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Gynecologic cancer comes with the medical condition in which cancer or tumor cells develop in the reproductive organs of a woman’s body. Cancer is always named according to the part of the body where it starts.

Types

➤ Cervical Cancer is the most common gynecological cancer in developing countries like Nepal. It starts growing in the cervix which is the lower part of the uterus.

➤ Ovarian cancer grows in the ovaries or fallopian tubes which are located on both sides of the uterus.

➤ Uterine cancer involves uterine muscles and endometrium. The tumor of uterine muscle is called sarcoma and that of endometrium is called endometrial carcinoma. The uterus is the pear-shaped organ where the baby grows during pregnancy.

➤ Vaginal cancer involves the vagina, which is the hollow tube-like structure

➤ Vulvar cancer begins in the vulva, the outer part of the female genital organs.

➤ Gestational trophoblastic Neoplasia: It involves mostly the uterus and infrequently ovaries.

Symptoms

➤ Abnormal vaginal bleeding or discharge is common in all types of gynecologic cancers except vulvar cancer.

➤ Abdominal fullness, gastritis-like symptoms, and lower abdominal or back pain are commonly seen in ovarian cancer though most of the cases are asymptomatic in the early stages.

➤ Abnormal uterine bleeding like excessive, irregular bleeding and lower abdominal pain is common for uterine cancers.

➤ Increased frequency or urgency to urinate and constipation are common for ovarian and vaginal cancers.

➤ Vulvar Itching, burning, pain, and changes in the color of overlying skin are found only in vulvar cancer.

Diagnosis

Diagnosis of cancer requires a thorough history, clinical examination, and relevant investigations to reach to a conclusion.

At PCH, we have the following modalities to suspect and diagnose the cases:

1. 1. History and Clinical Examination

   2. Imaging: Ultrasonography, CT scan, MRI, PET-CT for all kinds of gynecological cancer

   3. Colposcopy and biopsy for cervical cancer

   4. Endometrial biopsy for Endometrial cancer

   5. Tumor markers for diagnosis, prognosis, and follow-up in ovarian carcinoma

   6. IHC( Immunohistochemistry) as and whenever required to differentiate the type and origin of the tumor

   7. Diagnostic Laparoscopy in cases of doubtful ovarian malignancy

Treatment

Gynecologic cancers are treated in different ways. It depends on the type and stage of the cancer. At PCH we treat the disease following the most updated guidelines. Cases are discussed on the tumor board weekly and the best treatment modality is selected and individualized.

Treatment modalities are:

➤ Surgery: Generally cancer surgery is more radical and involves the removal of surrounding tissues and lymph nodes. The principle of surgery in oncology is to remove all visible diseases.

⮚ Cervical cancer: We perform Radical hysterectomy either open or laparoscopically.

⮚ Endometrial Cancer: Laparoscopic/Open Hysterectomy and bilateral salpingo-ophorectomy plus  pelvic and para-aortic lymphadenectomy and omentectomy

⮚ Ovarian Carcinoma: Staging Laparotomy or Debulking surgery

⮚ Vulvar Carcinoma: Radical vulvectomy and b/I inguinal lymphadenectomy +local flap reconstruction if required

⮚ Vaginal cancer: Vaginectomy

➤ Chemotherapy: In unresectable cases or advanced cases, chemotherapy is given as neoadjuvant therapy or palliative therapy. Chemotherapy drugs are used to shrink or kill cancer. The drugs can be pills or injectables. Chemotherapy in ovarian cancer is usually given as neo-adjuvant and adjuvant therapy. Gestational trophoblastic cancer responds very well to chemotherapy

➤ Radiation: It is the method in which high-energy rays are used to kill cancer. Mostly used in advanced cases of cervical cancer, vulvar cancer, and vaginal cancer.

➤ Immunotherapy and hormonal therapy.