Disseminated tumor cells in gynecological cancers prognostic and clinical significance-Essay

The title of my Dissertation is:
Disseminated tumor cells in gynecological cancers prognostic and clinical significance

(is already published in 2006, Gynecologic Oncology 103 (2006) 942?947 I will send the Pdf by email)

My professor mention that:
Results
Is too short!!!
You have to tremendously expand your results.
Please describe for each entity the clinical faction, the individual correlations and survival aims.
Then combine all these tumor entities and analyze it by FIGO, Nodal Status.

Discussion
Please describe and discuss the results for the individual tumor cases (ovarian, cervical and endometrial), then discuss it for the whole group.
You have to expand your discussion up to 10-15 pages.

Results
Bone marrow aspirates were obtained from 201 patients with diagnosed of primary gynecological cancers (cervical, ovarian and endometrial cancer) none of whom had a history of cancer or secondary malignancy. Of these patients, 69 (34.3 percent) had ovarian cancer, 54 (26.8%) had cervical cancer and 78 (38.8%) had endometrial cancer. Clinical data are summarized in Table 7. Table 8 shows the positivity rates subdivided by cancer diagnosis.
Of 201 patients, 52 (25.8%) had cytokeratin positive cells detected in the bone marrow at the time of surgery for gynecological cancers (Table 7). The remaining 148 patients did not have evidence of cytokeratin staining on bone marrow analysis. All patients staged using FIGO method (Table 7). 53% of these patients were at FIGO I stage, 13% at FIGO II and 34% at FIGO stage III/IV.
The overall incidence rate of disseminated tumor cells in patients with gynecological cancer was 26% (ovarian cancer 36%, endometrial cancer 17% and for cervical cancer 26%) (Table 7). Disseminated tumor cells were identified by cytokeratin positivity and cytomorphology. The number of CK (cytokeratin) positive cells ranged from 1 to 20 per 2 x 106 mononuclear cells. Including all cancer types, a significant correlation could be seen between bone marrow positivity and FIGO stage (Table 7). Only 19% of patients at FIGO I stage were bone marrow positive compared to 36% and 35% at FIGO II and III?IV stage, respectively (p<0.01) (Table 8). It should be pointed out that no significant differences were found between bone marrow positivity and other clinico-pathological factors such as FIGO tumor stage, lymph node status, grading, lymphangiosis carcinomatosa or vascular invasion except for cervical cancer. There were 18 disease recurrences of 199 patients during follow-up and 12 of these patients had local recurrence. Recurrence rates were 17% in ovarian cancer, 4% in endometrial cancer and 4% in cervical cancer (Table 9). The highest incidence of disseminated tumor cells was seen in patients with ovarian cancer with 36% followed by 26% in cervical cancer and 17% in endometrial cancer. Cervical cancer patients with positive lymph nodes were more likely to be bone marrow positive compared to those with negative lymph node status (p<0.01). (Table 8) Detection of tumor cell dissemination did not significantly correlate with higher recurrence rates (p=0.2) (Table 9) neither with shortened disease-survival (p=0.03). The recurrence rate was 14% in patients with CK-positive cells compared to 8% in CK-negative patients.

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