Gynecologic Cancer

  Gynecologic  |  Head & Neck  |  Gastrointestinal  |  Urologic  |  Breast Cancer

These are cancers occurring in the uterus, cervix, ovaries, fallopian tubes, vagina and vulva.

A standard approach would be the initial diagnosis is confirmed by a biopsy and a clinical staging is done by pelvic examination.

Radiological imaging in the form of CT scans or MRI scans helps in confirming the clinical stage and rules out obvious metastatic disease.

The options of management would then be discussed with the patient taking the overall picture i.e. age of the patient, associated medical problems, pathology of the biopsy, clinical stage and findings of the scans.

  Cervical Cancer:

This is one of the most common cancers in women.


Early Stage Cancer: Stage A1, A2, B1 usually would be advised surgery. Radical Hysterectomy would be done by the standard open approach or by the laparoscopic method.

Stage B2, IIA disease: Treatment needs to be individualized. In selected patients initial chemotherapy (known as neoadjuvant chemotherapy) may need to be given to downsize the tumor before planning surgery. In some patients it is possible to operate primarily. An alternative to surgery is concurrent chemotherapy and radiotherapy i.e. both therapies are given simultaneously.

Stage IIB, IIIA, IIIB, IVA: These stages are usually treated with concurrent chemotherapy and radiotherapy.

Recurrent or Residual disease: Selected patients would undergo radical surgery – usually exenterations i.e. removal of uterus + adjacent organ/organs. Following exenterations patients require rehabilitation from stoma care specialist.

  Ovarian And Fallopian Tube Cancers:

Evaluations are done by


CT scans,

Usually there is no requirement for a biopsy prior to surgery.

Tumor markers CA 125, CEA.

  Treatment options:

If chemotherapy is planned initially then it is necessary to obtain confirmation of diagnosis of cancer prior to starting treatment. We would do this either by fluid cytology in case of presence of free fluid in the abdomen or by a diagnostic laparoscopy.

Nearly all these cancers require a combination of surgery and chemotherapy as their treatment.

Most often a primary surgery is followed by chemotherapy.

Surgery involves an extensive clearance of all tumour bearing tissues and organs, lymph node dissections. It is a painstaking surgery and should be done by specialists, as one of the major prognostic factors for these cancers is the quality of surgical clearance of the disease.

When chemotherapy is given following surgery 6 cycles are used at 3 week intervals. Chemotherapy is managed as a day care procedure. Sometimes when chemotherapy is used prior to surgery usually 3 cycles are given prior to reassessment for response and surgery. In these patients after the surgery the rest of the 3 cycles would be administered.

  Uterine/Endometrial Cancers:
  Endometrial cancers are diagnosed by

Endometrial biopsy

Curettage of the uterine cavity.

CT scan or

MRI scan is done to assess the extent of disease and rule out obvious spread.

Surgery is the mainstay in the management and also it helps stage the disease so that further treatment can be planned.

Radiation and/or chemotherapy is sometimes required depending on the surgico-pathologic staging. Surgery for endometrial cancer is often done laparoscopically, in selected patients the open approach might be preferable.

  Vulval Cancer:

Presently most vulval cancers present with small non-healing ulcers and/or persistent itching. Hence most are at a relatively early stage and are amenable to vulvectomy. In case there is spread to the inguinal nodes then those are surgically excised after a 3-4 week period to allow the vulvectomy wound to heal. As and when required adjuvant therapy is advised depending on pathology reports of the excised surgical specimen.

  Vaginal Cancer:

Most primary vaginal cancers would be managed by concurrent chemotherapy and radiotherapy.

However, there will be individual cases where in it is thought that this treatment may not be effective enough, or there is a presentation with a fistula formation – in those patients often exenteration surgery is required.

Those patients who have relapsed or have residual disease after the initial chemotherapy / radiotherapy need to be assessed for exenterative procedures as the last resort.