When different histologic types of cervical cancer are considered and trends are reexamined, it becomes apparent that observed declines are reflective of squamous cell carcinomas predominately; the rates for adenocarcinomas continue to rise. This rise in incidence may be due to the greater difficulty in screening for glandular precursor lesions that often arise high within the endocervical canal.  These strategies reflect new information concerning the natural history of cervical carcinogenesis and the performance of screening and diagnostic tests, and they take into account the cost and efficacy of various treatment and follow-up options. This document will describe staging criteria and treatment for cervical glandular carcinomas. For practical purposes, it will focus on the glandular cells and adenocarcinoma histologies onlyRead More

Worldwide, cervical cancer is the second most common malignancy in women and a major cause of morbidity and mortality. Cervical cancer is gender-specific disease that disproportionately affects women in the lowest socioeconomic classes throughout the world. In 2004, the 57th World Health Assembly adopted World Health Organization's global reproductive health strategy, which identified five priority areas including "combating sexually transmitted infections"; the strategy also specifically addressed cervical cancer prevention. Screening programs have successfully reduced disease rates in developed countries that support cytology-based services; these services are too complex for most developing countries to implement. Many important advances have also taken place in the diagnosis and treatment of cervical cancer. This review also defines the strategies for diagnosis and management of abnormal cervical cytology and histology. These strategies reflect new information concerning the natural history of cervical carcinogenesis and the performance of screening and diagnostic tests. The most important component in the management of cervical cancer will always be primary prevention.Read More

Globally, cervical cancer is a major health problem, with a yearly incidence of 371,000 cases and an annual death rate of 190,000. 78% of cases occur in developing countries where cervical cancer is the second most frequent cause of cancer-related death in women. Invasive cervical carcinoma, once the most common reproductive-tract cancer in the United States, has recently fallen to the rank of third most common. The purpose of this document is to describe staging criteria and treatment for cervical carcinoma. For practical purposes, it will focus on the squamous and adenocarcinoma histologies only. In addition, new evidence has documented conclusively that survival rates for women with cervical cancer improve when radiotherapy is combined with cisplatin-based chemotherapy in advanced cases.Read More

Sexual health is a state of physical, emotional, mental and social well-being in relation to sexuality; it is not merely the absence of disease, dysfunction or infirmity. Sexual health requires a positive and respectful approach to sexuality and sexual relationships, as well as the possibility of having pleasurable and safe sexual experiences, free of coercion, discrimination and violence. As patients move away from the acute phase of illness, healthy sexual functioning is an important step toward re-establishing their sense of well-being. Several physiologic and psychological factors specific to oncology patients (e.g. advanced disease, radical surgery, pelvic irradiation, symptoms related to menopause, pre-morbid sexual dysfunction, and negative self-concept) can promote sexual morbidity. These issues may place cancer survivors at increased risk for the development of sexual problems.Read More

Each year approximately 36,000 women in the United States are diagnosed with endometrial cancer. There are currently no routine screening techniques for endometrial cancer in the general population. It is predominantly a disease of affluent, obese, postmenopausal women of low parity. Over the last few decades, age-standardized incidence rates have risen in most countries and in urban populations. Developing countries and Japan have incidence rates four to five times lower than western industrialized nations, with the lowest rates being in India and south Asia. There are currently no routine screening techniques for endometrial cancer in the general population. The vast majority of women have early-stage disease at diagnosis owing to postmenopausal bleeding. The American Cancer Society (ACS) has recommended that at the time of menopause, the average-risk woman should be informed about the risks for symptoms of endometrial cancer and be strongly encouraged to report any unexpected bleeding or spotting to her gynecologist. When appropriate, genetic counseling and testing should be offered.Read More

Although ovarian cancer is the second most common female reproductive cancer, preceded by cancer of the uterus, more women die from ovarian cancer than from cervical and uterine cancers combined. Ovarian cancer remains the most lethal of the gynecologic malignancies. The role of the generalist obstetricians -- gynecologists and primary care physicians in early detection of ovarian cancer is also defined in this article. Recommended cancer-screening protocols in women with high-risk is also discussed. Data suggest that currently available screening tests do not appear to be beneficial for screening low-risk, asymptomatic women. An annual gynecologic examination with an annual pelvic examination is recommended for preventive health care. Approximately one in 70 women will develop ovarian cancer in their lifetime. This increases to 4% to 6% if there is a family history in a first-degree relative.Read More

Ovarian cancer remains the most lethal of gynecologic malignancies, and its mortality exceeds the combined mortality from both cervical and endometrial cancer in the United States. Ovarian malignancy is the fourth most common cause of cancer death in American women and accounts for 5% of all cancer deaths. Insightful overview of the current understanding of the ovarian malignancy as well as the areas of continuing challenges are also discussed in this series of the articles exploring different aspects of ovarian cancer. While therapy for ovarian malignancy has undergone important progress, there is growing concern about the quality of life of these patients. The contributors to this symposium include many of the experts who have advanced the management of this disease, and their articles thoughtfully describe the progress and point to future areas of reproductive research.Read More

In gynecologic oncology, every clinical intervention has two distinct aims. One is to produce objective improvement in the patient's medical condition and second aim, regardless of whether medical improvement is possible, is to produce amelioration of the patient's subjective symptoms. Helping the patient get better and feel better. Communication skills are essential for both. While there has been a dramatic improvement in the cure rate of gynecological malignancies and women survive longer than 5 years, with what is commonly considered a "chronic" cancer. In each phase of the illness -- diagnosis, surgery and chemotherapy with curative intent, remission and survivorship, relapse and sequential chemotherapy, bowel obstruction and end of life; quality of life (QOL) is one of the most important considerations. There has recently been a large increase in studies reporting the assessment of QOL; that has changed the field from descriptive reporting to quantitative science. History and development of QOL evaluation and various approaches to QOL assessment (psychometric based and utility based) are also discussed. It describes strategies for meaningful interpretation of QOL profiles. We hope the science of the study of QOL will be the foundation and confirmation of many of the anticipated advances for patients.Read More

Epithelial ovarian cancer is the most lethal gynecologic malignancy in adult women. Exploratory laparotomy is required for histologic confirmation, staging and tumor debulking and should be performed by a surgeon trained in these aspects of ovarian cancer management. Because of the propensity of epithelial ovarian cancer to spread beyond the confines of the ovary, the majority of patients will require postoperative chemotherapy in an attempt to eradicate residual tissue. With advanced-stage disease (stages III and IV), postoperative combination chemotherapy with a taxane and platinum combination is the standard of care. Such treatment is capable of inducing responses in >70% of patients with residual epithelial ovarian cancer and is also capable of prolonging both disease-free and overall survival. Ongoing efforts to identify anti-angiogenesis compound to incorporate agents with novel mechanisms of action are also discussed. Role of radiotherapy and other modalities are explored. Ultimately, it is hoped, a combination of these approaches will result in an improvement in the survival of patients with this devastating disease.Read More