Tumors of female reproductive system

Background. Рostmastectomy radiation therapy (PMRT) is one of the causes of complications in patients with breast cancer after delayed breast reconstruction (DBR).

Aim. To conduct a retrospective analysis of DBR outcomes and evaluate the impact of PMRT on the frequency and nature of complications.

Materials and methods. Data from 178 patients with breast cancer who underwent DBR at N. N. Petrov National Medical Research Oncology Center, from 2015 to 2021 were included. In 87 patients, PMRT was administered to the soft tissues of the anterior chest wall and regional lymph nodes (group 1). Reconstruction with tissue expanders was performed in 66 (75.9 %), women while 1 (1.1 %) patient received a permanent implant. Six (6.9 %) patients underwent combined reconstruction using an expander with a thoraco-dorsal flap (TDF). In five (5.7 %) cases, a permanent implant was combined with TDF. Autologous reconstruction techniques were used in 10.3 % of cases (9 patients). Among the remaining 91 women PMRT was not performed (group 2). In this group, 69 (75.8 %) patients underwent reconstruction with tissue expanders, 2 (2.2 %) patients received permanent implants, 10 (11 %) patients had implants combined with TDF, and the combination of tissue expander with TDL was used in 2 (2.2 %) patients. Eight (8.8 %) patients underwent autologous reconstruction. Complications were assessed based on data from the medical information system “Vista” and telephone surveys and were determined as reconstructive failure (RF) and capsular contracture (CC) of Baker grades III–IV.

Results. The mean follow-up duration was 48 months [14.5; 89.0] in the PMRT group and 63 months [38; 94] in the non-PMRT group. The overall complication rate was 27.5 % (49 cases), including reconstructive failures in 23 % (41 cases) and clinically significant СС (Baker III–IV) in 4.5 % (8 cases). RF occurred in 29.9 % of patients who received PMRT versus 16.5 % in those who did not (p = 0.03). The incidence of CC did not differ significantly: approximately 4.6 % in the PMRT group versus 4.4 % in the non-PMRT group (p = 0.95). Among patients who received PMRT after reconstruction with tissue expander RF were higher (33.3 %) compared to 14.5 % in non-irradiated patients (p = 0.01). Complications following autologous reconstruction occurred frequently regardless of PMRT status and probably were associated with the ability of surgery.

Conclusion. Radiotherapy increases the risk of RF after DBR but was not associated with the risk of CC. Our data highlight the need to consider the impact of PMRT when planning DBR.

Background. A common manifestation of breast diseases is mastodynia. Quite a large number of drugs are used to correct these symptoms, but it is the use of indole-3-carbinol that is pathogenetically determined.

Aim. To study the effect of the dietary supplement “Imaston” on the course of diffuse benign breast dysplasia accompanied by mastodynia.

Materials and methods. 130 patients of reproductive age from 18 to 53 years old, with preserved menstrual function, were examined and treated. The patients were randomized in a 1:1 ratio with stratification by the presence of surgical interventions on the pelvic organs or breast.

Results. Against the background of the ongoing therapy of the dietary supplement “Imaston”, a decrease in pain syndrome was noted. The criterion for the effectiveness of therapy was the reduction of pain syndrome by 2 points or more. According to this criterion, 100 % effectiveness of therapy was obtained in both groups. In therapy group 1, the dynamics of pain reduction was higher. At the time of control visit 3, 71.2 % of patients in therapy group 1 had pain syndrome of 2 points or less, while 66.1 % in the control group. Ultrasound evaluation showed a decrease in the total number and volume of cysts by 23.2 %. There was also a decrease in the thickness of the mammary parenchyma by 16.22 %, compared with the initial values. At the same time, the dynamics in therapy group 1 was more pronounced than in the control group: 16.2 % versus 15.8 %. There was a marked decrease in the diameter of the ducts by 61.2 % against the background of the use of dietary supplements “Imaston” 1 capsule 2 times a day.

Conclusion. The study proved the effectiveness of the dietary supplement “Imaston” , containing 200 mg of indole-3-carbinol and 60 mg of trans-resveratrol in 1 capsule, in the treatment of diffuse breast dysplasia, in particular accompanied by pain syndrome.

Breast cancer still occupies a leading position among oncological diseases in women, despite the successes in its diagnosis and treatment. Multifocal and multicentric forms of breast cancer, which are characterized by the development of several tumors in one or different quadrants of the mammary gland, remain especially difficult for clinical practice. These features significantly affect the choice of treatment tactics, the scope of surgical intervention and prognosis. The article considers modern approaches to the diagnosis and treatment of multifocal and multicentric forms of breast cancer and analyzes the possibilities and limitations of breast-conserving surgery in these cases.

This review focuses on current information regarding the clinical and diagnostic characteristics of lobular breast cancer. It presents information on the molecular biological characteristics and biological behavioral characteristics of various subtypes of preinvasive and infiltrative cancers of this histological type. Optimal treatment options for preinvasive and early invasive lobular breast cancer are identified.

Aim. The study of medical and social risk factors for the development of anxiety in pre-pregnant women.

Materials and methods. The study included 200 primigravid patients of reproductive age (18–35 years) at 36–37 weeks of gestation. The first group consisted of 100 women with elevated levels of state and trait anxiety, while the second group included 100 women with low levels of state and trait anxiety. The levels of state and trait anxiety were assessed using the State-Trait Anxiety Inventory (STAI) by C. D. Spielberger and Yu. L. Khanin. A high level of anxiety was defined as a score of 31 points or higher on the STAI scale, while a low level was defined as a score below 31 points.

Results. The analysis showed that women in group 1 had significantly higher levels of state and trait anxiety compared with the control group (51.42 ± 14.78 and 37.42 ± 4.09 vs. 21.75 ± 7.31 and 18.67 ± 3.05 points, respectively; p <0.05). In this group, negative (54 %) and neutral (39 % vs. 13 %) reactions to pregnancy, as well as unplanned pregnancies (67 % vs. 24 %), were more frequently reported. In addition, in this group, the socio-medical analysis revealed a higher prevalence of higher education (66 % vs. 52 %), employment (63 % vs. 49 %), unsatisfactory family relationships (34 % vs. 6 %), and low income (58 % vs. 38 %). Correlation analysis confirmed a strong positive association between high anxiety levels and higher education, moderate associations between high anxiety levels and employment and low income, and negative correlations between high anxiety levels and unemployment and satisfactory family relationships.

Conclusion. The study demonstrated that a high level of state and trait anxiety in primigravid women is statistically significantly associated with several medico-social factors. Strong positive correlations were identified between anxiety and higher education, employment, and low socioeconomic status, whereas a negative correlation was found with satisfactory family relationships. These findings suggest that the combination of occupational workload and socioeconomic instability contributes to the development of psycho-emotional stress during pregnancy. Conversely, a supportive family environment may serve a protective role, reducing anxiety levels. The results highlight the need for a comprehensive assessment of the social conditions of pregnant women and the development of psychoprophylactic and social support programs for women at risk in order to improve perinatal outcomes and overall quality of life.

Background. Uterine artery embolization (UAE) is currently widely used to treat uterine fibroids. Despite this, the issue of the effect of UAE on reproductive function remains controversial.

Aim. To study the impact of EMA performed for uterine fibroids on women's reproductive function.

Materials and methods. A retro- and prospective analysis of the case histories of 100 patients aged 26 to 45 years who underwent UAE for uterine fibroids was conducted.

Results. In the majority of cases (96 %), UAE was effective. Repeated UAE was required only in 4 % of patients. Eight (8 %) patients underwent transcervical myomectomy during the first year after UAE. One (1 %) patient underwent laparoscopic myomectomy, one (1 %) – hysterectomy for fibroid necrosis in the second year of observation. Regular menstrual cycle after UAE was observed in 80 % of women, 18 % had an irregular menstrual cycle, which was restored within 12 months after surgery. And 2 % at the age of 45, experienced menopause. Pregnancy occurred in 58 % of patients. 34 (58.5 %) of pregnancies resulted in the first live birth. 13 (21.9 %) were terminated at the request of the women. In 3 (4.9 %) of cases, pregnancy ended in spontaneously miscarriage. In 5 (9.8 %) and 3 (4.9 %) of cases, non-viable and ectopic pregnancy was detected, respectively. The frequency of complications during pregnancy, childbirth and postpartum period in our study did not differ from those in the general population.

Conclusion. The use of UAE for the treatment of uterine fibroids in patients of reproductive age planning pregnancy is highly effective alternative to surgical and drug treatment.

Background. Endometrial cancer (EC) is closely associated with carbohydrate and lipid metabolism disorders, which are triggers for obesity and decreased sensitivity of insulin-dependent tissues to insulin (insulin resistance), which in turn leads to hormonal imbalance, increased estrogen levels and the presence of a chronic low-intensity inflammatory reaction. Important mediators that regulate inflammatory reactions and indirectly affect carbohydrate metabolism are adipokines and specialized pro-resolving mediators (SpRM).

Aim. To study the relationship between the content of SpRM and adipokines in blood serum of patients with EC and dysmetabolic disorders and clinical / morphological characteristics of the tumor.

Materials and methods. A single-center, non-interventional, cross-sectional comparative study included 45 patients with EC (endometrioid adenocarcinoma, T1–2N0M0). The study assessed the serum levels of adipokines (adiponectin and visfatin), SpRM (maresin-1 and protectin D1) in comparison with carbohydrate metabolism indices, body mass index, clinical and morphological characteristics of the tumor (tumor size, presence of myometrial invasion and tumor grade).

Results. In EC patients with dysmetabolic disorders, a significant decrease in the level of adiponectin was revealed (1.4-fold decrease in the case of hyperglycemia (p = 0.048) and a 1.45-fold decrease in the case of body mass index ≥30 kg / m² (p = 0.041). A 2.25-fold decrease in the level of visfatin was found in cases with impaired tissue sensitivity to insulin (p = 0.011). Carbohydrate metabolism disorders in EC are accompanied by loss of correlation relationships between the studied parameters. The present study was the first to demonstrate results concerning the content of SpRM (maresin-1 and protectin D1) in EC. In EC patients with normal blood glucose concentration, statistically significant differences in the levels of adiponectin were found between patients with different depth of myometrial invasion.

Conclusion. The revealed changes in the levels of adipokines and SpRM are not specific to the tumor process; however, they affect the clinical and morphological characteristics of the tumor. These biologically active components have a regulatory effect on various metabolic pathways, which must be taken into account during EC treatment.

Background. Globally, the increase in cancer rates is explained by improved diagnostic quality, an aging population, and the accumulation of unfavorable risk factors within the population. High achievements in early diagnosis of female cancer are based on expanding access to primary care and improving screening programs. Cancer is a heterogeneous group encompassing tumors with different origins, histological structures, clinical courses, and treatment outcomes, which necessitates selecting high-risk groups during routine medical examinations and periodic checkups, exploring new potential markers at this stage of population health monitoring.

Aim. To investigate the role of the CA62 marker in screening programs for women at high risk of cancer.

Materials and methods. The group of women with a high cancer risk was selected using automated questionnaires and amounted to 18.7 %. The main adverse risk factors were: age over 55 years combined with two external factors, including smoking/alcohol/poor diet, and physical inactivity; excess weight with a BMI >30 kg/m²; and a positive family history of cancer.

Results. In 2023 and 2024, the CA-62 marker was analyzed in 1,099 women at high cancer risk. The analysis was performed using the CLIA-CA-62 chemiluminescence immunoassay (IVD). Values >5500 U/mL were found in 80 (7.27 %) women. A detailed examination of these patients revealed cancer in 5 (6.25 %) patients. Furthermore 8 (5.3 %) cases of cancer were found in the group of 150 women with reference values for the CA 62 marker.

Conclusion. Thus, our analysis showed no benefit from using the CA-62 marker in screening programs for women with high-risk factors for cancer and requires further study.

Gynecologic oncology is a significant challenge for modern healthcare, requiring innovative approaches to diagnosis, treatment, and outcome prediction. Artificial intelligence (AI) is revolutionizing oncology practice, opening up new opportunities to improve the care of patients with gynecologic malignancies. This review assesses the current state of AI use in gynecologic oncology based on a systematic literature review. The methodology included searching in PubMed, Web of Science, and Scopus databases for the period 2010–2024 using the key terms “artificial intelligence”, “machine learning”, and “deep learning” in combination with “cervical cancer”, “ovarian cancer”, and “endometrial cancer”. The results show that of the 71 studies, 34 focused on cervical cancer, 21 – on ovarian cancer, and 13 – on endometrial cancer, with 49 % of the studies using imaging data and 51 % using numerical data. AI demonstrates high accuracy in cervical cancer screening (up to 95 %), significantly improves outcome prediction in ovarian cancer (AUC 0.77–0.88), and shows promising results in endometrial cancer diagnosis. Radiomics-based machine learning models achieve a C-index of 0.85 for predicting disease-free survival and overall survival in cervical cancer after chemoradiation therapy. The discussion highlights the theoretical significance of AI for personalized medicine in gynecologic oncology and its practical importance for improving clinical outcomes, but also highlights the need to address validation issues, ethical considerations, and integration into clinical practice. Prospects include the development of multimodal models, the integration of more data, and the creation of explainable algorithms to enhance clinician confidence.