Gynecological Cancer & Treatment Options

Gynecologic cancers include cancer of the uterus, ovaries, cervix, vagina, vulva and fallopian tubes. According to the American Cancer Society, 264,624 cases of gynecological cancers were diagnosed in 2008.

Risk Factors

All women are at risk for getting gynecologic cancer. Risk factors increase the chances of developing a cancer, but do not guarantee it will occur.

• Uterine and Endometrial cancer: early menstruation, late menopause, never having been pregnant, obesity, diabetes, use of estrogen therapy alone (without progestin) for hormone replacement therapy, Tamoxifen (a drug used to treat breast cancer) or a genetic syndrome called hereditary non-polyposis colon cancer (HNPCC).
• Cervical cancer: strong association with sexually transmitted diseases (human papillomavirus (HPV) infection, Chlamydia), sexual activity at an early age, multiple sexual partners, smoking, obesity, family history of cervical cancer.
• Ovarian cancer: never having been pregnant, use of estrogen therapy alone (without progestin) for hormone replacement therapy, family history of breast or ovarian cancer, genetic mutation in BRCA1 or BRCA2 gene.
• Vaginal cancer: age (most women are 60 years of age or older at diagnosis), history of cervical cancer, smoking, history of genital warts.
• Vulvar cancer: the majority of women diagnosed with this disease are greater than 50 years of age, smoking, human papillomavirus (HPV) infection, HIV infection.

Diagnosis

Many times no apparent signs of gynecologic cancers are present. Some common symptoms that would require further evaluation include:

• Unusual bleeding, such as postmenopausal spotting or bleeding, bleeding after intercourse or bleeding between periods
• Persistent itching of the vulva (skin around the vaginal opening) or a sore in the genital area that does not heal
• Pain or pressure in the pelvis
• Ongoing vaginal discharge

Most gynecologic cancers are diagnosed through a variety of tests including:

• Pelvic examination to evaluate the vulva, vagina, cervix, uterus, ovaries and fallopian tubes
• PAP smear to examine cells for cervical or vaginal cancer
• MRI, CT, PET scan or ultrasound of the abdomen and pelvis
• Removal of a small amount of tissue from a suspicious area, called a biopsy

Treatment

Sometimes only one type to treatment is necessary, other times a combination of surgery, chemotherapy and/or radiation therapy are more appropriate.

Surgery

The type, extent and timing of surgery will depend on the location and stage of the tumor.

Chemotherapy

This involves the administration of anticancer drugs for certain types and stages of gynecological cancers. It may be delivered after surgery when there is no evidence of cancer, but a chance it may come back or to help shrink a tumor before surgery.

Radiation Therapy

There are several methods by which the radiation therapy treatments can be given: External beam radiation or Brachytherapy.  Many times, both types of treatment are used to treat the cancer.

• External beam radiation therapy involves a series of painless, daily (Monday through Friday) outpatient treatments delivered for five to six weeks. The main technique for delivering external beam radiation therapy is

• 3-dimensional conformal therapy (3-D conformal) refers to a method of treatment delivery that incorporates 3-dimensional computer planning and treatment systems to produce a high-dose area of radiation that conforms to the shape of the area to be treated. This technique allows the delivery of precise doses of radiation to the pelvic region through multiple treatment fields while sparing surrounding tissues.

• Brachytherapy is a form of internal radiation therapy involving the surgical implantation of radioactive material into a tumor or surrounding tissue. It is often used in combination with external beam radiation therapy to treat patients with uterine, cervical or vaginal cancer.

• High-dose-rate brachytherapy (HDR) involves the placement of radioactive sources into or next to the cancer. After an applicator is placed in the vagina, small plastic tubes (catheters) are connected to this apparatus. A special machine passes a small amount of radioactive material through these catheters allowing a high dose of radiation to be delivered to a small, precise area while sparing surrounding normal tissue. The radiation, catheters and the applicator are removed at the end of each treatment. This procedure may be performed weekly for a series of three to five treatments usually following your external beam radiation therapy.

• Low-dose-rate brachytherapy (LDR) also involves the placement of radioactive sources next to the cancer. After an applicator is placed in the vagina, radioactive material is placed within this apparatus and usually remains in place for approximately 48 to 72 hours. This procedure takes place after you have completed a course of external beam radiation therapy and requires a short hospital stay.

Treatment Side Effects

Side effects from these treatments may include temporary hair loss in the treatment area, fatigue, increased urinary frequency or burning, vaginal itching or irritation, light vaginal spotting or discharge. Some rectal discomfort such as itching, burning or pain during bowel movements and diarrhea may also occur.