WHAT PROCEDURES ARE DONE AT THE DIVISION OF GYNECOLOGIC ONCOLOGY?
- Screening tests for gynecological cancers
- Abnormal smear, HPV and preinvasive cervical pathologies
- HPV vaccine
- Cervical Cancer
- Endometrial cancer
- Uterine sarcomas
- Ovarian Cancer
- HIPEC (heated chemotherapy)
- Vulva-vagina cancer
- Gestational trophoblastic diseases
- Sentinel Lymph Node surgery
What is Colposcopy?
Detailed examination of the cervix enables to detect precancerous conditions and cancer at very early stage.
For cervix cancer screening, the most common methods are Papanicolaou (Pap) smear analysis and Human papillomavirus (HPV) test. Cervix should be examined in detail, when suspicious findings regarding precancerous conditions are identified on these tests. This examination method is called as colposcopy. This procedure brings about early diagnosis with high diagnostic accuracy, if performed by specialists.
Why is colposcopy performed?
In case abnormal findings are noted during cervical cancer screening test (smear and/or HPV test), colposcopy is recommended to make diagnosis. The other reason is frequently recurring vaginal bleeding after sexual intercourse.
During the examination, the cervix is dilated 36 times more with colposcope. Some stains are applied to determine the areas where abnormal cells may be present on the cervix. Meanwhile, biopsy may be recommended depending on the width, type and location of these areas. After biopsy result is reported, it can be clearly understood whether there is precancerous lesion. In many cases, no abnormal finding is identified after a detailed colposcopic exam and the patient is asked to attend follow-up visit at certain interevals.
GYNECOLOGICAL CANCER SCREENING TESTS
What is Cancer Screening?
Cancer screening tests are performed to make early diagnosis for individuals with no apparent complaint. Depending on the type of cancer, screening tests and time plan vary. High-risk age group varies in every type of cancer.
What kind of cancer screening test can be performed for women?
- Cervical cancer
- Ovarian cancer
- Breast cancer
- Colon and Rectal Cancer
The most important factor in almost all cervical cancers is persistent high risk HPV infection. HPV 16 and 18 include 70% of cervical cancers across the globe, while HPV types 31, 33, 45, 52 and 58 lead to 20% of cervical cancers. Also, HPV 16 and 18 cause 90% of anal cancers.
Until now, three HPV vaccines have been developed and introduced into the market to reduce HPV-related disease burden.
Cervical cancer is a preventable disease. It is possible to make early diagnosis and provide effective treatment with smear/pap smear and HPV DNA tests.
Endometrial cancer is located in the inner lining of the uterus, namely endometrium. The uterus consists of two portions, one is cervix extending to the vagina at lower segment, the other is corpus at upper segment. The corpus is composed of two parts; the innermost layer is called as endometrium. Changes occur in the endometrium during menstrual cycles. At the end of the cycle, the endometrium is shed and menstruation starts. This cycle continues until menopause. Almost all endometrial cancers arise from the abnormal growth of the cells in the endometrium and such cancers are called as endometrial adenocarcinoma.
What is cervical cancer?
Cervical cancer occurs when the cervical cells start growing abnormally.
Cause of cervical cancer
Human papillomavirus (HPV) is the primary cause of almost all cervical cancers. There are more than 100 types of HPV. Most types are associated with low risk but yet pose the risk of cervical cancer. High-risk types may cause the growth of abnormal cells that may result in cervical cancer. Indeed, two types of HPV (HPV 16 and 18) cause the most of cervical cancer cases. HPV 16 and/or 18 are responsible for 70% of cervical cancer cases.
· Bleeding after sexual intercourse
· Post-menopausal bleeding
· Abnormal vaginal discharge
· Pain in inferior abdominal quadrants
These complaints may be caused by many factors aside from cancer. It is recommended to consult with your physician in case of abnormal vaginal bleeding.
Uterine sarcomas are derived from mesoderm arising from the wall of the uterus. Such tumors comprise 2%-6% of all malignant uterine tumors. Radiotherapy applied to the pelvis for any condition increases the risk of uterine sarcoma. Uterine sarcomas are generally the most malignant group of uterine tumors.
The most common 3 types are endometrial stromal sarcoma, leiomyosarcoma and malignant mixed mullerian tumor.
- Endometrial stromal tumors:
- malignant mixed mullerian tumor
Cancer affects the cells which are the basic unit of our body. When cancer affects the cells through various mechanisms, the cells start dividing abnormally and growing in uncontrolled manner.
In healthy individuals, the ovaries consist of the cells that reproduce as much as the body needs. Redundant cells are abnormal and these are called as tumor. Tumors may be benign or malignant. For instance, fluid-filled ovarian cysts observed in women aged below 30 are benign. They may disappear spontaneously or may be excised with surgery. Benign tumors do not invade the surrounding tissues. However, malignant tumors invade both the ovaries and surrounding tissues. Ovarian cancer may spread to the intestines, stomach and even distant body parts through blood or lymphatic way. Such a spread is called as “metastasis”.
No specific complaint develops in many patients with ovarian cancer. Thus, many patients seek medical attention at advanced stage. At this stage, symptoms like abdominal distension, nausea and weight loss occur.
HIPEC (heated chemotherapy)
HIPEC- Hyperthermic Intraperitoneal Chemotherapy is a cancer treatment method in which heated chemotherapy drugs are administered to the abdominal cavity for a while. HIPEC, also called “heated chemotherapy”, is a surgical operation performed after the tumors or lesions are excised from the abdomen. While this procedure was applied for the stomach and intestinal cancers at the beginning, it has been used for ovarian cancer since 2016.
How is heated chemotherapy (HIPEC) applied?
After all visible tumors in the abdomen are excised, four HIPEC catheters are placed in the abdominal cavity and the tips of these catheters are advanced to the relevant areas in the abdomen. Chemotherapy drugs are heated up to 42 degree Centigrade in HIPEC device and pumped to the abdominal cavity. The procedure lasts about 70-90 minutes. HIPEC procedure is designed to kill all invisible cancer cells. Later, solution is removed and incision is closed.
HIPEC and ovarian cancer surgery are performed by experienced physicians. Our studies regarding HIPEC have been reported in the literature.
VULVA – VAGINA CANCER
Vulva cancer is a type of cancer that occurs on the exterior surface of the female genitalia. Vulva is a skin area surrounding the urethra and vagina, including the clitoris and labia minora.
Vulva cancer is generally characterized by a lump or wound in the vulva and causes itching and pain. Vulva cancer is rare and comprises approximately 4% of the gynecologic cancers. The condition may occurs at any age; however, vulva cancer frequently emerges at advanced ages in post-menopausal women.
Signs and symptoms of vulva cancer may include:
· Continuous itching (pruritis)
· Pain and tenderness
· Skin changes like discoloration or thickening
· A lump, wart-like or cauliflower shaped mass or open wound (ulcer)
· Abnormal bleeding
· Feeling of burn
GESTATIONAL TROPHOBLASTIC DISEASES
Gestational Trophoblastic Disease (Molar pregnancy)
The disease, colloquially known as molar pregnancy, is defined as Gestational Trophoblastic Disease in Medicine. GTD is a disease that arises from the placental tissue and associated with many pathologic conditions, particularly hydatidiform mole, invasive mole, choriocarcinoma and trophoblastic tumor. There are many types. In case there is no improvement in GTD, gestational trophoblastic tumor (GTT) develops. GTT generally occurs after hydatidiform mole. Rarely, the condition may occur after miscarriage and spontaneous vaginal delivery. From pathological perspective, there are two forms of GTT typically; invasive mole and choriocarcinoma.
Today, GTT is known as a disease that can be easily managed and treated completely. GTT is a pregnancy-related disease. Thus, this condition is frequently observed in societies with high fertility rate, like our country, and it is an important health problem. The disease occurs in 1 pregnancy out of every 1000 pregnancies, albeit varying from country to country.
Factors related to GTT
2. Nutritional Facts
4. Number of pregnancies
5. History of molar pregnancy
6. Contraception methods
75%-80% of mole cases present to the clinic with abnormal bleeding.
SENTINEL LYMPH NODE SURGERY
As well as in many organ cancers in Oncology, one of the most important prognostic factors in genital cancers is disease spread to the lymph nodes. Although lymph node involvement is present in <20% of gynecologic cancer patients for whom surgical treatment is planned, the procedures performed to investigate lymphatic involvement cause delay in surgical intervention and prolonged hospital stay, the risk of critical intraoperative complication increases and persistent sequels occur. Sentinel lymph node (SLN) is defined as the first lymph node to which an anatomic region drains. SLN is based on the thesis that the status of SLN provides information regarding the entire lymphatic system. If there is no involvement in SLN, disease in the remaining regional lymph nodes is not expected. Today, SLN surgery can be successfully performed for endometrial cancer, cervical cancer and vulva cancer in gynecology. SLN surgery results in shorter operative period and hospital stay.
Also, unnecessary surgery and complications are avoided and life quality improves. Since this surgery is performed without making large abdominal incisions with Robotic or Laparoscopic Systems, the patient recovers quickly and pain is less severe. Thus, targets are achieved with surgical treatment.