Uterine Cancer and Cervical Cancer by xumiaomaio

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									Uterine Cancer and Cervical
          Cancer
       Thomas Randall, M.D.
       Pennsylvania Hospital
    Perelman School of Medicine
     University of Pennsylvania
         Endometrial Cancer
• Endometrial cancer is
  a disease in which
  malignant (cancer)
  cells form in the
  tissues of the
  endometrium.
Possible signs of endometrial cancer
include unusual vaginal discharge or
         pain in the pelvis.
• A doctor should be consulted if any of the
  following problems occur:
  – Bleeding or discharge not related to
    menstruation (periods).
  – Difficult or painful urination.
  – Pain during sexual intercourse.
  – Pain in the pelvic area.
  Tests that examine the endometrium are
    used to detect (find) and diagnose
             endometrial cancer.

• Endometrial biopsy
• Dilation and Curettage (D&C)
Dilatation and curettage (D and C). A speculum is inserted into the vagina to widen it in order to look at the cervix (first panel). A dilator is used to widen the cervix (middle panel).
A curette is put through the cervix into the uterus to scrape out abnormal tissue (last panel).
 Certain factors affect prognosis (chance of
      recovery) and treatment options.
The prognosis (chance of recovery) and treatment
  options depend on the following:
• The stage of the cancer (whether it is in the
  endometrium only, involves the whole uterus, or
  has spread to other places in the body).
• The grade of the tumor, or how the cancer cells
  look under a microscope.
• Whether the cancer cells are affected by
  progesterone.
• Endometrial cancer is often highly curable.
Stage
Grade
After endometrial cancer has been diagnosed, tests are
 done to find out if cancer cells have spread within the
          uterus or to other parts of the body.
  • The process used to find out whether the
    cancer has spread within the uterus or to
    other parts of the body is called staging.
  • Certain tests and procedures are used in
    the staging process.
  • A hysterectomy (an operation in which the
    uterus is removed) will usually be done to
    help find out how far the cancer has
    spread.
 There are three ways that cancer
       spreads in the body.
• Through tissue. Cancer invades the
  surrounding normal tissue.
• Through the lymph system. Cancer
  invades the lymph system and travels
  through the lymph vessels to other places
  in the body.
• Through the blood. Cancer invades the
  veins and capillaries and travels through
  the blood to other places in the body.
                  Stage I
• In stage I, cancer is found in the uterus
  only. Stage I is divided into stages IA and
  IB, based on how far the cancer has
  spread.
• Stage IA: Cancer is in the endometrium
  only or less than halfway through the
  myometrium (muscle layer of the uterus).
• Stage IB: Cancer has spread halfway or
  more into the myometrium.
                 Stage II
• In stage II, cancer has spread into
  connective tissue of the cervix, but has not
  spread outside the uterus.
                      Stage III
• In stage III, cancer has spread beyond the uterus and
  cervix, but has not spread beyond the pelvis. Stage III is
  divided into stages IIIA, IIIB, and IIIC, based on how far
  the cancer has spread within the pelvis.
• Stage IIIA: Cancer has spread to the outer layer of the
  uterus and/or to the fallopian tubes, ovaries, and
  ligaments of the uterus.
• Stage IIIB: Cancer has spread to the vagina or to the
  parametrium (connective tissue and fat around the
  uterus).
• Stage IIIC: Cancer has spread to lymph nodes in the
  pelvis and/or around the aorta (largest artery in the body,
  which carries blood away from the heart).
                  Stage IV
• In stage IV, cancer has spread beyond the
  pelvis. Stage IV is divided into stages IVA and
  IVB, based on how far the cancer has spread.
• Stage IVA: Cancer has spread to the bladder
  and/or rectal wall.
• Stage IVB: Cancer has spread to other parts of
  the body beyond the pelvis, including the
  abdomen and/or lymph nodes in the groin.
                Treatment
• Hysterectomy
  – Abdominal incision
  – Vaginal incision
  – Laparoscopic
  – Robotic
• Types
  – Total +/- removal of tubes and ovaries
  – Radical
Options for Treatment
Robotic Surgery?
Robotic Surgery
          Treatment Options
• Treatment usually begins with
  hysterectomy with or without ‘surgical
  staging’
• After surgery the pathology report will
  determine the stage
• The stage and other factors can give an
  estimate for the risk of recurrence of the
  cancer
            “Surgical Staging”
• Hysterectomy and
  removal of pelvic and
  paraaortic lymph nodes
• Advantage – can identify
  and remove cancer cells
• Disadvantage –
  complications
• Never proven to improve
  survival
            Adjuvant Therapy
• Treatment given to decrease the risk of
  recurrence
• Many women with endometrial cancer are at low
  risk for recurrence
• Radiation therapy
  – Decreases local recurrence
  – Not proven to increase survival
• Chemotherapy
  – Usually for women at high risk
  – May increase survival
• Hormonal therapy
Treatment Options for Recurrent
      Endometrial Cancer
• Radiation therapy as palliative therapy to
  relieve symptoms and improve the
  patient’s quality of life.
• Hormone therapy.
• Chemotherapy.
• Clinical trials.
 Patients may want to think about
   taking part in a clinical trial.
• http://www.cancer.gov
• http://www.uphs.upenn.edu/obgyn/clinical-
  trials/
           Uterine Sarcoma
• Uterine sarcoma is a
  disease in which
  malignant (cancer)
  cells form in the
  muscles of the uterus
  or other tissues that
  support the uterus.
           Uterine Sarcoma
• Uterine sarcoma is rare (1/800 women
  having hysterectomy for fibroids)
• Risk factors:
  – Pelvic radiation
  – Tamoxifen
 Diagnosis of Uterine Sarcoma
• Abnormal Bleeding
• Rapid uterine enlargement
• Enlargement of the uterus after
  menopause
     What Affects Recovery?
• The prognosis (chance of recovery) and
  treatment options depend on the following:
  – The stage of the cancer.
  – The type and size of the tumor.
  – The patient's general health.
  – Whether the cancer has just been diagnosed
    or has recurred (come back).
    Treatment of Uterine Sarcoma
•   Hysterectomy and excision of any tumors
•   Possible radiation therapy
•   Chemotherapy
•   Clinical Trials
               Cervical Cancer
• Cervical cancer is a
  disease in which
  malignant (cancer) cells
  form in the tissues of the
  cervix.
• The cervix is the lower,
  narrow end of the uterus
  (the hollow, pear-shaped
  organ where a fetus
  grows). The cervix leads
  from the uterus to the
  vagina (birth canal).
Human papillomavirus (HPV) infection is the
 major risk factor for development of cervical
                     cancer.
• HPV infection can be detected by pap
  testing
• Not everyone with HPV will develop
  cancer
• Smoking cigarettes increases the risk that
  people will get cervical cancer
 Risk Factors For Cervical Cancer
• Giving birth to many children.
• Having many sexual partners.
• Having first sexual intercourse at a young
  age.
• Smoking cigarettes.
• Using oral contraceptives ("the Pill").
• Having a weakened immune system.
 Screening for Cervical Cancer
• Regular pelvic exams with pap smears
• Treatment of Cervical Dysplasia
  – Colposcopy
  – LEEP or Cone Biopsy
  – ?Treatment with HPV vaccine
Pap Test
  Possible signs of cervical cancer include
     vaginal bleeding and pelvic pain.
• A doctor should be consulted if any of the
  following problems occur:
  – Vaginal bleeding.
  – Unusual vaginal discharge.
  – Pelvic pain.
  – Pain during sexual intercourse.
The prognosis (chance of recovery)
  depends on the following:
• The patient's age and general health.
• Whether or not the patient has a certain
  type of human papillomavirus.
• The stage of the cancer (whether it affects
  part of the cervix, involves the whole
  cervix, or has spread to the lymph nodes
  or other places in the body).
• The type of cervical cancer.
• The size of the tumor
              Treatment
Treatment options depend on the following:
• The stage of the cancer.
• The size of the tumor.
• The patient's desire to have children.
• The patient’s age.
  Treatment for Young Women
• Fertility sparing treatments may be
  available for young women with cervical
  cancer who have smaller tumors
• Cone biopsy
• Trachelectomy
     Staging Cervical Cancer
Clinical:
• Pelvic exam (sometimes in the OR)
• CT scan
• MRI
                  Stage I
• Stage IA – microscopic tumor, can be
  treated with more limited surgery or
  radiation
• Stage IB – visible tumor confined to the
  cervix, treated with ‘radical surgery’ or with
  radiation +/- chemotherapy
     Stage II Cervical Cancer
• Stage IIA – tumor in the upper vagina,
  treated with radical surgery
• Stage IIB – tumor in the tissues outside
  the cervix, treated with radiation and
  chemotherapy
  Stage III, IV Cervical Cancer
• Stage IIIA – Involvement of the lower
  vagina
• Stage IIIB – Spread to the pelvic wall or
  blockage of the urinary tract
• Stage IVA – spread into the bladder or
  rectum
• Stage IVB – distant spread
• All treated with chemotherapy and
  radiation
    Prevention of Cervical Cancer
•   Screening
•   Barrier contraception
•   Smoking cessation
•   HPV vaccine

								
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