Gynecological+Neoplasms

//Western Diagnosis//

=Endometrial carcinoma= 1. 4th in frequency in women - most common gyn CA; breast, colorectal, lung are the others 2. highest incidence between 50-60 yrs 3. prolonged estrogen exposure

Signs & Symptoms
a. abN uterine bleeding b. 1/3 of all postmenopausal bleeding

Diagnosis
a. endometrial biopsy b. D&C

Treatment
a. surgery: total hysterectomy with bilateral salpingo-oophorectomy b. progesterone in advanced or recurrent disease

=Ovarian carcinoma= 1. 18% of all gyn neoplasms: death surpasses that of cervical and uterine CA combined - 4th in CA fatalities in women 2. in 50’s 3. incidence higher in countries with high fat intakes 4. early detection difficult 5. symptoms once it has enlarged and extended 6. ovary >5cm diameter watched closely: may be gone after 6 wks 7. any ovarian enlargement in a postmenopausal woman usually signifies malignancy

History
a. family or personal: breast, endometrial, colon CA b. nulliparity c. infertility d. late childbearing [first child after age 35] e. delayed menopause

Signs & Symptoms
a. usually grow to considerable size before sx b. early sx: vague lower abdominal discomfort, mild digestive complaints, feeling full soon after eating, urgent urination following eating c. late sx: abdominal swelling, pelvic pain

Metastasis
a. local in pelvis b. abdominal c. liver d. lung e. bone

Diagnosis
a. ultrasound b. laparoscopy c. laparotomy

Treatment
a. surgery b. chemotherapy c. success hindered by late dx, widespread metastasis

=Cervical Carcinoma= 1. 3rd most common of female reproductive tract 2. 50 yrs of age 3. greater in women with a hx of early, frequent coitus with multiple sex partners: HPV - subtypes 4. cervical dysplasia, carcinoma-in-situ, invasive carcinoma

Diagnosis
a. PAP smear: with HPV testing [current rec. to start at age 21. period. those getting the virus before this time tend to clear it. Age 21-30 do every 2 years, after 30 every 3 years if they've had 3 consecutive normal ones, at 65 or 70 if last 3 tests normal than can stop] b. colposcopy c. Schiller’s test d. biopsy

atypical squamous cells (ASC) is most common & most benign abnormal finding squamous intraepithelial lesions (SIL)- mild infections generally caused by HPV Atypical glandular cells (AGC) Adenocarcinoma in situ (IAS) Adenocarcinoma

Treatment
a. excision: LEEP (loop electrosurgical excision procedure), cryotherapy, lasertherapy, conization b. radiation c. radical surgery d. natural TX