William M. Rich, MD

This is a term that includes several conditions that are associated with the results of a pregnancy. The conditions are molar pregnancy, invasive mole, metastatic mole and gestational choriocarcinoma(korio carcinoma). These are cancers and cancer like conditions of placental elements. The concept is so far beyond most people's experience, that unless they have been to medical school they will never have heard of it. It is not uncommon.

Cancer of the vagina is rare. It is almost always a squamous cell cancer. The exception is an adenocarcinoma that occurs in women who were exposed to DES (diethylstilbestrol) in-utero. One of the reasons that it is rare is that cancers of the vagina that also involve the vulva are considered to be vulvar cancers; if it involves the cervix it is considered to be a cervical cancer. Vaginal cancer may cause symptoms of abnormal bleeding and foul discharge. Bleeding after intercourse is a symptom of cancer of the vagina as well as cancer of the cervix.

The cervix is the part of the uterus connected to the upper vagina. It is the structure that dilates during childbirth to allow the baby to traverse the birth canal. There are two major types of cancer that develop from the cervix. Squamous cell cancers arise from the squamous epithelium that covers the visible part of the cervix. Adenocarcinomas arise from the glandular lining of the endocervical canal.

Cancer of the vulva is not a common disease. There are about 4,000 new cases each year in the United States. Although it can occur in women in the third and fourth decade it is usually diagnosed in older women. Over 95% of vulvar cancers arise from the squamous epithelium. The remainder are mostly melanomas. The cause of squamous cancer of the vulva is unknown but there is a weak association with Human Papilloma Virus (HPV). The most important feature about vulvar cancers is the premalignant phase.

Cancer statistics are usually not based on an accurate count of cases but on estimations derived from various sources. There is no national cancer registry that counts every cancer diagnosed each year. The American Cancer Society publishes annual estimates based on a compilation of several local tumor registries and extrapolates these to the US population. Like all statistics, cancer numbers can be misused and misunderstood.

Cancer is an abnormal proliferation of cells which have uncontrolled growth. They have the ability to grow into adjacent tissue and to spread to distant parts of the body. A cell is the basic building block and the fundamental functioning unit of the body. A sphere about one fourth of an inch in diameter contains about 1,000,000,000 cells (109).

There are four conventional primary methods to treat a cancer: surgery, radiation, chemotherapy, and immunotherapy. There are four goals of treatment: cure, prevention, prolongation of survival, and palliation. Palliation means that treatment is given to remedy a symptom of the cancer without being able to treat the cancer itself.

Archive of William M. Rich, MD

The uterus is the pelvic organ that holds the pregnancy and that bleeds each menstrual period. The cervix is that part of the uterus fixed at the top of the vagina. The normal size of the uterus is about that of a lemon. The uterus is divided into three parts. The great bulk of the uterus is composed of smooth muscle and forms a thick uterine wall.

The Pap test is a screening test for malignant and premalignant changes of the cervix. A positive result indicates that there may be a problem and that further diagnostic procedures must be done. The Pap test is not a diagnostic test. It cannot be used to exclude a cancer of the cervix for a person who has symptoms that could be due to a cervical cancer.

A list of key terms for gynecologists and patients dealing with cancer.

Receiving a diagnosis of cancer is a major life change. Neither the patient, the family nor friends will be the same again.

Ovarian cysts are enlargements of the ovary that appear to be filled with fluid. They can be a simple fluid filled bleb or contain complex internal structures. The term cyst is used to differentiate them from solid enlargements. Simple cysts have no internal structures and are less worrisome than those with complex structures or solid components. A sonogram or ultrasound test can determine if a cyst is simple or complex.