Epidemiology of Epidemiology of Gynaecological CancersGynaecological Cancers

General General OverviewOverview

• On global basis cervical cancer is the most common pelvic malignancy in developing countries.

• Cancer of the uterus and ovary are more common in the industrialized countries.

• Incidence of cervical cancer has decreased in industrialized countries due to cervical screening.

• Other gynaecological cancers are rare in all parts of the world.

• There is wide variation in geographical distribution.– Cervical cancer is 9 times higher in East Africa than in

Middle East.– Uterine cancer are 10 times higher in Central America

than in West Africa.– Ovarian cancers are 4 times higher in Europe than in

Middle Africa.– Variation can be discussed in life style and public health

intervention.

Ca VulvaCa Vulva

TypesTypes– Squamous cell carcinomaSquamous cell carcinoma– MelanomaMelanoma

Risk FactorsRisk Factors– Age (60 – 70)Age (60 – 70)– ObesityObesity– Diabetes mellitusDiabetes mellitus– Chronic skin lesionsChronic skin lesions– Poor hygiene Poor hygiene – Pelvic irradiationPelvic irradiation– Human papilloma virus 16,18,31Human papilloma virus 16,18,31

Ca CervixCa CervixTypesTypes

– Squamous cell carcinomaSquamous cell carcinoma– Odeno carcinoma Odeno carcinoma

Risk FactorsRisk Factors– AgeAge– SmokingSmoking– Hereditary factorsHereditary factors– PovertyPoverty– Husbands occupationHusbands occupation– No. of partnersNo. of partners– Prostitutes Prostitutes – Viruses Viruses

– Herpes simplex virus type II, human papilloma virus Herpes simplex virus type II, human papilloma virus 16,1816,18

– SpermatozoaSpermatozoa

Ca Uterus Ca Uterus TypesTypes

– Adeno carcinomaAdeno carcinoma– Squamous cell carcinomaSquamous cell carcinoma– Sarcoma Sarcoma

Risk FactorsRisk Factors– Age (40 – 60)Age (40 – 60)– ObesityObesity– Impaired carbohydrate toleranceImpaired carbohydrate tolerance– NulliparityNulliparity– Late menopauseLate menopause– Functioning ovarian tumoursFunctioning ovarian tumours– Estrogen therapy Estrogen therapy – Pelvic radiation Pelvic radiation

Ca OvaryCa Ovary

Mortality from ovarian cancer has doubled in England..Risk FactorsRisk Factors

– Industrialized society Women working in asbestos factories and talc particles in soap powders, deoderants.

– Pelvic irradiation – Early menarche – Late menopause– Oral contraception– Low parity– Early age of first pregnancy – Nutrition and infection – Genetic pre disposition

Pelvic malignancies - Pelvic malignancies - Retrospective AnalysisRetrospective Analysis

Historical Background

• Rigon stun in 1842 using death Rigon stun in 1842 using death record from 1760 – 1839.record from 1760 – 1839.

• He found high prevalence of uterine He found high prevalence of uterine cancer in married than in unmarried cancer in married than in unmarried women and extremely rare in nuns.women and extremely rare in nuns.

Study designStudy design

Single institution based retrospective.Single institution based retrospective.

ObjectivesObjectives

1.1. Prevalence of malignancies of the Prevalence of malignancies of the genital tract in patients reporting to genital tract in patients reporting to FFH RWPFFH RWP

2.2. Commonest malignancyCommonest malignancy

3.3. Relationship of age to various Relationship of age to various malignanciesmalignancies

Place and durationPlace and duration

• Study was carried out at FFH RWP Study was carried out at FFH RWP

• From January 2002- June 2005From January 2002- June 2005

Subjects and methodsSubjects and methods

• 161 cases of pelvic malignancy 161 cases of pelvic malignancy diagnosed on surgery and diagnosed on surgery and histopathological examination histopathological examination admitted in gynae ward over a period admitted in gynae ward over a period of 3of 3½½ years were selected. years were selected.

Inclusion criteria:Inclusion criteria:

All diagnosed cases of pelvic All diagnosed cases of pelvic malignancy malignancy admitted to FFH RWP. admitted to FFH RWP.

Exclusion criteria :Exclusion criteria : Benign pelvic tumorsBenign pelvic tumors

Recurrent malignant tumorsRecurrent malignant tumors

Surgical procedures were performed by Surgical procedures were performed by the consultant gynecologistthe consultant gynecologist

Types of surgery:Types of surgery:1.1. Staging laparotomyStaging laparotomy2.2. Debulking surgeryDebulking surgery3.3. TAH + BSOTAH + BSO4.4. Wertheims hysterectomyWertheims hysterectomy5.5. Radical vulvectomyRadical vulvectomy

The senior pathologist’s of Army The senior pathologist’s of Army Medical College evaluated and Medical College evaluated and reported the histopathology.reported the histopathology.

ResultsResults

Total cases Total cases (n) = 161(n) = 161

ovarian ovarian (n) =(n) = 75 46.5% 75 46.5%

uterine uterine (n) = 42 26%(n) = 42 26%

cervical cervical (n) = 30 18%(n) = 30 18%

vaginal vaginal (n) = 05 3.1%(n) = 05 3.1%

vulvar vulvar (n) = 09 5.5%(n) = 09 5.5%

ResultsOvarian cancerOvarian cancer

Serous cystadenocarcinoma Serous cystadenocarcinoma (n) = 42 (56%) (n) = 42 (56%)Dysgerminoma Dysgerminoma (n) = 13 (17%) (n) = 13 (17%) Endometroid Endometroid (n) = 11 (14%) (n) = 11 (14%)Mucinous cystadenocarcinoma Mucinous cystadenocarcinoma (n) = 03 (n) = 03 (04%)(04%)Yolk sac tumour Yolk sac tumour (n)= 02 (2.6%) (n)= 02 (2.6%)Krukenberg Krukenberg (n) = 02 (2.6%) (n) = 02 (2.6%)Granulosa cell tumourGranulosa cell tumour (n) = 01 (1.3%) (n) = 01 (1.3%)Brenner tumourBrenner tumour (n) = 01 (1.3%) (n) = 01 (1.3%)

Total Total (n) = 75 (n) = 75

Uterine carcinomaUterine carcinoma

Adenocarcinoma Adenocarcinoma (n) = 28 (66%) (n) = 28 (66%)

Choriocarcinoma Choriocarcinoma (n) = 04 (n) = 04 (9.5%)(9.5%)

Mixed mullerian Mixed mullerian (n) = 03 (n) = 03 (7.1%)(7.1%)

Metastatic squamous cell Metastatic squamous cell (n) = 03 (n) = 03 (7.1%)(7.1%)

Endometrial stromal sarcoma (n) = 02Endometrial stromal sarcoma (n) = 02 (4.7%)(4.7%)

Leiomyosarcoma Leiomyosarcoma (n) = 02 (n) = 02 (4.7%)(4.7%)

Total Total (n) = 42 (n) = 42

Cervical carcinoma

Squamous cell carcinoma Squamous cell carcinoma (n) = 26 (86%)(n) = 26 (86%)

Adenocarcinoma Adenocarcinoma (n) = 04 (13%) (n) = 04 (13%)

Total Total (n) = 30(n) = 30

Vaginal Carcinoma

Squamous cell carcinoma Squamous cell carcinoma (n) = 03 (n) = 03 (60%)(60%)

Metastatic adenocarcinoma Metastatic adenocarcinoma (n) = 01 (n) = 01 (20%)(20%)

Leiomyosarcoma Leiomyosarcoma (n) = 01 (n) = 01 (20%)(20%)

Total Total (n) = 05(n) = 05

Vulvar carcinoma

Squamous cell carcinomaSquamous cell carcinoma (n) = 09 (n) = 09

Pelvic MalignanciesPelvic Malignancies

74

42

30

5 9

0

5

10

15

20

25

30

35

40

45

50

55

60

65

70

75

Ovarian

Uterine carcim

ona

Cervical carcinoma

Vaginal carcinoma

Vulvar carcinoma

Age Distribution of Ovarian Age Distribution of Ovarian CarcinomaCarcinoma

0

2

4

6

8

10

12

14

16

18

20

1 _10 10 _19 20-29 30-39 40-49 50-59 60-69 70-79 80above

EpithelialTumour

Germ celltumours

Age Distribution Uterine Age Distribution Uterine CarcinomaCarcinoma

0

1

2

3

4

5

6

1_9 10_19 21-29 30-39 40-49 50-59 60-69 70-79 80 &above

Adeno

Chorio

Sarcoma

Mixed

Age Distribution of Cervical Age Distribution of Cervical carcinoma carcinoma

0

1

2

3

4

5

6

7

8

9

10

1_9 10_19 20-29 30-39 40-49 50-59 60-69 70-79 80 &above

Squamous

Adeno

Age Distribution of Vaginal Age Distribution of Vaginal CarcinomaCarcinoma

0

0.5

1

1.5

2

2.5

3

3.5

4

4.5

5

1_9 10_19 20-29 30-39 40-49 50-59 60-69 70-79 80 &above

Mixed

Age Distribution of Vulvar Age Distribution of Vulvar carcinomacarcinoma

0

0.5

1

1.5

2

2.5

3

3.5

4

4.5

5

1_9 10_19 20-29 30-39 40-49 50-59 60-69 70-79 80 &above

Squamous

Surgical staging of the tumors

Ovarian CaOvarian Ca

1.1. stage I 07stage I 07

2.2. Stage II 17Stage II 17

3.3. Stage III 15Stage III 15

4.4. Stage IV 36Stage IV 36

Uterine CaUterine Ca

– Stage I 21Stage I 21– Stage II 14Stage II 14– Stage III 05Stage III 05– Stage IV 02Stage IV 02

Cervical Cervical CaCa

• Stage I 08Stage I 08

• Stage II 03Stage II 03

• Stage III 13Stage III 13

• Stage IV 07Stage IV 07

Vaginal CaVaginal Ca

• Stage I 2Stage I 2

• Stage II 1Stage II 1

• Stage III 0Stage III 0

• Stage IV 2Stage IV 2

Vulvar CaVulvar Ca

• Stage I 1Stage I 1

• Stage II 6Stage II 6

• Stage III 2Stage III 2

Relationship of type of Relationship of type of malignancy to marital malignancy to marital

status and agestatus and age Young( 7-24 yrs) unmarried reported Young( 7-24 yrs) unmarried reported

with ovarian malignancies only.with ovarian malignancies only.

Types:Types:

• dysgerminoma 8dysgerminoma 8

• Yolk sac tumor 2Yolk sac tumor 2

• Mucinous cystadenocarcinoma 1Mucinous cystadenocarcinoma 1

Unmarried (>24 yrs)Unmarried (>24 yrs)

TypesTypes

• Cervical ca 1Cervical ca 1

• Vulvar ca 2Vulvar ca 2

• Ovarian 1Ovarian 1

ConclusionsConclusions• The most common pelvic malignancy was The most common pelvic malignancy was

ovarianovarian

• The most common ovarian tumour was serous The most common ovarian tumour was serous cystadenocarcinoma in elderly patients and cystadenocarcinoma in elderly patients and dysgerminoma in younger patients. dysgerminoma in younger patients.

• The commonest uterine malignancy was The commonest uterine malignancy was adenocarcinoma adenocarcinoma

• Cervical cancer was the 3Cervical cancer was the 3rdrd commonest commonest tumour and it was mainly squamous cell tumour and it was mainly squamous cell carcinoma. carcinoma.

• Vulvar and vaginal tumours were rare.Vulvar and vaginal tumours were rare.

THANK YOUTHANK YOU