Gynaecological cancers, or cancers that affect a woman’s reproductive system, are among the most common cancers in Malaysia.
This is especially true for common gynaecological cancers such as ovarian cancer, cervical cancer and uterine cancer.
Globocan 2012 statistics (International Agency for Research on Cancer) indicate that cervical cancer remains the second most common cancer among women in Malaysia and the fourth leading cause of death in women aged between 15 and 44, while ovarian cancer is the fifth most common cancer among Malaysian women.
Thousands of new cases of gynaecological cancers are diagnosed every year, yet it has been observed that women in Malaysia still fail to seek help quickly and there is still room for improvement in terms of awareness.
It is not uncommon for women to worry they may have cancer, and at the same time live in a state of hopeful denial until their symptoms are worse. The delay continues in some cases even after a diagnosis is made, when patients do not quickly decide on treatment due to fear of side effects.
It is important for patients to realise that for many gynaecological cancers, the potential for a cure is very real if the disease is discovered and treated at an early stage.
Patients should have an open discussion with their doctor or medical team regarding any concerns they may have regarding the diagnosis or treatment so that any concerns can be dealt with appropriately and patients can move on to start their treatment.
Common gynaecological cancers
Ovarian cancer is used to describe cancers that arise from the cells of the ovary. Most commonly, tumours arise from the epithelium (lining cells of the ovary), fallopian tube and primary peritoneum (the lining inside the abdomen that coats many abdominal structures).
These are all considered to be one disease process.
Uterine cancer is a cancer that develops in the uterus, with the most common types of uterine cancer arising from the endometrium (the inner lining of the uterus).
Cervical cancer occurs when abnormal cells on the cervix grow out of control. The cervix is the lower part of the uterus that opens into the vagina. Cervical cancer is one of the most common cancers in women worldwide.
Knowing the signs and symptoms
Unfortunately, in some cases of cancer, the signs and symptoms tend to be vague and non-specific.
For example, early-stage ovarian cancer rarely causes any symptoms, while advanced ovarian cancer may cause non-specific symptoms that are often mistaken for benign conditions.
Signs and symptoms of ovarian cancer may include abdominal bloating or swelling, quickly feeling full when eating, weight loss, discomfort in the pelvis area, and changes in bowel habits and frequent urination.
For uterine cancer, the most common symptom is abnormal vaginal bleeding. Most women diagnosed with this cancer are post-menopausal, so any vaginal bleeding is unusual, while younger women encounter heavier than usual periods or bleeding in between normal periods.
Other symptoms include lower abdomen pain and pain during sex.
Advanced uterine cancer may cause pain in the back, legs, or pelvis, loss of appetite, tiredness and nausea.
Early cervical cancers and pre-cancers usually have no symptoms. When the cancer becomes more advanced, women experience abnormal vaginal bleeding, unusual vaginal discharge, and pain during vaginal intercourse.
Understanding risk factors
Ovarian cancer risk increases with age, especially for women over 50. Additionally, women with a first-degree relative (mother, daughter, or sister) with ovarian cancer are about three times more likely to develop the disease.
This risk increases when two or more first-degree relatives have ovarian cancer.
About 10% to 15% of ovarian cancers occur because of genetic mutation, such as the BRCA1 or BRCA2 gene. This mutation also increases the risk of fallopian tube cancer and primary peritoneal cancer, which are similar to ovarian cancer.
There are other genetic conditions linked to an increased risk of ovarian cancer, which you may discuss with your doctor.
Risk factors are unclear for uterine cancer. However, there are contributing factors, some of which are similar to ovarian cancer.
For cervical cancer, risks include human papillomavirus (HPV) infection, immune system deficiency, having had genital herpes, smoking, being aged between late teens and mid-30s (although women over 40 remain at risk and need to continue having regular cervical cancer screenings), and previous exposure to diethylstilbestrol (DES).
Managing risk factors
Going for regular women’s health examinations can help detect ovarian cancer early.
During a pelvic exam, the healthcare professional feels the ovaries and uterus for size, shape, and consistency. A pelvic exam can be useful because it can find some reproductive system cancers at an early stage, but most early ovarian tumours are difficult or impossible for even the most skilled examiner to feel.
Pelvic exams may, however, help identify other cancers or gynaecological conditions.
While there is no known way to prevent uterine cancer, it may be possible to reduce the chances of getting uterine cancer by maintaining a healthy weight and getting exercise, and taking progesterone in addition to oestrogen for hormone replacement therapy.
Women should get Pap smears on a regular basis as it is a very effective way to detect cervical cancers before they become serious. The first sign of cervical cancer is when changes are detected on a Pap smear.
The Pap smear is a routine test that looks for precancerous and cancerous changes in the cervical cells. When abnormalities are detected, action can immediately be taken to remove those cells and prevent the cancer from developing.
Depending on their age and health profile, women aged 21 years and above are advised to discuss their Pap smear needs with their doctor.
Diagnosis and treatment
For ovarian cancer, tests can include an ultrasound, blood studies, CT scans, barium enema x-rays, colonoscopy, MRI, and chest x-rays depending on the doctor’s findings.
Ultimately, the surgical opening of the abdomen (exploratory laparotomy) is necessary to confirm or rule out an ovarian cancer diagnosis.
Surgery is the standard treatment for ovarian cancer. Ordinarily, the two ovaries and the other reproductive organs are removed, but young women who have only a small tumour in one ovary and who still want to have children may have just the cancerous ovary removed.
In most women with advanced disease, some cancer remains after surgery.
Most women receive chemotherapy, which can prolong survival and may result in a cure.
Radiation therapy may be used to help alleviate symptoms in certain patients with advanced disease.
Even if no cancer is detected after treatment, follow-up exams are essential.
The options for diagnosing uterine cancer are selected by the doctor based on the age and medical condition of the patient, the type of cancer suspected, signs and symptoms, and previous test results.
The options include pelvic examination, transvaginal ultrasound, computed tomography (CT or CAT) scan, magnetic resonance imaging (MRI) and biopsy.
Uterine cancer is treated by one or a combination of treatments, including surgery, radiation therapy, chemotherapy and hormone therapy.
Treatment options and recommendations depend on several factors, including the type and stage of cancer, possible side effects, and the woman’s overall health, and her age and personal preferences, including whether or how treatment will affect the ability to have children.
If cervical cancer is suspected, the doctor will ask about the patient’s medical history and do a physical exam, including a pelvic exam and a Pap test. Tests to confirm a diagnosis of cervical cancer include various biopsies, while tests to find out the stage and treatment for cervical cancer include a chest x-ray, a CT scan, an MRI, a PET scan and a biopsy.
Cervical cancer found in its early stages can be successfully treated. The choice of treatment and prognosis depends on the type and stage of cancer. The patient’s age, overall health, quality of life, and desire to be able to have children must also be considered.
Treatment choices include surgery, radiation therapy, chemoradiation and chemotherapy.
Ultimately, medicine and healthcare is a truly personal process that each person should discuss closely with their doctor.
Women and their families shouldn’t fear what their doctors have to say – they genuinely want to help.
Dr Christina Lai Nye Bing is a specialist in clinical oncology. This article is courtesy of Sunway Medical Centre. For further information, e-mail firstname.lastname@example.org. The information provided is for educational and communication purposes only and it should not be construed as personal medical advice. Information published in this article is not intended to replace, supplant or augment a consultation with a health professional regarding the reader’s own medical care. The Star disclaims all responsibility for any losses, damage to property or personal injury suffered directly or indirectly from reliance on such information.