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By J. Richard Smith, Giuseppe Del Priore, Robert L. Coleman, John M. Monaghan, John Curtin

(Martin Dunitz) manhattan Univ., long island urban. Atlas for postgraduates fascinated about the surgical administration of gynecological malignancy. contains a complete description of nearly all of investigative and surgeries required of the gynecological oncologist. provides transparent written and pictorial guideline. contains colour hand-drawn illustrations and pictures.

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Isolated recurrences in the vagina do not cause elevation, while distant metastasis normally does. Among the general tumour markers for gynaecological malignancy, CYFRA 21–1 was found to be elevated in 52% of endometrial malignancies (Inaba et al 1995) and urinary β-core or UGF levels were elevated in 38–48% of samples from women with endometrial carcinoma (Kinugasa et al 1995, Cole et al 1996). Cervical cancers Screening for cervical cancer uses exfoliative cytology and currently there are no serological markers being explored in this context.

As a marker, CYFRA 21–1 had an accuracy of 61% in diagnosing ovarian malignancy, which was higher than that of CA125 (53%). The positive predictive value (PPV) of CYFRA 21–1 for ovarian cancer of 94% was significantly higher than the PPV of 69% achieved with CA125. The potential usefulness of CYFRA 21–1 as a tumour marker for ovarian malignancy needs to be explored further before any firm conclusions can be drawn. Tumour-associated trypsin inhibitor In ovarian cancer patients elevated levels of a 6 kDa polypeptide, the tumour-associated trypsin inhibitor (TATI), have been detected in both urine and serum.

There is growing evidence that pro-αC is the most commonly elevated of the inhibin-related peptides (Lambert-Messerlian et al 1997, Burger et al 1998) and combining pro-αC with CA125 may increase the sensitivity for detection of epithelial ovarian cancer (Seifer and Schneyer 1997, Lambert-Messerlian et al 1997). Activin is a dimer of the two β-subunits of inhibin and exists as activin A (βAβA), activin B (βBβB) and activin AB (βAβB). Serum activin A has been found to be significantly elevated in epithelial ovarian cancers (Welt et al 1997, Petraglia et al 1998) with the highest levels detected in undifferentiated tumours.

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