Gynecological Project
Gynecological neoplasms of interest in this early detection project are tumors of the uterus (neck and body) and ovaries.
THE NECK OF THE CERVIX TUMORS or UTERINE CERVICAL CANCER
The neck of the cervix is the lower part of the organ and defines the passage between the vagina and the uterine body. Cervical cancers are classified on the basis of the cells they originate from and are mainly two types: squamous cell carcinomas (80%) and adenocarcinomas (15%). The mixed forms are less common defined as adenosquamous carcinomas (3-5%)
The cells in transformation initially have characteristics defined as precancerous (CIN, SIL). Left to themselves, in time they can lead to a tumor or in some cases regression.
Evidently, preventing their formation and diagnosing and treating them in a timely manner reduces the risk of developing a neoplasm.
RISK FACTORS
Infection with the Human Papilloma Virus (HPV): infection is transmitted through sexual contact, although not all strains of the virus are involved in the onset of the disease: only the HPV 16 and HPV 18 strains appear to be responsible for the majority of cervical cancers. Sexual activity at an early age and multiple sexual partners may increase the risk of infection, as well as conditions of immune defence insufficiencies related to disease (e.g. AIDS) or transplants.
Not all HPV infections cause cancer; the immune system can combat them without any health consequences
A positive family history: the presence of close relatives with this cancer
Obesity
Diet low in fruit and vegetables
Smoking
SIGNS AND SYMPTOMS:
The initial stages are generally asymptomatic and unspecified: abnormal blood leakage between a cycle and the next or after sexual intercourse; no presence of blood in vaginal secretions; pain.
EARLY DIAGNOSIS
Scheduled Pap tests as part of screening programs has proven to be effective in changing the natural history of cervical cancers, at least in Western countries. 3,500 new cases occur In Italy every year while the diagnosis of advanced forms and the likelihood of dying from this disease are much more rare. However, the disease still hits many victims in developing countries.
The following is recommended:
a yearly gynecological examination after the age of 18 (earlier if sexually active)
Pap test every 3 years (between 25 and 64 years old)
HPV test (Papilloma Virus) on medical advice
Colposcopy on medical advice
To prevent cervical cancer over the last few years, women have had access to an additional weapon: the vaccine against the human papilloma virus administered to adolescents at their twelfth year reduces the risk of infection from HPV 16 and HPV 18. Vaccinating adult women appears to be of no effect since they are sexually active, have already come into contact with the virus and may have already eliminated it.
CANCER OF THE UTERUS BODY
The uterus has the shape of an inverted funnel and is formed by two parts: the neck and body.
The body is made from very different materials: the inner part is called the endometrium and consists of glandular tissue; the myometrial outer part is represented by muscle tissue.
The majority of uterine tumors originate from the endometrium and are called endometrial carcinomas. In almost all cases they are preceded by atypical endometrial hyperplasia forms.
It differs from uterine sarcomas when tumors arise from the uterine muscle and connective tissue.
RISK FACTORS
Age: they rarely appear before 50 years old. Commonly affect women over 60.
Obesity: high calorie and fat diet
Diabetes: diabetic women often overweight
Hormones: estrogens play an important role. Sex hormones are responsible for the changes related to the menstrual cycle and provide a strong impetus to the proliferation of endometrial cells.
All conditions that affect the level of estrogen may increase the risk of developing this disease:
– Early menarche
– Late menopause
– The absence of pregnancies
– Treatment with antiestrogens
– Estrogen-secreting ovarian tumors
Radiotherapy: for the treatment of other pelvic tumors
SIGNS AND SYMPTOMS:
Abnormal vaginal bleeding: between one cycle and another or after menopause
vaginal discharge: also smelly
Pain in the pelvic area or spine
EARLY DIAGNOSIS:
The endometrial cancers account for almost all the uterine tumors. They account for between 5-6% of female cancers with 7,700 new cases a year in Italy.
Unfortunately, there are no effective screening programs to detect the disease at an early stage.
However, it is recommended to carry out the following:
annual gynecological visit
transvaginal pelvic ultrasound + annual doppler echocardiography for women in peri and post menopause and on medical advice
endometrial cytology for atypical bleeding and on medical advice
OVARIAN CANCER
The ovaries are two organs located at the side of the uterus connected via the uterine tubes (fallopian tubes). They are responsible for the production of female sex hormones and reproductive egg cells.
Ovarian tumors are divided into benign, malignant and intermediate malignancy (borderline).
On the base of the original cell:
Epithelial cells: they arise from the cells that line the organ. They account for more than 90% of ovarian tumors.
Germ cells: they originate from germ cells where oocytes are formed. They account for 5% of malignant ovarian tumors and predominantly affect the youth. They produce tumor markers detectable in the blood (alpha fetoprotein and chorionic gonadotropin).
Stromal cells: they originate from the supporting tissue of the ovary. They produce both male and female hormones. They account for about 4% of all ovarian tumors.
RISK FACTORS
Age: the majority of malignant tumors appear after menopause with a peak between 50 and 70 years old for epithelial forms
Positive personal and family history: predisposed to the disease
Geographical area: the incidence of the malignant form shows higher rates in Europe and North America
Endocrine factors: early menarche, infertility, absence of children, late menopause predisposed to disease
Environmental factors: an association has been observed with an exposure to asbestos, talc, with obesity and a high fat diet
Genetic factors: dependent defects in the BRCA1 and BRCA2 genes show a predisposition to breast and ovarian cancers. In these cases the cancer affects more women of the same family and at a younger age.
Another genetic condition associated with the onset of these tumors is the Lynch 2 syndrome associated with nonpolypoid colonic carcinoma.
SIGNS AND SYMPTOMS
Unfortunately, the cancer shows no symptoms in early stages. The symptoms are often vague and unspecific:
– Abdominal or pelvic pain
– Bloating
– Flatulence
– Digestive disorders
– Hive disorders
– Urinary disorders
EARLY DIAGNOSIS
Ovarian cancer is the sixth most common female cancer and is the most common cause of death from gynecological cancers, likely due to a delay of diagnosis (about 2/3 of cases are diagnosed in advanced stages).
Scientifically reliable screening programs do not currently exist, but the following are considered useful:
annual gynecological visit
annual pelvic transvaginal ultrasound on medical advice.
Periodic monitoring is particularly recommended for women with a family history of ovarian cancer or in case of genetic mutations such as those found in the hereditary cancer syndromes of breast / ovarian cancer and non polypoid colorectal cancer.
The determination of the CA 125 marker has not proven to be of any help since it is not specific enough, although it is very useful in monitoring an already diagnosed and treated disease.
The GYNAECOLOGICAL PROJECT of the Foundation aims to carry out free gynecological examinations (check up + Pap test + transvaginal ultrasound) in order to perform an early diagnosis of suspicious lesions, allowing for an intervention in the most appropriate and timely way possible
Checkups are performed by appointment at the clinics listed below. They are free of charge thanks to funds / resources / donations that the Foundation is able to devote to this sector.
- ANT Institute in Bologna
private facilities within the national territory which ANT has a special agreement with regarding
