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GYNECOLOGIC CANCERS
 There are three main types of gynecologic cancers: Uterine, Cervical, and Ovarian. Uterine is the most common gynecologic cancer.
This cancer is the most frequent gynecologic cancer.
Endometrial Cancer, also called adenocarcinoma, begins in the endometrium, the lining of the uterus. Endometrial cancer accounts for about 95 percent of uterine cancers. While it mostly affects postmenopausal women, 25 percent of cases are seen in premenopausal women, with 5 percent of these under age 40.
After diagnosis, you may be referred to a gynecologic oncologist, a doctor who’s had specialty training in both the surgical and the chemotherapeutic management of gynecologic cancers. Your doctor will surgically remove the uterus and cervix (a simple hysterectomy) or those organs plus the upper part of the vagina and nearby tissues (a radical hysterectomy). The doctor also may take out nearby lymph nodes, as well as the fallopian tubes and ovaries.
Your doctor will inspect the removed organs to stage your cancer — that is, to determine the extent to which the disease has spread. Since surgery removes the tumor, it not only helps determine the stage of the disease but also may be curative.
Your doctor may use a staging method known as the FIGO (International Federation of Gynecology and Obstetrics) system. Although subdivisions exist, in simple terms, cancer confined to the uterus is stage I; cancer with cervical involvement is stage II; cancer with local spread outside the uterus is stage III; and cancer with spread to the bladder, rectum or further is stage IV. Most patients have stage I and II uterine cancers, which have the highest survival rates.
Your doctor also may determine the tumor’s grade after examining tumor cells under a microscope. If the cells appear similar to normal tissue, the tumor is considered low-grade. If they don’t look like normal tissue, the tumor is high-grade. Low-grade tumors usually grow more slowly than high-grade tumors, which are more likely to spread.
Knowing your tumor’s stage and grade helps your doctor decide whether to recommend further treatment after surgery. Options for further treatment include radiation therapy, hormone therapy and chemotherapy, alone or in combination. Your doctor may use these therapies without surgery if your tumor can’t be removed or if health problems prevent surgery. In some cases, radiation therapy shrinks the tumor before surgery.
This type of cancer develops in the cervix, the lower part of the uterus that connects the uterus to the vagina. This cancer is most commonly found in women of reproductive age. The most important risk factor for cervical cancer is infection with the sexually transmitted human papillomavirus.
The two main kinds of cervical cancer are:
- Squamous Cell Carcinoma. About 80 to 90 percent of cervical cancers are squamous cell carcinomas, which arise from the squamous cells that cover the cervix.
- Adenocarcinoma. This less common type of cervical cancer develops in the glandular cells lining the cervical canal. Between 10 and 20 percent of cervical cancers are this type.
The treatment for cervical cancer depends on the stage. Stage I disease is limited to the cervix and is most often treated by radical hysterectomy and removal of the lymph nodes. (The “radical” part of the hysterectomy involves removing more of the tissues that attach to and support the uterus; the cancer is known to spread to these tissues first.)
A fertility-preserving surgery, the radical trachelectomy, takes out the cervix, the top part of the vagina and the pelvic lymph nodes but leaves the rest of the uterus.
Radiation may be used instead of surgery to treat small tumors, or it may be used after surgery for patients at high risk of having the cancer return.
In stage II, the cancer has descended to the upper part of the vagina or reached the tissue around the uterus. In stage III, the cancer is in the lower part of the vagina or the pelvic wall and possibly in the pelvic lymph nodes. In stage IV, the cancer has invaded other body parts.In general, stages II, III and IV are usually treated with a combination of radiation and chemotherapy. The chemotherapy makes the tumor more sensitive to destruction by the radiation, and it also kills cancer cells outside the radiation field.
This cancer originates in the ovaries, the two organs attached to the sides of the uterus that produce the eggs and hormones needed for reproduction.
Epithelial Ovarian Cancer is the most common type of ovarian cancer and begins in the epithelial cells on the ovary’s surface. Epithelial cancer constitutes about 85 to 90 percent of ovarian cancers.
Once ovarian cancer is diagnosed, surgery is usually the first treatment. You may be referred to a gynecologic oncologist for care. Research has shown that surgery by gynecologic oncologists results in higher survival rates than surgery by doctors without this type of specialty training, because gynecologic oncologists are more likely to remove all of the cancer at the time of surgery.
Usually the uterus, ovaries, fallopian tubes and nearby lymph nodes are removed for staging. Fatty tissue, called the omentum, in the stomach area, also may be taken out, as well as any fluid in the abdominal area. If the cancer is more extensive, the surgeon may remove it from the intestines, liver and other affected areas. This is called debulking.
Staging also should be performed when a cancerous ovary is removed by a surgeon who was not expecting to find cancer, because a third of these patients are found to have a higher stage than was presumed.
Equally important is having surgery performed before chemotherapy, with the exception of patients whose cancer has spread outside the abdomen or pelvis (such as to the liver, brain or lung) or patients who are too high a risk for surgery because of heart, lung or other severe medical conditions. In those cases, chemotherapy may be the first treatment.
Disease limited to one or both ovaries is stage I, local spread to organs in the pelvis is stage II, spread to the abdominal lining or lymph nodes is stage III and distant spread is stage IV. The doctor also may determine the tumor’s grade, which indicates how abnormal the cells are.
After surgery, staging and grading, your doctor may recommend intravenous chemotherapy, most commonly in the form of a two-drug combination, although single agent and oral regimens are sometimes used. A newer chemotherapy technique, intraperitoneal chemotherapy, involves injecting the drugs into the abdominal cavity.
Radiation is rarely used for primary treatment. It is most commonly used to treat some recurrences.
Women who are diagnosed with ovarian cancer should know about an inherited condition known as familial breast-ovarian cancer syndrome. This common syndrome is responsible for 10 percent of ovarian cancers and 5 to 10 percent of all breast cancers. Women with one of these cancers face increased risk of developing the other.
Read blogs from oncology professionals at MyCancerAdvisor.com:
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