Early stage gynaecological cancers
There are many cancers which affect the female reproductive system, comprising the womb, vagina, ovaries and fallopian tubes. The womb is a bag of muscle about the size of your fist. During pregnancy, the developing baby is held by this muscle. The ovaries and fallopian tubes are located to the side of the womb.
The most common gynaecological cancers are cervical cancer, endometrial and other uterine (womb) cancers, and ovarian cancer. Treatment options depend on the type and stage of a patient's cancer.
Women with early stage gynaecological cancer are often treated using hysterectomy (removal of the womb). It may also be necessary to remove the ovaries, fallopian tubes and specific lymph nodes.
Endometrial cancer is the most common abdominal cancer in women, but has a good overall prognosis.
The symptoms it produces mean that this type of cancer is usually detected early even without screening. Endometrial cancer is largely a disease of post-menopausal women. It is most common in women aged between 65 and 75.
Cancer of the lining of the womb is often influenced by female sex hormones (oestrogens). This occurs in older women, particularly older women who are overweight (oestrogens can be produced in fat tissue), or in younger women as a result of early onset of periods and long periods or the incorrect use of oestrogen-only hormone replacement therapy in women who have not had a hysterectomy.
As mentioned above, around 80% of endometrial cancers are influenced by female sex hormones. Some endometrial cancers nonetheless arise through non-hormone-dependent mechanisms. This type of cancer is more common in older women and women of Afro-Caribbean origin. There are no other risk factors (being overweight or having oestrogen therapy do not increase the risk of contracting this type of endometrial cancer). The prognosis for this type of cancer is significantly worse than for hormone-dependent cancers.
From a circumscribed point, endometrial cancer either grows into the muscle layer of the womb or into the cavity of the womb. The deeper the cancer penetrates, the more common it is to find secondary cancers in the lymph nodes (lymph node metastases).
The most common symptom of endometrial cancer is bleeding after the menopause. Indeed bleeding is often the only symptom. This kind of bleeding can, however, also occur with other tumours of the reproductive system (such as cervical or vaginal cancer), hormone replacement therapy or ovarian cancer. If a woman experiences bleeding from the cervix after going through the menopause, the first line of investigation should nonetheless be endometrial cancer. The longer the time elapsed since entering the menopause, the greater the likelihood that bleeding is due to endometrial cancer.
Post-menopausal bleeding is the most obvious symptom of endometrial cancer. Vaginal ultrasound can be used to determine whether further diagnostic measures are required. If the lining of the womb is less than 4 mm thick, it is unlikely to be a cancerous condition. If the lining of the womb is more than 6 mm thick, curettage and endoscopy of the womb (hysteroscopy) should be carried out to allow a diagnosis to be made.
Endometrial cancer is treated surgically by
- a longitudinal incision
- removal of the womb and both ovaries
Depending on depth of penetration and histological findings, it may also be necessary to remove lymph nodes in the lesser pelvis and along the aorta.
In unfavourable cases, abdominal radiotherapy and radiotherapy via a radiation source placed in the vagina should be given. To date, prophylactic chemotherapy has not been shown to provide any benefit for patients with endometrial cancer.
Chemotherapy is largely reserved for relapses, which usually occur within 3 years of the operation. In patients who have not previously undergone radiotherapy, relapses are treated with radiotherapy and in some cases also with chemotherapy or hormones (especially progesterone).
If your doctor advises you to have an operation for endometrial cancer, the da Vinci® technique offers decisive advantages. Da Vinci® surgery utilises the very latest technology and requires just a few small surgical incisions, allowing you to resume an active life faster. The da Vinci® system enables your doctor to perform the operation with better visualisation, greater precision, more freedom of movement and better control.
Cervical cancer is a malignant tumour of the neck of the womb. This is the most common tumour of the female reproductive system, making up around 40–50% of all such cancers. Cervical cancer is particularly common between the ages of 35 and 45 and between the ages of 65 and 75. Due to the success of cancer prevention programmes, cervical cancer is increasingly becoming a disease of older women.
Cervical cancer is more common and occurs earlier in women who become sexually active at a young age, have large numbers of partners or are smokers. It is also more common in women who have had a sexually-transmitted disease or diseases. Cervical cancer arises in stages. The disease starts out with damage to cervical cells, which can then undergo a second step to become cancerous. The best known trigger for this type of cell damage is infection with the human papilloma virus (HPV). This virus is primarily transmitted through sex and is undoubtedly a major, but certainly not the sole, cause of cancerous changes to the lining of the cervix.
Cervical cancer can grow in two different ways – either cauliflower-like into the vagina, or into the wall of the cervix, causing the cervix to thicken.
Initially, the cancer is confined to the cervix. Over time, it spreads to the wall of the vagina, the ligaments supporting the uterus and into the uterine cavity. The cancer then grows into the bladder and rectum. Even where the cancer is confined to the cervix, 20% of women will have lymph node metastases (secondary cancers in the lymph nodes). Rarely and only much later, metastases may spread via the blood to the lungs, liver, bones and brain.
Early symptoms of cervical cancer include increased discharge and bleeding between periods. Bleeding after sex or when straining to go to the toilet may also be an indication of cervical cancer. Because early stage cervical cancer does not cause any symptoms, even these ‘early symptoms’ may be signs of an advanced tumour. Late symptoms of cervical cancer occur when the tumour compresses important neighbouring structures, potentially blocking the ureters or the blood vessels to the legs, for example. If the cervical cancer grows into surrounding nerves, this can cause severe pain in the sacral area or pelvis.
Diagnosis is made by means of a gynaecological examination. Thanks to cervical smears taken as part of the cervical cancer screening programme, cervical cancer is usually detected at an early stage.
If abnormalities are found on a cervical smear or something suspicious is found in the cervical area during a gynaecological examination, a piece of tissue (a biopsy) is taken from the cervix and sent to the lab to be examined under a microscope.
Treatment depends on the stage of the cancer. In the best case, a piece of the cervix is removed (cervical conisation) and the patient is cured. Conisation involves removing a cone-shaped piece of tissue around the cervix. More advanced disease requires removal of the womb and neighbouring structures, including parts of the vagina, the ligaments supporting the uterus and/or lymph nodes. Whether the ovaries are left in place or removed depends on the patient’s age. Tumours which are too advanced are treated using radiotherapy. The uterine cavity is irradiated directly in situ.
The da Vinci® technique allows procedures of this type to be carried out with extreme precision and control and with minimum damage to other structures.
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