GYNAE ONCO1 (1).pptxbbshjsjsbbsbshhsbsbsnsjshs

Jjahhsbnsjsjsjbssbhs nhshshsjsjsbsbshjs

1. ENDOMETRIAL CARCINOMA

2. CLINICAL FEATURES Endometrial cancer is asymptomatic in 7–10% Manifests as menorrhagia or irregular menses in Perimenopausal women. Menopausal woman presents with Postmenopausal bleeding. History of PCOS or HRT may be present.

3. RISK FACTORS ENDOGENOUS EXOGENOUS Nulliparity UNCONTROLLED ESTROGEN THERAPY PCOS Tamoxifen Early menarche HEREDITARY Functioning ovarian tumours OTHER RISK FACTORS Obesity Hypertension Diabetes Hyperlipidaemia

4. TYPES Type I are oestrogen-dependent (1)Account for 90% growth. (2)The source of oestrogen may be endogenous or exogenous ogenous. (3)They are well-differentiated with good prognosis. Type II are oestrogen-independent (1) Develop in atropic endometrium (2) They are mostly undifferentiated with poor prognosis (3)P3 mutations are recognized in type II tumours.

5. INVESTIGATION Pap smear : cytological endometrial cells reveal large round cells with dark nuclei filling most of the cells. Aspiration cytology: every 6-monthly is effective in screening high-risk cases Fractional curettage: histological study of en- docervical scraping followed by cervical dilatation and curettage from the isthmus, body of the uterus and fundus separately,To evaluate extent of the lesion. Hysteroscopy and biopsy: visualizes the entire uterine lining and select biopsy from suspicious areas.

6. Ultrasound: studying the endometrial thickness, irregular line, detecting polyp and associated ovarian pathology and extension to the cervix. Sonosalpingography is very useful in detecting endometrial polyp which could be malignant. CT Scan MRI X-ray of lungs, bone and liver scanning by ultra- sound are useful in advanced stage. PET–CT reveals metabolic activity in the tissue and is a gold strandard for staging. CA-125 & other tumor markers

7. DIFFERENTIAL DIAGNOSIS Endometriosis. Tubercular endometritis. Atypical hyperplasia. Polyp

8. STAGING Stage I * Tumour confined to the corpus uterus IA* No or less than half myometrial invasion IB* Invasion equal to or more than half of the myometrium Stage II* Tumour invades cervical stoma, but does not extend beyond the uterus** Stage III* Local and/or regional spread of the tumour IIIA* Tumour invades the serosa of the corpus uteri and/or adnexae# IIIB* Vaginal and/or parametrial involvement# IIIC* Metastases to pelvic and/or para-aortic lymph nodes.

9. IIIC1* Positive pelvic nodes IIIC2* Positive para-aortic lymph nodes with or without positive pelvic lymph nodes Stage IV Tumour invades bladder and/or bowel mucosa, and/or distant metastases IVA* Tumour invasion of bladder and/or bowel mucosa IVB* Distant metastases, including intra-abdominal metastases and/or inguinal lymph nodes

10. TREATMENT Total hysectomy with removal of ovaries is the treatment in elderly women. Hysterectomy combined with lymphadenectomy or postoperative radiotherapy: The postoperative radio-therapy is required in Stages IA (Grade 3), IA2, IB and II. CHEMOTHERAPY Chemo-radiation yields a better effect. The study of lymph nodes will determine the need for postoperative radiotherapy.

11. In a younger woman, Progestogen therapy ,medroxyprogesterone acetate (30–40 mg) daily for 6–12 months with life-long follow-up. Mirena IUCD in young females BRACHYTHERAPY

12. Prophylaxis Adding progestogen for 12 days in hormone replacement therapy reduces the risk of endometrial hyperplasia and cancer to 2%. A woman on tamoxifen needs periodical ultrasound scanning to study the endometrial thickness. Raloxifen has no adverse effect on the endometrium Mirena IUCD is effective against simple endometrial hyperplasia. Oral combined pills reduces cancer risk by 40–50%.

13. Cervical Cancer

14. INTRODUCTION Cervical Cancer is the most common Gynecological Neoplasm around the World. Generally develops in younger population(Compared to other gynaecological malignancy) The median age at diagnosis is 49 years. Cervical cancer is the growth of abnormal cells in the lining of Cervix. Developing countries(85 %) > Developed countries. In developed countries incidence of this disease has fallen considerable to regular screening procedures using Vaccination and Pap Smear.

15. SOURCE --WHO cervical cancer profile INDIA

16. RISK FACTORS HPV-related Non-HPV-related Early onset of sexual activity - <18 YEARS  2x risk 1) Low socioeconomic status  2) Multiple sexual partners – Compared with one partner, the risk is approximately twofold with two partners and threefold with six or more partners 2) Contraceptive use a) OCPs  Risk declines after use ceased . b) Intrauterine device  copper and   levonorgestrel   intrauterine devices (IUDs) may be associated with  lower  rates of cervical cancer 3) History of sexually transmitted infections 3) Cigarette smoking – Smoking is associated with an increased risk of  squamous  cell carcinoma but not of adenocarcinoma. 4) Early age at first birth (younger than 20 years old) and increasing parity  d/t increases risk of exposure to HPV 5) Immunosuppression

17. HPV 16 is more commonly associated with squamous cell carcinoma of the cervix. HPV 18 is a risk factor or cervical adenocarcinoma

18. PATHOGENESIS Tumorigenesis Persistent HPV infection -> preinvasive dysplastic cervical lesions -> squamous cell carcinoma,the cervix typically arises at the squamocolumnar junction Replication proteins E1 and E2 (enable the virus to replicate within cervical cells) E1 and E2 enable the virus to replicate within cervical cells They can lead to cytologic changes detected on pap smear Dysplasia to invasive cancer requires several years.

19. Tumour Spread: Exophytic if a cancer arises from the ectocervix Endophytic if it arises from the endocervical canal As tumor invades deeper into the stroma, it enters blood capillaries and lymphatic channels termed lymphovascular space involvement(LVSI) Its presence is regarded as a poor prognostic indicator, especially in early-stage cervical cancers

20. Distant metastasis results rom hematogenous dissemination, and the lungs, ovaries, liver, and bone are the most frequently affected With extension through the parametria to the pelvic sidewall, ureteral blockage frequently develops, resulting in hydronephrosis. Additionally, the bladder may be invaded by direct tumor extension through the vesicouterine ligaments (bladder pillars) The rectum is invaded less because it is anatomically separated rom cervix by the posterior cul-de-sac

21. CLINICAL FEATURES Most women are asymptomatic watery, blood tinged vaginal discharge. Intermittent vaginal bleeding that follows coitus or douching is seen. As malignancy enlarges-bleeding typically intensifies, and occasionally uncontrolled hemorrhage from tumor bed is noted.

22. DIAGNOSIS & STAGING

23. Colposcopy PAP SMEAR