Jinekolojik Kanserlerde Tanı ve Sınıflandırma
Özet
Bu çalışma, jinekolojik kanserlerin (vajen, vulva, serviks, uterus korpusu, over, fallop tüpü ve periton) tanı, epidemiyoloji, risk faktörleri, klinik ve histopatolojik sınıflandırmalarını kapsamlı bir şekilde incelemektedir. Nadir görülen vajen ve vulva kanserlerinde HPV enfeksiyonunun, sigara kullanımının ve preinvaziv lezyonların önemi vurgulanmaktadır. Dünyada kadınlar arasında en sık görülen jinekolojik malignitelerden biri olan serviks kanserinin gelişiminde onkojenik HPV tiplerinin (özellikle Tip 16 ve 18) birincil etken olduğu, tarama (Pap smear, KETEM) ve aşılama programlarının insidansı büyük ölçüde azalttığı belirtilmektedir. Uterus korpusu maligniteleri içinde yer alan endometrium kanserinin obezite, diyabet, hipertansiyon ve karşılanmamış östrojen maruziyetiyle doğrudan ilişkili olduğu; Lynch ve Cowden sendromları gibi herediter faktörlerin riski artırdığı ifade edilmektedir. Ayrıca endometrial karsinomların tedavisinde geleneksel histomorfolojinin yanı sıra POLEmut ve p53abn gibi moleküler sınıflandırmaların prognostik değerine değinilmektedir. Kadın genital sistem ölümlerinde ilk sırada yer alan epitelyal over kanserleri ile fallop tüpü ve periton tümörlerinde tanı, ultrasonografi (RMI) ve CA-125/HE4 gibi tümör belirteçleriyle desteklenirken, kesin teşhis histopatolojik olarak konulmaktadır. Son olarak, daha genç yaş gruplarında hızlı büyüme gösteren overin germ hücreli tümörleri ile hormonal aktivite (östrojen/androjen fazlalığı) gösteren seks-kord stromal tümörlerin klinik özellikleri, ayrıcı tanıları ve Dünya Sağlık Örgütü (DSÖ) kriterlerine dayalı patolojik alt tipleri detaylandırılmaktadır.
This study comprehensively examines the diagnosis, epidemiology, risk factors, clinical features, and histopathologic classifications of gynecologic cancers, including vaginal, vulvar, cervical, uterine corpus, ovarian, fallopian tube, and peritoneal malignancies. In rare vaginal and vulvar cancers, the significance of HPV infection, smoking, and preinvasive lesions is highly emphasized. For cervical cancer, which is one of the most common gynecologic malignancies worldwide, oncogenic HPV types (especially Types 16 and 18) are identified as the primary causative agents, and national screening (Pap smear, KETEM) and vaccination programs are noted to significantly reduce incidence. Regarding uterine corpus malignancies, endometrial cancer is directly associated with obesity, diabetes, hypertension, and unopposed estrogen exposure, while hereditary factors such as Lynch and Cowden syndromes notably increase risk. Furthermore, the prognostic value of new molecular classifications, including POLEmut and p53abn, alongside traditional histomorphology is highlighted for endometrial carcinomas. Epithelial ovarian, fallopian tube, and peritoneal cancers rank first in gynecologic cancer mortality; their diagnosis is supported by ultrasonography (RMI) and tumor markers like CA-125 and HE4, with definitive diagnosis established histopathologically. Lastly, the clinical presentations, differential diagnoses, and specific pathologic subtypes based on World Health Organization (WHO) criteria are detailed for rapid-growing ovarian germ cell tumors in younger populations and hormonally active sex-cord stromal tumors that cause estrogen or androgen excess.
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