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Chapter 093. Gynecologic Malignancies (Part 7)

Patients with stage IV disease (outside the abdomen or invading the bladder or rectum) are treated palliatively with irradiation, surgery, and platinum-based chemotherapy. Progestational agents produce responses in ~10–20% of patients. Well-differentiated tumors respond most frequently, and response can be correlated with the level of progesterone receptor expression in the tumor. The commonly used progestational agents hydroxyprogesterone (Dilalutin), megestrol (Megace), and deoxyprogesterone (Provera) all produce similar response rates, and the antiestrogen tamoxifen (Nolvadex) produces responses in 10–25% of patients in a salvage setting. . | Chapter 093. Gynecologic Malignancies Part 7 Patients with stage IV disease outside the abdomen or invading the bladder or rectum are treated palliatively with irradiation surgery and platinum-based chemotherapy. Progestational agents produce responses in 10-20 of patients. Well-differentiated tumors respond most frequently and response can be correlated with the level of progesterone receptor expression in the tumor. The commonly used progestational agents hydroxyprogesterone Dilalutin megestrol Megace and deoxyprogesterone Provera all produce similar response rates and the antiestrogen tamoxifen Nolvadex produces responses in 10-25 of patients in a salvage setting. Chemotherapy is not very successful in advanced endometrial carcinoma. The most active single agents with consistent response rates of 20 include cisplatin carboplatin doxorubicin epirubicin and paclitaxel. Combinations of drugs with or without progestational agents have generally produced response rates similar to single agents. Cervix Cancer Incidence and Epidemiology Carcinoma of the cervix was once the most common cause of cancer death in women but over the past 40 years the mortality rate has decreased by 50 due to widespread screening with the Pap smear. In 2007 11 150 new cases of invasive cervix cancer occurred and 50 000 cases of carcinoma in situ were detected. There were 3670 deaths from the disease and of those patients 85 had never had a Pap smear. Worldwide cervical cancer is the third commonest cancer diagnosed and it remains the major gynecologic cancer in underdeveloped countries. It is more common in lower socioeconomic groups in women with early initial sexual activity and or multiple sexual partners and in smokers. Etiology and Genetics Venereal transmission of human papilloma virus HPV has an important etiologic role. Over 66 types of HPVs have been isolated and many are associated with genital warts. Those types commonly associated with cervical carcinoma are 16 18 31 33 52 and 58