1. Epidemiology of Gynaecological Cancers

2. General Overview 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.

3. Ca Vulva Types –Squamous cell carcinoma –Melanoma Risk Factors –Age (60 – 70) –Obesity –Diabetes mellitus –Chronic skin lesions –Poor hygiene –Pelvic irradiation –Human papilloma virus 16,18,31

4. Ca Cervix Types –Squamous cell carcinoma –Odeno carcinoma Risk Factors –Age –Smoking –Hereditary factors –Poverty –Husbands occupation –No. of partners –Prostitutes –Viruses –Herpes simplex virus type II, human papilloma virus 16,18 –Spermatozoa

5. Ca Uterus Types –Adeno carcinoma –Squamous cell carcinoma –Sarcoma Risk Factors –Age (40 – 60) –Obesity –Impaired carbohydrate tolerance –Nulliparity –Late menopause –Functioning ovarian tumours –Estrogen therapy –Pelvic radiation

6. Ca Ovary. Mortality from ovarian cancer has doubled in England. Risk 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

7. Pelvic malignancies - Retrospective Analysis

8. Historical Background Rigon stun in 1842 using death record from 1760 – 1839. Rigon stun in 1842 using death record from 1760 – 1839. He found high prevalence of uterine cancer in married than in unmarried women and extremely rare in nuns. He found high prevalence of uterine cancer in married than in unmarried women and extremely rare in nuns.

9. Study design Single institution based retrospective.

10. Objectives 1. Prevalence of malignancies of the genital tract in patients reporting to FFH RWP 2. Commonest malignancy 3. Relationship of age to various malignancies

11. Place and duration Study was carried out at FFH RWP Study was carried out at FFH RWP From January 2002- June 2005 From January 2002- June 2005

12. Subjects and methods 161 cases of pelvic malignancy diagnosed on surgery and histopathological examination admitted in gynae ward over a period of 3½ years were selected. 161 cases of pelvic malignancy diagnosed on surgery and histopathological examination admitted in gynae ward over a period of 3½ years were selected.

13. Inclusion criteria: Inclusion criteria: All diagnosed cases of pelvic malignancy admitted to FFH RWP. All diagnosed cases of pelvic malignancy admitted to FFH RWP. Exclusion criteria : Exclusion criteria : Benign pelvic tumors Benign pelvic tumors Recurrent malignant tumors Recurrent malignant tumors

14. Surgical procedures were performed by the consultant gynecologist Surgical procedures were performed by the consultant gynecologist Types of surgery: Types of surgery: 1.Staging laparotomy 2.Debulking surgery 3.TAH + BSO 4.Wertheims hysterectomy 5.Radical vulvectomy

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

16. Results Total cases (n) = 161 Total cases (n) = 161 ovarian (n) = 75 46.5% ovarian (n) = 75 46.5% uterine (n) = 42 26% uterine (n) = 42 26% cervical (n) = 30 18% cervical (n) = 30 18% vaginal (n) = 05 3.1% vaginal (n) = 05 3.1% vulvar (n) = 09 5.5% vulvar (n) = 09 5.5%

17. Results Ovarian cancer Serous cystadenocarcinoma (n) = 42 (56%) Dysgerminoma (n) = 13 (17%) Endometroid (n) = 11 (14%) Mucinous cystadenocarcinoma (n) = 03 (04%) Yolk sac tumour (n)= 02 (2.6%) Krukenberg (n) = 02 (2.6%) Granulosa cell tumour (n) = 01 (1.3%) Brenner tumour (n) = 01 (1.3%) Total (n) = 75

18. Uterine carcinoma Adenocarcinoma (n) = 28 (66%) Choriocarcinoma (n) = 04 (9.5%) Mixed mullerian (n) = 03 (7.1%) Metastatic squamous cell (n) = 03 (7.1%) Endometrial stromal sarcoma (n) = 02 (4.7%) Leiomyosarcoma (n) = 02 (4.7%) Total (n) = 42

19. Cervical carcinoma Squamous cell carcinoma (n) = 26 (86%) Squamous cell carcinoma (n) = 26 (86%) Adenocarcinoma (n) = 04 (13%) Adenocarcinoma (n) = 04 (13%) Total (n) = 30 Total (n) = 30

20. Vaginal Carcinoma Squamous cell carcinoma (n) = 03 (60%) Metastatic adenocarcinoma (n) = 01 (20%) Leiomyosarcoma (n) = 01 (20%) Total (n) = 05

21. Vulvar carcinoma Squamous cell carcinoma (n) = 09

22. Pelvic Malignancies

23. Age Distribution of Ovarian Carcinoma

24. Age Distribution Uterine Carcinoma

25. Age Distribution of Cervical carcinoma

26. Age Distribution of Vaginal Carcinoma

27. Age Distribution of Vulvar carcinoma

28. Surgical staging of the tumors Ovarian Ca 1. stage I 07 2. Stage II 17 3. Stage III 15 4. Stage IV 36

29. Uterine Ca – Stage I 21 – Stage II 14 – Stage III 05 – Stage IV 02

30. Cervical Ca Stage I 08 Stage I 08 Stage II 03 Stage II 03 Stage III 13 Stage III 13 Stage IV 07 Stage IV 07

31. Vaginal Ca Stage I 2 Stage I 2 Stage II 1 Stage II 1 Stage III 0 Stage III 0 Stage IV 2 Stage IV 2

32. Vulvar Ca Stage I 1 Stage I 1 Stage II 6 Stage II 6 Stage III 2 Stage III 2

33. Relationship of type of malignancy to marital status and age Young( 7-24 yrs) unmarried reported with ovarian malignancies only. Young( 7-24 yrs) unmarried reported with ovarian malignancies only. Types: Types: dysgerminoma 8 dysgerminoma 8 Yolk sac tumor 2 Yolk sac tumor 2 Mucinous cystadenocarcinoma 1 Mucinous cystadenocarcinoma 1

34. Unmarried (>24 yrs) Types Types Cervical ca 1 Cervical ca 1 Vulvar ca 2 Vulvar ca 2 Ovarian 1 Ovarian 1

35. Conclusions The most common pelvic malignancy was ovarian The most common pelvic malignancy was ovarian The most common ovarian tumour was serous cystadenocarcinoma in elderly patients and dysgerminoma in younger patients. The most common ovarian tumour was serous cystadenocarcinoma in elderly patients and dysgerminoma in younger patients. The commonest uterine malignancy was adenocarcinoma The commonest uterine malignancy was adenocarcinoma Cervical cancer was the 3 rd commonest tumour and it was mainly squamous cell carcinoma. Cervical cancer was the 3 rd commonest tumour and it was mainly squamous cell carcinoma. Vulvar and vaginal tumours were rare. Vulvar and vaginal tumours were rare.

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