What Women Should Know About Gynecologic Cancer

What are Gynecologic Cancers?

Gynecologic cancers are cancers arising from the organs of the female reproductive tract. These include the uterus, ovary, cervix, vulva and vagina.

It is estimated that every year in the US alone, nearly 90,000 women are diagnosed with gynecologic cancer and nearly 30,000 die from the disease. Although all women are at risk of developing gynecologic cancer, the risk increases with age.

It is important that every woman is aware and is able to recognize signs and symptoms which may be suggestive of gynecologic cancer and seek immediate medical advice for the same.

Like all cancers, early diagnosis and treatment offer a better chance of cure.

What are the Types of Gynecologic Cancers?

The five types of gynecologic cancer include the following:

1. Uterine or womb cancer – Arises from the lining of the uterus (endometrium), the pear shaped organ in which the baby grows.

2. Ovarian cancer – Begins in the ovaries, which are 2 in number and which are tiny almond shaped organs located on either side of the uterus.

3. Cervical cancer – It is also termed cancer cervix and is the lower part of the uterus.

4. Vaginal cancer – This cancer arises from the vagina, the hollow tubular organ that connects the cervix to the outside of the body. It is also referred to as the birth canal.

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5. Vulval cancer – The vulva forms part of the woman’s external genitalia and includes the inner and outer lips of the vagina, the clitoris, and the opening of the vagina and its glands.

What are the Risk Factors of Gynecological Cancer?

Cancer Type	Risk factors
Cervical cancer	Human Papilloma virus (HPV) infection Chlamydial infection Smoking Unprotected sex, early age of intercourse and/or giving birth Multiple childbirths, three or more Longterm oral contraceptive pill use Reduced immunity
Uterine cancer	Being obese or overweight Increasing age more than 50 years Difficulty in becoming pregnant Genetic factors (Lynch syndrome) Diabetes Estrogen hormone replacement therapy (HRT) for menopause Women with polycystic ovary syndrome (PCOS) Taking Tamoxifen, a drug used to treat breast cancer Oral contraceptive pill reduces the risk of uterine cancer
Ovarian cancer	Increasing age- middle aged or older Family history (presence of BRCA gene mutations, Lynch syndrome) History of breast, uterine or colorectal cancer History of infertility History of endometriosis Longterm use of estrogen alone (without combining progesterone) East European or Jewish ancestry Oral contraceptive pill reduces risk of ovarian cancer
Vulvar cancer	Smoking HPV infection History of cervical cancer or precancer Ongoing vulvar itching or burning
Vaginal cancer	Smoking HPV infection History of cervical cancer or precancer Reduced immunity

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What are the Common Symptoms of Gynecologic Cancer that Women Should Know About?

Cancer Type	Clinical features
Cervical cancer	Vaginal bleeding after sex Bleeding in between periods, or after menopause Abnormal foul smelling vaginal discharge Pain and discomfort during sex Back pain
Uterine cancer	Vaginal bleeding after menopause Bleeding in between periods in premenopausal women Abnormal bloodstained vaginal discharge Pelvic pain
Ovarian cancer	Abdominal distension and persistent bloated sensation Persistent abdominal and pelvic pain Abnormal vaginal bleeding or discharge Unable to eat, feeling nauseous, feeling full after small quantity of food Changes in bowel habits Frequent need to pass urine
Vulvar cancer	Raised lump on the vulva that may be painful, itchy or bleeding Persistent non-healing ulcer on the vulva Painful or thickened area on the vulva
Vaginal cancer	Vaginal bleeding after sex Abnormal bleeding in between periods or after menopause Raised lump on the vaginal skin Sore area on the vagina that may bleed on touch Frequent need to pass urine

What are the Ways to Prevent Gynecologic Cancer or Early Detection?

Cancer Type	Methods of Prevention
Cervical cancer	Protect form HPV infection by practising safe sex, limiting number of sexual partners Avoid intercourse at young age Quit smoking Regular followup with the gynecologist from 30 years until menopause to undergo Pap smear test that detects precancerous changes in the cervix and HPV infection HPV vaccine for all girls aged 9-11 years reduces risk of HPV associated cancer of cervix, vulva and vagina; if you are older consult your doctor for further advice
Uterine Cancer	There is no method known to prevent uterine cancer. However you can reduce your risk by the following measures:  Maintain a healthy body weight and be active Use birth control pills If you are taking estrogen alone, combine with progesterone Followup regularly with your doctor if you have a family history of uterine, ovarian or colon cancer
Ovarian Cancer	Seek immediate medical attention if –  You notice any signs or symptoms of breast cancer for at least two weeks You have a history of breast, uterine or colorectal cancer (high risk) A close relative like your mother or sister tests positive for BRCA mutation or had ovarian cancer (high risk) Your doctor may advise you to undergo tests such as rectal and vaginal examinations, transvaginal ultrasound and CA-125 blood test, all of which may aid in diagnosis of ovarian cancer. If you are a high risk person you will be advised regular followup to detect any abnormalities early and start treatment
Vulvar Cancer and Vaginal Cancer	Protect from HPV infection by practising safe sex, and limiting number of sexual partners HPV vaccine of all girls aged 9-11 years; if you are older consult your doctor for further advice Quit smoking

Tips to Take Charge of Your Health when You Have Gynecologic Cancer

The following measures will help to ensure that you receive optimal treatment associated with a better outcome and longterm prognosis.

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Ensuring Referral to a Gynecologic Oncologist

If a woman is suspected to have gynecologic cancer, she should immediately be referred to a gynecologic oncologist. A gynecologic oncologist is an obstetrician/gynecologist who has specialized in the diagnosis and treatment of cancers of the female reproductive system, such as cervical, ovarian, uterine, vaginal and vulvar cancers.

With a gynecologic oncologist, the woman and her family can be confident of receiving the most optimal treatment that includes performing accurate staging surgery, debulking surgery to remove tumors that have spread to the abdomen and pelvis, knowledge of administering chemotherapy and radiotherapy, taking into consideration the woman’s concerns on sexual life and childbearing, and her emotional and physical well-being.

Studies indicate that patients treated by gynecologic oncologists have a better outcome when compared to patients not treated by cancer specialists.

Addressing Concerns Regarding Fertility and Emotional Issues

The woman should feel free to discuss fertility preserving options, sperm banks, referral to reproductive endocrinologists, and adoption agencies.

The woman and her family should enquire about availability of a psychologist to address their emotional needs and spiritual support and resources available. Ask about availability of financial help if needed.

Choosing the Right Center for Treatment

When choosing the center to undergo treatment, it is essential to choose a hospital where specialist gynecologic oncologists and their team are available and the center handles a good volume of gynecologic cancer patients. The center should have facilities to address the emotional and mental issues of the patient and her family as well such as psychotherapy and counseling.

Knowing the Disease Stage

Staging systems are clinically used to assess the severity of an ongoing cancer and generally divided into four stages. The first stage refers to the early phases of the disease, when malignant cells occur in a relatively limited region and are easy to treat, while the fourth stage denotes a very advanced condition in which cancerous cells have spread to adjacent organs and tissues and are more challenging to treat.

The treatment modalities offered will vary depending on the stage of the cancer and the patient’s condition.

Knowing about Treatment Options Available

The various treatment options available include surgery chemotherapy, radiotherapy and immunotherapy. The ideal treatment options or treatment combinations will vary for each patient depending on the stage of the disease and other considerations. You should discuss with your doctor about the expected duration of treatment, and the possible side effects.

Surgery is done in early stages to remove the tumor and adjacent lymph nodes; in later stages, debulking surgery is performed to reduce tumor burden when cancer has spread to other organs and sites.

Chemotherapy involves administration of drugs that kill cancer cells. Chemotherapy may be given before or after surgery depending on each case. Chemotherapy is associated with side effects such as nausea, vomiting, hair loss, and decreased immunity with increased susceptibility to infections. Your doctor will discuss these with you.

Radiotherapy involves administration of radiation either externally (external radiotherapy), or internally called intracavitary brachytherapy/radiotherapy (administering radiation into the body cavity such as vagina). Brachytherapy or internal radiation therapy, enables giving a higher total dose of radiation to treat a smaller area and in a shorter time than is possible with external beam radiotherapy. In interstitial radiotherapy, radiation needles are placed directly into the cancer and surrounding tissues.

Latest modalities in gynecologic cancer treatment include immunotherapy where immunotherapeutic agents are given to activate the body’s immunity to fight the tumor; immunotherapy also works by reversing tumor immunosuppressive mechanisms that have enabled the tumor to escape - the tumors can then be overcome by the patient’s immune system.

Learning How the Prognosis or Outcome is Determined

The prognosis is determined by evaluating the results of various tests such as biopsies, ultrasounds or PET-CT scans that determine the size, extent, genetic makeup, degree of spread and the aggressiveness of the tumor. Other factors taken into consideration include the age, overall health condition and fitness of the patient.

Health Tips

• Be aware of and recognize symptoms and signs of gynecologic cancer and seek prompt medical attention
• Protect yourself from HPV infection by practising safe sex (using condoms) and limiting number of sexual partners
• Consult your gynecologist regarding HPV vaccine
• Get regular Pap smears if you are between the age of 21-65 years
• Maintain a healthy weight and exercise regularly
• Eat healthy and sleep well
• Avoid smoking
• If you have a family history of gynecologic cancer, consult a gynecologist to learn about precautions to take to prevent gynecologic cancer