No abstract
Summary: Age specific incidence rates of non‐invasive and invasive cancer for 1963 are reviewed. Comparative figures for non‐invasive (506 patients) and invasive cancer (1,679 patients) from 1955 to 1964, inclusive, are given. Results of diagnosis by Papanicolaou smear are analysed, with surprise positive and false negative rates. Results of colposcopic examinations are given, including false negative rate and pick‐up rate for false negative Papanicolaou smear. Association of marital status, motherhood, and pregnancy with non‐invasive cancer is given. Methods of treatment of intra‐epithelial cancer are given and a comparison is drawn between the periods 1955‐60 and 1961‐64. Follow‐up figures are analysed with a brief review of causes of death. A histological review of 71 sections according to the definitions of the Vienna Committee on Terminology showed that only 65% were considered to be noninvasive, 28% were thought to be benign dysplasia and 7% were classified as invasive (Stage 1a). A description of treatment and follow‐up of the latter group of patients is given.
summary Ninety cases of carcinoma of the vagina are reviewed, 72 being primary cancers (1 non‐invasive) and 18 secondary cancers. The incidence of primary carcinoma of the vagina is 1.6% of 4,446 cases of primary genital cancer registered at the NewSouth Wales Gynaecological Cancer Registry. Staging was conducted according to the recommendation of the Cancer Committee of F.I.G.O. and this showed that 31 tumours were Stage 1, 28 Stage 2, 4 Stage 3 and 8 Stage 4. The site of the tumour was in the upper vagina in 39 cases, in the lower vagina in 15 cases, and in the middle third of the vagina in the remaining 17 cases. The mean age of patients with primary invasive carcinoma was 66.5 years, compared with 58.5 years for those with secondary carcinoma. The highest incidence of primary carcinoma was noted in the 70–80 age group, whereas for secondary carcinoma it was in the 50–60 age group. Primary invasive tumours were of squamous type in 80% of cases and adenocarcinoma in only 8 % Two‐thirds of the secondary tumours were adenocarcinomas. Neither marital status nor parity appeared to have any significant association and there was no predisposing cause that could be substantiated. Lymphatic involvement was observed clinically in 20% of patients; 25% of surgically removed nodes showed histological evidence of metastases. Difficulty was often experienced in determining whether a tumour involving the cervix or vulva was a primary or secondary vaginal tumour. For primary tumours, irradiation alone was used in 45 of the 71 patients, surgery alone in 12, surgery and irradiation in 7 and no treatment was employed in 7. A description of methods of applying radiotherapy is given and a dissection is made of the results of treatment according to both the site and the stage of the disease. Fifty per cent. of secondary tumours were treated by surgery compared with 27% of primary tumours. The best results, regardless of the nature of treatment, were obtained when the tumour was in the upper vagina and the principles of treatment applied in carcinoma of the cervix could be carried out. Annual and cumulative relative survival ratios are given for primary carcinoma of the vagina and these are compared with those for primary carcinoma of other genital sites. The 5‐year survival figure of 33.8% is considerably lower than that for other sites except the ovary. Secondary tumours of the vagina from the colon, rectum, cervix, vulva, body of the uterus, and urethra are discussed in relation to pathology and treatment. Secondary squamous tumours appear to have a better outlook than glandular tumours, particularly if treated by surgery.
A series of 413 cases of cancer of the ovary from the N.S.W. Gynaecological Cancer Registry is reviewed in relation to some of the problems set up for examination by the World Health Organisation Committee. A new recommended system of staging is shown and compared to the recent F.I.G.O. method.The frequency of carcinoma of the ovary in relation to other genital carcinoma in women is 12.3% and is only exceeded by cervical cancer, 55.2% and corporeal cancer, 25.8%. The survival rates are discussed and compared with those from other genital s i t e s a n c e r of the ovary being the lowest with a cumulative relative 5-year survival of 32%.Different methods of assessing end results are discussed. In this series the following results were obtained: cumulative relative 5-year survival 32% ; absolute 5-year survival 25.5%; and relative 5-year survival 27.9%. Many patients with cancer of the ovary are not diagnosed until the disease is in Stage 3 or 4: in N.S.W. this represents 43% of cases. There was a relative 5-year survival of 67% for Stage la, 30.8% for Stage lb, 22.2% for Stage 2a, 14.8% for Stage 2b, 1 1.1 % for Stage 3 and 4.1 % for Stage 4.The effect of rupture at operation or spill from a malignant cyst is discussed in relation to its effect on prognosis. The 5-year survival rate for 20 patients whose tumour had ruptured was 30%, much lower than the figure of 77% for the 74 patients whose tumour remained intact. When 15 patients in each group with Stage l a lesions of the same pathological type (papillary) were compared, the figures were even more pronounced-27% and 87% respectively. Ovarian conservation in patients with early (Stage la) tumours was associated with a lower 5-year survival rate (67% versus 75 % ) .Ascites was reported in 78 patients (19%); this association was of serious prognostic significance since only 3 of the patients ( 4 % ) lived 5 years and each of these was in Stage la. Ascites was present in only 5 of the patients (3.9% ) with Stage l a tumours. Mucinous carcinomas had a more favourable prognosis (61%-5-year survival) than anaplastic (28.5% ), serous or papillary (26.2% ) and endometrioid (24.7%) turnours; germ cell tumours (43%) and granulosa and theca cell tumours (35 % ) were of an intermediate malignancy. The pathological composition of the tumours was as follows: papillary (44.8%), endometrioid (23.0%), mucinous (12.1%), anaplastic and undefined (12.5%), granulosa and thecoma (5.5%), germ cell (1.9%).A brief description is given of the characteristics that distinguish frank malignancy from malignancy of low potential.Surgery alone was the treatment in 44.3% of the patients, surgery and irradiation in 32.3%, irradiation alone in 10.4%, and 13.0% were untreated.The 5-year survival figures for surgery alone was 41.1 % , for combined treatment was 30.4%, and for radiotherapy alone no patient survived for 5 years. However, 42.3% of those treated by surgery alone comprised the most favourable cases (unruptured Stage l a ) compared with only 15.7% of those treated by combined therapy. Co...
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