Uterine fibroids, masses of muscle and connective tissue that are stimulated by estrogen, occur in some 20 to 50 percent of women between the ages of 30 and 50. Fibroids are more often seen in African-American women. Diagnosis is made by physical exam, ultrasound or x-rays. The size of these benign tumors varies from pea size up to that of a tennis or softball. These smooth, firm, rounded tumors are usually asymptomatic. However, large tumors can cause excessive menstrual bleeding, menstrual cramps, urinary frequency, constipation, low abdominal pain, and infertility. Tumors that distort the uterine cavity or endometrium can cause infertilty or spontaneous abortion. Treatment is dependent on age, symptoms, parity and patient condition. No treatment is required for asymptomatic persons. For women approaching menopause the withdrawal of estrogen causes a stasis or regression of the fibroids. Hysterectomy may be necessary in women with excessive bleeding.
Endometrial cancer affects mostly postmenopausal women and is the third most prevalent cancer in women. Exogenous estrogens may contribute to the development of endometrial cancer. Obesity, diabetes, hypertension, family history, and upper socioeconomic levels are also associated with a higher incidence of these slow growing tumors. Endometrial cancer spreads first to the cervix and myometrium followed by the vagina, pelvis and lungs. Abnormal uterine bleeding is often the first sign. Other signs include cramping, bleeding after intercourse, or swollen lymph nodes. Diagnosis is by dialation of the cervix and scraping the endometrial lining for microscopic study. Early stages of endometrial cancer are curable by hysterectomy and radiation.
Early onset of sexual intercourse, low socioeconomic status, race, promiscuity, and multiparity are all risk factors for the development of cervical cancer. Cervical cancer is seen most frequently in the 30-50 year old woman who began intercourse prior to the age of 20. There are profound differences in the incidence and death rate associated with race (e.g., African-Americans, Hispanics and American Indians have higher death rates than the national average). Race and age are risk factors that obviously cannot be controlled. The age of onset of sexual relations and promiscuity are, however, matters of personal choice. Frequent unprotected sex with multiple partners is a definite risk factor for the development of cervical cancer. A link to genital herpes and other sexually transmitted disease has been found.
As the carcinoma progresses it may metastasize to the bladder, rectum, lymph nodes, lungs, bones and liver. Early cervical cancer is asymptomatic making early diagnosis key. Routine (yearly) Pap smears are and excellent diagnostic tool. Treatment is by laser surgery, electrocautery or cryosurgery to remove the lesion early. In advanced or recurrent cases, hysterectomy and radiation therapy may be indicated.