Genital Cancers in women

Gynaecological cancers involve the reproductive organs, namely ovaries, uterus and cervix (mostly), vulva (not uncommon) and fallopian tubes and vagina (very rare). Amongst these, the ovarian cancer is the most lethal gynaecological cancer and the fourth most common cause of cancer death in females. Cervical cancer was once a most deadly disease but with widespread screening by simple pap smear has reduced the complication rate to about 50 per cent. Mortality due to uterine (Endometrial) cancer has markedly fallen during last few years but still it occupies the eighth position in cancer death in females.

The cancers of the genital tract are mostly found in the ladies between 40 and 60 years of age, but it is not uncommon even in younger Germ cell tumors, Choriocarcinoma etc, can be seen in young ladies around 20, endometrial cancer is common in post-menopausal ladies between 55 and 65 years age.

Nulliparity, early menarche, late menopause, high fat diet, obesity, history of breast or colonic cancers are the common risk factors for ovarian and endometrial malignancies. Polycystic ovarian syndrome, chronic anovulation, unopposed estrogen replacement without progesterone as in HRT, tamoxifen use in breast cancer, etc favors the development of endometrial cancer.


Cervical cancer is common in poor socio-economic conditions, early sexual activities, multiple partners, multiparity, smoking, and infection by sexually transmitted virus called Human Papilloma Virus or HPV.

Carcinoma vulva is also thought to be associated with HPV infection. The cancers of the fallopian tubes and vagina are mostly secondary to cancer of other sites but primary lesions may also occur. A strong family history is the common risk factor for the development of ovarian cancer. In families with two or more first-degree relatives with ovarian cancer needs regular screening as the risk may exceed 50 per cent.

Symptoms of genital cancers in women

Patients suffering from genital cancers may present themselves with various symptoms. Some may remain asymptomatic even at the late stage of the disease. Patients with ovarian cancer usually present with non-gynecological complaints like vague lower abdominal discomfort, bowel dysfunction, feeling of heaviness or mass in the lower abdomen etc. Irregular or Postmenopausal bleeding, offensive vaginal discharge are common in uterine cancer. Patient with invasive stage of cervical cancer often complains of abnormal or inter menstrual vaginal bleeding, post-coital bleeding, yellowish vaginal discharge, lumbosacral pain, urinary obstruction, loss of appetite, weight loss, palpable lymph nodes etc. But non¬invasive types remain almost asymptomatic. Vulval cancer is associated with pruritus, pain, burning, swelling, color change (leukoplakia or hyperpigmentation) and ulceration. The cancer of the fallopian tubes may remain obscured, rarely there may be colicky pain in the lower abdomen followed by a profuse vaginal discharge and relief of pain. In vaginal carcinoma, symptoms are post-coital bleeding or offensive vaginal discharge.

Diagnosis of genital cancers in women

Diagnosis is made through clinical examina¬tions supported by different investigations. Ovaries being small organs lying within the huge abdominal cavity, any change of the organ usually remain obscured for many days and thus the diagnosis is difficult and often late. Suggestive history, feeling of a pelvic mass, presence of fluid in the abdomen, visualization of ulcers in the cervix, vagina or vulva need referral for proper investigations.

Ultrasonography, MRI or CT scan and testing of tumor markers as CA-125, Carcino-embryonic antigen, alpha-feto protein, beta HCG etc, FNAC or intra-operative frozen section biopsy, con¬firms the presence of malignant cells in ovarian cancer.

Endometrial biopsy (preferably hysteroscopy guided) concludes the diagnosis with 90 per cent accuracy in endometrial cancers. Cervico-vaginal cytology (introduced by George Papanicolaou, commonly known as PAP Smear) is simple, cheap yet almost 90-95 per cent accurate in detecting the early lesions of cervical cancer. Based on this smear report the cervical conditions are grouped in different categories. Normal or susceptible PAP cases are advised for regular follow up, but suspected cases are guided for further investigation like testing for HPV, Colposcopy guided cervical biopsy, endocervical biopsy etc. Non-invasive cases are treated conservatively with regular follow up but invasive cases are managed accordingly. When any lesion is clearly visible in cervix, cervical biopsy is directly done. Additional investigations are necessary for staging of the definite cervical cancer cases.

Treatment genital cancers in women

Treatment includes surgical intervention, chemotherapy and radiotherapy, if detected early, the ovarian, uterine and cervical carcinoma can be effectively cured by removal of uterus with both the ovaries (Hysterectomy with bilateral salpingo-oophorectomy), precancerous vulval lesions by simple vulvectomy. In advanced cases more extensive surgery is necessary which may include omentectomy, debulking of tumour mass, lymphadenectomy (ovarian cancer), extended total hysterectomy (uterine cancer) Wertheim's hysterectomy (cervical or vaginal cancer) radical vulvectomy (Vulval cancer) etc. All these surgical procedures should be followed by adequate chemo or radiotherapy, the schedule of which depends upon the stages, cell type and extent of metastasis.

"Carcinogenesis is not an event but a process" Taking some adequate preventive measures can certainly restrict the advancement of this process. One should be careful to avoid the risk factors, report early to the doctors and surrender her to the screening or investigation procedures. Emphasis must be given that there is no role of alternative medicines to treat the cases of cancer. One should try to avoid obesity, early sexual exposure, and multiple sex partners. Use of oral contraceptives, tubal ligation, breast-feeding, hysterectomy with bilateral oophorectomy, correction of unopposed use of estrogen with addition of progesterone etc can minimize the chances of genital cancer. Each pregnancy reduces the risk of ovarian cancer by 10 per cent. Screening of the suspected or high risk cases should be carried on simultaneously. Awareness should be generated amongst the women for a periodic check up, particularly when she feels something unusual deviating from her healthy life. Simple clinical examinations, a transvaginal sonography, tests for few tumour markers, aspiration or fractional curettage of endometrial tissue, PAP smear etc can be carried out as screening procedures.

Gardasil, a major breakthrough recently, a vaccine against Human papilloma virus, which is responsible for Cervical Carcinoma is now available. All the girl children should be protected by the recommended dosage with this vaccine.

Despite major advances in screening and diagnosis of cancer, the effective control of the disease is not yet possible due to poor understanding and various myths about the disease conditions. In India, women seek medical help when it is incurable. Awareness, modern methods of screening and diagnosis, improved techniques of surgery, chemotherapy or radiotherapy have significantly decreased the sufferings of cancer, better survival rates, lesser morbid conditions and improved life-styles. Reducing mortality and high cure rate can only be possible if diagnosis could be made in the first or second stage of the disease, and if possible, in susceptible cases, even much earlier.