Female Genital System

Abstract

The incidence of gynecologic malignancies as a group have an incidence second only to to breast cancer. In the year 2009, approximately 192,370 new female breast cancers will be diagnosed compared to 80,720 gynecologic malignancies (cervix, 11,270; corpus uteri, 42,160; ovary, 21,550, vulva 3,580; other, 2,160). Gynecologic malignancies ranked third in estimated female cancer deaths in 2009: lung/bronchus, 70,490; breast, 40,170; and gynecologic, 28,120 (cervix, 4,070; corpus uteri, 7,780; ovary, 14,600; vulva, 900; other, 820). The incidence of cervical cancer has markedly decreased over the last 50 years with Papanicolaou (Pap) smear screening and colposcopy. Endometrial carcinoma has also decreased as a result of the changes in prescribed hormone supplementation. Unopposed, estrogens were responsible for a significant number of well-differentiated carcinomas in the menopausal patient. The addition of progesterone and liberal indications of endometrial biopsy have assisted in decreasing the incidence. In the uterus, tamoxifen is an estrogen agonist, whereas it is an antagonist in the breast. Uterine stimulation is present with patients receiving tamoxifen to treat breast cancer. All abnormal bleeding in this group of patients is a suspect for the presence of endometrial cancer. Endometrial biopsies are required to rule out this malignancy in menopausal patients with abnormal bleeding. Early diagnosis of ovarian cancer is difficult. Screening ultrasonography and CA-125 have low sensitivity and specificity when used to diagnose occult ovarian malignances in the asymptomatic patient. As a result, even in initial examination these patients have advanced disease, with high mortality.