Gynecology - Cancer Intro

Gynecology

[INTRO TO CANCER ]

In reading this first section some elements may seem out of place or confusing. We’re going to use the concep ts discussed here over and over again in each subsequent section regarding cancer. Each will have an etiology/risk that creates a precancer, and, if left untreated, will eventually become a fully invasive cancer. In women’s health certain diseases are more prevalent in different age groups, which are divided into three categories: premenstrual, reproductive, and postmenopausal. Having these conceptual understandings will help you move through each of the individual cancer sections. Cancer rates are often a subject of board examination. Having an idea of what’s going on is also useful for discussion with patients. Let’s hit the highlights. The most common cancers for women are also the most common cancers for men: Sex (Breast/Prostate), Lung, and Colon.  However, they do kill in a different order: Lung, Sex, Colon. For gynecologic cancers ovarian cancer kills (though it is very rare) while endometrial is the most common. Historically, cervical cancer has been the most common. But now that we’re armed with the HPV vaccine and pap smears the incidence of cervical cancer is very low. We usually catch it in a  precancerous phase so it “doesn’t count” as cervical can cer. It’s necessary to be able to identify the pathogenesis for every cancer. All gynecologic cancers have an etiology with subsequent risk factors. As a patient’s risk factors increase so should the index of suspicion. The goal is to catch cancer before it’s invaded - as  precancer. For most gynecologic cancers (excluding cervical cancer) there are no screens that catch cancer this early. Once it’s precancer it takes about 3-7 years to penetrate and become an invasive cancer. This is particularly important for reproductive aged females - especially those who wish to  become pregnant. Finally, it’s useful to think of everyone as being in one of three age groups. Premenstrual girls have not been exposed to teratogens except the toxins in mom. Reproductive aged women can have sex and be exposed to viruses. Postmenopausal women have had a lifetime of exposure to estrogen, lose the protective  progesterone of ovulation, and have been exposed to whatever else they’ve has put into their body or come in contact with throughout their lives.

Cancer Cervical Vaginal Vagina Ovarian

Etiology HPV HPV HPV Ovulation

Precancer Dysplasia and Carcinoma In Situ Borderline

Endometrium Chorio

Estrogen Pregnancy

Hyperplasia Moles

Ovarian Cancer Fallopian Endometrial Cancer Cervical Cancers Vaginal Cancers Vulvar Cancer

 Mortality GYN Ovarian Endometrial Cervical

 Incidence GYN Endometrial Cervical Ovarian

 Incidence Women Breast Lung Colon

 Mortality Women Lung Breast Colon

Colonoscopy at 50 then q10years Mammograms at 40 (or 50) then q1year PapSmears at 21 then q3years

ETIOLOGY Toxic Exposure Hormones Viruses

PRECANCER Dysplasia Carcinoma In Situ

CANCER  Invasion of BM Sarcoma, Adeno

Identify and Modify Risk Factors

Local Resection is curative

Debulking and Chemo

Screen if Able

Premenstrual

Reproductive

Ø Ovulation 11 Ø Estrogen Maternal Toxin

Ovulation Estrogen Sex and Virus

Cancer Invasive Sqaumous cell Carcinoma Substrate Specific Adenocarcinoma Choriocarcinoma

Diagnose and Stage

Postmenopausal

51 Ø Ovulation Lifetime of Estrogen and toxins

Symptoms Post-Coital bleeding in Reproductive Age Black Vulvar Lesions (Melanoma) Red Vulvar Lesions (Paget’s) Ascites / Pelvic Mass / Asymptomatic

Screen Pap Ø Ø Ø

Post-Menopausal Bleeding

Ø B-HCG

!B-HCG despite delivery or abortion

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