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  • Gynecologic Oncology New or Old subspecialty Samir Fouad Khalaf Professor OBGYN Al-Azhar University President www.ArabicOBGYN.net
  • Gynecologic Oncology
    • A field of medical sub specialization that deals with the study and treatment of malignancies arising in the female reproductive tract, ovary, cervix, endometrium, vagina, vulva and trophoblstic diseases
    • During the second half of the 20 th . Century enormous progress has been made in the use of surgery, radiation therapy, chemotherapy and other treatment modalities for gynecologic cancers
    • Meanwhile, the field of obstetrics and gynecology grew into such an enormous field, clinically and scientifically, that it became impossible for one doctor to master both complicated obstetrics, infertility, surgery for benign conditions and the treatment of cancer
  • Gynecologic Oncology
    • The field started in 1960s in the USA and the first certificate started to be given in 1974
    • The field grows rapidly and many gynecologic Oncology Societies established.
    • SGO was founded in 1969
    • GOG founded in 1970 sponsored by the NCI and now have 50 centers and 160 affiliated institutes
    • IGCS was founded in 1986
    • AGOS May 2006
    • What is gynecologic Oncologist?
    • Is a specialized obstetrician/gynecologist
    • Therefore, gynecologic oncologists have had extensive training in providing care for women with and without cancer
    • Gynecologic oncologists are trained in providing comprehensive, multi-disciplinary care
    • They are skilled surgical oncologists who also are trained in administering chemotherapy
    • Therefore, they are able to provide an outstanding degree of continuity of care for their patients
    • Gynecologic oncologist is prepared to provide supportive services:
    • Pain management
    • Management of medical or surgical complications from treatment,
    • Management of complications of the cancer
    • Hospice referral
  • Gynecologic Cancers
    • Gynecologic cancers represent 14% of all solid tumors in women and 11% of deaths from them.
    • Cervical, uterine and ovarian cancer represent 95% of gynecologic cancers and collectively rank the fourth in both incidence and mortality among cancers that affect women in developed countries.
    • Worldwide, these tumors account for even larger share of cancer mortality in women
  • Cervical Cancer
    • Worldwide, it is the second most common cancer in women:
    • 493,000 cases of cancer cervix compared to 1.15million cancer breast (2002)
    • In developing countries cancer cervix account of 15% of all new female cancer compared to 3.5% in developed countries due to:
    • Socioeconomic differences
    • Behavioral differences
    • Presence of screening programs
  • Number of Cases of Cancer Cervix in Egypt, Jordan, USA 15.0% 11.9% 9.4% 70+ 30.2% 41.8% 52.1% 50-69 48.4% 44.3% 36.5% 30-49 Age distribution 5,284 194 96 Total Per100,000 USA 1999-2001 Jordan 1996-2001 Egypt 1999-2001
  • Endometrial Carcinoma
    • Worldwide it represents 3.9% of female cancer
    • It is more common in developed countries : 18/100,000 in USA & Canada compared to 6/100,000 in Africa and is related to:
    • Prolonged high estrogen levels
    • Few number of children
    • Use of HRT
  • Number of cases of Endometrial Carcinoma in Egypt, Jordan, USA 25.5% 31.6% 29.0% 60-70 34.6% 13.1% 10.5% 70+ 24.4% 28.9% 27.4% 50-59 15.5% 26.4% 33.1% <50 Age distribution 14,129 405 124 Total/100,000 USA 1999-2001 Jordan 1996-2001 Egypt 1999-2001
  • Ovarian Carcinoma
    • Epithelial ovarian carcinoma account for 90% of cases and is the leading cause of death in women with pelvic malignancies
    • The incidence is higher in industrial countries of the world
    • Women who are single and have low parity and a history of breast cancer are at risk
  • Age-standard incidence rate of Ovarian Carcinoma in Egypt,Jordan,USA 33.5 14.1 17.7 50-69 52.7 17.3 14.9 70+ 3.2 2.1 2.5 <50 10.0 4.6 5.4 Total/ 100,000 USA 1999-2001 Jordan 1996-2001 Egypt 1999-201
  • Women Knowledge about gynecologic Cancer
  • Concerning about developing gynecologic cancer
    • 87% concerned about developing cancer
    • 52% very concerned
    • 70% concerned about developing ovarian cancer
    • 68% concerned about cervical cancer
    • 66% concerned about uterine cancer
  • Knowledge about gynecologic cancer
    • Despite their concern about developing gynecologic cancer
    • - 30% feel they are not knowledgeable
    • - 55% feel they are only somewhat knowledgeable
    • - 14% say they are very knowledgeable
  • Information about Risk Factors
    • 54% believe they are at risk in their lifetime
    • 43% do not feel they are at risk
    • Women aged 35-44 are most likely to report felling that they are at risk
  • 60% 29% 15% 13% 13% 6% 4% 4% 3% 1% 1% 0% Not aware of any risk Hereditary/genetic Smoking Exposure to STD Multiple sex partners Obesity Hormones Diet Birth control pills Infertility Unsafe sex Tamoxifen
  • Factors decreasing risk 72% 19% 11% 11% 4% 4% 3% 1% 26% Not aware Healthy lifestyle/diet Regular check-up Pap smear Birth control pills Lack of family history Condoms Pregnancy Others
  • Awareness of Symptoms 47% 31% 20% 9% 5% 1% 4% 25% Do not know Abnormal bleeding Pelvic pain Vaginal discharge Bloating No symptoms Painful intercourse Others
    • Women are uncertain of what type of specialist they would see if they were diagnosed with gynecologic cancer:
    • 41% say they would need to see a gynecologist
    • 31% would need to see an oncologist
    • 11% mention that they would see gynecologic oncologist
    • 13% do not know what type of specialist they should see
  • conclusion
    • The field of gynecologic Oncology is not well understood in many countries and the specialty is still far from being established in Arab countries.
    • Doctors need to know more about this specialty in order to increase patient’s knowledge and guide patients to the proper management by referring them to the Gynecologic oncologist