. 23, Suppl 1, 2013, p.290.

Department of Gynecological Oncology, NationalOncologyHospital, Sofia, Bulgaria.

From 1987 till 2011, 1814 patients with endometrial cancer were treated at our Department, in 115 cases (6,3%) endometrial cancer was a part of combination of primary multiple malignant tumors. The most frequent combination was with breast cancer- 58 cases (50%), ovary- 25 cases (22%) and colon-rectum – 14 cases (12%). Endometrial cancer as a first tumor was

Stage I-75%, Stage II-13%, Stage III-11% and Stage IV-1%.Our results show that endometrial cancer is late diagnosed in cases with PMMT, and only 28 % were in stage I. Stage II- 33%, Stage III- 35% and Stage IV- 4% were detected. In cases of primary breast and colon-rectum cancers an algorithms for early detection of the endometrial cancer is recommended. In cases of abnormal genital bleeding or Pap smear are necessary investigation: vaginal and rectal examination, endocervical and endometrial curettage, histological findings with all standart tumor parameters, laboratory analyses: WBC, biochemical analyses including check for renal function and Hb, imaging: chest X-ray, abdominal and pelvic ultrasound (size and position of the tumor and tumor volume). Optional investigation are: pelvic NMR, CT of the abdomen (PET/CT if possible), cystoscopy, rectoscopy, IVU or sonographic renal examination. Involvement of the bladder or rectum should be confirmed histological. Recommended follow-up: every 3 months after completed therapy during the first year, every 6 months up to 5 years. Annually afterwards. Investigations in addition to gynecological examination should be performed depending on symptoms, local findings and general condition of the patient, and follow-up of the primary tumor as well.

ENDOMETRIAL CARCINOMA IN A 20 YEARS OLD OR LESS FEMALE: A RARE PRESENTATION OF FOUR CASES

G. CHAKALOVA, MD, PhD

J Clin Case Rep., 2013, 3:260.doi:10.4172/2165-7920.1000260.

Department of Gynecological Oncology, National Oncological Center, Sofia, Bulgaria

Abstract

Endometrial cancer is the most common gynecological cancer and is a disease of postmenopausal women. The disease appears in a 20 years or less extremely rare. Four case of endometrial cancer in 20 years old or less female, treated at Department of Gynecological Oncology, NationalOncologicHospital, Sofia, Bulgaria (1991-2009) are presented. The surgery mode and postoperative treatment was according the stage and histological type of the tumors. Thee patients were Stage IA, and one patient was Stage IIIC. A follow-up period till 31 December 2012 all the patients are free of disease.

Kay words: endometrial cancer; very young female;

FAMILIAL ENDOMETRIAL CANCER-INCIDENCE AND EARLY DETECTION

G. CHAKALOVA

Int.J. GynecolCancer, vol. 18, 2008, Supl., p.108.

Dep. Gynecologic Oncology, National Oncologic Hospital, Sofia, Bulgaria

Purpose: A prospective study of incidence of familial endometrial cancer is presented.

Materials: From 1982 till 2006 in our department 1508 patients with endometrial cancer were treated. 1116 patients were stage I, 212 patients were stage II, 165 patients were stage III, and 15 patients were stage IV.

Results: In 90 cases (6%) familial cancer was detected. Endometrial cancer was found in 65 cases (sister, mother or grandmother). The most frequent was the endometrial cancer in the mother-daughter combination – 44 cases. The sister-sister combination was found in 20 cases of endometrial cancer, and daughter- grandmother combination was found in 1 case. In 19 cases there was a familial ovarian-endometrial cancer, and in 6 cases – familial endometrial-breast cancer.

The early detection of familial endometrial cancer was done by gynecological investigation, ultrasound of the uterus and endometrial aspiration biopsy. They are important for early detection and risk reduction of familial endometrial cancer. BRCA 1 and BRCA 2 test as genetic screening will be useful too. In all suspected cases curettage with histological verification were performed. All 90 relatives were in stage I, and radical operation was performed.

Conclusion: the assessment of familial endometrial cancer is very important for risk reduction in oncogynecology.

Chakalova, G.

Familial endometrial cancer –incidence and early detection.

Int.J. GynecolCancer, vol. 19, 2009, Supl. 2,127.

FAMILIAL ENDOMETRIAL CANCER-INCIDENCE AND EARLY DETECTION

Prof. G. CHAKALOVA

Dep. Gynecologic Oncology, National Oncologic Hospital, Sofia, Bulgaria

Purpose: A prospective study of incidence of familial endometrial cancer is presented.

Materials: From 1982 till 2006 in our department 1508 patients with endometrial cancerwere treated. 1116 patients were stage I, 212 patients were stage II, 165 patients were stage III, and 15 patients were stage IV.

Results: In 90 cases (6%) familial cancer was detected. Endometrial cancer was found in 65 cases (sister, mother or grandmother). The most frequent was the endometrial cancer in the mother-daughter combination – 44 cases. The sister-sister combination was found in 20 cases of endometrial cancer, and daughter-grandmother combination was found in 1 case. In 19 cases there was a familial ovarian-endometrial cancer, and in 6 cases – familial endometrial-breast cancer.

Conclusion: the assessment of familial endometrial cancer is very important for risk reduction in oncogynecology.

FERTILITY SPARING TREATMENT FOR GYNECOLOGICAL CANCER

GALINA CHAKALOVA

Int. J. Gynecol. Cancer, vol. 21, Suppl 3, October 2011, p.1267.

NationalOncologyHospital, Sofia, Bulgaria

Background and aims: To explore the outcome and long-term follow-up of fertility sparing surgery for gynecological cancer.

Methods:A prospective study between 1987 and 2010 of all women with stage IA ovarian cancer and stage I cervical cancer, treated with fertility sparing surgery. All patients were between 19 and 35 years of age and desired future fertility.

Results: Forty-two women with stage IA (36 with Stage IA1 and 6 withStage IA2) carcinoma of the cervix were treated with conization. The tumors had squamous (86%) and adenocarcinoma (14%) histology. Fourteen women with stage IA ovarian low malignant potential (LMP) tumors underwent unilateral salpingo-ophorectomy with contralateral biopsy and omentectomy. Most tumors had serous (50%) or mucinous (33%) histology. In 2 cases (17%) histologically disgerminom was detected. No patients received adjuvant therapy.Between 6 and 34 months after the treatment, the patients became pregnant. In 41 cases, patients gave birth to 1 baby and in 11 cases – to 2 babies.The second childbirth appeared 2 to 5 years after the fist one. None of the women have developed recurrent disease after a median follow-up of 148 months. The follow-ups were performed with gynecological exams, cytology, ultrasound and tumor markers.