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About Gynecological Cancers

What are gynecological cancers?

This site focuses on cancers of women. These cancers are collectively termed gynecological cancers. Amongst these are cervical cancers (cancer of the mouth of the womb), Ovarian cancers, uterine cancers (cancer of the uterine body or the lining of the womb also called endometrial cancer), vulval cancers (cancer of the skin that surrounds the outer part of the vagina, between a woman’s legs). Breast cancer does not fall in the purview of gynaecological cancers.

Who should manage gynecological cancers?

Internationally, gynaecological cancers are managed by gynaecological oncologists. This is also the trend in India at present. Gynaecologists who are trained extensively in cancer surgery and focus only on performing these surgeries on a daily basis should be the persons (Gynecologic Ocologist Kolkata) who should treat these cancers. Most often these surgeries are extensive and require careful prior planning. All cancers require a multidisciplinary approach and radiation oncologists (also called clinical oncologists) and medical oncologists are involved in decision making and management of patients.

Treatment decisions are often taken through Tumour Boards comprising a multi-disciplinary approach and the best available evidence.

Reproductive Organs

The uterus is part of a woman’s reproductive system. It’s a hollow organ in the pelvis. The uterus has three parts:

  • Top: The top fundus of your uterus is shaped like a dome. From the top of your uterus, the fallopian tubes extend to the ovaries.
  • Middle: The middle part of your uterus is the body (corpus). This is where a baby grows.
  • Bottom: The narrow, lower part of your uterus is the cervix. The cervix is a passageway to the vagina.

The wall of the uterus has two layers of tissue:

  • Inner layer: The inner layer (lining) of the uterus is the endometrium..
  • Outer layer: The outer layer of muscle tissue is the myometrium.

Reproductive organs imageOvaries: These are 2 in number and placed on either side of the uterus, held in place by various ligaments. They release eggs every month which are carried through into the uterine cavity through the Fallopian Tubes.

Fallopian tubes are hollow structures, 2 in number, and lie in close proximity to the uterus.

Cervical Cancers

In India, Cervical Cancer is one of the commonest cancers in women of the reproductive age group. About 122000 new cases are detected every year and 67000 will die from the disease! In India every 7 minutes there is 1 death from cervical cancer. The commonest age group is 45 – 55 yrs.

Cervical cancer is the only cancer which is caused by an infective agent – Human Papilloma Virus. There is almost a 100% association of cancer causing HPV with cervical cancer, which means that cervical cancer will not be caused in the absence of HPV infection. Of the various types of HPV, types 16, 18, 31, 33 and 45 commonly cause cervical cancer. This infection is acquired sexually but may not require the actual act of coitus to contract this infection – as it can be transmitted by hand to genital touch. Condoms are known to reduce but not eliminate the risk of cervical cancer.

HPV infection is very common and about 1 in 5 women will have HPV. However, most women manage to get rid of the HPV on their own. It is in those that HPV persists, changes in the cervical cells take place and may slowly over a period of 15 – 20 years convert into cancer.

HPV infection does not produce any symptoms. Cervical cancer however may lead to foul-smelling vaginal discharge, bleeding after intercourse or bleeding after menopause.

Cervical cancer is staged clinically. There are 4 stages I to IV. Stage I upto IIA is early stage and surgery is often an option. Late stage is requires Radiotherapy while if there is spread of cancer to liver, lungs etc – Stage IVB – chemotherapy may be required.

Treatment decisions are often taken through a Tumour Board. The success and completeness of surgery depends on whether a trained gynaecological oncologist undertakes the surgery. The surgery does not involve a simple removal of the uterus – it requires removal of tissue on either side of the cervix (called parametrium) and a thorough removal of pelvic lymph glands. This entire procedure is called a Radical Hysterectomy with pelvic node dissection. The ovaries may or may not be removed.

Ovarian Cancers

Ovarian Cancer is the 4th commonest cancer in women in India, though world wide it ranks 7th. Ovarian cancer is a growth of abnormal malignant cells that begins in the ovaries or fallopian tubes. Malignant cancer cells in the ovaries can spread in two ways:  directly to other organs in the pelvis and abdomen (the more common way), through the bloodstream or lymph nodes to other parts of the body.

Types of ovarian cancer

The type of cell where the cancer begins determines the type of ovarian cancer you have. Ovarian cancer types include:

  • Cancer that begins in the cells on the outside of the ovaries. Called epithelial tumors, these cancers begin in the thin layer of tissue that covers the outside of the ovaries. Most ovarian cancers are epithelial tumors.
  • Cancer that begins in the egg-producing cells. Called germ cell tumors, these ovarian cancers tend to occur in younger women.
  • Cancer that begins in the hormone-producing cells. These cancers, called stromal tumors, begin in the ovarian tissue that produces the hormones estrogen, progesterone and testosterone.

Risk Factors

While most women with ovarian cancer do not have any known risk factors, some do exist. If a woman has one or more risk factors, she will not necessarily develop ovarian cancer; however, her risk may be higher than the average woman’s.

Genetics

About 10 to 15 percent of women diagnosed with ovarian cancer have a hereditary tendency to develop the disease. The most significant risk factor for ovarian cancer is an inherited genetic mutation in one of two genes: breast cancer gene 1 (BRCA1) or breast cancer gene 2 (BRCA2).  These genes are responsible for about 5 to 10 percent of all ovarian cancers.

Since these genes are linked to both breast and ovarian cancer, women who have had breast cancer have an increased risk of ovarian cancer.

Another known genetic link to ovarian cancer is an inherited syndrome called hereditary nonpolyposis colorectal cancer (HNPCC or Lynch Syndrome). While HNPCC poses the greatest risk of colon cancer, women with HNPCC have about a 12 percent lifetime risk of developing ovarian cancer.
Women who have one first-degree relative with ovarian cancer but no known genetic mutation still have an increased risk of developing ovarian cancer.  The lifetime risk of a woman who has a first degree relative with ovarian cancer is five percent (the average woman’s lifetime risk is 1.4 percent).

Increasing Age
All women are at risk of developing ovarian cancer regardless of age; however, a woman’s risk is highest during her 60s and increases with age through her late 70s. The median age (at which half of all reported cases are older and half are younger) at diagnosis is 63.

Reproductive History and Infertility
Research suggests a relationship between the number of menstrual cycles in a woman’s lifetime and her risk of developing ovarian cancer. A woman is at an increased risk if she:

  • started menstruating at an early age (before 12),
  • has not given birth to any children,
  • had her first child after 30,
  • experienced menopause after 50,
  • has never taken oral contraceptives.

Infertility, regardless of whether or not a woman uses fertility drugs, also increases the risk of ovarian cancer.

Hormone Replacement Therapy
Doctors may prescribe hormone replacement therapy to alleviate symptoms associated with menopause. Hormone replacement therapy usually involves treatment with either estrogen alone (for women who have had a hysterectomy) or a combination of estrogen with progesterone or progestin (for women who have not had a hysterectomy).

Women who use menopausal hormone therapy are at an increased risk for ovarian cancer. Recent studies indicate that using a combination of estrogen and progestin for five or more years significantly increases the risk of ovarian cancer in women who have not had a hysterectomy. Ten or more years of estrogen use increases the risk of ovarian cancer in women who have had a hysterectomy.

Obesity
Various studies have found a link between obesity and ovarian cancer.

Diagnosing ovarian cancer

Tests and procedures used to diagnose ovarian cancer include:
Pelvic examination.

  • Ultrasound. Ultrasound uses high-frequency sound waves to produce images of the inside of the body. An ultrasound helps your doctor investigate the size, shape and configuration of your ovaries.

To create a picture of your ovaries, your doctor may insert an ultrasound probe into your vagina. This procedure is called transvaginal ultrasound. Ultrasound imaging can create pictures of the structures near your ovaries, such as your uterus.

  • Surgery to remove samples of tissue for testing. If other tests suggest you may have ovarian cancer, your doctor may recommend surgery to confirm the diagnosis.

During surgery, a gynecologic oncologist makes an incision in your abdomen to explore your abdominal cavity and determine whether cancer is present. In some cases, the surgeon may use several small incisions and insert special surgical tools to perform minimally invasive surgery or robotic surgery.

The surgeon may collect samples of abdominal fluid and remove an ovary or other tissue for examination by a pathologist. If cancer is discovered, the surgeon may immediately begin surgery to remove as much of the cancer as possible.

  • CA 125 blood test. CA 125 is a protein found on the surface of ovarian cancer cells and some healthy tissue. Many women with ovarian cancer have abnormally high levels of CA 125 in their blood. However, a number of noncancerous conditions also cause elevated CA 125 levels, and many women with early-stage ovarian cancer have normal CA 125 levels. For this reason, a CA 125 test isn't usually used to diagnose or to screen for ovarian cancer, but it may be used after diagnosis to monitor how your treatment is progressing.
Doctors use the results of your surgery to help determine the extent — or stage — of your cancer. Your doctor may also use information from imaging tests, such as computerized tomography (CT). Your cancer's stage helps determine your prognosis and your treatment options.

Stages of ovarian cancer include:

  • Stage I Ovarian cancer is confined to one or both ovaries.
  • Stage II Ovarian cancer has spread to other locations in the pelvis, such as the uterus or fallopian tubes.
  • Stage III Ovarian cancer has spread beyond the pelvis or to the lymph nodes within the abdomen.
  • Stage IV Ovarian cancer has spread to organs beyond the abdomen, such as the liver or the lungs.
Treatment of ovarian cancer usually involves a combination of surgery and chemotherapy.

Surgery

Treatment for ovarian cancer usually involves an extensive operation that includes removing both ovaries, fallopian tubes, and the uterus as well as nearby lymph nodes and a fold of fatty abdominal tissue known as the omentum, where ovarian cancer often spreads. Your surgeon also removes as much cancer as possible from your abdomen (surgical debulking).
Less extensive surgery may be possible if your ovarian cancer was diagnosed at a very early stage. For women with stage I ovarian cancer, surgery may involve removing one ovary and its fallopian tube. This procedure may preserve the ability to have children.

Chemotherapy

After surgery, you'll most likely be treated with chemotherapy — drugs designed to kill any remaining cancer cells. Chemotherapy may also be used as the initial treatment in some women with advanced ovarian cancer. Chemotherapy drugs can be given in a vein (intravenously) or injected directly into the abdominal cavity, or both methods can be used. Chemotherapy drugs can be given alone or in combination.
Uterine Cancer (Endometrial Cancer)

Some factors which increase the chances of a woman having uterine cancer

We do know that some women are more likely than others to develop uterine cancer.

  • Abnormal overgrowth of the endometrium (endometrial hyperplasia): An abnormal increase in the number of cells in the lining of the uterus is a risk factor for uterine cancer. Hyperplasia is not cancer, but sometimes it develops into cancer. Common symptoms of this condition are heavy menstrual periods, bleeding between periods, and bleeding after menopause. Hyperplasia is most common after age 40.

    Obesity: Women who are obese have a greater chance of developing uterine cancer.
  • Reproductive and menstrual history: Women are at increased risk of uterine cancer if at least one of the following apply:
    • Have never had children
    • Had their first menstrual period before age 12
    • Went through menopause after age 55
  • History of taking estrogen alone: The risk of uterine cancer is higher among women who used estrogen alone (without progesterone) for menopausal hormone therapy for many years.
  • History of taking tamoxifen: Women who took the drug tamoxifen to prevent or treat breast cancer are at increased risk of uterine cancer.
  • History of having radiation therapy to the pelvis: Women who had radiation therapy to the pelvis are at increased risk of uterine cancer.
  • Family health history: Women with a mother, sister, or daughter with uterine cancer are at increased risk of developing the disease. Also, women in families that have an inherited form of colorectal cancer (known as Lynch syndrome) are at increased risk of uterine cancer.

Many women who get uterine cancer have none of these risk factors, and many women who have known risk factors don’t develop the disease.

Symptoms

The most common symptom of uterine cancer is abnormal vaginal bleeding. It may start as a watery, blood-streaked flow that gradually contains more blood. After menopause, any vaginal bleeding is abnormal.
These are common symptoms of uterine cancer:

  • Abnormal vaginal bleeding, spotting, or discharge
  • Pain or difficulty when emptying the bladder
  • Pain during sex
  • Pain in the pelvic area

These symptoms may be caused by uterine cancer or by other health problems. Women with these symptoms should tell their doctor so that any problem can be diagnosed and treated as early as possible.

Diagnosis

If you have symptoms that suggest uterine cancer, your doctor will try to find out what’s causing the problems.
You may have a physical exam and blood tests. Also, you may have one or more of the following tests:

  • Pelvic exam: Your doctor can check your uterus, vagina, and nearby tissues for any lumps or changes in shape or size.
  • Ultrasound: An ultrasound device uses sound waves that can’t be heard by humans. The sound waves make a pattern of echoes as they bounce off organs inside the pelvis. The echoes create a picture of your uterus and nearby tissues. The picture can show a uterine tumor. For a better view of the uterus, the device may be inserted into the vagina (transvaginal ultrasound).
  • Biopsy: The removal of tissue to look for cancer cells is a biopsy. A thin tube is inserted through the vagina into your uterus. Your doctor uses gentle scraping and suction to remove samples of tissue. A pathologist examines the tissue under a microscope to check for cancer cells. In most cases, a biopsy is the only sure way to tell whether cancer is present.

Grade

If cancer is found, the pathologist studies tissue samples from the uterus under a microscope to learn the grade of the tumor. The grade may suggest how fast the tumor is likely to grow.
Tumors with higher grades tend to grow faster than those with lower grades. Tumors with higher grades are also more likely to spread. Doctors use tumor grade along with other factors to suggest treatment options.

Staging

If uterine cancer is diagnosed, your doctor needs to learn the extent (stage) of the disease to help you choose the best treatment. The stage is based on whether the cancer has invaded nearby tissues or spread to other parts of the body. In most cases, surgery is needed to learn the stage of uterine cancer. The surgeon removes the uterus and may take tissue samples from the pelvis and abdomen. After the uterus is removed, it is checked to see how deeply the tumor has grown. Also, the other tissue samples are checked for cancer cells.
To learn whether uterine cancer has spread, your doctor may order one or more tests prior to surgery: like PAP test, Ca 125, Chest Xray, Ct scan or MRI
These are the stages of uterine cancer:

  • Stage I: The tumor has grown through the inner lining of the uterus to the endometrium. It may have invaded the myometrium.
  • Stage II: The tumor has invaded the cervix.
  • Stage III: The tumor has grown through the uterus to reach nearby tissues, such as the vagina or a lymph node.
  • Stage IV: The tumor has invaded the bladder or intestine. Or, cancer cells have spread to parts of the body far away from the uterus, such as the liver, lungs, or bones.

Treatment

Treatment options for people with uterine cancer are surgery, radiation therapy, chemotherapy, and hormone therapy. You may receive more than one type of treatment.
The treatment that’s right for you depends mainly on the following:

  • Whether the tumor has invaded the muscle layer of the uterus
  • Whether the tumor has invaded tissues outside the uterus
  • Whether the tumor has spread to other parts of the body
  • The grade of the tumor
  • Your age and general health

Your treatment will be planned by a team of specialists through a tumour board. Specialists who treat uterine cancer include gynecologic oncologists (doctors who specialize in treating female cancers), medical oncologists, and radiation oncologists. Your health care team can describe your treatment choices, the expected results of each, and the possible side effects. Because cancer therapy often damages healthy cells and tissues, side effects are common. Before treatment starts, ask your health care team about possible side effects and how treatment may change your normal activities. You and your health care team can work together to develop a treatment plan that meets your needs.

Vulval Cancers

Vulva is the skin that surrounds the outside of the vagina, between the legs of a woman.

Vulval cancer is rare. Vulval cancer is a disease that affects mostly elderly women and is uncommon below the age of 50 years.

Vulval cancers are sometimes diagnosed on examination during another procedure. Symptoms of vulval cancer include vulval itching, irritation or pain. Women may also notice a lump, bleeding or discharge. Any change in the vulval skin in a  woman  who is menopausal, requires a biopsy. Sometimes there may be an obvious swelling, a bleeding or a foul smelling ulcer or area of colour change (whitening or pigment deposition), or warts. Any woman who is not menopausal and has warts or other vulval signs should have a biopsy.

The treatment of vulval cancer is primarily by surgery. Staging is surgical–pathological and not clinical.

 

Consultation

AMRI Hospitals, Salt Lake

Saturday: 10 AM – 12 AM
Monday: 12 – 2 PM

AMRI Hospitals, Mukundapur

Saturday: 1PM – 3 PM
Monday: 3 PM – 5 PM

AMRI Medical Centre

Wednesday: 5PM – 6 PM
Friday: : By appointment only

Calcutta Medical Research Institute

Tuesday: 5 – 7 PM
Friday: : 5 – 7 PM

Saroj Gupta Cancer Centre and Research Institute

Wednesday, Thursday & Friday: – By prior appointment

Westbank Cancer Centre

Tuesday: 2 – 4 PM

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