The common cancers affecting the female reproductive system are cervical, uterine or endometrial and ovarian cancer. Cervical cancer is the second most common cancer in women in India after breast cancer. The cervix is the lowest part of the uterus through which the baby passes during delivery.
Endometrial or uterine cancer affects the lining of the uterus and ovarian cancer affects one or both ovaries. Other cancers include vaginal and vulval [external genitalia] cancers, both are very rare.
Cervical cancers present with white discharge or spotting of blood between menses. In advanced stages, back pain, abdominal pain or nausea and vomiting due to block to the flow of urine may occur. Endometrial or uterine cancer affects the lining of the uterus and typically presents with bleeding after the menopause. It commonly affects obese women after the menopause; many of them are diabetic as well. Uterine cancer usually presents at an early stage and apart from bleeding, there are no other symptoms.
Ovarian cancer usually does not cause any symptoms and most often presents late. It is usually detected during an ultrasound done for abdominal discomfort or swelling or during a routine check up. Rarely the ovary bearing the tumour may twist, causing severe abdominal pain - leading to an early diagnosis. Commonly, cancer of the ovaries, presents late with fluid in the belly [ascites], large tumours in one or both ovaries and multiple cancers in the peritoneum [lining of the belly]. Abdominal pain, loss of appetite, constipation and vomiting occur in the late stages.
Screening for Gynac cancers has not proven to be useful. An annual Gynacologic check up is recommended every year from childbearing age. This should include breast examination and a pap smear [scrapings from the cervix, to look for cellular abnormalities]. Any discharge from the vagina needs to be looked at carefully and the cause determined. Any bleeding after menopause is abnormal and requires examination and a [scraping of the uterine lining] or hysteroscopy to look at the inside of the uterus. Any lady who has an ovarian mass with solid areas found on ultrasound, needs evaluation with tumour marker studies [special blood tests to look for cancer] and scans [CT or MRI scan].
For cervical and endometrial cancer, MRI or CT scan of the abdomen to determine the extent of the cancer. Ovarian cancer requires estimation of tumour markers such as Ca 125, CEA and Ca 19.9 levels, depending on the type of cancer suspected. CT scans or PETCT scans are required to accurately assess all sites involved by cancer. A biopsy of the tumour using a needle, which is guided, by CT or ultrasound is also required.
Early cases of ovarian cancer, where the tumour is located in one or both ovaries, without spread to other organs, are treated by surgery to remove the uterus, ovaries, nodes and omentum [fat pad in the upper belly]. This procedure is called cytoreduction. In most women, due to the advanced nature of the disease, surgery is not possible initially and 3 to 4 courses of chemotherapy are needed to shrink the tumours before surgery. Following surgery, further chemotherapy is required.
In women with advanced ovarian cancer with multiple tumours in the peritoneal cavity, which persist after chemotherapy, a procedure called peritonectomy with use of heated chemotherapy directly poured into the belly [HIPEC procedure] achieves a better result than surgery alone.
Endometrial cancer presents early and surgery is the best and often curative treatment. Surgery involves removal of the uterus, both ovaries and tubes and the lymph glands around the uterus in the pelvis. We now perform this operation by laparoscopy or robotic techniques - with tiny incisions and rapid recovery. Patients are often discharged within 2 days of the operation. Radiotherapy may be needed in some patients after surgery.
Most patients with cervical cancer, present at a late stage, with large tumours; which requires radiotherapy along with chemotherapy [Chemoradiation] to control the cancer. In early stages, surgery consisting of removal of the uterus, lymphatic tissues around it and the pelvic lymph glands is required. This operation is routinely performed robotically by us and gives excellent outcomes and early discharge from hospital.
Once the full course of treatment is completed, you will be asked to see the doctor after about 2 months. At that time a checkup consisting of physical examination, routine blood tests and tumour markers as appropriate are performed. If everything is normal, you will see us once in 3 months for the first 2 years, once in 6 months for the next 3 years and yearly thereafter. The need for CT/MRI/PETCT scans is decided based on the symptoms, findings during the examination and results of the routine tests.