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Cancer |
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CANCER : Gynaecological |
There are several different types of cancers that can start in a woman's reproductive system. These include:
- (Cancer of the neck of the womb)
- Uterine / Endometrial Cancer (Cancer of the body of the womb)
- Vulval Cancer (Cancer of the external genitals)
- Vaginal Cancer (Cancer of the birth canal)
The two common types of cancer among above are discussed below.
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CERVICAL CANCER
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Cervical cancer forms in tissues of the cervix (neck of the womb). It is usually a slow-growing cancer that may not have symptoms but can be found with regular Pap tests (a procedure in which cells are scraped from the cervix and looked at under a microscope). Studies have found a number of factors that may increase the risk of cervical cancer. These factors may act together to increase the risk even more: |
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| Human papilloma viruses(HPVs): |
HPV infection is the main risk factor for cervical cancer. HPV is a group of viruses that can infect the cervix. HPV infections are very common. These viruses can be passed from person to person through sexual contact. Most adults have been infected with HPV at some time in their lives. Some types of HPV can cause changes to cells in the cervix. These changes can lead to genital warts, cancer, and other problems. |
| Lack of regular Pap tests: |
Cervical cancer is more common among women who do not have regular Pap tests. The Pap test helps doctors find precancerous cells. Treating precancerous cervical changes often prevents cancer.
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| Weakened immune system (the body's natural defense system): |
Women with HIV (the virus that causes AIDS) infection or who take drugs that suppress the immune system have a higher-than-average risk of developing cervical cancer. For these women, doctors suggest regular screening for cervical cancer.
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| Age: |
Cancer of the cervix occurs most often in women over the age of 40.
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| Sexual history: |
Women who have had many sexual partners have a higher-than-average risk of developing cervical cancer. Also, a woman who has had sexual intercourse with a man who has had many sexual partners may be at higher risk of developing cervical cancer. I
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| Smoking cigarettes: |
Women with an HPV infection who smoke cigarettes have a higher risk of cervical cancer than women with HPV infection who do not smoke.
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| Using contraceptive pills for a long time: |
Using birth control pills for a long time (5 or more years) may increase the risk of cervical cancer among women with HPV infection.
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| Having many children: |
Studies suggest that giving birth to many children may increase the risk of cervical cancer among women with HPV infection. |
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Diagnostic Tests |
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Pelvic Exam and Pap Test |
The pelvic exam and Pap test allow the doctor to detect abnormal changes in the cervix. If these exams show that an infection is present, the doctor treats the infection and then repeats the Pap test at a later time. If the exam or Pap test suggests something other than an infection, the doctor may repeat the Pap test and do other tests to find out if cervical cancer is present. |
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Colposcopy |
A colposcopy is a widely used method to check the cervix for abnormal areas. The doctor applies a vinegar-like solution to the cervix and then uses an instrument much like a microscope (called a colposcope) to look closely at the cervix. The doctor may then coat the cervix with an iodine solution (a procedure called the Schiller test). Healthy cells turn brown; abnormal cells turn white or yellow. |
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Cervical Biopsy |
The doctor may remove a small amount of cervical tissue for examination by a pathologist. This procedure is called a biopsy. In one type of biopsy, the doctor uses an instrument to pinch off small pieces of cervical tissue. Another method used to do a biopsy is called loop electrosurgical excision procedure (LEEP). In this procedure, the doctor uses an electric wire loop to slice off a thin, round piece of tissue. |
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Endocervical Curettage |
The doctor also may want to check inside the opening of the cervix, an area that cannot be seen during colposcopy. In a procedure called endocervical curettage (ECC), the doctor uses a curette (a small, spoon-shaped instrument) to scrape tissue from inside the cervical opening.
These procedures for removing tissue may cause some bleeding or other discharge. However, healing usually occurs quickly. |
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Cone Biopsy |
If other tests are non-conclusive, a larger, cone-shaped sample of tissue is removed. This procedure, called conization or cone biopsy, allows the pathologist to see whether the abnormal cells have invaded tissue beneath the surface of the cervix. Conization also may be used as treatment for a precancerous lesion if the entire abnormal area can be removed. |
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Dilation and Curettage (D and C) |
In a few cases, dilation and curettage (D and C) is performed, to scrape tissue from the lining of the uterus as well as from the cervical canal. |
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Ultrasound |
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CT / MRI |
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PET-CT Scan |
| PET CT scan is helpful for staging of disease, particularly extent of nodal involvement and metastatic spread. It is also excellent to detect early recurrence / spread. |
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Staging |
Cervical cancer is staged with the FIGO (International Federation of Gynecology and Obstetrics) System of Staging. This system classifies the disease in stages 0 through IV. It is based on clinical staging rather than surgical staging. |
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| Stage 0: |
The cancer cells are very superficial (only affecting the surface) are found only in the layer of cells lining the cervix, and they have not grown into (invaded) deeper tissues of the cervix. This stage is also called carcinoma in situ (CIS) or cervical intraepithelial neoplasia (CIN) grade III.
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| Stage I: |
In this stage the cancer has invaded the cervix, but it has not spread anywhere else.
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| Stage IA: |
This is the earliest form of stage I. There is a very small amount of cancer, and it can be seen only under a microscope.
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| Stage IA1: |
The area of invasion is less than 3 mm deep and less than 7 mm wide.
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| Stage IA2: |
The area of invasion is 3-5 mm deep and less than 7 mm wide. |
| Stage IB: |
This stage includes Stage I cancers that can be seen without a microscope. This stage also includes cancers that can only be seen with a microscope if they have spread deeper than 5 mm into connective tissue of the cervix or are wider than 7 mm.
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| Stage IB1: |
The cancer can be seen but it is not larger than 4 cm.
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| Stage IB2: |
The cancer can be seen and is larger than 4 cm. |
| Stage II: |
In this stage, the cancer has grown beyond the cervix and uterus, but hasn't spread to the walls of the pelvis or the lower part of the vagina.
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| Stage IIA: |
The cancer has not spread into the tissues next to the cervix (called the parametria). The cancer may have grown into the upper part of the vagina.
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| Stage IIB: |
The cancer has spread into the tissues next to the cervix. |
| Stage III: |
The cancer has spread to the lower part of the vagina or the pelvic wall. The cancer may be obstructing the ureters.
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| Stage IIIA: |
The cancer has spread to the lower third of the vagina but not to the pelvic wall.
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| Stage IIIB: |
The cancer has grown into the pelvic wall. If the tumor has blocked the ureters (a condition called hydronephrosis) it is also a stage IIIB.
Note:In the alternate staging system by the American Joint Committee on Cancer, stage IIIB is defined by the fact that the cancer has spread to lymph nodes in the pelvis.
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| Stage IV: |
This is the most advanced stage of cervical cancer. The cancer has spread to nearby organs or other parts of the body.
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| Stage IVA: |
The cancer has spread to the bladder or rectum, which are organs close to the cervix.
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| Stage IVB: |
The cancer has spread to distant organs beyond the pelvic area, such as the lungs. |
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Five-year survival rates by stage |
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| Stage |
5-Year Survival Rate |
| IA |
Above 95% |
| IB1 |
Around 90% |
| IB2 |
Around 80%-85% |
| IIA/B |
Around 75%-78% |
| IIIA/B |
Around 47%-50% |
| IV |
Around 20%-30% |
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Treatment |
| The treatment depends upon stage. |
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Cryosurgery / Conization / cauterization / laser ablation
Surgery
Chemotherapy
Radiation therapy (external / internal)
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| A team of gynaecologist / surgeon, oncologist and a radiation therapist may be treating the patient. They are the best people to discuss various treatment options according to your stage. |
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| Your doctors will be able to discuss various treatment options with you in detail. |
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