Dr. Hugo Rodrigues Gaspar

Gynaecologist /Obstetrician 

Gynaecological cancer
Prevention begins with understanding

HPA Magazine 15

Gynaecological cancer is any type of cancer that originates in the female reproductive system. It is named according to the structure from which it originated: cervical cancer, endometrium (lining of the uterus), ovary/fallopian tube, vagina, vulva, gestational trophoblast neoplasia and uterine sarcomas. It also includes breast cancer not covered in this article.
According to the data of Globocan (International Cancer Research Agency), in 2018 there were 750 new cases of cervical cancer in Portugal, 1069 of the uterus, 574 of the ovaries, 222 of the vulva and 33 cases of vaginal cancer. 
Depending on the type of cancer, the risk factors, preventive strategies, diagnoses and treatment are different. In this article I will highlight some aspects of the most frequent types of cancer: cervix, endometrium and ovary.

BE PROTECTED AND INFORMED 
Evaluation by a Gynaecologist is very important and can prevent the onset or early diagnosis of many cases of oncological pathology, thus, greatly improving the prognosis of the disease and the radical treatment. The gynaecological evaluation should be performed at least once a year, or in case there are warning signs.

CERVICAL CANCER
The cause of cervical cancer is in most cases a persistent infection with the human papilloma virus (HPV). It is important to note that about 50-80% of sexually active women will have this infection at some stage in their lives, but only a small number will have cervical cancer. To prevent this type of cancer there is the HPV vaccine, which is currently part of the National Vaccination Plan, for both girls and boys. The vaccine can also be administered in adulthood and has an efficacy of about 90% in the prevention of pre-malignant lesions and cervical cancer. It should be noted that it can also protect other types of cancer: anus, oropharynx, vagina, vulva and penis.
Another strategy in the prevention of this type of cancer is to undergo a cervical cytology test (Pap smear) and /or the HPV test.

ENDOMETRIC CANCER
In developed countries it is the most frequent type of gynaecological cancer, appearing mainly after the age of 50 years, but it can also occur at an earlier age (4% appear before the age of 40 years). The risk factors are age, obesity, hormone therapy with oestrogens when progesterone is not used, therapy with tamoxifen (drug used to treat some cancers), having family members with endometrial or colorectal cancer, having undergone pelvic radiation therapy, among others.
The warning signs are abnormal vaginal bleeding and vaginal discharge. This type of cancer can also cause pain or pelvic pressure.
It should be noted that women should see their gynaecologist should bleeding occur after menopause. Fortunately, in most cases the diagnosis will not be endometrial cancer.

OVARIAN AND FELLOPIAN TUBE CANCER 
This type of cancer has a lower incidence than the previous ones, but it is unfortunately one of the most lethal types of cancer in women. Symptoms are initially negligible, so that about 75% of cases, when diagnosed, are already in an advanced stage.
You should be alert and seek medical help if: experience pelvic, abdominal or back pain; increased abdominal volume; feeling very full or having difficulty eating; urinary urgency; constipation or marked fatigue.
For the prognosis of this type of tumour, the initial treatment strategy, quality/differentiation of the surgery to be performed and the appearance of new therapies are very important.
One way to reduce the risk of its onset is to remove the fallopian tubes. This procedure should be considered in cases of permanent contraception (tube ligation) or surgery due to other causes.

THE IMPORTANCE OF A MULTIDISCIPLINARY TEAM AND SPECIALIZATION / DIFFERENTIATION
The diagnosis, treatment and follow-up of patients with gynaecological cancer must be multidisciplinary, that is, in addition to Gynaecology, it must include other medical specialties: Medical Oncology, Radio-oncology, Imaging and Laboratorial Pathology (among others).
Oncological Gynaecology is a sub-specialty of Gynaecology and Obstetrics that is dedicated to these pathologies. Each patient and each case are different and therefore the approach must be personalized. From a surgical point of view, the treatment of these patients can be complex and requires specialization. We know that minimally invasive surgery can be applied in many cases, with several advantages: less blood loss during surgery, less pain in the postoperative period, better aesthetic results and faster recovery. In certain situations, the classic procedure (laparotomy) is preferable and, in these situations, it is necessary to follow the most recent protocols for the pre, intra and postoperative approach. The collaboration of Anaesthesiology for its therapeutic success is also very important.
It is also important to have Specialists who specialize in General Surgery, Urology, Plastic Surgery, Intensive Care, Medical Genetics and Nuclear Medicine, with experience in treating cancer patients, as well as other health professionals: nurses, psychologists, nutritionists and physiotherapists. Differentiation and teamwork are crucial to provide the quality care that respects the specificity of each patient.