Gynecologic Oncology

To mark January 2004 as Cervical Cancer Screening Month, the National Cervical Cancer Public Education Campaign today urged women to get screened for cervical cancer in order to prevent the disease.

Cervical cancer is the second most common gynecological cancer amongst women world-wide. Despite optimized protocols, standard treatments still face several disadvantages. Therefore, research aims at the development of immune-based strategies using tumor antigen-loaded dendritic cells for the induction of cellular anti-tumor immunity.

In a recent study, researchers found that, while the IUD did not protect HPV infection, it may impede the progression of HPV to cervical cancer.  With this in mind would you recommend the use of an IUD to your patients who have tested positive for HPV in order to possibly prevent cervical cancer?

Based on the protective effects of intrauterine devices against endometrial cancer, researchers hypothesized that IUDs may also have a protective effect against cervical cancer. However, results from epidemiological and clinical studies to date have been inconclusive.

Of the 600,000 hysterectomies performed yearly in the U.S., approximately 300,000 are accompanied by prophylactic bilateral oophorectomy, traditionally suggested as the best strategy to decrease the rate of ovarian cancer.

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.

Very few experiences can be as frightening as receiving a call that your pap smear came back abnormal. Although cervical cancer is the first thing that may comes to mind, most of the time an abnormal pap smear indicates a minor problem with the cervix that may or may not need treatment.

The Papanicolaou (Pap) test is the best screening test we have in medicine. Countries that perform the test, like the USA, prevent over 90% of cervical cancers. Pap tests should not detect cervical cancer, because it is the cervical cancer we want prevent. Our goal is to detect pre-cancerous changes, and treat cases in their pre-cancerous state. Earlier findings require less costly and less painful treatment.

Ovarian cancer, long considered a silent killer because of the lack of warning signs, may not be so silent. A new consensus statement released by the Gynecological Cancer Foundation reveals that women who have developed ovarian cancer may have had common disease symptoms.

Many medical conditions, including all cases of cancer, must be diagnosed by removing a sample of tissue from the patient and sending it to a pathologist for examination. This procedure is called a biopsy, a Greek-derived word that may be loosely translated as "view of the living."

The Society of Gynecologic Oncologists (SGO) has endorsed the American Cancer Society's (ACS) new guidelines, "Early Detection of Cervical Neoplasia and Cancer," released in the Nov./Dec. issue of CA: A Cancer Journal for Clinicians. The new guidelines represent a significant step forward in advising the health care community and the public on the importance of cervical cancer screening and the relationship between the Human Papillomavirus (HPV) virus and cervical cancer.

There are many ways to treat cervical dysplasia (CIN). Factors influencing the choice of treatment for cervical dysplasia include the extent and severity of the dysplasia, the age of the woman, and whether or not she has any other gynecological problems. Often the experience of the physician or other clinician, and the availability of equipment are also major factors. The following are the most common methods of treating cervical dysplasia:

A continence center represents a center of excellence concept. A specific commitment to making a unique entity is required to fulfill this goal. This commitment should represent a high degree of motivation to provide unique and progressive care for patients afflicted with voiding dysfunction.

On October 6, 2000 the Health Care Financing Administration (HCFA) announced that it was initiating a national policy for coverage of biofeedback treatments of urinary incontinence (UI). This is a significant development both for physicians already using biofeedback and for those contemplating adding conservative therapies to their practice.

Pantaleoni first performed hysteroscopy in 1869, but it was not until the early 1970s that hysteroscopy became part of the gynecologist's armamentarium. The need for visual appraisal of the endocervix and endometrial cavity and technical advances in instrumentation increased the awareness of, and interest in, the advantages of hysteroscopic sterilization techniques.

The National HPV & Cervical Cancer Campaign is a public education campaign whose goal is to reduce the number of preventable deaths each year by cervical cancer through increased education, outreach and communication between women and their health care providers.

The challenge we face in interpreting Pap smears is to facilitate the assignment of smears into either a low-risk category (including "within normal limits" and "benign cellular changes") or a high-risk category (including "squamous intraepithelial lesion" and higher-grade categories).

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

Patient safety is finally being institutionalized due to growing concern over the terrible cost of inadvertent human error. Medicine's punitive perfectibility model in dealing with unintended injury is slowly evolving to accept error during surgery, as an inevitable yet manageable reality of operations (Leap, 1994).

Women with cervical intraepithelial neoplasia now have a number of treatment options including cold-knife conization, laser ablation, and loop electrosurgery but, all too often, the physician s preference is the determining factor in selection of therapy. This detailed presentation of the advantages and disadvantages of electrosurgery will help the physician to decide whether this procedure truly fits the needs of a given patient.

With the media attention focused on cancer genes and registries aimed at tracing hereditary cancers, many women with a family history of cancer and some with no such history are asking their physicians for advice and testing. This article explains the nature of breast and ovarian cancer inheritance and gives recommendations for screening and intervention based on the latest findings in this fast-changing field.