tailieunhanh - GYNECOLOGICAL MALIGNANCIES

In response to Texas’s affiliate rule, the federal Centers for Medicare and Medicaid Services (CMS) announced that it would no longer provide federal matching funds for the program because the rule denies beneficiaries the freedom to choose providers, as assured under federal policy and stated that the waiver and federal funding would terminate after six months. 4 Two lawsuits are now in progress as a result of these decisions. The state of Texas has sued CMS to prevent the loss of federal funds and a group of Planned Parenthood clinics has sued the state to prevent implementation of. | GYNECOLOGICAL MALIGNANCIES By Dr. Stephen Welch For the most part gynecological cancers can be treated for cure. As with the majority of solid tumour cancers if gynecologic cancers are discovered at an early stage surgery can be curative and other treatments such as radiotherapy or chemotherapy may be given post-operatively to consolidate treatment ie. adjuvant treatment . All modalities of treatment can be considered in order to palliate symptoms and control disease growth even if cure is not possible. As such a multidisciplinary approach to the treatment of gynecologic cancers is necessary. The most common gynecologic cancers cervical endometrial and ovarian are discussed below. Rarer cancers of the gynecologic tract include sarcomas germ cell tumours gestational trophobastic tumours vulvar and vaginal cancers. 1. CERVICAL CARCINOMA Epidemiology - In Canada 1 350 new cases of invasive cervical cancer are diagnosed annually. Approximately 400 deaths per year occur from this disease. Age The median age at diagnosis is 47 years. 47 of women with invasive cervical cancer are diagnosed under 35 years of age. Older women age 65 account for 10 of all cervical cancer diagnoses. Risk factors Incidence is inversely related to socio-economic status. Risk increases with early age of first coitus total number of sexual partners and number of sexual partners before age 20. Increased risk with sexually transmitted diseases like gonorrhea syphilis herpes simplex trichomonas and chlamydia. With genital warts the risk is increased 3-fold. Smoking is strongly associated. Etiology Most cervical cancers originate in the transformation zone where metaplasia occurs squamo columnar junction . More than 95 of cervical cancers are associated with infections with the human papilloma virus HPV . HPV types 6 and 11 are usually found in benign condylomata acuminata low-grade dysplasias and laryngeal papilomas. HPV types 16 and 18 less commonly types 31 33 35 and 39 are most highly associated

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