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Challenges in Managing Patients with Hereditary Cancer at Gynecological Services.

ABSTRACT: Aim:To reveal current problems and challenges faced by our gynecologic services department in managing patients with hereditary cancers. Methods:We collected clinical data of patients with hereditary cancers, identified via genetic testing (or clinically diagnosed in cases of Cowden syndrome or Peutz-Jeghers syndrome), and treated in our gynecological department from 2012 to 2018. Results:Fifteen patients had hereditary breast and ovarian cancer (HBOC), 6 had Lynch syndrome, 2 had Cowden syndrome, and 2 had Peutz-Jeghers syndrome. Five patients diagnosed with HBOC were younger than 40?years at diagnosis. Risk-reducing salpingo-oophorectomy (RRSO) was performed on 1 patient with a BRCA1 mutation at age 38?years. Seven patients overall underwent RRSO, and none had malignancies on pathological examinations. Peritoneal washing cytology (PWC) was suspicious for malignancy in one patient; however, subsequent PWC at 6?months after RRSO was negative. A patient with endometrial cancer and Lynch syndrome and a patient with atypical endometrial hyperplasia (AEH) and Cowden syndrome strongly desired fertility preservation. They achieved remission after medroxyprogesterone acetate treatment and multiple dilations and curettages, respectively. One patient with Lynch syndrome developed AEH after 11?years of surveillance. Laparotomy revealed adjacent low-grade and high-grade serous ovarian cancer with positive ascites cytology. She had no recurrence during 7-year follow-up after laparotomy. Conclusion:Managing patients with hereditary cancer, positive or false-positive ascites cytology discovered during RRSO, and desired preservation of fertility is highly challenging.

SUBMITTER: Ueda M

PROVIDER: S-EPMC6556775 | biostudies-literature | 2019

REPOSITORIES: biostudies-literature

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Challenges in Managing Patients with Hereditary Cancer at Gynecological Services.

Ueda Mako M Tsubamoto Hiroshi H Kashima-Morii Mina M Torii Yoshitaka Y Kamihigashi Mariko M Wakimoto Yu Y Nakagomi Nami N Hashimoto-Tamaoki Tomoko T Sawai Hideaki H Shibahara Hiroaki H

Obstetrics and gynecology international 20190527

<h4>Aim</h4>To reveal current problems and challenges faced by our gynecologic services department in managing patients with hereditary cancers.<h4>Methods</h4>We collected clinical data of patients with hereditary cancers, identified via genetic testing (or clinically diagnosed in cases of Cowden syndrome or Peutz-Jeghers syndrome), and treated in our gynecological department from 2012 to 2018.<h4>Results</h4>Fifteen patients had hereditary breast and ovarian cancer (HBOC), 6 had Lynch syndrome ...[more]

PMID: 31263500

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Project description:Cancer is a global major public health problem since it is a leading cause of death, accounting for nearly 10 million deaths in 2020 worldwide and the most recent epidemiological data suggested that its global impact is growing significantly. In this context, cancer survivors have to live for a long time often in a condition of disability due to the long-term consequences, both physical and psychological. These difficulties can seriously impair their working ability, limiting the employability. In this context, the occupational physician plays a key role in the implementation and enforcement of measures to support the workers affected by cancer, to address issues such as the information on health promotion, the analysis of work capacity and the management of disability at work and also promoting a timely and effective return to work and preserving their employability. Therefore, the aim of this study was to gather useful information to support the occupational physicians in the management of workers affected by cancer, through a survey on 157 Italian occupational physicians. Based on the interviewees' opinions, the most useful occupational safety and health professionals in terms of job retention and preservation of workers affected by cancer are the employers and the occupational physicians themselves, whose role is crucial in identifying and applying the most effective reasonable accommodations that should be provided to the workers affected by cancer. The provision of these accommodations take place on the occasion of mandatory health surveillance medical examination to which the worker affected by cancer is subjected when he returns to work. Results on training and information needs showed that the management of the workers affected by cancer is essentially centered on an appropriate fitness for work judgment and on the correct performance of health surveillance. However, an effective and successful management model should be based on a multidisciplinary and integrated approach that, from the earliest stages of the disease, involves the occupational physicians and employers.

Dataset Information

Challenges in Managing Patients with Hereditary Cancer at Gynecological Services.

Publications

Challenges in Managing Patients with Hereditary Cancer at Gynecological Services.

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