Understanding Gynecologic Cancer
Gynecologic cancer encompasses malignancies affecting the female reproductive system, including the cervix, ovaries, uterus, fallopian tubes, vagina, and vulva.
Symptoms vary but may include abnormal bleeding, pelvic pain, and changes in bowel or bladder habits. Early detection through screenings and prompt treatment can improve outcomes.
This may include premature menopause care, management of effects of radiation chemotherapy or surgeries. Many patients need support and education about how cancer treatment has affected their sexual health.
Three types of Gynecologic Cancer
A Guide to Accompany You Through Your Treatment
Ovarian Cancer
In the female reproductive system, two ovaries lie on either side of the uterus. The fallopian tubes arise from the uterus and extend to the ovaries on both sides. The ovaries, small almond size structures, create eggs (ova) and the hormones estrogen and progesterone. Cells from either the fallopian tubes or the ovaries can grow and become cancerous. The term “ovarian cancer” is actually used to describe cancers that arise from both organs. The specific type of cancer varies, the most common type is “serous cancer” which often starts in the fallopian tube. Other less common types are mucinous, clear cell, endometrioid and germ cell or stromal cell types.
The main risk factors for ovarian cancer are:
genetic changes
A small percentage of ovarian cancers are caused by gene mutations, such as BRCA1 and BRC2, which increase the risk of ovarian cancer and also breast cancer.
family history
If any blood relatives have been diagnosed with ovarian cancer, you may have greater likelihood of developing the disease.
menstruation age
For menstruation onset at an early age, menopause onset at a later age, or both, there may be a greater risk of ovarian cancer.
being overweight or obese
The risk of ovarian cancer rises if overweight or obese.
no pregnancies
If you’ve never been pregnant, you may have an increased risk of ovarian cancer.
Ovarian cancer may not exhibit any symptoms in the early stages. As it develops, more symptoms may occur, such as bloating, weight loss, pelvic area pain, and back pain. It may also contribute to changes in bowel movements and increase the frequency of urination.
There have been many studies trying to find an accurate screening test for ovarian cancer. Unfortunately there is no proven screening test that can detect ovarian cancer at an early asymptomatic stage.
The following are exams and methods your doctor may use to determine whether or not you have ovarian cancer:
Pelvic exam
For a pelvic exam, your doctor examines the inside of your vagina while pressing the lower part of your belly to feel your pelvic organs.
Imaging tests
Some imaging tests, such as an ultrasound or CT scan may be ordered. Imaging tests may aid in determining the form and size of your ovaries.
Blood tests
Your doctor might test your blood for tumour markers that indicate ovarian cancer. For example, a cancer antigen (CA) 125 test can detect a protein that’s often found on the surface of ovarian cancer cells. These tests may provide clues about your diagnosis and prognosis.
Surgery
Surgery is the most common way that ovarian/fallopian tube cancer is both diagnosed and treated. This usually involves bilateral salpingo-oophorectomy and hysterectomy (removal of ovaries, fallopian tubes and uterus). The pathology report, which is a summary of the analysis of the organs removed at the time of surgery, makes the final diagnosis. The removal of cancerous tumours is an essential part of treatment.
Treatment for ovarian cancer depends on many factors, including the stage of your cancer, other health problems you may have, and your preferences. For treatment, you may undergo surgery, chemotherapy, or both. For early-stage ovarian cancer, treatment may be surgery alone. If it is suspected or proven that the cancer may have spread outside the fallopian tube or ovaries, then chemotherapy is recommended. Recent research has found that other medications besides chemotherapy, such as PARP inhibitors, can be very effective in treating ovarian cancer. Your oncology team will outline these for you.
Endometrial Cancer
Endometrial cancer (or uterine cancer) occurs in the layer of cells that line the uterus. The uterus is an avocado-shaped cavity where a fetus develops. Other cancer types can begin in the uterus, although they are rarer.
The main risk factors for endometrial cancer are:
An inherited colon cancer syndrome
Lynch syndrome, formally known as hereditary nonpolyposis colorectal cancer (HNPCC), increases the risk of colon cancer as well as other cancers, such as endometrial cancer. If you or a family member have been diagnosed with Lynch syndrome, ask your doctor what next steps you should take.
Changes in hormones
Estrogen and progesterone are the two main female hormones. Levels of these hormones fluctuate over time which changes the endometrium. A disorder that causes the body to produce more estrogen than progesterone leads to a greater risk of you developing endometrial cancer.
Years of Menstruation
Beginning menstruation at an early age (before age 12) or beginning menopause later raises the likelihood of developing endometrial cancer. In essence, the more periods you have had, the greater exposure your endometrium has had to estrogen.
No pregnancies
If you have never been pregnant, you have a greater risk of endometrial cancer.
Older age
As you age, your risk of developing endometrial cancer grows. Endometrial cancer most occurs after menopause onset.
Obesity
Your risk of endometrial cancer rises if you are overweight. A possible reason is that excess body fat interferes in hormone balance.
You can calculate your Body Mass Index here
Hormone therapy for breast cancer
If prescribed tamoxifen (breast cancer treatment), then discuss the risk of developing endometrial cancer with your doctor. Taking this drug can increase your risk.
Common signs and symptoms of endometrial cancer:
- Vaginal bleeding after menopause
- Bleeding between periods
- Increase or change in your period
- Pelvic pain
Endometrial cancer often consists of an early-stage diagnosis as it frequently presents symptoms of abnormal vaginal bleeding. Women with no symptoms do not commonly undergo routine screening; however, women with symptoms can have an ultrasound scan or endometrial biopsy. The ultrasound scan performed can be either a transvaginal scan, where the scan inserts into your vagina or an abdominal scan, where the scan moves over your stomach area. Endometrial biopsy is done by a doctor , its a specialized procedure to sample cells from the lining of the uterus
Some tests and procedures your doctor may perform to determine endometrial cancer:
Hysteroscopy
In some cases, your doctor may use an elastic, thin, and lighted hysteroscope to examine the inside of your uterus.
Tissue Sampling
This biopsy procedure consists of taking a small sample of tissue from the cells lining your uterus; it does not even require anesthesia.
Treatment for endometrial cancer depends on different factors, such as your cancer stage, other health problems you may have, and your preferences. For treatment, surgery, chemotherapy, radiotherapy, or a combination of the three can be employed.
For the surgery, you will undergo an operation to remove the uterus (hysterectomy), Fallopian tubes, and ovaries (salpingo-oophorectomy). After a hysterectomy, you will be infertile. Also, the removal of the ovaries will generate the onset of menopause.
Radiotherapy utilizes high power energy beams to destroy cancer cells. Radiotherapy can occur before or after surgery. If unable to undergo surgery, the doctor may recommend radiation therapy as your sole treatment.
Chemotherapy involves using chemicals to destroy cancer cells. You are prescribed either one or more chemotherapy drugs. These drugs can be taken orally (pills) or through your veins (intravenously). This method may be used before, after, and during the treatment plan.
Targeted therapy involves drugs that block specific weaknesses within cancer cells which causes them to die. This technique pairs well with chemotherapy to treat advanced endometrial cancer.
The specific treatment recommendations will be made by your gynecologist and oncology team
Cervical Cancer
Cervical cancer is a type of cancer that occurs in the lower part of the uterus that connects to the vagina, called the cervix.
The main risk factors for cervical cancer are:
Human papillomavirus (HPV)
HPV is a sexually transmitted infection and is one of the most relevant risk factors associated with cervical cancer. Usually, our body prevents the virus from doing harm, but in some people, it may survive for years. This results in changes to the cell which may develop cancer in the future. Factors which may increase your risk of contracting HPV include the number of sexual partners and age of initial sexual activity. You can reduce your risk of developing cervical cancer by having screening tests and receiving a vaccine that protects against HPV infection.
Smoking
There is a higher risk of developing a certain type of cervical cancer in people who smoke.
Early-stage cervical cancer produces no signs or symptoms. More advanced cervical cancer may result in vaginal bleeding after intercourse, between periods or after menopause. It may also present with pain during intercourse and/or watery, bloody vaginal discharge.
Routine Pap tests can detect precancerous conditions of the cervix. During a Pap test, your doctor obtains cells from your cervix, which are then examined under a microscope. Abnormal cells can be detected, and your doctor can advise you on treatment options according to the findings. In British Columbia, a new test has been implemented, using HPV testing from a self-collected vaginal swab as an alternative to traditional pap test. This is a very effective screening test, which removes the need for a doctors visit and a pelvic exam.
In case your doctor suspects of cervical cancer, an examination of your cervix will be required. A special instrument (called a colposcope) is used to check for abnormal cells, when your doctor takes a sample of tissue for biopsy. This may be done through a punch biopsy, where a tool pinches off small tissue samples, or an endocervical curettage, which uses another instrument to scrape tissue samples.
Treatment for cervical cancer depends on several factors, such as the stage of the cancer, other health problems you may have and your preferences. Surgery, radiation, chemotherapy, or a combination of the three may be used. Early-stage cervical cancer is typically treated with surgery. A broad spectrum of diverse types of surgery may be performed depending on your cancer stage. This may include simpler procedures such as removing only the region of the cancer to removing the entire uterus and nearby structures.
Radiation therapy may also be used as treatment for cervical cancer. It uses high-powered energy beams to kill cancer cells. It may be used as the primary treatment option or as enhancement treatment after surgery. Radiation therapy is often combined with chemotherapy as the primary treatment for locally advanced cervical cancers.
Chemotherapy is a drug treatment that uses chemicals to kill cancer cells. Other treatment options include targeted drug therapy, which blocks weaknesses in the cancer cells, and immunotherapy, which helps your immune system fight the cancer.
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Help women like you.
Hereditary Cancer Prevention
We serve patients with have inherited cancer predisposition gene mutations such as BRCA1, BRCA2, Lynch syndrome, RAD51C RAD51D, or PALB2. For these people, overall cancer risks can be higher than the general population and specific screening or preventative surgeries are recommended.
Gynecologic Cancer Survivorship
For people that have had a diagnosis of cervical, uterine or ovarian cancer in the past, the physical and emotional impact of cancer diagnosis and treatment can be long-lasting. We provide survivorship care after discharge from active treatment by helping patients with the long term side effects of cancer.
Premature Menopause
Menopause usually happens around 51 years of age. For our patients, many will have had early menopause because of preventative surgeries or cancer treatment. This may be temporary or permanent depending on your age, the type of drugs administered, the dose of drugs and the length of treatment.