Gynecologic Cancers
Facts about Gynaecological Cancers
Gynaecological cancers include cancer of the uterus, ovaries, cervix, vagina, vulva and Fallopian tubes.
Widespread screening with the Pap test has allowed doctors to find pre-cancerous changes in the cervix and vagina. This has helped prevent the development of some invasive cancers.
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Risk Factors for Gynaecological Cancers
While all women are at risk for gynaecological cancers, some factors can increase a woman's chances of developing the disease.
- Uterine cancer: Never pregnant, beginning menstruation early, late menopause, diabetes, use of oestrogen alone (called unopposed oestrogen) for hormone replacement therapy, family history of uterine cancer, high blood pressure and complex atypical hyperplasia. Tamoxifen, a drug frequently used to treat breast cancer, increases the risk of uterine cancer slightly. A genetic syndrome called hereditary nonpolyposis colon cancer (HNPCC) may also increase a woman's risk.
- Cervical cancer: Strongly associated with sexually transmitted diseases, especially several strains of human papilloma virus (HPV), sexual activity at an early age, multiple sexual partners, smoking and obesity.
- Ovarian cancer: Obesity, never pregnant, unopposed oestrogen, personal or family history of breast or ovarian cancer, genetic mutations in the BRCA1 or BRCA2 gene, HNPCC.
- Vaginal cancer: History of genital warts or an abnormal Pap test. There is an increased risk of clear cell carcinoma in women whose mothers took the drug diethylstilbestrol (DES) while pregnant. Women previously treated for carcinoma in-situ or invasive cervical cancer also have a higher risk of developing vaginal cancer.
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Signs and Symptoms of Gynaecological Cancers
There are often no outward signs of gynaecological cancers. However, some common symptoms include:
- Unusual bleeding, such as postmenopausal bleeding, bleeding after intercourse or bleeding between periods.
- A sore in the genital area that doesn't heal or chronic itching of the vulva.
- Pain or pressure in the pelvis.
- Persistent vaginal discharge.
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Screening for Gynaecological Cancers
Gynaecological cancers are often detected through a series of screening examinations.
- Your doctor will first perform a pelvic examination to evaluate your vulva, vagina, cervix, uterus, Fallopian tubes, ovaries and rectum.
- During the pelvic examination, your doctor will gently scrape some cells from the cervix and vagina to examine under a microscope. This is called a Pap test.
- If the Pap test is abnormal, your doctor may perform a test called a colposcopy to closely examine the cervix. Scraping cells from the cervical canal (endocervical curettage) may also be necessary.
- A small sample of tissue may be taken from any suspicious area. This test is called a biopsy.
- Occasionally, doctors need to examine a larger sample of cervical tissue. It is obtained during a procedure called conization or cone biopsy.
- In some situations, your doctor may recommend an examination under anaesthesia to better evaluate the extent of a cancer. Tests requiring anaesthesia include examination of the bladder (cystoscopy) and rectum (sigmoidoscopy).
- Abnormal uterine bleeding, a common symptom of uterine cancer, is usually evaluated by performing a dilatation and curettage, also called a D and C.
- Your doctor may also ask for MRI, CT, PET or ultrasound scans of the abdomen and pelvis to better evaluate areas that cannot be directly viewed, such as the ovaries.
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Treatment Options for Gynaecological Cancers
Treatment for gynaecological cancers depends on several factors, including the type of cancer, its extent (stage), its location and your overall health. It is important to talk with several cancer specialists before deciding on the best treatment for you, your cancer and your lifestyle.
- A gynaecologic oncologist is a doctor who specialises in surgically removing gynaecological cancers.
- A radiation oncologist is a doctor specially trained to treat cancer with radiation therapy.
- A medical oncologist is a doctor who specialises in treating cancer with drugs (chemotherapy).
Sometimes, your cancer may be cured by using only one type of treatment. In other cases, your cancer may be best cured using a combination of surgery, radiation therapy and chemotherapy.
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Understanding Radiation Therapy
Radiation therapy, sometimes called radiotherapy, is the careful use of radiation to safely and effectively treat cancer.
- Radiation oncologists use radiation therapy to aim to cure cancer, to control cancer growth or to relieve symptoms, such as pain.
- Radiation therapy works within cancer cells by damaging their ability to multiply. When these cells die, the body naturally eliminates them.
- Healthy tissues are also affected by radiation, but they are able to repair themselves in a way cancer cells cannot.
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External Beam Radiation Therapy
External beam radiation therapy involves a series of daily outpatient treatments to accurately deliver radiation to the cancer. Each treatment is painless and is similar to getting an X-ray. They are often given in a series of daily sessions, each taking less than half an hour, Monday to Friday, for five to six weeks. In some cases, you may receive more than one treatment in a day, often several hours apart.
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Brachytherapy
Brachytherapy (also called internal or intracavitary radiotherapy) involves placing radioactive sources in or next to the cancer. This is usually done at the same time or after external beam radiation therapy. Brachytherapy is very important in the treatment of vaginal, cervical and uterine cancers.
There are two main types of brachytherapy:
- Low-dose rate brachytherapy is delivered over the course of 48 to 72 hours. You will be admitted into the hospital to receive this treatment.
- High-dose rate brachytherapy is given over the course of several minutes, but the entire procedure typically takes a few hours. You may be able to go home immediately after this treatment.
- Depending of the type of cancer you have, you may need to have several sessions of brachytherapy to cure your cancer.
- Our Radiation Oncologists work with doctors at other centres to arrange brachytherapy.
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Potential Side Effects
The side effects you may experience will depend on the area being treated, the type of radiation used and whether or not you also received chemotherapy. Before treatment, your doctor will describe what you can expect.
- Some patients experience minor or no side effects and can continue their normal routines.
- Some patients may notice fatigue, skin irritation, vaginal irritation, frequent urination, burning with urination and/or diarrhoea. These will all resolve after treatment ends.
- Some patients will have sexual changes, such as changes in the vagina.
- If at any time you develop side effects, tell your doctor, radiation therapist or nurse. He or she can give you medicine to help.