BACKGROUND AND PRE-CANCEROUS DISEASES OF FEMALE REPRODUCTIVE ORGANS

BACKGROUND AND PRE-BACKGROUND AND PRE-CANCEROUS DISEASES OF CANCEROUS DISEASES OF FEMALE REPRODUCTIVE FEMALE REPRODUCTIVE

ORGANS.ORGANS.

Korobkova H.Korobkova H.

BENIGN AND PRE-BENIGN AND PRE-CANCEROUS CERVICAL CANCEROUS CERVICAL

DISEASES.DISEASES. Epithelial normoplasia is typical Epithelial normoplasia is typical

forfor benign pathologic benign pathologic processes in the cervixprocesses in the cervix, i.e. , i.e. the processes of mitotic division, the processes of mitotic division, differentiation, maturation and differentiation, maturation and exfoliation of epithelial cells take exfoliation of epithelial cells take normal course.normal course.

Pre-cancerous diseases of Pre-cancerous diseases of the cervixthe cervix are characterized by are characterized by epithelial dysplasia in the course epithelial dysplasia in the course of which hyperplasia and of which hyperplasia and proliferation occur; proliferation occur; differentiation, maturation and differentiation, maturation and exfoliation of the epithelial cells exfoliation of the epithelial cells undergo degenerative changes.undergo degenerative changes.

IMPORTANT!!!IMPORTANT!!!

Congenital (physiological) Congenital (physiological) ectopic cervix can continue till ectopic cervix can continue till the age of 23. the age of 23. These patients These patients should receive medical supervision should receive medical supervision with regular cytologic investigations with regular cytologic investigations and do not need to undergo and do not need to undergo treatment.treatment.

AETIOLOGY OF CERVICAL AETIOLOGY OF CERVICAL DISEASESDISEASES..

1.Heredity1.Heredity..2.Mechanical and chemical effect on the cervix 2.Mechanical and chemical effect on the cervix

with:with: - chemical and mechanical contraceptive agents;- chemical and mechanical contraceptive agents; - cervical injuries at childbirth;- cervical injuries at childbirth; - abortions and intrauterine procedures recorded - abortions and intrauterine procedures recorded

in the medical history.in the medical history.3. Changes in hormonal homeostasis:3. Changes in hormonal homeostasis: - menstrual irregularities;- menstrual irregularities; - early menarche;- early menarche; - more than 3 pregnancies in the patient’s - more than 3 pregnancies in the patient’s

medical history;medical history; - absence of regular sexual life;- absence of regular sexual life; - early beginning of sexual life.- early beginning of sexual life.

4. Infections:4. Infections: - herpetic infection;- herpetic infection; - Human Papilloma Virus;- Human Papilloma Virus; - cervical and vaginal inflammatory processes - cervical and vaginal inflammatory processes

recorded in the patient’s medical history;recorded in the patient’s medical history; - multiple sexual partners;- multiple sexual partners; - frequent intercourse and chaotic sexual life;- frequent intercourse and chaotic sexual life; - trichomoniasis;- trichomoniasis; - chlamidiosis;- chlamidiosis; - mycoplasma and/or ureaplasma. - mycoplasma and/or ureaplasma. 5. Change of the general condition with probable 5. Change of the general condition with probable

abnormalities of immune homeostasis:abnormalities of immune homeostasis: - work that entails use of chemical agents;- work that entails use of chemical agents; - presence of chronic extragenital diseases.- presence of chronic extragenital diseases.

HISTOLOGICAL CLASSIFICATION OF HISTOLOGICAL CLASSIFICATION OF PATHOLOGIC PROCESSES IN THE PATHOLOGIC PROCESSES IN THE

CERVIX.CERVIX. A. Benign pathologic processes.A. Benign pathologic processes.I. Hyperplastic processes associated with hormonal I. Hyperplastic processes associated with hormonal

abnormalities.abnormalities.1. Ectopia (pseudoerosion).1. Ectopia (pseudoerosion).2. Polyps.2. Polyps.3. Papillomas.3. Papillomas.4. Simple leukoplakia.4. Simple leukoplakia.5. Cervical endometriosis.5. Cervical endometriosis.

II. Pathologic processes associated with inflammatory II. Pathologic processes associated with inflammatory genesis.genesis.

1.Genuine erosion1.Genuine erosion..2.Cervicitis2.Cervicitis..

III. Posttraumatic processesIII. Posttraumatic processes..1.Ectropion1.Ectropion..2.Cicatrical deformities2.Cicatrical deformities..

BB. . Pre-cancerous processesPre-cancerous processes..1. 1. Cervical dysplasiaCervical dysplasia:: - - mildmild;; - - moderatemoderate;; - - severesevere..2. 2. Leukoplakia with cellular atypiaLeukoplakia with cellular atypia..3. 3. ErythroplakiaErythroplakia..4. 4. Cervical adenomatosisCervical adenomatosis..В. В. Cervical carcinomaCervical carcinoma..

CLINICAL MANIFESTATIONSCLINICAL MANIFESTATIONS..

Pathologic dischargePathologic discharge.. Contact bloody dischargeContact bloody discharge..

DIAGNOSTIC METHODS OF DIAGNOSTIC METHODS OF INVESTIGATIONINVESTIGATION..

History takingHistory taking.. Speculum examination of the cervix.Speculum examination of the cervix. Shiller’s testShiller’s test.. Bacterioscopic and bacteriological Bacterioscopic and bacteriological

investigation of cervical mucus and investigation of cervical mucus and vaginal discharge.vaginal discharge.

Cytologic investigationCytologic investigation.. Investigation to detect TORCH-infections Investigation to detect TORCH-infections

(Chlamydia, mycoplasma, ureaplasma, (Chlamydia, mycoplasma, ureaplasma, herpetic infection, human Papilloma virus).herpetic infection, human Papilloma virus).

ColposcopyColposcopy.. Cervical biopsyCervical biopsy.. Hormone blood level (estradiol, Hormone blood level (estradiol,

progesterone, follicle-stimulating progesterone, follicle-stimulating hormone, luteinizing hormone).hormone, luteinizing hormone).

Investigation of local, humoral and Investigation of local, humoral and cellular immunity (according to cellular immunity (according to indications).indications).

TREATMENT.TREATMENT.

Treatment objective Treatment objective is to is to eliminate the pathologic process eliminate the pathologic process of the cervix and those changes of the cervix and those changes in the body that were conducive in the body that were conducive to the onset of this process.to the onset of this process.

Treatment principlesTreatment principles::

1.To avoid recurrence of 1.To avoid recurrence of pathology.pathology.

2.To use organ-preserving 2.To use organ-preserving treatment methods in women of treatment methods in women of reproductive age.reproductive age.

Treatment methodsTreatment methods

1.Conservative1.Conservative..

2.Surgical2.Surgical:: - local destruction - local destruction

(electrocoagulation, cryodestruction, (electrocoagulation, cryodestruction, laser destruction);laser destruction);

- radical surgical treatment (cervical - radical surgical treatment (cervical excision, cervicectomy).excision, cervicectomy).

3.Combined3.Combined..

TREATMENT STAGESTREATMENT STAGES..

First stageFirst stage ( (preparatorypreparatory):): Treatment of disease that caused Treatment of disease that caused

development of pathological development of pathological conditions in the cervix: conditions in the cervix: inflammatory diseases of female inflammatory diseases of female reproductive organs, hormonal reproductive organs, hormonal abnormalities.abnormalities.

Second stage (direct Second stage (direct treatment of the disease):treatment of the disease):

According to premorbid background, According to premorbid background, generative function and the patient’s generative function and the patient’s age exposure of the pathological age exposure of the pathological condition to treatment methods condition to treatment methods (chemical coagulation, (chemical coagulation, cryodestruction , laser vaporization, cryodestruction , laser vaporization, electrocoagulation, electroexcision, electrocoagulation, electroexcision, electroconization).electroconization).

Third stage:Third stage:

Performing post-operative Performing post-operative rehabilitation proceduresrehabilitation procedures

following surgical and combined following surgical and combined treatmenttreatment

Conservative therapyConservative therapy:: Antiinflammatory therapy (antibacterial, Antiinflammatory therapy (antibacterial,

antimycotic, antiviral, antiseptic) is antimycotic, antiviral, antiseptic) is prescribed in order to normalize vaginal prescribed in order to normalize vaginal flora. Three 7 - 8 days long courses with 10 - flora. Three 7 - 8 days long courses with 10 - 12 days long intervals between them.12 days long intervals between them.

Hormonal therapy – oral contraceptives are Hormonal therapy – oral contraceptives are prescribed for 6 – 9 menstrual cycles. prescribed for 6 – 9 menstrual cycles.

Therapy intended for stimulation of Therapy intended for stimulation of restorative processes: helium-neon laser, restorative processes: helium-neon laser, ointment tampons soaked with sea-ointment tampons soaked with sea-buckthorn oil, buckthorn oil,

cod-liver oil, rosehip oil, etc.cod-liver oil, rosehip oil, etc.

PREVENTION OF CERVICAL PREVENTION OF CERVICAL CARCINOMA.CARCINOMA.

Cervarix – Cervarix – is a vaccine against is a vaccine against certain types of human certain types of human papillomavirus, cervical carcinoma papillomavirus, cervical carcinoma and pre-cancerous conditions of the and pre-cancerous conditions of the cervix.cervix.

Cervarix is injected i.m. into deltoid Cervarix is injected i.m. into deltoid muscle.muscle.

The administration scheme is 3 The administration scheme is 3 doses every 0, 1 and 6 months.doses every 0, 1 and 6 months.

Contraindications to Contraindications to vaccinationvaccination..

Hypersensitivity to the active Hypersensitivity to the active substances or to any of the excipients.substances or to any of the excipients.

Severe systemic diseasesSevere systemic diseases.. PregnancyPregnancy.. Thrombocytopenia or any coagulation Thrombocytopenia or any coagulation

disorders since bleeding may occur disorders since bleeding may occur following an intramuscular following an intramuscular administration.administration.

Febrile conditionsFebrile conditions..

ENDOMETRIAL ENDOMETRIAL HYPERPLASIAHYPERPLASIA..

Endometrial hyperplasia Endometrial hyperplasia isis a benign a benign pathology of endometrium, pathology of endometrium, characterized by progressing of characterized by progressing of clinicopathologic manifestations from clinicopathologic manifestations from simple and complex hyperplasia to simple and complex hyperplasia to atypical pre-cancerous endometrial atypical pre-cancerous endometrial conditions and normally results from conditions and normally results from relative or absolute relative or absolute hyperestrogemenia.hyperestrogemenia.

AETIOLOGY OF THE AETIOLOGY OF THE DISEASEDISEASE

Anovulatory infertilityAnovulatory infertility. . Climacterical periodClimacterical period.. Persistence of folliclePersistence of follicle.. Follicular cystFollicular cyst.. Estrogen producing ovarian tumorsEstrogen producing ovarian tumors.. ObesityObesity.. Diabetes mellitusDiabetes mellitus.. Insulin resistanceInsulin resistance.. HeredityHeredity..

CLASSIFICATION OF CLASSIFICATION OF HYPERPLASTIC ENDOMETRIAL HYPERPLASTIC ENDOMETRIAL

CONDITIONS (WHO, 1994).CONDITIONS (WHO, 1994). Simple non-atypical endometrial Simple non-atypical endometrial

hyperplasiahyperplasia.. Complex non-atypical endometrial Complex non-atypical endometrial

hyperplasiahyperplasia.. Simple atypical endometrial Simple atypical endometrial

hyperplasiahyperplasia.. Complex atypical endometrial Complex atypical endometrial

hyperplasiahyperplasia.. Endometrial adenocarcinomaEndometrial adenocarcinoma..

CLINICOPATHOLOGIC CLINICOPATHOLOGIC CLASSIFICATION OF CLASSIFICATION OF

ENDOMETRIAL HYPERPLASIAS.ENDOMETRIAL HYPERPLASIAS.

Background conditions: glandular Background conditions: glandular hyperplasia, endometrial polyps.hyperplasia, endometrial polyps.

Pre-cancerous diseases: Pre-cancerous diseases: adenomatosis (atypical adenomatosis (atypical hyperplasia).hyperplasia).

Endometrial cancerEndometrial cancer..

CLINICAL CLINICAL PRESENTATIONSPRESENTATIONS..

Menstrual irregularities (delay of Menstrual irregularities (delay of menstruation during 2 -3 months).menstruation during 2 -3 months).

MetrorrhagiaMetrorrhagia.. InfertilityInfertility.. Nervous system abnormalities (depression, Nervous system abnormalities (depression,

sleep disturbance, mood swings).sleep disturbance, mood swings). HeadacheHeadache.. General weakness, dizzinessGeneral weakness, dizziness.. Skin pallorSkin pallor..

DIAGNOSTICSDIAGNOSTICS

Main diagnostics objectivesMain diagnostics objectives.. Detection of hyperplasia and clinical Detection of hyperplasia and clinical

interpretation of the results of interpretation of the results of histological examination performed histological examination performed on the endometrium. on the endometrium.

Determination of hormone Determination of hormone dependency of the hyperplasia and dependency of the hyperplasia and evaluation of individual hormonal evaluation of individual hormonal balance in the patient.balance in the patient.

Investigation methodsInvestigation methods History of diseaseHistory of disease.. Speculum examinationSpeculum examination.. Bimanual examinationBimanual examination.. Cytological examination of the cervical matter.Cytological examination of the cervical matter. USUS.. HysteroscopyHysteroscopy.. Aspiration biopsy of endometrial tissue.Aspiration biopsy of endometrial tissue. Fractional diagnostic curettage of uterine cavity.Fractional diagnostic curettage of uterine cavity. Determination of blood hormone level: follicle-Determination of blood hormone level: follicle-

stimulating hormone, luteinizing hormone, stimulating hormone, luteinizing hormone, estradiol, progesterone.estradiol, progesterone.

Determination of thyroid gland functional Determination of thyroid gland functional activity.activity.

Administration of glucose tolerance test.Administration of glucose tolerance test.

УЛЬТРАЗВУКОВЕ УЛЬТРАЗВУКОВЕ ДОСЛІДЖЕННЯДОСЛІДЖЕННЯ

Товщина ендометріюТовщина ендометрію

ПролПролііферативна феративна фазафаза

• СекреторнСекреторна фазаа фаза

УЛЬТРАЗВУКОВЕ УЛЬТРАЗВУКОВЕ ДОСЛІДЖЕННЯДОСЛІДЖЕННЯ

структура структура ендометріюендометрію рельєф рельєф порожнини порожнини маткиматки наявність супутньої патології ендометріюнаявність супутньої патології ендометрію анатомічні особливості придатків маткианатомічні особливості придатків матки

• Поліп ендометріюПоліп ендометрію

ДІАГНОСТИКАДІАГНОСТИКА Діагностична можливість вишкрібання Діагностична можливість вишкрібання

порожнини матки значно розширюється при порожнини матки значно розширюється при використанні гістероскопіївикористанні гістероскопії

Гістероскопія дозволяє:Гістероскопія дозволяє:

IMPORTANTIMPORTANT!!!!!!

Only histological Only histological examination can confirm examination can confirm the diagnosis of the diagnosis of endometrial hyperplasia.endometrial hyperplasia.

БУДОВА ЕНДОМЕТРІЮБУДОВА ЕНДОМЕТРІЮ

Проліферативний ендометрійПроліферативний ендометрій

Секреторний ендометрійСекреторний ендометрій

ДІАГНОСТИКАДІАГНОСТИКА

• Діагноз гіперплазії Діагноз гіперплазії ендометрію може ендометрію може бути встановлений бути встановлений тільки в результаті тільки в результаті гістологічного гістологічного дослідження !!!дослідження !!!

Ultrasonic data that serve as Ultrasonic data that serve as indication for histological indication for histological

examination of endometrial examination of endometrial tissue:tissue:

- thickness of endometrium exceeds - thickness of endometrium exceeds 16mm;16mm;

- EUR more than 0,33 (EUR stands for - EUR more than 0,33 (EUR stands for endometrial thickness – anterior endometrial thickness – anterior posterior size of uterus ratio, this posterior size of uterus ratio, this indicator allows the investigator to indicator allows the investigator to evaluate faster endometrium involution evaluate faster endometrium involution rate as compared to myometrium.rate as compared to myometrium.

In postmenopausal women:In postmenopausal women:- thickness of endometrium - thickness of endometrium

exceeds 5mm;exceeds 5mm;- - EUR more thanEUR more than 0,15. 0,15.

For monitoring of endometrial For monitoring of endometrial condition during hormonal condition during hormonal therapy it is recommended to therapy it is recommended to use hysteroscopy and use hysteroscopy and aspiration biopsy.aspiration biopsy.

TREATMENT STAGESTREATMENT STAGES

First stage – First stage – extirpation of extirpation of transformed endometrium in order to transformed endometrium in order to determine the type of endometrial determine the type of endometrial pathology by means of morphological pathology by means of morphological investigation and select the investigation and select the appropriate therapeutic approach.appropriate therapeutic approach.

Second stage – Second stage – hormonal therapy hormonal therapy aimed at suppression of endometrial aimed at suppression of endometrial growth. The course of treatment is 6 growth. The course of treatment is 6 months, histological reanalysis months, histological reanalysis should be done after 6 months.should be done after 6 months.

GestagensGestagens:: Norcolut, orgametril, utrogestan, dufaston Norcolut, orgametril, utrogestan, dufaston

to be taken from the 5th to the 25th day of to be taken from the 5th to the 25th day of the menstrual cycle during 6 menstrual the menstrual cycle during 6 menstrual cycles. cycles.

12,5% solution of 17- oxyprogesteron 12,5% solution of 17- oxyprogesteron capronat to be administered i/m 500mg capronat to be administered i/m 500mg twice weekly.twice weekly.

Depo-prover i.m. administration, 200-Depo-prover i.m. administration, 200-400mg once weekly.400mg once weekly.

GnRH agonists 3 – 6 injections:GnRH agonists 3 – 6 injections: - goserelin 3,6 mg s/c once per 28 days;- goserelin 3,6 mg s/c once per 28 days; - buserelin 3,75 i/m once per 28 days;- buserelin 3,75 i/m once per 28 days; - buserelin nasal spray 900mg once daily.- buserelin nasal spray 900mg once daily.

Third stageThird stage – – optimizationoptimization of of hormonal status for prevention hormonal status for prevention

of hyperestrogemenia of hyperestrogemenia development.development.

In women of reproductive age:In women of reproductive age: - hormonal contraceptives containing - hormonal contraceptives containing

gestagen with pronounced antiproliferative gestagen with pronounced antiproliferative effect (Janine, Yarina, Jazz);effect (Janine, Yarina, Jazz);

- local administration of gestagens - local administration of gestagens (intrauterine system Myrena).(intrauterine system Myrena).

In perimenopausal womenIn perimenopausal women:: – – menostasia with administration of GnRH menostasia with administration of GnRH

agonists (3 months) combined with intake agonists (3 months) combined with intake of gestagens during 6 months.of gestagens during 6 months.

Fourth stage – Fourth stage – regular regular medical examinations duringmedical examinations during 5 years following effective 5 years following effective hormonal therapy and 6 hormonal therapy and 6 months following surgical months following surgical treatment.treatment.

INDICATIONS FOR INDICATIONS FOR SURGICAL TREATMENTSURGICAL TREATMENT

In reproductive age:In reproductive age: 1. Complex endometrial hyperplasia without 1. Complex endometrial hyperplasia without

atypia in cases when conservative therapy fails to atypia in cases when conservative therapy fails to demonstrate its effectiveness during 3 months.demonstrate its effectiveness during 3 months.

2. Simple atypical or complex non-atypical 2. Simple atypical or complex non-atypical hyperplasia in cases when therapy fails to hyperplasia in cases when therapy fails to demonstrate its effectiveness during 6 months.demonstrate its effectiveness during 6 months.

In menopausal patientsIn menopausal patients:: 1. Complex endometrial hyperplasia with atypia – 1. Complex endometrial hyperplasia with atypia –

in patients with confirmed diagnosis.in patients with confirmed diagnosis. 2. Simple atypical or complex non-atypical 2. Simple atypical or complex non-atypical

hyperplasia in cases when therapy fails to hyperplasia in cases when therapy fails to demonstrate its effectiveness during 3 months.demonstrate its effectiveness during 3 months.

Types of surgical treatment:Types of surgical treatment:

- Hysteroscopic resection or - Hysteroscopic resection or endometrial ablation;endometrial ablation;

- - hysterectomyhysterectomy. .

CANCER OF FEMALE CANCER OF FEMALE REPRODUCTIVE ORGANSREPRODUCTIVE ORGANS

EtiologyEtiology CervixCervix- Human papillomavirusHuman papillomavirus;;- - - multiple sexual partnersmultiple sexual partners;;- -- early beginning of sexual life early beginning of sexual life;;- - - high fertilityhigh fertility;;- -- poor sex hygiene poor sex hygiene;;- --immunodeficiencyimmunodeficiency;;- -- trichomoniasis trichomoniasis;;- -- chlamidiosis chlamidiosis;;- -- smoking smoking..

EndometriumEndometrium TheoriesTheories:: - - sexualsexual ( (late start and prolonged absence late start and prolonged absence

of sexual lifeof sexual life);); - - reproductivereproductive ( (early menarcheearly menarche, , late late

menopausemenopause, , chronic anovulationchronic anovulation, , infertilityinfertility, , hysteromyomahysteromyoma, , endometrial endometrial hyperplasiahyperplasia););

pharmacologicalpharmacological ( (administration of administration of estrogens without progestinsestrogens without progestins););

- - endocrinal pathologyendocrinal pathology ( (obesityobesity, , diabetes diabetes mellitusmellitus, , hyperlipidemiahyperlipidemia););

- - hereditaryhereditary ( (cancerous diseases in the cancerous diseases in the medical history of genetic relativesmedical history of genetic relatives).).

OvaryOvary - - Anamnestic recordAnamnestic record ((family cancerfamily cancer);); - - RadiationRadiation;; - - InfertilityInfertility;; - - Ovarian tumors and tumor-like Ovarian tumors and tumor-like

growthsgrowths;; Metastases from mammary glands, Metastases from mammary glands,

lungs, gastrointestinal tractlungs, gastrointestinal tract ((Crukenberg’s cancerCrukenberg’s cancer), ), uterusuterus..

PathogenesisPathogenesis

CervixCervix

Disorders of the cellular genetic Disorders of the cellular genetic apparatus involving cellular genes apparatus involving cellular genes and virogenes, with invariable and virogenes, with invariable integration of the virogene into the integration of the virogene into the cellular genecellular gene..

EndometriumEndometrium

Prolonged exposure of endometrium Prolonged exposure of endometrium to estrogens in the environment of to estrogens in the environment of progesterone insufficiencyprogesterone insufficiency..

OvaryOvary

Large amounts of estrogens and Large amounts of estrogens and androgens induce hyperplasia and androgens induce hyperplasia and metaplasia of ovarian epithelium; the metaplasia of ovarian epithelium; the ‘inclusion cysts’ that develop after ‘inclusion cysts’ that develop after this penetrate the stroma of the this penetrate the stroma of the ovary and cause malignant ovary and cause malignant transformationstransformations;- ;- Ovulation is a Ovulation is a stress for ovarian tissuestress for ovarian tissue. .

Clinical signsClinical signs CervixCervix

- - LeucorrheaLeucorrhea ( (profuse white watery profuse white watery dischargedischarge););

- - Acyclic bloody dischargeAcyclic bloody discharge;; - - Contact bloody dischargeContact bloody discharge ( (increased tissue increased tissue

fragilityfragility);); - - Pathologic leucorrheaPathologic leucorrhea ( (purulentpurulent);); - - PainPain ( (when the process extendswhen the process extends);); - - Impaired bladder and rectum functionImpaired bladder and rectum function ( (in in

metastatic conditionsmetastatic conditions).).

EndometriumEndometrium

- - LeucorrheaLeucorrhea;; - - Acyclic uterine bleedingAcyclic uterine bleeding;; - - PainPain;; - - Disturbance of urination and Disturbance of urination and

defecation.defecation.

OvaryOvary

- - Acyclic bloody dischargeAcyclic bloody discharge;; - - AscitesAscites;; - - Pain.Pain.

DiagnosticsDiagnostics CervixCervix

- - Medical historyMedical history;; - - Speculum examinationSpeculum examination;; - - Shiller’s testShiller’s test ( (treatment with Lugol’s treatment with Lugol’s

iodine solutioniodine solution);); - - Cytologic investigation of cervical matterCytologic investigation of cervical matter;; - - ColposcopyColposcopy;; - - BiopsyBiopsy;; - - Hormone blood levelHormone blood level;; - - Oncological marker levelOncological marker level СА-125. СА-125.

EndometriumEndometrium - - Medical historyMedical history;; - - Speculum examinationSpeculum examination;; - - Bimanual examinationBimanual examination ( (enlarged, softened enlarged, softened

uterus with deformed contoursuterus with deformed contours);); - - Cytological investigation of cervical matterCytological investigation of cervical matter;; - - Fractional diagnostic curettageFractional diagnostic curettage;; - - HysteroscopyHysteroscopy;; - - USUS;; - - Hormone blood levelHormone blood level;; - - Oncological marker level Oncological marker level САСА-125;-125; - - Computer-aided tomographyComputer-aided tomography;; - - Nuclear magnetic resonanceNuclear magnetic resonance;; - - LymphographyLymphography. .

OvaryOvary - - Medical historyMedical history;; - - Bimanual examinationBimanual examination ( (enlarged, enlarged,

tuberous, painless ovariestuberous, painless ovaries);); - - Cytological investigation of cervical Cytological investigation of cervical

mattermatter;- ;- USUS;; - - Oncological marker level Oncological marker level САСА-125-125;; - - Hormone blood levelHormone blood level;; - - Abdominal cavity puncture performed via Abdominal cavity puncture performed via

posterior fornixposterior fornix, , cytological investigation cytological investigation of extracted matterof extracted matter;;

- - Computer-aided tomography (CAT)Computer-aided tomography (CAT);; - - Nuclear magnetic resonance (NMR)Nuclear magnetic resonance (NMR);; - - LaparoscopyLaparoscopy..

TreatmentTreatment CervixCervix

- - SurgicalSurgical:: аа) ) preinvasive carcinomapreinvasive carcinoma ( (invasion depth under invasion depth under

3mm3mm) – ) – conization of cervixconization of cervix;; бб) ) Wertheim’s surgeryWertheim’s surgery ( (extensive extensive

panhysterectomypanhysterectomy: : extirpation of uterus, uterine extirpation of uterus, uterine appendagesappendages,, parametrium, and local lymphatic parametrium, and local lymphatic nodesnodes););

- - Radiation therapyRadiation therapy : : long-focus and long-focus and intracavitary intracavitary ((applied at all stagesapplied at all stages););

- - Chemotherapy Chemotherapy ineffectiveineffective;; - - ImmunotherapyImmunotherapy:: Leukocytic Leukocytic αα--interferoninterferon, , recombinant interferonrecombinant interferon, ,

cycloferoncycloferon, , immunomodulatorsimmunomodulators

EndometriumEndometrium - - SurgicalSurgical:: extensive extensive panhysterectomy (panhysterectomy (Wertheim-Wertheim-

Meigs surgeryMeigs surgery);); --RadiotherapyRadiotherapy Intracavitary and long-ficusIntracavitary and long-ficus;; - - Hormonal therapyHormonal therapy:: аа) ) continuous administration of progestinscontinuous administration of progestins;; бб) ) tamoxyphentamoxyphen ( (antiestrogenantiestrogen);); - - ChemotherapyChemotherapy Ineffective in cases when there are Ineffective in cases when there are

metastases in ovariesmetastases in ovaries..

OvaryOvary

SurgicalSurgical:: extensive extensive panhysterectomy (panhysterectomy (Wertheim-Wertheim-

Meigs surgeryMeigs surgery);); - - ChemotherapyChemotherapy:: cisplatincisplatin, , carboplatincarboplatin, , cyclophosphancyclophosphan, ,

doxorubicinedoxorubicine;; - - Hormonal therapy Hormonal therapy continuous administration of progestinscontinuous administration of progestins;; tamoxyphentamoxyphen;; - - Radiotherapy Radiotherapy ineffectiveineffective. .

PreventionPrevention CervixCervix

- - CERVARIX vaccinationCERVARIX vaccination;; - - Early detection of cervical diseasesEarly detection of cervical diseases;; - - Timely treatment Timely treatment

EndometriumEndometrium

- - Early detection of endometrial and Early detection of endometrial and uterine diseasesuterine diseases;;

- - Timely treatmentTimely treatment

OvaryOvary

- - Administration of oral contraceptives Administration of oral contraceptives in women of reproductive age for the in women of reproductive age for the term of 1 year or longerterm of 1 year or longer;- ;- Timely Timely treatment of gynecological diseasestreatment of gynecological diseases..