Every six minutes, a woman is diagnosed with gynaecological cancer. Of the five types of cancer prevalent in women, cervix uteri is found to be the most common. Gynecologic cancers are often detected through a general screening procedure by an oncologist or gynaecologist. If diagnosed and treated early enough, the majority of early-stage and a significant number of stage 2 and 3 cancer can be treated or managed, and potentially cured. For advanced stages of cancer, palliative chemotherapy and targeted therapy can significantly improve quality of life and chances of survival.
Diagnosis is essential for medical experts to give you precise care, track and manage an illness. It is important for women to be aware of the symptoms, causes and screening tests for gynaecologic cancers. With recent advancements in science and technology, healthcare delivery to address cancers have evolved considerable. There are now screening measures in place for cancer diagnosis in more major hospitals in urban India.
Ovarian Cancer
Ovarian cancer typically affects women above 45 years of age. A few of the reasons that women suffer from this type of cancer is due to their hereditary — family history of ovarian cancer, presence of BRCA1 or BRCA2 genes – which are linked with ovarian cancer – and an unhealthy lifestyle that leads to obesity.
This type of cancer is not easy to detect in its early stages due to its vague symptoms like bloating, abdominal pain, increased frequency or urgency of urination, fatigue, constipation, irregular menstrual cycle.
A high index of suspicion is required to diagnose early ovarian cancer.
Uterine Cancer
Most often, the causes for this form of cancer is early or a delayed menstrual cycle, medicines such as hormone replacement, or obesity.
Some of the symptoms women with early stage uterine cancer can expect are unusual vaginal spotting or bleeding, pelvic pain or vaginal discharge or heavy white discharge.
Cervical Cancer
Cervical cancer develops in a woman's cervix (the outer, part of the uterus) and is usually caused by changes in DNA, like mutations. The incidence of cervical cancer is also tied to the prevalence of human papillomavirus (HPV) in the population – it is surprisingly widespread but women are more susceptible to cancer risk from HPV infection.
Other risk factors are a history of smoking, oral contraceptive use, intercourse from an early age, multiple sexual partners and immunosuppression. Commonly reported symptoms are irregular menstrual cycle, bleeding after sex, vaginal or heavy white discharge and frequent pain in the lower abdomen, waist or back.
As per GLOBOCAN 2018 data, cervical cancer is the second most common cancer among Indian women. It can be detected through regular screening for cancer in health check-ups.
Treatment options
Treatment depends on the type of cancer, stage and general health of the woman. The decision for a single treatment or a combination becomes very challenging, especially when the woman is young, and cancer is advanced. Gynecologic cancers are treated in several ways, mainly depending on the kind of cancer and how far it has spread.
For instance, ovarian cancer can be treated by an operation which is known as ‘staging laparotomy’ or ‘debulking’ along with ‘Chemotherapy’ before or after the operation. Uterine cancer can be treated by hysterectomy (an operation to remove the uterus) and radiation therapy after surgery if the cancerous cells are still present in the body.
Cervical cancer can be treated by operation or surgery at the earliest stage and ‘radiation therapy’ and ‘chemotherapy’ for the advanced stage.
How to reduce risk
- Protect yourself from HPV— Some gynaecological cancers are caused by the Human Papillomavirus (HPV), a very common sexually transmitted infection. The HPV vaccine reduces the burden of the HPV-related gynecologic cancers such as, cervical, vaginal, and vulvar cancers. It is recommended that girls aged 11 to 12 years be vaccinated. It can also be given as early as age 9 and until age 26
- Get screened early — Early screening helps in recognizing the disease before there are any symptoms which can lead to effective treatment
- Recognize the warning signs — Recognize the symptoms and talk to your doctor if you believe that you are at an increased risk of gynecologic cancer
- Make healthy choices — Maintain a healthy diet and control your weight to reduce obesity. It is also good to set achievable weight loss goals
- Get genetic testing done — The rising incidence of cancer among women once again signifies the importance of regular screening and going for annual health check-ups, especially if your mother, daughter, sister or any female relatives have had ovarian cancer or breast cancer before the age of 45. Consult with your doctor and opt for genetic testing to assess the risk.
Cancer management during COVID-19
The pandemic has indeed created a delay in healthcare delivery especially for cancer patients who need to make frequent visits to healthcare facilities.
To lower the risk of infection among cancer patients, most cancer centres have adopted online methods of reaching out to the patient and caregiver. However, with ease in government restrictions, cancer patients can now visit the hospitals, diagnostic centres and continue their treatment and undergo screening for cancer.
While we are still grappling with the virus, doctors should take maximum precautions to minimize the risk of contracting the virus. This includes the screening of cancer patients and staff to identify any COVID-19 suspect, adopt outpatient consultations for patients who do not need active management, continue to conduct follow-up sessions over video/audio call.
Awareness to prevent gynecologic cancer
Stigma related to gynecologic cancer care and diagnosis needs to be debunked for more women to come forward and get themselves screened. September is recognized as Gynecological Cancer Awareness Month and is a perfect time to encourage women to learn more and be aware of cancers of the cervix, vagina, vulva, ovaries, and uterus including early detection and prevention.
India's National Cancer Control Program emphasizes the importance of early detection and treatment. Married women can undergo the ‘Screening test’ to get themselves a regular check-up even if they do not have any health concerns. A ‘Pap Smear’ is the most common test that is conducted in this screening test. It looks for abnormal cell changes in the cervix to detect cervical cancer in its early stage. This test will help identify any cancer in the initial stage and can be treated easily.
The author is a medical oncologist at the P.D Hinduja Hospital in Mumbai
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