Genital tract cancer afflicts a significant portion of postmenopausal women. These malignancies account for 13% of all cancers in women. Approximately 75,400 new cases were diagnosed and 24,700 deaths resulted from gynecologic malignancies in 1999. Risk of developing a gynecologic cancer increases with age. Figures 37.1 and 37.2 show the age-related incidence and mortality, respectively, of these malignancies. As with other cancers, early detection provides the best opportunity for successful management. Therapeutic strategies include surgery, chemotherapy, and radiation treatment. Integration of these diverse modalities is best coordinated by a gynecologic oncologist who has the skills necessary to accomplish surgical and medical treatment of these women, as well as the knowledge of appropriate circumstances for the use of radiotherapy.
- Etiology and Pathology
- Symptoms, Signs, and Diagnosis
- Staging, Prognosis, and Treatment
- Etiology and Pathology
- Symptoms, Signs, and Diagnosis
- Symptoms and Signs
- Prognosis and Treatment
- Symptoms, Signs, and Diagnosis
- Symptoms and Signs
- Prognosis and Treatment
- Symptoms, Signs, and Diagnosis
- Symptoms, Signs, and Diagnosis
Additional Issues for the Geriatric Patient
Since 1990, Medicare coverage for Pap smears has been available. Presently, Medicare pays only the cost of laboratory analysis; the physician visit is covered only if Medicare-eligible services are rendered. Screening interval has been set at every 3 years under the current guidelines. The law permits provisions for more frequent Pap smears in high-risk women. However, no such benefits have been enacted to date.
Given that elderly women are at particularly high risk of developing malignancies, they should be entitled to receive adequate screening for these cancers. Older women are often uninformed about the importance of screening, and physicians are often reluctant to put elderly patients through the discomfort of a pelvic exami-nation if they are asymptomatic. Geriatric patients usually can safely undergo radical surgery, dose-intense chemotherapy, and radiotherapy after thorough medical evaluation. Decisions to withhold optimum therapy should be made in conjunction with the patient and should be based on intercurrent medical conditions rather than on age alone.
Treatment for gynecologic cancer commonly influences a woman's image of herself and her sexuality. It is imperative that physicians caring for these patients be sensitive to their concerns. Frank discussions about how treatment for cancer will affect appearance and sexuality must be conducted with the patient and her partner before initiation of therapy. Remediable causes of dysfunction should be corrected and referral for counseling considered if problems persist. It is important that sexual apprehensions be taken seriously and that practitioners recognize the importance of sexual issues to older individuals.
Ovarian cancer is one of the most treatable solid tumors, as the majority will respond temporarily to surgery and cytotoxic agents.
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