Gynecologic Oncology

Gynecologic Oncology Surgery

Gynecologic oncology surgery is a discipline that deals with cancers and precancerous lesions of female genital organs. Gynecologic oncology surgeons need to have a comprehensive training for treatment of gynecologic cancers. Therefore, gynecologist oncologists plan and supervise surgical management, chemotherapy and palliative care for the lifetime of women with gynecologic cancers, after diagnosis is established. A team of medical oncologist, pathologist, radiologist, radiation oncologist and nurses is involved in treatment of gynecologic oncology patient and gynecologic oncologist acts like captain of the treatment team. Moreover, the challenging diagnosis and treatment protocols should be performed by experienced teams in fully equipped hospitals.

Diseases Dealt By Gynecologic Oncology:

It deals with and treats malignant tumors of external genital organs (vulva), cervix, uterus and ovaries and other pathologies that may transform into malignant diseases. Gynecologic oncology management combined with multidisciplinary approach is required to prevent, diagnose and treat malignant diseases of female genital organs.

Some brief details about diseases dealt by gynecologic oncologic surgery department

External female genital organ (vulva) cancer:

Vulvar cancer begins in the skin that lines the vagina, also including clitoris and labia. Vulvar cancers are not prevalent. The human papilloma virus that increases the risk of cervical cancer is, unfortunately, also increasing the risk of vulvar cancer. Vulvar cancer is a treatable condition, but early diagnosis maximizes the efficiency of treatment, as is the case with all other cancers, before the tumor spreads. Vulvar cancer is commonly detected at very elderly population.

The cancer can be completely cured, if it is diagnosed at an early stage; these conditions require a doctor visit for early diagnosis;

• Vulvar itching and burn that does not disappear and persist for a certain period of time; bleeding not related to menstrual bleeding; pale and red discoloration of labial skin, rashes, warts and superficial changes that cause thickening of the labial skin; vulvar tenderness and swelling; inguinal pain in voiding or sexual intercourse.
• For patients who visit a doctor with these complaints, biopsy specimen is taken to verify whether there is a precancerous lesion of vulva (VIN) or vulvar cancer. If there is no lesion that can be seen by naked eye, vulvoscopy is used to guide the biopsy procedure.
• Local large excision, vulvectomy, radiotherapy and chemotherapy can be used alone or in combinations for treatment of vulvar cancer depending on the stage.

Endometrial Cancer:

Ebdometrial cancer begins in the innermost layer of uterus that falls out in each menstrual cycle. Endometrial cancer is one of the most common female reproductive system cancers. Incidence usually increases in postmenopausal ages.

The risks of endometrial cancer include age, obesity, hormonal disorders and genetic predisposition. There is no appropriate screening test for endometrial cancers. Complaints emerge in early stage of the disease in most women. The most common sign of endometrial cancer is postmenopausal bleeding. Usual menstrual pattern may change in younger women. In conclusion, endometrial cancer is diagnosed and treated at an early stage in most cases. Postmenopausal vaginal bleeding is the most common sign of the endometrial cancer.

Treatment of Endometrial Cancer;

Surgical management is the most preferred treatment modality for endometrial cancers. Surgery not only removes the endometrial cancerous tissues, but also determines the stage. A surgical procedure removes uterus and cervix (hysterectomy) as well as Fallopian tubes and ovaries in minimum. Usually, dissection of pelvic and intra-abdominal lymph nodes are also included. For the surgical management, traditional open surgery (abdominal skin incision) or minimally invasive surgery techniques (laparoscopic or robotic) can be used.

Radiation Therapy: radiation therapy is commonly used for women with endometrial cancer. It helps reduction of relapse risk in women in the light of the surgical findings. Radiotherapy is considered for endometrial cancers that are deeply located in the uterine wall and spread to cervix, vagina or lymph nodes. Radiotherapy can supersede surgical treatment, if the cancer cannot be completely removed with a surgical procedure or a surgery is not safe due to various medical reasons.

Chemotherapy: chemotherapy is typically recommended for advanced-stage (Stage III-IV) endometrial cancers and relapses (re-occurrence of the disease following the baseline treatment).

Hormone therapy: hormone therapy is not regarded as standard treatment, but a physician can recommend this modality for a patient with strong future conception plans, if the cancer is confined to the uterus.

Ovarian Cancer: ovarian cancer begins in ovaries. There are two ovaries in the body, one at each side of the uterus; ovaries are a pair of reproductive organ that produce eggs and is the main source of female sex hormones, estrogen and progesterone. Ovarian cancer is the ninth most common cancer in women, but it is the most fatal gynecologic cancer. Cause of ovary cancer is not clearly known and there is no method that is routinely used for early diagnosis. An ovarian cancer cannot being in the absence of high risk, but it may not develop in people with high risk. However, the risk of ovarian cancer may be higher in women with following conditions; carrier status of BRCA1 or BRCA2 mutation; strong family history of breast or ovarian cancer; personal history of breast cancer; women who are maintained in on estrogen (progesterone-free) replacement therapy for more than five years; endometriosis; advanced maternal age in pregnancy and childbirth; advanced age; and obesity – especially if BMI is equal to or above 30.

Gynecologic oncologists are trained and educated in comprehensive treatment of gynecologic cancers. In other words, they coordinate every aspect of management in women with ovarian cancer, ranging from diagnosis to surgery, chemotherapy, survival and palliative care till the death.

Cervical Cancer: cervical cancer begins in the lower part of the uterus, called cervix. Cervix is the lower part of the uterus that opens to the vagina and dilates and effaces during labor. Cervical cancer is among the most fatal cancers in women and it is still prevalent in developing countries. Five-year survival rate is 92% for women with cervical cancer diagnosed at an early stage. These promising outcomes for cervical cancer arise out of Pap smear test that enables early detection of precancerous cells. Although cervical cancer is diagnosed in women older than 65 approximately by 20 percent, the condition mostly involves women at 30s, 40s and 50s of age.

Cervical cancer is secondary to long-standing and persistent high-risk HPV infection. Approximately 13 high-risk types of HPV are identified that may lead to cervical cancer. HPV 16 and 18 are two high-risk HPVs that are commonly identified in cervical cancers in Turkey. Pap smear and HPV test can decrease the risk of cervical cancer.

Risk factors for cervical cancer;

• HPV-positive women,
• Women without HPV immunization,
• Women who do not have Pap smear test at regular intervals to identify precancerous lesions,
• Women with abnormal Pap smear result or diagnosed with precancerous cellular changes in the cervix,
• Women with history of cervical cancer
• Women with more than one sex partner, resulting in increased risk of HPV infection,
• Women with a partner who has high-risk sexual activities (for instance, if a partner having sexual intercourse with more than one partner, the risk of HPV infection is high for both partners)
• Women having sexual intercourse at young age
• HIV infection or any condition that suppresses or weakens the immune system.
• Smoking women

Colposcopy: colposcopy enables magnified or close-up examination of cervix, vagina and vulva. Colposcope is a tool with an integrated light source and it allows close-up examination of the cervix; thus, it guides physicians to biopsy the cancerous tissue that is at an early stage and cannot be seen with naked eye. Colposcopy is performed to reveal out the cause of abnormal cellular changes, if any, and this test helps detection of cervical cancers at a very early stage.

What are treatment options? Treatment options for cervical cancer depends on the stage of cancer. Treatment is relatively easier and surgery is preferred for cervical cancers that are diagnosed at early stages.

Surgery: the surgical management of small and early-stage cancer is hysterectomy (surgical removal of uterus and cervix). Various types of hysterectomy can be recommended depending on spread of the cervical cancer. The surgery can be carried out with conventional open surgery or minimally invasive techniques, such as laparoscopy or robotic surgery. Selection of surgical technique is based on many factors, including but not limited to experience and preference of surgeon, size of cancer and anatomic structure of the patient. Your doctor will discuss this decision with you in detail.