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- Volume 1, Issue 1, 2009
Southern African Journal of Gynaecological Oncology - Volume 1, Issue 1, 2009
Volume 1, Issue 1, 2009
Author Greta DreyerSource: Southern African Journal of Gynaecological Oncology 1 (2009)More Less
Author Gerhard LindequeSource: Southern African Journal of Gynaecological Oncology 1 (2009)More Less
All lists of cancers in women in South Africa include gynaecologic cancers in high ranking orders. In particular cervical cancer is still one of the most common cancers in women in South Africa and probably still the most common cancer of women in Africa. In other parts of the world cervical cancer has been surpassed by endometrial cancer in frequency of occurrence. This pays tribute to the ultimate success of well designed and properly executed screening programmes for cervical cancer in many countries. Ovarian cancer seems to also occur with an increasing frequency around the world. This disease with its guarded prognosis has been associated with gene mutations in an important proportion of cases. The geographical regional HIV pandemic also made an impact on gynaecologic cancer occurrence. Cancers of the vulva and cervix are more commonly diagnosed in sufferers from HIV than in non-infected women. The more rare gynaecologic cancers include soft tissue sarcomas, cancers of the rest of the Mullerian system, and gestational trophoblastic neoplasia.
Author L.A. DennySource: Southern African Journal of Gynaecological Oncology 1, pp 5 –8 (2009)More Less
The cervical epithelium is derived from two embryologically distinct sources. The portio vaginalis of the cervix is covered by non-keratinised stratified squamous epithelium, similar to the vaginal epithelium. Mucus-secreting columnar cells of the same embryological derivation as the uterine endometrium cover the endocervical canal. At birth there is an abrupt junction between the original squamous epithelium and the columnar epithelium of the endocervix, known as the original squamo-columnar junction (OSCJ). In the majority of cases, this junction is on the ectocervix, but may be on the vagina, particularly in diethylstilbestrol (DES) exposed women. At about one year of age, the cervix begins to elongate resulting in the migration of the squamocolumnar junction towards the external os. At the time of menarche or during pregnancy, both the uterus and cervix enlarge. Enlargement of the cervix is accompanied by alterations in its shape, resulting in greater eversion of the endocervical columnar epithelium towards the vagina.
Over time, the columnar epithelium exposed on the portio vaginalis of the cervix is remodelled and replaced by metaplastic squamous epithelium. As this occurs, the original squamocolumnar junction (OSCJ) moves towards the endocervical os or endocervical canal, creating a new SCJ. The area between the original and the new SCJs is called the transformation zone (TZ) and is characterised histologically by metaplastic epithelium.
The concept of the TZ is central to the understanding of the pathogenesis of squamous cell cancer of the cervix and its precursors, because virtually all cervical squamous neoplasia originates at the new SCJ and coincides with the distribution of the TZ. In addition, in reproductive life, the TZ is located on the exposed portion of the cervix and is amenable to cytological and histological sampling and colposcopic examination. While the TZ is difficult to visualise with the naked eye, its localisation is greatly enhanced by the application of 5% acetic acid and the use of the colposcope.
Author M. MoodleySource: Southern African Journal of Gynaecological Oncology 1, pp 11 –13 (2009)More Less
Cervical cancer remains the second most common cancer among women worldwide and the most common cancer amongst black African women in South Africa. Annually there are 500 000 cases of cervical cancer worldwide, of which the mortality is about 50%. This is largely due to presentation at a late stage. Lack of availability of treatment facilities may be another factor contributing to this high mortality.
Ironically, cervical cancer is one of the few medical conditions with a precursor lesion, which if appropriately detected and treated, can result in a reduction of both the prevalence and mortality from cervical cancer. It turns out that southern Africa like so many other parts of the developing world, suffers from the same ills such as a lack of finances, lack of knowledge of the disease and a lack of political will to curb the prevalence of the disease. A significant amount of the health budget needs to be spent treating this disease every year.
There is now a large body of evidence implicating the oncogenic human papillomavirus (HPV) as a necessary agent in the pathogenesis of cervical cancer. To date, two commercial vaccines have been developed to curb the diseases caused by the high risk and low risk HPVs. However, similar to the problems of screening for cervical cancer, it remains a challenge to ensure that there will be sufficient dissemination of information about the vaccines to the community, uptake of the vaccine by women and the political will to implement a preventative vaccine strategy.
Modelling research shows Cervarix-induced immune response may be prolonged for at least 20 years for both HPV 16 and 18 : press releaseSource: Southern African Journal of Gynaecological Oncology 1 (2009)More Less
Results of three statistical models presented recently at the European Research Organisation on Genital Infection and Neoplasia (EUROGIN) annual meeting in Nice suggest that young women vaccinated with GlaxoSmithKline's HPV vaccine Cervarix could look forward to a prolonged immune response against the two most common cancer-causing human papillomavirus virus (HPV), types HPV 16 and 18 for at least 20 years.
Author M.H. BothaSource: Southern African Journal of Gynaecological Oncology 1, pp 16 –20 (2009)More Less
Endometrial carcinoma is a less common gynaecological malignancy in the developing world, yet a significant number of individuals are diagnosed each year in South Africa. The relative frequency of endometrial carcinomas has increased over the last years in developing economies due to an increase in obesity and a decrease in fertility rate. In South Africa endometrial carcinoma is more common in certain subpopulations. Asian women have a life time risk of 1 in 106 to develop endometrial carcinoma. The overall risk for women of all races in South Africa is 1 in 146. The most common histological type is endometriod-type adenocarcinoma but other histological types include mucinous adenocarcinoma, clear cell carcinoma, uterine papillary serous carcinoma (UPSC), squamous carcinoma and also carcinosarcoma.
The endometrium represents a specialised tissue in the uterine cavity which, during the reproductive years, undergoes profound histological changes during each menstrual cycle. The endometrium is stimulated by trophic hormones during each cycle to undergo normal growth and eventually be transformed into a secretory endometrium with active mucin production. The two hormones controlling the endometrial cycle are oestrogen and progesterone. Oestrogen causes growth (proliferative phase) and progesterone causes luteinisation and mucin secretion (secretory phase). It is clearly established that excessive oestrogen production will lead to over stimulation of the endometrial stratum functionalis and if normal secretory phase endometrial changes do not occur under the influence of progesterone regular shedding of the endometrium is absent which may eventually lead to hyperplastic and malignant changes.
Source: Southern African Journal of Gynaecological Oncology 1, pp 23 –27 (2009)More Less
Ovarian cancer is the eighth most frequently diagnosed cancer and currently is the leading cause of death from gynaecologic cancer. Globally, the five-year survival is only 15-20% for patients with clinically advanced ovarian cancer despite aggressive surgery and platinum based chemotherapy. The poor overall prognosis is primarily due to the fact that the disease is almost invariably advanced when the diagnosis is made. In Africa the most common malignancies in females are cancer of the cervix (23.3%), breast cancer (19.3%), Kaposi's sarcoma (5.1%), liver cancer (5.0%), non-Hodgkin lymphoma (38%), and cancer of the ovary (3.7%).
In South Africa, the National Cancer Registry reported 529 cases of ovarian cancer in 2001. Of these cases, 207 were in white patients, 225 in black patients, 69 in coloured patients and 16 were reported in the Asian community. Known risk factors include age, primigravidity, history of breast, endometrial and colon cancer, intraperitoneal talc powder or vegetable fibre, ovarian hormonal hyperstimulation, delayed childbearing, high-fat diet, fertility drugs and the Lynch II syndrome. The use of the combined oral contraceptive pill, sterilisation and a previous hysterectomy appear to have a protective effect and decrease the incidence.
Young breast cancer patients in the developing world : incidence, choice of surgical treatment and genetic factors : reviewSource: Southern African Journal of Gynaecological Oncology 1, pp 29 –31 (2009)More Less
Carcinoma of the breast is the most common cause of cancer in women in Western society. Although breast cancer occurs predominantly in older premenopausal and postmenopausal women, it also occurs in young women. Literature defines breast cancer in a young woman (or early onset breast cancer) as occurring in a woman less than 35 years of age. A diagnosis of breast cancer in a young woman impacts severely on all aspects of her life, as well as on those around her.
In Africa and other developing countries, the breast cancer burden is increasing and poor reporting and data availability may underestimate the exact numbers. The average age of diagnosis may be younger for women in developing countries than for women in developed countries. African patients are more likely to be premenopausal at diagnosis and the breast cancers tend to be more advanced at presentation than in other population groups in a country such as South Africa.
The choice of surgical treatment in early onset cancer depends on various factors. Young age is an independent risk factor for worse outcome regardless of whether a patient had a mastectomy or breast conserving therapy. Breast concerving treatment is an option for treatment of breast cancer in a young patient given the correct indications and that the patient is fully informed about the high risk of local recurrence.
The extent of genetic factors such as mutations on BRCA 1 and 2 (BReast CAncer 1 and 2) genes is still largely unknown on the continent of Africa, and much research still needs to be done. In the USA, only 5-10% of early onset breast cancers are attributable to mutations on BRCA 1 and 2 genes, and another 15-20% of early onset breast cancers are due to gene polimorphisms and environmental factors.
General breast awareness among women of all age groups in Africa should be promoted. This includes how to perform self breast examinations and to seek urgent medical attention when a breast lump is discovered. In time, given the resources, good screening programmes on this continent to detect breast cancer at its earliest presentation would be the ideal.
Author L.C. SnymanSource: Southern African Journal of Gynaecological Oncology 1, pp 32 –37 (2009)More Less
Gestational trophoblastic disease (GTD) represents a group of tumours arising from the trophoblastic tissue of the placenta. It comprises a spectrum of clinical entities ranging from non invasive molar pregnancy, to metastatic gestational trophoblastic neoplasm, and can follow any type of pregnancy.
Author A. MoutonSource: Southern African Journal of Gynaecological Oncology 1, pp 39 –42 (2009)More Less
Cancers of the vulva and vagina occur less commonly than the other genital tract tumours, accounting for approximately 9% of all cancers of the female genital tract worldwide. Despite the adjacent status of the two organs the aetiology of cancers of the vulva and vagina are not always shared. Staging is also complex as tumours with a major vaginal component and a minor vulvar component are classified and staged as vulvar tumours. Similarly, tumours with a major vaginal component and a minor cervical component are classified as cervical tumours.
Source: Southern African Journal of Gynaecological Oncology 1, pp 44 –45 (2009)More Less
Source: Southern African Journal of Gynaecological Oncology 1 (2009)More Less