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Ovarian cancer is a lethal malignancy, rarely diagnosed early, and there is currently little, if any, preventive strategies which can be followed. This study attempts to identify lifestyle profiles which might be associated with ovarian cancer, and could then be subject to subsequent modification in an effort to prevent or decrease the incidence of this disease. The Health Promoting Lifestyle Profile (HPLP) questionnaire which is a multidimensional measure of lifestyle was administered to a 'well population' and to patients with the known and confirmed diagnosis of ovarian cancer. HPLP is a multidimensional measure of lifestyle which looks at self-actualization, health responsibility, exercise, nutrition, interpersonal support and stress management. It provides an objective lifestyle profile of individuals and groups of individuals. A t-test for independent samples was performed using the SPSSX statistical program. The separate variance t-test was used. The t-values of self-actualization, interpersonal support, health responsibility and exercise factors were significant at the 0.05 level. Patients diagnosed with ovarian cancer had significantly lower scores compared to those of healthy women. The t-value of the nutrition and stress management scores were not significantly different. This retrospective study strongly suggests that there is a lower score on the HPLP questionnaire for self-actualization, health promotion and lifestyle, interpersonal support, exercise and health responsibility for patients with ovarian cancer, as compared to healthy controls. There is no relationship between the subscores of nutrition and stress management, and the development of ovarian cancer. This would suggest there is a relationship between lifestyle and the development of ovarian cancer.

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A descriptive study of 67 patients with uterine sarcoma reveals the patients to be elderly (mean age 73 years) with significant co-existent medical problems. Despite this, primary surgical therapy is associated with minimal morbidity. Overall, survival is 63% for disease confined to the uterine corpus, and considerably less for more extensive disease. Nodal status, depth of myometrial invasion, peritoneal washings, cervical involvement, histologic type of sarcoma and treatment do not accurately predict survival. Patients alive 26 months after treatment are likely to survive their disease.

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BACKGROUND: This study reviewed all patients managed by the Gynecologic Oncology service of a tertiary care facility (n = 468) whose deaths occurred between 1980 and 1990 to ascertain the site of death and potential factors affecting whether patients died at home or in a hospital. METHODS: Gynecologic Oncology Tumor Registry data were analyzed for patient diagnosis, age at diagnosis, age at death, marital status, insurance coverage, and year of death in relation to location of death. RESULTS: This study found that 78% of patients died in the hospital, and 22% died at home. The mean terminal hospital stay was 15 days. The variables examined in this study could only accurately predict location of death in 59% of the cases. Examination of the variable year of death, however, demonstrated that the likelihood of death in the hospital generally increased from 1980 to 1990, despite introduction of diagnosis related groups and aggressive efforts by caregivers to facilitate and encourage death at home. CONCLUSIONS: Philosophical and economic considerations to the contrary, a significant majority of terminal patients with gynecologic cancers will die in a hospital, thus extensively utilizing our limited health resources.

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We retrospectively reviewed the cases of 51 patients with borderline ovarian tumors seen over a 9-year period. Half of these tumors were manifested by abdominal distention and pain; the remainder were found incidentally at the time of surgery planned for other reasons. Overall survival is excellent, but proper surgical staging reveals that approximately 15% of patients have metastasis beyond the ovaries, most commonly to the omentum, peritoneum, and retroperitoneal lymph nodes.

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The management of gynecologic malignancies is exceedingly complex, requiring thoughtful coordination of surgery, radiation therapy and chemotherapy. Despite the fact that the natural history and clinical course of these cancers are generally well understood, the scarring caused by surgery and/or radiation, and the marked limitations of pelvic examination make clinical staging and evaluation of limited value and known inaccuracy in following women with ovarian, cervical, uterine, vulvar and vaginal cancers. Understandably, the development of computerized axial tomography (CT), and its ability to visualize the abdomen and pelvis, lead to rapid acceptance of CT scans in defining extent of cancer and following patient response to various therapeutic interventions (Chen et al. 1980; Feigen et al. 1987; Photopoulos et al. 1977). Authors have compared the accuracy of CT findings with physical examination, surgical findings, lymphography, conventional radiography or ultrasound (Clarke-Pearson et al. 1986; Vercamb et al. 1987; Amendola 1981; Kerr-Wilson et al. 1984). However, little has been written on the effect of CT scanning on patient management. If we define and accept the accuracy of CT scanning in detecting pelvic and abdominal disease, can we show a benefit in patient management? Or, does CT scanning provide us with expensive information, or misinformation, which fails to translate into better patient care. Do complex imaging modalities compliment thorough examination and experienced clinical judgement, or only duplicate findings and provide extraneous information? To answer these questions, eighty-one months experience in using CT scanning in managing patients with gynecologic malignancies was reviewed.

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Twenty-seven patients with frankly invasive nonmucinous invasive adenocarcinoma of the ovary were monitored using a serial CA-125 and lipid-associated sialic acid (LASA-P) levels prior to cytoreductive surgery, during chemotherapy, before second-look surgery or disease progression, and during subsequent follow-up. All levels were measured using previously described techniques. Serum LASA-P levels correlated well with CA-125 levels during all phases of treatment with no significant difference in predictive value of elevated or normal levels. LASA-P levels, thus, offer another, possibly less expensive, method of monitoring patients with invasive ovarian adenocarcinoma during therapy and in predicting the likelihood of a positive second-look laparotomy.

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Preoperative serum CA-125 levels were elevated in only three of 13 patients (23%) with a pelvic mass who were found to have surgical stage I invasive ovarian adenocarcinoma. This low incidence is surprising, since elevated levels have been found in greater than 80% of patients with advanced ovarian cancer. This suggests serious limitations for using serum CA-125 levels as a screening test for ovarian cancer.

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Serum CA 125 levels were measured preoperatively by standard radioimmunometric techniques in 89 patients with primary endometrial carcinoma before definitive surgical staging and resection. Fifty-seven of 58 (98%) patients with clinical and surgical Stage I or II disease had normal preoperative serum CA 125 levels. All eight patients with clinically advanced endometrial cancer (International Federation of Gynecology and Obstetrics Stage III or IV) had elevated CA 125 levels before surgery. Twenty of 23 patients (87%) with clinical Stage I or II endometrial cancer who were found to have extrauterine spread of disease during staging laparotomy had elevated preoperative serum CA 125 levels. Thus preoperative CA 125 levels were elevated in 28 of 31 patients (90.3%) with surgically staged endometrial adenocarcinoma with extrauterine disease and may play a useful role in detecting those patients with clinically localized endometrial cancer who have occult extrauterine spread of disease.

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Cutaneous metastases from gynecologic malignancy are rarely reported, and when present are invariably accompanied by intraperitoneal disease. In the present case extensive metastases to the skin of the abdomen, groin, thigh and perineum appeared six weeks following extensive "second look" laparotomy which revealed no evidence of intraperitoneal or retroperitoneal disease. The appearance of cutaneous metastases was preceded by only a one month history of leg swelling, erythema, and a markedly elevated serum CA-125. Problems in the differential diagnosis and management of this clinical situation are discussed.

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All women referred to the Department of Obstetrics and Gynecology, School of Medicine, State University of New York at Stony Brook, for evaluation of vulvar condylomata were reviewed to identify concurrent cervical and vaginal pathology. Over the five-year period 1981-1985, referrals to our colposcopy clinic for vulvar condylomata increased from 7.8% to 29.2%. All patients underwent a thorough history, physical examination and colposcopic evaluation of the cervix, vulva and vagina. Of the patients with vulvar condylomata, 68% had biopsy-proven cervical and vaginal pathology. While 50% of patients with cervical disease had human papillomavirus infection alone, the other 50% had concurrent cervical intraepithelial neoplasia (CIN) or CIN only. Proper evaluation of patients with vulvar condylomata must include colposcopy of the cervix and vagina.

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