Gynecologic Oncology A subspecialty of Age

1
Gynecologic Oncology A subspecialty of Age

• Samir Fouad Khalaf
• Professor OBGYN
• Al-Azhar University
• President www.ArabicOBGYN.net

2
Origin of the Word "Cancer

• The word cancer came from the father of medicine,
  Hippocrates, a Greek physician. Hippocrates used
  the Greek words, carcinos and carcinoma to
  describe tumors, thus calling cancer "karkinos".
• The Greek terms actually were words to describe a
  crab, which Hippocrates thought a tumor
  resembled. Although Hippocrates may have named
  "Cancer", he was certainly not the first to
  discover the disease

3
The First Documented Case of Cancer

• The world's oldest documented case of cancer
  hails from ancient Egypt, in 1500 b.c.
• The details were recorded on a papyrus,
  documenting 8 cases of tumors occurring on the
  breast. It was treated by cauterization with a
  hot instrument called "the fire drill".
• It was also recorded that there was no treatment
  for the disease, only palliative treatment.
• There is evidence that the ancient Egyptians were
  able to tell the difference between malignant and
  benign tumors.
• According to inscriptions, surface tumors were
  surgically removed in a similar manner as they
  are removed today.

4
The Birth of the Pathological Autopsy

• In 1628, the first autopsy was done which paved
  the way to learning human anatomy and physiology
  .
• It wasn't until 1761, that pathological autopsies
  were performed to research cause of death in ill
  patients.
• In 1980s molecular biology start to influence our
  understanding of the disease process

5
Theories on the Causes of Cancer

• The lymph theory developed in the 17th century,
  .
• It was believed that abnormalities in the
  lymphatic system was the cause .
• In late 19th century Rudolph Virchow
  recognized that cells, even cancerous cells,
  derived from other cells.

6
Other theories

• Other theories surfaced, such as cancer
  being cause by trauma, parasites, and it was
  thought that cancer may spread "like a liquid".
• It was later concluded that cancer spread
  through malignant cells by German surgeon, Karl
  Thiersch.In 1926 a Nobel Prize was wrongfully
  awarded for the discovery of the cause of stomach
  cancer- a worm. The 20th century saw the
  greatest progression in cancer research.
• Research identifying carcinogens,
  chemotherapy, radiation therapy and better means
  of diagnosis were discovered. Today, we are
  able to cure some types of cancer, and research
  is ongoing. Clinical trials and research studies
  are out key to finding a cure, or a definitive
  method of prevention.

7
Gynecologic Oncology

• A field of medical sub specialization that deals
  with the study and treatment of malignancies
  arising in the female reproductive tract, ovary,
  cervix, endometrium, vagina, vulva and
  trophoblstic diseases

8

• During the second half of the 20th. Century
  enormous progress has been made in the use of
  surgery, radiation therapy, chemotherapy and
  other treatment modalities for gynecologic
  cancers
• Meanwhile, the field of obstetrics and gynecology
  grew into such an enormous field, clinically and
  scientifically, that it became impossible for one
  doctor to master both complicated obstetrics,
  infertility, surgery for benign conditions and
  the treatment

9
Gynecologic Oncology

• The field started in 1960s in the USA and the
  first certificate started to be given in 1974
• The field grows rapidly and many gynecologic
  Oncology Societies established.
• SGO was founded in 1969
• GOG founded in 1970 sponsored by the NCI and now
  have 50 centers and 160 affiliated institutes
• IGCS was founded in 1986
• AGOS May 2006

10

• What is gynecologic Oncologist?

11

• Is a specialized obstetrician/gynecologist
• Therefore, gynecologic oncologists have had
  extensive training in providing care for women
  with and without cancer

12

• Gynecologic oncologists are trained in providing
  comprehensive, multi-disciplinary care
• They are skilled surgical oncologists who also
  are trained in administering chemotherapy
• Therefore, they are able to provide an
  outstanding degree of continuity of care for
  their patients

13

• Gynecologic oncologist is prepared to provide
  supportive services
• Pain management
• Management of medical or surgical complications
  from treatment,
• Management of complications of the cancer
• Hospice referral

14
Gynecologic Cancers

• Gynecologic cancers represent 14 of all solid
  tumors in women and 11 of deaths from them.
• Cervical, uterine and ovarian cancer represent
  95 of gynecologic cancers and collectively rank
  the fourth in both incidence and mortality among
  cancers that affect women in developed countries.
• Worldwide, these tumors account for even larger
  share of cancer mortality in women

15
Cervical Cancer

• Worldwide, it is the second most common cancer in
  women
• 493,000 cases of cancer cervix compared to
  1.15million cancer breast (2002)
• In developing countries cancer cervix account of
  15 of all new female cancer compared to 3.5 in
  developed countries due to
• Socioeconomic differences
• Behavioral differences
• Presence of screening programs

16
Number of Cases of Cancer Cervix in Egypt,
Jordan, USA
17
Endometrial Carcinoma

• Worldwide it represents 3.9 of female cancer
• It is more common in developed countries
  18/100,000 in USA Canada compared to 6/100,000
  in Africa and is related to
• Prolonged high estrogen levels
• Few number of children
• Use of HRT

18
Number of cases of Endometrial Carcinoma in
Egypt, Jordan, USA
19
Ovarian Carcinoma

• Epithelial ovarian carcinoma account for 90 of
  cases and is the leading cause of death in women
  with pelvic malignancies
• The incidence is higher in industrial countries
  of the world
• Women who are single and have low parity and a
  history of breast cancer are at risk

20
Age-standard incidence rate of Ovarian Carcinoma
in Egypt,Jordan,USA
21
Women Knowledge about gynecologic Cancer
22
Concerning about developing gynecologic cancer

• 87 concerned about developing cancer
• 52 very concerned
• 70 concerned about developing ovarian cancer
• 68 concerned about cervical cancer
• 66 concerned about uterine cancer

23
Knowledge about gynecologic cancer

• Despite their concern about developing
  gynecologic cancer
• - 30 feel they are not knowledgeable
• - 55 feel they are only somewhat knowledgeable
• - 14 say they are very knowledgeable

24
Information about Risk Factors

• 54 believe they are at risk in their lifetime
• 43 do not feel they are at risk
• Women aged 35-44 are most likely to report
  felling that they are at risk

25
(No Transcript)
26
Factors decreasing risk
27
Awareness of Symptoms
28

• Women are uncertain of what type of specialist
  they would see if they were diagnosed with
  gynecologic cancer
• 41 say they would need to see a gynecologist
• 31 would need to see an oncologist
• 11 mention that they would see gynecologic
  oncologist
• 13 do not know what type of specialist they
  should see

29
conclusion

• The field of gynecologic Oncology is not well
  understood in many countries and the specialty is
  still far from being established in Arab
  countries.
• Doctors need to know more about this specialty in
  order to increase patients knowledge and guide
  patients to the proper management by referring
  them to the Gynecologic oncologist