Gynecological Cancers

What are Gynecological Cancers, Symptoms, Types and Treatment

20 percent of solid cancers in women are gynecological cancers. It is the general name for cancers that occur in the cervix, ovary, uterus, fallopian tubes, vagina, endometrium or vulva. Endometrial, ovarian and cervical cancers are the 3 most common gynecological cancers in women.

Gynecological Cancer Symptoms

In order to understand the signs of gynecological cancer, the body must be well known. Many women normally encounter problems such as vaginal bleeding, discharge, pain or pressure in the pelvic region, changes in the vulva skin, and such situations should be taken seriously and checked. Symptoms of gynecological cancer:

• Vaginal bleeding
• Weight loss, loss of appetite
• Vaginal discharge
• Tiredness
• Pain in the pelvis or abdomen
• Change in toilet needs
• Change in vulva
• Bleeding during sexual intercourse

Vaginal Bleeding

Endometrium is the most common type of cancer among the gynecological cancer types. More than 90 percent of women diagnosed with endometrial cancer experience irregular bleeding. Be sure to inform your doctor if you experience any vaginal bleeding during the postmenopausal period, as these may be signs of cancer of the vulva, ovary, uterus or cervix.

Weight Loss

Sudden weight loss is among the first signs of cancer. See your doctor if you have experienced significant weight loss without any change in your eating habits. In addition, loss of appetite is one of the symptoms of ovarian cancer.

Vaginal discharge

Bloody, dark, or foul-smelling discharge is usually a sign of infection, but cervical, vaginal, or endometrial cancers also show these symptoms.

Tiredness

If you feel tired all the time and this fatigue interferes with your daily work life or activities, you may need to have a checkup.

Pain in the Pelvis or Abdomen

Pain is among the early symptoms of cancer. Ovarian cancer is largely associated with back and abdominal pain, while pelvic pain or a feeling of pressure are among the symptoms of uterine cancer.

Types of Gynecological Cancer

There are five different types of gynecological cancer with different characteristics and treatment options. Uterine, ovarian and cervical cancers are among the most common types of gynecological cancers today.

Uterine/Endometrial cancer

One of the most common types of cancer, the uterus is made up of cells called the endometrium, and these cells sometimes divide and multiply uncontrollably, causing uterine cancer. If it can be detected early and treatment is started early, the rate of surviving the disease may increase.

Vulvar Cancer

The area on the outer surface of the genital area is called the vulva, and sometimes pain may occur in this sensitive area. It is possible that these pains, which occur more during sexual intercourse and during menstruation, may also be a harbinger of cancer. When diagnosed early, vulvar cancer is also curable.

Cervical Cancer

Cervical cancer is most common among women and is caused by the HPV (Human Papilloma Viruses) virus, which is also contagious.

Vaginal Cancer

Vaginal cancer, which is mostly seen in advanced ages, is associated with HPV or HIV infections, and its symptoms include bleeding during or after intercourse, and bleeding after menopause.

Ovarian Cancer

Ovarian cancer occurs as a result of uncontrolled proliferation or growth in the epithelium or embryonic cells in the ovarian tissue.

What is Cervical Cancer, Symptoms, Diagnosis

Invasive cancer is the least common of other gynecological cancers, and 90 percent of cases are associated with HPV. Smoking, race (more in black people), weak immune system, first sexual intercourse at a young age, multiparity, having more than one partner, oral contraceptives (OC), chlamydia infections are other risk factors.

There are two main types of cells lining the cervix. Squamous cells predominantly cover the ectocervix, while columnar epithelial cells form the layer predominantly covering the endocervix. These 2 cell types come together in an area called the transformation zone. The starting point for most cervical cancers is the transformation zone. Cervical precancers and cancers are classified according to their microscopic appearance.

There are 2 basic types of invasive cervical cancers;

Squamous cell carcinoma

Adenocarcinoma

About 80 to 90 percent of cervical cancers are squamous cell carcinomas. These cancers develop in the squamous cells lining the surface of the ectocervix. Squamous cell carcinomas often begin in the transformation zone where the ectocervix meets the endocervix. The vast majority of other cervical cancers are adenocarcinomas. Cervical adenocarcinomas have been more common than squamous cell carcinomas of the cervix in the last 20-30 years, largely because the widespread use of Pap smears allows early diagnosis of squamous cell carcinomas. Cervical adenocarcinoma develops from mucus-producing gland cells in the endocervix. Apart from these two main cancer types, approximately 5 percent of cervical cancers consist of uncommon pathologies. These cervical cancers may have features of squamous cell carcinomas on the one hand and adenocarcinomas on the other, and are defined as adenosquamous carcinomas or may be neuroendocrine tumors.

Clinic

Vaginal bleeding is the first and most common symptom of cervical cancer. There may be postcoital bleeding, irregular vaginal bleeding and foul-smelling discharge in the early period.

Risk factors:

Several risk factors have been identified that increase the risk of developing cervical cancer, and the most important risk factors include:

-Human papillomavirus (HPV) infection

-Smoking

-Immunosuppression

In addition to these 3 risk factors, several other factors have been identified that are associated with increased rates of cervical cancer.

HPV 16 is the most common and most important virus type in HPV infection, while HPV-18 often causes malignant type cancers. HPV types in cervical cancer are HPV 16 and 18, about 70 percent. HPV can infect the cells on the surface of the skin and the cells lining the genitals, anus, mouth and throat. As a result, HPV can be passed from one person to another through skin-to-skin contact. Another way of spreading HPV is sexual intercourse, which includes oral sex as well as vaginal and anal intercourse.

Although cervical infection caused by HPV is the most common cause of cervical cancer, not all women with HPV infection develop cervical cancer, but sometimes the infection continues and becomes chronic. Chronic infection, especially when caused by certain high-risk types of HPV, can eventually cause certain cancers, such as cervical cancer. Therefore, HPV infection is necessary but not sufficient as a causative factor for cervical cancer.

Cervical cancer does not show any symptoms in the preinvasive period, but it can be diagnosed by vaginal cytology. In all suspicious cytology, biopsy or Endocervical Curettage should be performed with colposcopic control. If microinvasive cancer, adenocarcinoma in situ or advanced dysplasia is detected in the biopsy, the diagnosis is confirmed by conization. Instead, precancerous changes in the normal cells of the cervix develop gradually and may eventually progress to cancer. Physicians use a variety of terms to describe these precancerous changes, including squamous intraepithelial lesion (SIL), cervical intraepithelial neoplasia (CIN), and dysplasia.

Invasive cervical cancer can be prevented with adequate screening and follow-up programs. Two screening tests can help prevent or detect cervical cancer early:

Pap smear test: Abnormal cells that can progress to invasive cervical cancer are investigated.

HPV testing: Evidence of viruses that can cause cell abnormalities is sought.

Pap and HPV tests are screening tests, not diagnostic tests. Abnormal test results indicate that further testing is needed to confirm whether a person actually has precancer or cancer.

This follow-up test may include medical history and physical examination of the pelvis, colposcopy, and biopsy. Instead of the PAP classification, which is the first classification system today, to report Pap test results, a set of standard terms called the Bethesda System are used.

It is possible to classify epithelial cell atypia as mild to severe ASC-US, low grade squamous intraepithelial lesion (LSIL), high grade squamous intraepithelial lesion (HSIL), and invasive carcinoma. LSIL corresponds to mild dysplasia and HPV condylomas, and HSIL to CIN II and III. In terms of morphological features, it can be graded as CIN I (dysplasia in the lower 1/3 layer), CIN II (dysplasia in the lower 2/3 layer), CIN III (dysplasia of the entire mucosa).

The HPV DNA test can be used in conjunction with the Pap test to screen for cervical cancer in women aged 30 and older, but it is not a replacement for the Pap test. Sexually active women in their 20s are more likely to have an HPV infection that will clear up on their own than older women. For these young women, the results of the test are not considered meaningful and may create more confusion. Therefore, the HPV DNA test is not recommended as a screening test for women under 30 years of age.

Endometrial Cancer

It is a malignancy originating from the endometrium and is the most common gynecological cancer. Obesity, hypertension and diabetes increase the risk of endometrial cancer. The most common endometrial tumors are polyps and benign, while endometrial carcinoma is the most common invasive cancer of the female genitalia.

Endometrial cancers are of 2 types. Type 1 occurs due to unopposed estrogen exposure, which is more common at an early age, is usually detected at an earlier stage, has a better course and is related to obesity. Type 2 is seen at an older age and develops on the background of endometrial atrophy, has a more aggressive course, and lung metastasis of endometrial cancer is quite common.

Ovarian Cancer

It is a type of cancer that originates from the ovaries and is usually a difficult-to-treat malignant cancer. It tends to spread to other organs and areas of the body. Its symptoms are usually bloating, pelvic pain, abdominal distension, decreased appetite. In addition to these, postmenopausal hormone treatments, obesity and pregnancy treatment are among the risk factors for ovarian cancer. Hormonal birth control techniques, tubal ligation and breastfeeding reduce the risk of ovarian cancer. Genetic factors such as BRCA-1 and BRCA-2 mutations, BRAF, KRAS and c-erB2 oncogene may also have an impact on the development of ovarian cancer.

The diagnosis of ovarian cancer can be determined by blood tests and transvaginal USG. Sometimes abdominal fluid can be examined or a biopsy taken to confirm the diagnosis. Diagnosing ovarian cancer is not an easy thing, as most symptoms are non-specific in the early stages. In addition, the diagnosis can be confused with Irritable Bowel Syndrome, and pregnancy should be excluded by looking at the B-HCG levels of patients with a possibility of pregnancy.

It is possible to classify as ovarian cancers, tumors originating from the surface epithelium, Germ cell tumors, Sex-Cord Stromal tumors. Tumors of surface epithelium originate from the coelomic epithelium and Serous tumors are among the most common tumors of the ovary, while mucinous tumor is the only smoking-related ovarian cancer.