►Fibroid (Bg Tm) & Endometriosis (not )

►Uterine Mg (Endometrial ca &Cancer Cx)

Neoplasm
►Cancer [Vulva, Vagina, Ovary]
►GTN

-Definition
-Incidence
-Risk Factors (PDF)
-Pathology 
Site
N/E
M/E
Grading
Staging
Spread
-Complications
-Diagnosis  Hx, Exam. & Investigations
-Prognosis
-ttt
 Uterus

Vagina
Cancer
Fibroid 1 Endometriosis2 Endometrial
Cancer Cx
Cancer Vulva Ovarian Cancer GTT3
[Not Tm] Carcinoma
=Leiomyoma Presence of Mg Tm of………….. Mg
=Fibromyoma endometrial body of Uterus Cx of Uterus ♀Ext. Genitalia Vagina Ovary Gestational
=Myoma tissue Trophoblastic
Def.

(glands & stroma) dse 

Bg Tm of outside normal
Myometrium uterine cavity [proliferative
abnormalities
[Smooth ms of of trophoblast]
uterus]
affects 20% of 1% of postmenopausal General Incidence  4th MC Mg Tm of 3rd MC Mg Tm of -Far east 

1-2 % of All Gyna Mg Tm

women > 30 y affects 15-20%
women 10-13/10 5
FGT FGT 1/5000
(Gynecological Cancer) or 1/6000
of women > 30 y MC Mg uterine Tm 2nd MC Mg Tm in ♀
-USA & Europe 
2nd MC Tm in♀ 25 % of
[after Breast??]
?? worldwide [after Breast]  1/20000
chronic pelvic 3-4 % of All Gyna
MC Bg Tm
of FGT
pain
30 % of cases
In many developing countries
2nd MC of FGT MC Tm of FGT
Mg Tm
[all gynecologic
 Incidence A2
Last pregnancy
After Cancer Cx cancers] 1st [Leading] cause
of infertility
MC uterine Tm In developed countries of death 50% of Cases
MC Tm of FGT 2nd MC Tm ↑↑ over last from FGT Cancer Follow
Incidence

After Endometrial Ca decade in Western Vesicular mole

Accurate assessment
hemisphere > 2/3 of cases in 25% of Cases
of incidence is Difference of incidence in Follow
difficult (d2 widespread advanced stage at time
developed than developing countries infection by HPV) of diagnosis [usually Abortion or
Prolonged life expectancy [old age] being asymptomatic till Ectopic pregnancy
The need of
+ Post-menopausal HRT have metastasized] 20% of Cases
laparoscopy or
laparotomy + Low parity Follow
for the diagnosis, Normal pregnancy
but it is expected to………
Early & ⬆ rate of diagnosis of
endometrial carcinoma / precancerous
Lesion of Cancer Cx
Least Cause mortality 2nd cause of mortality 
of FGT cancer  of FGT Cancer
d2 80% of cases  [after Ovarian Ca]
confined to uterus at
time of diagnosis
1
Fibroid is the commonest name but leiomyoma is the most correct & other names are fibromyoma & myoma
2
Presence of endometrial tissue inside Myometrium  Called Adenomyosis [No longer Considered Endometriosis interna]
3
GTT [Gestational Trophoblastic Tm] = Choriocarcinoma = Chorion Epithelioma
 Uterus

Vagina
GTT*

Cancer
Cancer Vulva Ovarian Cancer
Fibroid Endometriosis Endometrial Ca Cancer Cx
 Age
> 30 y (especially 30 - 40y) mAge of Diagnosis 45-60y 60-70y 60-70y No age is immune >40y
about 60y
𝟏
there is another peak d2  Incidence of
𝟒
Perimenopausal in younger patients in But usually defective Ova
𝟑 association e' HPV postmenopausal
𝟒
Postmenopausal infection
 Parity
Nullipara or low parity1 Multipara2 No Effect
Nullipara or low parity1
Multipara2
[Hyper estrogenic State] [ Incidence of Ovulation]
 SES [Socioeconomic status]
Risk Factors [PDF]

High High Low Low High Low

(low parity & use of (High parity & (low parity + (Poverty &
(low parity & use of ERT) (Bad Hygiene)
ERT + Old age) Early Marriage) High Fat Content in Diet) malnutrition)
 Familial Predisposition
Family Hx of Familial ovarian cancer
Cancer breast, +ve family Hx   Risk
ovary or colon of developing epithelial
Lynch II syndrome# cancer ovary
+ve Family Hx ‫وتشرح كما موضح تحت الجدول‬ +ve Family Hx
Hereditary Breast-
ovarian cancer syndrome
 Lynch II syndrome#
‫وتشرح كما موضح تحت الجدول‬
 Race
Negros ---   in
in Black & Christians South east Asia
 esp. Philippines

in Jewesses & Muslims

(circumcision of males)
#
Lynch II syndrome
hereditary nonpolyposis colorectal cancer "HNPCC" (Lynch I syndrome)
+ ↑↑ incidence of Other GIT (Extra Colon), breast & GU cancers [endometrial, ovarian]
*
Same Risk factors of Vesicular Mole but  risk in multipara [ ‫] مع مراعاة الرز الفلبيني في شرق اسيا‬
1
Nullipara   Estrogen [Fibroid, Endometriosis & Endometrial Ca] &  Incidence of Ovulation d2 Trauma of ovulation [in Cancer Ovary]
2
Multipara  d2 Repeated laceration of Child birth [in Cancer Cx] &  Incidence of GTT (Tm originate form the placenta "Trophoblast")
  Specific Risk Factors
ⓐ Hyper-estrogenic state ⓐHyper-estrogenic ⓐSexual activity & ⓐChronic irritation ⓐSTD✓ ⓐOvulation & ⓐ Food
Evidence: state
STDs (Most important & pruritis HPV type ovulatory drugs
 Common in rice &spicy
risk factors) -Lack of cleanliness 16 & 18 Mainly predispose to
nullipara & low parity eating individual
*Sexual activity: & improper vulval Common epith. Tm Have  Risk
not appear before puberty & skin aeration
[Nullipara or low parity] -Infection + pruritis
never arises de novo
after menopause Causes: Almost unknown in As in monilial vulvo-
‫وتشرح من اسفل الجدول‬ virgins & nuns vaginitis (esp. DM) ⓑ Previous pelvic
  in size in pregnancy irradiation
Risk Factors [PDF]

PDFs & Mech ‫وتشرح‬ -Chemicals

 [regresses] after labor *STDs: ✓ Deodorants, perfumed soaps
shrunk after menopause HPV sprays, synthetic underwear
mineral oils, Arsenical subs.
type 16, 18 found in 90%
 contains estrogen Rc of cases of high grade ⓑ STDs ✓
& is produced by estrogen in CIN & cancer Cx HPV [most important]
experimental animals HSV type II Condyloma accuminata
Causes: ⓑ Cancer corpus
HIV HSV type II & HIV
‫وتشرح‬ triad
Syphilis & LGV &
ⓑManipulation of ⓑ Smoking Granuloma inguinale
FGT during menses ⓒSenile endometritis Mech ‫وتشرح‬
e.g HSG & PV  Precancerous Lesions
Endometrial CIN -VIN VAIN Dysgenetic gonads Previous
ⓒ Outflow tract hyperplasia (Risk of Mg ‫)وتشرح‬ -Vulval dystrophy predispose to -Vesicular mole
obstruction 
Causes of
(Risk of Mg ‫)وتشرح‬ [Hypertrophic with germ cell Tm [GCT] -Abortion
atypia & Lichen sclerosus] -FTND
Cryptomenorrhea

Hyper-estrogenic state Cancer Cx

Predispose to Sexual Activity
 Fibroid  Endometriosis & adenomyosis  Endometrial (hyperplasia, Carcinoma) PDFs
 Cystic mammary hyperplasia of breast & Cancer breast 1-Early age of sexual activity (Adolescents)
2-Early age at the 1st pregnancy
Causes
3-Multiple sexual partners & prostitution
ⓐ Physiological -Early menarche [before 12y'] & late menopause [after 52y']
-Nullipara & low parity
Mechanism
1-smegma is oncogenic
ⓑ Pharmacological ERT Not COCs?? As it's protective for both endomet. & ovary 2-Introduction of oncogenic viruses by STDs
ⓒ Pathological Estrogen secreting ovarian Tm 3-semen act as mutagen with abnormal growth of cx. Epith.
Chronic anovulation (metropathia hemorrhagica & PCOS) Smoking
ⓓ Biochemical Cancer corpus triad (DM, HTN, obesity) Products of cigarettes smoke concentrated in Cx mucus
DM → d2 hyperinsulinemia &  IR
Obesity → d2 conversion of androstenedione to E1 in adipose tissue Mφ (Langerhan's cells)
 Endometriosis Endometrial Ca Ovarian Cancer
Exact cause is unknown COCs or gestagens Factors  ovulation 

Protective Factors
(dse of theories) -Up to 50 %  in incidence e.g high parity & COCs
A) Implantation theory -Protection lasts many years after stopping them
[transplantation theory] [Sampson 1920] Multiparity, late menarche & early menopause
● Theory: → Endometriosis is caused by
implantation of endometrial cells by Frequent intake of vegetables, fruits Diet rich in Vit. A & fibers
retrograde menstruation1 & whole grain foods
● Evidences:
-Cigarette smoking ????!!! - Mumps oophoritis
Clinical Evidence 
-Menstrual reflux from fallopian tubes is
- Prophylactic oophorectomy
observed during laparoscopy
-Patients è outflow tract obstruction
(cryptomenorrhea) 
have ↑↑ risk of endometriosis.
Experimental evidence 
Endometrial fragments "from menstrual fluid" can
grow in tissue culture & after implantation
Etiology

under skin
B) Celomic metaplasia theory
● Theory Endometriosis is caused by
metaplasia of cells lining pelvic peritoneum.
● Evidences  No clinical or experimental
for this theory
As an extension to metaplasia theory, induction theory proposes that
endogenous biochemical factors can induce metaplasia of pelvic
peritoneum cells
C) Vascular-lymphatic theory:
● Theory Endometrium is transported via
vascular & lymphatic systems.
● Evidence 
Occurrence of endometriosis at distant sites
(as lungs)
D) Genetic factor
Risk is 7 times greater if 1st degree relative has endometriosis
E) Immunologic factors
Immune system may be altered in women è endometriosis
as a result of ↓↓ cell mediated cytotoxicity allowing endometrial cells to
survive outside endometrial cavity

1
Menstrual debris through tubes during menstruation.