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Management of Gynaecological cancers
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Management of Gynaecological cancers

Post by on Sunday, May 15, 2022

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As per Globocan 2012, there were 14.1 million cancer incidents, 8.2 million cancer deaths, and 32.6 million people living with cancer (within 5 years of diagnosis), with a known incidence of 1.1 million in 2015. However, this estimate is conservative, as the real rate is at least 1.5 to 2 times higher than noted in the literature. This is the lack of hospital-based and population-based cancer registries in India. India’s age-standardized cancer incidence, estimated at 150-200 per 100,000 population, is higher than in Africa and on par with China.

Breast and cervical cancers among women, and head and neck, lung and gastrointestinal cancers among men, represent more than 60% of the incidence burden. Now India has nearly touched three times the incidence of the US and China for head, neck, and cervical cancers. 

Gynaecological cancer refers to the five cancers that start in a woman's reproductive system. These include: 

• Cervical cancer 

• Endometrial or Uterine cancer 

• Ovarian cancer 

• Vaginal cancer 

• Vulval cancer 


Symptoms of Gynecological Cancers 

• Abnormal vaginal bleeding or discharge is a common symptom of all gynecologic cancers except vulvar cancer. 

• Early satiety, bloating, and abdominal or back pain are common symptoms limited to ovarian cancer. 

• Pelvic pain is joint for ovarian and uterine cancers. 

• Frequent or urgent need to urinate and constipation are common symptoms of ovarian, cervix and vaginal cancers. 

• Itching, pain, or tenderness of the vulva, and changes in vulva colour or skin, such as a rash, or warts, are found in vulvar cancer. 


What is possible to reduce risk? 

 I. HPV Vaccine: Cervix, vaginal, and vulvar cancers are caused due to human papillomavirus (HPV), a widespread sexually transmitted virus. The HPV vaccine protects against this HPV. HPV vaccination is recommended for girls aged 11 to 12 years but can be given starting at age 9. HPV vaccine also is recommended for all females till the age 26 years. A two-dose schedule is recommended if vaccination is started before age 15, with the doses given 6 to 12 months apart. Three doses of vaccine are required for people who start the series after their 15th birthday. A critical aspect of HPV vaccination is that it prevents new HPV infections but does not treat existing infections. That is why the HPV vaccine works best when given before any exposure to HPV. 


II. Screening is when an examination or test is used to look for disease even before there are any symptoms. On the other hand, diagnostic tests are used when a person has symptoms. Cancer screening is effective when it can find the disease early, leading to a more effective treatment. Pap test of all the gynecologic cancers, only cervical cancer has a screening test which is also called a Pap test. The Pap test helps prevent cervical cancer by finding pre-cancerous changes on the cervix that might become cervical cancer if not treated appropriately. HPV test - a test called the HPV test looks for HPV infection, which is a common cause of cervical cancer. It can screen women aged 30 years and older for cervical cancer. 


III. Recognize the warning signs:  Since there is no simple and reliable way to screen for any gynecologic cancers except cervical cancer, it is especially important to recognize warning signs and learn if there are things you can do to reduce your risk.

IV. Talk to the Doctor: If there is an increased risk, It is essential to learn about the family's health history of breast or ovarian cancer. The doctor may recommend genetic counselling and testing based on this. It is helpful for a small percentage of women who have a family history of these cancers.


Types of Treatment

Gynecologic cancers can be treated in one or several ways. It depends on the type of cancer and how far its spread has occurred. Treatment modalities may include surgery, chemotherapy, and radiation therapy. Women with gynecologic cancer often need more than one kind of treatment.


Surgery involves surgeons performing procedures to excise cancer tissue with wide margins in operation.  

Hysterectomy: A hysterectomy is the surgical removal of the uterus and cervix. Sometimes the fallopian tubes and ovaries are removed as well. In addition, the doctor may choose to remove pelvic lymph nodes near the uterus to determine if or where cancer has spread. The extent of surgery depends on how much cancer is present. A hysterectomy is usually done for cervical cancer that is stage IA2 and higher.

Hysterectomies can be done as:

?Open: During open surgery, an incision is made in the abdomen. Doing so exposes the organs so the surgeon can access them. The uterus and cervix are removed through the abdominal incision.

?Laparoscopic: Tubes are inserted into small incisions. Images from the laparoscope are viewed on a special monitor. Healing and recovery time for laparoscopic surgery is generally faster than for open surgery.

?Robotic-assisted: Robotic arms are inserted through small incisions. This allows for a greater range of movement than a doctor's hand.

In addition, a hysterectomy can be done through the vagina. During a vaginal approach, no external incision is needed. The vagina is kept open by special instruments. The uterus and cervix are then removed through the vagina. If a laparoscope is used for a vaginal hysterectomy, a pencil-thin scope is inserted next to the navel to access the uterus and cervix.

In general, vaginal procedures can be done for lower stage cancer. Abdominal hysterectomies are done for later stages.


Trachelectomy: Trachelectomy (or cervicectomy) is a procedure to remove the cervix in women with stages 1A2 to 2 cancer. It may be done as a way to preserve fertility in young women who wish to have children after treatment. Like a hysterectomy, a trachelectomy can be done through the abdomen or vagina using the methods mentioned above. The amount of tissue removed around the cervix depends on the extent of cancer.

Trachelectomy is not considered the standard treatment and is not available everywhere. In some cases, surgical staging done during this procedure turns up more cancer than originally thought. When this happens, prior understanding and consent to have a hysterectomy may be required.

Women who become pregnant after this procedure have a significant increase in the risk of premature birth or miscarriage. Cesarian delivery is also necessary after a trachelectomy.


Pelvic Exenteration: If cancer has spread beyond the cervix into nearby organs, a more extensive procedure will be necessary. These include the vagina, urinary bladder, rectum, or lower portion of the colon. If the bladder, rectum, and/or part of the colon are removed, further surgery will be needed to store and remove wastes with a urostomy and/or colostomy. A vagina can be reconstructed from other bodily tissues.


Pelvic Lymph Node Dissection: Cancer can spread to the lymph nodes located in the pelvic region outside the uterus. Once there, it can travel to other parts of the body through the lymphatic system. Therefore, some or all lymph nodes suspected of having cancer will be removed and examined under a microscope during surgery.


Chemotherapy:It involves using drugs to shrink or kill the cancer cells. The drugs can be pills or intravenous medicines given in veins, or sometimes both. 


Radiation: Radiotherapy uses high energy x-rays to treat cervical cancer cells.Radiotherapy machines are massive and could make you feel nervous when you see them for the first time. The machine might be fixed in one position or able to rotate around your body to give treatment from different directions. The machine does not touch you at any point.

Before your first treatment, your radiotherapy technologist will explain what you will see and hear. 

Brachytherapy:It is a radiation therapy treatment technique used to control cancers at several sites. Its name is derived from two terms, ‘Brachy’ means short and ‘Therapy’ means treatment. In this modality, the radiation source is placed at a very short distance to the diseased region, damaging cancer cells and destroying their ability to proliferate. It gives superior accuracy, conformity and localization as a physician can place the source near the tumour.


Which treatment is right for patient?

Choosing the proper treatment involves discussing with the cancer doctor(oncologist) the treatment options available for your type and stage of cancer. The oncologist will be able to explain the risks and benefits of each treatment and its side effects.

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