Cancer: Gynaec Oncology Surgery

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1. Cancer of the Uterus (Womb)

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Cancer of the womb also referred to as uterine or endometrial cancer is one of the common female genital cancers. This form of cancer is more prevalent amongst women who have been through menopause.  The most common symptom of womb cancer is unusual or abnormal vaginal bleeding. Women who have been through menopause, any vaginal bleeding is unusual. In women who have not yet been through menopause, unusual bleeding maybe: periods heavier than usual or vaginal bleeding in between normal periods. Less common symptoms include pain in the tummy (lower abdomen) and pain during sex.

 

Most cancers of the womb are treated with a removal of the uterus also referred to as hysterectomy and removal of both ovaries. The lymph glands may also be removed. This will depend on the type and stage of cancer.

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Hysterectomy 

 

A hysterectomy is a commonly performed operation. There are a number of ways this is carried out and your gynaecologist will advise the most appropriate and suitable type of procedure for you.

 

• Total Abdominal Hysterectomy and Bilateral Salpingo-Oophorectomy (BSO) This is when the womb (uterus), neck of the womb and both fallopian tubes and ovaries are removed. This operation may be performed through either a bikini style incision or through an up and down cut in the tummy.

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• Total Laparoscopic Hysterectomy and BSO This operation is carried out through tiny ‘Keyhole’ incisions in your abdomen to help remove the uterus, tubes and ovaries.

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• Robotic Assisted Hysterectomy and BSO This operation uses a da Vinci robot operated by a robotically trained surgeon.  This is carried out through tiny ‘Keyhole’ incisions in your abdomen to help remove the uterus, tubes and ovaries.  The robot is used for more intricate surgery and aims for quicker recovery time, significantly less blood loss and pain.

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2. Cervical Cancer

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The cervix is part of the female reproductive system and is in the lower part of the womb also known as the neck of the womb. Cervical cancer develops when abnormal cells in the lining of the cervix grows in an uncontrollable way. It is caused by the Human Papilloma Virus (HPV) which is predominantly sexually transmitted. It mainly affects sexually active women aged between 30 and 45. The main symptom is unusual bleeding which can occur during or after sex, in between periods, or new bleeding for those who have been through menopause. Screening for cervical cancer is vital to ensure early intervention and treatment which prevents this problem from ever occurring.

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Screening for Cervical Cancer – PAP Smear Test With or Without HPV Testing.

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Cervical screening commonly known as a PAP smear test involves taking a small sample of cells from the surface of the cervix. This is sent to a laboratory to check for abnormal cells and (if required) the presence of HPV DNA. Abnormal cells may not necessarily mean cancer, but when left untreated could develop into cancer. Depending on the result of the smear test, a more detailed confirmatory assessment of the cervix, called Colposcopy may be advised.

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As per international guidelines, a routine PAP smear should be done once every 3 years from the age of 25-49 years and once every 5 years from the age of 50-65 years.

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Colposcopy

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A colposcopy is a detailed examination of the cervix which should always be performed by a trained and qualified Colposcopist. A colposcopist will use a colposcope which is a special magnifying instrument to get a clear view of the cervix to rule out precancerous / cancerous changes. If abnormal cells are seen, it may be suggested to have a small tissue biopsy (tissue sample sent to a lab) or have the entire abnormal tissue removed at the time of examination.

 

 

HPV Vaccine - Prevention of Cervical Cancer

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HPV vaccine is available in India. Vaccination works best when it’s done before a person is sexually active and exposed to HPV, but it still can reduce the risk of getting HPV if given after a person has become sexually active. The ideal age for HPV vaccination is age 11 to 12 years but it can be given from 9 to 26 years of age. For those aged 9-14 years, 2 shots of vaccine are recommended. For those aged 15 – 26 years, 3 shots of vaccine are recommended.

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3. Ovarian Cancer

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The ovaries are a pair of small organs located low in the tummy that are connected to the womb and store a woman’s supply of eggs. In ovarian cancer, cancer cells arise from the ovary. This is called primary ovarian cancer. Majority of cases occurs in women who have gone through menopause. Younger women could also be affected. The earlier the disease is detected, the better the survival rate. The most common type of ovarian cancer is epithelial ovarian cancer, which develops from the surface layer of cells in the ovary.

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Common symptoms may include feeling constantly bloated, a swollen tummy, discomfort in tummy or pelvic area, feeling full too quickly and or needing to pass urine more often than normal. Other symptoms are persistent indigestion, pain during sex, change in bowel habits, vaginal bleeding particularly after menopause, nausea or feeling tired all the time, unintentional weight loss.

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The risk of  getting ovarian cancer  increases in women who are over 50 years of age, a family history of ovarian cancer or breast cancer, endometriosis, hormone replacement therapy HRT or being overweight. The main treatments include surgery to remove as much of the cancerous cells as possible and in most cases followed by chemotherapy to eliminate remaining cancer cells.

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