Gynecologic Oncology

Gynecologic oncology is a specialized field of medicine that focuses on treatment for cancers of the ovaries, vagina, uterus, cervix, and vulva. A gynecologic oncologist cares for people who have these conditions, diagnosing their cancers and recommending the best treatment.

Gynecologic oncologists look for tumors in a person’s reproductive organs and determine if the disease has spread to other parts of the body, too. That helps them make sure a person gets timely and appropriate treatment for their condition.

Types of gynecologic cancers

Gynecologic cancers include:

Cervical cancer
Fallopian tube cancer
Gestational trophoblastic disease (GTD)
Primary peritoneal cancer
Ovarian cancer
Uterine cancer
Vaginal cancer
Vulvar cancer

Signs and symptoms of stage 1 cervical cancer can include :

Watery or bloody vaginal discharge that may be heavy and can have a foul odor.
Vaginal bleeding after intercourse, between menstrual periods or after menopause.
Menstrual periods may be heavier and last longer than normal.

If cancer has spread to nearby tissues or organs, symptoms may include:

Difficult or painful urination, sometimes with blood in urine.
Diarrhea, or pain or bleeding from your rectum when pooping.
Fatigue, loss of weight and appetite.
A general feeling of illness.
Dull backache or swelling in your legs.
Pelvic/abdominal pain.

Vaccination of Cervical Cancer

Cervical cancer, mainly caused by Human Papillomavirus infection, is the leading cancer in Indian women and the second most common cancer in women worldwide. Though there are several methods of prevention of cervical cancer, prevention by vaccination is emerging as the most effective option, with the availability of two vaccines. Several studies have been published examining the vaccine’s efficacy, immunogenicity and safety. Questions and controversy remain regarding mandatory vaccination, need for booster doses and cost-effectiveness, particularly in the Indian context.

Cervical cancer is the fifth most common cancer in humans, the second most common cancer in women worldwide and the most common cancer cause of death in the developing countries. Sexually transmitted human papilloma virus (HPV) infection is the most important risk factor for cervical intraepithelial neoplasia and invasive cervical cancer. The worldwide incidence of cervical cancer is approximately 510,000 new cases annually, with approximately 288,000 deaths worldwide. Unlike many other cancers, cervical cancer occurs early and strikes at the productive period of a woman’s life. The incidence rises in 30–34 years of age and peaks at 55–65 years, with a median age of 38 years (age 21–67 years). Estimates suggest that more than 80% of the sexually active women acquire genital HPV by 50 years of age. Hence, the advent of a vaccine against HPV has stirred much excitement as well as debate.

Management of Cervical / Ovarian & Endometrial Cancer

A complete physical examination is the first step in the evaluation of a woman with suspected endometrial cancer. Inspection of the external genitalia, bimanual and rectovaginal examination are essential. Palpation of the inguinal and supraclavicular nodes may reveal enlargement in cases of advanced disease.

An endometrial biopsy can be performed safely and easily in the office setting in most patients. The sensitivity for detecting endometrial carcinoma approaches that of a dilation and curettage (D&C) and avoids the expense and morbidity of an operative procedure. Occasionally, D&C is necessary when an in-office biopsy is not possible due to cervical stenosis or patient discomfort.

If endometrial cancer is confirmed, further studies are needed to optimize treatment planning, including a chest x-ray to rule out metastatic disease. Other studies may be performed based on a patient’s risk factors and typically include computed tomography (CT) scans of the abdomen and pelvis and serum cancer antigen 125 (CA 125).

Surgery
Standard staging surgery for endometrial cancer generally includes hysterectomy, bilateral salpingo-oophorectomy, pelvic and para-aortic lymph node assessment, and general abdominopelvic survey with biopsy of suspicious appearing lesions. Omentectomy may be performed for high-grade histologies. In most cases, staging surgery can be performed using minimally invasive surgery techniques.

In many cases, patients are at low risk of lymph node metastasis and full lymphadenectomy can be avoided to decrease surgical morbidity and postoperative lymphedema. Intraoperative assessment of tumor size, grade, and depth of invasion can be used to decide whether lymphadenectomy is indicated (Figure 1). Alternatively, for women without high-risk features and disease apparently limited to the uterus, sentinel node biopsy can be considered. Sentinel nodes are identified intraoperatively by tracers that are injected into the cervix and are thought to represent the first node or nodes to drain the uterus and cervix. Lymph node mapping is successful in 80% to 90% of patients and has demonstrated approximately 95% sensitivity.