Gynaecological Cancer
Uterine Cancer
In Australia, uterine cancer is the most common gynaecological cancer with more than 2000 women newly diagnosed every year. Typically it is a disease of postmenopausal women. We distinguish two types:
Type 1 uterine cancer is the most common form, most likely caused by obesity, diabetes mellitus or high cholesterol. These cancers require surgery but normally show a very good prognosis. The cancer type is endometrioid and not uncommonly, endometrial hyperplasia is a precancerous condition leading to uterine cancer.
Type 2 uterine cancer includes serous, clear cell, sarcomas and other rather aggressive types of uterine cancer. Causes of these cancer types are unknown. Treatment requires surgery followed by radiotherapy, chemotherapy or a combination of both.
Sometimes uterine cancer can be inherited. See Lynch syndrome.
Prior to surgery, the diagnosis of uterine cancer needs to be established on either an endometrial sampling (in the office) or a curette (day surgery).
More about the treatment and outcomes of uterine cancer.
Ovarian Cancer
In Australia, ovarian cancer is a common gynaecological cancer with more than 1600 women newly diagnosed every year. We distinguish several types:
- Epithelial ovarian cancer (EOC): Approx 85% of all ovarian cancers are epithelial. Typically EOC is a disease of postmenopausal women. These cancers require surgery and most patients will require chemotherapy postoperatively. Approx 16 to 18% of these cancers are hereditary.
- Non-epithelial ovarian cancer: Thee cancers account for approx 5% of all ovarian cancers. Typically they develop in very young women. Surgery is essential but often only one ovary needs to be removed and fertility can be preserved. Sometimes chemotherapy is required and these cancers carry a very good prognosis.
- Borderline tumours are tumours in between malignant and benign. They carry a very good prognosis but surgery is required. Chemotherapy is not effective. Sometimes young women are affected and fertility can be preserved in the majority of women. Borderline tumours are not inherited.
In contrast to most other malignant tumours a diagnosis (benign or malignant) will not be available before surgery. I discourage radiologists to drain pelvic masses for the aim to establish a diagnosis because of the enormous risk of tumour cell dissemination during such a procedure. Therefore surgery not only aims to treat the condition but also needs to establish a diagnosis before a treatment can commence.
Certain tools are available to estimate the risk of malignancy, and these tools include medical imaging (CT scan and ultrasound) and tumour markers (CA125, CA19.9, CEA, HE4). Depending on this risk assessment I will recommend one of the following:
- Very low risk of malignancy (less than 1%): I recommend a repeat ultrasound (ideally transvaginally) and tumour marker test in 2 to 3 months
- Low to medium risk of malignancy: surgical exploration may be useful. I would prefer a laparoscopic (key hole) approach.
- High risk of malignancy: surgery is ideally performed through an open abdominal incision. A laparoscopic approach is reasonable if the tumour is far advanced and it needs to be determined if surgery should be the first choice of treatment.
More about the treatment and outcomes of ovarian cancer.
Cervical Cancer
In Australia, cervical cancer has become less frequent. Approx 400 patients are diagnosed every year in Australia, which is a decline of 34% from 2002. This fortunate and very encouraging data are the result of the cervical (PAP smear) screening program that has been introduced to Australia some 20 years ago. We also hope that the cervical cancer incidence will further decline due to the effects of the vaccination program that has been established in 2007. Human Papilloma Virus (HPV) causes cervical cancer and smoking co-contributes to its development.
Typically, a PAP smear will pick up abnormalities on the cervix. However, a PAP smear will not ascertain a diagnosis of cervical cancer. The vast majorities of abnormalities detected by PAP smears are harmless or pre-cancerous. A biopsy of the cervix is required to determine if the abnormality is inflammation (benign), pre-cancer (CIN; Cervical Intraepithelial Neoplasia) or cancer.
CIN will require treatment if it is severe (CIN2 or CIN3). Excision requires day surgery and follow-up for 24 months. CIN1 requires follow-up only but not surgery. The chances that it disappears by itself is very high (>80%).
In contrast, cervical cancer requires instant action. After a diagnosis has been established by biopsy, the extent of disease needs to be explored. A CT scan of the pelvis, abdomen and chest or ideally a PET/CT will determine if the cancer has spread to local lymph nodes or anywhere else.
More about the treatment and outcomes of cervical cancer.
Vulval & Vaginal Cancer
In Australia, vulval cancer is uncommon with only 400 women newly diagnosed every year. The incidence of vulval cancer has been rising by 25% since 2002 but its precursors (precancerous stages) have more than doubled. Typically vulval cancer is a disease of postmenopausal women. We distinguish two types:
One type is related to HPV infection (similar to cervical cancer) and this type is more common in young women. It encompasses approximately 60% of all vulval cancers. Smoking is a co-factor that often facilitates cancer growth.
The second type is related to chronic inflammatory (vulval dystrophy) or autoimmune processes mainly in elderly women.
Most patients present with a fleshy, nodular or warty mass, plaque or ulcer on the labia. A biopsy of the lesions needs to be performed to secure a histological diagnosis or to determine if a preinvasive (precursor) lesion is present. Vulval cancer typically spread into groin and pelvic lymph nodes. Prior to treatment a CT scan of the pelvis, abdomen and chest needs to ascertain that the cancer has not spread beyond the vulva.
More about the treatment and outcomes of vulval and vaginal cancer.
What you can expect after surgery