The female pelvis is accustomed to a wide range of natural and pathologic conditions that a woman may experience in her life. The uterus significantly enlarges during pregnancy. The ovaries can be subject to various natural and pathologic states ranging from benign cysts to advanced ovarian carcinoma.
From the gross anatomy of the female pelvis to the microscopic anatomy, form follows function and allows for reproductive processes as well the possibility for pathologic conditions. The anatomy of the female genitourinary organs (see the image below) is addressed in the following section, along with certain anatomic variants.
Cervical cancer is cancer that begins in the uterine cervix, the lower end of the uterus that contacts the upper vagina. Cervical cancer occurs in almost 13,000 women each year in the U.S., leading to about 4,100 deaths. Since 1980, the incidence of cervical cancer has fallen by 45%, and the mortality (death) rate for cervical cancer has declined by 49%. Survival rates among African-American women are lower than for any other racial or ethnic group in the U.S. Cervical cancer remains a common cause of cancer and cancer death in women in developing countries without access to screening (Pap testing) for cervical cancer or vaccines against human papillomaviruses (HPVs).
Cervical cancer is different from cancer that begins in other regions of the uterus (uterine or endometrial cancer). If detected early, cervical cancer has a very high cure rate. Vaccination against HPVs, which are known to cause cervical cancer, is an effective preventive measure.
Endometrial cancer is a type of cancer that begins in the uterus. The uterus is the hollow, pear-shaped pelvic organ in women where fetal development occurs.
Endometrial cancer begins in the layer of cells that form the lining (endometrium) of the uterus. Endometrial cancer is sometimes called uterine cancer. Other types of cancer can form in the uterus, including uterine sarcoma, but they are much less common than endometrial cancer.
The term ovarian cancer includes several different types of cancer (uncontrolled division of abnormal cells that can form tumors) that all arise from cells of the ovary. Most commonly, tumors arise from the epithelium, or lining cells, of the ovary. These include epithelial ovarian (from the cells on the surface of the ovary), fallopian tube, and primary peritoneal (the lining inside the abdomen that coats many abdominal structures) cancers. These are all considered to be one disease process. There is also an entity called ovarian low malignant potential tumor; these tumors have some of the microscopic features of a cancer, but tend not to spread like typical cancers.
There are also less common forms of ovarian cancer that come from within the ovary itself, including germ cell tumors and sex cord-stromal tumors. All of these diseases as well as their treatment will be discussed.