Gynaecological cancers include uterine (endometrial) cancer, ovarian cancer, cervical cancer, vulvar cancer and vaginal cancer.
Endometrial cancer is the most common gynaecological cancer. It is the malignant neoplastic growth of the uterine lining. Most commonly seen in women > age 50 years out of which 75% occur in post- menopausal women. Risk factors include obesity, liver disease, diabetes, family history of uterine or ovarian cancer, early menarche and late menopause etc. It may present with Dyspareunia, low back pain, purulent genital discharge, dysuria, pelvic pain, weight loss and a change in bladder and bowel habits.
Cervical cancer is cancer of the uterine cervix. Approximately 570,000 cases occur worldwide each year with around 275,000 deaths attributable to it. It is the primary cancer killer of women worldwide. Cervical cancer starts with abnormal changes in the cellular lining of the cervix, typically in the squamous– columnar junction of the cervix. It may present with symptoms such as post-coital bleeding, foul vaginal discharge, abnormal bleeding, unilateral leg swelling or pain, pelvic mass, pelvic pain, gross cervical lesion or may be completely asymptomatic until advanced stages of the disease.
Ovarian cancer is cancer that forms in the tissue of the ovary and it is called “the overlooked disease” or “the silent killer”. Ovarian cancer is the second most common gynaecologic cancer after uterine cancer. It causes more deaths than any other gynaecologic cancer. Older women are at highest risk (frequently in women between 55 and 75 years of age). 75%will survive one year and about 25% will survive 5 years after treatment. Symptoms at presentation are vague like pelvic discomfort or pain, persistent indigestion, gas, or nausea, abdominal pressure, swelling, or bloating, unexplained weight loss or gain, urinary urgency or burning with no infection and changes in menstruation.
Vaginal cancer is malignant tissue growth arising in the vagina. It is rare, representing less than 3% of all genital cancers. This type of cancer usually occurs in women over age 50. Vaginal cancer can be effectively treated, and when found early it is often curable. The etiology of vaginal cancer however has not been identified. However, history of vaginal warts caused by Human Papilloma Virus (HPV), smoking, advancing age, cervical cancer and exposure to radiation have been implicated in causation.
Vulvar cancer is an abnormal neoplastic growth on the external female genitalia. It is responsible for 0.6% of all malignancies in women and 4% of all female genital cancers. It is the fourth most common gynaecologic cancer, after endometrial, ovarian, and cervical cancers and typically occurs in women between 30 and 40 years of age. Risk factors are similar to those of vaginal cancer with HPV playing a significant role.
Surgery with chemotherapy and radiotherapy is the mainstay of treatment for all gynaecologic cancers although specifics depend on the stage at presentation. While screening for ovarian, vulval and vaginal cancers is not available, prevention of cervical and endometrial cancers can be achieved through routine screening using Pap smear test. The long latent period of 10-15 years between cervical dysplasia which can be detected by Pap smear and invasive cancer allows for adequate treatment if screening is done in a timely fashion. Pap smears have proved successful in reducing the incidence of invasive cancer by 80% and the mortality by 70%. Pap smear screening should be started within 3 years of onset of sexual activity or by age of 21, whichever is first. Screening frequency is recommended at yearly until three consecutive normal pap smears, then frequency can be reduced to once every 2-3 years. Annual screening for high-risk women is highly recommended. Presence of malignant cells, inflammatory cells, bacteria etc. is duly noted and treatment provided accordingly.