Serat Centhini

Begja-begjane kang lali,Luwih begja kang eling lawan waspada

Joyoboyo - Kerajaan Kediri 1135 - 1157 M
Ronggowarsito 1802 – 1873 M

Cervical Cancer Diagnosed after Simple Hysterectomy

Cervical Cancer Diagnosed after Simple Hysterectomy
How to avoid suboptimal management ?

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Color Doppler Sonography Analysis of Adnexal Masses

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Quotations

Integritas adalah mengatakan kebenaran pada diri sendiri
Kejujuran adalah mengatakan kebenaran pada orang lain

VEGF-C : Angiogenesis & Lymphangiogenesis

Vascular endothelial growth factor (VEGF) adalah sinyal kunci yang digunakan oleh sel yang kekurangan oksigen (oxygen-hungry cells) untuk memicu pertumbuhan pembuluh darah. VEGF adalah regulator utama angiogenesis abnormal bekerja dengan menstimulasi mitogenesis dari sel endotel dan meningkatkan permeabilitas pembuluh darah. Ekspresi VEGF berpotensiasi pada respon terhadap hipoksia dan aktifasi oleh onkogen.
VEGF, yang juga disebut vascular permeability factor(VPF), termasuk kedalam keluarga supergene VEGF-platelet-derived growth factor (PDGF). Anggota keluarga yang lain adalah VEGF-B, VEGF-C, VEGF-D dan VEGF-E. VEGF juga bertindak sebagai mediator sekresi dan aktivasi enzim-enzim dalam proses degradasi matriks ekstra-seluler. VEGF bekerja pada sel-sel endotelial, menginduksi ekspresi aktivator dan inhibitor plasminogen, ekspresi reseptor urokinase dan ekspresi matrix metalloproteinases, kolagenase interstisial dan gelatinase A, juga pada saat yang bersamaan menurunkan kadar inhibitor jaringan metalloproteinases 1 dan 2.

VEGF-C berperan dalam proses limphangiogenesis, proses pembentukan saluran limfatik baru. Sistem vaskuler limfatik mempunyai peranan penting dalam menjaga keseimbangan cairan jaringan, sebagai mediator respon imun aferen dan dalam metastasis tumor ganas ke kelenjar getah bening regional. VEGF-C dapat bekerja baik pada pembuluh darah maupun pembuluh limfe melalui aktifasi pada reseptor VEGF R2. Sinyal tansduksi VEGF-C/VEGF R3 diketahui berperan penting pada proses liphangiogenesis.

Endodermal Sinus Tumor

Endodermal Sinus Tumor
Role of Conservative Surgery and Chemotherapy.

Update Review


Introduction
Endodermal sinus tumor ( EST ) is second most common malignant ovarian germ cell tumor. The management of these tumor can be challenging, but a rational approach can be outline based on current data. Occurs in childhood, adolescence, and adult life (most <30 years), EST can be pure or a component of a mixed germ cell tumor and almost always a unilateral solid or solid and cystic tumor. (1-2 )
Generally,malignant ovarian germ cell tumor has one of the most successful treatment outcomes in gynecological malignancy. More than 80% of the patients can be cured from this rare type of tumor.EST was highly malignant neoplasm that is radioresistant but responds to combination chemotherapy. Surgery plus chemotherapy is the best treatment for this type of disease and AFP assay may be a useful tool for monitoring patient progress.(3)
Surgical eksploration and unilateral salpingo-oophorectomy are the treatment of EST.Does addition hysterectomy and contralateral salpingo-oophorectomy can improve outcome theraphy ? How about the role of second-look laparotomy ? Dysgerminoma is extremely sensitive to chemotherapy, and treatment with chemotherapy cures the majority of patients even with advanced disease. Which regime is much better among VAC, VBP and BEP ?. How about the role of gemcitabine base chemotherapy in refractory germ cell tumors?. Prior to advances in chemotherapy, the prognosis for these aggressive tumours was poor.Over the past decade, new chemotherapeutic regimes have made germ cell tumours among the most highly curable cancers.(4,5,6,7 )


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Neoadjuvant Chemotherapy

Title. NEOADJUVANT CHEMOTHERAPY VERSUS PRIMARY SURGERY IN ADVANCED OVARIAN CANCER. MORBIDITY AND PROGRESSION FREE STUDY
H.Priyanto,A.Andrijono Oncology Division - Department of Obstetrics and Gynecology.Faculty of Medicine University of Indonesia -Dr. Cipto Mangunkusumo Hospital. 6 Salemba Raya Street Jakarta 10430 –Indonesia
Objective. The aim of the study was to compare the morbidity and progression free of disease women with advanced ovarian cancer treated with neoadjuvant chemotherapy (NAC) followed by surgery with those treated conventionally with cytoreductive surgery followed by cytotoxic chemotherapy.
Materials and methods. : Eighty –four consecutive patients with advanced-stage ovarian cancer based on extend of disease on clinical impression and imaging between 2000-2004 were reviewed retrospectively. 64 patients treated conventionally (CT) with primary surgery followed by platinum-based adjuvant chemotherapy, 20 patients treated with neoadjuvant chemotherapy (NAC),and eighth patiens subsequently underwent interval debulking and adjuvant chemotherapy
Results : The response rate to NAC assessed at three cycles was 40 %. Performance status ( Hb, Albumin, Ascites, Pleural Efusion, Ca 125 and Stage ) NAC group was worse than CT group. Progression free of disease 12 and 24 mounths on NAC was 30% and 5 %,CT group was 10% and 7,5 %. Parameters of surgical aggressiveness ( massive bleeding, organ injury and ICU stay ) were significantly lower in NAC group than the conventional group. Complication rate of surgical injury on CT group was 17 % and zero on NAC group.
Conclusion : Neoadjuvat chemotherapy followed by interval debulking in advaced ovarian cancer does’t effect on progression free of disease but significantly reduce morbidity and permit a less aggressive surgery to be performed.

Presented on - FIGO 2006 World Congress - Kuala Lumpur, Malaysia
- ESGO 2007 15th International Meeting-Berlin,Germany