Gynaecological Cancer Management: Cervical, Ovarian, Uterine, Vulvar, Vaginal

Gynaecological cancers represent a significant area of concern in women's health globally, including in Singapore where they contribute prominently to the overall cancer burden. 

According to data from the Singapore Cancer Registry, during the period from 2017 to 2021, cancers of the uterus, ovary, and cervix were identified as the fourth, sixth, and tenth most prevalent cancers, respectively, among women in Singapore.

Advances in treatment options for gynaecological cancers in Singapore have been significant, ranging from surgery and radiation therapy to targeted therapies and immunotherapy. These treatments are tailored to the individual's specific type of cancer, its stage, and other personal health factors, aiming to maximise survival rates and improve the quality of life. The focus on early detection and regular screenings, such as HPV/Pap smear for cervical cancer, has also been a critical aspect of improving outcomes, as early-stage cancers are generally more treatable and have better prognosis.

Cervical cancer

Early-stage (I and II)

1. Surgery: 

   • Removal of the cervix (radical hysterectomy) or a more conservative procedure called a trachelectomy for fertility preservation.

2. Radiation therapy: 

   • External beam radiation or brachytherapy (internal radiation).

3. Chemotherapy: 

   • May be recommended in combination with radiation therapy.

Advanced-stage (III and IV)

1. Chemoradiotherapy: 

   • A combination of chemotherapy and radiation therapy.

2. Surgery:

   • In some cases, surgery may be considered after chemoradiotherapy.

3. Systemic therapy:

   • Chemotherapy or targeted therapies for advanced cases.

Ovarian cancer

Early-stage

1. Surgery: 

   • Removal of the affected ovary or ovaries (oophorectomy) and, in some cases, a hysterectomy and removal of nearby tissues.

2. Chemotherapy: 

   • Adjuvant chemotherapy after surgery.

Advanced-stage

1. Surgery:

   • Debulking surgery to remove as much of the tumor as possible, followed by chemotherapy.

2. Chemotherapy: 

   • Standard treatment, often a combination of platinum-based drugs and taxanes.

3. Targeted therapies: 

   • PARP inhibitors for certain genetic mutations.

Uterine (endometrial) cancer

Early-stage

1. Surgery: 

   • Total hysterectomy with bilateral salpingo-oophorectomy. Lymph node dissection may also be performed.

2. Radiation therapy: 

   • External beam radiation or brachytherapy in some cases.

3. Hormone therapy: 

   • For hormone receptor-positive tumors.

Advanced-stage

1. Surgery: 

   • Debulking surgery for advanced cases, followed by chemotherapy.

2. Chemotherapy: 

   • Often a combination of drugs.

3. Hormone therapy or targeted therapies: 

   • Depending on the molecular characteristics of the tumor.

Vulvar cancer

Early-stage

1. Surgery: 

   • Wide local excision or vulvectomy.

2. Lymph node dissection:

   • Removal of nearby lymph nodes.

3. Radiation therapy: 

   • Adjuvant radiation in some cases.

Advanced-stage

1. Surgery: 

   • Extensive surgery for larger tumors, sometimes followed by reconstruction.

2. Chemotherapy or radiation therapy: 

   • Depending on the extent of the disease.

Vaginal cancer

Early-stage

1. Surgery:

   • Removal of the tumor with wide margins.

2. Radiation therapy: 

   • Adjuvant radiation in some cases.

Advanced-stage

1. Surgery: 

   • More extensive surgery or pelvic exenteration in advanced cases.

2. Chemotherapy or radiation therapy: 

   • Depending on the extent of the disease.

Conclusion

Key aspects of gynaecological cancer management guidelines include:

1. Screening and early detection:

   • Regular screenings for cervical, ovarian, uterine, and other gynaecological cancers.

   • Education and awareness programs to promote early detection and prevention.

2. Diagnostic evaluation:

   • Accurate staging through imaging studies and pathological assessments.

   • Consideration of genetic testing for hereditary factors influencing cancer risk.

3. Treatment modalities:

   • Surgery: Often the primary treatment for gynaecological cancers, aiming for complete tumor removal.

   • Chemotherapy: Administered to destroy cancer cells or shrink tumors.

   • Radiation therapy: Targeted radiation to eliminate cancer cells or alleviate symptoms.

4. Multidisciplinary approach:

   • Collaboration between gynaecologic oncologists, medical oncologists, radiation oncologists, and other specialists.

   • Individualised treatment plans based on the type and stage of cancer.

5. Supportive care:

   • Addressing physical and emotional aspects of cancer through palliative care and supportive services.

   • Management of treatment side effects to enhance the overall quality of life.

6. Follow-up and surveillance:

   • Regular follow-up appointments for monitoring and early detection of recurrence.

   • Survivorship programs to address long-term physical and psychological effects.

FAQ

What are the common types of gynaecological cancers?

Gynaecological cancers include cervical, ovarian, uterine (endometrial), vaginal, and vulvar cancers.

How can I reduce my risk of gynaecological cancers?

Regular screenings, maintaining a healthy lifestyle, HPV vaccination, and understanding family history can help reduce risks.

What screening tests are available for gynaecological cancers?

Pap smears for cervical cancer, pelvic exams, transvaginal ultrasounds, and blood tests for certain markers are common screening methods.

What does a cancer diagnosis involve?

Diagnosis includes imaging tests, biopsies, and pathological examinations to determine the type, stage, and characteristics of the cancer.

What are the main treatment options for gynaecological cancers?

Treatment may involve surgery, chemotherapy, radiation therapy, or a combination, depending on the type and stage of cancer.

How is surgery used in gynaecological cancer management?

Surgery aims to remove tumors and affected tissues. Procedures may include hysterectomy, oophorectomy, and lymph node dissection.

What is the role of chemotherapy in gynaecological cancer treatment?

Chemotherapy uses drugs to kill or slow the growth of cancer cells. It may be used before or after surgery, or as the primary treatment for advanced stages.

When is radiation therapy recommended for gynaecological cancers?

Radiation therapy is often used after surgery to eliminate remaining cancer cells or as a primary treatment for specific cancers.

How important is a multidisciplinary approach in gynaecological cancer care?

Collaboration between gynaecologic oncologists, medical oncologists, radiation oncologists, and other specialists ensures comprehensive and tailored treatment plans.

What are the potential side effects of gynaecological cancer treatments?

Side effects may include fatigue, nausea, hair loss, and changes in fertility. The impact varies based on the type of treatment.

How frequently should follow-up appointments occur after treatment?

Follow-up schedules depend on the type and stage of cancer but generally involve regular check-ups and screenings to monitor for recurrence.

Are there support services available for gynaecological cancer patients?

Yes, support services include counseling, support groups, and survivorship programs to address emotional and physical well-being.