This document outlines various female genital tract malignancies. It discusses vulvar cancer, vaginal cancer, cervical cancer, womb cancer, ovarian cancer, and fallopian tube cancer. For each cancer, it covers epidemiology, causes and risk factors, pathogenesis, clinical manifestations, diagnosis, staging, and treatment approaches. It provides details on surgical procedures, radiation therapy regimens, chemotherapy regimens, and strategies for prevention. The document aims to comprehensively overview the major female genital tract cancers.
Vaginal cancer is a rare type of cancer most common in women 60 and older.
Women are more likely to develop vaginal cancer if they have the human papillomavirus (HPV) or if your birth mother took diethylstilbestol (DES) when she was pregnant.
There are several types of vaginal cancer:
Squamous cell carcinoma
About 70 of every 100 cases of vaginal cancer are squamous cell carcinomas. These cancers begin in the squamous cells that make up the epithelial lining of the vagina. These cancers are more common in the upper area of the vagina near the cervix. Squamous cell cancers of the vagina often develop slowly. First, some of the normal cells of the vagina get pre-cancerous changes. Then some of the pre-cancer cells turn into cancer cells. This process can take many years.
The medical term most often used for this pre-cancerous condition is vaginal intraepithelial neoplasia (VAIN). "Intraepithelial" means that the abnormal cells are only found in the surface layer of the vaginal skin (epithelium). There are 3 types of VAIN: VAIN1, VAIN2, and VAIN3, with 3 indicating furthest progression toward a true cancer. VAIN is more common in women who have had their uterus removed (hysterectomy) and in those who were previously treated for cervical cancer or pre-cancer.
In the past, the term dysplasia was used instead of VAIN. This term is used much less now. When talking about dysplasia, there is also a range of increasing progress toward cancer - first, mild dysplasia; next, moderate dysplasia; and then severe dysplasia.
Adenocarcinoma
Cancer that begins in gland cells is called adenocarcinoma. About 15 of every 100 cases of vaginal cancer are adenocarcinomas. The usual type of vaginal adenocarcinoma typically develops in women older than 50. One certain type, called clear cell adenocarcinoma, occurs more often in young women who were exposed to diethylstilbestrol (DES) in utero (when they were in their mother’s womb). (See the section called "What are the risk factors for vaginal cancer?" for more information on DES and clear cell carcinoma.)
Melanoma
Melanomas develop from pigment-producing cells that give skin its color. These cancers usually are found on sun-exposed areas of the skin but can form on the vagina or other internal organs. About 9 of every 100 cases of vaginal cancer are melanomas. Melanoma tends to affect the lower or outer portion of the vagina. The tumors vary greatly in size, color, and growth pattern. More information about melanoma can be found in our document called Melanoma Skin Cancer.
Sarcoma
A sarcoma is a cancer that begins in the cells of bones, muscles, or connective tissue. Up to 4 of every 100 cases of vaginal cancer are sarcomas. These cancers form deep in the wall of the vagina, not on its surface. There are several types of vaginal sarcomas. Rhabdomyosarcoma is the most common type of vaginal sarcoma. It is most often found in children and is rare in adults. A sarcoma called leiomyosarcoma is seen more often in adults.
what is endometriosis? Theories in endometriosis, sites of endometriosis. types and clinical presentation. signs and symptoms.
Investigations :TVS, CA125
laparoscopic findings
chocolate cyst and extrapelvic endometriosis.
Classification of endometiosis
Diffential diagnosis
Management :of asymptomatic and symptomatic cases
drugs and minimally invasive surgery
surgey and preventive measures in endometiosis.
Types of Menstrual disorders and there causes and symptomsMedical Knowledge
In this slide, you can understand the types of menstrual disorders, Mahvari or haiz.
You can learn about the types of Menstruation.
Types of Menstrual disorders.
cause of menstruation
symptoms of menstruation
diagnosis of menstruation
Treatment of menstruation bleeding
Heavy bleeding or menstrual cramps
Menstrual cycle
Amenorrhea
Dysmenorrhea
Oligo menorrhea
PMS (Premenstrual syndrome) or PMDD (Premenstrual dystrophic disease)
Menorrhagia
You can download Powerpoint of menstrual disorders here:
https://docs.google.com/presentation/d/1SCDUYcPYP7vpE4kzWoBwzYnyg4vzNAcXWrFp_iIZAnA/edit#slide=id.p1
You can download video from:
https://youtu.be/APWG2liWR7E
Vaginal cancer is a rare type of cancer most common in women 60 and older.
Women are more likely to develop vaginal cancer if they have the human papillomavirus (HPV) or if your birth mother took diethylstilbestol (DES) when she was pregnant.
There are several types of vaginal cancer:
Squamous cell carcinoma
About 70 of every 100 cases of vaginal cancer are squamous cell carcinomas. These cancers begin in the squamous cells that make up the epithelial lining of the vagina. These cancers are more common in the upper area of the vagina near the cervix. Squamous cell cancers of the vagina often develop slowly. First, some of the normal cells of the vagina get pre-cancerous changes. Then some of the pre-cancer cells turn into cancer cells. This process can take many years.
The medical term most often used for this pre-cancerous condition is vaginal intraepithelial neoplasia (VAIN). "Intraepithelial" means that the abnormal cells are only found in the surface layer of the vaginal skin (epithelium). There are 3 types of VAIN: VAIN1, VAIN2, and VAIN3, with 3 indicating furthest progression toward a true cancer. VAIN is more common in women who have had their uterus removed (hysterectomy) and in those who were previously treated for cervical cancer or pre-cancer.
In the past, the term dysplasia was used instead of VAIN. This term is used much less now. When talking about dysplasia, there is also a range of increasing progress toward cancer - first, mild dysplasia; next, moderate dysplasia; and then severe dysplasia.
Adenocarcinoma
Cancer that begins in gland cells is called adenocarcinoma. About 15 of every 100 cases of vaginal cancer are adenocarcinomas. The usual type of vaginal adenocarcinoma typically develops in women older than 50. One certain type, called clear cell adenocarcinoma, occurs more often in young women who were exposed to diethylstilbestrol (DES) in utero (when they were in their mother’s womb). (See the section called "What are the risk factors for vaginal cancer?" for more information on DES and clear cell carcinoma.)
Melanoma
Melanomas develop from pigment-producing cells that give skin its color. These cancers usually are found on sun-exposed areas of the skin but can form on the vagina or other internal organs. About 9 of every 100 cases of vaginal cancer are melanomas. Melanoma tends to affect the lower or outer portion of the vagina. The tumors vary greatly in size, color, and growth pattern. More information about melanoma can be found in our document called Melanoma Skin Cancer.
Sarcoma
A sarcoma is a cancer that begins in the cells of bones, muscles, or connective tissue. Up to 4 of every 100 cases of vaginal cancer are sarcomas. These cancers form deep in the wall of the vagina, not on its surface. There are several types of vaginal sarcomas. Rhabdomyosarcoma is the most common type of vaginal sarcoma. It is most often found in children and is rare in adults. A sarcoma called leiomyosarcoma is seen more often in adults.
what is endometriosis? Theories in endometriosis, sites of endometriosis. types and clinical presentation. signs and symptoms.
Investigations :TVS, CA125
laparoscopic findings
chocolate cyst and extrapelvic endometriosis.
Classification of endometiosis
Diffential diagnosis
Management :of asymptomatic and symptomatic cases
drugs and minimally invasive surgery
surgey and preventive measures in endometiosis.
Types of Menstrual disorders and there causes and symptomsMedical Knowledge
In this slide, you can understand the types of menstrual disorders, Mahvari or haiz.
You can learn about the types of Menstruation.
Types of Menstrual disorders.
cause of menstruation
symptoms of menstruation
diagnosis of menstruation
Treatment of menstruation bleeding
Heavy bleeding or menstrual cramps
Menstrual cycle
Amenorrhea
Dysmenorrhea
Oligo menorrhea
PMS (Premenstrual syndrome) or PMDD (Premenstrual dystrophic disease)
Menorrhagia
You can download Powerpoint of menstrual disorders here:
https://docs.google.com/presentation/d/1SCDUYcPYP7vpE4kzWoBwzYnyg4vzNAcXWrFp_iIZAnA/edit#slide=id.p1
You can download video from:
https://youtu.be/APWG2liWR7E
This presentation describes epidemiology, risk factors, pathology, clinical examination, staging and management of cervical carcinoma. SCREENING is not included
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
6. The vulva is
the external
genitalia of
the female
reproductive
tract
Vulva
7.
8. Vulvar cancer
Vulvar cancer is a
cancer that
starts in the
external female
sex organs –
inner edges of
the labia majora
or labia minora
9. Vulvar cancer epidemiology
• 4th most common gynecologic cancer
(following uterus, ovary and cervix)
• Comprises 5% of gynecologic
malignancies
• Mean age at diagnosis is 65y, but is
decreasing
10.
11. • Cigarette smoking
• Human Papilloma Virus (HPV)
infection
• Immunosuppression
• Chronic vulvar conditions such as
lichen sclerosus
• VIN/CIN
• Prior history of cervical cancer
Causes & Risk Factor
12. Pathogenesis
1. HPV infection (60%)
Two pathways of vulvar carcinogenesis:
2. Chronic inflammatory (vulvar
dystrophy) or autoimmune
processes
14. Clinical Manifestations
• Most patients present with a single vulvar
plaque, ulcer or mass
• Labia major is the most common site
• Lesions are multifocal in 5% of cases A
synchronous second malignancy is found
in 22% of cases, usually CIN/cervical cancer
19. Clinical Manifestations
• Pruritus is the most common presenting
symptom (especially if associated with
vulvar dystrophy such as lichen
sclerosus)
• Vulvar bleeding or discharge
• Dysuria
• Enlarged groin lymph node
20.
21. Diagnosis
• Biopsy of gross lesions
• If no gross lesion present but high
clinical suspicion, perform colposcopy
22. Types of Vulvar Cancer
• Squamous cell carcinoma SCCA (>90% of cases)
• Melanoma
• Sarcoma
• Basal cell carcinoma
• Verrucous carcinoma
• Adenocarcinoma (Bartholin gland)
23. Vulvar Cancer Staging (Surgical)
Stage Description
IA Lesion <2 cm with <1 mm stromal invasion, no nodal
metastases
IB Lesion >2 cm with >1 mm stromal invasion, no nodal
metastases
II Lesion any size, extension to adjacent structures, no
nodal metastases
III Lesion of any size with involvement of the lower urethra,
vagina or anus OR groin lymph node metastases
IVA Tumor invading upper urethra, bladder mucosa, rectal
mucosa, pelvic bone
IVB Any distant metastases, including pelvic lymph nodes
24. Treatment of SCCA Vulvar
Stage Treatment
IA Wide local excision (WLE)
IB WRE and inguinal-femoral lymphadenectomy
II WRE and inguinal-femoral lymphadenectomy
III WRE and inguinal-femoral lymphadenectomy
OR chemoradiation +/- surgery to resect
residual disease as needed
IVA chemoradiation +/- surgery to resect residual
disease as needed
IVB Chemotherapy
25. Treatment of SCCA Vulvar : Surgery
Wide Radical Excision (WRE):
• Excision of vulvar lesion down to the
fascia of the urogenital diaphragm
• 2 cm tumor-free margin
Inguinal-Femoral Lymphadenectomy:
• Removal of the superficial inguinal
and deep femoral lymph nodes
26. • Radiation in combination with chemotherapy
is an alternative to surgery in women with
stage III/IVA disease
• Indicated if positive inguinal/pelvic nodes
• Indicated if positive margins after WRE if
re-excision not possible or desirable (i.e.
around the clitoris or anal sphincter)
Treatment of SCCA Vulvar : Radiation therapy
27. Treatment of SCCA Vulvar : Chemotherapy
• Indicated for metastatic disease (stage
IVB)
• Platinum-based
• Treatment is palliative
28. Chemotherapy regimens SCCA Vulvar
First-Line Combination Therapy
REGIMEN DOSING
Paclitaxel (Taxol) + cisplatin
(Platinol; CDDP)
Day 1: Paclitaxel 135mg/m2 IV, admi over
24 hr plus
Day 2: Cisplatin 50mg/m2 IV at a rate of
1mg/min.
Repeat cycle every 3 weeks for 6
cycles.
Carboplatin (Paraplatin) +
paclitaxel
Day 1: Carboplatin AUC=5mg/mL/min
administered over 1 hr, followed
by paclitaxel 175mg/m2 administered
over 3 hrs.
Repeat cycle every 3 weeks for 6–9
cycles or until disease progression or
unacceptable toxicity
29. Chemotherapy regimens SCCA Vulvar
First-Line Combination Therapy cont’d
REGIMEN DOSING
Cisplatin + topotecan
(Hycamtin)
Days 1–3: Topotecan 0.75mg/m2 IV
administered over 30 min plus
Day 1: Cisplatin 50mg/m2 IV.
Repeat cycle every 3 weeks.
Cisplatin + gemcitabine
(Gemzar)
Days 1 and 8: Cisplatin
30mg/m2 + gemcitabine 800mg/m2.
Repeat cycle every 4 weeks.
30. Chemotherapy regimens SCCA Vulvar
First-Line Monotherapy
REGIMEN DOSING
Cisplatin (preferred as a
single agent)
Day 1: Cisplatin 50mg/m2.
Repeat cycle every 3 weeks
for a total of 6 cycles.
31. Chemotherapy regimens SCCA Vulvar
Second-Line Therapy
REGIMEN DOSING
Bevacizumab (Avastin)
Day 1: Bevacizumab 15mg/kg
IV.
Repeat cycle every 3 weeks.
Docetaxel (Taxotere)
Day 1: Docetaxel 100mg/m2 IV,
administered over 1 hr.
Repeat cycle every 3 weeks
33. Melanoma of the Vulva
• 2nd most common type of vulvar cancer (5-6%)
• Occurs more frequently in white women
• Mean age at diagnosis is 68y
• Treatment is wide local excision with 2
cm margins and sentinel lymph node
biopsy
35. Basal Cell Carcinoma
• 2% of vulvar cancers
• Usually occur in white, postmenopausal
women
• May be locally invasive but usually do not
metastasize
• Slow-growing
• Treatment is wide local excision
37. Paget Disease of the Vulva
• <1% of vulvar malignancies
• Most common presenting symptom is pruritus
• Lesion is usually well demarcated slightly
raised edges and a red background
• Most patients are postmenopausal and
Caucasian
• Treatment is wide local excision
43. Vaginal cancer
• Vaginal cancer,
sometimes referred
to as primary
vaginal cancer.
• Cancer that starts in
the vagina.
44. Vaginal cancer
There are two main kinds of vaginal cancer:
primary
vaginal cancer
secondary
vaginal cancer
the cancer
originates in the
vagina
cancer spreads to
the vagina from
another organ
Represents 2-3% of Pelvic Cancers
45. Primary vaginal cancer
• Squamous cell
carcinoma:
:80-85% , 50 yrs. and up
.
• Clear cell
adenocarcinoma
:10%, teenagers and
young women
[14 – 20 yrs. ]
• Melanoma :2-3%, women over 50
48. Causes & Risk Factor
• Cigarette smoking
• Human Papilloma Virus (HPV 16 and 18) infection
• Immunosuppression
• VIN/CIN
• Prior history of cervical cancer
• Treatment for womb cancer by radiotherapy
49.
50. Clinical Manifestations
• Painless vaginal bleeding, between periods,
after menopause, or after sex
Symptoms appear , often in later stages.
They can include:
• Vaginal discharge (may smell or be bloody)pain
during sex
• A lump in the vagina that you can feel
• A persistent itch in the vagina
53. Diagnosis
• Biopsy to look for either precancerous
(VAIN) or cancerous cells
• Scans and x-rays to see if the cancer
has spread to other parts of your body.
54. Vagina cancer Staging
• Stage I : Confined to Vaginal Wall
• Stage II : Subvaginal tissue but not
to pelvic sidewall
• Stage III : Extended to pelvic sidewall
• Stage IVA: Bowel or Bladder
• Stage IVB: Distant metastasis
55. Treatment of vaginal cancer
• Surgery with Radical Hysterectomy and
pelvic lymph dissection in selected
stage I tumors high in Vagina
• All others treated with radiation with
chemosensitization
56. Treatment of vaginal cancer cont’d
radiotherapy concurrently with
weekly intravenous Cis-platinum
chemotherapy (40 mg/m2)
• Radiation with chemosensitization
57. 5 year Survival
• Stage I 70%
• Stage II 51%
• Stage III 33%
• Stage IV 17%
58.
59. Prevention
The few things known to help, though,
are avoiding smoking, and getting
regular smear tests to detect
precancerous or cancerous cells early:
VAIN VIN ; HPV CIN
61. Summary – Vagina Cancer
• Represents 2-3% of Pelvic Cancers
• 84% of cancers in vaginal area are secondary
• Clear cell adenocarcinoma most occurs
teenagers and young women
• Treatment includes most surgery, radiation
• Chemosensitization with cisplatin
65. Cervical cancer
Cervical cancer
begins in the cervix
(the neck of the
womb), which is a
strong muscle that
forms the passage
between the womb
and the vagina.
66. Cervical cancer epidemiology
• Approximately 570,000 cases
expected worldwide each year
• 275,000 deaths
• Number one cancer killer of women
worldwide
• With the advent of the Pap smear, the
incidence of cervical cancer has declined
67.
68. Cervical Cancer Etiology
• Cervical cancer is a sexually transmitted
disease.
• HPV is the primary cause of cervical
cancer.
• Some strains of HPV have a predilection to
the genital tract and transmission is usually
through sexual contact (16, 18 High Risk).
69. Cervical Cancer Risk Factors
• smoking
• giving birth to more than 7 children
having your first child before 17yrs
• Number of sexual partners
• Early age of intercourse
70. Cervical Cancer Risk Factors
• High-risk male partner
• Taking the pill
• Having a weakened immune system
75. the stages of cancer progression
The pre-cancerous
stage before the
cells turn cancerous
is called Cervical
Intra-epithelial
Neoplasia commonly
in short called CIN
82. Treatment of Early Disease
• Conization or simple hysterectomy -
microinvasive cancer
• Radical hysterectomy - removal of the uterus
with its associated connective tissues, the
upper vagina, and pelvic lymph nodes..
• Chemoradiation therapy
84. Advanced Staging
• Chemoradiation is the mainstay of treatment
• 4-5 weeks of external radiation treats the primary
tumor and adjacent tissues and lymph nodes
• Chemotherapy acts as a radiation sensitizer
and may also control distant disease
85. Locally advanced cervical cancer regimens
First-Line Therapy with Radiotherapy
REGIMEN DOSING
Cisplatin
40mg/m2 IV on days 1, 8, 15, 22, 29, and
36 (total dose not to exceed 70mg per
week).
Cisplatin + 5-FU
Days 1 and 29: 4 hrs prior to external-
beam radiotherapy: Cisplatin
50mgDinfusion /m2 IV at 1mg/min with
standard hydration, plus
Days 2–5, and 30–33: 5-FU
1000mg/m2 IV continuous infusion over
24 hrs (total dose 4000mg/m2 each
course).
86. Locally advanced cervical cancer
regimens cont’d
First-Line Therapy with Radiotherapy
REGIMEN DOSING
Cisplatin + 5-FU
Days 1–5 of radiotherapy: Cisplatin
75mg/m2 IV over 4 hrs followed by 5-FU
4000mg/m2 IV over 96 hrs.
Repeat cycle every 3 weeks for 2
additional cycles.
Cisplatin + 5-
FU +hydroxyurea
Days 1 and 29: Cisplatin
50mg/m2 IV followed by 4000mg/m2 5-
FU over 96 hrs; hydroxyurea 2g orally
twice weekly for 6 weeks.
87. Locally advanced cervical cancer
regimens cont’d
First-Line Therapy with Radiotherapy
REGIMEN DOSING
Cisplatin + gemcitabine +
radiotherapy +brachytherapy
Induction therapy
Days 1, 8, 15, 22, 29 and 36: Cisplatin
40mg/m2 + gemcitabine
125mg/m2 + concurrent external-
beam radiotherapy 50.4Gy in 28
fractions, followed by brachytherapy
30–35Gy in 96 hrs.
Adjuvant therapy
Day 1: Cisplatin 50mg/m2, plus
Days 1 and 8: Gemcitabine
1,000mg/m2.
Repeat every 3 weeks for 2 cycles.
90. Reduce the risk
• reduce the risk of contracting the virus, which
in turn can reduce the risk of getting cervical
cancer
• start having sex when mature , and less sexual
partners because more you have higher your
chances are of developing cervical cancer
91. Summary – Vagina Cancer
• Number one cancer killer of women worldwide
• HPV is the primary cause of cervical
cancer
• Number of sexual partners
• Treatment includes surgery, and
chemotherapy asso radiotherapy
• Prevent by a frequent Pap smear test
95. Womb cancer
• Also known
as, cancer of the
uterus, uterine cancer
or endometrial
cancer(++)
• begins in the lining
or walls of the
uterus.
96. Epidemiology
• Most common gynecologic malignancy
• Eighth leading cause of female mortality
from cancer
• 97% arise from the endometrium
(endometrial carcinoma)
• 3% arise from the mesenchymal
components (sarcoma)
97. Types of womb cancer
• Uterine :
sarcoma
There are two main types of womb cancer:
95% of womb cancers
“starts in the womb’s lining, or endometrium
often caught early, and treated
successfully.
both less common and harder to treat.
starts in the muscle wall of the womb
• Endometrial:
cancer
98. Sub-types
• Leiomyosarcoma : Cancer of the muscle wall - the most
common sarcoma of the womb
• Papillary serous :
carcinoma
Around 5% of womb cancers
• Clear cell carcinoma: Extremely rare, 1 to 2% of
womb cancers
• Adenocanthomas: combine both glandular and
cervical types of malignant cells
99. Two main types of womb cancer
Endometrial
carcinoma
Uterine
sarcoma
100. THE FIRST TYPE OF
WOMB CANCER:
ENDOMETRIAL
CARCINOMA (95%)
102. Epidemiology
• Median age of diagnosis: 60 years
• Most common in women > age 50 years
• Incidence is highly dependent on age
• 75% of uterine cancers occur in post-
menopausal women
105. • NULLIPAROUS WOMEN & WOMEN
WITH PCOD
NON OVULATION
HIGH OESTROGEN
ENDOMETRIAL HYPERPLASIA
NULLIPAROUS WOMEN
ENDOMETRIAL CANCER
106. • Obesity reduces level of serum
hormone binding protein
free estrogen circulates in body
OBESITY
• Peripheral fat : conversion of
epiandrostenedione to
oestrone
109. Clinical manifestations
• Other Signs/Symptoms
– Vaginal Discharge(80-90%)
– Pelvic Pain, Pressure
– Referred Leg Pain
– Change in Bowel Habits
– Pyometria/Hematometria
110. Diagnosis
• Pap Smear
– Only 30-50% patients with cancer will have
an abnormal result
• Endometrial Biopsy
– False negative rate of 5-10%
111. Diagnosis
• Transvaginal Ultrasound
– Not for routine screening or diagnosis
• Fractional Dilation and Curettage
– Use in cases of cervical stenosis,
patient intolerance to exam, recurrent
bleeding after negative biopsy
112. Endometrial Cancer Grade
• The grade is based on the percentage of the
solid component.
– Well Differentiated (Grade 1): <5%
– Moderately Differentiated (Grade 2): 5-50%
– Poorly Differentiated (Grade 3): > 50%
114. Type I Endometrial Carcinoma
• Well differentiated endometrioid
• Better prognosis
• Superficial myometrial invasion
• Infrequent lymph node metastases
• Associated with hyperplasia
• Younger/peri-menopausal women
115. Type II Endometrial Carcinoma
• Older/post-menopausal women
• Thin
• Poorly differentiated carcinoma
– Papillary Serous
– Clear Cell
• Deep myometrial invasion
• Frequent lymph node metastases
• Associated with atrophy
116. Endometrial Carcinoma Treatment
• Surgery is the mainstay of treatment
followed by adjuvant radiation and/or
chemotherapy based on stage of disease.
• Primary radiotherapy or hormonal therapy
may be employed in patients who have
contraindications to surgery.
117. Hormone Therapy
• Appropriate in patients that desire fertility
preservation
• ONLY-G1 tumors!!
• High dose progestins
– Young patient
– Well differentiated
cancer
118. Endometrial Cancer hormonal regimens
Hormonal Regimens (for Endometrioid Only)
Tamoxifen (Nolvadex) Tamoxifen 20mg orally twice daily.
Medroxyprogesterone
acetate(MPA)
Medroxyprogesterone acetate 200mg
orally once daily.
Tamoxifen +medroxyprog
esterone acetate
Medroxyprogesterone acetate 80mg
orally twice daily for 3 weeks
alternating with tamoxifen 20mg orally
twice daily.
Repeat cycle every 3 weeks.
Combination is associated with grade 4
thromboembolic events in a few
patients.1
119. Endometrial Cancer chemotherapy regimens
Chemotherapy Regimens and other Treatment Regimens
REGIMEN DOSING
Cisplatin (Platinol;
CDDP) +doxorubicin (Adria
mycin) (for adjuvant use)
Day 1: Doxorubicin
45mg/m2 IV + cisplatin
50mg/m2 IV, followed by
Days 2–11: Optional filgrastim
5mcg/kg/day.
Repeat cycle every 3 weeks; maximum 6
cycles.
Cisplatin + doxorubicin +p
aclitaxel (Taxol)
Day 1: Doxorubicin
45mg/m2 IV + cisplatin
50mg/m2 IV followed by
Day 2: Paclitaxel 160mg/m2 3-hr IV
infusion, followed by
Days 3–12: Filgrastim 5mcg/kg SC.
Repeat cycle every 3 weeks for max 7
cycles.
Maximum BSA of 2.0 was used for
calculations.
121. Uterine Sarcoma
• 3% of all uterine cancers
• 15% of all deaths from uterine
cancer
• Types Carcinosarcoma
Leiomyosarcoma
Endometrial Stromal Tumors
122. Carcinosarcoma
• Post-menopausal- median age of 62 years
• Associated with diabetes, hypertension, and
obesity
• 7-37% of patients have prior pelvic irradiation
• Poor prognosis
123. Leiomyosarcoma
• Median age 52 years
• Premenopausal have a better prognosis
• Leiomyosarcoma:
1. Mitotic count: > 10 mitosis per HPF
2. Cellular atypia
3. Coagulative necrosis
124. Uterine Sarcoma Treatment: Surgery
3. Bilateral salpingo-ophorectomy
NOT in premenopausal women
1. Stage I/II sarcomas should be treated with
hysterectomy
2. Lymphadenectomy is indicated in all
sarcomas except leiomyosarcoma
126. Uterine Sarcoma Chemotherapy regimens
Chemotherapy
REGIMEN DOSING
Doxorubicin (Adriamycin)
Day 1: 75mg/m2 IV bolus.
Repeat cycle every 31 days OR
60mg/m2–70mg/m2 IV typically dosed every
3 weeks.
Gemcitabine (Gemzar) +do
cetaxel (Taxotere) +granulo
cyte-colony-stimulating
factor (G-CSF)
Days 1 and 8: Gemcitabine 900mg/m2 IV
over 90 min, followed by
Day 8: Docetaxel 100mg/m2 IV over 60
min, followed by
Days 9–15: G-CSF
150mcg/m2 SC OR on Day 9 or
10: Pegfilgrastim 6mg SC.
Repeat cycle every 3 weeks until disease
progression or toxicity occurs.
Gemcitabine
Days 1, 8 and 15: Gemcitabine
1,000mg/m2 IV.
Repeat cycle every 4 weeks.
128. The Fallopian tubes
The Fallopian tubes, also
known as oviducts, uterine
tubes, and salpinges are
two very fine tubes leading
from the ovaries into
the uterus, via the utero-
tubal junction
130. Fallopian tube cancer
• Fallopian tube cancer begins in a
woman’s fallopian tubes
• Adenocarcinoma
• sarcoma
• chorisarcoma
• others
• Secondary + + +
131. Epidemiology
• 5 years survival 56%
0.3% of all gynecology malignancies
3.6 / million women
• One of the most rare malignancy of the female
genital tract
• Mean age of diagnosis 50 yrs.
2/3 menauposal
133. Pathogenesis
• Similar to endometrial and ovarian cancer
Oncogene :
crb
Tumeurs suppressors genes :
p53
134. Clinical manifestations of FTC
•A pelvic mass or lump
•Vaginal bleeding, especially after menopause
•Abdominal or pelvic pain or feeling of pressure
•Vaginal discharge, which may be clear, white,
or tinged with blood
135. Diagnosis of FTC
• Preoperative diagnosis very rare
• Sonography
• Serum ca 125
136. Staging of FTC
• Stage I : confined to fallopian
• Stage II : confined to pelvis
• Stage III: extra pelvic disease
• Stage IV: distant Metastasis
137. Treatment of FTC
• For early disease
• As an adjuvant therapy
• Reassessment laparotomy
Surgery
• Platinum based combination
chemotherapy
Chemotherapy
138. Summary
• Very rare genecology malignancy
• 5 years Survival is 56 %
• Staging and treatment similar to
ovarian cancer
144. Epidemiology
• It causes more deaths than any other
gynecologic cancer.
• 80 percent will survive one year and about
50% will survive five years.
• Ovarian cancer is the second most common
gynecologic cancer after uterine cancer.
145. Risk factors
• Family history of the disease is one of the most
significant risk factors
• The risk of ovarian cancer increases with age
• Rates are highest where diets tend to be
high in fat. Animal fats (red meats, whole
milk or cheese)
146. Types of ovarian cancer
• There are many different types, but the most
common are three:
Ovarian Epithelial Carcinoma; begins in
the cells of the surface of the ovaries.(90%)
Malignant Germ Cell Tumor; Cancer
that begins in the egg cells.
147. Types of ovarian cancer cont’d
Stromal; Cancer that develops on the
connective tissue that holds the ovary
together and produces most of the
female hormones.
• malignant and stromal make up about 10%
148. Pathogenesis
1. Genetic Mutation: Inherited 5 to 10% of Ovarian
Cancer
2. Genetic Mutation: Environmental
Infertility & infertility drugs
Estrogen & Hormone Replacement Therapy
Obesity in adulthood
Talcum Powder
149. Pathogenesis cont’d
3. Oncogenes and Tumor-suppressors
The genes most affected in families with
a history of Ovarian Cancer are BRCA1
and BRCA2
The suppressor Gene p53
150. Clinical manifestations
• Abdominal pressure, swelling, or bloating
• Urinary urgency or burning with no infection
• Pelvic discomfort or pain
• Persistent indigestion, gas, or nausea
151. Clinical manifestations cont’d
• Changes in bladder and bowel habits
• Persistent lack of energy
• Low back pain
• Changes in menstruation.
152. Diagnosis
• Physical
Malignancy: irregular, solid consistency, is
fixed, nodular, or bilateral, is associated
with ascites
• Ultrasound
Low positive predictive value for cancer
153. Diagnosis cont’d
• Tumor markers
Epithelial: CA 125, elevated in 80%
35 U/mL is upper limit of normal
Also elevated in many benign conditions
155. Ovarian Cancer Treatments
There are many different kinds of treatments
available, depends on certain factors, like:
• the stage and size of the tumors,
• your age,
• general health,
• Desire to have kids
156. Ovarian Cancer Treatments cont’d
• Surgery -Is the most common. The surgeon
tries to remove as much of the tumor as possible
• Chemotherapy-. Chemo is commonly
used after surgery to kills cancer cells that
weren’t removed
157. Ovarian Cancer Treatments cont’d
• Radiation Therapy- The main goal is to
reduce pain symptoms
Biotherapy/Immunotherapy- Boosts the
body’s immune system to fight the disease.
158. Ovarian cancer chemotherapy regimens
Intravenous First-Line Primary Chemotherapy/Primary Adjuvant
Therapy (Stage II–IV)
REGIMEN DOSING
Paclitaxel (Taxol) + carboplatin(Pa
raplatin)
Day 1: Paclitaxel 175mg/m2 IV
administered over 3 hrs + carboplatin
AUC=5–7.5mg/mL/min IV administered
over 1 hr.
Repeat every 3 weeks for 6 cycles.
Docetaxel (Taxotere) +carboplatin
Day 1: Docetaxel 60–75mg/m2 IV followed
by
carboplatin AUC=5–6mg/mL/min IV.
Repeat every 3 weeks for 6 cycles.
Dose-dense
paclitaxel +carboplatin
Day 1: Carboplatin AUC=6mg/mL/min IV
administered over 1 hr, plus
Days 1, 8, and 15: Paclitaxel 80mg/m2 IV
administered over 1 hr.
Repeat every 3 weeks for 6 cycles.
159. Ovarian cancer chemotherapy regimens
Intraperitoneal First-Line Therapy for
Advanced Disease
REGIMEN DOSING
Paclitaxel + cisplatin (Platinol;
CDDP)
Day 1: Paclitaxel 135mg/m2 continuous
IV infusion over 24 hrs,followed by
Day 2: Cisplatin 75–
100mg/m2 IP, followed by
Day 8: Paclitaxel 60mg/m2 IP
(maximum body surface area 2m2).
Repeat every 3 weeks for 6 cycles.
160. General Conclusion
FGTM occur in each of the know anatomical segment :
vulvar, vagina, cervix, uterus, fallopian and ovary
FGTM is common and cervical cancer is responsible
for more deaths following by ovarian cancer then
womb cancer
Option exist now for prevention, detection and treatment ,
Abnormal bleeding and discharge is the most
common clinical manifestation
Surgery and chemotherapy are the main treatment
option , hence the need for us to master the adverse
effects of cytotoxic drugs