LEUKORRHEA IN GYNECOLOGIC MALIGNANCIES

FLUOR ALBUS
LIQUID DISCHARGE FROM VAGINA IN EXCESSIVE AMOUNT, NOT BLOOD

LEUKORRHEA
WHITISH DISCHARGE FROM VAGINA OR UTERINE CAVITY

NOT NECESSARILY WHITE IN COLOR DEPENDS UPON ETIOLOGY

(ABNORMAL, EXCESSIVE) (VAGINAL) DISCHARGE

ORGANIC SOURCE OF LEUKORRHEA

VULVA
VAGINA CERVIX
Vulva

UTERUS FALLOPIAN TUBES

FALLOPIAN TUBES: ENDOSALPINX GLANDS

UTERUS: ENDOMETRIAL GLANDS

CERVIX: ENDOCERVICAL GLANDS

VULVA : ACCESSORY GLANDS: BARTHOLIN SKENE

VAGINA: EPITHELIAL TRANSUDATE

LEUKORRHEA:

PHYSIOLOGIC

PATHOLOGIC

ETIOLOGY
LEUKORRHEA PHYSIOLOGIC
Newborn babies Premenarche Before and after menstruation Ovulation Pregnancy Sexual stimulation Psychological factors Anemia, fatigue

PATHOLOGIC

Infection Foreign body Hormonal Cancer Atrophic vaginitis

PATHOLOGIC LEUKORRHEA
MOSTLY INFECTION

INCREASE IN VOLUME

UNUSUAL SMELL CHANGE IN CONSISTENCY

CHANGE IN COLOR

Vaginal discharge and the associated vulvar itching are the most comon reasons for a woman to seek gynecological care. While these may seem minor complaints to the provider, the patient may feel intensely anxious over the possibility of an underlying STD or even cancer

Practical Guide to Diagnosing and Treating Vaginitis (Plourd DM, Medscape General Medicine 1 (2), 1999)

The most common symptoms due to gynecologic disorders include vaginal itching, a vaginal discharge,..

http://www.merck.com/mmhe/seczz/ch242/ch242b.html

A doctor should be seen if there are any of the following: bleeding or discharge not related to menstrual periods, ..

http://jamesline.com/cancertypes/gynecologic/about/vaginal/

* SUPERINFECTION * BLEEDING

RAPID CELLULAR PROLIFERATION

NECROSIS

WHY LEUKORRHEA IN (GYNECOLOGIC) CANCER?

DECREASED INTERCELLULAR COHESIVE STRENGTH

BLOODY VAGINAL DISCHARGE

INSUFFICIENT INCREASED VASCULARIZATION

Cancer :

a complex disease that arises because of genetic alterations that disrupt numerous cellular functions:
proliferation

programmed
senescence

cell death

ultimately control the number of cells in a population

Unlike normal cells,

in the malignant growth, cells do not cease multiplying when they reach a critical mass. In the growth process, cancer cell loss will increase from tumor cells with insufficient nutrients and vascular supply.

..patients with malignant gynecologic tumors in childhood and adolescence .. presented only with bloody vaginal discharge.

Genital symptoms, even common, alert us to the possibility of a genital tract tumor.

(Int J Gynaecol Obstet. 1994 Jun;45(3):227-34)

CLINICAL FINDINGS

BLOODY/BLOOD-TINGED DISCHARGE

MALODOROUS

There are no outward signs of gynecologic cancers. However, some common symptoms include: .. persistent vaginal discharge ..

http://www.perthradiationoncology.com.au/gynecologic-cancers.htm

WHAT GYNECOLOGIC CANCERS ?

CERVICAL CANCER VAGINAL CANCER UTERINE/ENDOMETRIAL CANCER VULVAR CANCER

FALLOPIAN TUBE CANCER

RADIOTHERAPY MAY SOMETIMES CAUSES VAGINAL DISCHARGE

Cervical Cancer

Warning signs include abnormal bleeding and/or abnormal discharge from the vagina
http://www.magee.edu/ClinicalServices/GYNEOncology/Page1.asp

There are often no symptoms with an early stage cervical cancer. As the cancer becomes invasive, .. a continual vaginal discharge may

Vaginal discharge is the second most common symptom, after abnormal vaginal bleeding, and is often the herald of advanced disease.

Cervical cancer is easily recognized when it presents as a visible lesion, but a problem arises when it adopts unusual presentations. Copious vaginal discharge from cervical adenocarcinoma may lead to a false-negative Papanicolaou (Pap) smear.

Treatment of cervicitis can result in a delay in diagnosis. Successful and timely diagnosis and treatment of cervical cancer requires experience and vigilance.

(Semin Surg Oncol.1999 Apr-May; 16(3):261-6)

Primary lymphoma arising from the female genital tract has been rarely encountered. Primary cervical lymphoma is even rarer in gynecologic oncology practice and accounts for approximately only 1 % of extranodal lymphomas. .

Presented with abnormal vaginal discharge.

Although most reported cases in the literature have a normal Pap smear, some may represent with co-existent cytological abnormalities

VAGINAL CANCER
The symptoms of vaginal cancer include abnormal vaginal discharge or bleeding not related to menstruation ..

www.eyesontheprize.org/FAQ/gynca/vaginal.html

UTERINE CANCER

The hallmark symptom of endometrial cancer is abnormal vaginal bleeding or discharge, especially in postmenopausal women.
http://www.aribella.com/gyncancer2.htm

Endometrial cancer affects patients..more frequently in menopause (>50) and in postmenopause (>70)..the most frequent symptoms are bleeding and vaginal discharge.

VULVAR CANCER

Vulvar cancer can manifest itself through abnormal bleeding or discharge

TUBAL CANCER
Carcinoma of the fallopian tube is the least common of the gynecologic malignancies. Because of its rarity and the absence of typical symptoms, preoperative diagnosis is seldom made. Patient as well as physician delay in diagnosis is often considerable.

Unexplained vaginal

Primary adenocarcinoma of the fallopian tube is a rare neoplasm that constitutes less than 1 % of gynecologic malignancies.
Although the triad of menorrhagia, leukorrhea, and pain is said to be pathognomonic, preoperative diagnosis of this lesion is most unusual.

(Urol Radiol.1988;10(2):113-5)

DISCHARGE IN GYNECOLOGIC CANCER: SHOULD IT BE TREATED?

CAUSAL TREATMENT IS THE MOST APPROPRIATE

SYMPTOMATIC WHEN I

WHAT MICROORGANISM ?
Cytologic diagnoses of neoplastic modifications .. Gardnerella sp.was the most prevalent microbiologic agent. Distribution of human papillomavirus showed a decrease with age.

Drugs matching normal vaginal ecosystem physiology :

Normal Saline Flush Inj Dextrose 10%-Normal Saline IV Dextrose 5% in Normal Saline IV Cefazolin in Normal Saline IV Diflucan in Normal Saline IV Fluconazole in Normal Saline IV Gentamicin in Normal Saline IV Meperidine (PF)-Normal Saline Inj

Midazolam in Normal Saline Inj Morphine in Normal Saline Inj