Preventive measures of Gynecological Cancers:

• Screening tests for cervical cancers
• HPV Vaccination
• Healthy diet to maintain a normal BMI
• Regular exercise
• Avoid smoking

There are following types of Gynecologic Cancers:

• Cervical Cancer : Cervical cancer begins in the cervix. The cervix is the lower, narrow end of the uterus.
• Ovarian Cancer : It begins in the ovaries, which are located on each side of the uterus.
• Uterine Cancer : Uterine cancer begins in the uterus, the pear-shaped organ in the pelvis.
• Vaginal Cancer : Vaginal cancer originates in the vagina, which is hollow, a tube-like channel between the bottom of a uterus and outside of the body.
• Vulvar cancer : occurs on the outer surface area of the female genitals

Symptoms of Gynecologic Cancer

• Abnormal vaginal bleeding — post coital, intermenstrual, post menopausal
• Abnormal vaginal discharge
• Pelvic pain or pressure
• Backache
• Abdominal pain/ bloating
• Itching or burning of the vulva
• Changes in vulva color or skin (rash, sores, warts, or ulcers)
• Increased urination, constipation, or diarrhea

Risk factors for Gynecologic Cancer

• Cervical Cancer : Young age at first intercourse (younger than 16 years), cigarette smoking, multiple sexual partners, high parity (high number of pregnancies), low socioeconomic status
• Ovarian cancer may arise because of low parity, infertility, PCOS, endometriosis, early menarche (early age for starting menses), late menopause, family history of breast or colon cancer.
• Uterine cancer risk factors are : Obesity, nulliparity, prior history of breast or ovarian cancer and related treatment, unopposed estrogen therapy.
• Vaginal cancer has been noticed mainly in women who were older than 70. Other reasons may be exposure to DES, HIV or HPV infection, vaginal adenosis or irritation.
• Vulvar cancer occurs in old age and risk factors are HPV and smoking.

Cervical Cancer:

Of all the gynaecological cancers, only cervical cancer has screening tests, that can find this cancer in pre cancerous stage, when treatment does not require removal of uterus and is most effective.

Screening tests for cervical cancer are:


• Pap test +/— HPV testing
• Colposcopy

Symptoms of cervical cancer can include:

• Bleeding between periods or after intercourse
• Pain during intercourse
• Longer or heavier periods than usual
• Unusual discharge from the vagina
• Vaginal bleeding after menopause

Symptoms of advanced cervical cancer can include:

• Leg pain or swelling of the legs
• Lower back pain
• Urinary complaints (difficulty in urination/ increased frequency)

Treatment:

• Radical Hysterectomy - Removal of uterus with cervix and a part of vagina including surrounding tissues (parametrium) with or without the removal of fallopian tubes and ovaries.
• Pelvic Lymph Node Dissection- Removal of lymph nodes over the pelvic vessels — for early stages of cervical cancer.
• Radiation Therapy & Chemotherapy - Radiation therapy with the combination of chemotherapy can be used for advanced cervical cancer.





Ovarian Cancer :      


There is no proven screening test for ovarian cancer, so it’s important that you let your doctor know if you notice any changes in the body.
Ultrasonography in combination with CA-125 and clinical examination must be used as screening tests annually in high risk patients (family history of endometrial, ovarian, breast and colon cancer)


Symptoms of ovarian cancer can include:


• Abdominal bloating/ distension
• Pain in lower abdomen
• Loss of appetite
• Feeling full quickly after eating
• Indigestion
• Urinary changes – needing to go more often or more urgently
• Changes in bowel habits, including constipation/ diarrhea
• Unexplained weight loss or weight gain
• Unexplained fatigue

Treatment:

• Treatment is planned according to the extent and stage of disease.
• In early stages : Hysterectomy with removal of bilateral tubes and ovaries, Pelvic + Para-aortic lymphadenectomy with omentectomy +/— chemotherapy is the treatment of choice for ovarian cancer
• Complete peritonectomy, lesser omentectomy, bowel resection with anastomosis, splenectomy, removal of hepatic metastasis are also done as a part of cytoreduction surgery (removal of all the visible tumor) for advanced ovarian cancer which can be followed by HIPEC for better results.





Uterine Cancer:


There is no proven screening test for uterine cancer, so it’s important that you let your doctor know if you notice any of the following symptoms.



Symptoms of uterine cancer include:


• Watery vaginal discharge
• Bleeding between periods or after menopause
• Heavy irregular periods
• Discomfort or pain in the abdomen

Treatment:

• In early stages: Hysterectomy with removal of bilateral tubes and ovaries with Pelvic and Para-aortic lymphadenectomy if required.
• This surgery can be done by opening the abdomen or by the minimally invasive methods like : laparoscopy/ robotic surgery.
• Sentinel lymph node mapping - In this method oncologist uses fluorescent imaging to identify potentially cancerous lymph nodes.
• Radiation therapy, Chemotherapy, and Immunotherapy can also be given in uterine cancer.
• In some cases, Hormone therapy also could be given.





Vaginal Cancer:


HPV can sometimes cause vaginal cancer, so as with cervical cancer, its recommended to get HPV testing and Vaccination against HPV.
Smoking also raises the risk of vaginal cancer.


Symptoms of vaginal cancer:


• Vaginal discharge
• Bleeding after intercourse
• Pain in the pelvic area
• A protruding mass from vagina
• Difficulty/increased frequency of urine, blood in urine.
• Difficulty in passing stools.

Treatment:

• Local excision — in very early cases especially in lower 1/3rd of vagina
• Vaginectomy , to completely or partially remove the vagina with or without lymph node dissection
• Radiation therapy
• Chemotherapy





Vulvar cancer:


Immunisation against HPV infection and quitting smoking can decrease the risk of vulvar cancer.



Symptoms of vulvar cancer:


• Itching/pain on the vulva
• Mass/growth over the vulva

Treatment:

• Wide local excision
• Radical vulvectomy - removal of the vulva with or without inguinofemoral lymph node dissection
• Radiation and Chemotherapy