© Borgis - Postępy Nauk Medycznych 7/2013, s. 499-500
prof. Romuald Dębski, MD, PhD
Oncology is one of the most dynamic developing branch of medicine. Each medical specialty is combined more or less with the cancerous problems, each of them has its own specific nature, tissue and organ characteristics. There are some medical specialties, where popularizing and improvement of chemotherapeutic guidelines or introducing the cumulating therapy led to a crucial improvement of the treatment effectiveness. The treatment efficiency of Hodgkin’s disease identified to single figures at the beginning of the XX century states nowadays to more than 90%. Almost the same effectiveness was gained in treatment of non-Hodgkin lymphomas. There was also a huge progress in the effectiveness of breast cancer treatment although the main meaning here was popularizing of the early diagnosis methods and as a consequence a higher percentage of treatment in the clinically lower-advanced changes. The main progress we observe involoves popularizing of genetic tests as a cancer risk assessment of large intestine, breast and ovary. The large amounts of capital expenditures put to basic tests led to the better understanding of cancer biology or means in clinical trials – hundreds of new chemotherapeutics, immunotherapy, introducing different combinations and schemas of treatment contributed to increased rates of the cure of many cancer diseases. Unfortunately, there are still organs and diseases which stay less cured or just uncured despite of the great progress of knowledge. The good example of such a treatment could be the gall bladder cancer, some kinds of lung cancer, central nervous system tumors, generalized melanoma and in gynecology – all tumors clinically advanced – relatively rare endometrial cancer, more often cervical cancer, vulval cancer but most of all ovarian cancer. Ovarian cancer not giving any previous clinical symptoms are diagnosed most often in a very advanced cancer process. Ovarian cancer, even in a very well defined group of the very high cancer risk who are carriers of BRCA1 or BRCA2 gene mutation, despite of performing the systematic vivid exams (transvaginal ultasonography with a Doppler blood flow assessment) and taking biochemical markers (CA125 and lately HE4), in more than 50% a cancer is diagnosed in the third stage of a clinical severity, which is in the stage of intraperitoneal dissemination. As far as chemotherapy has made a great progress in a treatment of germinal ovarian cancer, tumors which twenty years ago were a sentence for the young women, today they are permanently cured in the majority. We cannot perform such relation for the most often tumor – ovarian cancer. There were many raised hopes with completely new and modified chemotherapy and the immune system stimulating drugs. Popularizing of the most modern drugs, possibility of chemosensibility of cancer cells assessment, introducing better and more expensive non standard chemotherapy make costs of treatment higher and with the minimal influence on the long-treatment results.
As regards tumors with bad prognosis, diagnosed in the very advanced clinical stage or non sensitive to radio and chemotherapy, the base meaning is in detecting pre-cancerous changes. Removing of these changes minimize or even eliminate the risk of cancer developing. An example of these kind of movements is colonoscopy with prophylactic excision of the colon polyps or pap smear assessment which allow to recognize and treat dysplastic changes.
Cancer of the vulva is a disease affecting older women and although it grows very slowly, it is diagnosed very late as a noticeable mass with affected lypmhnodes. The surgical treatment involves vulvectomy and bilateral lyphadenectomy, which is very disabling. First of all, it is a very long operation, which can put a great strain on the older woman who is most often not in good general condition. Secondly, the wide postoperative wound very rare can heal by concrescence, it often splits, festers and heals after very long weeks by granulation. Often the biggest problem is wound healing after groin lyphadenectomy. The more precisely lyphadenectomy is done and the more lymph nodes are removed, there is the higher risk of developing of lymph reservoir in a subcutaneous tissue. Taking into consideration the fact, that groin nodes connect a run of lymph from the vulva and the lower limb, the volume of lymph can become quite large. These reservoirs are similar to those which appear after mastectomy with lyphadenectomy. The problem is in keeping the groin area in good hygienic conditions by not quite agile women. It can cause the wrong postoperative wound healing. There is completely different extent of operation than in case of diagnosis of the pre-cancerous changes. There is possibility to perform a restricted operation without the necessity of lyphadenectomy. Surgery much less disabling, but as it was showed in analysis of Bytom Site fully effective. Despite the fact that most of vulval cancers are preceded by the precancerous changes, the diagnosis at this stage is made very rare. These changes are or clinically mute or give very non specific effects, which can be treated for many months or even years as the inflammatory changes. Women rarely go to the doctor complaining on such changes, so that is why a diagnosis is made mostly late, at the stage of symptomatic, disintegrated, festering tumor of vulva.
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