The IX t h Makassed Medical Congress - American University of Beirut
The IX t h Makassed Medical Congress - American University of Beirut
The IX t h Makassed Medical Congress - American University of Beirut
Create successful ePaper yourself
Turn your PDF publications into a flip-book with our unique Google optimized e-Paper software.
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