Manoel Afonso Guimarães Gonçalves

By Fernando Anschau, Chrystiane da Silva Marc, Maria Carolina Torrens and Manoel Afonso Guimarães Gonçalves

Part of the book: Topics on Cervical Cancer With an Advocacy for Prevention

By Manoel Afonso Guimarães Gonçalves, Fernando Anschau, Daniela Martins Gonçalves and Chrystiane da Silva Marc

Part of the book: Hysterectomy

By Manoel Afonso Guimarães Gonçalves and Fernando Anschau

The diagnostic process begins at the first meeting with the patient, where we must relate the symptoms and signs associated with endometrial disease. Communication skills are fundamental for excellence in medical care. Even with the development and improvement of new technologies in recent decades, be it endoscopy, ultrasound, computed tomography or magnetic resonance imaging, the communication is also essential. We must have skills to recognize and elucidate a wide variety of signs and symptoms when we take a history and do a physical examination of the patient, where abnormal uterine bleeding is the first main sign that can lead to an early diagnosis of endometrial cancer. The endometrium, as every target organ of steroid hormones, shows involutional changes during ovarian failure. In peri-menopause, however, tissue hyperactivity stages occur with some frequency, showing a marked endometrial sensitivity to hormonal fluctuations, whether on an absolute or relative level. Irregular blood loss occurs in many women during this period, and although being most times of functional origin, it requires investigation. It is noteworthy that the most frequent cause of abnormal bleeding of organic origin in menopause is endometrial. Endometrial pathologies appear with advancing age. Therefore an appropriate workup should diagnose or rule out disease at this site. Thus, preventive measures should be adopted, such as screening and early diagnosis, and the best treatment for the patient should be established.

Part of the book: Gynecologic Cancers

By Fernando Anschau and Manoel Afonso Guimarães Gonçalves

Cancer of the Vulva: a review In reporting on cancer of the vulva, we should keep in mind some important aspects of its epidemiology and its early detection. Most of the papers on the subject refer to vulvar cancer as a rare disease, accounting for 4 to 5% of all malignant neoplasms of the female genital tract and less than 1% of women's cancers. The incidence varies from 1 to 3.6 cases per 100,000 women, with peak incidence at ages 70-79 years. Even though the incidence increases with age, the proportion of young patients with vulvar cancer has greatly increased due to its association with infection with human papillomavirus (HPV). The risk of developing cancer of the vulva is related to behavioral, reproductive, hormonal and genetic aspects. Factors that increase risk include other genital cancers, chronic inflammatory diseases of the vulva, smoking, history of genital warts and vulvar intraepithelial neoplasia (VIN). We can consider that, given the epidemiological evidence, there are two etiologic pathways for vulvar cancer: one related to older patients, in the seventh or eighth decades of life, associated with mutations in TP53 and non-neoplastic epithelial disorders such as chronic inflammation or vulvar lichen, shows precursor lesions of differentiated VIN; the other is more common in young patients, accounts for approximately 43-60% of squamous carcinoma of the vulva, is associated with HPV infection, and is a common precursor lesion of VIN. Eighty-five to ninety percent of vulvar cancers are squamous in origin (squamous cell carcinoma); however, when considering the embryological origin of the vulva - the three germ layers - different histologic types can compose neoplasms affecting the region.

Part of the book: Gynecologic Cancers