Elasticidad de la demanda

Figure 1.11 M icroscopic im age higliligliting prim ary peritoneal serous carcinom a (H& E x 20).

PPC is believed to develop de novo from the peritoneal lining o f the pelvis and abdom en, (Schorge et al., 2000b) although sim ilar to epithelial ovarian cancer (EO C) the distal fallopian tube has emerged as a potential origin for this malignancy. PPC m ay develop in w om en years after having a bilateral oophorectom y. (Piver et al., 1993) PPC exhibits a distinct pattern o f allelic loss com pared to EOC. (Bandera et al., 1998; Cass et al., 2001; Huang et al., 2000) O verexpression o f p53, EGFR, ERBB2, ERBB3, and ERBB4 genes has been reported in addition to loss o f normal WT-1 expression. (Schorge et al., 2000a; Schorge et al., 2000b) p53 m utations com m only occur in PPC, but KRAS m utations are infrequent. (Schorge et al., 2000b) G erm line BRCA-1 m utations occur in PPC with a frequency com parable to the BRCA-1 mutation rate in ovarian cancer. The staging, treatm ent and prognosis are sim ilar to those o f epithelial ovarian cancer.

1.5.5 Serous adenocarcinom a o f the endom etrium

This is a prim ary adeno ca rcin o m a o f the endom etrium characterized b y a com plex pattern o f papillae with cellular b u d d in g and not infrequently containing p s a m m o m a bodies. T h e re is no know n associated with exogenous or endogenous hyperestrogenism , and it is not associated with endom etrial hyperplasia unlike endom etrioid adenocarcinom a.

Serous a d e n ocarcinom a is characterized by a papillary architecture with broad fibrovascular cores, secondary or even tertiary papillary processes and prom inent sloughing o f cells (Figure 1.12) There m a y be solid nests, foci o f necrosis and a complex branching architecture. N uclei are typically rounded, apically located and have macronucleoli. M itoses, often atypical , are co m m o n . This tu m o u r is considered high grade by definition. Serous endom etrial intraepithelial carcinom a is believed to be a precursor lesion to the invasive tum our and typically arise in a b a c kground o f atrophic e ndom etrium . Deep m yom etrial and lymphatic invasion is c o m m o n as is extrauterine spread, and as such recurrence is c o m m o n and the overall prognosis is poor.

Chapter 1 General Introduction

Figure 1.12 Serous carcinom a of the endom etrium A, C ro ss image with white friable tu m o u r exhibiting papillary excrescences. B, Microscopic image exhibiting the typical papillary p a tte r n (H & E xlO; Rosai).

1.6 E pidem iology o f urogenital tract m alignancy

Renal cell carcinom a is alm ost exclusively a disease o f adults. Its incidence increases up until the 6’’’ decade. A pproxim ately 28000 new cases are diagnosed yearly in the US alone. (M otzer et al., 1996) K idney and renal pelvis cancer accounted for 1.4% o f all cancers in Ireland betw een the years 1995-2004 (Figure 1.13). (w w w .ncri.ie) 3743 cases were diagnosed during this tine period. The cum ulative risk varied from 0.5% for females to 1.0% for males. Up to 25% o f patients have m etastastes at presentation and as such the overall 5 year survival is about 45% .

B ladder cancer tends to be m ore com m en in men than in women with a ratio o f 3:1. A bout 80% o f patients are aged between 50 and 80 years. More than 50 000 cases o f bladder cancer are detected annually with the death toll approxim ately 10 000 annually. (Landis et al., 1998) B ladder cancer accounted for 2.1% o f all cancers in Ireland between the years 1995-2004 (Figure 1.13). (w w w .ncri.ie) 5596 cases w ere diagnosed during this time period. The cum ulative risk varied from 0.5% for fem ales to 1.5% for males. Prognosis is grade and stage dependant with 98% 10-year survival with grade I lesions and 40% 10-year survival with grade III or higher lesions.

C hapter 1 G eneral Introduction

1

5ra

European Age Standardised Rates for 19S4 - 2005 (ctxnbined)

1

1

---

1

2C)00 >00 1C

1--- 1---

1

Figure 1.13 E uropean A ge-standardised Rate for kidney, renal pelvis and bladder cancer in Ireland (1994-2005). (w w w .ncri.ie)

Endom etrial carcinom a is the most com m on invasive cancer o f the female genital tract and

accounts for 7% o f all invasive cancers in women. 34 000 cases are diagnosed annually in the

US. It tends to be exclusively a disease o f post/peri-m enopausal w om en and is uncom m on in

w om en under 40 years o f age. (Brinton et al., 1992) Corpus uteri cancer accounted for 1.1% o f

all cancers in Ireland from the years 1994-2005 (Figure 1.14). (w w w .ncri.ie) 2915 cases w ere

diagnosed during this period. The cum ulative risk was 1.2% for females. The overall prognosis is

stage dependant with 90% survival with stage I disease with less than 20% survival rates in stage

III or more.

1 _---1---1---

2 0 X 15 00 1000 5 00 000 5 00 1000 150 0 20 00 F enale □ Male Eurapean Age Standardised Rates for 19S4 - 2005 (combined)

Figure 1.14 E uropean A ge-standardised Rate for corpus uteri cancer in Ireland (1994- 2005). (w w w .ncri.ie)

Ovarian cancer is one o f the most com m on cancers in w omen and the leading cause o f death from gynaecological m alignancy in the w estern world. (W J, 1998) Cancer o f the ovary represents about 30% o f all cancers o f the female genital organs. A bout 205000 cases o f ovarian cancer are diagnosed w orldw ide each year. (Ferlay J, 2001) It accounts for 3% o f female cancers in Ireland with approxim ately 350 new cases diagnosed each year (Figure 1.15) (w w w .ncri.ie) O varian cancer often presents at an advanced stage and at an advanced age, and despite im provem ents in drug therapy, overall survival is poor. (Christine and Holscheider, 2000) In the US, m ore w om en die from ovarian cancer than from all other gynaecological m alignancies com bined. (G reenlee RT, 2001)

20,00

0 00 500 1000 1500

Ireland

I Female

European Age Standardised Rates for 1994 - 2005 (combined)