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Prognostic Factors Influencing the Effect of Chemotherapy in Cervical and Ovarian Cancer
Hruda, Martin ; Rob, Lukáš (advisor) ; Mlynček, Miloš (referee) ; Špaček, Jiří (referee)
First part of the thesis: Prognostic factors influencing the effect of chemotherapy in ovarian cancer INTRODUCTION: Membrane transporter proteins (for example ABC, SLC and ATPases) take part in oncogenesis and the formation of chemoresistance, however the interpretation of their importance in ovarian cancer prognosis is still limited. METHODS: Gene expression profiling was performed on 39 ABC and 12 SLC transporters and 3 ATPases in epithelial ovarian cancer (EOC) tissues and the results were assessed with respect to prognosis and clinical presentation of EOC patients. In a cohort of tissues with primary EOC (n = 57) and control tissues (n = 14) we assessed relative expression of genes and compared it with the clinical and survival information. The data was verified on a separate cohort (n = 60). RESULTS: 6 ABC genes and the SLC22A18 gene were considerably over-expressed in the cancer tissues in comparison with control tissues and the expression of 12 ABC genes, 5 SLC genes, ATP7A, ATP11B was reduced. The expression of ABCA12, ABCC3, ABCC6, ABCD3, ABCG1, SLC22A5 genes was greater in HGSC in comparison with other types. Expression of ABCA2 was considerably related to tumour grade in both cohorts. Particularly, the expression levels of ABCA9, ABCA10, ABCC9 and SLC16A14 were considerably related to...
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Predictive Factors of Vulvar Precancer Lesions - Optimisation of Diagnostic - Therapeutic Management
Pichlík, Tomáš ; Rob, Lukáš (advisor) ; Mlynček, Miloš (referee) ; Špaček, Jiří (referee)
Vulvar cancer accounts for only 5% of gynaecological malignancies and belongs to uncommon gynaecological tumours. The incidence is around 4/100,000 women and the mortality reaches almost 2/100,000 women and has not changed a lot during last decades. The therapy of genital warts and premalignant lesions of the vulva does not lead to significant drop of recurrence despite various therapeutic modalities. Three different data sets of women were included into this work. The first set focuses on data of HPV distribution across different vulvar lesions, where 54 genital warts, 102 vulvar precancer lesions, 49 vulvar cancers and 44 vulvar dystrophies were included respectively. Second set focuses on epidemiology and the importance of surgical margins in the treatment of vulvar H-SIL, where 65 women were included. The last set is focused on the problems of HPV and non-HPV associated vulvar cancers in relation to recurrence. 133 vulvar cancers were included into the data set and 105 vulvar cancers were analysed with the portion of 53 HPV associated and 52 non-HPV associated vulvar cancers. The main objective is to analyse own data sets and expand the knowledge of predictive factors of vulvar lesions. Our findings will be applied in clinical practice with the intention to optimise diagnostic-therapeutic...
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The influence of reduced radicality of oncosurgical treatment on urogenital tract morbidity
Chmel, Roman ; Rob, Lukáš (advisor) ; Halaška, Michael (referee) ; Mlynček, Miloš (referee) ; Roztočil, Aleš (referee)
Cervical cancer is the fourth most common gynecological malignancy in Czech Republic. The incidence of cervical cancer in 2008 was 19.2/100000 (1021 women) and mortality reached 6/100000. Both radiotherapy and surgery have comparable results in the treatment of cervical cancer but surgical treatment is still the favoured modality especially in young female. Very succesful curability of early stages of this disease (88-97 %) based on individualized therapy currently leads to emphasize the quality of life increasing of treated women. Morbidity related to the treatment is connected with radicality of surgery. The dominant objective of the submitted study was prospective detection of preoperative and postoperative control over the micturition and urinary continence in 142 evaluated women who underwent nerve-sparing radical abdominal hysterectomy type C1, less radical surgery - laparoscopic pelvic lymphadenectomy and laparoscopic assisted vaginal hysterectomy type A or less radical fertility sparing surgery - laparoscopic pelvic lymphadenectomy and simple trachelectomy. Postoperative morbidity is connected with both pelvic lymphadenectomy and resection of the paracervix and proximal part of vagina with hypogastric nerve and inferior hypogastric plexus injury. The lower urinary tract function before and after the...
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Risks and limits of laparoscopy in the treatment of gynecological cancers
Charvát, Martin ; Robová, Helena (advisor) ; Kužel, David (referee) ; Mlynček, Miloš (referee)
The thesis evaluates the results of experimental protocol involving the fertility sparing treatment procedure in early stage cervical carcinoma (LAP I protocol). Sentinel lymph node detection and experimental extirpation of afferent channels using laparoscopy and its technical aspects were analysed in prospective group of 85 women. The oncologic results and early/late morbidity show that established surgical procedures can be considered safe with minimal morbidity, provided that the indication criteria are met. The second part analyses the results of 148 women with no further pregnancy plans suffering from cervical tumors less than 2 cm in size with invasion less than half of the stroma (LAP II protocol). The oncological results in our defined group are very good and comparable to 'standard' procedure of modified radical hysterectomy type B or C with lower morbidity. In the separate section the thesis analyses the possibilities of laparoscopy in endometrial cancer treatment including the potentials of use of sentinel lymph node detection and technical aspects of laparoscopy in obese women. Currently the biggest controversy is the use of laparoscopy in malignant ovarian tumors. Our oncogynaecological study group at FN Motol prefers the laparotomic approach and we chose to include the set of advanced...
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Evaluation of postoperative lymphoedema after differently radical surgery for vulvar and cervical carcinoma
Nováčková, Marta ; Halaška, Michael (advisor) ; Špaček, Jiří (referee) ; Mlynček, Miloš (referee) ; Kučera, Eduard (referee)
The aim of this study was a prospective detection of postoperative lymphedema of the lower limbs in patients after the surgery for cervical and vulvar cancer using different methods of examination and their comparison and monitoring of postoperative complications and quality of life. Totally 78 women were followed after the surgery for cervical cancer and 36 for carcinoma of the vulva. Due to the radicality of the surgery the patients were divided into the conservative and radical groups. Lower limbs lymphedema were evaluated preoperatively and 3, 6 and 12 months after the surgery by the measurement of the lower limbs circumference, multifrequency bioelectrical impedance analysis (MFBIA) and subjective feeling. Quality of life using the European Organisation for Research and Treatment of Cancer (EORTC) questionnaires was evaluated before and 6 and 12 month after the surgery. 12 months after the cervical cancer surgery 35.9 % of patients reported subjective lymphedema, 37.18 % lymphedema were objectively diagnosed by the measurement of lower limb circuits and in 52.56 % of cases the increase of amount of extracellular fluid was detected by the MFBIA Ri/R0 method. The prevalence of lymphedema after the surgery for vulvar cancer reached 19.44% by the subjective assessment, 38.89 % by the measurement of...
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Risks and limits of laparoscopy in the treatment of gynecological cancers
Charvát, Martin ; Robová, Helena (advisor) ; Kužel, David (referee) ; Mlynček, Miloš (referee)
The thesis evaluates the results of experimental protocol involving the fertility sparing treatment procedure in early stage cervical carcinoma (LAP I protocol). Sentinel lymph node detection and experimental extirpation of afferent channels using laparoscopy and its technical aspects were analysed in prospective group of 85 women. The oncologic results and early/late morbidity show that established surgical procedures can be considered safe with minimal morbidity, provided that the indication criteria are met. The second part analyses the results of 148 women with no further pregnancy plans suffering from cervical tumors less than 2 cm in size with invasion less than half of the stroma (LAP II protocol). The oncological results in our defined group are very good and comparable to 'standard' procedure of modified radical hysterectomy type B or C with lower morbidity. In the separate section the thesis analyses the possibilities of laparoscopy in endometrial cancer treatment including the potentials of use of sentinel lymph node detection and technical aspects of laparoscopy in obese women. Currently the biggest controversy is the use of laparoscopy in malignant ovarian tumors. Our oncogynaecological study group at FN Motol prefers the laparotomic approach and we chose to include the set of advanced...
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Evaluation of postoperative lymphoedema after differently radical surgery for vulvar and cervical carcinoma
Nováčková, Marta ; Halaška, Michael (advisor) ; Špaček, Jiří (referee) ; Mlynček, Miloš (referee) ; Kučera, Eduard (referee)
The aim of this study was a prospective detection of postoperative lymphedema of the lower limbs in patients after the surgery for cervical and vulvar cancer using different methods of examination and their comparison and monitoring of postoperative complications and quality of life. Totally 78 women were followed after the surgery for cervical cancer and 36 for carcinoma of the vulva. Due to the radicality of the surgery the patients were divided into the conservative and radical groups. Lower limbs lymphedema were evaluated preoperatively and 3, 6 and 12 months after the surgery by the measurement of the lower limbs circumference, multifrequency bioelectrical impedance analysis (MFBIA) and subjective feeling. Quality of life using the European Organisation for Research and Treatment of Cancer (EORTC) questionnaires was evaluated before and 6 and 12 month after the surgery. 12 months after the cervical cancer surgery 35.9 % of patients reported subjective lymphedema, 37.18 % lymphedema were objectively diagnosed by the measurement of lower limb circuits and in 52.56 % of cases the increase of amount of extracellular fluid was detected by the MFBIA Ri/R0 method. The prevalence of lymphedema after the surgery for vulvar cancer reached 19.44% by the subjective assessment, 38.89 % by the measurement of...
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The influence of reduced radicality of oncosurgical treatment on urogenital tract morbidity
Chmel, Roman ; Rob, Lukáš (advisor) ; Halaška, Michael (referee) ; Mlynček, Miloš (referee) ; Roztočil, Aleš (referee)
Cervical cancer is the fourth most common gynecological malignancy in Czech Republic. The incidence of cervical cancer in 2008 was 19.2/100000 (1021 women) and mortality reached 6/100000. Both radiotherapy and surgery have comparable results in the treatment of cervical cancer but surgical treatment is still the favoured modality especially in young female. Very succesful curability of early stages of this disease (88-97 %) based on individualized therapy currently leads to emphasize the quality of life increasing of treated women. Morbidity related to the treatment is connected with radicality of surgery. The dominant objective of the submitted study was prospective detection of preoperative and postoperative control over the micturition and urinary continence in 142 evaluated women who underwent nerve-sparing radical abdominal hysterectomy type C1, less radical surgery - laparoscopic pelvic lymphadenectomy and laparoscopic assisted vaginal hysterectomy type A or less radical fertility sparing surgery - laparoscopic pelvic lymphadenectomy and simple trachelectomy. Postoperative morbidity is connected with both pelvic lymphadenectomy and resection of the paracervix and proximal part of vagina with hypogastric nerve and inferior hypogastric plexus injury. The lower urinary tract function before and after the...
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