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Female Reproductive System Tumors

Cervical Cancer​

Overview​

  • Definition: Malignant tumor originating in the cervix.

Etiology​

Similar to cervical squamous intraepithelial lesion.

  • HPV Infection.
  • Sexual Behavior and Number of Deliveries.
  • Others: Such as smoking.

Histopathology​

  • SIL continues to develop, breaking through the basement membrane beneath the epithelium, infiltrating the stroma, forming invasive cancer.

Pathological Types​

  • Invasive Squamous Cell Carcinoma: Common type, accounting for 75-80%.
    • Macroscopic Types (4):
      • Exophytic Type: Most common, cauliflower-like, often involving the vagina.
      • Endophytic Type: Infiltrates deep tissues, cervix appears smooth, enlarged, hard, and barrel-shaped.
      • Ulcerative Type: Combination of the above two types, forming ulcers or cavities, resembling a volcanic crater.
      • Cervical Canal Type: Originates within the cervical canal, often invading the blood vessels of the cervical canal and isthmus and metastasizing to pelvic lymph nodes.
    • Microscopic Types (2):
      • Microinvasive Squamous Cell Carcinoma.
      • Invasive Squamous Cell Carcinoma. (Differentiated from high-grade to low-grade or using keratinized versus non-keratinized criteria)
  • Adenocarcinoma:
    • Macroscopic Types (2):
      • Ordinary Cervical Adenocarcinoma: The most common histological subtype of adenocarcinoma, 90%, occasionally showing interstitial mucinous pools but no explicit mucin in tumor cells, cytoplasm is amphophilic or acidophilic.

Leiomyomas of the Uterus​

Overview​

  • Common benign tumor composed of smooth muscle and connective tissue.

Etiology​

  • Unknown, local high sensitivity of leiomyoma tissue to estrogen + progesterone promotes differentiation suggesting a link.
  • Genetic studies of leiomyomas have confirmed some abnormalities.

Leiomyoma Degeneration​

  • Glassy: Most common, myocytes disappear, uniform transparent area without structure.
  • Cystic: Inner wall lacks epithelial coverage.
  • Red: Special necrosis during pregnancy or puerperium.
  • Sarcomatous: Rare.
  • Calcareous: Layered deposition seen microscopically in calcified areas.

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Treatment​

  • Observation: No treatment if asymptomatic.
  • Medication:
    • Mild symptoms in women nearing menopause, follow-up every 3-6 months.
    • GnRH-a (Gonadotropin-releasing hormone analog): High-dose continuous or long-term non-pulsatile administration.
    • Mifepristone: Antagonizes progesterone, not suitable for long-term use, risk of endometrial cancer.
  • Surgery:
    • Indications: Menorrhagia caused by leiomyomas, infertility due to leiomyomas, severe abdominal pain, compression, suspected sarcomatous change.
    • Myomectomy: Possibility of recurrence, preserves fertility.
    • Hysterectomy: Suspected malignancy, no need to preserve fertility.

Endometrial Cancer​

Overview​

  • Definition: Epithelial malignant tumor arising in the endometrium.
  • Endometrial adenocarcinoma is the most common.

Etiology​

  • Type I: Estrogen-dependent: Obesity, hypertension, diabetes, infertility, delayed menopause, anovulatory diseases.
  • Type II: Non-estrogen-dependent: Unclear.

Type I: High sugar, fat, women, endless.

Clinical Presentation​

  • Vaginal Bleeding: 90%, in premenopausal women, increased menstrual flow, prolonged menstrual periods, and menstrual irregularity.

Diagnosis​

  • Medical History.
  • Diagnostic Curettage: Routine choice for vaginal bleeding, segmental curettage to exclude endometrial cancer.

Ovarian Tumors​

Histological Classification​

  • Epithelial Tumors: Most common, divided into serous, mucinous, endometrioid, clear cell, transitional cell (Brenner tumor), mixed seromucinous.
  • Germ Cell Tumors: Derived from germ cells, divided into teratomas, dysgerminomas, yolk sac tumors, embryonal carcinomas, non-gestational choriocarcinomas, mixed germ cell tumors.
  • Sex Cord-Stromal Cell Tumors: Derived from sex cords and mesenchymal tissue of the primitive gonads, divided into pure stromal tumors, pure sex cord tumors, mixed sex cord-stromal tumors.
  • Metastatic Tumors.

Staging​

  • Stage I: Limited to the ovary or fallopian tube.
  • Stage II: Tumor involves one or both ovaries with pelvic spread.
  • Stage III: Accompanied by histologically confirmed extra-abdominal metastasis.
  • Stage IV: Metastasis beyond the abdomen.

Ovarian Epithelial Tumors​

Overview​

Treatment​

  • Common Chemotherapy Regimen: Paclitaxel, Carboplatin.