Ginekologik onkologiya

Vikipediya, ochiq ensiklopediya

Ginekologik onkologiya tibbiyotning ixtisoslashgan sohasi bo'lib, ayol jinsiy tizimi saratoni, jumladan tuxumdon saratoni, bachadon saratoni, vaginal saraton, bachadon bo'yni saratoni va vulva saratoniga qaratilgan . Mutaxassis sifatida ular ushbu saraton kasalliklarini tashxislash va davolash bo'yicha keng qamrovli tayyorgarlikka ega.

Amerika Qo'shma Shtatlarida har yili 82 000 ayolga ginekologik saraton tashxisi qo'yiladi.[1] 2013-yilda taxminan 91 730 ta tashxis qo'yilgan.[2]

Ginekologik Onkologiya Jamiyati va Yevropa Ginekologik Onkologiya Jamiyati ginekologik onkologlar uchun professional tashkilotlardir va Ginekologik Onkologiya Guruhi ginekologik onkologlar va ginekologik saraton bilan shug'ullanadigan boshqa tibbiyot mutaxassislari uchun professional tashkilotdir. Ayollar saratoni jamg'armasi AQShning asosiy tashkiloti bo'lib, ginekologik saraton kasalliklari haqida xabardorlikni oshirish va tadqiqotlarni moliyalashtirish hamda ta'lim dasturlari va materiallarni taqdim etadi.

Ixtisoslashgan markazlarda davolanayotgan ginekologik saratoni bilan og'rigan ayollar standart tibbiy yordamga qaraganda uzoqroq umr ko'rishini ko'rsatadigan past sifatli dalillar mavjud.[3] 9000 dan ortiq ayollarni birlashtirgan uchta tadqiqotning meta-tahlili shuni ko'rsatdiki, ginekologik saratonni davolash bo'yicha ixtisoslashgan markazlar umumiy yoki jamoat shifoxonalari bilan solishtirganda tuxumdon saratoni bilan kasallangan ayollarning umrini uzaytirishi mumkin. Bundan tashqari, 50 000 dan ortiq ayollarni baholagan uchta boshqa tadqiqotning meta-tahlili shuni ko'rsatdiki, o'quv markazlari yoki ixtisoslashtirilgan saraton markazlari jamoat yoki umumiy kasalxonalarda davolanganlarga qaraganda ayollarning hayotini uzaytirishi mumkin.

Ginekologik saraton ayollar saratonining 10-15% ni tashkil qiladi, asosan reproduktiv yoshdagi ayollarga ta'sir qiladi, lekin yosh bemorlarning tug'ilishiga tahdid soladi.[4] Davolashning eng keng tarqalgan usuli - bu jarrohlik va jarrohlik bo'lmagan aralashuvlar (radioterapiya, kimyoterapiya) aralashmasidan iborat kombinatsiyalangan terapiya.[4]

Xavf omillari[tahrir | manbasini tahrirlash]

Semirib ketish[tahrir | manbasini tahrirlash]

Semirib ketish endometriyal va tuxumdon saratoni kabi ginekologik saraton rivojlanish xavfining oshishi bilan bog'liq.[5] Endometrium saratoni uchun BMI shkalasidagi har 5 birlik o'sish xavfning 50-60% ga oshishi bilan bog'liq.[6] 1-toifa endometrium saratoni eng keng tarqalgan endometrium saratonidir.[7] 1-toifa endometrium saratoni tashxisi qo'yilgan bemorlarning 90% ga yaqini semirib ketgan.[8] Semirib ketish va tuxumdon saratoni o'rtasidagi bog'liqlik mumkin bo'lsa-da, bu bog'liqlik asosan saratonning past darajadagi pastki turlarida uchraydi.[9]

Genetik mutatsiyalar[tahrir | manbasini tahrirlash]

BRCA1 va BRCA2 kabi genetik mutatsiyalar tuxumdon saratoni rivojlanishi bilan kuchli bog'langan.[10] BRCA1 mutatsiyasi tuxumdon saratoni rivojlanish xavfini 36% - 60% ga oshirishi ko'rsatilgan.[11] BRCA2 mutatsiyasi tuxumdon saratoni rivojlanish xavfini 16% - 27% ga oshirishi ko'rsatilgan.[11]

Inson papilloma virusi (HPV)[tahrir | manbasini tahrirlash]

Inson papilloma virusi (HPV) jinsiy yo'l bilan yuqadigan keng tarqalgan kasallik bo'lib, ba'zi ginekologik saratonlar, jumladan, bachadon bo'yni, vagina va vulva saratoni bilan bog'liq.[12] Inson papilloma virusi va bachadon bo'yni saratoni o'rtasidagi aniq bog'liqlik uzoq vaqtdan beri aniqlangan, HPV 70% dan 90% gacha.[13] Inson papilloma virusining doimiy infektsiyalari vaginal va vulva saratonining 70% dan 75% gacha harakatlantiruvchi omil ekanligi ko'rsatilgan.[13]

Chekish[tahrir | manbasini tahrirlash]

Chekish bachadon bo'yni, vulva va qin saratoni rivojlanishi uchun xavf omili ekanligi aniqlandi.[14][15][16] Hozirgi sigaret chekadigan ayollarda chekmaydiganlarga qaraganda bachadon bo'yni saratoni rivojlanish ehtimoli ikki baravar ko'p.[14] Bachadon bo'yni saratoni rivojlanishida chekish qanday rol o'ynashini tushunish uchun bir nechta mexanizmlar o'rganildi.[17] Bachadon boʻyni epiteliysining DNKsi chekish tufayli zararlangani aniqlangan.[17] Bachadon bo'yni hujayralarida DNKning shikastlanish darajasi chekmaydiganlarga qaraganda chekuvchilarda yuqori bo'lgan.[17] Bundan tashqari, chekish HPV ga qarshi immunitetni pasaytirishi va bachadon bo'ynidagi HPV infektsiyasini kuchaytirishi mumkinligi taxmin qilingan.[18] Shunga o'xshash mexanizmlar orqali chekuvchi ayollarda ham vulva saratoni rivojlanish ehtimoli 3 barobar ko'p ekanligi aniqlandi.[19][20] Chekish ham vaginal saraton xavfi bilan bog'liq.[21][16] Sigaret chekadigan ayollar chekmaydigan ayollarga qaraganda qin saratoni rivojlanish xavfi ikki baravar yuqori.[21][16]

Bepushtlik[tahrir | manbasini tahrirlash]

Bepushtlik yoshlarga ta'sir qiladigan keng tarqalgan kasallikdir.[22] Ba'zi tadqiqotlar shuni ko'rsatdiki, har 7 juftlikdan 1 nafari bepushtlik muammosi tufayli homilador bo'lolmaydi.[22] Bepushtlik ginekologik saraton uchun ma'lum xavf omilidir.[23] Fertil ayollarga qaraganda, tuxumdon saratoni va endometrium saratoni rivojlanish xavfi yuqori.[23]

Belgilari va alomatlari[tahrir | manbasini tahrirlash]

Alomatlar odatda saraton turiga qarab farq qiladi. Barcha ginekologik saraton kasalliklarida eng ko'p uchraydigan alomatlar anormal vaginal qon ketish, vaginal oqindi, tosda og'riq va siyishda qiyinchiliklardir.[24]

  • Shishish yoki qorinning shishishi
  • Tez-tez siyish
  • Tos yoki bel og'rig'i
  • To'yinganlikning kuchayishi / ishtahaning yo'qolishi
  • O'zgartirilgan ichak harakatlari
  • Charchoq
  • Ozish
  • Menopauzadan keyingi qon ketish
  • Anormal vaginal qon ketish (og'ir yoki tartibsiz hayz ko'rish)
  • Vaginal oqindi
  • Siydik chiqarishda qiyinchilik
  • Tosdagi og'riq

Vaginal saraton[25][26]

  • Anormal vaginal qon ketish
  • Vaginal oqindi
  • Pelvis og'rig'i
  • Og'riqli va tez-tez siyish
  • Qorin og'riq
  • Yomon hidli vaginal oqindi
  • Tosda og'riq va / yoki bel og'rig'i
  • Qonning aniqlanishi
  • Menopauzadan keyingi qon ketish

Qin saratoni[27][28]

  • Pruritus: qinda doimiy qichishish
  • Qin qon ketishi
  • Qin og'rig'i, og'riq yoki noziklik
  • Siydik chiqarishda yonish hissi
  • Qinda ko'rinadigan sig`ilga o'xshash massa yoki yara

Muolajalar[tahrir | manbasini tahrirlash]

Tuxumdon saratoni[tahrir | manbasini tahrirlash]

Aksariyat hollarda tuxumdonlardan tashqari metastazning o'tmishdagi nuqtasi aniqlanadi, bu kasallikning yuqori xavfini va agressiv kombinatsiyalangan terapiya zarurligini anglatadi. Odatda jarrohlik va sitotoksik vositalar talab qilinadi.[4][29] Gistologiya turi deyarli epitelialdir, shuning uchun davolanish patologiyaning ushbu kichik turiga tegishli bo'ladi.[4][29]

Tuxumdon saratoni yaxshi tabaqalangan 1-bosqich o'smalari bo'lgan deyarli barcha hollarda jarrohlik yo'li bilan davolash mumkin.[4][30] Yuqori o'sma darajalari platinaga asoslangan kimyoterapiya kabi yordamchi davolashdan foyda ko'rishi mumkin.[4][30]

Optimal debulking saraton makroskopik darajada rivojlangan holatlarni davolash uchun ishlatiladi.[4][31] Ushbu protseduraning maqsadi 1 dan katta o'simta qoldirmaslikdir ta'sirlangan reproduktiv organlarning muhim qismlarini olib tashlash orqali amalga oshiriladi.[4][31] Qorin bo'shlig'i histerektomiyasi, ikki tomonlama salpingo-oferektomiya, omentektomiya, limfa tugunlaridan namuna olish va peritoneal biopsiyalarni o'z ichiga olgan optimal debulyarlikka erishish uchun bir nechta aralashuvlardan foydalanish mumkin.[4][31] Kimyoterapiya va optimal yo'qotish o'rtasidagi natijalarni taqqoslaydigan randomizatsiyalangan nazorat ostida sinovlar yo'q, shuning uchun hozirgi parvarish standarti odatda jarrohlik aralashuvlardan boshlab ikkalasini ham ketma-ket qo'llashni o'z ichiga oladi.[4]

Agar o'simta 1 dan yuqori bo'lsa, birlamchi jarrohlikdan so'ng kimyoterapiyaning yarmigacha intervalgacha bo'shatish operatsiyasi qo'llanilishi mumkin.[4][32] Bu kimyoviy sezgir bemorlarning o'rtacha omon qolishini 6 oygacha oshirishi ko'rsatilgan.[4][32]

Klinik tadkikotlarda o'simta holatini baholash uchun ikkinchi ko'rinishdagi laparotomiyadan foydalanish mumkin, ammo yaxshilangan natijalar bilan bog'liqlik yo'qligi sababli standart tibbiy yordamning asosiy qismi emas.[4][33]

Tug`ruqni saqlaydigan jarrohlik jinsiy hujayrali saraton yoki qorin bo'shlig'i limfomasini istisno qilish uchun to'liq differensial tashxisni o'z ichiga oladi, ularning ikkalasi ham ko'rinishida rivojlangan tuxumdon saratoniga o'xshaydi, ammo yumshoqroq usullar bilan davolash mumkin.[4][34] Tug`ruqni saqlovchi jarrohlik ehtiyotkorlik uchun ikkinchi marta laparotomiya qilish tavsiya etiladigan kam sonli holatlardan biridir.[4][34]

Platinaga asoslangan kimyoterapiya epitelial tuxumdon saratonini davolashda muhim ahamiyatga ega. Karboplatin nojo'ya ta'sirlar uchun sisplatinga qaraganda yaxshiroq ta'sir qiladi va ambulatoriya sharoitida randomizatsiyalangan klinik tadkikotlarda qo'llaniladi.[4] Paklitaksel tuxumdon saratonining kech bosqichi uchun ayniqsa samarali qo'shimcha hisoblanadi.[4] Ba'zi tadqiqotlar shuni ko'rsatadiki, intraperitoneal kimyoterapiya tomir ichiga yuborishdan afzalroq bo'lishi mumkin.[4]

Bachadon bo'yni saratoni[tahrir | manbasini tahrirlash]

Bachadon bo'yni saratoni 2A bosqichigacha jarrohlik yo'li bilan davolanadi.[4][35] Agar eng erta bosqichda aniqlansa, loop konusning biopsiyasi orqali mahalliy eksizyon qilish yetarli.[4][35] Agar bemor ushbu nuqtadan tashqarida bo'lsa, tos limfa tugunlariga metastazni baholash uchun ikki tomonlama limfadenektomiya qilinadi.[4] Agar limfa tugunlari salbiy bo'lsa, bachadonni kesish amalga oshiriladi.[4] Aks holda, histerektomiya va radiatsiya terapiyasining kombinatsiyasi tez-tez qo'llaniladi.[4] Ba'zi hollarda bu kombinatsiyalangan yondashuv faqat kimyoterapiya bilan almashtirilishi mumkin.[4]

Endometrium saratoni[tahrir | manbasini tahrirlash]

Kasallikning dastlabki bosqichida histerektomiya va ikki tomonlama ooferektomiya amalga oshiriladi.[4][36] Limfatik tarqalish bilan ko'proq tajovuzkor holatlar ko'pincha radioterapiya bilan davolanadi.[37] Gormon terapiyasi ko'pincha tizimli tarqalishni davolashda qo'llaniladi, chunki endometrium saratoni bilan og'rigan bemorlar yoshi kattaroqdir va boshqa kasalliklarga ega bo'lib, ularni kimyoterapiyada qo'llaniladigan qattiq sitotoksik vositalarga bardosh bera olmaydi.[4][37] Minimal laparoskopik jarrohlik endometrium saratoni uchun boshqa ginekologik saratonga qaraganda ko'proq qo'llaniladi va klassik jarrohlik aralashuvlarga nisbatan afzalliklarga ega bo'lishi mumkin.[4]

Qin saratoni[tahrir | manbasini tahrirlash]

Kasallikning kamligi dalillarga asoslangan terapiya nisbatan zaif ekanligini anglatadi, ammo asosiy e'tibor saraton to'qimasini to'g'ri baholash va limfa tarqalishini kamaytirishga qaratilgan.[38]

Skuamoz bo'lmagan gistologik subtiplarning ozchiligi odatda inguinal tugunlarni olib tashlashni talab qilmaydi.[4][38] Biroq, bu 1 dan ortiq skuamoz hujayrali karsinomalarda tarqalishining oldini olish uchun kerak.[4][38] Agar tugun kasalligi tasdiqlansa, yordamchi radioterapiya qo'llaniladi.[4][38]

Vaginal saraton[tahrir | manbasini tahrirlash]

Davolash vaginal saraton bosqichiga bog'liq.[39] Jarrohlik rezeksiyasi va aniq radioterapiya erta bosqichdagi vaginal saratonni davolashning birinchi qatoridir.[39] Tuxumdonlar va jinsiy funksiyani saqlab qolish, shuningdek, radiatsiya xavfini yo'q qilish tufayli radiatsiya terapiyasidan jarrohlik afzalroqdir.[39] Vaginal saratonning yanada rivojlangan bosqichlarida tashqi nurli radiatsiya terapiyasi (EBRT) davolashning standart usuli hisoblanadi.[39] Tashqi nurli radiatsiya terapiyasi bemorning tos bo'shlig'iga 45 Gy dozada kuchayishni o'z ichiga oladi.[39]

Epidemiologiya[tahrir | manbasini tahrirlash]

  • Har 70 ayoldan 1 nafari hayotining qaysidir davrida tuxumdon saratoniga chalinadi. Skandinaviya mamlakatlarida kasallik Yaponiyanikiga qaraganda 6,5 baravar yuqori. Bu genetik va ekologik tabiatning ko'p faktorli sabablari bilan bog'liq.[4]
  • Bachadon bo'yni saratoni ginekologik saratonlarning eng katta foizini tashkil qiladi.[4] Rivojlanayotgan mamlakatlardagi ayollar ko'proq rivojlangan holatlar bilan murojaat qilishadi.[4]

Hayot sifati[tahrir | manbasini tahrirlash]

Jinsiy hayot[tahrir | manbasini tahrirlash]

The experience of cancer influences the psychological aspect of sexuality, by posing a risk of developing barriers such as body image issues, low self esteem, and low mood or anxiety.[40] Other barriers include changes to reproductive organs or sex drive as well as potential genital pain.[40] Partners may also be affected by these changes in the relationship, especially with regards to intimacy and sexuality, which may in turn affect gynecological cancer patients by creating a perception of adverse relationship outcomes such as emotional distance or lack of interest.[41][40]

Manbalar[tahrir | manbasini tahrirlash]

  1. ↑ „Gynecologic Cancer“. Mount Sinai Hospital.
  2. ↑ „About Gynecologic Cancers“. Foundation for Women's Cancer. 2016-yil 13-avgustda asl nusxadan arxivlangan. Qaraldi: 2014-yil 21-iyul.
  3. ↑ „Centralisation of services for gynaecological cancer“. The Cochrane Database of Systematic Reviews. № 3. March 2012. CD007945-bet. doi:10.1002/14651858.cd007945.pub2. PMC 4020155. PMID 22419327.
  4. ↑ 4,00 4,01 4,02 4,03 4,04 4,05 4,06 4,07 4,08 4,09 4,10 4,11 4,12 4,13 4,14 4,15 4,16 4,17 4,18 4,19 4,20 4,21 4,22 4,23 4,24 4,25 4,26 4,27 4,28 4,29 4,30 4,31 4,32 Kehoe, Sean (2006-12-01). „Treatments for gynaecological cancers“. Best Practice & Research Clinical Obstetrics & Gynaecology. Evidence-Based Gynaecology: Part II (inglizcha). 20-jild, № 6. 985–1000-bet. doi:10.1016/j.bpobgyn.2006.06.006. ISSN 1521-6934. PMID 16895764.
  5. ↑ McTiernan, Anne; Irwin, Melinda; VonGruenigen, Vivian (2010-09-10). „Weight, Physical Activity, Diet, and Prognosis in Breast and Gynecologic Cancers“. Journal of Clinical Oncology. 28-jild, № 26. 4074–4080-bet. doi:10.1200/JCO.2010.27.9752. ISSN 0732-183X. PMC 2940425. PMID 20644095.
  6. ↑ Webb, Penelope M. (2013-05-16). „Obesity and Gynecologic Cancer Etiology and Survival“. American Society of Clinical Oncology Educational Book. № 33. e222–e228-bet. doi:10.14694/EdBook_AM.2013.33.e222. ISSN 1548-8748. PMID 23714508.
  7. ↑ Setiawan, Veronica Wendy; Yang, Hannah P.; Pike, Malcolm C.; McCann, Susan E.; Yu, Herbert; Xiang, Yong-Bing; Wolk, Alicja; Wentzensen, Nicolas; Weiss, Noel S. (2013-07-10). „Type I and II Endometrial Cancers: Have They Different Risk Factors?“. Journal of Clinical Oncology. 31-jild, № 20. 2607–2618-bet. doi:10.1200/JCO.2012.48.2596. ISSN 0732-183X. PMC 3699726. PMID 23733771.
  8. ↑ Olsen, Catherine M.; Green, Adèle C.; Whiteman, David C.; Sadeghi, Shahram; Kolahdooz, Fariba; Webb, Penelope M. (2007-03-01). „Obesity and the risk of epithelial ovarian cancer: A systematic review and meta-analysis“. European Journal of Cancer (inglizcha). 43-jild, № 4. 690–709-bet. doi:10.1016/j.ejca.2006.11.010. ISSN 0959-8049. PMID 17223544.
  9. ↑ Olsen, Catherine M.; Nagle, Christina M.; Whiteman, David C.; Ness, Roberta; Pearce, Celeste Leigh; Pike, Malcolm C.; Rossing, Mary Anne; Terry, Kathryn L.; Wu, Anna H. (2013-04-01). „Obesity and risk of ovarian cancer subtypes: evidence from the Ovarian Cancer Association Consortium“. Endocrine-Related Cancer (ingliz (Amerika)). 20-jild, № 2. 251–262-bet. doi:10.1530/ERC-12-0395. ISSN 1351-0088. PMC 3857135. PMID 23404857.
  10. ↑ Neff, Robert T.; Senter, Leigha; Salani, Ritu (August 2017). „BRCA mutation in ovarian cancer: testing, implications and treatment considerations“. Therapeutic Advances in Medical Oncology. 9-jild, № 8. 519–531-bet. doi:10.1177/1758834017714993. ISSN 1758-8340. PMC 5524247. PMID 28794804.
  11. ↑ 11,0 11,1 Huang, Yong-Wen (2018-01-12). „Association of BRCA1/2 mutations with ovarian cancer prognosis“. Medicine. 97-jild, № 2. e9380-bet. doi:10.1097/MD.0000000000009380. ISSN 0025-7974. PMC 5943891. PMID 29480828.
  12. ↑ Bansal, Anshuma; Singh, Mini P; Rai, Bhavana (2016). „Human papillomavirus-associated cancers: A growing global problem“. International Journal of Applied and Basic Medical Research. 6-jild, № 2. 84–89-bet. doi:10.4103/2229-516X.179027. ISSN 2229-516X. PMC 4830161. PMID 27127735.
  13. ↑ 13,0 13,1 Van Dyne, Elizabeth A.; Henley, S. Jane; Saraiya, Mona; Thomas, Cheryll C.; Markowitz, Lauri E.; Benard, Vicki B. (2018-08-24). „Trends in Human Papillomavirus–Associated Cancers — United States, 1999–2015“. Morbidity and Mortality Weekly Report. 67-jild, № 33. 918–924-bet. doi:10.15585/mmwr.mm6733a2. ISSN 0149-2195. PMC 6107321. PMID 30138307.
  14. ↑ 14,0 14,1 Collins, Stuart; Rollason, Terry P.; Young, Lawrence S.; Woodman, Ciaran B. J. (January 2010). „Cigarette smoking is an independent risk factor for cervical intraepithelial neoplasia in young women: A longitudinal study“. European Journal of Cancer (inglizcha). 46-jild, № 2. 405–11-bet. doi:10.1016/j.ejca.2009.09.015. PMC 2808403. PMID 19819687.
  15. ↑ Hussain, Shehnaz K.; Madeleine, Margaret M.; Johnson, Lisa G.; Du, Qin; Malkki, Mari; Wilkerson, Hui-Wen; Farin, Federico M.; Carter, Joseph J.; Galloway, Denise A. (July 2008). „Cervical and Vulvar Cancer Risk in Relation to Joint Effects of Cigarette Smoking and Genetic Variation in Interleukin 2“. Cancer Epidemiology, Biomarkers & Prevention (inglizcha). 17-jild, № 7. 1790–9-bet. doi:10.1158/1055-9965.EPI-07-2753. ISSN 1055-9965. PMC 2497438. PMID 18628433.
  16. ↑ 16,0 16,1 16,2 Daling, Janet R.; Madeleine, Margaret M.; Schwartz, Stephen M.; Shera, Katherine A.; Carter, Joseph J.; McKnight, Barbara; Porter, Peggy L.; Galloway, Denise A.; McDougall, James K. (2002-02-01). „A Population-Based Study of Squamous Cell Vaginal Cancer: HPV and Cofactors“. Gynecologic Oncology (English). 84-jild, № 2. 263–270-bet. doi:10.1006/gyno.2001.6502. ISSN 0090-8258. PMID 11812085.{{cite magazine}}: CS1 maint: unrecognized language ()
  17. ↑ 17,0 17,1 17,2 Fonseca-Moutinho, José Alberto (2011). „Smoking and Cervical Cancer“. ISRN Obstetrics and Gynecology (inglizcha). 2011-jild. 847684-bet. doi:10.5402/2011/847684. PMC 3140050. PMID 21785734.
  18. ↑ Xi, Long Fu; Koutsky, Laura A.; Castle, Philip E.; Edelstein, Zoe R.; Meyers, Craig; Ho, Jesse; Schiffman, Mark (December 2009). „Relationship between cigarette smoking and human papillomavirus type 16 and 18 DNA load“. Cancer Epidemiology, Biomarkers & Prevention (inglizcha). 18-jild, № 12. 3490–6-bet. doi:10.1158/1055-9965.EPI-09-0763. ISSN 1055-9965. PMC 2920639. PMID 19959700.
  19. ↑ Madeleine, Margaret M.; Daling, Janet R.; Schwartz, Stephen M.; Carter, Joseph J.; Wipf, Gregory C.; Beckmann, Anna Marie; McKnight, Barbara; Kurman, Robert J.; Hagensee, Michael E. (1997-10-15). „Cofactors With Human Papillomavirus in a Population-Based Study of Vulvar Cancer“. JNCI: Journal of the National Cancer Institute (inglizcha). 89-jild, № 20. 1516–1523-bet. doi:10.1093/jnci/89.20.1516. ISSN 0027-8874. PMID 9337348.
  20. ↑ Mm, Madeleine; Jr, Daling; Jj, Carter; Gc, Wipf; Sm, Schwartz; B, McKnight; Rj, Kurman; Am, Beckmann; Me, Hagensee (1997-10-15). „Cofactors with human papillomavirus in a population-based study of vulvar cancer“. Journal of the National Cancer Institute (inglizcha). 89-jild, № 20. 1516–23-bet. doi:10.1093/jnci/89.20.1516. PMID 9337348.
  21. ↑ 21,0 21,1 „Risk Factors for Vaginal Cancer“ (en). www.cancer.org. Qaraldi: 2020-yil 2-dekabr.
  22. ↑ 22,0 22,1 S, Gurunath; Z, Pandian; Ra, Anderson; S, Bhattacharya (September 2011). „Defining infertility--a systematic review of prevalence studies“. Human Reproduction Update (inglizcha). 17-jild, № 5. 575–88-bet. doi:10.1093/humupd/dmr015. PMID 21493634.
  23. ↑ 23,0 23,1 Lundberg, Frida E.; Iliadou, Anastasia N.; Rodriguez-Wallberg, Kenny; Gemzell-Danielsson, Kristina; Johansson, Anna L. V. (2019). „The risk of breast and gynecological cancer in women with a diagnosis of infertility: a nationwide population-based study“. European Journal of Epidemiology (inglizcha). 34-jild, № 5. 499–507-bet. doi:10.1007/s10654-018-0474-9. PMC 6456460. PMID 30623293.
  24. ↑ Funston, Garth; O'Flynn, Helena; Ryan, Neil A. J.; Hamilton, Willie; Crosbie, Emma J. (2018-04-01). „Recognizing Gynecological Cancer in Primary Care: Risk Factors, Red Flags, and Referrals“. Advances in Therapy (inglizcha). 35-jild, № 4. 577–589-bet. doi:10.1007/s12325-018-0683-3. ISSN 1865-8652. PMC 5910472. PMID 29516408.
  25. ↑ Kaltenecker, Brian; Tikaria, Richa (2020), „Vaginal Cancer“, StatPearls, Treasure Island (FL): StatPearls Publishing, PMID 32644552, qaraldi: 2020-11-20
  26. ↑ PDQ Adult Treatment Editorial Board (2002), „Vaginal Cancer Treatment (PDQ®): Patient Version“, PDQ Cancer Information Summaries, Bethesda (MD): National Cancer Institute (US), PMID 26389348, qaraldi: 2020-11-20
  27. ↑ Ghurani, Giselle B.; Penalver, Manuel A. (2001-08-01). „An update on vulvar cancer“. American Journal of Obstetrics and Gynecology (inglizcha). 185-jild, № 2. 294–299-bet. doi:10.1067/mob.2001.117401. ISSN 0002-9378. PMID 11518882.
  28. ↑ Alkatout, Ibrahim; Schubert, Melanie; Garbrecht, Nele; Weigel, Marion Tina; Jonat, Walter; Mundhenke, Christoph; Günther, Veronika (2015-03-20). „Vulvar cancer: epidemiology, clinical presentation, and management options“. International Journal of Women's Health. 7-jild. 305–313-bet. doi:10.2147/IJWH.S68979. ISSN 1179-1411. PMC 4374790. PMID 25848321.
  29. ↑ 29,0 29,1 Chandra, Ashwin; Pius, Cima; Nabeel, Madiha; Nair, Maya; Vishwanatha, Jamboor K.; Ahmad, Sarfraz; Basha, Riyaz (2019-09-27). „Ovarian cancer: Current status and strategies for improving therapeutic outcomes“. Cancer Medicine. 8-jild, № 16. 7018–7031-bet. doi:10.1002/cam4.2560. ISSN 2045-7634. PMC 6853829. PMID 31560828.
  30. ↑ 30,0 30,1 Cortez, Alexander J.; Tudrej, Patrycja; Kujawa, Katarzyna A.; Lisowska, Katarzyna M. (2018). „Advances in ovarian cancer therapy“. Cancer Chemotherapy and Pharmacology. 81-jild, № 1. 17–38-bet. doi:10.1007/s00280-017-3501-8. ISSN 0344-5704. PMC 5754410. PMID 29249039.
  31. ↑ 31,0 31,1 31,2 Schorge, John O; McCann, Christopher; Del Carmen, Marcela G (2010). „Surgical Debulking of Ovarian Cancer: What Difference Does It Make?“. Reviews in Obstetrics and Gynecology. 3-jild, № 3. 111–117-bet. ISSN 1941-2797. PMC 3046749. PMID 21364862.
  32. ↑ 32,0 32,1 Tangjitgamol, Siriwan; Manusirivithaya, Sumonmal; Laopaiboon, Malinee; Lumbiganon, Pisake; Bryant, Andrew (2013-04-30). Tangjitgamol, Siriwan (muh.). „Interval debulking surgery for advanced epithelial ovarian cancer“. The Cochrane Database of Systematic Reviews. 4-jild, № 4. CD006014-bet. doi:10.1002/14651858.CD006014.pub6. ISSN 1469-493X. PMC 4161115. PMID 23633332.
  33. ↑ Creasman, W. T. (December 1994). „Second-look laparotomy in ovarian cancer“. Gynecologic Oncology. 55-jild, № 3 Pt 2. S122–127-bet. doi:10.1006/gyno.1994.1350. ISSN 0090-8258. PMID 7835795.
  34. ↑ 34,0 34,1 Tomao, Federica; Di Pinto, Anna; Sassu, Carolina Maria; Bardhi, Erlisa; Di Donato, Violante; Muzii, Ludovico; Petrella, Maria Cristina; Peccatori, Fedro Alessandro; Panici, Pierluigi Benedetti (2018-12-06). „Fertility preservation in ovarian tumours“. ecancermedicalscience. 12-jild. 885-bet. doi:10.3332/ecancer.2018.885. ISSN 1754-6605. PMC 6345054. PMID 30679952.
  35. ↑ 35,0 35,1 Šarenac, Tanja; Mikov, Momir (2019-06-04). „Cervical Cancer, Different Treatments and Importance of Bile Acids as Therapeutic Agents in This Disease“. Frontiers in Pharmacology. 10-jild. 484-bet. doi:10.3389/fphar.2019.00484. ISSN 1663-9812. PMC 6558109. PMID 31214018.
  36. ↑ Emons, G.; Mallmann, P. (March 2014). „Recommendations for the Diagnosis and Treatment of Endometrial Cancer, Update 2013“. Geburtshilfe und Frauenheilkunde. 74-jild, № 3. 244–247-bet. doi:10.1055/s-0034-1368268. ISSN 0016-5751. PMC 4812876. PMID 27065482.
  37. ↑ 37,0 37,1 Denschlag, Dominik; Ulrich, Uwe; Emons, Günter (August 2011). „The Diagnosis and Treatment of Endometrial Cancer“. Deutsches Ärzteblatt International. 108-jild, № 34–35. 571–577-bet. doi:10.3238/arztebl.2011.0571. ISSN 1866-0452. PMC 3167060. PMID 21904591.
  38. ↑ 38,0 38,1 38,2 38,3 Sznurkowski, Jacek Jan (July 2016). „Vulvar cancer: initial management and systematic review of literature on currently applied treatment approaches“. European Journal of Cancer Care. 25-jild, № 4. 638–646-bet. doi:10.1111/ecc.12455. ISSN 1365-2354. PMID 26880231.
  39. ↑ 39,0 39,1 39,2 39,3 39,4 PDQ Adult Treatment Editorial Board (2002), „Vaginal Cancer Treatment (PDQ®): Health Professional Version“, PDQ Cancer Information Summaries, Bethesda (MD): National Cancer Institute (US), PMID 26389242, qaraldi: 2020-12-04
  40. ↑ 40,0 40,1 40,2 Abbott-Anderson, Kristen; Kwekkeboom, Kristine L. (March 2012). „A systematic review of sexual concerns reported by gynecological cancer survivors“. Gynecologic Oncology. 124-jild, № 3. 477–489-bet. doi:10.1016/j.ygyno.2011.11.030. ISSN 1095-6859. PMID 22134375.
  41. ↑ Iżycki, Dariusz; Woźniak, Katarzyna; Iżycka, Natalia (June 2016). „Consequences of gynecological cancer in patients and their partners from the sexual and psychological perspective“. Przegla̜d Menopauzalny = Menopause Review. 15-jild, № 2. 112–116-bet. doi:10.5114/pm.2016.61194. ISSN 1643-8876. PMC 4993986. PMID 27582686. 
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