GynecologicOncology
Whatis Gynecologic Oncology?
Gynecologic oncology is an area of medicine and oncology that specializes in cancers of thecervix, fallopian tubes, ovaries, uterus, vagina, and vulva (including thelabia.
Whatis Vulvar Cancer?
Vulvarcancer is cancer that is found in and on the vulva.
Estimated new cases and deaths from vulvar cancer in the United States in2006 are:
New cases: 3,740.
Deaths: 880.
Vulvar cancer is primarily a disease of elderly women but has been observed in premenopausal women as well. It is most commonly squamous cell carcinoma in type, although other histologic types do occur. Vulvar cancer is highly curable when diagnosed in an early stage.
Survival is most dependent on the pathologic status of the inguinal nodes. In patients with operable disease without nodal involvement, the overall survival rate is 90%; however, in patients with nodal involvement, the overall 5-year survival rate is approximately 50% to60%.
Risk factors for node metastasis are clinical node status, age, degree of differentiation, tumor stage, tumor thickness, depth of stromal invasion, and presence of capillary-lymphatic spaceinvasion.
Overall, about 30% of patients with operable disease have nodal spread. A multifactorial analysis of risk factors in squamous vulvar cancer demonstrated that nodal status and primary lesion diameter, when considered together, were the only variables associated with prognosis. Patients with negative inguinal nodes and lesions no more than 2 cm had a 98% 5-year survival rate, while those with any size lesion with 3 or more unilateral nodes or 2 or more bilateral nodes had a 29% 5-year survival rate. Intermediate groups with intermediate survival were alsoidentified. These discriminants were most useful within FIGO stage III disease.
In many cases, the development of vulvar cancer is preceded by condyloma or squamous dysplasias. The prevailing evidence favors human papillomavirus (HPV) as a causative factor in genital tract carcinomas. The labia majora is the most common site of involvement and accounts for about 50% of cases. The labia minora accounts for 15% to 20% of cases. The clitoris and Bartholin’s glands are less frequentlyinvolved.
The pattern of spread is influenced by the histology. Well-differentiated lesions tend to spread along the surface with minimal invasion, while anaplastic lesions are more likely to be deeply invasive. Spread beyond the vulva is either to adjacent organs such as the vagina, urethra, and anus, or via the lymphatics to the inguinal and femoral lymph nodes, followed by the deep pelvic nodes. Hematogenous spread appears to be uncommon.
Whatis Vulvar Vestibulitis?
VulvarVestibulitis is a condition which causes redness and pain of the vestibule. VulvarVestibulitis is an inflammation of this skin and the mucous secreting glandsfound in the skin. The mucous secreting glands are called the lesser vestibularglands.
VulvarVestibulitis may include all the area around the opening of the vagina but isnormally seen in the lower part of the vaginal opening.
VulvarVestibulitis occurs inwomen of all ages. It can occur in women who are sexually active and also inwomen who have never been sexually active.
Manywomen with this problem have suffered physically and emotionally for months oryears, have seen a number of physicians, and have tried many unsuccessfultreatments in search of relief.
Whatare the signs and symptoms of VulvarVestibulitis?
* Severe pain with pressure (for example: biking, exercise,tight fitting clothes ).
* Vaginal entry such as tampon use or intercourse.
* Burning, stinging, irritation, or raw sensation within thevestibular area.
* Vestibular redness
* The urge to urinate frequently or suddenly.
Yourdoctor or health care provider will examine the vulva and vestibule to identifythe common skin changes seen with VulvarVestibulitis. Pain is usually felt ifthe vestibule area is touched with a cotton tipped applicator. A sample of yourvaginal discharge is collected and tested to rule out infection.
Whatcauses VulvarVestibulitis?
The exact cause is unknown, but many studies are being conducted to determinethe cause of VulvarVestibulitis.
Thefollowing factors have been associated with VulvarVestibulitis:
* HPV (Human Papilloma Virus)
* Chronic Yeast Infections
* Chronic bacterialinfections
* Chronic changes of pH (acid-basebalance in the vagina)
* Chronic use ofchemicals/irritants such as detergents, soaps, spermicides or lubricants.
Whatis the treatment for VulvarVestibulitis?
Treatmentmay include any of the following:
* Follow the Guidelinesfor Vulvar Skin Care
* Steroid Ointments
Howit is used: A thin layer is applied to the vulvovaginal areas.
Howit Works: Decreases redness, irritation, and burning. Caution: Use only asprescribed by your doctor. Overuse may result in thinning of the skin which willmake your problem worse rather than helping it.
* Trichloroacetic Acid (TCA)may be used in some cases as determined by the severity of the symptoms youhave. TCA is a chemical that is used to destroy small areas of the irritatedskin allowing new healthy skin to grow in its place.
* Interferon Injectionsare used to increase your body's response to infection.
Helpfultreatment hints for VulvarVestibulitis:
* Vitamin A and D Ointment Howit is used: Apply to the areas of discomfort.
Howit Works: Protects the skin, decreases irritation, heals, and soothes.
* Lidocaine Gel may be prescribed after initial treatment.
How it isused: Apply lidocaine gel to thevulvovaginal areas ofdiscomfort.
How it Works: Numbs areas before intercourse.
Caution: Afterapplying, wait until area becomes less sensitive before intercourse.Burning may occur for a short time (
* Witch Hazel Pads (TUCS Pads) How it is used: Apply to the vulvovaginal areas ofdiscomfort.
How itWorks: Decreases burning and irritation after intercourse and urinating.
* Cleansing Bottle - Pour plain luke-warm water over the vulva afterurinating to remove urine from irritated area.
* Calcium Citrate Tablets- How it is used: Take orally 1200-1800mg.elemental calcium every day.How it Works: Thought to decrease certain crystals in the urine which maycause burning.
* Cranberry Juice How itis used: Drink an 8oz. glass every day.
Howit Works: Increases the acid content of the urine to decrease bladderirritation.
* Limit High Oxalate Foods - May decrease amount of oxalate crystalsin urine. Oxalatecrystals cause urinary symptoms such as the urge to urinate frequently orsuddenly.
Whatis a Vaginal Vault Prolapse?
The vaginal vault is the area at the top of the vagina, next to and adjacent to the cervix. It can only “fall” or descend downwards toward theintroitus, or the entrance of the vagina, after a woman's womb has been removed (hysterectomy). Vaginal Vault Prolapse occurs in about 15% of women who have had a hysterectomy for uterineprolapse, and in about 1% of women who have had a hysterectomy for other reasons.
Whatis Pelvic Organ Prolapse?
Pelvic Organ Prolapse is a very common condition, particularly among older women. It's estimated that half of women who have children will experience some form of Pelvic Organ Prolapse in later life. Many women, particularly because they may no longer be sexually active, and fail to continue receiving their annual pelvic exams, don't seek help from their doctor. Therefore, the actual number of women affected by Pelvic Organ Prolapse is unknown.
Pelvic Organ Prolapse may also be called; genital prolapse, pelvic relaxation,pelvic prolapse, uterine prolapse, uterovaginal prolapse, pelvic floor disorder, urogenital prolapse or vaginal wallprolapse.
Whatis Pelvic Prolapse?
Pelvic Prolapse is anotherterm used for "pelvic organ prolapse." Pelvic prolapse is a very common condition, particularly among older women. It's estimated that half of women who have children will experience some form of Pelvic Organ Prolapse in later life. Many women, particularly because they may no longer be sexually active, and fail to continue receiving their annual pelvic exams, don't seek help from their doctor. Therefore, the actual number of women affected by Pelvic Organ Prolapse is unknown.
Pelvic Prolapse may also be called; genital prolapse, pelvic relaxation, uterine prolapse, uterovaginal prolapse, pelvic floor disorder, urogenital prolapse or vaginal wallprolapse.
Whatis a Prolapsed Uterus?
A Prolapsed Uterus refers to a collapsed uterus, or descended uterus, or other change in the position of the uterus in relation to the surrounding structures within the pelvis. The pelvis contains many soft tissue structures vital to normal body functions, supported primarily by the diaphragms, layers of muscles, fibrous coverings called fasciae, and various ligaments and tendons. These soft tissues of the pelvis derive their ultimate support from the bony pelvis.
A Prolapsed Uterus may be one of three types, depending on the severity:
• First-degree prolapse occurs when the uterus sags downward into the upper
vagina.
• Second-degree prolapse occurs when the cervix is at or near the outside of the
vagina.
• Third-degree prolapse (sometimes referred to as total prolapse) occurs when the entire uterus extends outside the vagina.
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