Surgery for Gynaecologic Cancers

Gynaecological cancers are cancers arising from the female genital system and include tumors arising from the uterus, ovary, cervix, vagina and vulva. Gynaecological cancers are the second most common cancers arising in women after breast cancer and are the most common cause of cancer related death in women.
Cervical Cancer
Cancers of cervix appear as growths arising from the uterine cervix and present with vaginal discharge or bleeding. The main reasons for development of cervical cancer include poor personal hygiene, HPV infection, multiple pregnancies and multiple sexual partners. Diagnosis is confirmed with a good pelvic examination by a surgical oncologist or gynaecologic oncologist and biopsy from the lesion. Disease staging is done with MRI Pelvis and PET CT . early stage cancers are treated with radical hysterectomy with pelvic lymph node dissection, while locally advanced cancers need concurrent chemo-radiation
Cervical cancer is preventable. One should maintain good personal hygiene and treat any pelvic infections diligently. All women in their teens should be encouraged to get three shots of injection Gardasil which is the only vaccine available to prevent cancer.
Uterine Cancer
Cancers of uterus (endometrium) most often present in elderly post-menopausal women. The most common symptom is abnormal post-menopausal bleeding. Diagnosis is confirmed by hysteroscopy and endometrial biopsy. MRI abdomen is done for local tumor staging. Surgery remains the main curative treatment and includes removal of uterus (hysterectomy) with pelvic and para aortic lymph node dissection. Some patients may need radiation therapy and chemotherapy in addition to surgery depending on post-operative histopathology report.
Ovarian Cancer
Ovarian cancers are the fourth most common cancers in women. Ovarian cancer is also known as the whispering disease as there are no specific signs and symptoms and is therefore difficult to diagnose in early stage. Initial symptoms are vague and include abdominal pain, distension and bloating, which are often correlated with GI upset. Routine USG of abdomen may show ovarian masses and tumors as well as free fluid in abdomen. The primary doctor must have a high index of suspicion of cancer on finding complex ovarian masses and abdominal or peritoneal nodules on ultrasonography of abdomen. CA 125 is a reliable tumor marker for diagnosis as well as follow of after treatment.
Treatment of ovarian cancer involves multimodality management with chemotherapy and cytoreductive surgery depending on the stage in the correct sequence. Patients undergoing optimal cytoreductive surgery with complete removal of abdominal disease always do better compared to patients with sub optimal resection.
The most common ovarian cancers in younger women are germ cell tumors which are diagnosed by special tumors markers βHCG and AFP. In most of these patients with early stage disease a fertility preserving surgery is feasible followed by some form of chemotherapy if required.