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The IX t h Makassed Medical Congress - American University of Beirut

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T h e I X t h M a k a s e d M e d i c a l C o n g r e s s<br />

developed countries.<br />

Over the past decade, we have witnessed significant advances in screening techniques for<br />

cervical cancer. <strong>The</strong> introduction <strong>of</strong> liquid based cytology has helped overcome the limitations<br />

<strong>of</strong> the conventional PAP smear by optimizing transfer <strong>of</strong> cells to slide, allowing the evaluation <strong>of</strong> a<br />

random and representative sample and minimizing the obscuring material. <strong>The</strong> development <strong>of</strong><br />

hybrid capture technology has allowed easy and universal access to diagnosing HPV infection.<br />

<strong>The</strong> ALTS trial revealed that HPV testing improved the sensitivity for detection <strong>of</strong> high-grade<br />

cervical precancerous lesions in patients with ASCUS Pap. It improved patient management by<br />

directing at-risk patients to colposcopy<br />

<strong>Medical</strong> providers <strong>of</strong> gynecologic care should be well educated as to the correct interpretation<br />

<strong>of</strong> pap smears and HPV tests and should know the appropriate medical management <strong>of</strong><br />

abnormal test results. In fact, early diagnosis and adequate treatment <strong>of</strong> precancerous cervical<br />

lesions are paramount to reduce cervical cancer associated mortality.<br />

References<br />

1. Buys SS, Partridge E, Green MH, et al. Ovarian Cancer screening in the prostate, lung,<br />

colorectal and ovarian (PLCO) cancer screening trial: findings from the initial screen <strong>of</strong> a<br />

randomized trial. Am J Obstet Gynecol 2005; 193:1630-9<br />

2. Menon U, Skate SJ, Lewis S, et al. Prospective study using the risk <strong>of</strong> ovarian cancer algorithm<br />

to screen for ovarian cancer. J Clinic Oncol 2005; 23(31):7919-7926.<br />

3. Update on ovarian cancer screening. Munkarah AR, Chatterjee M, Tainsky MA. Current<br />

opinion Obstet Gynecol 2007; 19:22-26<br />

4. Ho GYF, Bierman R, Beardsley L, Chang CJ, Burk RD. N Engl J Med. 1998; 338:423–428.<br />

5. Ferlay J, et al. Cancer incidence, Mortality and Prevalence Worldwide. IARC 2004.<br />

6. Solomon D, et al. J Natl Cancer Inst. 2001; 93:293-299<br />

7. Yang BH, Bray FI, Parkin DM, Sellors JW, Zhang ZF. Cervical Cancer as a priority for<br />

prevention in different world regions: an evaluation using years <strong>of</strong> life lost. Int J Cancer,<br />

2004; 109(3):418-424<br />

OVARIAN GERM CELL TUMORS<br />

Adnan R Munkarah, MD<br />

Ovarian germ cell tumors represent around 25% <strong>of</strong> all ovarian neoplasms. <strong>The</strong>y usually affect<br />

women in the first three decades <strong>of</strong> life. <strong>The</strong> first step in the management is surgical and involves<br />

removal <strong>of</strong> the affected ovary and staging. Preservation <strong>of</strong> one ovary and the uterus is frequently<br />

possible especially that most patients have localized disease and are young with a desire to<br />

preserve their reproductive function. In most cases, postoperative chemotherapy is necessary.<br />

<strong>The</strong> evolution <strong>of</strong> chemotherapy regimens in these neoplasms has paralleled those applied<br />

in testicular tumors. Currently, the combination <strong>of</strong> bleomycin, etoposide and platinum is the<br />

standard regimen achieving excellent cure rates. Fortunately, over 80% <strong>of</strong> patients regain their<br />

menstrual function after therapy. In addition case series have reported successful pregnancies<br />

following treatment. In patients with recurrent disease, cure is still a possibility. While combination<br />

98

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