GYNAEC CANCERS have been discussed here in a simplified manner to help u understand the topic well.....Do make use of it

1. -DR.AKIF A.B

3. TYPES Progression to cancer
1) Simple hyperplasia without
atypia
1%
2)Complex hyperplasia without
atypia
3%
3) Simple hyperplasia with atypia 8%
4) Complex hyperplasia with atypia 25-30%

4. SIMPLE COMPLEX
- It results from increased
Estrogen conditions
Less associated with estrogen
- May be associated with glucose
intolerance
May be associated with glocose
intolerance
Glands are large : Increases
gland/stroma ratio
Glands number is increased
Scanty mitosis Numerous mitoses
Glands lined by columnar
epithelium
Lined by stratified squamous
epithelium
Stroma is sparsely cellular Densely cellular

5. Characteristics of Atypical cells
1) Large in size
2) Loss of polarity
3) Hyperchromatic nuclei and prominent nucleolus
4) Irregular shape
5) Altered nucleus/cytoplasmic ratio

6. Without Atypia With Atypia
Pre
menopausal
Post
menopausal
simple complexMedroxyproge
sterone for
21days a
month for
3months
- Progesterone
containing
IUCD
No
therapy
Progeste
one
therapy
Ideal :
Hysterectomy
Premenopausal women
willing fertility : High
dose progesterone with
risk of cancer explained

7. Most common Gynaecological cancer in Developed
countries : Endometrial Cancer
MC Gynaecological cancer in Developing countries :
Cervical Cancer

8. -MC age group : >60years
-Risk factor:
Family Family history
Has Hypertension
O Obesity
L Late menopause and early menarche
D Diabetes
A Atypical endometrial hyperplasia
U Unopposed estrogen or increases estrogen
N Nulliparity
T Tamoxifen therapy
I h/o Infertility

9. 1) Smoking : It decreases estrogen levels
2) OCPs : Progesterone containing OCPs are protective
-MC variety of Endometrial Carcinoma = Adenocarcinoma
-MC malignant variety of endometrial Ca. = Clear cell Ca. (Hobnail cells)

10. CLEAR CELL CA.
(HOBNAIL CELLS)

11. Clinical Features
1) Abnormal vaginal bleeding
2) Postmenopausal bleeding (MC)
3) Discharge per vagina
4) Pelvic discomfort
5) Referred pain in Hypogastrium and Iliac fossa : Simpson’s Pain

12. Trans Vaginal
USG
If Endometrial
Thickness is
<4mm >4mm
No further
Investigation
Biopsy
-Best test for diagnosing Endometrial Cancer = Hysteroscopy & Biopsy

14. -Staging is Surgical. It includes
1) Hysterectomy
2) Bilateral Salpingo-oopherectomy
3) Pelvic LN dissection
4) Para aortic LN dissection

15. STAGE DESCRIPTION TREATMENT
IA Cancer confined to uterus and
<50% myometrium invoved
Grade I & II :Staging
Grade III : Staging +
Radiotherapy
IB Cancer confined to uterus and
>50% myometrium involved
Staging + Radiotherapy
II Endocervical Stroma involved Modified Radical
Hysterectomy +
Radiotherapy
IIIA Tumor Invades Serosa or
adnexa
IIIB Vaginal and/or parametrial
Involvement
IIIC Metastasis to pelvic LN
IIID Metastases to Para-aortic LN
IV Distant metastases
Debulking surgery
+ Radiotherapy

16. In stage IA, cancer is in
the endometrium only
or less than halfway
through the
myometrium (the
muscle layer of the
uterus).
In stage IB, cancer has
spread halfway or
more into the
myometrium.
STAGE IA AND STAGE IB
ENDOMETRIAL CANCER.

17. Cancer has
spread into
connective
tissue of the
cervix, but has
not spread
outside the
uterus.
Stage II endometrial cancer

18. Cancer has spread to the
outer layer of
the uterus and/or to the
fallopian tubes, ovaries, and
ligaments
of the uterus.
Stage IIIA

19. Cancer has
spread to the
vagina and/or to
the parametrium
(connective tissue
and fat around the
uterus and cervix).
Stage IIIB

20. Cancer has spread
to lymphnodes in
the pelvis and/or around
the aorta

21. Cancer has spread into
the bladder and/or
bowel.
STAGE IVA
ENDOMETRIAL CANCER.

22. Cancer has spread to
other parts of the
body beyond
the pelvis, including
the abdomen and/or
lymph nodes in
the groin.
Stage IVB

24. -MC time of Recurrenece = within 2years
-MC Symptom of local recurrence = Vaginal bleeding
-MC symptom of Pelvic Recurrence = Pelvic Pain
Embronal Rhabdomyosarcoma
-MC Malignant tumor of genital tract in girls
-Arises from submucosa of vagina and cervix

26. -Also k/a Inclusion Cyst
-Retention cysts of cervical glands
-Seen on external os
- No treatment is required
-If large : Ablation

27. - Treatment : Polypectomy

28. WHO CIN Description Betheseda
classification
Mild dysplasia CIN I Dysplastic cells
seen on lower 1/3rd
of epithelial lining
of cervix
LSIL
Moderate dysplasia CIN II Dysplastic cells
seen on lower 2/3rd
of epithelial lining
of cervix
HSIL
Severe dysplasia CIN III Dysplastic cells
seen on >2/3rd of
epithelial lining of
cervix
HSIL
Carcinoma in situ Dysplastic cells
seen full thickness
but basement
membrane is intact
HSIL

29. LSIL : Low Squamous Intraepithelial Lesion
HSIL : High Squamous Intraepithelial Lesion
CIN occurs at : Squamocolumnar Junction/
Transformation Zone

30. -HPV
-Sexually Transmitted Infections
-Coitus before 18yrs
-Multiple sex partner
-Multiparity
-Poor hygiene
-Poor socioeconomic status
-Smoking
-Immunosuppressed
-Women on OCP, Progesterone therapy
-In utero exposure to DES

31. -MC etiology factor for associated with Cancer Cervix.
Low risk HPV 6,11 Genital warts
High Risk HPV 16, 18 Cancer cervix

37. A very small amount of cancer that can
only be seen with a microscope is found in
the tissues of the cervix.
In stage IA1, the cancer is not more than 3
millimeters deep and not more than 7
millimeters wide.
In stage IA2, the cancer is more than 3 but
not more than 5 millimeters deep, and not
more than 7 millimeters wide.
STAGE IA1 AND IA2 CERVICAL CANCER

38. In stage IB1, the cancer can only
be seen with a microscope and is
more than 5 mm deep and more
than 7 mm wide OR the cancer
can be seen without a
microscope and is 4 cm or
smaller.
In stage IB2, the cancer is larger
than 4 cm.
STAGE IB1 AND IB2 CERVICAL CANCER

39. Cancer has spread beyond the
cervix but not to the pelvic wall or
to the lower third of the vagina.
In stages IIA1 and IIA2, cancer
has spread beyond the cervix to
the vagina.
In stage IIA1, the tumor can be
seen without a microscope and is
4 centimeters or smaller.
In stage IIA2, the tumor can be
seen without a microscope and is
larger than 4 centimeters.
In stage IIB, cancer has spread
beyond the cervix to the tissues
around the uterus.
STAGE II CERVICAL CANCER

40. Cancer has spread to
the lower third of the
vagina but not to the
pelvic wall.
STAGE IIIA CERVICAL CANCER

41. Cancer has spread to
the pelvic wall;
and/or the tumor
has become large
enough to block the
ureters
STAGE IIIB CERVICAL CANCER

42. Cancer has
spread to
nearby organs,
such as the
bladder or
rectum.
STAGE IVA CERVICAL CANCER.

43. The cancer has
spread to other parts
of the body, such as
the lymph nodes,
lung, liver, intestine,
or bone.
STAGE IVB CERVICAL CANCER