01 Aug Gynecologic Oncology (cancer of female reproductive organs)

• Ovarian cancer
  • Primary: Epithelial ovarian cancer.
  • Secondary: Metastatic from another body organ.
  • Might arise from the fallopian tubes.
  • Risk factors:
    • Advanced age.
    • One of several gene mutations. BRCA1 or BRCA2 gene.
    • Estrogen replacement therapy.
    • Compromised immune system.
  • Signs and Symptoms:
    • Abdominal distension.
    • Vaginal bleeding.
    • Shortness of breath.
    • Weight loss.
  • Management:
    • Laparoscopy, possible laparotomy for staging.
    • Peritoneal fluid cytology.
    • Surgical debulking or possibly a surgical excision of the ovarian mass. Several debulking surgeries for metastatic disease.
    • Chemotherapy for women with more than stage I disease. Multiple chemotherapy options.
  • Uterine cancer is
    • Endometrial (inner lining of the uterus).
    • Uterine sarcoma (smooth muscle of the uterus) is rare.
    • Risk factors:
      • Unopposed estrogen therapy: stimulate the estrogen receptors in the endometrium, causing hyperplasia of the endometrium.
      • PCOS and chronic anovulation.
      • Early menarche and/or late menopause.
      • Rarely gene mutations: FGFR2 gene.
    • Signs and Symptoms:
      • Vaginal bleeding mostly postmenopausal.
      • Bleeding between menstrual periods.
      • Mass effect in uterine sarcoma with an enlarged uterus imposing on the bladder and rectum, leading to constipation and urinary tract symptoms.
    • Management:
      • Diagnostic D&C.
      • Surgery: total hysterectomy.
      • Hormonal therapy to block the estrogen receptor.
      • Radiation therapy.
    • Cervical cancer: common
      • Risk Factors
        • Human papillomavirus.
        • Compromised immune system.
        • Birth control pills
        • IUD for a long period of time.
        • Frequent yeast infections.
      • Signs and Symptoms:
        • Spotting at intercourse.
        • vaginal pain.
        • Abnormal vaginal bleeding.
        • Urinary tract pain.

Foully smelling discharge from the vagina.

• Abnormal Pap test.

• Management:
• Vaginal cancer: rare. Two types: of vaginal cancer
  • Squamous cell cancer: Originates in the squamous cells that line the vagina.
  • Adenocarcinoma: arises in the cells that make the mucus and other fluids in the normal vagina. Rare.
  • Risk factors:
    • Advanced age.
    • In Utero exposure to DES in utero.
    • Infection with human papillomavirus.
  • Signs and symptoms:
    • Vaginal bleeding between periods.
    • Excessive amount of vaginal discharge.
    • Pelvic pain.
    • Palpable lump in the vagina.
    • dysuria, and constipation.
  • Management:
    • Biopsy
    • Radiation
    • Surgery
  • Vulvar cancer: is a cancer of the external lips of the vagina.
    • As in skin cancers.
    • Other specific Vulvar cancer: prevalent among women with an HPV infection of the vulva.
    • Risk factors:
      • Older than 50 years of age.
      • HPV infection.
      • Compromised immune system.
      • Lichen sclerosus.
    • Risk factors:
      • Lump in the vulva.
      • Having a part of the skin being unusually textured.
      • Vulvar burning pain or itching.
      • Dysuria in severe cases
    • Management: