Reproductive cancers start in the organs related to reproduction. These organs are located in the pelvis. The pelvis is the area in the lower abdomen between the hip bones.
The most common reproductive cancers in the womb are-
Uterine- begins in the uterus (womb), the organ where the baby grows when the women is pregnant.
Cervical- begins in the cervix, the lower end of the uterus that attaches to the vagina.
Ovarian- begin in the ovaries, the two organs that make and house a woman’s eggs.
Vaginal- begins in the vagina, the hollow channel that leads from the uterus to the outside of the body.
Vulvar- begins in the vulva, the area around the opening of the vagina.
Although the exact cause of endometrial cancer is unknown; increased level of oestrogen appears to have a role as oestrogen stimulates the building of the lining of uterus. There is significant association between diabetes mellitus, obesity and hypertension with endometrial cancer.
Diagnosis of Endometrial cancer –
A pelvic examination is frequently normal in the early stages of endometrial cancer. Changes in the size, shape and consistency of the uterus and surrounding structures may be seen when the disease is more advanced.
Clinical features of Endometrial Cancer –
Irregular bleeding and discharge occurring in peri-menopausal or post-menopausal women. It is brown, watery and offensive. The bleeding is not heavy. Occasionally, the patient passes a piece of polypoidal growth per vagina. There may be pain the hypogastrium which can be radiated to 80th iliac fossa.
Treatment of Endometrial Cancer –
If the growth is limited to corpus, the standard treatment is by total hysterectomy and removal of apppendages and cuff of vagina.
Or uerithicus hysterectomy is done when cervix is involved.
Surgery and radiotherapy can be performed in combination.
Radiotherapy alone is given when the patient is unfit or the disease is advanced.
Chemotherapy is given in advanced or recurrent disease.
Hormonal therapy is given in which disease re-occurs and facilities are available for oestrogen and progesterone. Receptors such as assessment will provide a guide as to the most appropriate cytotoxic therapy now-a days. Medroxy progesterone acetate is used. This therapy is free from side effects.
Predisposing factors- family history, endometriosis, infertility, early menopause, blood group –A, high social status.
Age- It may occur at any age but commonly at 40-70 years, nulliparity is associated factor.
Symptomatic- In its early stage it is asymptomatic. There is abdominal pain, swelling, rapid enlargement of the abdomen, dysphasia and progressive loss of weight. Rarely oedema of leg (one-sided) in advanced stages. Symptoms of bowel obstruction.
Ovarian Tumour – Diagnosis and Investigations
Blood Test CA- 125
Treatment of Ovarian Tumour depends upon the stage of the disease-
Removal of the ovarian tumour. Abdominal hystrecoscopy with bilateral salphingoophrenictomy.
Growth with pelvic metastasis
Treatment as above plus removal of metastasis
Stage 3- Inoperable Care
Growth with periosteal involvement. Growth should be removed as much as possible. This at least retards the occurrence of metastasis and gives relief to the patient and prolongs her life.
Exploratory laparotomy should be performed for the diagnosis and some palliation can be extended by debunking tumour mass and ascites. In laparotomy, all exploration is made at omentum, mesentry, small and large bowel liver surface, retropritoneal lymph nodes. Para aortic lymph nodes are inspected if enlarged, are removed.
Post-operative adjunctive therapy is given as soon as possible for residual lesion in stage II, III and IV.
Adjunctive chemotherapy is given in stage I or stage II without residual tumour. At higher stages chemotherapy is given with minimal second look. Laproscopy is done sometimes after incomplete removal of tumour, after long term chemotherapy and exploration of the cavity is done to rule out any persistent disease. Peritoneal washing is taken for cytology.
It is the carcinoma arising from the vulvar skin. It is a rare disease. 1-2% of female genital cancer. It can be primary commonest or secondary to the carcinoma of other genital organs. The later is rarest leukoplakia is a pre-cancerous lesion. 5% can develop carcinoma syphilis and other veneral disease can predispose. Labia majora is the common most site. Labia minora and clitoris is the next common. Anterior part of vulva is more affected. Perineum urethra, vaginal interoitus and anus are less affected. 60 to 70 years is the commonest age period nulliparity favour the conditions. History of pruritis vulva for prolonged period may be prevented.
Symptoms of pruritis vulva, peripheral sore or lump, foul discharge and bleeding. There may be dysuria.
Prophylactic Treatment for Carcinoma Vulva –
Vulvar dystrophy and cellular atypia is treated by vulvectomy.
Curative Treatment for Carcinoma Vulva –
Radical vulvectomy and resection of bilateral superficial and deep inguinal and pelvic lymph nodes is the treatment of choice.
Radiotherapy for Carcinoma Vulva –
This carcinoma does not respond to radiotherapy and vulva tolerated radiation badly.