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A recent trends involves the shift of cancer burden from developing to underdeveloped countries In the USA and Europe, cervical cancer is the most common type in women Cervical cancer occurrence is related to the human papilloma virus HPV. HPV infection is transmitted through sexual activity and the possibility of transmission is increased with early stage of initiation of sexual activity, multiple sexual partners and high-risk sexual partner It accounted for 13, cases worldwide, with 9, presenting in developing countries.

The disease primarily occurs in women older than 60 years of age. The highest prevalence of genital tract cancer in underdeveloped countries is due to lack of awareness, risky sexual behavior and absence of population-based screening procedure especially for cervical cancer A retrospective analysis of gynaecological malignancies identified at CENAR over the last 11 years January, and December, was carried out. The records of all the patients of CENAR, Quetta, were retrospectively reviewed to identify any cases of gynaecological malignancies.

The clinical record of all the patients was reviewed with factors including name, age, sex and type of cancer. Results were presented as number and percentage. Gynaecological malignancies were ranked the third most common tumor in females with a frequency of Of the ovarian malignancies, epithelial tumors were observed predominantly in Mucinous adenocarcinoma was the most common histological type of epithelial ovarian cancer with patients, followed by serous adenocarcinoma, 93 patients; endometrial adenocarcinoma, 16 patients; and clear cell carcinoma, 2 patients.

Dysgerminoma was the most common histological type of germ cell tumor with 35 patients, 9 patients with teratoma, and 5 patients with ovarian choriocarcinoma. Granulosa cell tumor was the most common histological type of sex cord tumor with 29 patients. Table III shows that cervix was the main histological type of cancer, with squamous cell carcinoma observed in Uterus as the main histological type of cancer with endometrial tumor was found in 66 Adenocarcinoma was the most common histological type of endometrial tumor with 43 patients, while 14 patients were affected with papillary carcinoma, 9 patients with embroynal tumor and 19 patients with leiomyosarcoma.

Of the vulvar and vaginal malignancies, squamous cell carcinoma was predominant in 36 In gestational trophoblastic neoplasm, choriocarcinoma was observed in 18 The burden of gynaecological cancer is on the increase worldwide, but it is higher in developing than developed countries, with approximately five million new cancer cases diagnosed annually In this study, ovarian cancer was the most common site of gynaecological tract malignancies which is comparable to other studies.

A study conducted in Tehran reported that of cases, the highest percentage was ovarian cancer Of the ovarian malignancies, Epithelial tumor was the most common type while the sex cord and germ cell tumor of ovary were less common Mucinous adenocarcinoma was the most common histological type of epithelial tumor while dysgerminoma was a common malignant type of germ cell tumor and granulosa cell tumor a common malignant type of sex cord.

Similar findings were observed in other studies 20 , Results showed that the majority of ovarian cancer occurs in the 50—59 year age group. A similar finding was identified in another study in which ovarian malignancies were common within the 5th and 6th decades of life Ovarian cancer has the highest mortality rate among gynecologic cancers, even in developing nations Late stage diagnosis requires long, complex, very aggressive and costly treatment; thus, the management of ovarian cancer in developing countries poses a great challenge In this study, cervical cancer ranked second of all the gynecologic malignancies, whereas international studies identified cervical cancer as ranking first in gynecologic malignancies.

In Pakistani women, it is the second most common cancer type, with the majority of patients presenting at 15—44 years of age. Approximately 5, women are diagnosed with cervical cancer and approximately 3, succumb to the disease annually 3. Results also showed that cervical cancer is predominant in the younger age groups 40—49 years. Studies conducted in different parts of Pakistan showed that HPV is the major cause of cervical cancer among Pakistani women 25 , HPV infection is transmitted through sexual contact This disparity can be attributed to differences in religious background affecting the sexual and reproductive behaviour of both male and female populations.

A woman of this region Pakistan engages in monogamous relations thereby decreasing the likelihood of HPV-related infection and cervical cancer The incidence of cervical cancer is lower in Pakistan as compared to developed countries. Nevertheless, mortality is higher due to late diagnosis of cervical cancer Late diagnosis occurs due to lack of a structural program for screening in Pakistan A study performed on university students reported that These results indicate that even the educated population of Pakistan has no basic knowledge about HPV, cervical cancer and its screening test These malignancies constitute the third leading site of malignancy in women after breast and ovary Similarly, one study from India reported that uteri cases are the third most common malignancy in the female genital tract after cervix cases , and ovary cases In uterus, the main histological type of cancer was endometrial tumor with 66 patients Adenocarcinoma was the most common histological type of endometrial tumor.

Vulvar cancer rarely presents in Asia as compared to North America and Europe. Among the vulvar and vaginal malignancies, squamous cell carcinoma was predominant Similarly previous findings showed that SCC is present in Gestational trophoblastic neoplasm is the least common malignancy of gynecological malignancies, in the 30—39 years age group.

Table of contents

In those studies, diseases were more common in the reproductive age, which is comparable to the present study. The reason for the high frequency of the gestational trophoblastic neoplasm in this study as compared to other studies may be the fact that patients of CENAR had low socioeconomic and poor education status. A study reported that the highest incidence in Asia is generally due to low socioeconomic status and poverty It is a disease that can be successfully treated as indicated by two different studies which showed that successful treatment was achieved in Gestational trophoblastic neoplasm is successfully treated even in the presence of metastasis.

Blaustein's Pathology of the Female Genital Tract

The major risk factors for the disease include advanced maternal age and a past history of the gestational trophoblastic disease In the CENAR center, data collection concerning cancer management is poorly established because it is a complicated, multidimensional health issue. Consequently, due to lack of facilities its management it remains in the primary stages.

The reason for the high frequency of gynaecological malignancies in this study may be the fact that women have little access to health care facilities, not taking decisions concerning their individual health, women's position in the family is assured with the birth of the child, especially a male child, lack of structural program for screening, poverty and low socioeconomic status.

Due to a lack of facilities and financial resources, the screening program is not feasible in developing countries; as a result most patients present with advanced stage cancer. Prevention is the gold standard for reducing morbidity and mortality in advance stage gynecological malignancies for countries such as Pakistan, which have a rapidly growing population, poor resources and poverty.

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A more practical way for reducing late diagnosis of cancer in the country involves development of well-equipped specialized centres providing affordable treatment to reduce the burden of advanced stage cancer. In conclusion, gynaecological cancer is the third most common malignancy among females registered and treated in the CENAR center. Ovarian cancer is the leading gynaecological malignancy.

The most common age group for the different malignancies is comparable to other studies. Int J Gynecol Cancer. Kent A: HPV vaccination and testing. Rev Obstet Gynecol.

Int J Cancer. Ann Saudi Med.

Anatomy and physiology of the female reproductive system

J Pak Med Assoc. Mishra K: Gynaecological malignancies from palliative care perspective. Indian J Palliat Care. Denny L: Cervical cancer prevention and treatment in low-resource settingsA textbook of gynecology for less-resourced locations. It gives a platform to the authors to publish their research work which can be available for everyone across the globe to read.

For those who have problem in writing manuscript or do statistical work, JCDR comes for their rescue. The journal has a monthly publication and the articles are published quite fast. In time compared to other journals. The on-line first publication is also a great advantage and facility to review one's own articles before going to print. The response to any query and permission if required, is quite fast; this is quite commendable.

I have a very good experience about seeking quick permission for quoting a photograph Fig. I never thought it would be so easy. No hassles. Reviewing articles is no less a pain staking process and requires in depth perception, knowledge about the topic for review. It requires time and concentration, yet I enjoy doing it. The JCDR website especially for the reviewers is quite user friendly.

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My suggestions for improving the journal is, more strict review process, so that only high quality articles are published. I find a a good number of articles in Obst. May be a bimonthly or quarterly publication to begin with. Only selected articles should find a place in it. An yearly reward for the best article authored can also incentivize the authors.

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Duke Pathology - Week Female Reproductive System

Though the process of finding the best article will be not be very easy. I do not know how reviewing process can be improved.


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