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Gynaecologic Oncology

Cervical Cancer

The development of cervical cancer is related to sexual activity and the Human Papilloma Viruses (HPV). Vaginal cancers are rare and usually secondary to cervical cancer.

Diagnosis

Cervical screening is a test to check the health of the cervix and also to reduce the risk of cervical cancer. This can be because if cell changes are found by the smear pathology, then the appropriate treatment can be determined to prevent the further growth of abnormal cells. This is why regular smear examinations are so important: to detect any cell changes at the earliest possibility. Abnormalities are common, as one in ten women’s cervix will show cell changes. The most important thing to realise, is that most of these cell changes will not lead to cervical cancer. Furthermore early detection and treatment can prevent around >99% of cancers developing.

If your smear shows abnormal cell changes, your doctor will explain exactly what this means and what needs to be done. They may ask you to have a repeat smear because cells may return to normal by themselves. However they may ask to perform a closer examination called a colposcopy. Refer to our information on Colposcopy and Abnormal Smears for further information.

A cone biopsy is also another type of biopsy and involves the removal of a cone-shaped portion of the cervix. Several methods exist for obtaining this specimen and include an electrosurgical technique called loop electrosurgical excision procedure (LEEP) or loop excision of the transformation zone (LETZ). These methods are only performed after an abnormal cell result is shown on your smear and colposcopy results.

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Endometrial Cancer

Endometrial cancer is the most common gynaecological cancer and the 4th most common malignancy in women. While there has been a rise in incidence of endometrial cancer, there has been a fall in death rate. This could be due to the increase in the use of hormone replacement therapy (HRT). While the use of the contraceptive pill reduces the risk of endometrial cancer, obesity and late menopause increase the risk. In pre-menopausal women, endometrial cancer presents as menstrual irregularity with heavy vaginal bleeding. In post-menopausal women, the cancer usually presents itself as post-menopausal bleeding.

Diagnosis

A diagnosis can be made via a smear test, bloods, an ultrasound; to test the endometrial thickness and a biopsy. The prognosis of patients with endometrial cancer is related to the stage of the disease and the histological grade of the tumour, but overall the cure rates are very high.

Ovarian Cancer

In terms of mortality, ovarian cancer is the most common cancer affecting the female reproductive system. While it can occur at any age, women between the ages 55-59 are mostly affected. The associated death rate has doubled over the past 40 years. This is in contrast to the incidence of breast cancer, which has remained constant, and cervical and endometrial cancers which have fallen in incidence. This trend is probably due to women having smaller families and increasingly high fat diet. Risks include infertility, marked premenstrual tension, family history, celibacy, increased number of abortions and early menopause.

Diagnosis

Much effort is currently being made to develop a screening test for ovarian cancer. Unfortunately, most ovarian cancers are present at an advanced stage. The screening includes vaginal examination, ultrasound scanning and certain blood tests. Because ovarian cancer is sometimes genetic, the above screening methods are recommended for women with one first-degree relatives diagnosed with ovarian cancer.

Fallopian Tube Cancer

Cancer of the Fallopian tubes is rare and is often mistaken for ovarian cancer until a laparotomy (an examination of the internal abdominal organs) is performed.

Vulval Cancer

Vulval cancer accounts for 3-5% of all genital tract malignancies in women and is primarily a disease of the elderly. A link has been shown between Human Papilloma Virus (HPV) and vulval cancer, but no cause or effect has been proven. Most lesions are squamous and probably develop over a long period of time. Many are of wart-like growth and may be asymptomatic. However if they are symptomatic, the may be painful, bleeding and have a foul smell. Vulval intra-epithelial neoplasia (VIN) precedes vulval cancer by 10-40 years and is detectable by examinations such as vulvoscopy.

Diagnosis

It is essential to biopsy any vulval lesion to determine diagnosis and treatment.

Treatment of Gynaecological Cancers

Treatment options depend on the individual, your doctor and the specific cancer. Whether it is surgery, radiotherapy or chemotherapy, your doctor will discuss all treatment options with you.