Early Detection of Gynecological Tumors

• Pubic cysts (sebaceous gland cysts, cysts of the Bartholin’s duct, Nuck’s duct cysts, inclusion cysts, mucinous cysts, Skene’s gland cysts, endometriotic cysts)
• Solid tumors of the pubis (fibromas, lipomas, hidradenomas, myoblastoma, pigmented mole (lat. naevus pigmentosus), hemangioma, cavernous angioma, angiokeratoma)

Pre-cancer, which means it can become cancer if not treated in time. Symptoms are itching, raised skin changes of various colors (brown, red, pink, white or gray). The disease can also appear without symptoms. Investigations for diagnosis are colposcopy and biopsy. Treatment is often successful and involves surgical excision of the change.

• Cysts of the vagina (mesonephritic cysts/Gartner duct cysts, paramesonephritic cysts, inclusion cysts, hymenal cysts, endometriotic cysts)
• Solid tumors of the vagina (polyps, fibroids and myomas, moles (nevi), hemangiomas, paragangliomas)

• Cancer of the vulva (Carcinoma vulvae)
• Pubic melanoma
• Paget’s disease
• Cancer of the vagina (Carcinoma vaginae)

• Erythroplakia (ectopy, ectropion, erosion vera)
• Cervical polyps (endocervical polyps, ectocervical polyps
• Cervical condylomas (condyloma acuminatum, condyloma planum)

Potentially premalignant cell changes on the surface of the cervix are detected by the Papatest.

• Pap test is recommended once a year to once every 3 years, (depending on risk behavior) for all sexually active women
• the time for the first Pap test is after the first sexual intercourse
• CIN is caused by chronic infection with HPV (human papillomavirus)
• There are over 100 types of HPV
  – Low-risk HPV causes warts
  – High-risk HPV causes cell changes on the cervix that show up as CIN on a Pap test

Types of CIN:

• CIN I – mild, superficial cell changes on the surface of the cervix – most often (60%) disappear after a year
• CIN II and CIN III – moderate and severe cell changes on the surface of the cervix
• CIS (carcinoma in situ) – initial limited carcinoma of the cervix

Procedure:

• CIN I – vaginal smears, cervical smears, Pap tests are repeated every 4 months
• if CIN I repeats, a colposcopy (examination of the cervix with a special magnifier) is required
• in case of CIN II and CIN III, in addition to colposcopy, a biopsy (taking a tissue sample for analysis under a microscope) is required
• if the biopsy confirms the diagnosis, in addition to a repeated Pap test, an operation is required (LETZ conization or cold knife conization, during which the diseased tissue is removed from the surface of the cervix)

Cervical cancer, or cervical cancer, is a malignant disease that affects women. The biggest risk factor for the disease is infection caused by the human papillomavirus (HPV). The disease can be prevented in 80% of cases by regular examination with a Pap test. Cervical cancer ranks second, both in terms of frequency of occurrence and mortality from gynecological cancers after breast cancer. This disease most often occurs in women aged 45 to 50. About 37% of affected women are under the age of 35, while women over 65 make up 10% of the affected. The highest mortality according to age groups is for women aged 65, which is related to the advanced stage of the disease at the time of diagnosis. Every year, around 500,000 women fall ill in the world, and around 250,000 die.

The causes are not completely known, but the risk factors that increase the possibility of the disease are as follows:

• HPV infections – subtypes 16, 18, 31, 33 and 35. HPV can be transmitted sexually, so any sexually active woman is at risk
• People from lower socioeconomic classes with weaker opportunities for regular health care
• Early onset of sexual life and a greater number of sexual partners
• Smoking

About 80% of malignant tumors of the cervix develop from the mucosa of the exocervix and are classified as squamous cell cancer (Ca planocellulare or squamocellulare). About 18% of malignant tumors of the cervix arise from the mucous membrane of the cervical canal and are classified as raccylindrical cells (adenocarcinoma). The rest of 2% is made up of other histological types.

Therapy depends on the stage of the disease. Surgical removal of the uterus and lymphadenectomy of regional iliac lymph nodes with removal of the upper third of the vagina is the method of choice in the early stage of the disease. If surgery is contraindicated or the patient does not want treatment, radiotherapy is an option. In advanced cases, chemotherapy may also be included. In the presence of metastases, the action should be palliative, and depending on the site of metastasis, radiotherapy or chemotherapy is applied, with the aim of improving the quality of life.

Myomas are benign tumors of the uterus, which are made of smooth muscle cells and connective tissue. They belong to the most common formations in the small pelvis, and are the cause of 1/3 of surgical interventions that remove the uterus (hysterectomies). About 20-25% of women over the age of 35 have fibroids. They are usually symptomless, rarely occur before puberty, and decrease in menopause due to reduced levels of hormones, predominantly estrogen. Fibroids are dependent on estrogen hormones and can grow during hormone replacement therapy or during pregnancy. They appear individually, but more often they appear as multiples. By localization, fibroids can be intramural, subserous and submucosal. They can be on the stalk, embedded in the cervix, and ligamentous.

Depending on the wall and structure of the uterus, fibroids can basically grow in three ways:

• Intramural myoma: develops inside the wall of the uterus, thereby disrupting its thickness and increasing its volume.
• Subserous myoma: develops on the outer surface of the uterine wall. With its growth, it protrudes outward so that it minimally disturbs the appearance of the uterine wall and is covered only by a thin membrane – peritoneum (lat. serosa).
• Submucosal myoma: it develops in the same way as subserous, only towards the cavity of the uterus covered with mucosa (lat. mucosa).

Symptoms

The most common symptom is abnormal bleeding from the uterus, mostly following menstrual bleeding (prolonged menstrual bleeding). It does not have to be related to menstruation and is usually more abundant. Other symptoms include: pelvic pain, usually associated with menstrual bleeding, which is mainly caused by submucosal fibroids that stimulate uterine contractions. Sometimes there is a sudden acute pain as a result of torsion of the fibroid on the stalk or degeneration of a large fibroid. Fibroids can create pressure and heaviness in the small pelvis, pressure on neighboring organs, stool constipation, urinary retention and infertility. About 3% of infertile patients have fibroids as the cause of infertility.

Fibroids and pregnancy

In the case of pregnancy planning, it is necessary to assess the size of fibroids, their number and localization. With the presence of fibroids, the risk for spontaneous abortion is 18%, and for premature birth 20-30%. In the 2nd and 3rd trimester of pregnancy, fibroids can grow and soften. Also, they can stimulate uterine contractions and tocolysis is needed.

Treatment

Treatment of fibroids depends on symptoms, age, parity, desire for pregnancy and its size. Hysterectomy, exstirpatio myomatis is usually performed with a classic laparotomy procedure or laparoscopically. In the case of submucosal myomas, hysteroscopic myoma ablation is also performed. Asymptomatic fibroids are checked regularly during gynecological examinations. After menopause, fibroids shrink and never grow. In the event that myoma grows in menopause, this is an indication for surgery to remove the uterus to rule out malignant transformation of the myoma.

Bleeding therapy: Progesterone preparations are generally given about 10 days a month, they are used mainly in perimenopause. GNRH analogues are given at a younger age, because they induce false menopause, reduce the size of fibroids. Myoma embolization is rarely performed.

After evaluation and PHD treatment of the uterus, the LNG-IUD insert is successfully used for submucous fibroids.

Cancer of the uterus (carcinoma of the endometrium) most often affects the inner layer of the uterus (endometrium). If detected and treated at an early stage, the cure rate is high (more than 90%). Progression of the disease, i.e. detection at a later stage reduces cure. The most common type of uterine cancer is adenocarcinoma. Adenocarcinoma involves the cells of the inner layer of the uterus. Sarcoma is another type of uterine cancer, it grows from muscle or other tissue (rare). Uterine cancer is rare in women under the age of 40. It is most common in women aged 60-75.

Women at higher risk of uterine cancer:

• Obese women
• Women who often have an absence of menstrual bleeding
• Women who are late in menopause (the time when menstruation ends, which is most often around the age of 50)
• Women who have polycystic ovary syndrome (PCOS)
• Women who have endometrial hyperplasia (abnormal thickness of the endometrium)
• Women who have had ovarian, breast or bowel cancer
• Women who have a family history of uterine cancer

Some women take estrogen after menopause to replace the hormone that the ovaries no longer secrete. These women may have an increased risk of uterine cancer. If estrogen is combined with another hormone – progesterone – the risk of uterine cancer decreases. The most common type of birth control pill is a combination (estrogen and progesterone). Women who take such pills reduce the risk of uterine cancer. This reduced risk lasts for at least ten years after a woman stops taking birth control pills. If a woman has some or all of the risk factors for uterine cancer, she may never get it. But women at risk should watch out for symptoms of uterine cancer. They should discuss their concerns with a doctor and have regular check-ups.

Symptoms

So far, there is no simple way to detect uterine cancer at an early stage in women who have no symptoms. The key to early detection of the disease is paying attention to the symptoms. The main symptom of uterine cancer is abnormal bleeding, spotting or vaginal discharge. It can be permanent or occasional. A watery discharge with a specific odor may precede abnormal bleeding. Discharge can be the first sign of a problem. Except when taking hormone therapy, any bleeding or spotting after menopause is not normal. Most methods for diagnosing uterine cancer can be done in an outpatient clinic. Methods include ultrasound or endometrial biopsy. Hysteroscopy can sometimes be performed with local anesthesia. Dilation and curettage are performed in the hospital.

Treatment

If uterine cancer is detected, the stage of the disease and the method of treatment will be determined by surgery. The stage of the disease helps the doctor decide which method of treatment has the best chance of success. About 75% of women have the first stage of uterine cancer. Of these women, 85-90% will have no signs of cancer 5 or more years after treatment. For the treatment of uterine cancer in a large number of patients, the uterus, ovaries and fallopian tubes are removed. Pelvic lymph node tissue may be tested to see if the cancer has spread. In some cases, radiation is also necessary after surgery. Chemotherapy or progesterone (hormonal) therapy can be used for uterine cancer that has spread to other organs.

Prevention

There are things you can do to reduce your risk of uterine cancer or increase the chance of it being detected early:

• Contact a doctor for any abnormal bleeding (most bleeding is not caused by cancer)
• Perform annual gynecological examinations
• Consume food with less fat and cholesterol and more fiber (fruits, vegetables, whole grains)

Ovarian cancer is a disease that affects one or both ovaries, the organs located on each side of the uterus. Patients whose cancer has not spread beyond the ovaries have an 85-95% chance of five-year survival after treatment. Types of ovarian cancer:

• Covering epithelium
• Specialized ovarian stroma
• Lipoid tumors
• Originating from rete ovarii
• Reproductive cells
• Germ and stromal cells
• Of uncertain origin
• Connective tissues
• Which cannot be classified
• Metastatic (secondary)
• Tumor-like changes

Cancer/carcinoma of the covering epithelium is the most common. Approximately 90% of ovarian cancer develops from epithelial cells. These are the cells that cover the surface of the ovary. Most women who have epithelial ovarian cancer are over 40 years old. In approximately 10% of cases, ovarian cancer arises from germ cells, and the rest of cases arise from stromal tumors. Those two types of ovarian cancer more often affect women under 40 years of age.

Risk

Women of any age can get ovarian cancer, but the risk increases with age. It most often affects women between the ages of 50-75. It is less common in women younger than 40, and more common in white women. Women who have given birth to more children are less likely to get ovarian cancer. Women who have used or are using birth control pills also get sick less often.

Risk factors:

• women who have given birth once and women who have never given birth
• childbirth at a later age
• taking fertility drugs for a long time
• ovarian cancer in the family. Women can have some or all of the risk factors and not get ovarian cancer. Women without risk factors should also know the symptoms of ovarian cancer and get checked regularly

Symptoms

Ovarian cancer often has no symptoms in its early stages. The result is that ovarian cancer cannot be detected until it is advanced. This makes treatment more difficult. There are several symptoms of the disease that can be mild and difficult to detect.

The warning signs are:

• Feeling of discomfort in the pelvis
• Poor digestion, gas, bloating that cannot be explained
• Irregular bleeding
• Pain and feeling of bloating in the abdomen

Detection

The best way to detect ovarian cancer at an early stage is a gynecological examination. During the examination, the doctor can feel a tumor or cyst on the ovaries. A small number of cysts are malignant. Cysts must be regularly checked for growth. Other tests to detect ovarian cancer include ultrasound, chest X-ray and laparoscopy. Ultrasound testing and the CA 125 antigen blood test are being studied as methods of early detection of ovarian cancer. The malignancy of a tumor can only be confirmed by surgery.

Treatment

If there is a suspicion that a woman has ovarian cancer, surgery is necessary. The surgeon will examine the extent of the disease, remove the cancer and decide on further treatment. The procedure depends on the degree and speed of the cancer’s spread. When planning the treatment, the patient’s age, state of health and wishes are taken into account. In most women, the uterus, ovaries and fallopian tubes are removed by surgery. In some cases, some lymph nodes and part of the intestine must be removed. Surgery is often followed by chemotherapy and radiation. Chemotherapy often involves taking cisplatin or carboplatin along with other drugs.