Gynecologic cancer

Signs and symptoms usually vary depending on the type of cancer. The most common symptoms across all gynecological cancers are abnormal vaginal bleeding, vaginal discharge, pelvic pain and urination difficulties. Vulvar cancer • Pruritus: persistent itch in the vulva • Vulvar bleeding • Vulvar pain, soreness or tenderness • Burning sensation when urinating • A visible wart-like mass or sore on the vulva == Risk factors ==

Obesity Obesity is associated with an increased risk of developing gynecologic cancers such as endometrial and ovarian cancer. For endometrial cancer, every 5-unit increase on the BMI scale was associated with a 50-60% increase in risk. Type 1 endometrial cancer is the most common endometrial cancer. As many as 90% of patients diagnosed with Type 1 endometrial cancer are obese. Although a correlation between obesity and ovarian cancer is possible, the association is predominantly found in low-grade subtypes of the cancer. Genetic mutations Genetic mutations such as the BRCA1 and BRCA2 have been strongly linked to the development of ovarian cancer. The BRCA1 mutation has been shown to increase the risk of developing ovarian cancer by 36% - 60%. The BRCA2 mutation has been shown to increase the risk of developing ovarian cancer by 16% - 27%. A clear link between human papilloma virus and cervical cancer has long been established, with HPV associated with 70% to 90% of cases. Persistent human papilloma virus infections have been shown to be a driving factor for 70% to 75% of vaginal and vulvar cancers. Current women smokers are twice as likely to develop cervical cancer compared to their non-smoking counterparts. The cervical epithelium's DNA is damaged due to smoking. Through similar mechanisms, women smokers have also been found to be 3 times more likely to develop vulvar cancer. Smoking has also been associated with an elevated risk for vaginal cancer. Some studies have shown that 1 in every 7 couples will fail to conceive due to infertility problems. Infertile women are at a higher risk of developing ovarian cancer and endometrial cancer when compared to fertile women. == Treatments ==

Ovarian cancer The vast majority of cases are detected past the point of metastasis beyond the ovaries, implicating a higher risk of morbidity and a need for aggressive combination therapy. Surgery and cytotoxic agents are typically required. Histology type is almost primarily epithelial, so treatments will refer to this subtype of pathology. Higher tumour grades may benefit from adjuvant treatment such as platinum-based chemotherapy. The goal of this procedure is to leave no tumour larger than 1 cm by the removal of significant portions of affected reproductive organs. This has been shown to increase median survival of chemosensitive patients by up to 6 months. Fertility preserving surgery involves a thorough differential diagnosis to rule out germ cell cancer or abdominal lymphoma, both of which resemble advanced ovarian cancer in presentation but are treatable with gentler methods. Fertility preserving surgery is one of the few cases where a second look laparotomy is recommended for caution. Local excision via loop cone biopsy is sufficient if detected in the earliest stage. More aggressive cases with lymphatic spread are often treated with radiotherapy. Hormone therapy is most commonly used to treat systemic spread, as endometrial cancer patients tend to be older and have other illnesses that make them poor candidates to withstand harsh cytotoxic agents used in chemotherapy. The minority of non-squamous histological subtypes do not typically require removal of the inguinal nodes. Surgical resection and definitive radiotherapy are the first-line of treatment for early-stage vaginal cancer. External-beam radiation therapy involves the delivery of a boost to the pelvic side of the patient at a 45 Gy dose. == Prognosis ==

The experience of cancer influences the psychological aspect of sexuality, by posing a risk of developing barriers such as body image issues, low self-esteem, and low mood or anxiety. Other barriers include changes to reproductive organs or sex drive as well as potential genital pain. == Epidemiology ==

• 1 in 70 women will develop ovarian cancer at some point in their life. Scandinavian countries have an incidence appropriately 6.5 times higher than that of Japan's. This is due to multifactorial reasons, both of genetic and environmental nature. • Cervical cancer makes up the largest percentage of gynaecological cancers. Women in developing countries tend to present with more advanced cases. == References ==