GYNECOLOGICAL ONCOLOGY . . . CONT.
adenocarcinoma • most are metastatic, usually from the cervix, endometrium ovary, or colon • most primaries are clear cell adenocarcinomas • 2 types: non-DES and DES syndrome • management as for SCC diethylstilbestrol (DES) syndrome • most existing cases have already been documented • maternal use and fetal exposure to DES predisposes to cervical or vaginal clear cell carcinoma • < 1 in 1,000 risk if exposed • DES opposes the process of squamous metaplasia • clinical presentation • adenosis or the replacement of normal squamous epithelium of vagina by glandular epithelium • occurs in 30-95% of exposed females • adenosis usually transforms via metaplasia to normal squamous epithelium • malformations of upper vagina, cervix, and interior of uterus (T-shaped) • cockscomb or hooded cervix, cervical collar • pseudopolyps of cervix
Table 6. Staging Classification of Vaginal Cancer (Clinical Staging)
intraepithelial neoplasia (VAIN) carcinoma in situ
1 2 3 4
limited to the vaginal wall involves subvaginal tissue, but no pelvic wall extension pelvic wall extension extension beyond true pelvis or involvement of bladder or rectum
New squamocolumnar junction
Original squamocolumnar junction
Figure 8. The Cervix
Printed with permission from Essentials of Obstetrics and Gynecology. 2nd ed. N.F. Hacker and J.G. Moore (eds.), W.B. Saunders Co., 1992.
Benign Cervical Lesions endocervical polyps • common post-menopause • treatment • polypectomy • +/– D&C
Malignant Cervical Lesions SSC (95%), adenocarcinoma (5%) 8 000 deaths annually in North America
MCCQE 2000 Review Notes and Lecture Series