ch 16. Gynocological Cancers

Posted: May 19, 2012 in Gynocology

Gynecologic cancer is a group of cancers that affect the tissue and organs of the female reproductive system. Each type of cancer is named after the organ it originates.

Types of gynecologic cancer include:

  1. Cervical
  2. Endometrial
  3. Fallopian Tube
  4. Gestational Trophoblastic Disease
  5. Ovarian
  6. Vulvar
  7. Vaginal

Cervical Cancer :

Cervical cancer is cancer that starts in the cervix, the lower part of the uterus (womb) that opens at the top of the vagina. It’s 12% of  all gynecologic cancers.

  •  Mean age is 47.
  •  20% of cases in women >65yrs
  •  10% of cases in women >75yrs

Types :

  1.       Squamous Cell      85-90%
  2.       Adenocarcinoma   10-15%
  3.       Numerous others   <5%

Etiology :

The primary risk factor for developing cervical cancer is the human papillomavirus (HPV). HPV is a common sexually transmitted infection that is spread through sexual, skin-to-skin contact. The virus can cause changes in cervical cells that could develop into cervical cancer if left undetected, unmonitored, or untreated.

Cervical human papillomavirus (HPV) : HPVs establish productive infections only in keratinocytes of the skin or mucous membranes. While the majority of the known types of HPV cause no symptoms in most people, some types can cause warts (verrucae), while others can – in a minority of cases – lead to cancers of the cervix, vulva, vagina, penis, oropharynx and anus.

  • 80% of sexually active women will acquire HPV.
  • 70% of infections are gone in 1 year and ninety percent in 2 years.
  • However, when the infection persists — in 5% to 10% of infected women — there is high risk of developing precancerous lesions of the cervix, which can progress to invasive cervical cancer.

    HPV With HIV(+) Female Patient.

Human Papillovirus

Cervical Cancer Stages

Endometrial Cancer :

Syn : Endometrial adenocarcinoma; Uterine adenocarcinoma; Uterine cancer; Adenocarcinoma – endometrium; Adenocarcinoma – uterus; Cancer – uterine; Cancer – endometrial; Uterine corpus cancer .

Most common Gynocological Cancer.Endometrial cancer is cancer that starts in the endometrium, the lining of the uterus (womb).Mean age is 61 yrs.

Types :

Endometrial Carcinoma : Most endometrial cancers are carcinomas (usually adenocarcinomas), meaning that they originate from the single layer of epithelial cells that line the endometrium and form the endometrial glands.There are many microscopic subtypes of endometrial carcinoma.

  1. Endometrioid type (most common)
  2. Papillary serous carcinoma (more aggressive)
  3. Clear cell endometrial carcinomas (aggressive and high recurence rate

Endometrial Sarcoma : In contrast to endometrial carcinomas, the uncommon endometrial stromal sarcomas are cancers that originate in the non-glandular connective tissue of the endometrium. Uterine carcinosarcoma, formerly called Malignant mixed müllerian tumor, is a rare uterine cancer that contains cancerous cells of both glandular and sarcomatous appearance – in this case, the cell of origin is unknown.

Fallopian tube cancer :

Primary fallopian tube cancer (PFTC), often just tubal cancer, is a malignant neoplasm that originates from the fallopian tube.ubal cancer is thought to be a relatively rare primary cancer among women accounting for 1 – 2% of all Gynocological Cancers.

Diagnosis : A pelvic examination may detect an adnexal mass. A CA-125 blood test is a nonspecific test that tends to be elevated in patients with tubal cancer. More specific tests are a gynecologic ultrasound examination, a CT scan, or an MRI of the pelvis. Occasionally, an early fallopian tube cancer may be detected serendipitously during pelvic surgery.

Gestational trophoblastic disease (GTD) :

Gestational trophoblastic disease (GTD) is a term used for a group of pregnancy-related tumours.The cells that form gestational trophoblastic tumours are called trophoblasts and come from tissue that grows to form the placenta during pregnancy.

Features :

  1. This tissue may grow at the same rate as a normal pregnancy.
  2. Can produces chorionic gonadotropin, a hormone which is measured to monitor fetal well-being.
  3. Common in child-bearing age, it may rarely occur in postmenopausal women.

The main types of gestational trophoblastic diseases are:

  • Hydatidiform mole ( Benign)
  • Invasive mole (Malignant)
  • Choriocarcinoma (Malignant)
  • Placental-site trophoblastic tumor (Malignant)

Hadatidiform Mole : Hydatidiform mole is an overgrowth of placental tissue or an abnormal growth that develops from a non-viable, fertilized egg at the beginning of a pregnancy. It often is referred to as a molar pregnancy. Instead of the normal embryonic cell division that results in the development of a fetus, the placental material grows uncontrolled and develops into a shapeless mass of watery, small, blister-like sacs (vesicles). The cause of hydatidiform mole is unknown, but is thought to be caused in part by chromosomal abnormalities .

Invasive mole : An invasive mole (formerly known as chorioadenoma destruens) is a hydatidiform mole that has grown into the muscle layer of the uterus. Invasive moles can develop from either complete or partial moles, but complete moles become invasive much more often than do partial moles.

Choriocarcinoma : Choriocarcinoma is a malignant form of GTD. It is much more likely than other types of GTD to grow quickly and spread to organs away from the uterus.Choriocarcinoma most often develops from a complete hydatidiform mole.


Placental-site trophoblastic tumor :

Placental-site trophoblastic tumor (PSTT) is a very rare form of GTD that develops where the placenta attaches to the lining of the uterus. This tumor most often develops after a normal pregnancy or abortion, but it may also develop after a complete or partial mole is removed.

Ovarian Cancer :

Ovarian cancer

Ovarian cancer is cancer that starts in the ovaries. The ovaries are the female reproductive organs that produce eggs.Ovarian cancer affects females of any ages.Cancer should be suspected in any woman between 40 and 80 with persistent gastrointestinal symptoms cannot be diagnosed.Diagnosis is difficult.  70% of diagnoses are stage III or IV.

Types :

  1.       Epithelial—About 85-90% (>50 yrs)
  2.       Germ cell—10-15%  (<20yrs)
  3.       Gonadal stroma—5-10%
  4.       Mesenchymal

Symptoms :

Ovarian cancer symptoms are often vague.

Woman should see herr doctor if she has the following symptoms on a daily basis for more than a few weeks:

  1. Bloating or swollen belly area
  2. Difficulty eating or feeling full quickly
  3. Pelvic or lower abdominal pain; the area may feel “heavy” to you (pelvic heaviness)

Other symptoms are also seen with ovarian cancer. However, these symptoms are also common in women who do not have cancer:

  1. Abnormal menstrual cycles
  2. Digestive symptoms:
  3. Constipation
  4. Increased gas
  5. Indigestion
  6. Lack of appetite
  7. Nausea and vomiting
  8. Unexplained back pain that worsens over time
  9. Vaginal bleeding that occurs in between periods
  10. Weight gain or loss
  11. Other symptoms that can occur with this disease:
  12. Excessive hair growth that is coarse and dark
  13. Sudden urge to urinate
  14. Needing to urinate more often than usual

Vaginal cancer :

Vaginal cancer is any type of cancer that forms in the tissues of the vagina. Primary vaginal cancer is rare in the general population of women and is usually a squamous carcinoma. Metastases are more common.

Feature :

  1. Common at +50 Years
  2. Can affects at any age ,even in Infancy.
  3. 5 – 10% of patients have no symptoms.

Types :

  1. Squamous cell carcinoma (Vaginal squamous cell carcinoma arises from the thin, flat squamous cells that line the vagina. This is the most common type of vaginal cancer. It is found most often in women aged 60 or older.)

Adenocarcinoma (aginal adenocarcinoma arises from the glandular (secretory) cells in the lining of the vagina that produce some vaginal fluids. Adenocarcinoma is more likely than squamous cell cancer to spread to the lungs and lymph nodes. It is found most often in women aged 30 or younger.)

Vaginal Cancer

Vulvar cancer :

Vulvar cancer is a rare type of cancer. It forms in a woman’s external genitals, called the vulva. The cancer usually develops slowly over several years. First, precancerous cells grow on vulvar skin. This is called vulvar intraepithelial neoplasia (VIN), or dysplasia. Not all VIN cases turn into cancer, but it is best to treat it early.

Often, vulvar cancer doesn’t cause early symptoms. However, see your doctor for testing if you notice

  • A lump in the vulva
  • Vulvar itching or tenderness
  • Bleeding that is not your period

Being older and having a human papillomavirus infection are risk factors for vulvar cancer. Treatment varies, depending on your overall health and how advanced the cancer is. It might include laser therapy, surgery, radiation or chemotherapy.

Types :

  1. Squamous cell carcinoma.
  2. Melanoma
  3. Basal cell carcinoma
  4.  Adenocarcinoma
  5.  Sarcoma.

Patient with vulvar cancer after 4 weeks ( A) and 6 weeks ( B) of chemoradiation.

  1. August Sandrock says:

    Bloating is also dependent on the foods that you consume. Always avoid foods that causes bloating like fatty foods. ;’`*:

    Hope This Helps!“>

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