1 / 62

GYNECOLOGICAL TUMORS

GYNECOLOGICAL TUMORS. RATH 4412. EPIDEMIOLOGY AND ETIOLOGY. Incidence rates- 2010 Endometrial (uterine corpus) 43,470 new cases Ovarian 21,880 new cases Cervical 12,200 new cases of invasive cancer Other 2,300 Death rates- 2010 Ovarian, ranks 5 th among cancer deaths for women- 13,850

kavindra-gaurhari
Download Presentation

GYNECOLOGICAL TUMORS

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. GYNECOLOGICAL TUMORS RATH 4412

  2. EPIDEMIOLOGY AND ETIOLOGY • Incidence rates- 2010 • Endometrial (uterine corpus) 43,470 new cases • Ovarian 21,880 new cases • Cervical 12,200 new cases of invasive cancer • Other 2,300 • Death rates- 2010 • Ovarian, ranks 5th among cancer deaths for women- 13,850 • Endometrial- 7,950 • Cervical- 4,210 • Other- 780

  3. Approximately 83,750 new cases per year of gynecological tumors (2010)

  4. Average age of onset • Clear cell vaginal 19 • Cervical cancer 48 • Uterine cancer 58 • Ovarian cancer 60 • Vulvar/vaginal 65+

  5. Cervical Cancer • Cervical cancer is more prevalent among young women • Multiple partners • Early sexual activity • Oral contraceptives • Family- mother, sister • Lower socioeconomic status-won’t seek medical attention • Multiple births- 3 or more • Younger than 17 years for first baby

  6. Multiple pelvic infections • Chlamydia infections • bacteria that can infect the sex organs. • Genital warts • Unprotected sex, HPV passed during sex • Diethylstilbestrol (DES) • Smoking • Smoking- women who smoke are twice as likely to get cervical cancer • Tobacco smoke produces chemicals that may damage DNA in cervical cells • Immunosuppression • HIV • Diet

  7. HPV Virus • Cervical cancer is caused by the HPV virus • Spreads through sex • Cause infection • If infection is not treated can lead to cancer • No treatment for HPV- does not have symptoms, cannot be treated • The cell changes that HPV causes in the cervix can be treated

  8. Endometrial Cancer • Endometrial cancer has increased due to: • Aging population • High calorie/high fat diets • Diabetes • hypertension • Estrogen use 60’s and 70’s • Most patients are 50 years of age and older • Linked to women taking tamoxifen

  9. Vaginal and Vulvar Cancer • Vaginal and vulvar cancers are rare • Occur in older women • Vulvar cancer is 3x more common than vaginal cancer • Vulvar cancer is associated with • Diabetes • STD’s • Poor hygiene • Abnormal changes in the vaginal lining • Loss of hormone stimulation • Use of DES by pregnant mother

  10. Ovarian Cancer • Ovarian cancer • Ages 50-70- develop after menopause • Late or few pregnancies • Late menopause • Lack of oral contraceptive use or the use of fertility drugs longer than 1 year • Family history

  11. Personal history of breast, colon, endometrial cancer • Diet high in fat and red meat • Obesity • Industrialized nation • Estrogen replacement after menopause • BRCA1 or BRCA2 gene mutation

  12. Women with a family history of ovarian cancer: • Lifetime risk increases from 1% to 40% • Must have annual rectovaginal pelvic exam • CA 125 serum determination • Transvaginal ultrasound

  13. Endometrial cancer • Most endometrial cancers are of the glandular cells found in the lining of the uterus • Most endometrial cancers develop over several years • Is the most common gynecological cancer in female reproductive organs

  14. SIGNS AND SYMPTOMS • Unusual bleeding, spotting, or other abnormal discharge • Vaginal bleeding is the most common symptom • Approx 1/3 of post menopausal bleeding is cancer related • Pelvic pain and/or mass and weight loss

  15. EARLY DETECTION • No specific screening tests • Regular pelvic exams • If at high risk for hereditary nonpolyposis colon cancer, a yearly endometrial biopsy should be done beginning at age 35

  16. Detection and diagnosis • Endometrial biopsy • A tissue sample is obtained by using a thin flexible tube and suction • Placed into the uterus through the cervix • Has approximately a 94% sensitivity rate • D and C (dilation and curettage) • Done when the biopsy is inconclusive • Cervix is dilated • Tissue is scraped from inside the uterus • Ultrasound

  17. PATHOLOGY • Adenocarcinoma of the endometrial lining is the most common type • Grade 1- most cancer cells look like normal tissue • Grade 2- in between • Grade 3- more than half of the cells are unlike the normal cells • Progesterone receptors • Positive cells for this receptor are slow growing and spread more slowly

  18. Cystoscopy • CT scan • MRI • Chest x-ray • IVP • CA 125 blood test • CA 125 is a substance released into the bloodstream by many endometrial and ovarian cancers • Very high CA 125 levels suggest that the cancer has probably spread beyond the uterus

  19. STAGING • FIGO system • I-IV, the lower the number, the less the cancer has spread, page 816, Washington • Most endometrial cancers are stage I

  20. Poor prognosis • Higher grade • Increased depth of invasion into the myometrial muscle • Lymph node involvement • Cancer cells in the peritoneal fluid or • Cancer cells on serosal surfaces

  21. SPREAD • Lymphatic spread initially to the internal and external iliac pelvic nodes • If pelvic nodes are involved, there is about a 60% chance that there will be periaortic node involvement

  22. TREATMENT • Surgery and/or • Radiation Therapy • Can be given pre- or post-op • Can be treated with photon or brachytherapy • Doses depend on treatment or combinations of treatment • Radiation therapy alone is usually used for inoperable patients and stages III and IV • Depends on the stage, grade and medical condition of the patient

  23. PROGNOSIS • Depends on the stage and grade • Patients treated with radiation therapy and surgery have an overall survival rate of 81.6% • A five year disease free all stages 88%% • For all stage I, grade I (early stage) patients, 95% 5 year survival rate

  24. Ovarian cancer • Ovarian cancer is the most deadly of all the gynecologic cancers • It has few symptoms until it is widely spread • The number of new cases of ovarian cancer have been going down since 1991 • 3 in 4 women will survive at least 1 year after diagnosis

  25. Almost half of women with ovarian cancer will reach 5 year survival • When younger than 65 years of age, better survival

  26. DETECTION AND DIAGNOSIS • By the time ovarian cancer may be suspected, it may have already spread beyond the ovaries • Seek a doctor if any of these signs are unusual or have symptoms daily for a few weeks • Specific Signs • Bloating • Pelvic/abdominal pain • Trouble eating • Early satiety • Urination frequency/urgency

  27. Pelvic Ultrasound • Abdominopelvic CT scan • MRI • Chest x-ray • Laparoscopy with biopsy • CA 125 • Renal and liver function blood work

  28. PATHOLOGY AND STAGING • The AJCC/TNM system is used • Describes the cancer in terms of extent of the tumor, spread to nearby lymph nodes, and to other organs • 90% are epithelial (surface of ovary) • 7% stromal • 3% ovarian germ cell- includes dysgerminomas which are treated like seminomas • Page 817, Washington

  29. TREATMENT • Surgical evaluation and debulking of the tumor • Postoperative therapy may include: • Single agent or combination chemotherapy and/or • Whole abdominal and pelvic radiation therapy • Radiation therapy might include external beam or • Brachytherapy

  30. PROGNOSIS • 5 year survival rates • Well differentiated stages IA and IB, 90%-100% • Microscopic residual disease, stage II, treated with radiation therapy, 74% • Residual disease less than 2 cm, 58% • Residual disease greater than 2 cm, 39%

  31. CERVICAL CANCER • Cervical cancer is a slowly progressive disease • Noninvasive carcinoma in situ occurs approx 10 years earlier before becoming invasive • Dysplasia • Cervical cancer begins in the lining of the cervix

  32. According to the ACS there will be about 12,2000 new cases of invasive cervical cancer in the US in 2010 • Non-invasive cervical cancer is about 4 times as common as the invasive type • When found and treated early, there is a high cure rate

  33. SIGNS AND SYMPTOMS • Any unusual discharge from the vagina • Blood spots or light bleeding other than a normal period • Bleeding or pain during sex- common

  34. DETECTION AND DIAGNOSIS • Pap test- finds changes in the cells of the cervix caused by HPVs • The death rate declined 74% from 1955-1992 due to pap test • Pelvic exam • HPV cannot be cured or treated, but the cell changes that it causes can be treated • Biopsy of any suspicious lesions

  35. Colposcopy- use a colposcope to look at the cervix. Can destroy or remove pre-cancerous lesions • Cystoscopy- looks at spread to the bladder • Proctoscopy- looks at spread to the rectum • Chest x-ray • CT • MRI

  36. PATHOLOGY AND STAGING • There are two main types of cancer: • Squamous cell carcinoma, 80-90% • Adenocarcinoma, 10-20% • Features of both types, mixed carcinoma • Small cell and clear cell make up a small percentage and have a higher metastatic potential • FIGO Staging, page 785, Washington

  37. TREATMENT • Early stage 0 (carcinoma in situ) and stage Ia1, invasive cancer • Total abdominal hysterectomy with a small amount of vaginal tissue (vaginal cuff) • Stage Ia2 • TAH or an aggressive modified radical hysterectomy • Medically inoperable patient • Tandem and ovoid implant delivering 60-70 Gy

  38. Surgery is often used for younger women • Radiation is usually used for women who have a higher risk for surgical complications • Radiation is used with a combination of external beam therapy and implants • External beam doses increases with advanced disease • Implant doses may stay the same or decrease depending on critical organ doses

  39. Kinds of surgery • Cryosurgery- used for pre-invasive cancer • Laser surgery- used for pre-invasive cancer • Cone biopsy- cone shaped piece of tissue is removed from the cervix • Simple hysterectomy- removal of uterus either through the abdomen or vagina.

  40. Radical hysterectomy and pelvic lymph node dissection- removal of the uterus, tissues next to the uterus, upper part of the vagina, and pelvic lymph nodes • Pelvic exenteration- radical hysterectomy and pelvic node dissection including removal of the bladder, vagina, rectum and part of the colon

  41. Five year survival • Early invasive cancer, 92% • All stages combined, 71%

  42. Cervical Cancer and Pregnancy Very early stage cancer • Safe to continue the pregnancy to term • Several weeks after delivery, a hysterectomy is recommended • Later stage cancer- decide whether or not to continue pregnancy • If pregnancy is continued, the baby should be delivered by cesarean section as soon as it is able to survive outside of the womb • Advanced cancer • Immediate treatment is the safest option • All of these options should be discussed with the patient’s doctor

  43. VULVa cancer • Usually presents with a subcutaneous lump or mass • Advanced disease- exophytic mass • Most common location- labia majora • Patient has had a long history of irritation

  44. PATHOLOGY AND STAGING • Squamous cell carcinoma, 90% • Adenocarcinomas, 10% • Staging- stage I-IVa

  45. TREATMENT • Surgery- radical vulvectomy with a groin node dissection • More conservative approach using wide local excision with external irradiation of the primary and inguinal nodes

  46. Five year survival • Overall five year survival rate, 70% • Disease free with surgery • Stage I 100% • Stage II 86% • Stage III 59% • Stage IV 25% • The five year survival goes down with nodal involvement

  47. SIDE EFFECTS OF GYNECOLOGIC TREATMENT • acute effects • Fatigue bleeding • Diarrhea nausea • Dermatitis • dysuria • Subacute effects • Menopause enteritis • Vaginal dryness obstruction • Chronic cystitis • proctosigmoiditis

  48. A simulation radiograph demonstrating a treatment field used to treat the vulva, pelvic, and inguinofemoral lymph nodes

More Related