Gynecological Surgery

Therapies in Gynecology

Therapies in gynecology are Radiotherapy, Chemotherapy, Immunotherapy and Genetherapy. Pre-treatment evaluation and proper monitoring during therapy are mandatory to prevent or minimize the toxicity. Growth factors or granulocyte colony-stimulating factor are used to prevent hemorrhagic toxicity of chemotherapy. Multiple chemotherapeutic agents have been used to kill cancer cells, they have also been used to sensitize cells to radiation. Chemoradiation improves outcome especially with squamous cell cancers.

Radiotherapy and chemotherapy are the important modalities of therapy for human cancers apart from sugery. Bias towards any particular one is unscientific. They may have a curative role when used as a primary therapy. Multidisciplinary approach is needed for the treatment of some malignancies to improve the outcome. Radiotherapy and chemotherapy should be considered even for palliation of incapacitating symptoms when cure may not be achieved.

Ionizing radiation used for therapy may be 1. Electromagnetic radiation 2. Particulate radiation.

Techniques of Radiation Therapy

Ø  Brachy Therapy

Ø  Particulate Radiation

Ø  After Loading Technique

Ø  External Beam Radiotherapy

Ø  Intensity Modulated Radiation Therapy

Ø  Three-dimensional Conformal Radiation Therapy (3D CRT)

Immunotherapy in Gynecology:

Approaches to augment the immune response to         human tumour include: Active immunotherapy and Passive Immunotherapy. Immunotherapy in malignancy-is being explored recently. Cytokines (Polypeptides) have antitumor and immune stimulating effects. Augmentation of immune system is achieved by active (interferon, IL-2) and passive immunotherapy

Active Immunotherapy (to induce host immune response).

Biological immunostimulants—administration of BCG (Bacille Calmette-Guerin), C parvum (Corynebacterium parvum).

Chemical immunostimulants—Levamisole, cimetidine.

Cytokines, interferons (IFN), interleukine (IL-2), and tumor necrosis factor (TNF)

Chemotherapeutic drugs—cisplantin, doxorubicin

Passive immunotherapy (Immunologically active substances are directly transferred to the host)

Ø  Cytokines: Interferon, TNF.

Ø  LAK cells: Together with IL-2

Ø  Monoclonal antibodies

Ø  Activated macrophages: Interferon

Ø  Immunotherapy has its limitations. Immune response enhancement leading to rejection of tumor can occur when the following conditions are fulfilled:

Ø  Biological response modifiers are indirect contact with tumor’s

Ø  Tumor bulk is minimal

Ø  Blood supply is good

Ø  Monoclonal antibodies to be conjugated with agents (Chemotherapy drugs, toxins, interferon) for precise delivery to tumor cells

Genetherapy: the effect of oncogene function can be transformed by two approaches. One attempt is to remove the oncogene product or to block its function. Alternatively, one can use antisense oligonucleotides in an attempt to block the production of oncogene by preventing the transcription of chromosomal DNA to RNA. Antisense oligonucleotide can be administered systematically. Cytokine gene transfer to tumour cells. Cells are engineered to produce cytokines including interleukines 2, 4, 5 and 6 TNF and others. Clinical trials are in progress in patients with squamous cell carcinoma,  

Familial cancer (breast, ovary, and colon) is explained on the basis of genes (oncogene, tumor suppressor gene and mutator gene). Point mutation, deletion and insertion are the important changes. Gene therapy to the tissues at risk by insertion of normal copies of genes is a way forward.

Tumor Markers: indicate the presence and also the site of tumor. It is useful in screening, diagnosis and management of cases and also for follow up. Gynecological tumor markers in common use are—hCG in trophoblastic tumor, AFP in germ cell tumor, CA-125 in ovarian epithelial tumor and SCC in carcinoma cervix HER-2/ner, an oncogene product is used for epithelial ovarian cancer.

Related conferences:

Cancer Science 2018, Summit on August 09-10, 2018 Madrid, Spain

Cancer Congress 2018, on September 17-18, 2018 San Diego, USA

Cancer 2018, Congress on October 03-04, 2018 Los Angeles, California, USA

World Cancer 2018, Summit on October 11-13, 2018 Zurich, Switzerland

Cancer Therapy-2018, Conference on October 29-30, 2018 San Francisco, California, USA

World Cancer 2018, Summit on July 02-03, 2018 Thailand, Bangkok

Medical Oncology-2018, Conference on May 28-30, 2018 Osaka, Japan

Clinical Oncology-2018, Congress on June 1-2, 2018 Osaka, Japan

Global Cancer 2018, Summit on March 12-14, 2018 Singapore

Epigenetics-2018, Conference on October 22-24, 2018 Turkey