1. Modern treatment of vulvar cancerSebastjan Merlo, 2020, pregledni znanstveni članek Povzetek: Vulvar cancer accounts for 3%5% of malignant diseases of the female genital tract. The Slovenian incidence rate is 5.5/100,000, which means 57 new cases per year. The most common histological type (90%) is squamous cell carcinoma. Based on etiology, it can be classified into the first type which correlates with human papillomavirus (HPV) infection and the second type which is not associated with HPV. The most common and long-lasting symptom of vulvar cancer is pruritus. The preferred diagnostic procedure to confirm the diagnosis is a punch or incision biopsy. Surgery in combination with radiotherapy is the standard treatment for vulvar cancer. Sentinel lymph node biopsy with lymphoscintigraphy is now a standard part of surgical treatment. Chemotherapy is a palliative treatment option. Conclusions. Vulvar cancer is a rare disease. Because of the pathogenesis, surgery and radiotherapy are the main treatment modalities. The sentinel node biopsy (SNB) represents a contemporary approach to the vulvar cancer treatment and significantly reduces morbidity. Improvements in treatment of vulvar cancer contributed to the decrease of mortality among Slovenian women.
Ključne besede: vulvar cancer, surgical treatment, sentinel lymph node biopsy, lymphoscintigraphy
Objavljeno v DiRROS: 16.07.2024; Ogledov: 13; Prenosov: 3
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2. The prevalence of occult ovarian cancer in the series of 155 consequently operated high risk asymptomatic patients : Slovenian population based studyAndreja Gornjec, Sebastjan Merlo, Srdjan Novaković, Vida Stegel, Barbara Gazić, Andraž Perhavec, Ana Blatnik, Mateja Krajc, 2020, izvirni znanstveni članek Povzetek: We assessed the prevalence, localization, type and outcome of occult cancer at risk-reducing salpingo-oophorectomy or salpingectomy (RRSO) in asymptomatic carriers of pathogenic or likely pathogenic BRCA1/2 variants and high-risk BRCA1/2 negative women. Patients and methods. A retrospective analysis of all consecutive gynaecologic preventive surgeries from January 2009 to December 2015 was performed. Participants underwent genetic counselling and BRCA1/2 testing before the procedure. Data on clinical parameters, adjuvant treatment and follow-up were collected and analysed. Results. One hundred and fifty-five RRSO were performed in 110 BRCA1, 35 BRCA2 carriers of pathogenic or likely pathogenic variants and 10 high-risk BRCA1/2 negative women, at the mean age of 48.3 years. Nine occult cancers (9/155, 5.8%) were identified; eight in BRCA1 positive women and one in high-risk BRCA1/2 negative woman. We identified four non-invasive serous intraepithelial tubal carcinomas (3 in BRCA1 carriers and 1 in a high-risk BRCA1/2 negative woman) and five invasive tubo-ovarian high grade serous cancers (all detected in BRCA1 carriers). Only one out of nine patients (11.1%) with occult cancer had a slightly elevated CA-125 value preoperatively. Conclusions. A 5.8% prevalence of occult invasive and noninvasive tubo-ovarian serous cancer after RRSO was found in high risk asymptomatic and screen negative women. We conclude that RRSO should be performed in BRCA1/2 carriers and in high-risk BRCA1/2 negative women. Age of preventive gynaecologic surgery should be carefully planned, taking into account the completion of childbearing age and type of mutation. The results favour the tubal hypothesis of tubal origin of high grade serous ovarian and peritoneal cancer. Cytology result of peritoneal cavity washing was important for the decision making process in determining treatment. Cytology examination should be performed in all cases of RRSO. CA-125 assay did not prove to be an effective screening tool for early cancer detection in our patients.
Ključne besede: risk-reducing salpingo-oophorectomy, occult serous cancer, serous tubal intraepithelial cancer, BRCA1/2 pathogenic or likely pathogenic variant
Objavljeno v DiRROS: 12.07.2024; Ogledov: 45; Prenosov: 10
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3. The role of neoadjuvant chemotherapy in patients with advanced (stage IIIC) epithelial ovarian cancerErik Škof, Sebastjan Merlo, Gašper Pilko, Borut Kobal, 2016, izvirni znanstveni članek Povzetek: Primary treatment of patients with advanced epithelial ovarian cancer consists of chemotherapy either before (neoadjuvant chemotherapy, NACT) or after primary surgery (adjuvant chemotherapy). The goal of primary treatment is no residual disease after surgery (R0 resection) what is associated with an improvement in survival of patients. There is, however, no evidence of survival benefits in patients with R0 resections after prior NACT. Methods. We retrospectively reviewed the records of patients who were treated with diagnosis of epithelial ovarian cancer at Institute of Oncology Ljubljana in the years 2005%2007. The differences in the rates of R0 resections, progression free survival (PFS), overall survival (OS) and in five-year and eight-year survival rates between patients treated with NACT and patients who had primary surgery were compared. Results. Overall 160 patients had stage IIIC epithelial ovarian cancer. Eighty patients had NACT and eighty patients had primary surgery. Patients in NACT group had higher rates of R0 resection (42% vs. 20%; p = 0.011) than patients after primary surgery. PFS was 14.1 months in NACT group and 17.7 months after primary surgery (p = 0.213). OS was 24.8 months in NACT group and 31.6 months after primary surgery (p = 0.012). In patients with R0 resections five-year and eight-year survival rates were 20.6% and 17.6% in NACT group compared to 62.5% and 62.5% after primary surgery (p < 0.0001), respectively. Conclusions. Despite higher rates of R0 resections achieved by NACT, survival of patients treated with NACT was inferior to survival of patients who underwent primary surgery. NACT should only be offered to patients with advanced epithelial cancer who are not candidates for primary surgery.
Ključne besede: ovarian cancer, advanced ovarian cancer, neoadjuvant chemotherapy, primary surgery
Objavljeno v DiRROS: 30.04.2024; Ogledov: 251; Prenosov: 77
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5. Rak jajčnikov : ponovno nekaj novega2023, zbornik recenziranih znanstvenih prispevkov na domači konferenci Povzetek: Rak jajčnikov je najpogostejši vzrok smrti pri ženskah, ki zbolijo za ginekološkimi raki, saj je bolezen za večino bolnic v napredovalih fazah pogosto usodna. To je posledica težavne prepoznavnosti bolezni v zgodnjih fazah, ko je zdravljenje učinkovito. /// Na žalost preventivni program za zgodnje odkrivanje raka jajčnikov še ne obstaja, zato je pri več kot 75 % bolnic bolezen odkrita v napredovalih stadijih, kar posledično prinaša slabo prognozo. Tako pri zdravnikih kot pri ženskah je pomanjkljivo poznavanje zgodnjih znakov bolezni, kar lahko vodi v napačno diagnostiko in triažiranje bolnic v neprimerno zdravstveno ustanovo. /// Diagnoza se postavi s pomočjo ustreznih diagnostičnih preiskav, potrdi pa se s patohistološko preiskavo. 90 % rakov jajčnikov izvira iz epitelija, medtem ko so drugi tipi redki. Osnovno zdravljenje vključuje kirurški poseg, katerega cilj je popolnoma odstraniti bolezen in doseči stanje brez vidnega ostanka bolezni. Sledi sistemska terapija, medtem ko obsevanje pri zdravljenju raka jajčnikov nima ključnega pomena. /// Ugotovljeno je, da je zdravljenje raka jajčnikov najuspešnejše v specializiranih ustanovah, kjer delujejo strokovnjaki z usmerjenostjo v ginekološko-onkološko področje. V Sloveniji si nenehno prizadevamo za standardizirano in kakovostno obravnavo žensk z rakom jajčnikov.
Ključne besede: ginekološki raki, elektronske knjige
Objavljeno v DiRROS: 22.11.2023; Ogledov: 490; Prenosov: 204
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6. Uporaba elektro-kirurških inštrumentov v ginekološki kirurgijiSebastjan Merlo, 2023, objavljeni znanstveni prispevek na konferenci Povzetek: Uporaba sodobnih elektro-kirurških inštrumentov omogoča krajše čase operativnih posegov. Obenem pa zahteva posebno pozornost zaradi visokih temperatur konice inštrumenta in tkiva v okolici. Izogibati se je potrebno neposrednemu stiku z žilnimi in živčnimi strukturami. Stik s temi strukturami namreč poveča tveganje toplotnih poškodb občutljivih struktur. Izogibati se je potrebno tudi ponavljajočim in dolgim aktivacijam z neustreznim časom hlajenja, saj le to poveča tveganje za toplotne poškodbe med operacijo. Poleg tega so aktivna rezila vseh naprav za ultrazvočno koagulacijo in rezanje razvila visoke temperature, ki presegajo 100 °C, zato je med preprijemanjem tkiva potrebno ustrezno obdobje hlajenja. Ob primerni uporabi, tudi glede na priporočila proizvajalca, pa vse omenjene naprave lahko štejemo za varne in učinkovite.
Ključne besede: rak maternice, ginekološki raki, ginekološka onkologija
Objavljeno v DiRROS: 30.05.2023; Ogledov: 376; Prenosov: 216
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7. Rak jajčnikov - novosti : ginekološki simpozij2022, zbornik recenziranih znanstvenih prispevkov na domači konferenci Povzetek: Rak jajčnikov je najpogostejši vzrok smrti pri ženskah, ki zbolijo za ginekološkimi raki. Za večino obolelih z napredovalim rakom je bolezen usodna. Razlog za to je slaba prepoznavnost bolezni v zgodnjih stadijih, ko je zdravljenje učinkovito.
Ključne besede: ginekološki raki, klinična slika, laparoskopija, sledenje pacientov, etiologija, imunoterapija, intraperitonealna kemoterapija, COVID-19, zborniki, elektronske knjige
Objavljeno v DiRROS: 04.01.2023; Ogledov: 677; Prenosov: 330
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