| TO
WELCOME
TO CONTENTS |
|
|
|
|
|
| NEVER,
NEVER IGNORE POSTMENOPAUSAL BLEEDING, AND DO NOT LET YOUR DOCTOR IGNORE
IT EITHER. YOU MUST PROVE THAT IT IS NOT DUE TO A UTERINE CANCER.
A great site with
an overview of all gynecological cancers, complete with glossary
of terms is at http://www.gyncancer.com/
|
|
|
The National Institutes of Health Consensus Development Conference on Ovarian Cancer:
Screening, Treatment, and Followup brought together epidemiologists; obstetrician/gynecologists; gynecologic, medical, and radiation oncologists; and the public to address the following questions: (1) What is the current status of screening and prevention in ovarian cancer? (2) What is the appropriate management of early stage ovarian cancer? (3) What is the appropriate management of advanced epithelial ovarian cancer? (4) What is the appropriate followup after primary therapy? and (5) What are the directions for future research? The consensus panel concluded that there is no evidence available yet that the current screening modalities of CA 125 and transvaginal ultrasonography can be effectively used to reduce mortality from ovarian cancer nor that their use will result in decreased rather than increased morbidity and mortality. They recommended that further prospective research be done to evaluate this very important issue. Women with stage IA grade 1 and most IB grade 1 ovarian cancer do not require postoperative adjuvant therapy. Many remaining stage I patients do require chemotherapy. Subsets of stage I must be fully defined and ideal treatment determined. Women with stages II, III, and IV epithelial ovarian cancer (other than low malignant potential tumors) should receive postoperative chemotherapy. Physicians should be encouraged to discuss clinical trial participation with women, and women should be encouraged to participate. All women should have access to accurate and complete information regarding ovarian cancer. Furthermore, there must be no barriers to women's access to qualified specialists, optimal therapy, and protocols. |
|
| National Ovarian Cancer Coalition at http://www.ovarian.org/pages.asp?page=RESOURCES has a phenomenal collection of ovarian cancer and related links. The original creator of the page was a member of The Ovarian Discussion List, Beth McCabe, known as Yerstrooly. She passed away on July 28, 1997. At the time this reference was first posted, the page was maintained by OVCA survivor Jacquie Gower "in memory of all those we have lost" but in July 2001 Jacquie also died. | |
| Ovarian cancer
extracts from http://www.gyncancer.com/ovarian-cancer.html
Why effective screening is impossible There is no easy way to evaluate an abnormal test. All you can do is say that your cancer test is positive but that it is probably wrong by a factor of 99 to 1, and maybe you should just forget about it. Or, you could repeat it in several months and pick the best two out of three results. Or, if you wish to pursue it, you will eventually have to remove the ovaries to prove that there is no cancer. Unlike the abnormal Pap test that can easily be evaluated as many times as you wish there is no easy way to evaluate an abnormal Ca-125 or ultrasound test. There is no recognized professional organization that has evaluated this problem that recommends screening. It may be possible someday but not now. Those with a documented familial ovarian cancer syndrome where the lifetime risk of developing ovarian cancer is about 50% are advised to have annual physical examinations and consider an annual pelvic sonogram. Those who have set up ovarian cancer screening programs for women with a family history of ovarian cancer have not reported any substantial benefit. Even if you decided to undergo regular Ca-125 and pelvic sonogram testing, how often should it be done? Every year seems not very adequate for ovarian cancer. How long should it be done? For the next 30 years? cause: unknown
management of cysts - for "wait and see versus operate" visit http://www.gyncancer.com/ovarian-cancer.html#management |
|
| Ovarian
cysts (extracts from http://www.gyncancer.com/ovarian-cysts.html
)
Ovarian cysts
If:
Schedule a reexamination
for 4 weeks. If it is gone or getting smaller then it was a functional
cyst: either a follicle cyst or a corpus luteum cyst. Nothing more needs
to be done. If it persists then a diagnosis must be arrived at surgically.
Note Women on birth control pills should not develop functional cysts. (The function of the pill is to suppress ovulation, although some women ovulate on their pills) Premenarchal and postmenopausal women should not develop functional cysts. Women in these groups with a cyst as well as those with a complex or a solid cyst will have to be evaluated surgically. This is the only way to make sure that the cyst is or is not a cancer. |
|
RISK FACTORS FOR UTERINE ADENOCARCINOMA age - the cancer of the perimenopausal and postmenopausal woman.There is also a well-recognized association with estrogen. Postmenopausal women who are taking estrogen also will have an unopposed estrogen stimulation to the uterine glands and be at increased risk for developing an adenocarcinoma of the SYMPTOMS The most frequent symptom of cancer of the uterus is abnormal bleeding. In postmenopausal women any bleeding is considered cancer of the uterus until proven not to be. The only way to prove that there is or is not a cancer inside the uterus is by removing some of the lining.The procedure is called a D&C, dilatation of the cervix and curettage of the uterine lining. Sometimes a scope can be inserted through the cervix into the uterus and the lining visualized and biopsied directly. This is called a hysteroscopy . The problem with postmenopausal hormone replacement is that it often causes some irregular bleeding which may require a biopsy. If the hormones are taken on a cyclic basis where there are several days each month when bleeding may occur and if the bleeding is light and occurs on those days then biopsy need not be done. If it occurs at any other time in the cycle then a biopsy should be done. If the hormones are both being taken on a continuous basis each day and bleeding occurs then a biopsy should be performed SCREENING
http://www.ama-assn.org/sci-pubs/journals/most/recent/issues/jama/ma80013a.htm Endovaginal Ultrasound to Exclude Endometrial Cancer and Other Endometrial Abnormalities Conclusion.—Endovaginal ultrasound has a high sensitivity for detecting endometrial cancer and other endometrial disease and can reliably identify postmenopausal women with vaginal bleeding who are highly unlikely to have significant endometrial disease so that endometrial sampling may be unnecessary. JAMA. 1998;280:1510-1517 (Endometrial thickness of less than 5mm is "safe" - Tishy) uterus. |
|
|
http://text.nlm.nih.gov/nih/upload-v3/CDC_Statements/Cervical/cervical.html NIH Consensus Development Statement on cervical cancer This is a large site with the stated objective: To provide physicians and the general public with a responsible assessment of current screening, prevention, andtreatment approaches to cervical cancer. Conclusions. Carcinoma of the cervix is causally related to infection with the human papillomavirus (HPV). Reducing the rateof HPV infection by changes in sexual behaviors in young people and/or through the development of an effective HPV vaccine would reduce the incidence of this disease. Pap smear screening remains the best available method of reducing the incidence and mortality of invasive cervical cancer. Persons with stage IA1 disease have a high cure rate with either simple hysterectomy or, where fertility preservation is an issue, by cone biopsy with clear margins. For patients with other stage I and stage IIA disease, radical surgery and radiation are equally effective treatments. These patients should be carefully selected to receive one treatment or the other but not both, as their combined use substantially increases the cost and morbidity of treatment. Women with more advanced, nonmetastatic disease should be treated with radiation. Recurrent cervical cancer confined to the pelvis should be treated with the modality not previously received. Radiation is recommended to palliate symptoms in patients with metastatic disease. Extracted with permission from a detailed site at http://www.gyncancer.com/cervix.html The cervix is the part of the uterus connected to the upper vagina. It is the structure that dilates during childbirth to allow the baby to traverse the birth canal. There are two major types of cancer that develop from the cervix. Squamous cell cancers arise from the squamous epithelium that covers the visible part of the cervix. Adenocarcinomas arise from the glandular lining of the endocervical canal. About 85% of cervical cancers are squamous cell cancers and the remainder adenocarcinomas. Each of these major types has several subtypes that may require special treatment; otherwise they are all managed similarly. Squamous cell cancers are unique because there is a well established progression through premalignant changes before a cancer develops. These premalignant changes are easy to detect by a simple screening test called the Pap test. CAUSE The cause of cervical cancer is unknown. There is a strong association with certain subtypes of the Human Papilloma Virus (HPV) for the squamous cell cancers SCREENING Screening means to test for the presence of a cancer before there are any symptoms or findings on examination. If there are symptoms or abnormal findings on examination then a diagnostic test must be done; not a screening test SYMPTOMS There may be no symptoms of a very early cervical cancer, but by the time it is large enough to detect visually it is usually symptomatic with abnormal bleeding. Often this abnormal bleeding occurs after sexual intercourse DIAGNOSIS A major mistake is to rely on a Pap test to rule out a cancer in a woman who has symptoms or findings that could be due to a cancer. A normal Pap test never excludes a cancer. Cancer can only be excluded by the proper biopsies. It is known that about 10% of women with an obvious cancer of the cervix will have a Pap test that is essentially normal. STAGING TREATMENT PROGNOSIS Most early cancers are cured; most advanced cancers are not RECURRENCES CERVICAL CANCER DURING PREGNANCY |