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In 23 (about 43%) patients cytologically screended within 4 years before the diagnosis invasive cervical cancer 11 had a benign smear; when reviewed, two were borderline cases and three were misinterpreted. Twelve patients had different degrees of squamous cell dysplasia. In three of these the cancer was detected during the follow up procedures. Four did not respond to calls for follow up. Five were checked without any active measure but sampling new smears. Atypical smears must be clinically evaluated and treated in order to detect invasive carcinomas. The therapeutic results, however, may be controlled by repeat smears.

A total of 555 cases of malignant epithelial ovarian tumour diagnosed in vivo was reported to the Regional Tumour Registry for Southern Sweden, Lund during 1974-1978. Of these 428 (77%) were referred to the Department of Oncology, Lund, which serves the Southern Swedish Health Care Region. Patients not being referred were mostly elderly with advanced tumours. The selection of patients will thus affect the evaluation of the treatment results. The standard surgical procedure was bilateral salpingo-oophorectomy with or without hysterectomy, and infracolic omentectomy. 95% of the patients were treated according to a randomized trial including postoperative chemotherapy, radiotherapy or a combination of both. Preoperative radiotherapy in primarily inoperable patients increased the operability. 34% of all stage IIb, IIc, III, and IV-patients were thus operated or reoperated with only small residual tumour or none at all following surgery. Stage, grade and size of postoperative residual tumour were the most important prognostic factors. The five-year cumulative survival rate for all patients referred to the Department of Oncology was 32%.

Twenty-five patients with malignant vulvar melanoma have been treated with radical vulvectomy using the warm knife-open wound technique. Following preoperative radiation therapy, dissection of the groin and, in some cases, pelvic lymphadenectomy, were performed as a second procedure. Crude five-year survival was 9/21 (approximately 43%). Patients with tumours of Clark level II--IV have been found to have a good prognosis (7/9), while those with Clark V-tumours have had an extremely poor prognosis (2/10). Prophylactic dissection of the inguinal nodes has not been found to improve the prognosis, and pelvic lymphadenectomy is considered to be inadvisable.

A prospective randomized trial for comparing the effects of chemotherapy and radiotherapy on survival in malignant epithelial ovarian tumours was carried out during the years 1975-1978 in 142 (90%) of a total material of 157 patients in Stage I and Stage II of this disease. Stratification was done according to the state of the tumour capsule and the type of histology found in Stages Ia and Ib. Two types of randomized treatment were given: A. Patients with no extracystic excrescences and intact tumour capsule with mucinous tumours in Stages Ia and Ib were given Melphalan or were not treated, while those with non mucinous tumours were given Melphalan or radiotherapy; B. All of the other patients with tumours in Stage I and Stage II were treated with radiotherapy alone, or were irradiated in combination with Melphalan treatment. Both of these treatment groups had about the same rates of 2- and 5-year survival. It was seen that the histological grade and the amount of residual tumour left at surgery are important prognostic factors. Postoperative treatment does not seem to improve cases of well differentiated, early mucinous tumours in Stage Ia. Acceptable results were obtained, however, irrespective of histological type, in early Stage I, moderately differentiated tumours treated with Melphalan or radiation therapy, and in well- or moderately differentiated tumours in Stage I or Stage IIa using irradiation alone or in combination with chemotherapy. Stages IIb and IIc, and all poorly differentiated tumours in Stages I and II, require more aggressive treatment.

The early diagnosis of ovarian carcinoma is as difficult and rare as ever before. Despite the appearance of sophisticated drugs and combinations of these with surgery and radiotherapy the prognosis still remains the same as during the last 30 years, i.e. overall survival between 20 to 30%. This study concerns the impact of prophylactic oophorectomy in Sweden. 4.6% of ovarian carcinoma patients had received pelvic surgery at some time prior to the diagnosis of ovarian cancer and after the age of 40. With the help of statistical data it is estimated that about one hundred out of the approximately thousand women per year who now develop ovarian cancer in Sweden could be saved if prophylactic oophorectomy were practised in our country. Various aspects of prophylactic oophorectomy and its effects are discussed. It is our opinion that every gynaecologist/surgeon should seriously take into consideration and discuss the possibility of prophylactic oophorectomy in the perimenopausal patient before operation. Not to perform prophylactic oophorectomy during pelvic surgery after the menopause seems to us to be an unreasonable practice.

In a material of 777 patients with carcinoma of the uterine body, Stages I and II, 115 (15%) had poorly differentiated tumours, and 662 (85%) moderately-to-well differentiated tumours. The five-year tumour death rate was 34% and 12%, respectively. No differences in local recurrences and metastases in the pelvis were recorded in the two tumour groups. On the other hand, distant metastases occurred in 23% of patients with poorly differentiated tumours, and only in 5% among patients with moderately-to-well differentiated tumours. Whether chemotherapy integrated in the treatment-scheme would reduce the frequency of distant metastases and improve the survival rate remains an open question.

Six hundred and forty-four patients with primary malignant tumours of the female genital tract were subject to a two-stage screening program on admission, with clinical examination in all and mammography in 380. Clinical examination alone revealed 4 cancers, while supplementary mammography screening of 369 patients with normal clinical examination revealed an additional 6 tumours, of which 5 were invasive. The prevalence rate was about three times that found in two mass-screening programs in different parts of Sweden. Thus, it could be concluded that there is an increased risk for mammary carcinoma in patients with gynaecologic malignancies. It seems reasonable therefore, to recommend mammography routinely in this group of patients.