Several types of cancer related to women’s health fall into this general category. They are uterine, ovarian (which includes fallopian tube and peritoneal cancer), cervical, vulvar and vaginal cancers. When surgery is needed, it may be done robotically or traditionally. Robotic procedures can include hysterectomy; removal of ovaries; staging procedures for uterine and ovarian cancers with the removal of uterus, tubes, ovaries, lymph nodes and omentum; and radical hysterectomy for cervix cancers.
What follows are details about each type of gynecological cancer.
Uterine cancer is the most common gynecological cancer, with about 60,000 women diagnosed with it each year in this country. Most uterine cancers (about 80 percent) are endometrial in origin, which means they begin in the tissue lining the uterine cavity.
Endometrial cancer is divided into two types: Type I and Type II. Type I cancers are typically diagnosed at an early stage and can be addressed by surgery alone. Type II cancers (10 to 20 percent) are at a more advanced stage at diagnosis and may require treatment in addition to surgery.
Endometrial biopsy: Most uterine cancers occur in women who already have gone through menopause. The most common symptom is vaginal bleeding. Any woman with bleeding after menopause should see her doctor immediately. Uterine cancer usually is diagnosed with an endometrial biopsy, a procedure that often is done in the doctor’s office. If the patient is several years past menopause, the doctor may not be able to perform the biopsy in the office and she may require a dilation and curettage (D&C) procedure for diagnosis. During this procedure, the uterine lining is scraped to remove tissue for further testing.
The main treatment for uterine cancer is surgery that removes the uterus, fallopian tubes, ovaries and lymph nodes. The information obtained during surgery determines the stage of uterine cancer, and the patient is placed into low, intermediate or high risk categories.
Patients at low risk for recurrence may not require any additional treatment after surgery. Patients at intermediate or high risk for recurrence may benefit from radiation, chemotherapy or both.
Ovarian/Fallopian Tube/Peritoneal Cancer
Ovarian cancer affects about 16,000 women per year in the U.S. A woman's risk for this disease is about 1 percent, unless she has a genetic mutation, which carries a higher risk for disease.
Many patients with ovarian cancer are not diagnosed at an early stage because the symptoms can be so vague. As the cancer grows, common symptoms that appear are:
- Abdominal bloating
- Change in bowel habits, constipation or diarrhea
- Feeling full quickly when eating
- Decreased appetite
- Increased urgency or frequency to urinate
- Abdominal pain
If a woman has a persistence of the symptoms for 2 to 3 weeks, she should call her doctor and mention her concern about ovarian cancer. Early detection is key.
Methods of diagnosing this type of cancer include:
- A pelvic mass might be felt on pelvic exam.
- A pelvic ultrasound is conducted to look at the ovaries specifically.
- CT scan of the abdomen and pelvis can be conducted to determine how widespread the cancer might be.
Surgery: Surgery and possible follow-up chemotherapy are the most common treatments. Several surgical options exist depending on the extent of disease.
- Laparoscopy can be used initially to determine whether and how far the cancer has spread. Laparoscopy involves placing a latent scope into the patient’s abdomen to determine the extent of disease. If the disease is diagnosed early, it may be possible to do the surgery either laparoscopically or robotically.
- Laparotomy can be used when it is determined the disease may be widespread. This requires a large incision to debulk the disease. Debulking means reducing the bulk of the disease so chemotherapy will be more effective.
Chemotherapy: The use of drugs or chemical substances to kill cancer cells may be used either before or after surgery. In some situations, if the cancer is so widespread that it cannot be effectively debulked, the patient may be given intravenous chemotherapy to decrease the extent of disease so surgery is possible. If the cancer can be removed initially, chemotherapy may be administered afterward directly into the patient’s abdominal cavity, which is also referred to as an IP or intraperitoneal injection.
Most cervical cancers are related to the human papillomavirus. HPV is extremely common and most sexually active women in their lifetime will be exposed to the virus. Fortunately, a vaccine against this virus exists and is recommended for children beginning at age 9. This vaccine is most effective if received before becoming sexually active.
Regular pap smears are effective in detecting pre-cancerous changes in the cervix. Women should begin having pap smears at age 21. How often you need a pap smear depends on a woman’s age, whether or not she carries HPV and other medical conditions.
Routine pap smear: Many cervical cancers are detected in this common test.
Biopsy: An abdominal pap will likely be followed up by a colonoscopy, or the cervix will examined under magnification. Biopsies of the cervix are taken to confirm the diagnosis.
PET or CT scans: More advanced cases will require additional positive emission tomography or computer tomography scans to determine extent of disease.
Surgery: Early-stage cervix cancers can be treated surgically. A wedge of the cervix can be removed to adequately treat the cancer. This is called a conization. If a cone procedure is not adequate, a patient may require either a radical hysterectomy or cervicectomy to remove the cervix.
Chemotherapy and radiation: More advanced cervix cancers require both chemotherapy and radiation.
This cancer is relatively rare and accounts for only about 5 percent of all gynecologic cancers. It often affects older women. Most women will have precancers of the vulva, which often occur at a younger age. Most precancers are associated with the human papillomavirus.
Biopsy: Precancers of the vulva often involve an itchy, uncomfortable spot on the vulva. Since many, non-cancerous conditions of the vulva have similar symptoms, it is important to have a biopsy to determine what is causing the symptoms.
Surgery: Most vulvar cancers and precancers are treated surgically. The type of surgery depends on the extent of the precancer or cancer. Early precancers can often be treated by laser. Some require tissue to be excised.
Chemotherapy and radiation: Advanced vulvar cancers may require chemotherapy and radiation in addition to surgery.
Vaginal cancers are very rare, accounting for about 1 percent of all gynecological cancers. Most cases are associated with the human papillomavirus (HPV). This is the reason women who have had abnormal pap smears often require continued pap smears even after having a hysterectomy.
Bleeding is the most common symptom of vaginal cancer. A woman with irregular bleeding should see her doctor, who will do a pap test and pelvic exam. Tissue will be biopsied for a definitive diagnosis.
Chemotherapy and radiation: Most women with vaginal cancer require chemotherapy and radiation for treatment.
There are several radiation treatment options:
- External beam radiation therapy involves aiming beams from special X-ray machines, called linear accelerators, at the tumor from outside the body. During treatment, a beam of radiation (high-energy X-rays) is directed through the skin to destroy cancerous cells. Treatment is typically given on a daily basis, from Monday through Friday, over a period of 5 to 6 weeks. In some cases, external beam radiation therapy may be administered with other treatment types, such as brachytherapy or chemotherapy.
- High dose rate brachytherapy is a type of internal radiation treatment. The radiation source is placed inside the body, as close to the tumor as possible. With high dose rate brachytherapy, the source stays inside the body for a short period of time, and is then removed. For women with gynecologic cancers involving the uterus or cervix, brachytherapy is often a very important part of treatment. Brachytherapy can be done alone or in combination with other treatment types.
- Vaginal high dose rate brachytherapy may be recommended for women whose uterus has been removed as part of the treatment for uterine or cervical cancer. Brachytherapy treatments may then be recommended to the vagina. Vaginal brachytherapy gives radiation to a small area by having a hollow tube, called an applicator, placed inside the vagina. A radioactive source will travel into the applicator from a storage unit though a cable. It will remain in the vaginal applicator for 3 to 15 minutes, until the correct amount of radiation is administered, as prescribed by the patient’s physician. Most patients will have three to five treatments with one or two treatments administered each week. Each treatment takes about one hour. The patient is not radioactive after the treatment.