Gynecologic Cancers
More than 500,000 people die from cancer each year among all types. The most prevalent gynecologic cancers include vaginal, cervical, vulvar, uterine, and ovarian cancers. If a woman suffers any atypical vaginal bleeding or pain between periods, after sexual activity, or after menopause, she should be recommended to consult her primary healthcare physician. Gynecologic malignancies can be treated with chemotherapy, radiotherapy, and surgery. Healthcare professionals should push women to continue having routine gynecological checkups with their doctors and to actively maintain their gynecologic health.
Only cardiovascular disease causes more deaths in the United States than cancer, which claims more than 500,000 lives each year. According to the American Cancer Society (ACS), gynecologic malignancies also afflict women, even though breast disease is the most common type of cancer affecting women. The most frequent gynecologic cancers, according to the CDC, include vaginal and vulvar cancer as well as cervical, uterine, and ovarian cancer. All women are at risk for gynecologic malignancies, according to the CDC, and that risk grows with age. Gynecologic cancers cause an estimated 28,000 deaths per year and affect more than 85,000 women in the United States.
Doctors can advise women to undergo routine examinations and screenings to protect gynecologic health or to spot an issue early on because there are screening criteria for various gynecologic cancers. Human papillomavirus (HPV) is associated with almost all cervical cancer, as well as 40-70% of vaginal and vulvar cancer cases. To prevent HPV, the Advisory Committee on Immunization Practices currently advises routine immunization of males and females between the ages of 11 and 12.
To help patients make wise decisions about their health and general well-being, doctors have the chance to provide them with relevant information during counseling on risk factors, potential preventive measures, and the recent advances made in gynecologic cancer treatments.
Cancer Gynecologist
A cancer gynecologist is a specialist who deals with and treats any malignancy that develops in a female's reproductive organs. Cervical, ovarian, uterine, vaginal, and vulvar cancers are the five primary forms that involve a woman's reproductive organs. They are collectively known as gynecologic cancer.
Gynecologic Cancer Symptoms
Gynecologic malignancies are linked to specific signs and symptoms, however, not all affected women experience the same signs and symptoms. Furthermore, some symptoms can be challenging to distinguish since they may resemble or mimic those of other diseases. If a woman experiences pain or unusual vaginal bleeding between periods, after sexual activity, or after menopause, she should be recommended to consult her primary healthcare physician for treatment.
With any gynecologic malignancy, abnormal vaginal bleeding and discharge might happen. Uterine and ovarian cancer sometimes cause pelvic pain. Similarly, not all ovarian cancer patients may experience the symptoms of bloating, constipation, or an excessive desire to urinate.
Vulvar cancer results in a visible lesion, itching, and pain. A patch of skin on the vulva can be a different color from the skin around it. There are currently only routine screening tests for cervical cancer (the Pap smear and HPV testing). Doctors advise women to get routine gynecologic exams to look for disease because early-stage gynecologic cancer symptoms are sometimes vague and can also be brought on by other, less dangerous conditions.
Cervical Cancer
According to the ACS, more than 4,000 American women will lose their lives to cervical cancer this year, with an estimated 12,289 new cases of the disease being diagnosed by the end of 2017. Cervical cancer can develop as early as age 20, however, the average age at diagnosis is typically about 50. Cervical intraepithelial neoplasia, which is thought to be brought on by HPV type 16, 18, 31, 33, 35, or 39 infections, leads to cervical cancer. The Papanicolaou (Pap) smear is the only recommended screening test available, but it only detects alterations in cervical cells rather than cancer. Dysuria, odorous discharge, abnormal vaginal bleeding, and vaginal soreness are some of the common symptoms of cervical cancer. Cervical cancer cannot develop unless HPV is present. The only disease that can be prevented by routine screening tests and follow-up when necessary, according to the CDC, is cervical cancer. Cervical cancer is thought to be relatively treatable if discovered early.
Cervical Cancer Risk Factors
Smoking, HIV, using oral contraceptives for longer than five years, having many sexual partners, and having given birth to three or more children are risk factors for cervical cancer.
Cervical Cancer Screening
Based on advice from the ACS, the American Society for Colposcopy and Cervical Pathology, the American Society for Clinical Pathology, the U.S. Preventive Services Task Force, and the American College of Obstetricians and Gynecologists, routine screening recommendations for particular age groups include the following:
- No screening is advised for those younger than 21 years
- Cytology (Pap smear) every three years for women aged 21 to 29.
- Cytology alone every three years (acceptable) or HPV and cytology co-testing every five years (recommended) for women between 30-65.
- No screening was advised if sufficient prior screening was negative and risk was low in women older hand 65.
Cervical Cancer Treatment
Chemotherapy, radiotherapy, and surgery may all be used to treat cervical cancer. Radiation and chemotherapy are options if a hysterectomy is necessary but the patient is not suitable for surgery.
Most patients with stage IB (high-risk) to stage IVA cervical cancer should get chemotherapy in addition to radiation therapy. Although 5-fluorouracil is frequently utilized, cisplatin is the drug that is used the most frequently. Cisplatin is still the drug that is most frequently recommended to patients with the metastatic illness. Additionally used were topotecan, ifosfamide, gemcitabine, and paclitaxel. According to studies, the combination of topotecan and cisplatin improves overall survival but also increases acute toxicity.
The FDA authorized bevacizumab in August 2014 for the treatment of persistent, recurring, or advanced (metastatic) cervical cancer. This medication is authorized for chemotherapy combinations using either paclitaxel and topotecan or paclitaxel and cisplatin. Approval was based on the GOG-0240 study which assessed the efficacy and safety of bevacizumab plus chemotherapy (paclitaxel and cisplatin or paclitaxel and topotecan) in women with persistent, recurrent, or metastatic carcinoma of the cervix. A statistically significant improvement in overall survival and an intensification in the rate of tumor shrinkage were demonstrated in trial subjects treated with bevacizumab plus chemotherapy compared with chemotherapy alone. However, hypertension, thromboembolic events, and gastrointestinal fistulas were greater in the bevacizumab group.
Prevention of HPV
Gardasil 9, the only HPV vaccination offered in the United States, is a 9-valent vaccine that has been authorized for use in girls and women between the ages of 9 and 26 to prevent cervical cancer, vaginal, vulvar, and anal cancers, as well as genital warts. It is also licensed for boys between the ages of 9 and 15 to prevent genital warts and anal cancer brought on by nine different kinds of HPV. Patients should be informed that this vaccine does not offer complete protection from all forms of cervical cancer and that they should continue receiving regular checkups for the disease. Pain, swelling, and redness at the injection site are the most often reported side responses.
Endometrial Cancer
Endometrioid adenocarcinoma is the typical kind of endometrial cancer. Whether it be menorrhagia, metrorrhagia, or any amount of postmenopausal bleeding, more than 90% of patients with endometrial cancer will come with abnormal vaginal bleeding; the typical age at diagnosis is 60 years. According to the ACS, there were 61,350 new cases of endometrial cancer diagnosed in 2017, and 10,900 women will fade away from cancer. After breast, lung, and colorectal cancer, endometrial cancer accounts for 8% of all cancers in women. Compared to Asian or African American women, Caucasians have a higher incidence of endometrial cancer, while African American women have the highest mortality rate. Endometrial adenocarcinoma is a fairly prevalent gynecologic malignancy in the United States, although it has a favorable prognosis because most affected women show symptoms at an early stage; it accounts for 4% of all female cancer mortality.
Endometrial Cancer Risk Factors
Obesity and metabolic syndrome, diabetes, and age more than 50 are significant risk factors linked to endometrial cancer. Tamoxifen use for more than five years, prior pelvic radiotherapy, a family history of breast or ovarian cancer, unopposed estrogen brought on by polycystic ovary syndrome, nulliparity, late menopause, estrogen treatment without progesterone, or anovulation disorders are additional risk factors for endometrial cancer.
90% of women with endometrial cancer are thought to experience abnormal uterine bleeding (postmenopausal hemorrhage, premenopausal recurrent metrorrhagia, etc.); 33% of those who initially experience postmenopausal bleeding are ultimately found to have endometrial cancer. A vaginal discharge may appear in some women weeks or months before postmenopausal bleeding starts.
Endometrial Cancer Treatment
Surgical excision, radiotherapy, chemotherapy, hormonal treatment, and targeted therapy are all possible treatments for endometrial cancer. A total hysterectomy, salpingo-oophorectomy, lymphadenectomy, and occasionally radiation therapy and/or chemotherapy are the standard forms of treatment. In the adjuvant treatment of sarcomas and endometrial malignancies, radiation therapy is crucial. Adjuvant therapy for high-grade, recurring, or metastatic endometrial cancer sometimes includes chemotherapy. The most often employed chemotherapeutic drugs include paclitaxel, carboplatin, doxorubicin, and cisplatin. In general, two or more medications are combined for treatment, and the most popular ones are cisplatin and doxorubicin, as well as carboplatin and paclitaxel. Additionally, cisplatin/paclitaxel/doxorubicin and paclitaxel and doxorubicin may be administered. Adjuvant therapy for uterine malignancies that are receptor-positive includes the use of hormone therapy as well.
Ovarian Cancer
The most frequent kind of gynecologic cancer in women between the ages of 55 and 64 is ovarian cancer, which kills more women than any other gynecologic malignancy. Ovarian cancer affects more than 22,000 women in the United States each year, and it claims the lives of an estimated 14,000 of them. In most developed countries, the 5-year survival rate is 45% overall, with lower rates of survival at more advanced stages.
Because ovarian cancer is generally asymptomatic or has vague symptoms in its early stages, more than 75% of affected women receive their diagnosis at an advanced stage. Abnormal vaginal bleeding, discomfort or pressure in the pelvic area, back or abdominal pain, bloating, feeling full too quickly or having trouble eating, and changes in bathroom habits are typical signs and symptoms.
Ovarian Cancer Risk Factors
Those with particular genetic markers, such as the BRCA1 or BRCA2 gene, nulliparity, late childbearing, early menarche, late menopause, and family history of ovarian cancer are the most prominent risk factors for the disease.
Ovarian Cancer Treatment
Typically, chemotherapy using drugs like carboplatin and paclitaxel is followed by surgery, including a hysterectomy, bilateral salpingo-oophorectomy, and cytoreductive surgery.
Vulvar Cancer
According to the ACS, there will likely be 6,000 vulvar cancer diagnoses in the United States in 2017. While vulvar cancer incidence rises with age and the average age at diagnosis is 70, it appears to be increasing in younger women. In 2017, 1,200 women with vulvar cancer passed away.
Vulvar Cancer Risk Factors
Risk factors for vulvar intraepithelial neoplasia include chronic granulomatous disorders, HPV infection, heavy smoking, lichen sclerosus, squamous hyperplasia, and squamous carcinoma of the vagina and cervix.
When therapy for vulvar cancer is given promptly, the prognosis is favorable. The usual indications of vulvar cancer are pain, vulvar bleeding, and itching. According to the predisposing factors, vulvar cancer can be divided into two groups: The first type is related to HPV infection and typically affects younger patients, whereas the second type is unrelated to HPV and frequently affects elderly women who do not have neoplastic epithelial problems. Primary vulvar cancer is the term used to describe cancer that starts in the vulva. It is referred to as secondary vulvar cancer if it begins in another area of the body before spreading to the vulva.
Vulvar Cancer Treatment
If necessary, radiotherapy and chemotherapy are employed as treatments. The most widely used chemotherapy regimens are platinum-based, such as cisplatin, administered alone or in combination with another medication, such as 5-fluorouracil, paclitaxel, and vinorelbine, or mitomycin C. Chemotherapy for vulvar carcinoma is generally palliative and frequently ineffective. There is now no accepted standard of care and the actual response rate to these chemotherapies is poor because there are so few cases that need chemotherapy.
Vaginal Cancer
An estimated 1% of all gynecologic cancers each year are vaginal cancers, which are extremely uncommon. The usual age at diagnosis is between 60 and 65 years old. The American Cancer Society (ACS) projected that there were 4,800 new cases of vaginal cancer in 2017 and 1,250 deaths.
The upper portion of the posterior vaginal wall is where the bulk of vaginal malignancies are found. Local treatments can frequently treat early-stage tumors, but there is no standard therapy for metastatic cancer that is effective.
Vaginal Cancer Risk Factors
Cervical or vulvar cancer as well as HPV are risk factors for vaginal cancer. Between 30 and 50 percent of women with vaginal carcinomas are thought to have undergone a hysterectomy in the past for a benign, premalignant, or malignant condition.
Vaginal Cancer Treatment
Depending on the stage of cancer, treatment options may include surgery and radiotherapy, both of which are highly effective in the early stages of the disease. Radiation therapy is the main therapy for more advanced stages of the disease. There are currently no established pharmacological regimens for treating advanced vaginal cancer, and chemotherapy is not curative.
Conclusion
Every year, around 28,000 Americans pass away from common gynecologic cancers including cervical, uterine, ovarian, vaginal, and vulvar cancer. Signs and symptoms of gynecologic cancer should be recognized by women. Women can learn about gynecologic cancers from doctors, who can also encourage them to talk openly with their medical specialists about risk factors and screenings.