Cancer

There are several different types of cancers that can start in a woman's reproductive system. These include:

• Ovarian Cancer
  
• Cervical Cancer (Cancer of the neck of the womb)
  
• Uterine / Endometrial Cancer (Cancer of the body of the womb)
  
• Vulval Cancer (Cancer of the external genitals)
  
• Vaginal Cancer (Cancer of the birth canal)

The two common types of cancer among above are discussed below.

OVARIAN CANCER

Ovarian cancer is a disease in which normal ovarian cells begin to grow in an uncontrolled, abnormal manner and produce tumors in one or both ovaries. Three basic types of ovarian tumors exist, designated by where they form in the ovary. They include:

• Epithelial tumors
  About 85 percent to 90 percent of ovarian cancers develop in the epithelium - the thin layer of tissue that covers the ovaries. This form of ovarian cancer generally occurs in postmenopausal women.
• Germ cell tumors
  These tumors occur in the egg-producing cells of the ovary and generally occur in younger women.
• Stromal tumors
  These tumors develop in the estrogen- and progesterone-producing tissue that holds the ovary together.
  

Risk factors

Ovarian Cancer Staging (TNM System)

Staging System

Ovarian cancer staging usually is described in terms of the FIGO system (staging scheme developed by the International Federation of Gynecology and Obstetrics) and the TNM system (classification system developed by the American Joint Committee on Cancer [AJCC]).

Ovarian cancer treatment ultimately depends upon such staging. In general, the lower the stage, the more favorable is the prognosis.

T Stage (Tumors)

The primary tumor (T) is classified according to the following categories:

Nodal staging (N)

Spread /Metastatic Staging (M):

Stage Grouping

The TNM system places ovarian cancer growth at a particular stage. There are four basic stage groupings within the TNM system:

Tumor Grade

Tumor grade generally refers to the degree of differentiation - or maturity - of the cells that make up the tumor within the ovary. Yet, worldwide, there are many different systems for the grading of ovarian cancers, without a common standard. Most investigators use criteria such as the architectural "pattern" of the cells and their nuclear content (e.g., DNA "ploidy," or how many pairs of chromosomes are present), although additional factors may be considered, such as the tumor's margin, invasion of the blood vessels, and penetration of the ovarian capsule (surface).

Most epithelial cancers are categorized by three grades of cells:

• Grade 1 - the least malignant, with well-differentiated cells
  
• Grade 2 - intermediate, with moderately differentiated cells
  
• Grade 3 - the most malignant, with poorly differentiated cells

The low-grade (e.g., Grade 1) tumors grow more slowly and have a better prognosis than high-grade tumors.

Diagnostic imaging Tests

Ultrasound

CT / MRI

Intravenous pyelogram (IVP)

PET-CT Scan

Laboratory Tests

In addition to imaging studies, other tests may be used to help verify a diagnosis of ovarian cancer. These include blood analyses for tumor markers, tests for genetic mutations, and the microscopic examination of ovarian cells.
CA125 is a blood protein known as a tumor marker. Research has shown that roughly 85% of women with clinically apparent ovarian cancer have increased levels of CA125. CA125 is not a fool proof test, as the protein also is increased during the first trimester of pregnancy, during menstruation, and in the presence of noncancerous illnesses (e.g., liver failure, pelvic inflammatory disease, endometriosis) and cancers of other sites (e.g., breast, lung, pancreas, colorectal). Some ovarian cancers may not have elevated CA125.

Women who are at high risk because of a positive family history of ovarian and/or breast cancer should be offered BRCA1 and BRCA2 mutation screening.

Treatment

Other Therapies;

Immunotherapy

Gene Therapy

Gene therapy eventually may provide some control over cancer susceptibility and its treatment. Ovarian cancer, like all cancers, is believed to result from a build-up of genetic defects within the cells. Genetic engineers hope to correct such damage by transplanting copies of normal genes into cells with genetic defects. In addition, genetic manipulation may enable researchers to alter tumor cells so that they "commit suicide," are targeted by the immune system, or become more sensitive to chemotherapy. Investigators also have spent a lot of time trying to improve the resistance of bone marrow cells to chemotherapeutic agents, so that the doses of such drugs can be intensified. The practical applications of gene therapy are still being refined.

Hormone Therapy

There have been many reports of the potential benefits of hormone treatments in patients with ovarian cancer that does not respond to conventional therapy. For example, individuals with treatment-resistant (refractory) epithelial cancers have been treated with:

• progestins - crude forms of the female sex hormone progesterone
  
• oestrogens - for example, diethylstilbestrol (DES)
  
• combination estrogen/progestin therapy
  
• antiestrogens
  
• androgens - male sex hormones
  
• gonadotropin - releasing hormone (GnRH) - a hormone of the hypothalamus that stimulates the                             release of ovary-related hormones from the pituitary gland.