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Gynaecological cancers

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Gynecological cancers are many but incidence varies.

Vulval cancer :
accounts for about 4 % of gynecological cancers. Mostly seen in the aged women. Premalignant conditions like vulval intraepithelial neoplasia (VIN),and human papiloma virus are well noted. Other conditions like lichen sclerosis of vulva and leukoplakia also have some potential to turn malignant. Many types of cancer can happen but squamous cell cancer is most common. Any abnormal lesion on vulva of an aged lady should not be ignored and opinion of a gynecologist to be taken. Treatment involves surgery like radical vulvectomy and chemo-radiotherapy depends on the grade & stage of cancer.

Vaginal cancer :
this is rare & mostly found in aged women. Premalignant condition e.g VAIN are noted & human papiloma virus is thought as a causative agent.

Cervical cancers
Worldwide, cervical cancer is considered to be the second commonest cancer as far as mortality and incidence is concerned. Cervical cancer kills more women in India than anywhere in the world. Moreover, it kills the women at their prime as it is a cancer of the women at reproductive age.
Some important signs ( irregular P/V bleeding, bleeding after sex, vaginal white discharge) of this lethal gynecological cancer are often ignored by the women. This is the reason so many women get killed by this disease where if detected truly early it can be cured and even fertility can be preserved. To detect it early regular screening ( once in three years) is a very important. By the screening, we can detect it either before it become invasive cancer or in very early stage. At these early stage it is possible to do fertility preserving surgery and cut down in mortality.
Now we know that there are some virus (some strains of HPV) which play important role in cervical cancer development. These viruses can be transmitted either by sexual contact or other ways of transmission. All the girls should be aware of this fact and may be given vaccine which can prevent infection of some common strains of HPV. All of you should be the part of this awareness so that we do not lose many women at their prime age due to cervical cancer. Radiotherapy is the main way of treatment if detected later than stage1. Surgery should be done only in Stage 1 or stage 2A. A good gynecologist along with a oncologist will guide you if needed.


Endometrial cancer:
Endometrial cancer is the cancer of the linning of the womb. This mostly happens to the women at perimenopausal or menopausal age group. Risk factors include early menarche, late menopause, obesity, infertility, estrogen excess, hyperplasia of endometrium etc. Unfortunately there is NO screening method for early detection of this type of cancer.That is why any symptoms like heavy irregular bleeding after forty, bleeding after menopause, abnormal white discharge after menopause should be reported as early as possible to a gynecologist and to be investigated to rule out this cancer. If detected early, Hysterectomy with BSO will save you without the need of chemotherapy or radiotherapy.
Tubal cancer: This is a rare cancer and although similar to endometrial cancer behaves more virulently.
Ovarian cancer: Many types of cancers can happen in ovaries as different types of cells including stem cells are within the ovaries. Ovarian cancers are mostly seen at two periods of life. One is before a girl start menstruation and another is when menstruation is coming to an end.
No method of screening is considered ideal for this type of cancer. And most ovarian cancer first appear as a cyst in the ovary. RMI is scoring system for risk assessment. Clinical judgments from a good gynecologist is important.


Ovarian carcinoma
•Arise from ovarian or coelomic epithelium
•75% are serous and 20% are mucinous
•Risk factors include: ◦Advancing age
◦Nulliparity
◦Family history (BRCA1 and BRCA2)
◦Possibly fertility drugs

Clinical features •Clinical features are non-specific
•Early features include urinary frequency, abdominal discomfort
•Later features include distension, early satiety and anorexia
•Abdominal mass and ascites are late features

Staging
•Ovarian carcinoma spreads by three routes ◦Trans-coelomic
◦Lymphatic
◦Haematogenous
•The staging of the disease is surgical
•20-40% of patients are upstaged after surgical intervention

FIGO staging of ovarian cancer
•Stage 1 - Tumour limited to ovaries
•Stage 2 - Involvement of one or both ovaries with pelvic extension
•Stage 3 - Involvement of one or both ovaries with extension beyond the pelvis
•Stage 4 - Involvement of one or both ovaries with distant metastases
Treatment involves surgical optimal clearance with chemotherapy.

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