Tumors of the gynecological system

Tumors of the gynecological systemTumors of the gynecological system may be benign or malignant and may occur in any por­tion, but several sites are seen in much greater frequency than others. The skin covering of the vulva is subject to the same tumors, moles, warts, etc., as other skin areas. Cer­tain types of warts which predominate in warm moist areas may occur more commonly here. These are called condylomata or perineal warts. Some types may be from specific germ infections but most are without specific cause. Treatment may be by drug applications, elcctric cautery, or surgical excision.

Malignancy of the vulva and the vagina is rather rare, but when present demands radical x-ray and surgical treatment.

Benign tumors of the cervix are most com­monly cervical polyps. These are small pendu­lous growths which stem out from the cervical lining to protrude from the cervical opening. They are usually multiple and may give rise to abnormal bleeding. Their treatment entails their removal by surgical electric cautery or excision.

The cervix is a most common site of can­cer in the female. Whenever there is the least suspicion of malignant change in this organ, cervical biopsy must be performed, for it is only by this means that the presence of cancer may be confirmed. This is a minor procedure wherein a small piece of tissue is taken from the cervix for microscopic study. This may be accomplished in the surgeon’s office at the time of pelvic examination, or may be done concur­rently with other vaginal procedures. Treatment of cervical cancer entails the use of radium ap­plications in specially designed containers which are left in place in and around the cervix for a specific period of time, as calculated by the x-ray specialist. This may be augmented by the further use of x-ray from the therapeutic x-ray machine. Surgical treatment of cervical cancer may be necessary in conjunction with, or in place of. radium and x-ray therapy, and can entail ampu­tation of the cervix, complete removal of the uterus, and other extensive intra-abdominal operations to extirpate all possible extension of the disease.

Tumors of the uterine body are relatively common. A benign tumor arising in the muscula­ture, known as a fibroid, is most common. Fibroid tumors may be solitary or multiple and occur any place within the uterine wall. They may vary from the size of a small pea to sev­eral inches in diameter, and tend to be spherical in shape. Occasionally the entire substance of the uterus may be replaced by fibroid tumors, greatly distorting the organ. These tumors are usually slow-growing and their characteristics on physical examination are quite definite. Care­ful continued observation of a fibroid tumor by repeated physical examinations may allow defer­ment of operative removal until after the child­bearing years. Some will enlarge too rapidly, however, and produce such symptoms that de­lay is not reasonable. These tumors remain harmless as long as their growth is slow and limited to the uterine wall. But some will pro­gress to crowd other pelvic organs, and some will erode into the uterine canal to cause ex­cessive bleeding. Often these benign tumors lie dormant and of the same size for several years, but then growth may resume. In some there seems to be a hormonal relationship with growth and they may tend to get smaller after the menopause (change of life). Some fibroids may interfere with the normal retention of a pregnancy, but many cause no trouble whatso­ever, even through several pregnancies.

The operative removal of fibroid tumors may simply entail a shelling out of the growth from the uterine body but may require removal of the entire uterus. Occasionally a fibroid will in­volve the cervical portion of the uterus, in which case it may be excised by the vaginal approach.

In a few fibroid tumors a malignant change takes place and their removal is imperative.

Other malignancies of the uterine body also demand radical surgical removal. Adjacent or­gans such as the bladder and the intestines which have become involved with uterine cancer may also have to be partially removed with the can­cerous mass. X-ray treatment after removal of malignancies from the gynecological system may be indicated.

Tumors of the ovaries may be benign or malignant, the latter group unfortunately pre­vailing in frequency. The benign tumors may be solid but more often arise as a new growth in the wall of a cyst. These tend to continu­ally enlarge and often disturb the hormonal function of the organ. Sincc the nature of ovarian tumors cannot be accurately determined by physical examination, early operative ap­proach is indicated.

Malignant ovarian growths often present a treacherous course, since their symptoms may occur late with little warning that a serious dis­ease process is present. Symptomless onset and symptomless progression of ovarian cancer make mandatory the recommendation that all women past middle age have a routine physical exam­ination every six months. Cancer of the ovary may be a primary new growth from the ovary itself, or may be a secondary spread from other intra-abdominal organs, most often from the stomach or the intestines. Ovarian malignan­cies, like benign ovarian tumors, may be solid or of cystic origin. They tend to spread within the abdominal cavity, often transplanting onto adjacent structures. Usually with such spread there is marked increase in the amount of intra- abdominal fluid, the condition known as ascites.

Treatment of ovarian tumors demands early operation since the status of malignancy or be- nignancy cannot be determined otherwise; since ovarian hormonal function may be increased or decreased by either; since all tend to con­tinually enlarge, and since early operative re­moval of malignant tumors offers the best cure. The operative procedure may necessitate the concurrent removal of adjacent involved struc­tures. X-radiation therapy may be indicated postoperatively.

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