Gynecologic Oncology A subspecialty of Age Samir Fouad Khalaf Professor OBGYN Al-Azhar University President www.ArabicOBGYN.net
Origin of the Word "Cancer
The word cancer came from the father of medicine, Hippocrates, a Greek physician. Hippocrates used the Greek words, carcinos and carcinoma to describe tumors, thus calling cancer "karkinos".
The Greek terms actually were words to describe a crab, which Hippocrates thought a tumor resembled. Although Hippocrates may have named "Cancer", he was certainly not the first to discover the disease
The First Documented Case of Cancer
The world's oldest documented case of cancer hails from ancient Egypt, in 1500 b.c.
The details were recorded on a papyrus, documenting 8 cases of tumors occurring on the breast. It was treated by cauterization with a hot instrument called "the fire drill".
It was also recorded that there was no treatment for the disease, only palliative treatment.
There is evidence that the ancient Egyptians were able to tell the difference between malignant and benign tumors.
According to inscriptions, surface tumors were surgically removed in a similar manner as they are removed today.
The Birth of the Pathological Autopsy
In 1628, the first autopsy was done which paved the way to learning human anatomy and physiology .
It wasn't until 1761, that pathological autopsies were performed to research cause of death in ill patients .
In 1980s molecular biology start to influence our understanding of the disease process
Theories on the Causes of Cancer
The lymph theory developed in the 17th century, .
It was believed that abnormalities in the lymphatic system was the cause .
In late 19th century Rudolph Virchow recognized that cells, even cancerous cells, derived from other cells.
Other theories surfaced, such as cancer being cause by trauma, parasites, and it was thought that cancer may spread "like a liquid".
It was later concluded that cancer spread through malignant cells by German surgeon, Karl Thiersch. In 1926 a Nobel Prize was wrongfully awarded for the discovery of the cause of stomach cancer- a worm. The 20th century saw the greatest progression in cancer research.
Research identifying carcinogens, chemotherapy , radiation therapy and better means of diagnosis were discovered. Today, we are able to cure some types of cancer, and research is ongoing. Clinical trials and research studies are out key to finding a cure, or a definitive method of prevention.
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
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:
Management of medical or surgical complications from treatment,
Management of complications of the cancer
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
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:
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 Jordan Egypt
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
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
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