MINISTRY OF PUBLIC HEALTH OF UKRAINE
NATIONAL PIROGOV MEMORIAL MEDICAL UNIVERSITY, VINNYTSYA
CHAIR OF OBSTETRICS AND GYNECOLOGY №1
METHODICAL INSTRUCTIONS
for practical lesson
«Backgrounds and precancerous diseases of the female genital organs.
Malignant formations of the genital organs. Trophoblast diseases.»
MODULE 3: Diseases of the Female Reproductive system. Family planning.
CONTEXT MODULE 5: Principles of oncogynecology.
I. Scientific and methodical grounds of the theme
Early and active diagnosis of benign tumors and precancerous diseases of female
genitalia, their timely and correct treatment are the pledge for solution of cancer problems. II.
Aim:
A student must know:
1. Classification of precancerous diseases.
2. Methods of examination for diagnosis of precancerous diseases.
3. Conservative methods of treatment.
4. What are considered precancerous diseases?
5. Methods of examination for diagnosis of cervical carcinoma.
6. What is the method of early diagnosis of cervical carcinoma used?
7. Modern diagnostic methods of malignant diseases of female genitalia.
8. Modern therapeutic methods of malignant diseases of female genitalia.
A student should be able to:
1. Diagnose precancerous diseases of female genitalia.
2. Diagnose malignant tumors of uterus and adnexa.
3. Carry out a vaginal speculum-examination, vaginal examination, put up
primary diagnosis.
III. Recommendations to the student
PRECANCEROUS CERVICAL DISEASES
All precancerous cervical lesions are termed as "dysplasia" by decision of WHO
(1973) Experts Committee. Leukoplakia with atypia of cellular elements, erythroplakia and
adenomatosis also belong to this group. There are many synonyms of dysplasia such as:
atypia, atypic hyperplasia, basal cell hyperplasia, cervical intraepithelial neoplasia (CIN) and
others. Risk factors of dysplasia, and cervical cancer are: early beginning of sexual life,
multiple sexual partners, posttraumatic cervical changes in the result of abortions and
deliveries, infecting by HPV and VHS-2 viruses, change of hormonal balance
(hyperestrogeny), harmful working conditions and ecology. The disease most frequently is
found into women after 30 years. According to the localization dysplastic changes in young
patients appear in exocervix area and in women of climacteric age — in the cervical canal,
that is connected with the transitional zone migration.
Dysplasia
According to the degree of epithelium stinging, cultural atypia and saving of
epithelial layer architectonics three degrees of dysplasia have been distinguished. There are:

mild (CIN I)

moderate (CIN II)

severe (CIN III)
Hyperplasia and basal cell atypia occupies 1/3 of epithelium layer at CIN 1, at CIN
II the changes take about the half of mucous layer, and at CIN III all the epithelium or not less
than 2/3 of its layer is altered. The expressed atypia of the superficial layers is considered to
be the severe dysplasia.
The following types of epithelium changes are distinguished at colposcopy. They
are:
• areas of dysplasia:
areas of stratified squamous epithelium
areas of columnar epithelium metaplasia
• papillary zone of dysplasia:
papillary zone of stratified squamous epithelium hyperplasia
papillary zone of columnar epithelium metaplasia
precancer transformation zone
Diagnosis. Cytological research of smears allows to find the cells of basal and
parabasal layers with signs of dyskariosis.
Histochemical research in patients with dysplasia show a drastic lowering of
glycogen in cells up to full its absence and changes of tissue enzymes activity.
Cytogenetic researches testify that under this pathology the cells with tetraploid and
pentaploid number of chromosomes appeared.
For diagnosis verification it is necessary to perform biopsy with the following
histological research.
Leukoplakia with atypia
Clinically it does not differ from the simple leukoplakia. The processes of
keratinization of the cells in this disease are mistologicaly marked to be reinforced as
compared with leukoplakia. Cytological research of the stratified squamous epithelium
reveals cells without nucleus at simple leukoplakia. Basal and parabasal cells without
nucleoses are also present in the patients with leukoplakia and atypia.
Erythroplakia
It is a prettily heterogeneous form of dyskeratoses. The changes of cervical mucous
membrane are in thinning and keratinizing of epithelium. It looks like scarlet area in the result
of translucence of the basal membrane cells through thinned epithelial layer. It easily bleeds at
contact. The seats are single or plural with transition on fornices and vaginal walls. Thinning
of epithelial layer to 1-2 layers with nuclear atypia and cellular polymorphism is revealed
during the histological research.
Glandular hyperplasia with atypia
Local hyperplasy of the glands that looks like a clew, similar to endometrial glands
at histological research are found. The glands which have different form and size are covered
by epithelium, that is unlike the cervical one.
Treatment of precancer lesions is made by diathermic excision, cryosurgical and
laser destruction. The most radical and less traumatic method is laser coagulation
PRECANCEROUS UTERINE DISEASES
(uterine carcinoma precursors)
According to international classification (1982), such processes as glandular
endometrial hyperplasia, cystic glandular endometrial hyperplasia, endometrial polyps belong
to benign endometrial diseases.
Glandular endometrial hyperplasia with cellular proliferation, adenomatous
hyperplasia and adenomatous polyps are precancerous utenne diseases
Cystic glandular hyperplasia, which is found in postmenopausal women or in
reproductive period belongs to precancerous uterine lesions
Glandular endometrial hyperplasia and cystic glandular endometrial hyperplasia are
different stages of the same process. Difference between them is presence or absence of cysts
in endometrial hyperplasia Atypical cellular signs at these diseases are not present The
common endometrial polyp is made up of endometrial tissue.
Atypical adenomatous hyperplasia is characterized by structural rearrangement and
more intensive proliferation of glandular elements comparing with other types of hyperplasia.
Ethiology. The main causes of endometrial hyperplastic processes are different
hormonal disorders at hypothalamic-pituitary-ovarian levels.
Factors affecting the risk of endometrial hyperplasia are diabetes melhtus, late
menopause, women who have never childbeared.
Clinic. The precancerous processes manifest with acyclic uterine bleeding which
can be either appreciable or insignificant, but they are continuous More often these bleedings
arise after some weeks or months delay of menses. Cyclic bleedings which appear during
menses and last for a long period of time may be also present Reproductive age women
complain of infertility as a result of anovulation
Diagnosis. Bimanual examination doesn't find out abnormalities. Sometimes,
insignificant enlargement of uterus may be revealed at the examination.
Ultrasound examination of uterine cavity determines the endometrial depth At
glandular-cystic hyperplasia echogenic inclusions are up to 1cm in size, madenomatosis — up
to 2-3 cm Endometrial heterogenity, presence of small amount of inclusions are the
characteristic signs for endometrial processes Endometrial polyp is characterised by legible
contours and distinct borders between the formation in uterine cavity and its walls
Hysteroscopy, hysterography can also be used for diagnosis that gives a possibility to research
uterine cavity, determine the location of pathological process
It is necessary to start the treatment from the uterine curettage. Indication to
hormonal therapy is histological confirmation of uterine hyperplasia. Progestins are the
medications of choice because of hyperestrogenemia. Oxyprogesterone acetate should be
taken on the 12-14 days of reproductive cycle once per month during 5-6 cycles at
reproductive age. In case of polyposis it should be taken twice per month at 12 and 19 days of
reproductive cycle. In menopausal women it should be prescribed once or twice per week
during 5-6 months, then the dose is gradually reduced. Androgens may be prescribed these
menopausal patients. Surgical intervention should be performed in case of no efficiency from
hormonal therapy, its contraindications.
IV. Control questions and tasks
1. Classification of precancerous diseases of the vulva.
2. What is erythroplakia?
3. What is leukoplakia?
4. Classification of dysplasia.
5. What diseases are considered precancerous uterine diseases?
6. Clinic, diagnostics, treatment of endometrial polyp.
7. Treatment of leukoplakia and kraurosis vulvae.
8. Therapeutic methods of uterus cervix erosion.
CERVICAL CARCINOMA
Epidemiology. Cervical carcinoma is a common gynecologic malignancy. The average age of
diagnosis for invasive cervical cancer is approximately 50. During the last years a tendency to
increasing incidence of cervical carcinoma in young women is maked. Women relating to
early sexual intercourse with multiple partners have this disease more frequent. Squamous cell
carcinoma is practically never encountered in virgins. It is caused by the carcinogen or
promoting factor that is sexually transmitted.
Etiology. Sexually-transmitted diseases are infected by herpes simplex viruses of 2-serotype
(HSV-2) or by human papillomavirus (HPV-16/18, 29/31, 35), that can stay for a long time in
the latent form. They are the causes of cervical cancer. Cervical carcinoma may be
intraepithelial (preinvasive), microinvasive (growth of the process into stroma on the depth up
to 0,5 cm beneath from basal membrane) and invasive one.
Histologically there have been distinguished:

squamous cell keratinous carcinoma

squamous cell nonkeratinous carcinoma

adenocarcinoma

clear cell adenocarcinoma

dimorphic adeno-squamous cell carcinoma
Highly-differentiated, moderate-differentiated and low- differentiated (or undifferentiated)
cancers have been distinguished according to the potential malignancy.
Forms of tumor growth are: endophytic, exophytic, mixed.
At exophytic form a tumor grows into vagina, resembling a cauliflower and is able to fill into
vagina. The endophytic form is characterized by tumor growing into the muscular layer of the
cervix. As a result of this cervix enlarges and consolidates. During tumor disintegration a
crater ulcer is formed. A mixed pattern of cervical carcinoma growth has signs of both
endophytic and exophytic ones. Cervical carcinoma can be spread on the uterine body,
parametrium and vagina.
Regional lymphatic nodes are situated around the cervix (obturator lymph nodes, general
iliac, sacral, parasacral ones.
Clinic. It depends on the process stage. The duration of preinvasive and microinvasive cancer
is without any symptoms (preclinical stage). Serous or serous-bloody discharge, contact
bleeding after sexual intercourse, vaginal examination, speculum examination may be used in
the first stage. Pain in the hypogastrium and back, serous-purulent discharge, resembling meat
slops with unpleasant smell (caused by lymph and blood effluence during tumor
disintegration) on the second and third stage appears. Patients' general state is suffered. Fast
tiredness and irritability can appear. The tumor can erode urinary bladder and rectum due to
growing inside of them. Constipation and urinary disorders can occur in the result of this.
Diagnosis. The diagnosis is made after the speculum examination. The form of vaginal part of
the cervix, its dimensions and anatomic state is determined. Patients with suspicion of cervical
carcinoma should be obligatory examined per rectum. These examinations are called as
rectovaginal and rectoabdominal. It allows to estimate the state of lateral and back parametria
and uterine cervix better.
The cytological examination of the cervical canal and uterine secretion is the method of early
diagnosis of the cervical carcinoma.
Microscopic evaluation of smears is made by Papanicolau method (Pap smear screening):

I type — unaltered epithelium

II-a type — inflammatory process

II-b type — proliferation, metaplasia, hyperkeratosis, (at suitable clinical picture they
are interpreted as polyp, simple leuloplakia, endocervicosis)

III-a type — mild, moderate dyplasia on the background of benign process and
unaltered epithelium

III-b type — severe dysplasia of squamosus epithelium on the background of benign
process and in the region of unaltered epithelium

IV type — suspicion of malignization intraepithelial cancer

V type — cancer

VI type — the smear is uninformative (the material was taken wrongly)
For the patients with III-V types of smears for confirmation of diagnosis simple and
broadened colposcopy, and histological research must be held. Patients with III type of smears
undergo regular medical monitoring. Colposcopy (simple and broadened) is used for the early
diagnosis.
Treatment is performed by oncogynecologysts according to the process' invasion. The
intraepithelial and microinvasive cancer in young women undergo surgical treatment by
cervical conization or its amputation. In the middle-aged or elderly women with uterine
myoma, or ovarian cyst presence it is expedient to perform total hysterectomy with adnexa.
The I-b - II stage of cancer are treated by combined (radiation + surgery) or combined-radical
method (if contraindications for surgical intervention are present). Surgical intervention
foresees the total hysterectomy or Wertheim's operation (removal of the uterus with its
adnexa, the upper third of vagina and cellular tissue with regional lymphatic nodes).
Treatment of cervical carcinoma at the III stage is performed by combined-radical method:
distant irradiation of the initial focus and parametria followed by intracavitary curie-therapy.
Patients with stage IV are treated individually, the therapy is usually symptomatic.
ENDOMETRIAL CARCINOMA
Endometrial carcinoma belongs to hormone-sensitive diseases. Continuously increased
estrogen production leads to excessive endometrial proliferation with trans formation -into
malignant tumor. Immune status of organism, virus infection, genetic disorders play an
important role in the development of this disease. Obesity, diabetes mellitus are classically
associated with endometrial carcinoma and, therefore, qualified as risk factors.
Morphologically:
adenocarcinoma,
adenoacanthoma,
clear
cell
meso-nephroid
adenocarcinoma, adenosquamous carcinoma, undifferentiated cancer are the subtypes.
According to International classification, adenocarcinoma is classified into well, moderate
and poorly differentiated tumors.
Clinic. Abnormal uterine bleeding is the most important symptom of endometrial cancer.
Women in menopause may have abnormal bleeding or watery discharge (lymphorhea) from
vagina. Pain is the late symptom of endometrial cancer. At first it is the result of excretions
accumulation in the uterine cavity. It is dull in case of peritoneal, adjacent organs or nervous
nodes involvement. If the pathological process is extended into adjacent organs following
symptoms would be present: revealing of mucus and blood in the feces, coprostasis — in case
of rectal tumor; hematuria — in case of urinary bladder involvement; hydronephrosis as a
result of uterher's compression.
There are three types of cancer clinical course.
Slow, rather favourable clinical course. This form is observed in patients with significant
hyperestrogenemia and lipids and carbohydrates dysmetabolism impairment. Continuous
uterine bleeding as a result of endometrial hyperplasia is the most common symptom.
Lymphatic way of metastasing is absent. Histologycally, it is well-differentiated cancer with
superficial invasion of the myometrium.
Unfavourable clinical course. Metabolism disorder is absent The course of the disease is
rather short Endometrial carcinoma involves all layers of myometrium, extends to cervix,
parametrium and vagina It is a poorly differentiated tumor
Acute, extremely unfavourable clinical course. It is characterised by unfavourable factors
combination, such as deep extension of tumor, lymph nodes and peritoneal metastases
"Ovarian" type of metastases would be present It is characterised by ascitis and omentum
metastases
Diagnosis is made basing on history, clinics, physical and pelvic examination.
Other additional examinations should be performed, including ultrasonography, cytological
sampling of the endometrial cavity, hysteroscopy , hysterography, fractional curettage with
the cytological examination
Treatment. Surgical, combined treatment, combining of radiation and hormones should be
used.
UTERINE SARCOMA
All not epithelial malignant tumors belong to sarcomas. Presence of uterine myoma in preand postmenopausal women, especially during its fast growing belong to the risk factors of
uterine sarcomas. There are four histological types of uterine sarcomas:

leiomyosarcoma

endometrial stromal sarcoma

carcinosarcoma (malignant mixed homologous mesodermal tumor)

mixed heterologous mesodermal tumor

other types of sarcomas
Clinical findings. Uterine bleeding and pelvic pain are the most common presenting
symptoms.
General weakness, weight loss, subfebril temperature for a long period of time are the
symptoms of uterine sarcoma presence for a long period of time.
Metastasis. The preferential way of spread is via the bloodstream. Other less frequent ways
of spread are via the lymph nodes and by contiguity.
Diagnosis. In many cases, the diagnosis is an unexpected finding at the time of hysterectomy
done for other indications. Sampling research of the endometrial cavity either by biopsy and
curettage can assist in diagnosis less than 50% of cases owing to the fact that many of these
tumors are intramural and thus without endometrial extension. Hysterography or
hysterocervicography should be performed. Investigation of the adjacent organs should be
recommended in all types of uterine sarcomas.
Plain film of breast, liver and X-ray examination of skeleton should be prescribed for
diagnostics of distant metastases.
Treatment. The preferred treatment is total abdominal hysterectomy and bilateral salpingooophorectomy.
MALIGNANT OVARIAN NEOPLASMS
Most of the malignant neoplasms that arise in the ovary fall into three categories: primary
cancer (neoplasms derived from the ovarian surface epithelium, i.e. epithelial tumors),
secondary (neoplasms derived from papillary or pseudomucinous cystadenomas), metastatic
(intestinal and breasts' metastasis).
Etiology. Ovarian tumors belong to hormonal active tumors. One should remember that
unblastomatic unproliferative processes (follicle, luteal cysts) are the results of pituitary and
ovarian hormones disbalance. The observation that patients with breast cancer have a two fold
increase in the risk of developing of ovarian cancer supports the concept that hormones play
an important role in the cause of ovarian cancer.
Malignant ovarian neoplasms are usually categorized according to the origin of the cell and
are similar to their deign counterparts:

malignant epithelial cell tumors, which are the most common type, 46-48%

malignant germ cell tumors, 10-14%

malignant stromal cell tumors, 4,7%
There are malignant tumors with inside and outside growing. Mixed tumors are also common.
Epithelial cell ovarian carcinoma may reach both small and large sizes, they are typically
multiloculated and often have external excrescencies on otherwise smooth capsular surface.
The walls of malignant cysts have different thickness, and, as a rule, have papillary injections
on the inner surface. Epithelial tumors haven't cysts, they are soft. They are small in sizes,
with smooth surface and grow in the direction of the adjacent organs.
Sometimes the metastatic cancer can appear in the ovaries. The term Krukenberg tumor
describes the ovarian tumor that is metastatic from other sites such as the gastrointestinal tract
(80% from stomach, remainder from colon, breast, and endometrium). Most of these tumors
are characterized as infiltrative, mucinous carcinoma of predominantly signet-ring cell type
and as bilateral and associated with the widespread metastatic disease.
Ways of spread of ovarian cancer. Ovarian cancer can spread by means of several pathways
The neoplasm can directly invade adjacent organs such as the small intestine, rectosigmoid,
colon, peritoneum, omentum, uterus, fallopian
tubes, and broad ligament Spread can occur by means of the peritoneal fluid and malignant
cells can be implanted throughout the pelvis and abdominal cavity, including the omentum,
posterior cul-de-sac, mfundibulopelvic ligaments, paracolic gutters, right diaphragm and
capsule of the liver. Ascites can often develop with peritoneal metasteses.
Dissemination may also occur through lymphatics to the uterine tube, uterus, pelvic and
paraaortic lymph nodes. Metastases occasionally are detected in distal sites such as the
supraclavicular or inguinal lymph nodes.
The least common way of spread is hematogenous dissemination. Hematogenous metastases
occur in the liver parenchyma, skin, and lungs.
Clinic. Early diagnosis of ovarian cancer is difficult, because symptoms are often absent or
vague until the neoplasm has attained a large size and metastasized. Even large tumors usually
produce nonspecific symptoms. Early symptoms include vague sensations of pelvic or
abdominal discomfort, urinary frequency, and alterations in gastrointestinal function.
Hemorrhage into the tumor or torsion of the ovary containing neoplasm can produce sudden
pain and other symptoms of acute abdomen.
The physical findings in patients with ovarian neoplasms in early stages are similar to benign
ovanan cystadenomas. Usually, they are of small sizes, painless, movable, with firm
consistency. They are palpated on the back from the uterus. The tumor may be palpated by
means of rectal examination. One can feel the mass within the cul-de-sac. The tumor may be
fixed because it can fill the available space in the pelvis or because the pedicle is very short (it
looks like uterine myoma).
Diagnosis. Pelvic examination is the main one in diagnostics of ovarian cancer neoplasms.
Physical findings in patients are absent if a tumor is of small sizes. Bilateral tumors may be
palpated on the sides of the pelvis, sometimes in the back of the uterus. Malignant ovarian
tumors are similarly irregular with nodular surface and have the firm consistency.
Ultrasonography should determine tumor location, its internal surface. Ultrasonography is
especially useful for uncertain physical findings in case of obesity.
Laparoscopy with diagnostic purposes should be indicated for the patients for revealing
external peculiarities of the tumor, presence of dissemination and metastases. Sometimes
diagnostic laparotomy is necessary in the evaluation of ovarian cancer.
Radiographic examination is valuable in the diagnosis of chest and abdominal cavity
revealing. X-ray examination of stomach and intestine is obligatory for exception of
metastatic ovarian cancer. Fibrogastroscopy and biopsy, pneumo-pelviog -aphy may be useful
for diagnosis.
Lymphography is of value in the diagnosis of dysgerminoma when lymphogenic way of
spread is the main one. In 30% of patients sacral metastases are present.
Treatment. All histologic types of ovarian carcinoma are threated in the same way. The
standard surgical procedure for carcinoma of the ovary is total abdominal hysterectomy and
bilateral salpingoophorectomy. A partial or complete omentectomy should be performed, and
in the advanced disease, an attempt should be made to resect as much metastatic tumor as
possible.
The patient whose neoplasm has spread beyond the ovary is initially a candidate for
chemotherapy even if all tumor has been resected. Chemotherapy is usually advocated for
women with all stages of disease. A variety of drugs are active against the ovarian cancer.
Such of them as Methotrexate, Cyclophosphan, Sarcolizine are emerhed as drugs for
chemotherapy. Combination chemotherapy may be more effective than single-agent
chemotherapy in patients with bulky residual tumor, but it is also more toxic. Combination of
such agents as Cyclopho-sphane+Phtoruracil; Cyclophosphane+Methotrexate+Phtoruracil;
Cyclophos-phane+Adriablastine+Cisplatin should be prescribed. Tiotef and Cisplatin should
be administrated intraperitoneally.
Dysgerminoma
Dysgerminoma is the most common malignant germ cell tumor which is arising from
undifferenting gonades that are present in the ovarian sinus.
Clinic. The tumor is common in the infantile patients of 30 years of age. Patients generally
can observe pelvic or abdominal mass, abdominal enlargement or pain. The duration of
symptoms ranges from 1 month to 2 years with a median of 4 months. The metastases are
present in lungs.
Diagnosis is difficult and it is based on the results of clinical findings, laparo-scopy and
histologic investigation results.
Treatment is surgical with the following radiation therapy and chemotherapy.
Ovarian teratoblastoma
Ovarian teratoblastoma is a rare malignant tumor which is found in childhood in juvenile
period.
Clinic. Pain in the lower part of the abdomen and general weakness are common. In the
advanced cases ascites is present. Metastatses arise very quickly.
Diagnosis is based on the histologic results.
Treatment is surgical with the following radiation therapy.
ADENOCARCINOMA OF THE FALLOPIAN TUBE
Adenocarcinoma of the fallopian tube is one of the rarest malignancies of the female genital
tract It may developed pnmanly (from utenne tube) secondary, or metastatically (from lesions
arising in the adjacent organs such as uterus and ovanes). Primarily the disease affects the
older women. The average age is 40-55 years that had chronic tubal inflammation for a long
penod of time. The process is always unilateral.
Adenocarcinoma of the fallopian tube has pappilary, glandular-papillarty, papillary-solid and
solid structure. The process can quickly metastase inside the pelvis.
Clinic. Most patients with tubal carcinoma are asymptomatic, and diagnosis is made only
after the patient has undergone surgical exploration for a pelvic mass A few patients have
symptoms such as vaginal bleeding or discharge, lower abdominal pain, abdominal distension
and pressure. In many cases these symptoms are vague and nonspecific.
Diagnosis. Ultrasonography and laparoscopy, cytologic investigation of the uterine aspirate
can prove the diagnosis.
Treatment is surgical.
CANCER OF EXTERNAL GENITAL ORGANS (VULVAR CANCER)
Cancer of external genital organs is a malignant epithelial tumor, that appears in women
during menopause and looks like infiltration, dense nodes or papilar formations. Ulceration is
possible. Precancer diseases come before the appearing of neoplasm. Late puberty, early
menopause and high fertility are typical for the patients with vulvar carcinoma. Frequently
vulvar carcinoma is combined with obesity and diabetes mellitus.
Exophytic, nodular, ulcerous and infiltrative forms of the tumor are distinguished.
Clinical manifestations. The main symptoms are itching, burning, pain, purulenthemorrhagic discharge. Pain of tumors is usually localized in the region of clitoris.
Hemorragic discharge can appear at tumor disintegration.
Final diagnosis is made basing on the histological research.
Metastasing happens into nodes of inguinal-femoral collector.
Treatment is surgical. Vulvectomy and bilateral inguinal lymphadenectomy (Ducken's
operation), combined treatment (vulvectomy and radiotherapy) are used. Radiotherapy is
performed before the operation.
CARCINOMA OF THE VAGINA
Carcinoma of the vagina can be primary and metastatic. More frequently women can have
cancer in climacteric period and after menopause. Cancer canappear in the aged women with
long-termed decubital ulcer due to its infecting and traumatizing. Exophytic (as cauliflower)
or endophytic infiltrative growth is observed. Histologically carcinoma of the vagina is
divided into the squamous cell keratinizing carcinoma, non-keratinizing and adenocarcinoma.
Clinical manifestations. The purulent-hemorrhagic discharge, pain, disturbance of urination,
signs of general intoxication are common unexpectable. Bleeding can occur at disintegration
of the tumor. Nerves are pressed, ruined and patients feel pain if a tumor spreads to the
underlying tissues, paravaginal cellular tissue.
Final diagnosis is made after biopsy.
Treatment. Carcinoma of the vagina is treated by the combined radiotherapy. X-ray or
gamma-ray telethepary with insertion of radioactive preparations into vagina are used.
IV. Control questions and tasks
1. What is the Papanicolau method?
2. What are the forms of cervical carcinoma growth?
3. Diagnostic methods of vagina cancer.
4. Morphologically classification of endometrial carcinoma.
5. What kind the treatment should be used for endometrial carcinoma?
6. Stages of Primary Carcinoma of the ovary
7. What treatment is used for adenocarcinoma of the fallopian tube?
8. Stages of uterus cervix cancer.
9. Stages of uterus body cancer.
10. Classification of ovary cancer.
11. Methods of treatment.
V. List of recommended literature
1. Danforth’s Obstetric and gynaecology.-Seventh edition.-1994.-P.959-1121
2. Gynecology.-Stephan Khmil, Zina Kuchma, Lesya Romanchuk.-2003.-P.240244; 276-279
3. Gynaecology illustrated. David McKay Hart, Jane Norman.-Fifth Edition.2000.-P.170-172