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The gynecological surveillance of women with Lynch Syndrome in Sweden

Tzortzatos, G. (författare)
Andersson, E. (författare)
Soller, M. (författare)
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Askmalm, M. S. (författare)
Zagoras, Theofanis (författare)
Gothenburg University,Göteborgs universitet,Institutionen för biomedicin, avdelningen för medicinsk genetik och klinisk genetik,Institute of Biomedicine, Department of Medical and Clinical Genetics,University of Gothenburg, Sweden,Univ Gothenburg, Sahlgrenska Univ Hosp, Sahlgrenska Acad, Dept Clin Genet,Inst Biomed, S-41345 Gothenburg, Sweden.
Georgii-Hemming, P. (författare)
Lindblom, A. (författare)
Tham, E. (författare)
Mints, M. (författare)
Lindblom, Annika (författare)
Karolinska Institute, Sweden; Karolinska Institute, Sweden,Karolinska Inst, Karolinska Univ Hosp, Dept Clin Genet, S-17176 Solna, Sweden.;Karolinska Inst, Dept Mol Med & Surg, S-17176 Solna, Sweden.
Georgii-Hemming, Patrik (författare)
Uppsala universitet,Institutionen för immunologi, genetik och patologi
Mints, Miriam (författare)
Karolinska Institute, Sweden,Karolinska Inst, Karolinska Univ Hosp, Dept Womens & Childrens Hlth, Div Obstet & Gynecol, S-17176 Solna, Sweden.
Tham, Emma (författare)
Karolinska Institute, Sweden; Karolinska Institute, Sweden,Karolinska Inst, Karolinska Univ Hosp, Dept Clin Genet, S-17176 Solna, Sweden.;Karolinska Inst, Dept Mol Med & Surg, S-17176 Solna, Sweden.
Soller, Maria (författare)
Lund University,Lunds universitet,Avdelningen för klinisk genetik,Institutionen för laboratoriemedicin,Medicinska fakulteten,Division of Clinical Genetics,Department of Laboratory Medicine,Faculty of Medicine,Skane Univ Hosp, Dept Clin Genet, S-21428 Malmo, Sweden.
Stenmark Askmalm, Marie (författare)
Linköpings universitet,Avdelningen för cellbiologi,Medicinska fakulteten,Region Östergötland, Klinisk patologi och klinisk genetik
Andersson, Emil (författare)
Karolinska Institute, Sweden,Karolinska Inst, Karolinska Univ Hosp, Dept Womens & Childrens Hlth, Div Obstet & Gynecol, S-17176 Solna, Sweden.
Tzortzatos, Gerasimos (författare)
Karolinska Institute, Sweden,Karolinska Inst, Karolinska Univ Hosp, Dept Womens & Childrens Hlth, Div Obstet & Gynecol, S-17176 Solna, Sweden.
Askmalm, Marie Stenmark (författare)
Linkoping Univ, Dept Clin Pathol & Clin Genet, Fac Hlth Sci, Cty Council Ostergotland, S-58185 Linkoping, Sweden.;Linkoping Univ, Dept Clin & Expt Med, Cty Council Ostergotland, Fac Hlth Sci, S-58185 Linkoping, Sweden.
Mints, M (författare)
Karolinska Institutet
Tzortzatos, G (författare)
Andersson, E (författare)
Karolinska Institutet
Georgii-Hemming, P (författare)
Lindblom, A (författare)
Karolinska Institutet
Askmalm, MS (författare)
Tham, E (författare)
Karolinska Institutet
Soller, M (författare)
Zagoras, T (författare)
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ACADEMIC PRESS INC ELSEVIER SCIENCE, 2015
2015
Engelska.
Ingår i: Gynecologic Oncology. - : ACADEMIC PRESS INC ELSEVIER SCIENCE. - 0090-8258 .- 1095-6859. ; 138:3, s. 717-722
  • Tidskriftsartikel (refereegranskat)
Abstract Ämnesord
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  • Objective. Women with Lynch syndrome (LS) have up to a 60% lifetime risk of endometrial cancer (EC) and up to a 24% risk of ovarian cancer (OC). Gynecological surveillance is recommended, but the benefit and how it should be performed remain unclear. The purpose of this study was to assess diagnostic modalities for gynecological screening of LS patients in Sweden and clinical outcome. Methods. A retrospective nationwide study of 170 women with molecularly confirmed LS. Data including gynecological LS screening history, biopsy results (if any), genetic records, number of screening visits, results from screening including transvaginal ultrasound (TVUS), endometrial biopsy (EB), blood test for tumor marker cancer antigen (CA) 125, prophylactic surgery including age at procedure, and setting from which screening data were obtained from medical records. Results. A total of 117 women were eligible for gynecological screening and of these, 86 patients attended screening visits. Of these, 41 underwent prophylactic hysterectomy and/or bilateral salpingo-oophorectomy. Two patients (4.9%) were diagnosed with EC and two (4.9%) with precancerous lesions in conjunction with prophylactic surgery. Total incidence of gynecological cancer in the surveillance group (45 women) was 20% EC, 4% OC. Five patients had endometrial cancer or complex hyperplasia with atypia (n = 2) detected by endometrial biopsy. Four additional cases were detected due to interval bleeding. Both cases of ovarian cancer were detected by transvaginal ultrasound in patients with ovarian cysts under surveillance. The youngest woman with endometrial cancer was diagnosed at 35 years of age, before she was aware of her diagnosis of Lynch syndrome. Conclusions. Gynecological surveillance of women with Lynch syndrome may lead to earlier detection of precancerous lesions, which might have some impact on the morbidity from endometrial cancer although further studies are needed to prove this. Prophylactic hysterectomy with or without bilateral salpingo-oophorectomy reduces the cancer incidence. A practical approach to surveillance in Lynch syndrome women would be to offer annual surveillance beginning at age 30 years including probably both TVUS and EB in order to increase diagnostic yield with prospective data registry for follow-up studies. Prophylactic surgery could be performed at a suitable age after childbearing to obtain a balance between reducing the risk of cancer and minimizing long-term complications from premature menopause.

Ämnesord

MEDICIN OCH HÄLSOVETENSKAP  -- Klinisk medicin -- Cancer och onkologi (hsv//swe)
MEDICAL AND HEALTH SCIENCES  -- Clinical Medicine -- Cancer and Oncology (hsv//eng)
MEDICIN OCH HÄLSOVETENSKAP  -- Klinisk medicin -- Reproduktionsmedicin och gynekologi (hsv//swe)
MEDICAL AND HEALTH SCIENCES  -- Clinical Medicine -- Obstetrics, Gynecology and Reproductive Medicine (hsv//eng)

Nyckelord

Screening
Lynch syndrome
Endometrial cancer
Ovarian cancer
nonpolyposis colorectal-cancer
endometrial cancer
ovarian-cancer
risk
families
guidelines
carcinoma
surgery
hnpcc
Oncology
Obstetrics & Gynecology
Screening; Lynch syndrome; Endometrial cancer; Ovarian cancer

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