Gynecological Cancer

Cervical cancer starts in the cervix and is usually caused by long-standing infection with high-risk human papillomavirus. Endometrial cancer starts in the lining of the uterus and is the more common uterine cancer. A sarcoma of the uterus is rarer and is treated differently. Ovarian cancer, and the closely related fallopian tube and peritoneal cancers, often present with bloating or spread in the abdomen. Vulval and vaginal cancers are less common and still need the same careful pathology. Breast cancer has its own page.

• An abnormal Pap or HPV test that needs explanation, understanding that most abnormal screens are not cancer
• Bleeding after menopause, or bleeding between periods that has not been checked
• A biopsy that already names a cervical, uterine, or ovarian cancer
• A question about chemotherapy, or about a targeted drug after BRCA or related testing

HPV vaccination and cervical screening prevent many cervical cancers. They do not treat a cancer that is already there, and they do not remove the need to follow up an abnormal test. Risk for endometrial cancer is higher with age, obesity, tamoxifen use, and some inherited syndromes such as Lynch syndrome. Ovarian cancer risk is higher with age, endometriosis in some types, and inherited BRCA1 or BRCA2 changes. Most women with these cancers do not carry a known mutation. A family history of breast, ovarian, uterine, or bowel cancer is a reason to ask about genetic counselling.

Pregnancy, breastfeeding, and oral contraceptive use have complex relationships with risk that are not reasons to start or stop a medicine on your own. Smoking adds risk for cervical cancer. None of these facts assign blame. They help the clinic decide which extra questions are worth asking.

Post-menopausal bleeding is the symptom most clearly linked with uterine cancer and should be assessed promptly. Cervical cancer can cause bleeding after intercourse, between periods, or after menopause, and sometimes a watery or foul discharge. Ovarian cancer is harder. Persistent bloating, early fullness, pelvic pain, or a change in bladder or bowel habit that is new and lasts more than a few weeks deserves examination. These symptoms are also caused by common conditions. The point of assessment is to tell them apart.

An abnormal Pap smear usually does not mean cancer. It means cells need a closer look, often with colposcopy. A cancer diagnosis requires a biopsy. CA-125 and other blood markers can support the assessment of a pelvic mass. They do not diagnose ovarian cancer on their own, and a normal marker does not rule it out.

Examination, ultrasound, and biopsy are the core. Cervical biopsies may be taken in clinic. Endometrial tissue is sampled when bleeding needs an answer. Ovarian masses may be assessed with ultrasound and CT or MRI, and the definitive pathology sometimes comes only after surgery. CT scans look for spread. Pathology states the type and grade. For ovarian cancer, that includes whether it is high-grade serous, endometrioid, clear cell, mucinous, or another type, because drug choices differ.

Testing the tumour, and sometimes a blood test of the person, for BRCA and related genes is considered in many high-grade ovarian cancers because it can open maintenance therapy with a PARP inhibitor. Lynch syndrome testing is relevant in some endometrial cancers. These tests should be explained before they are ordered. A positive result can affect relatives, so the conversation is wider than the next prescription.

Surgery is central for many uterine and ovarian cancers and is performed by a gynaecological oncology surgeon when that expertise is available. The extent of surgery depends on stage and on how much disease the scans and the operation show. Cervical cancer may be treated with surgery in early disease or with radiation and chemotherapy together when it is more advanced. Radiation is planned by a radiation oncologist. Medical oncology plans the chemotherapy that accompanies these treatments and the medicines used when cancer has spread or returned.

Chemotherapy is common around surgery for ovarian cancer, either after the operation or before it when shrinkage would make surgery safer. Platinum drugs and taxanes are frequently used. For some ovarian cancers, a targeted antibody or a PARP inhibitor is discussed as maintenance after a response. That step depends on stage, the BRCA or HRD result, and how the cancer responded. It is not added for everyone. Cervical cancer treatment may include chemotherapy with radiation, and immunotherapy in selected advanced or recurrent disease. Uterine cancer that is low risk after surgery may need observation alone. Higher-risk or advanced uterine cancers may need chemotherapy, and immunotherapy or targeted therapy in defined molecular groups.

Hormone therapy has a role in some low-grade endometrial cancers and is not a substitute for surgery when surgery is the right curative step. It is also not the treatment for high-grade serous ovarian cancer. Fertility-sparing options exist only in carefully selected early cancers and must be discussed before treatment, with a specialist who can say whether they are safe in that specific case.

Platinum chemotherapy can cause nausea, low counts, kidney effects, and neuropathy. Hair loss is common with taxanes. Radiation to the pelvis can cause bowel and bladder irritation and effects on sexual function and menopause. These should be named before treatment, and symptoms during treatment should be reported rather than tolerated in silence. Early menopause after surgery or pelvic treatment can cause hot flushes and bone loss. Bone health, vaginal symptoms, and mood are part of follow-up.

PARP inhibitors are tablets. They can lower blood counts and cause fatigue or nausea, and they still need monitoring. Immunotherapy has a different side-effect pattern, including bowel, skin, liver, and hormone inflammation. Fever during chemotherapy is urgent. Complementary medicines and supplements should be listed, because interactions are real. Family and work plans can be discussed before the first cycle so the schedule is not a surprise.

Bring the biopsy, operation notes if you have already had surgery, imaging reports, and any CA-125 or HPV result. Write down menstrual history, pregnancies, and whether you still hope to be pregnant later, because that question has to be asked before chemotherapy or pelvic radiation, not after. A family history of breast, ovary, uterus, or bowel cancer should be mentioned so genetic testing is not forgotten.

Ask which organ the cancer started in, what the grade and stage mean in plain language, and whether chemotherapy is being advised to cure, to reduce the chance of return, or to control disease that has spread. Ask how surgery, radiation, and medicines fit together and who leads each part. Partners and parents often want to attend. That is useful when everyone hears the same plan, including what an abnormal screening test does not mean.

A visit about a gynecological cancer is used to read the records you already have, explain them in plain language, and outline options that may apply. Bring the biopsy or pathology report, scan CDs or reports, blood tests, and a list of treatment already given, including dates and drug names if you have them. A family member can come with you. The visit is not an emergency assessment, and it does not confirm a plan until the records have been reviewed.

Dr. Nishith Vaddeboina is a medical oncologist. Appointments published on this website are at American Oncology Institute, Nallagandla, Hyderabad. The biography also lists consultant work at Renova Century Hospitals. Confirm the hospital when you book. Plans are discussed against recognised guidance, including NCCN, ESMO, and ASCO, and then adjusted to the person in the room. Nothing on this page replaces that conversation.

Bleeding after menopause, bleeding after intercourse, or a pelvic mass on a scan should be assessed. An abnormal screening test needs the follow-up that was recommended. It rarely means you already have cancer. During treatment, fever, heavy bleeding, severe pain, vomiting, or breathlessness need urgent care.