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Why is the specialty of Gynecologic Oncology important?

Although gynecologic surgeries are routinely performed for non malignant causes, surgery in gynecological cancers is much more extensive and requires wide parametrial resection, lymph node dissection in the pelvis and para-aortic area and extrapelvic surgery especially in ovarian cancer.

Such extensive surgeries usually require additional training and experience compared to general gynecology. In addition, management of cancer today is a multimodality approach and integration of surgery with non surgical treatments such as chemotherapy and radiation therapy is essential to improve outcome.

Gynecological oncologists are best suited to this as they are focusing only on gynecological cancers. Results of management of gynecological malignancies are improved if they are managed by dedicated gynecologic oncologists as compared to general gynecologists.

How common are gynecological cancers?

Gynecological cancers are among the most important cancers of women. The cancers of the female genital tract include:

Cancer of uterine cervix

Endometrial cancer

Ovarian Cancer

Cancer of vulva

Intra-vesical (space in the urinary bladder)

Cancer of vagina

Other uncommon cancers

The extent of gynecological cancers in India is as follows:-

Cervical cancer: 30 per 100,000 women/year

Endometrial cancer: 2 per 100,000 women/year

Ovarian cancer: 4.7 to 8.7 per 100,000 women/year

What is cancer of the uterine cervix?

Uterus consists of two portions: upper portion called the body and the lower portion called the cervix. Cancer of the lower portion of the uterus (also known in popular parlance as the mouth of the womb) is called cancer of the uterine cervix. As mentioned above, it is the commonest cancer of women in India. Internationally, the incidence of cancer of the cervix is lower as the disease is preventable by screening.

What causes cancer of the cervix?

Cancer of the cervix is related to sexual activity. It is caused by a virus infection called the human papilloma virus. The virus is transmitted by sexual activity. Infection by this virus does not cause any symptoms but increases the risk of cancer of the cervix. The risk factors for cancer of the cervix include

Early marriage

Multiple sexual partners in women and their partners

Multiple pregnancies

Poor sexual hygiene in both men and women

How can cancer of the cervix be prevented or diagnosed at an early stage?

Cancer of the cervix is preventable because there is a long pre-cancerous phase and treatment at this stage prevents the development of actual cancer. The detection of this precancerous stage is simple by doing a test called the Pap smear. Pap smear examines the cells present in the vaginal secretions or scraped from the cervix and if any abnormal cells are found, the woman is investigated further with a biopsy or colposcopy. Simple treatment (cone biopsy of the cervix, cryotherapy, laser, etc.) at this stage controls the pre-cancerous stage and avoids the development of cancer.

For this approach to be effective, all women should undergo the Pap test regularly. The Pap test is very simple and cheap. It is started at yearly intervals and if found to be normal for three years, the interval can be increased to three years. If pap smear is done according to recommended criteria, we can stop doing pap smears at age of 65 years.

What are common symptoms of cancer of the cervix?

Cancer of the cervix has two common symptoms:

Dirty or foul smelling vaginal discharge.

Bleeding per vaginum after intercourse.

Irregular bleeding (Between menstrual cycle).

Post menopanial Bleeding per vaginum.

How is cancer of the cervix treated?

Cancer of the cervix can be treated with surgery or radiation therapy in early stages. In advanced stages, by radiotherapy with chemotherapy the patient is treated. Surgery for cancer of the cervix is called Radical hysterectomy (Commonly known as Wertheim's Hystrectomy) which is type III hystrectomy where not only uterus and cervix is removed but Paramethnum, vaginal culf and Bilat Pelvic Lymph node dissection done.

What are the symptoms of cancer of endometrium?

Cancer of the endometrium usually presents with abnormal bleeding per vagina. Bleeding can be seen between menstrual cycles or in post-menopausal Bleeding. For diagnosis D& C is done. Treatment is mainly Surgical that is Type II Hystrectomy where apart from uterus and cervix small vaginal culf with Bilat Pelvic Lymph node is disjected. In advanced stage Radiotherapy is added and leads to high success rate.

Women are at high risk under the following circumstances:-

Family history of cancer in breast, ovary, colon and endometrium.

Post menopausal, obese, diabetic women with bleeding per vagina.

Periomenopausal irregular bleeding per vagina.

What are the symptoms of cancer of the ovary?

Cancer of the ovary does not cause symptoms in the early stages. Early ovarian cancer is usually diagnosed due to the finding of a ovarian mass on ultrasound examination. Whenever an ovarian mass is found, cancer of the ovary should be suspected and ruled out by further assessment.

Advanced ovarian cancer leads to formation of fluid in the abdomen (ascites) that leads to abdomen becoming distended with a feeling of fullness. In these cases, chemotherapy in combination with aggressive surgery can lead to a good outcome.

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