Cervical Cancer, Endometrial Cancer and Ovarian Cancer
Cancer of the female reproductive tract (e.g., cervix, endometrium, ovaries) often is treated by a gynecologic oncologist. A gynecologic oncologist is an obstetrician/gynecologist (OB/GYN) who specializes in the diagnosis and treatment of women with cancer of the reproductive organs.
Anatomy Of The Cervix And Uterus
The uterus, or womb, is located in the female pelvis behind the bladder and in front of the rectum. It is a muscular organ with a narrow, hollow cavity and is about the size and shape of an upside-down pear. The hollow cavity is normally about the thickness of a pencil and it expands during pregnancy as the developing fetus grows inside.
The uterus is divided into two regions: the corpus (the broad, upper part) and the cervix (the narrow, bottom part). Both the corpus and cervix have the same thick, muscular walls that surround the birth canal (the narrow canal that leads from the uterus into the vagina). In the cervix, the canal is called the cervical, or endocervical, canal.
The cervix is lined with a layer of cells called epithelial cells. Epithelial cells are a general type of cell found throughout the body, and they vary in shape and size depending on where they are. In the cervix, the epithelial cells inside the canal are very different from the cells that line the portion of the cervix that borders the vagina. The cells inside the canal are tall and are referred to as columnar epithelium. On the outside wall of the cervix, where the cervix meets the vagina, the epithelial cells are flat, or squamous. A very delicate area of the cervix, called the squamous columnar junction, is where the tall columnar cells end and the flat, squamous cells begin. It is here that precancerous lesions are usually detected and where cells are sampled for Pap smear screening.
Cervical cancer is cancer of the cervix, the lower end of the uterus. This disease is preceded by a precancerous condition called cervical intraepithelial neoplasia (CIN), which may or may not develop into cancer. Studies have shown that, if left untreated, 15–70% of CIN cases eventually develop into invasive cervical cancer.
Cervical cancer is the sixth most common cancer in women in the United States and the most common cancer in women in many economically underdeveloped countries. Only breast cancer causes more cancer-related deaths in women worldwide.
The rate of cervical cancer has been decreasing steadily over the past several decades in the United States, due in large part to widespread routine Pap smear screening. A Pap smear is used to detect the early growth of precancerous CIN cells in the cervix, and is the single most important step a woman can take to prevent cervical cancer. In many developing countries where preventative health measures are not routine, the incidence and mortality from cervical cancer continue to rise.
Although the cause of cervical cancer is unknown, several risk factors have been linked to the disease. These range from sexually transmitted infections (e.g., human papillomavirus [HPV]) to tobacco smoking. Researchers are still trying to determine the actual causal role that these factors play in the development of cervical cancer.
The uterus is a muscular hollow organ located in the pelvis between the bladder and the rectum. It is divided structurally and functionally into two parts: the body and the cervix. The principal ligaments that support the uterus re the broad ligaments, the round ligaments, the utrerosacral ligaments, and the cardinal ligaments. Cancer of the uterine fundus (body) is the most common type of gynecologic malignancy and endometrial cancer is the fourth most common cancer in women. There are approximately 35,000 new cases per year, resulting in nearly 5000 deaths.
Ovarian cancer is cancer of the ovaries, which are female reproductive organs that are similar to the testes in men. They produce the ova (eggs) that, when fertilized, develop into a fetus, and also generate the female sex hormones estrogen and progesterone. There are two ovaries, each of which is located within the pelvis beside the uterus (womb).
The ovaries are oval-shaped and are approximately 1 1/2 inches in length. They are connected to the uterus by the fallopian tubes (oviducts), which carry the eggs into the uterine cavity. Each ovary contains numerous Graafian follicles, which are egg-containing tubes that grow and develop between puberty, sexual maturation, and menopause. When a woman is fertile, a Graafian follicle travels to the surface of the ovary each month, bursts, and releases an egg and its fluid contents into a fallopian tube.
The Graafian follicles are fixed in a network of supporting tissue (stroma) and blood vessels. They are covered by a clear, smooth, plasma-like membrane that develops from the peritoneum (lining of the abdominal cavity). Also within the ovaries are small numbers of corpus lutea (remains of Graafian follicles that have released an egg and are in the process of being reabsorbed by ovarian tissue). Each month the corpus luteum (scar tissue of a Graafian follicle) is responsible for the production of progesterone. Progesterone is the pregnancy hormone that readies the lining of the uterus for the arrival of a fertilized egg.