Ovarian cancer is a type of cancer that begins in the ovaries. The female reproductive system contains two ovaries, one on each side of the uterus. Ovarian cancer often goes undetected until it has spread within the pelvis and abdomen. At this late stage, ovarian cancer is more difficult to treat and is frequently fatal. Early-stage ovarian cancer, in which the disease is confined to the ovary, is more likely to be treated successfully.

Types of ovarian cancer

The type of cell where the cancer begins determines the type of ovarian cancer you have. Ovarian cancer types include:

• Epithelial tumors, which begin in the thin layer of tissue that covers the outside of the ovaries. About 90 percent of ovarian cancers are epithelial tumors.
• Stromal tumors, which begin in the ovarian tissue that contains hormone-producing cells. These tumors are usually diagnosed at an earlier stage than other ovarian tumors. About 7 percent of ovarian tumors are stromal.
• Germ cell tumors, which begin in the egg-producing cells. These rare ovarian cancers tend to occur in younger women.

Factors that can increase your risk of ovarian cancer include:

• Older age. Ovarian cancer can occur at any age but is most common in women ages 50 to 60 years.
• Inherited gene mutations. A small percentage of ovarian cancers are caused by gene mutations you inherit from your parents. The genes known to increase the risk of ovarian cancer are called breast cancer gene 1 (BRCA1) and breast cancer gene 2 (BRCA2). These genes also increase the risk of breast cancer. Other gene mutations, including those associated with Lynch syndrome, are known to increase the risk of ovarian cancer.
• Family history of ovarian cancer. People with two or more close relatives with ovarian cancer have an increased risk of the disease.
• Estrogen hormone replacement therapy, especially with long-term use and in large doses.
• Age when menstruation started and ended. Beginning menstruation at an early age or starting menopause at a later age, or both, may increase the risk of ovarian cancer.

Signs and symptoms of ovarian cancer may include:

• Abdominal bloating or swelling
• Quickly feeling full when eating
• Weight loss
• Discomfort in the pelvis area
• Changes in bowel habits, such as constipation
• A frequent need to urinate
• Abnormal Bleeding
• Back pain
• Difficulty breathing
• Indigestion

Treatment of malignant ovarian tumours essentially involves surgery and chemotherapy depending upon stage and tumour type.

Endometrial cancer is also known as uterine cancer. This cancer starts in the layer of cells that form in the lining of the uterus. There are different types of uterine cancer, one of the most common types starts in the endometrium, and this type is also called endometrial cancer, the ones that occur in the muscle or supporting stromal tissue of uterine wall, called uterine sarcomas which are relatively rare.

Signs and symptoms of endometrial cancer may include:

• Vaginal bleeding after menopause

• Bleeding between periods

• An abnormal, watery or blood-tinged discharge from your vagina

• Pelvic pain

It is detected at an early stage as it constantly produces unusual vaginal bleeding, which triggers the women to visit their doctors. If in case the endometrial cancer is discovered early, then removing the uterus surgically cures this type of cancer.

Risk factors

Factors that increase the risk of endometrial cancer include:

• Older age
• Hyperestrogenic states. A disease or condition that increases the amount of estrogen, but not the level of progesterone, in your body can increase your risk of endometrial cancer. Examples include irregular ovulation patterns, such as those that can occur in women with polycystic ovary syndrome, obesity and diabetes. Taking hormones after menopause that contain estrogen but not progesterone also increases the risk of endometrial cancer.
• Early menstruation and late menopause. This increase the duration of exposure of endometrium to estrogen and thereby increasing the chances of endometrial cancer
• Nulliparity. Women who have never been pregnant have a higher risk of endometrial cancer than do women who have had at least one pregnancy.
• Obesity Being obese increases one’s risk of endometrial cancer. This happens because of peripheral conversion of hormones in the adipose tissue.
• Hormone therapy for breast cancer. Women with breast cancer who take the hormone therapy drug tamoxifen have an increased risk of developing endometrial cancer
• An inherited colon cancer syndrome. Hereditary nonpolyposis colorectal cancer (HNPCC) is a syndrome that increases the risk of colon cancer and other cancers, especially endometrial cancer. HNPCC occurs because of a gene mutation passed from parents to children. The doctor may ask for cancer test s that includes a pelvic exam, imaging tests, and a biopsy. One of the most common treatments is a hysterectomy; it is a procedure wherein the uterus is removed, if enquired the surgery also removes the ovaries and fallopian tubes and addressing the draining lymph nodes by either sentinel lymph node excision or complete lymphadenectomy depending on a case-to-case scenario. Post-surgery the need for adjuvant radiation or chemotherapy can be discussed for individual cases.

The neck of the womb or the uterus is known as the cervix. It is the narrow portion where the body of the uterus joins the vagina. Cancer is a disease caused by the abnormal growth and division of cells. Cervical cancer begins in the cells on the surface of the cervix. Cancer cervix is the third most common cancer in Indian women. Approximately 97 thousand women are diagnosed with cervical cancer and 60 thousand women die of cervical cancer in India every year.

Certain types of HPV predominantly cause cervical cancer. 99.7% of women with cervical cancer have HPV infection. HPV has two types—high risk (types 16, 18, 31, 33, 35, 45, 58 etc) and low risk (types 6, 11, etc). Low risk HPV types 6 and 11 cause genital warts in 90% women.

Two vaccines—bivalent and quadrivalent are available for preventing HPV infection. They should ideally be used before sexual exposure. They can be given between ages 9-26 years. This vaccine does not treat existing HPV infection. Nonavalent HPV vaccines are available in the U.S. which give protection against 9 HPV strains.

Pap Smear and HPV DNA are screening tests for cancer cervix. Pap smear can detect cancerous cells or changes in the cells of the cervix that may lead to cancer. While examination in the outpatient clinic cells from the cervix are collected using a wooden spatula and brush. These cells are either spread on a slide (conventional Pap smear) or sent in a liquid (Liquid based cytology/ Liquid Pap) to the laboratory.

Pap tests should begin after age 21 years and three years after initiation of sexual activity. Women younger than 30 years should have a Pap test every 2 years. HPV infection is very common in younger women, but it usually goes away on its own. A positive HPV test result in a young woman is most likely become negative without any treatment. Hence, routine HPV testing in young women less than 30 years is not recommended. Women aged 30 years and older should have a Pap test every 3 years after three normal annual Pap test results in a row. If the uterus has been removed, need of doing a Pap smear must be discussed with a gynecologist. Pap smear results may not always be accurate. The results if indicate abnormality, should not trigger panic button—the opinion of a gynecologist must be sought immediately. For women 30 years or older, cancer-causing types of HPV can be detected at the same time the Pap test is performed using liquid based method. If the results of both HPV test and Pap test are normal, no further testing is required for another 3 years.

Confirmatory diagnosis of cervical cancer is obtained by performing a biopsy from cervix under colposcopic guidance. The biopsy can be obtained from the abnormal appearing area or growth on the cervix using a punch forceps or by cutting a conical piece of the cervix using knife (conization) or by using an electrical wire known as loop electro-excision procedure (LEEP) of the cervix.

A team of Gynae Oncologists, Radiation Oncologists and Medical Oncologists manages cervical Cancer. The woman is assessed and after confirming the diagnosis of cervical cancer, the case is discussed in the Tumor Board. Based on international evidence based guidelines, a plan of action is formulated. The options of management offered are surgery, radiotherapy, chemotherapy or a combination of all the above modalities. The treatment decided depends on the clinical staging of cancer. Surgery to remove cervical cancer may be an option when the cancer is confined to the cervix.

Vulval cancer is also known as vulvar cancer. The vulva relates to the woman’s external genitals that include the soft tissue which surrounds the vagina, the clitoris (a structure about the size of a pea located at the top of a woman's vulva, above the urethral opening) and the Bartholin’s glands, that are two small glands on the each side of the vagina that secrete a fluid to enhance lubrication. It frequently begins as vulvar intraepithelial neoplasia precancerous change), which appears when healthy skin cells around the vulva undergo unusual changes. If not treated timely, the abnormal cells can turn into cancer. Usually, early-stage cancer may be not cause any signs, but women may present with persistent vulval itching, painful intercourse and urination, a lump or swelling in the vulva, bleeding or discharge from vulvar swelling, reduced pigmentation of the skin or dark patches on the skin of the vulva.

All these symptoms may be produced by other common conditions, such as infection, but if in case you notice any of these; you should see your doctor. It is unexpected that the symptoms are caused by a serious problem but it is very important to get it checked, non- cancerous conditions can be intolerable and so much better when it gets treated.

A team of Gynae Oncologists, Radiation Oncologists and Medical Oncologists manages Vulvar Cancer. The woman is assessed and after confirming the diagnosis of cancer, the case is discussed in the Tumor Board. Based on international evidence based guidelines, a plan of action is formulated. The options of management offered are surgery, radiotherapy, chemotherapy or a combination of all the above modalities. The treatment decided depends on the clinical staging of cancer. Surgery to remove vulva along with lymph nodes in the inguinal and/or pelvic regionmay be an option when the cancer is confined to the cervix.

Gynecologic cancer is distinctive, and it has different signs and symptoms, with non-similar risk factors (things that can increase the patient’s chance of getting a disease), and different prevention strategies. Here are the subsequent risk factors for different kinds of gynecologic cancers. Each cancer having its own general risk factors and can affect women in various ways. Here are the risk factors such as:

• Post-menopausal (over age 50)
• Endometrial hyperplasia – it is a condition where the cells of the endometrium are not usual
• Cervical dysplasia – It is a condition where the cervical cells are uncommon
• Obesity
• Diabetes
• High blood sugar
• Other cancers such as colon, rectal, breast
• Early age of first menstruation
• Women who have never been pregnant
• Hormone-related issues
• Family history of breast or ovarian cancer/Genetic Syndrome

Gynecology Oncology is an order that focuses on the treatment of cancers of a gynecologic nature. A gynecological oncologist treats all these diseases; they have an extensive training in the diagnosis of these diseases. The Gynecologic oncologist is a specialist that specializes in diagnosing and treating cancers, which are located on a female reproductive organ. The gynecologic oncologist performs as the captain of female’s gynecologic cancer tram, it is very important to consult gynecologist prior the treatment is started so, that a better treatment process is selected for the patient.