By Dr. Olga Lobanova from Oncology department

1. Ministry of Public Health of Ukraine
National O.O.Bohomolets Medical University
Oncology Department
STUDY GUIDE
OF THE PRACTICAL COURSE
“ONCOLOGY”
Part I
For the students of medical faculties
Worked out by I.B.Shchepotin MD, PhD, DSci, Prof; G.A.Vakulenko MD, PhD,
DSci, Prof; V.E.Cheshuk MD, PhD, DSci; A.S.Zotov MD, PhD; O.I.Sidorchuk
MD, PhD; V.V.Zaychuk MD, PhD; L.V.Grivkova MD, PhD; O.E.Lobanova
MD; I.N.Motuzyuk MD; Y.V.Levchishin MD.
Kyiv - 2008

2. Ministry of Public Health of Ukraine
National O.O.Bohomolets Medical University
Oncology Department
“APPROVED”
Vice-Rector for Educational Affairs
Professor O. Yavorovskiy
______________
“___” __________ 2008
STUDY GUIDE
OF THE PRACTICAL COURSE
“ONCOLOGY”
Part I
For the students of medical faculties
Worked out by I.B.Shchepotin MD, PhD, DSci, Prof; G.A.Vakulenko MD, PhD,
DSci, Prof; V.E.Cheshuk MD, PhD, DSci; A.S.Zotov MD, PhD; O.I.Sidorchuk
MD, PhD; V.V.Zaychuk MD, PhD; L.V.Grivkova MD, PhD; O.E.Lobanova
MD; I.N.Motuzyuk MD; Y.V.Levchishin MD.
Kyiv - 2008

3. The texts of the lectures are approved by the methodical counsel
of Oncology Department.
Protocol № 19 « 17 » march 2008.

4. CONTENTS
7. Tumors of the bones.
8. Tumors of the soft tissue.
9. Skin cancer. Melanoma.
10. Cervical cancer. Ovarian cancer. Uterine cancer.

5. 7. Tumors of the bones
Sarcomas can attack people without differentiating the age; however they occur
very rarely, accounting for just about a percentage all cases of cancers put together.
Although, close to a half of occurrences are in the limbs, generally sarcomas are
really unusual and that they can appear in any place of our bodies with a few
examples being muscle, skin, cartilage, bones, nerves and any of the internal organs
Primary skeletal neoplasms (bone tumors)
• account for only 1 - 1,5% of malignant tumors (0,2% of all human tumors),
(1–1,5 for 100.000 of population),
• metastatic disease is much more common.
Benignant bone tumors
• occur 2-3 times frequently than malignant ones.
Malignant skeletal tumors
• more common for men (1,5-2 times frequently, than for women)
• soft tissue-related counterparts outnumber bone tumors by a margin of
approximately 10:1.
• bone tumors are mostly of mesenchymal origin
• Ewing sarcoma, reticulosarcoma, etc. have neuroectodermal precursor cells.
bone tumors dispose in long tubular bones (40-70%)
• affect lower extremities 2-2,5 times more frequently than upper ones
• tumors, located in proximal parts of extremities are malignant
• few of the bone tumors affect small bones of feet and hands
• malignant bone tumors accounts for the age from 10 to 40 years
• primary bone tumors are more common for children.
The commonest benignant bone tumors, which affect children are:
• chondroblastoma
• bone fibroma
• osteoma
The commonest malignant bone tumors ones are:

6. • Ewing’s and osteogenic sarcomas.
After 40 years the commonest bone tumors are:
• chondrosarcoma,
• reticulosarcoma
• fibrosarcoma.
Because of their rarity, not much is known about the etiology and risk factors
of bone tumors.
• Radiation is associated with increased risk of soft tissue sarcomas.
Other factors that may increase risk of soft tissue sarcomas, :
• Vinyl chloride, used in making plastics
• Dioxin, an unwanted byproduct of incineration
• Herbicides that contain the chemical phenoxyacetic acid
The route of metastasis
• is usually hematogenous, and
• the lung (up for 80%) are the most frequent site of involvement.
• Lymphatic spread occurs less often (3-20%) and usually late in the course of
the disease.
Clinical presentation
Triad of symptoms are typical for bone tumors:
1. the presence of the tumor,
2. the pain &
3. malfunction of the defeated skeletal segment.
• In the beginning of the malignant process poor symptom data can be
discovered. The patient's general condition & preproduction testing data have
not remarkable changes.
• When the tumor is localized in the scull, vertebrae & near the big nerves,
neurological symptoms occur.
Diagnosis is made on:
1. the anamnesis data,
2. clinical presentation,

7. 3. Rö-logical examination,
4. CT, MRI & angiography,
5. osteoscintigraphy (if it is necessary).
6. To evaluate the extend of soft-tissue defeating sonography, especially
dopplerography can be used.
7. The biopsy should be planned with the future surgical procedure in mind.
• Excisional biopsy is indicated for lesions less than 3cm in diameter,
• otherwise, incisional biopsy is indicated.
• Aspirate needle biopsy & trepan-biopsy are not descriptive.
Treatment of the bone tumors includes :
• surgery,
• radiotherapy &
• chemotherapy.
Surgical treatment includes:
1. both cripple operations –
• amputation or
• exarticulation of the extremity
2. & limb-sparing operations –
• excochleation,
• resection of the defeated bone,
• resection of the joint parts of the bones with the following substitution of this
defect by the plastic materials, bone transplants, polymers like hydroxilapatite),
• endoprosthesis of the big joints by modern prosthetic devices,
• distractive osteosynthesis.
• Sometimes cryotherapy can be used.
• Amputation & exarticulation are indicated when local resection cannot
be accomplished without jeopardizing of the function of the extremity
(i.e. involvement of major nerves or vessels occurs).

8. • If it is possible to remove the tumor completely, bone plastics or
endoprosthesis with the following radio- & chemotherapy are
accomplished even when solitary metastases are detected.
• radiotherapy
Bone sarcoma is a radioresistable tumor, that‘s why radiotherapy is applying
only as adjuvant for the surgery.
• chemotherapy
Endoarterial chemotherapy
is more effective then intravenous one. Treatment of the bone tumors, begins from
endoarterial chemotherapy during 4 days (2-6 courses with the 21-28 days intervals,
depending from the treatment effect) with the cisplatin, doxorubicin, metotrexat,
with the following radiotherapy (Σ dose 20-25Gy). Surgery after chemo- &
radiotherapy is developed.
System chemotherapy
After the operative treatment 5-6 courses of the system chemotherapy are usually
indicated:
• ifosfamid 3 mg/m2 & vincristin 1,4 mg/m2 during the 1 day, mesna 660
mg/m2 every 4 hours during 48 hours after the infusion of ifosfamid, cisplatin
100 mg/m2 during the 3 day.
• Or: doxorubicin 25 mg/m2 from the 1 to the 3 day, cisplatin 100 mg/m2
(prolonged infusion) during the 1 day. Cycles must be repeated every 3-4
weeks.
bone tumors treatment
• If the patient refuses to undergo the operation, radiotherapy (Σ dose
50-60Gy) & system chemotherapy (6 courses) can be used.
• The possibility of the chemotherapy dose escalation with the
synchronous use of the haemopoetic grows factors (G-GSF –
granulocytostimulated grows factor, GM-CSF – granulocyto- &
macrofagostimulated grows factor) is investigated now .

9. • Metastatic lesions in the lungs can be resected if the primary tumor is
under good control and there is no evidence of other sites of involvement.
prognosis
• In the I-II stages 5-year survival achieves 70-80%.
• In the advanced cases (III-IV stages) 5-year survival is less than 30%.
• The more common reason of the death are the distant metastases (to the lungs,
bones, liver & brain).

10. bone tumors algorithm
Treatment: R
Treatment:
E
surgical: excochleation, C surgical: resection of the defeated bone
resection of the U or exarticulation with the endoprosthesis
defeated bone or R of the joint, in exclusive cases –
exarticulation with the R
Benignant endoprosthesis of the
E
N
amputation of the limb .
bone tumors joint. C
E
Radical treatment: neoadjuvant
Radical treatment (except endoarterial & system chemotherapy
chondrosarcoma, reticulosarcoma & with the radiotherapy & the following
Diagnostics: Ewing´s sarcoma): neoadjuvant operation reresection of the defeated
Rö-graphia of the endoarterial & system chemotherapy with part of the bone,
defeated skeletal the radiotherapy & the following operation amputation/reamputation or
Clinical exarticulation of the limb with the
segment (2 resection of the defeated part of the bone
presen- (with the bone plastic or endoprosthetic), following chemo- & radiotherapy.
projections), CT, MRT
tation: osteoscintigraphy, amputation or exarticulation of the limb
Presence of angiography, with the following chemo- & radiotherapy.
the tumor, the sonography if it´s
pain &/or necessary, biopsy
malfunction of
the defeated
skeletal
segment
RECURRENCE
Radical treatment of the fibro- ,
chondrosarcomas: resection of the bone, if it´s
possible, more common – high amputation or
exarticulation of the limb.
Treatment of the reticulo- & Ewing´s sarcomas:
Malignant radiotherapy & system chemotherapy
bone tumors
Palliative treatment (if the patient refuse to undergo the radical operation or/& if
the radical treatment is impossible): radiotherapy & system chemotherapy are
indicated

11. 1. The more common symptoms of the bone sarcomas are:
a. the presence of the tumor, appearance of the the pain and malfunction of
the nearest joint
b. the presence of the tumor, appearance of the the pain and high temperature
c. the presence of the tumor, bleeding and malfunction of the stomach
2. Diagnosis of the bone sarcoma may be proved by:
a. physical, Rő-logical examination, sonography
b. physical, Rő-logical examination, sonography, biopsy, CT, MRT
c. physical examination, sonography, ECG
3. Bone sarcomas often occur in the age of:
a. less than 20 years
b. from 20 to 45 years
c. elder than 50 years
4. Bone sarcomas are:
a. the rare tumors
b. common tumors
5. Treatment options for soft tissue sarcomas include:
a. surgery
b. radiation therapy
c. chemotherapy
d. all answers are correct

12. 8. Tumors of the soft tissue
Connective (soft) tissues are are the ones that hold the body parts together and
connect one part to another. They are:
• muscle
• tendon
• ligament
• skin
• fat
• bone
• cartilage
• nerves
• blood vessels
• lymph vessels
Sarcoma starts in the body's connective tissues.
Cartilage tumors start in the bone, not in the joint.
Soft tissue tumors are developed from the nonepitelial and extraskeletal
tissues (except CNS, internal organs & endocrine system).
• These neoplasm's constitute only 0,2-2,6% of the malignant tumors and
affect
• equal often men & women,
• more common in the age of 20-50 years.
• In 70% cases soft tissue sarcomas affect the extremities and in 30% - the
body & pelvis.
• The AIDS epidemic has introduced us to what was previously a very rare -
Kaposi's sarcoma.
• Other soft tissue tumours may be associated with genetic syndromes such as
neurofibromatosis.
• Roughly 20 different types have been described, each with a slightly different
tendency to metastasize or to invade locally.

13. Histological classification on the soft tissue tumors (WHO 1998)
• Grading of bone tumors is roughly based on the cellularity of the lesion
compared to the amount of extra cellular matrix, nuclear features, the presence
of mitotic figures and necrosis. Staging via the TNM system is normally not
used, because metastases in lymph nodes are not frequent in these lesions.
Therefore staging is based on degree of differentiation of the tumor tissue and
local and distant spread of the tumor.
• I. Tumors & tumor-like lesions of the fibrous tissue.
• А. Benignant: Fibromas: 1. Solid fibroma; 2. Soft fibroma (fibromyoma); 3.
Dermatofibroma (Fibrous histiocytoma ); 4. Elastofibroma of the back.
• B. Benignant: Fibromatosis : 1. Scar fibromatosis; 2. Keloid; 3. Fasciitis
nodular; 4. Radiation fibromatosis; 5. Juvenile hyaline fibromatosis ; 6.
Abdominal fibromatosis (abdominal desmoid); 7. Aggressive fibromatosis
(nonabdominal desmoid); 8. Congenital fibromatosis.
• C. Malignant: 1. Fibrosarcoma.
• II. Fat tissue tumors.
• А. Benignant: 1. Lipoma (including fibrolipoma, angiolipoma etc.); 2.
Intermuscular lipoma; 3. Hibernoma; 4. Angiomyolipoma; 5.
Lipoblastomatosis; 6. Diffuse lipomatosis.
• Б. Malignant: 1. Liposarcoma.
• histological classification on the soft tissue tumors (continuation)
• III. Muscular tissue tumors
• А. Smooth muscle tumors.
• 1. Benignant: а) Leiomyoma; б) angiomyoma; в) leiomyoblastoma.
• 2. Malignant: а) Leiomyosarcoma .
• B. Striated muscle tumors.
• 1. Benignant: а) Rhabdomyoma ;
• 2. Malignant: а) Rhabdomyosarcoma .
• IV. Blood vessels tumors.
• А. Benignant.

14. • 1. Hemangioma : а) hemangioendothelioma benignant; б) capillary
hemangioma; в) cavernous; г) venous.
• 2. Intermuscular hemangioma (capillary, cavernous, arterio-venous);
• 3. System hemangiomatosis;
• 4. Hemangiomatosis with/without congenital arterio-venous fistula;
• 5. Hemangiopericytoma benignant, б) glomus tumor.
• 7. Angiolipoma.
• В. Malignant.
• 1. Hemangioendothelioma malignant (angiosarcoma);
• 2. Hemangiopericytoma malignant.
• V. Lymphatic vessels tumors.
• А. Benignant.
• 1. lymphangioma: а) capillary; б) cavernous: в) cystic;
• 2. Lymphangiomyoma;
• 3. System lymphangiomyomatosis .
• B. Malignant.
• 1. Lymphangioendothelioma malignant (lymphangiosarcoma);
• VI. Synovial tissue tumors.
• А. Benignant.
• 1. Benignant synovioma.
• B. Malignant.
• 1. Synovial sarcoma.
• VII. Mesothelial tissue tumors .
• А. Benignant mesothelioma .
• B. Malignant mesothelioma .
• VIII. The tumors of the peripheral nerves.
• А. Benignant.
• 1. Traumatic neuroma;
• 2. Neurofibroma;
• 3. Neurilemmoma (schwannoma );

15. • 4. Neurofibromatosis.
• B. Malignant.
• 1. Malignant schwannoma (neurofibrosarcoma);
• 2. Primitive neuroectodermal tumor (peripheral neuroepitelioma PNET).
• IX. Tumors of the sympatic ganglia.
• А. Benignant. 1. Ganglioneuroma.
• B. Malignant. 1. Neuroblastoma, ganglioneuroblastoma.
• Х. Tumors of the paraganglious stuctures.
• А. Pheochromocytoma: 1. Benignant; 2. Malignant.
• B. Chemodectoma: 1. Benignant; 2. Malignant.
• C. Nonclassified paraganglioma.
• XI. Plurypotential mesenchymal tumors
• А. Benignant: mesenchymoma.
• B. Malignant : Malignant mesenchymoma.
• ХII. Tumors of the possible extragenital origin.
• А. Benignant. 1. Teratoblastoma.
• B. Malignant.
• 1. Teratocarcinoma;
• 2. Embrional carcinoma.
• XIII. Tumor with nonelucidated hystogenesis.
• А. Benignant.
• 1. Granular cell tumor ;
• 3. Soft tissue osteoma;
• 4. Myxoma.
• 2. Soft tissue chondroma;
• B. Malignant.
• 1. Alveolar soft part sarcoma ;
• 2. Malignant granular cell tumor ;
• 3. Chondrosarcoma extraskeletal;
• 4. Osteosarcoma extrasceletal;

16. • 5. Malignant giant cell tumor of soft tissue/soft parts;
• 6. Malignant fibroxanthoma;
• 7. Kaposi's sarcoma ;
• 8. Giant cell tumor of tendon sheath .
• ХIV. Nontumorous or tumor-like lesions of the soft tissue.
• А. Xanthomas.
• B. Ganglia.
• C. Myositis ossi´ficans.
• D. Proliferative myositis.
• ХV. Nonclassified tumors of the soft tissue.
• The route of metastasis is usually hematogenous, and the lung (60-80%)
are the most frequent site of involvement.
• Lymphatic metastasis occurs less often (<20%) and usually later then
hematogenous ones.
Not much is known about the etiology and risk factors of the soft tissue
tumors. Most of the authors consider, that the trauma (even chronic one), doesn't
leads to the soft tissue sarcomas. There are few reports about the viral origin of the
sarcomas. Sometimes sarcomas may occur after the chronic inflammatory process or
benignant tumors.
Clinical presentation
These tumors usually present as an enlarging mass, wich is frequently painless.
If they occur in deep location, such as retroperitoneum, they are often quite large at
the time of diagnosis. In the beginning of the malignant process poor symptom data
can be discovered. The patient's general condition & preproduction testing data have
not remarkable changes.
The more common symptoms of the soft tissue sarcomas are:
• the presence of the tumor,
• appearance of the pain &
• (sometimes) the malfunction of the nearest joint.
When the tumor squeezes the big nerves or/& vessels, neurological symptoms occur.

17. Diagnosis is made on the
1. anamnesis data,
2. clinical presentation,
3. sonography (especially dopplerography),
4. Rö-logical examination,
5. CT, MRI & angiography, osteoscintigraphy if it is necessary.
6. Biopsy :
• excisional biopsy is indicated for lesions less than 3cm in diameter: otherwise,
• incisional biopsy is indicated. The biopsy should be planned with the future
surgical procedure in mind.
• Aspirate needle biopsy & trepan-biopsy are not descriptive.
Treatment
These tumors are frequently treated inadequately because they often have a
pseudocapsule, which may lead the surgeon to assume falsely that all of the tumor
has been removed. In reality, these tumor extend along tissue planes well beyond
their apparent margins.
As a rule, the main method of the treatment of the soft tissue tumors is surgical
one. When the tumor is benignant, the local excision is indicated.
Radical operations:
• limb sparing surgery, which is indicated when wide local excision
(excision of the tumor together with the surrounding tissues, taking into
account fascial zones) can be accomplished without jeopardizing the function
of the extremity (i.e., when the process is without involvement of major nerves
&/or vessels) ;
• amputation or exarticulation of the extremity (with the endoprosthesis
of the joints, when it is possible). Sometimes cryotherapy can be used.
If the recurrence arises, reexcision must be accomplished.
soft tissue tumors treatment
Radiotherapy can be used for adjuvant or neoadjuvant reason.

18. • Adjuvant radiotherapy is realized in a classic regimen of the fractions
with Σ dose 30-60Gy.
• Neoadjuvant radiotherapy is conducted by the big fractions (5Gy) during
4-5 seances.
• As a single method, or together with the chemotherapy, radiotherapy is
possible in the tumor is inoperable or/& the patient refuses from the operation.
Chemotherapy
Endoarterial chemotherapy is more effective then intravenous one.
Treatment of the soft tissue tumors, begins from endoarterial chemotherapy
during 4 days (1-4 courses with the 21-28 days intervals, depending from the
treatment effect) with the cisplatin, doxorubicin, metotrexat.
System chemotherapy : are usually indicated 5-6 courses of the adjuvant system
chemotherapy:
• ifosfamid 2,5 mg/м2 & mesna 660 mg/m2 every 4 hours during 48 hours after
the infusion of ifosfamid during 3 days, cisplatin 100 mg/m2 during the 1 day.
Or: doxorubicin 50 mg/m2, cyclophosphan 750 mg/m2, vincristin 1,4 mg/m2,
bleomycin 5 mg/m2 during the 1 day, prednisolon 60 mg/m2 1-5 days. Or: cisplatin
100 mg/m2 (prolonged infusion) during the 1 day, doxorubicin 50 mg/m2 during
2-4days, vincristin 1,5 mg/m2 at the 5 day, cyclophosphan 600 mg/m2 at the 6 day.
Cycles must be repeated every 3-4 weeks with the 21-28 days intervals.
The survival of the patients with the soft tissue sarcomas greatly depends on
• the staging of the disease &
• the grade of the differentiation of the cells.
In the I-II stages 5-year survival achieves 70-80%.
In the advanced cases (III-IV stages) 5-year survival is less than 30%.
The more common reason of the death are the distant metastases (to the lungs, bones,
liver & brain).

19. soft tissue tumors algorithm
Treatment R
Benignant ec Treatment
Surgical – local
tumors excision
ur
re
Surgical – local
n
ce
reexcision
Potent- R Treatmemt -
Diagnosis: Treatmemt - wide local ec
ial excision with the radiotherapy, ur wide local
Sonography malig- in the case of an re excision with
& Rö- nant extraabdominal localization, n
the
chemotherapy can be used ce
Clinical graphy, CT tumors radiotherapy
presenta- or MRI,
tion: angiography Treatment: endoarterial R
Treatment: endoarterial
•Tumor , incisive or chemotherapy & e
chemotherapy &
•Pain c
•Malfunction excisive radiotherapy with the radiotherapy with the
u
of the limb biopsy. following surgery (wide e
following surgery (wide
local excision, amputation local reexcision,
e
or exarticulation of the limb. reamputation or
e
exarticulation of the limb.
Postoperative chemo- &/or n
Postoperative chemo-
radiotherapy c
Malignant &/or radiotherapy
e
tumors
Treatment (if the tumor is inoperable or/& the patient refuses
from the operation) chemo- radiotherapy is indicated

20. 1. What are the soft tissue sarcomas?
a. malignant tumors that develop in connect, support, or surround tissues
b. benignant tumors that develop in connect, support, or surround tissues
c. malignant tumors that develop in epithelial tissues
d. benignant tumors that develop in epithelial tissues
2. The more common symptoms of the soft tissue sarcomas are:
a. the presence of the tumor, appearance of the the pain and malfunction of
the nearest joint
b. the presence of the tumor, appearance of the the pain and high temperature
c. the presence of the tumor, bleeding and malfunction of the stomach
3. Diagnosis of the soft tissue sarcoma may be proved by:
a. physical, Rő-logical examination, sonography
b. physical, Rő-logical examination, sonography, biopsy
c. physical examination, sonography, ECG
4. The most informative type of biopsy is:
a. excisional or incisional biopsy
b. core-needle biopsy
c. fine-needle aspiration
5. Treatment options for soft tissue sarcomas include:
a. surgery
b. radiation therapy
c. chemotherapy
d. all answers are correct

21. 9. Skin cancer. Melanoma.
Skin cancer (Cancroid)
Etiology
• high isolation
• long-term contact with chemical carcinogens – the products of oil refining, coal,
shale oils, arsenic combinations
• ionizing radiation
• constant skin injuries ( mechanical injuries, burns).
Patamorphology
• basal-cells (basalioma)
• Squamous Cell Carcinoma ( keratinized and non-keratinized)
• Epidemiology
Bulgaria the sickness rate is 36 for 100.000 of inhabitants;
England it is 1.9 for 100.000 of inhabitants;
Ukraine – 35-38 of 100.000 inhabitants.
It is observed that countrymen are more likely to have the skin cancer than the
city dwellers.
Facultative precancerous forms:
• keratosis
• skin horn
• senile skin atrophy
• atheroma
• deep skin mycosis
• keratoachanthoma
• papilloma
• red flat herpes
Obligate precancerous
• Bouen tumor
• Xeroderma Pigmentosum
• Cair disease

22. International classification according to the TNM system
• T- primary tumor
• TX-there is no enough evidence for the primary tumor
• T0- the primary tumor is not identified
• Tis- Carsinoma in situ
• T1-the tumor is 2 cm in the maximum measurement
• T2- the tumor is more than 2 cm, but less than 5 cm in the maximum
measurement
• T3- the tumor is more than 5 cm in the maximum measurement
• T4- the tumor grows into the lower organs (cartilages, muscles, bones).
N – regional lymph nodes
• Nx- there is no enough evidence for the evaluation of the regional lymph
nodes
• N0- there is no evidence of the regional lymph nodes affection
• N1- the regional lymph nodes are affected
M – distant metastasis
• Mx- there is not enough evidence to identify distant metastasis
• M0- distant metastasis are not identified
• M1- there are distant metastasis
Stage 0 Tis N0 M0
Stage I T1 N0 M0
Stage II T2 N0 M0
T3 N0 M0
Stage III T4 N0 M0
Any T N1 M0
Stage IV Any T Any N M1
Clinically forms of the skin cancer
• superficial
• infiltrative or deep-penetrative

23. • papillary
Diagnostics
• examination
• palpation
• dermatoscopy
• cytological analysis of the scrape, smear
• incisionary biopsy
• to diagnose the metastases in the regional lymph nodes it is common to use the
sonography
• of the distant metastases, the radiography of the pectoral cavity organs and the
ultrasonography of the abdominal cavity.
Differential diagnostics
• Red Lupus
• Tuberculosis
• Syphilitic gumma
• Actinomycosis
• melanoma
• Non-malignant skin growths
Treatment squamous cell carcinoma
• Surgery (Stage I,II) wide ablation of the tumor with the healthy skin area
around it (not less than 2 cm) together with the hypodermic cellular tissue and
fascia
• radiotherapy (Stage I,II) (closely-focused radiotherapy, total dose is 30-60
Gr).
• medicines (Stage III,IV) (chemotherapy)
• in the presence of the enlarged regional lymph nodes, on suspicion of having
metastasis, lymphadenectomia is performed at the same time with the excision.
Treatment basal-celled skin cancer
• electroexcision (the recovery takes place in 95 % of cases)
• closely-focused radiotherapy (the recovery takes place in 90 % of cases)

24. • excision (the recovery takes place in 95% of cases)
• cryotherapy
• the relapse is treated by the wide excision.
Prognosis
• In case of the regional lymph nodes metastases absence 5-years survival is
guaranteed in 75-80 % of cases, and when it is early diagnosed almost 80-100
% of patients completely recover and do not have relapses.
• 5-years survival with the regional lymph nodes -metastases and growing
through the close organs and tissues is only 24%.
Non-malignant skin tumors of the conjunctive tissue-like origin.
• fibroma ( soft and hard)
• dermatofibroma
• lipoma
• angioma
• gemangioendotelioma
• neurofibroma
The treatment used here is surgical.
Skin sarcomas (histological classification)
• The tumors of formed dense conjunctive fibrous tissue ( fibrosarcoma and
dermatosarcoma Darie).
• The tumors of the fat base ( liposarcoma)
• The tumors of muscle tissue ( miosarcoma)
• The tumors of the blood and lymphatic vessels
(angiosarcoma, angioendotelioma, Caposhy sarcoma, lymphangiosarcoma).
• The tumors of the undifferentiated cells (undifferentiated sarcoma,
mixosarcoma).
The treatment of the skin sarcoma
• surgical
• closely-focused radiotherapy with corticosteroids.

25. • in cases of the generalized forms of Kaposhy sarcomas the cytostatic therapy
is used – the combination of doxorubicin, vinblastin and bleomicin, and also
monochemotherapy with the prospidin.
• as the biotherapy they use intron A.

27. Skin melanoma
Etiology
The exogenous risk factors
• Physical factors: ultra-violet radiation from the sun, ionizing radiation,
electromagnetic radiation, fluorescence illumination, nevus traumatism.
• Chemical factors: harmful chemical agents used in the petrochemical, chemical
( in particularly producing nitric acid), producing rubber plants, in the
production of vinyl chloride, polyvinyl chloride, plastic, benzol, pesticides.
• Biological factors: the nutrition quality ( high level of daily protein and adipose
consumption), medical products (exogenous estrogens).
The endogenous risk factors
Biological constitution features, which presence raises the risk of the
melanoma development: racial and ethnic predisposition, the level of the body
pigmentation, hereditary ( family) factors, anthropometric indexes, immune failings,
endocrine factors, reproductive women’ factors.
Predecessors of the melanoma, that is such pathological skin changes , which
can have the probability of the malignant mutation: pigmentary parchment-skin,
Dubrei melanosis, nevuses
Melanoma pathomorphology
• Epithelial
• spindle-celled
• mixed
• small-celled
International classification according to the TNM system
• T- primary tumor
• Tis- melanoma in situ
• T1-the tumor is less than 1mm thick; a) without ulceration and the invasion
level is II/III b)with ulceration or invasion level is IV/V.
• T2- the tumor is 1,01-2.0 mm thick, a) without ulceration b)with ulceration
• T3- the tumor is 2,01-4,0 mm thick; a) without ulceration b)with ulceration

28. • T4- the tumor is more than 4 mm thick a) without ulceration b)with ulceration
N- regional lymph nodes
• N1- metastases in 1 gland a)micrometastases 1; b)macrometastases 2
• N2-metastases in 2-3 lymph nodes a) micrometastases1; b)macrometastases2
c)transitional metastases/satellites without metastatic lymph nodes
• N3-4 and more metastatic lymph nodes or the conglomeration of lymph nodes,
or transitional metastases/satellites with metastatic lymph nodes
• 1-micrometastases are diagnosed after the observation or selective
lymphodenectomia.
• 2.- macrometastases - are clinically found metastases in the lymph nodes,
confirmed by the therapeutical lymphodenectomia or extracapsular spreading
of metastases in the lymph nodes.
M-distant metastases
• M1a- there are distant metastasis on the skin, hypodermic or in the lymph
nodes.
• M1b – metastases in the lungs.
• M1c – other visceral or any distant metastases.
Clinical stages TNM Morphological stages pTNM
0 Tis N0 M0 Tis N0 M0
IA T1a N0 M0 T1a N0 M0
IB T1b N0 M0 T1b N0 M0
T2a N0 M0 T2a N0 M0
IIA T2b N0 M0 T2b N0 M0
T3a N0 M0 T3a N0 M0
IIB T3b N0 M0 T3b N0 M0
T4a N0 M0 T4a N0 M0
IIC T4b N0 M0 T4b N0 M0
III Any T N1 M0
N2 M0
N3 M0
IIIA T1-4a N1a M0
T1-4a N2a M0
IIIB T1-4b N1a M0
T1-4b N2a M0

29. T1-4a N1b M0
T1-4a N2b M0
T1-4a/b N2c M0
IIIC T1-4b N1b M0
T1-4b N2b M0
Any T N3 M0
IV Any T Any N Any M 1 Any T Any N Any M1
The main signs of nevuses malignisation
• Disappearing of the skin pattern on the nevus surface;
• appearance of the shiny, glossy nevus surface;
• appearance of the asymmetry or contours irregularity (scalloped) contours of
nevus, that is changes of its shape;
• Horizontal nevus growth;
• Appearance of the subjective heat sensation, itching or pain in the nevus area;
• Appearance of the single nodules ( satellites) around nevus;
• Appearance single nodules on the surface of the nevus without its visual
growth
• Peeling of the nevus surface with the formation of the withered “scabs”;
• Absence of hair or shedding of the hair on the nevus surface
• Partial (irregular) or complete color change of nevus –melanoma ( melanoma)
– appearance of the areas of so called bound depigmentation;
• Vertical growth of nevus- melanoma above the surrounding areas.
• The consistence change of the nevus-melanoma, which is defined with
palpation, that is its softening;
• Ulceration of the epidermis above the nevus-melanoma;
• Inflammation in the area of the nevus-melanoma and surrounding tissues;
• Weeping of the nevus-melanoma surface
• Bleeding of the nevus-melanoma.
Clinical-anatomical forms of the melanoma
• Superficial (70%)
• Nodule-like ( nodous, nodular) (15%)

30. • Acral lentigous and mucous melanoma ( 10%).
• Lentigo maligna melanoma (melanoma-like freckles)
Melanoma diagnostics
• studying anamnesis
• previous skin changes
• external tumor shape
• the state of the lymph nodes system
• dermatoscopy
• echography
• tumor thermography
• cytological analysis of the smears – the tumor prints, a sentinel node biopsy
• radioisotope scanning with the help of radio-active 32 P (300%)
Differential diagnostics of melanoma
• Youth melanoma ( Spits nevus)
• Blue nevus
• Galo-nevus
• Displastic nevuses
• Cavernous thrombotic gemangioma
• Non-malignant skin tumors
• Malignant skin tumors
• underungual, and underepidermal haematoma
• onihomikosis
• extrasexual chancre
• metastases of the other histogenesis tumors into the skin
Skin melanoma treatment
• The incision of the skin should be performed within the distance of 3-5 cm
from the tumor, in this case it is necessary to step back in the direction of the
regional lympho-outflow.
• It is necessary to ablate in one block the skin, hypodermic cellular tissue and
fascia.

31. • The surgery should be necessarily performed with the general anesthesia.
• When there is a suspicion of regional lymph nodes having metastases the
regional lymphadenectomy should be performed at the same time.
Stage I treatment
• The standard treatment in case of IA and IB stages - is wide excision of the
tumor at the distance of 2 cm from the tumor borders.
Stage II treatment
• The standard excision is at the distance of 3 cm from the tumor borders.
• Besides the tumor excision it is possible to perform immunotherapy using
interferon a-2b 3 ml ME/m2 of hypodermic injection 3 times per week during
3 years or until the relapse and melanoma metastases.
Stage III treatment
• The medical standard is wide excision of the primary tumor within 3 cm and
more combined with the regional lymphodenectomia.
• Chemotherapy ( chemoimmunotherapy), immunotherapy ( interferon a-2b,
BCG), polychemotherapy should be performed in usual or modified
( hyperthermia, hyperglycemia etc) conditions. As polychemotherapy
dacarbasin is used combined with the medications of platinum ( cisplatin),
alkaloids of periwinkle ( vinblastin), the medications of urea nitromesil group
(lomustin).
Stage IV treatment
• standard of this tumor treatment is systemic chemotherapy
• The surgical treatment of IV stage melanoma can be performed in the
presence of the single metastases in the lungs, gastrointestinal tract, bones or
brain. Palliative resections are done, which in some cases are very effective
and significantly prolong life.
• palliative radiotherapy can relieve the patients state
• in addition to melanoma treatment main schemes it is common to use
antiestrogens ( tamoksifen).
Prognosis

32. • in case of the localized process 5-years survival is possible in 75-86 %, 10-
years – 47%
• in case of the regional metastases - 33-52% and 13% accordingly
• in case of the distant metastasis 5-years survival does not exceeds 5-12%.

34. 1. 45 years old patient has a star-shaped scar on the back of the right hand. This scar
appeared after the professional trauma 8 years ago. Recently the scar began to seal
and then ulcerated in the center. Biopsy showed the squamous cell carcinoma.
Regional lymph nodes did not change. Treatment tactics?
a. radiotherapy
b. chemotherapy
c. surgery
d. surgery and radiotherapy
e. surgery and polychemotherapy
2. An oncologist was approached by the 55 years old patient. A year ago the cancer
of the lower lip was diagnosed. After a course of shortfocused X-ray therapy his
ulcer healed. A month ago the ulcer appeared once again in the same area as
well an enlarged solid lymph node submaxillary. Treatment tactics?
a. chemotherapy and radiotherapy
b. surgery and polychemotherapy
c. surgery
d. polychemotherapy
e. radiotherapy
3. 25 years old man complained of the tumor in the area of the left arm-pit and the
dark birth-mark on his shoulder-blade. He was born with this birth-mark but
during the last half of the year (six months) it increased noticeably. 2 weeks ago a
tumor appeared in the left armpit and consist of several painless nodes. The skin –
remains unchanged. Treatment tactics?
a. polychemotherapy
b. immunotherapy
c. radiotherapy
d. radiotherapy and chemotherapy
e. surgery and polychemotherapy
4. 28 years old women has a problem with her birthmark in the area of the small of
the back that extends over the skin for 2-3 mm, and which she traumatized

35. several times with her girdle. Regional nodes are not increased. By way isotope
diagnostics radioactive phosphorus is accumulating nevus in amount of 180%.
Diagnosis?
a. basal-cells (basalioma)
b. squamous cell carcinoma
c. skin melanoma
d. displastic nevuses
e. cavernous thrombotic gemangioma
5. 48 years old women complains of the dark intumescences on the sole of her right
foot. Objective: in the area of the arch of the right foot there is a pigmental
formation 1*2 sm, it extends over the skin fjr 1-2 mm, and it is covered with
the thin blood – crust. Regional nodes are not increased.
Diagnosis?
a. displastic nevuses
b. cavernous thrombotic gemangioma
c. basal-cells (basalioma)
d. squamous cell carcinoma
e. skin melanoma

36. 10. Cervical Cancer. Uterine cancer. Ovarian cancer.
Cervical Cancer
EPIDEMIOLOGY
 Cervical cancer is the 2nd most common cancer in women (after breast cancer)
and is the 3rd leading killer (behind breast and lung cancer).
 It affects about 16 per 100,000 women per year and causes death in about 9
per 100,000 per year.
 In the Ukraine, howeever, cervical cancer is the 3rd most common cancer of
women. About 12,800 women in the Ukraine are diagnosed with cervical
cancer and about 4,800 die each year.
 Among gynecological cancers it ranks behind endometrial cancer and ovarian
cancer.
HISTORY
1. Cervical cancer was common in female sex workers.
2. It was rare in nuns, except for those who had been sexually active before entering
the convent.
3. It was more common in the second wives of men whose first wives had died from
cervical cancer.
4. It was rare in Jewish women.
5. In 1935, Syverton and Berry discovered a relationship between HPV and skin
cancer in rabbits.
ETIOLOGY
1. The main cause of development of cervical cancer is human papillomavirus
(HPV) infection which responsible for more than 90% of the cases of cervical
cancer.
2. There are 230 types of HPV but only 7 common types of HPV which cause of
the cervical cancer: 16, 18, 31, 33, 42, 52 and 58.
3. Types 16 and 18 are the most dangerous in development of the cancer

37. Infect by HVP in world
Argentina & Honduras - 40%
USA – 26%;
Canada – 22%;
Sweden – 12,8%;
Denmark – 15,4%;
Japan – 10,7%
Spain – 5%.
RISK FACTORS
 Human papillomavirus infection
 Smoking
 HIV infection
 Chlamydia infection
 Dietary factors
 Oral contraceptives
 Multiple pregnancies
 Use of the hormonal drug diethylstilbestrol (DES)
 Family history of cervical cancer
PATHOPHYSIOLOGY
 HPV subtypes 16 and 18 introduce two genes called E6 and E7 which code for
proteins that inhibit p53 and Rb, which are two important tumor suppressor
genes in humans.
 The p53 gene product is involved in regulation of apoptosis (cell suicide), and
Rb is responsible for halting the cell cycle at the G1-phase.
HISTOLOGY
Types of malignant cervical tumors include the following:
 squamous cell carcinoma (about 80-85%) (Fig.3-7)
 adenocarcinoma
 adenosquamous carcinomas
 small cell carcinoma

38.  neuroendocrine carcinoma
 melanoma
 lymphoma
STAGING
 Cervical cancer is staged by the FIGO staging system which is based on
clinical examination, rather than surgical findings.
 For premalignant dysplastic changes, the CIN (cervical intraepithelial
neoplasia) grading is used.
The TNM staging system
Stage 0 - full-thickness involvement of the epithelium without invasion into the
stroma (carcinoma in situ)
 Stage I - limited to the uterus (Fig.6)
– IA - diagnosed only by microscopy; no visible lesions
 IA1 - stromal invasion less than 3 mm in depth and 7 mm or less
in horizontal spread
 IA2 - stromal invasion between 3 and 5 mm with horizontal
spread of 7 mm or less
Treatment consists of surgery (including local excision) in early stages
– IB - visible lesion or a microscopic lesion with more than 5 mm of depth
or horizontal spread of more than 7 mm
 IB1 - visible lesion 4 cm or less in greatest dimension
 IB2 - visible lesion more than 4 cm
 Stage II - invades beyond uterus
– IIA - without parametrial invasion
– IB - visible lesion or a microscopic lesion with more than 5 mm of depth
or horizontal spread of more than 7 mm
 IB1 - visible lesion 4 cm or less in greatest dimension
 IB2 - visible lesion more than 4 cm
 Stage II - invades beyond uterus
– IIA - without parametrial invasion

39. Treatment consists of surgery and radiotherapy in advanced stages of the
disease
 IIB - with parametrial invasion
 Stage III - extends to pelvic wall or lower ⅓ of the vagina
– IIIA - involves lower ⅓ of vagina
– IIIB - extends to pelvic wall and/or causes hydronephrosis or non-
functioning kidney
 IVA - invades mucosa of bladder or rectum and/or extends beyond true pelvis
 IVB - distant metastasis
Treatment consists of chemotherapy and radiotherapy
Clinical presentation
1. Vaginal bleeding
2. Contact bleeding or (rarely) a vaginal mass.
3. Moderate pain during sexual intercourse
4. Vaginal discharge
Symptoms of advanced cervical cancer may include:
 Heavy bleeding from the vagina
 Loss of appetite
 Weight loss
 Fatigue
 Pelvic pain
 Back pain
 Leg pain
 Single swollen leg
 Leaking of urine or feces from the vagina
 Bone fractures
DIAGNOSIS
• Palpation
• Visual inspection of the cervix aided by using an acetic acid (e.g. vinegar)
solution to highlight abnormal cells on the surface of the cervix

40. • Colposcopy
• Endocervical curettage is made by doing a biopsy of the cervix
• Hysteroscopy
• Cystoscopy
• Proctoscopy
• Intravenous urography
• X-ray examination of the lungs and skeleton
• Cervical conization.
Rules of taking biopsy.
1. Target
2. From 3 areas
3. Use special brush for biopsy
TREATMENT
Treatment consists of :
1. Surgery (including local excision)
2. Chemotherapy
3. Radiotherapy
4. The HPV vaccine, for the two most common strains of HPV has recently been
licenced
•Stage IA (microinvasive cancer) is usually treated by hysterectomy (removal of
the whole uterus including part of the vagina)
* An alternative for patients who desire to maintain fertility is a local surgical
procedure such as a LEEP or cone biopsy.
•Stage IA2 can be treated by hysterectomy with removed the lymph nodes
•Stages IB1 and IIA (less than 4 cm):
1. radical hysterectomy with removal of the lymph nodes
2. radiation therapy as external beam radiotherapy and
brachytherapy (internal radiation).
•Stage IB2 and IIA (more than 4 cm):
3. radiation therapy and cisplatin-based chemotherapy

41. 4. hysterectomy (which then usually requires adjuvant radiation
therapy),
5. cisplatin chemotherapy followed by hysterectomy.
•Stage (IIB-IVA) are treated with radiation therapy and cisplatin-based
chemotherapy.
Vaccine
1. Vaccine against four strains of HPV (6,11,16,18) is called Gardasil™ (Merck
& Co.).
2. Gardasil is targeted at girls of age 9 before they begin having sex and women
of age 26.
3. The vaccine works if given before infection occurs.
4. Vaccine is called Cervarix™ (Glaxosmithkline) has been effective in
preventing HPV strains 16 and 18
PROGNOSIS
5-year survival
Ia - 98%
Iб - 78-95%
III - 18-53%
IV - 6-20%

43. Uterine cancer
EPIDEMIOLOGY
•Uterine cancer is the 1st most common cancer of the female reproductive system.
•It affects about 140 000 women each year and causes death in about 9 - 10 per
100,000 per year in world and 7 – 8 per 100,000 in Western Europe, in Ukraine -
24,2 per 100,000
RISK FACTORS
•Women who experience menstruation begins before the age of 12 years old and
continues into a woman’s 50’s.
•Women who have never experienced pregnancy
•Women who do not experience regular cycles
•Women with Type 2 diabetes or women who are obese
•Women who participate in Estrogen-only Replacement Therapy (ERT)
•Uterine cancer is more prevalent in older women (over the age of 40)
•Women who have gone through menopause are especially encouraged to consult a
physician
HISTOLOGY
Types of malignant endometrial cancer, or cancer of the uterus, include
the following:
• Endometrioid adenocarcinoma
• Serous-papillary adenocarcinoma
• Adenosquamous carcinoma
• Light-cells adenocarcinoma
• Mucinous adenocarcinoma
• Squamous adenocarcinoma
• Secretory carcinoma
• Non-differentiated carcinoma
Сlinical presentation
Signs and symptoms of endometrial cancer include:

44. •watery discharges from the vagina
•abnormal vaginal bleeding
•bleeding after menopause
•spotting from the vagina
•discharges from the vagina
•pelvic pain
•weight loss
DIAGNOSIS
 Palpation
 Rectal exam
 Hysological exam include endometrial curettage is made by doing a biopsy of
the edometrium
 Cytological exam
 Hysterography
 Hysteroscopy,
 Ultrasonography
TREATMENT
The most common treatments for uterine cancer are:
 surgery,
 radiation therapy,
 chemotherapy,
 hormone therapy.
I. Surgery involves having a hysterectomy.
1. Simple hysterectomy (removal of the entire uterus)
2. Radical hysterectomy (removal of the uterus, surrounding tissues, and
cervix)
II. The option of radiation therapy involves using high-energy radiation.
III. Chemotherapy is most often used when the cancer has spread to other areas of
the body.

45. IV. Hormone therapy is mainly used to treat patients with endometrial stromal
sarcomas.
A progesterone-like hormone drug or a drug which stops the production of
estrogen can be used. Synthetic progestin - Depostat .
PROGNOSIS
5-year survival
Ia - 98%
Iб - 78-95%
III - 18-53%
IV - 6-20%

47. Ovarian cancer
EPIDEMIOLOGY
 Ovarian cancer is the 2nd most commonly diagnosed gynecologic malignancy
and the 5th leading cause of cancer death in women.
 The disease is more common in industrialized nations, with the exception of
Japan. In the United States, females have a 1.4% to 2.5% (1 out of 40-60
women) lifetime chance of developing ovarian cancer. In the Ukraine – 15,5
causes of 100 000 women
ETIOLOGY
Ovarian cancer is idiopathic, meaning that the exact cause is usually unknown.
The risk for developing ovarian cancer appears to be affected by several factors
RISK FACTORS
 Age between 55 and 74 years old
 Women who haven't been pregnant and never have a baby
 Older ages of first pregnancy
 Mutations of the BRCA1 or the BRCA2 gene
 Personal history of breast cancer or a family history of breast
 Syndrome hereditary nonpolyposis colorectal cancer (HNPCC, also known as
Lynch II syndrome)
CLASSIFICATION
Ovarian cancer is classified according to the histology of the tumor. Lesions
differ significantly in clinical features, management, and prognosis (ICD-O
codes provided where available).
I. Histology
 Surface epithelial-stromal tumours are the most common and prototypic
ovarian cancers. They are include:
 serous cystadenocarcinoma
 mucinous cystadenocarcinoma.
 Sex cord-stromal tumors include lesions that are hormonally active:
 estrogen-producing granulosa cell tumor

48.  virilizing Sertoli-Leydig cell tumor or arrhenoblastoma.
 Germ cell tumors originate from dysplastic germ material and tend to occur in
young women and girls. Lesions include:
 the dysgerminoma, a form of the choriocarcinoma
 malignant forms of the teratoma.
II.History
 Primary is the tumor which growth in ovary originally.
 Secondary, the result of metastasis from primary cancers elsewhere in the
body. For example, from breast cancer, or from gastrointestinal cancer (in
which case the ovarian cancer is a Krukenberg cancer)
Staging
Ovarian cancer staging is by the FIGO staging system and uses information obtained
after surgery.
The AJCC stage is the same as the FIGO stage.
 Stage I - limited to one or both ovaries
• IA - involves one ovary; capsule intact; no tumor on ovarian surface; no
malignant cells in ascites or peritoneal washings
• IB - involves both ovaries; capsule intact; no tumor on ovarian surface;
negative washings
• IC - tumor limited to ovaries with any of the following: capsule
ruptured, tumor on ovarian surface, positive washings
 Stage II - pelvic extension or implants
• IIA - extension or implants onto uterus or fallopian tube; negative
washings
• IIB - extension or implants onto other pelvic structures; negative
washings
• IIC - pelvic extension or implants with positive peritoneal washings
 Stage III - microscopic peritoneal implants outside of the pelvis; or limited to
the pelvis with extension to the small bowel or omentum
• IIIA - microscopic peritoneal metastases beyond pelvis

49. • IIIB - macroscopic peritoneal metastases beyond pelvis less than 2 cm in
size
• IIIC - peritoneal metastases beyond pelvis > 2 cm or lymph node
metastases*
 Stage IV - distant metastases--in the liver, or outside the peritoneal cavity
* Para-aortic lymph node metastases are considered regional lymph nodes (Stage
IIIC).
DIAGNOSIS
Ovarian cancer at its early stages (I/II) is difficult to diagnose until it spreads and
advances to later stages (III/IV). This is due to the fact that most of the common
symptoms are non-specific.
Diagnosis includes:
•Symptoms
•Physical examination
•Pelvic examination
•Instrumental examination
•Laboratory examination
 sense of pelvic heaviness
 vaginal bleeding
 weight gain or weight loss
 abnormal menstrual cycles
 unexplained back pain that worsens over time
 increased abdominal girth
 non specific gastrointestinal symptoms:
 vague lower abdominal discomfort
 increased gas
 indigestion
 lack of appetite
 nausea and vomiting
 Bloody stool

50.  inability to ingest usual volumes of food
 bloating
 Additional symptoms that may be associated with this disease:
 increased urinary frequency/urgency
 excessive hair growth
 Fluid buildup in the lining around the lungs (Pleural effusions)
 Positive pregnancy readings (in the absence of pregnancy. This is for germ cell
tumors only)
Note: There may be no symptoms until late in the disease.
Physical examination may reveal increased abdominal girth and /or ascites
(fluid within the abdominal cavity).
Pelvic examination may reveal an ovarian or abdominal mass. The
pelvic exam can include a rectovaginal component for better palpation of
the ovaries.
Instrumental examination
1. Abdominal ultrasound
2. Ultrasound of small pelvis
3. Trans-vaginal ultrasound
4. CT scan of the abdomen and pelvis
5. MRI
Laboratory examination
 The blood test called CA-125 is useful in differential diagnosis and in follow
up of the disease, but it has not been shown to be an effective method to screen
for early-stage ovarian cancer and is currently not recommended for this use.
 The blood test on levels of lysophospholipids (a type of fatty acid)
TREATMENT
The treatment consist of
1. Surgery
2. Chemotherapy
3. Radiation therapy

51. 4. Hormonal therapy
I. Surgery is the preferred treatment and is frequently necessary for diagnosis. The
type of surgery depends upon how widespread the cancer is when diagnosed (the
cancer stage), as well as the type and grade of cancer.
The types of surgery are:
Unilateral oophorectomy or bilateral oophorectomy - make only in stage 1, low
grade or low-risk disease, especially in young females who wish to preserve their
fertility
Panhysterectomy + omentectomy (in stage 1’2’3)
In advanced disease as much tumor as possible is removed (debulking surgery)
II. Chemotherapy can be used before and after surgery and to treat women who have
a recurrence.
1). Cysplatinum (Р) - 100 mg/м2 number 1 in 3 weeks; or
2). Cysplatinum (Р) - 50 mg/м2 number 1in week during 6-8 weeks; or
3). Carboplatinum (СвР) AUC 5-7 number 1 in 3 weeks; or
4). Cysplatin - 75 mg/м2 + cyclophophanum 750 mg/м2 number 1 in 3 weeks; or
5). Carboplatinum (СвР) AUC 5 + cyclophophanum 750 mg/м2 number 1 in 3
weeks;
III. Radiation therapy is not effective for treatment ovarian cancer.
IV. Hormonal therapy can be used androgens or/and ant estrogens
COMPLICATIONS
•spread of the cancer to other organs
•progressive function loss of various organs
•ascites (fluid in the abdomen)
•blockage of the intestines
PROGNOSIS
Size of residual tumor Duration of life
< 0,5 cm 40 months.
0,5 – 2 cm 18 months
2 cm 6 months

52.  Ovarian cancer has a poor prognosis. It is disproportionately deadly because
symptoms are vague and non-specific. More than 50% of women with ovarian
cancer are diagnosed in the advanced stages of the disease because no cost-
effective screening test for ovarian cancer exists.
 The 5-year survival rate for all stages is only 35% to 38%. If, however,
diagnosis is made early in the disease, 5-year survival rates can reach 90% to
98%.
Frequency of recidivations:
♦ in early stages - 20-30%
♦ in advanced stages - 65-96%.

54. 1. What is the main cause of development cervical cancer?
a. simple herpes virus
b. human papillomavirus
c. mechanical trauma
d. radiation
2. What are kinds of special treatment stage Ia cervical cancer you will choose?
a. radical hysterectomy
b. radiation therapy
c. cisplatin chemotherapy
d. LEEP
3. What are complications of ovarian cancer?
a. pathological fractures
b. ascites (fluid in the abdomen)
c. bleeding
d. pancreatitis
4. What is main laboratory test of ovarian cancer?
a. level of leukocytes
b. CA-125
c. level of glucose
d. level of blood protein
5. Radical hysterectomy is:
a. removal of the entire uterus
b. removal of the uterus, surrounding tissues, and cervix
c. removal of the uterus, surrounding tissues, cervix, omentumectomy
d. removal of the entire uterus without ovaries