Breast cancer, being the most common type of malignant diseases, remains a significant challenge for both clinicians and fundamental researchers. The implementation of screening mammography, as well as adjuvant and neoadjuvant systemic therapy has made a significant progress in tackling the disease. The studies aimed at the assessment of novel biomarkers of breast cancer, alternative to standard ones, are becoming increasingly relevant. A number of new markers, such as p53, CK5/6, SMA, p63, PHH3, E-cadherin, EGFR, FOXA1, androgen receptors, TILs etc., have demonstrated their high predictive and/or prognostic value in multiple studies. New findings suggest that evaluation of novel biomarkers in breast cancer requires further thorough analysis.

Recent studies have identified the role of biomarkers in choosing an optimal treatment strategy for breast cancer, estimated the prognostic value of biomarkers associated with tumor proliferative activity (including cyclin D1, G1-cyclin-dependent kinases 4 and 6, and cyclin-dependent kinases 8/19), specified the role of phospho-histone H3 (which is a proliferation marker that can be used to determine tumor grade), and evaluated the prognostic value of androgen receptors and other biomarkers. Multiple studies have also analyzed the expression of various biomarkers and their impact on overall and relapse-free survival.

This article discusses the problems associated with the search of the most effective treatment strategies for HER2-negative metastatic breast cancer in premenopausal women. Until recently, ovarian suppression and hormone therapy had been the main treatments used in this group of patients. The development of palbociclib, called a “breakthrough therapy”, as well as promising results of trials evaluating the efficacy of cyclin-dependent kinase 4 and 6 (CDK4/6) inhibitors added to hormone therapy in postmenopausal women suggested a need for the assessment of this treatment regimen in combination with ovarian suppression in younger patients.

According to the results of randomized trials and subgroup analysis, the addition of a CDK4/6 inhibitor to ovarian suppression and hormonal therapy significantly increases survival. The safety profile is similar to that of older patients. Randomized trials comparing the efficacy of palbociclib + ovarian suppression + aromatase inhibitor vs. chemotherapy in premenopausal women demonstrated significant benefits of a new treatment strategy: a CDK4/6 inhibitor as a part of combination therapy reduced the risk of progression by 36 % compared to capecitabine.

The research provided includes analysis of the current state of the problem on the use of oral contraceptives and menopausal hormone therapy. These therapeutic options were evaluated in terms of their importance for the risk of breast cancer. The possibility of using these drugs in a cohort of high-risk patients (women with family history of breast cancer) and in the group of patients with benign pathology was analyzed as well. Modern trends of menopausal hormone therapy prescription in different clinical situations were determined.

This critical analysis of the article of B. Fisher et al. “Twenty-five-year follow-up of a randomized trial comparing radical mastectomy, total mastectomy, and total mastectomy followed by irradiation” (2002) was written for physicians interested in learning how evidence based oncology has challenged the Halstedian model of breast cancer progression and the radical loco-regional treatment as the way to stop this progression. The 25-year update of the NSABP B-04 study is unique in its design and the remarkable length of follow-up. Our detailed analysis of the article provides an example how oncologists learn about biology of the disease, test the hypothesis of the metastatic spread of the tumor, and what the bases of the modern principles of loco-regional treatment of breast cancer are. Also, the modern clinical recommendations are written using similar systematic analysis of the available literature. The presented analysis explains the logic behind using various end-points. This analysis illustrates how the study helps to dismantle the stereotype that super radical surgical treatment of breast cancer was effective and to promote research in less aggressive loco-regional treatments of other tumors. To our knowledge this type of analysis has never been published before in Russian oncology literature.

Background. Borderline ovarian tumors (BOT), due to their unclear biological potential, remain a problem for oncogynecologists. On the one hand, frequent recurrences of tumors, and on the other hand, a high survival rate in the diagnosis of patients requires careful weighing of all risk factors when choosing surgical intervention tactics in patients with BOT. A large number of recurrences of BOT in patients of fertile age lead to disability of patients, deterioration of their quality of life and loss of reproductive function.

Objective: evaluation of the influence of clinical and morphological factors (the presence of non-invasive implants, bilateral lesion of the ovaries, the presence of psammous bodies and malignization tricks) and surgical factors (damage to the cyst capsule and carrying out fertility preserving operations) on the recurrence of BOT in various age groups.

Materials and methods. The material for the study was the protocols of an in vivo pathoanatomical study of a biopsy (surgical) material obtained from patients with a diagnosis of BOT for the period from 2000 to 2017 inclusive, according to the Regional Forensic Medical Bureau of Kursk. A total of 110 protocols for the first occurrence of BOT and 14 protocols for the tumor recurrences were analyzed. The age of patients undergoing an in vivo pathologic examination ranged from 19 to 75 years.

Results and conclusions. It has been revealed that psammous bodies, fertility preserving operations and reproductive age are associated with tumor recurrence. Groups of patients with foci of malignancy and bilateral lesions have a lower risk of BOT recurrence due to the radical surgical treatment tactics and possibly the use of chemotherapy in the first case. Non-invasive implants are not associated with the risk of BOT recurrence.

Objective: to determine the significance of hormonal, biochemical, echographic research methods in the diagnosis of endometrial cancer.

Materials and methods. Fifty patients with endometrial cancer with varying degree of severity were examined. The average age of patients with endometrial cancer was 62.4 ± 1.0 years. The study of the prevalence of the tumor process made it possible to establish that the frequency of patients with stage I was 68 %, with stage II – 30 %, and with stage III – 2 %.

Results and conclusions. According to hormonal studies, the statistical significance of a decrease in the luteinizing hormone/follicle-stimulating hormone ratio (0.69 ± 0.09), an increase in prolactin levels (467.3 ± 35.1 ng/ml), dehydroepiandrosterone sulfate (92.9 ± 14.4 ng/ml), estrone (101.6 ± 6.29 ng/ml), progesterone (1.9 ± 0.52 ng/ml), as well as a decrease in estradiol (17.4 ± 3.4 pg/ml) and testosterone (0.5 ± 0.02 ng/ml) levels. According to echographic studies, a pathological increase in the thickness of the endometrium (24.9 ± 2.7 mm) was established with the background of increasing the size of the uterus and ovaries. Indicators of biochemical studies in patients with endometrial cancer in the postmenopausal period were within the range of physiological fluctuations.

The analysis of the effectiveness of the use of morphine sulfate tablets in chronic pain syndrome in 52 patients with advanced cervical cancer (stage III–IV), which were under our supervision in 2015–2016, is presented. To assess the intensity of pain, was used a visual-analogue scale. All patients had pain syndrome: 39 (75 %) patients had severe pain (4–6 points), and 13 (25 %) had very severe unbearable pain (7–10 points). In all cases, with regular use of morphine sulfate tablets and ancillary drugs, a good effect of therapy was achieved: in 39 (75 %) patients the intensity of pain decreased from 4–6 points to 0–3 points, and in 13 (25 %) patients – from 7–10 points to 4–6 points.

The most common causes of treatment failure in ovarian cancer (ОС) include late diagnosis due to the absence of screening programs for its early detection and lack of vigilance by general practitioners and gynecologists. World experience suggests that screening of 100% of women has a minimal impact on mortality. Examination of women at high risk for OC is a sensible alternative to mass screening. This examination can be performed using universal computerized screening, which is a very promising and cost-effective method.

To identify the symptoms significantly associated with early-stage OC, we questionnaired 100 patients with morphologically verified stage IA–IC OC, admitted to the Department of Gynecology, Tula Regional Oncology Dispensary between 2010 and 2017 (experimental group). The control group included 200 women without malignant diseases, who underwent preventive medical examination in outpatient units of Tula. We analyzed the significance of 22 clinical symptoms and developed original computer software ScOv, which was subsequently used for identifying patients at high risk of OC among women aged 40 years and older by evaluating their complaints. The sensitivity and specificity of ScOv were 73.7 % and 88.8 % respectively. A retrospective check of the developed program demonstrated its high efficiency and prognostic value.

Primary retroperitoneal cysts are rare benign growths that are often random findings during diagnostic examinations or surgical treatment. The classification, etiology and clinical manifestations of retroperitoneal cysts are the subject of interdisciplinary debate. The most reliable test for their detection is ultrasound and computed tomography. Based on the available literature data, primary cysts of the retroperitoneal space are subject to complete removal within healthy tissues.

We present a clinical case of intraoperative detection of a large-sized retroperitoneal cyst in a 42-year-old woman hospitalized in the gynecological department of the Federal Research and Clinical Center for Specialized Medical Care and Medical Technologies, Federal Medical and Biological Agency of the Russian Federation, for surgical treatment of uterine myoma. During the planned surgical treatment revealed the presence of cystic formation of large sizes in the right anterior pararenal space. The final diagnosis was made after a pathological examination. Histologically, the inner epithelial lining of the cystic formation contained multiple ciliary cells, forming papillary structures similar in some areas, with folds of the mucous membrane of the fallopian tube.