Gynecological cancers

What is it about ?

Gynecological cancers are cancers of the female genital organs. Malignant tumors can develop in the following organs:

• The cervix;
• The uterus;
• The ovaries;
• Fallopian tubes;
• The vagina;
• The lips.

Risk factors

Cervical cancer

• Sex at a young age;
• Multiple sexual partners;
• Smoking;
• Multiple pregnancies;
• Infection with human papillomavirus (HPV).

Uterus cancer

• Menopause;
• Obesity ;
• Diabetes ;
• Multiple cysts in the ovaries (polycystic ovary syndrome) ;
• Menopause late ;
• Never having had a child (nulliparity);
• Long-term estrogen-based hormone therapy, without progestogen.

On the other hand, the prolonged use of a combined pill reduces the risk of uterine cancer.

Ovarian cancer

• Family history ;
• Endometriosis (= presence of uterine lining (endometrium) outside the uterus);
• Be over 40 years old;
• Never having had a child (nulliparity);
• Endometriosis.

Factors that reduce the risk of ovarian cancer are:

• Feeding with milk ;
• Combined pill ;
• Pregnancies.

What is their frequency?

Gynecological cancers

In 2018, the Cancer Registry Foundation registered in Belgium:

• 634 new cases of Cervical cancer¹ ;
• The disease mainly affects women between the ages of 30 and 70.

• 1,429 new cases of Uterus cancer² ;
• Uterine cancer is the 5^th most common cancer in women.
• The average age of women with uterine cancer is 70.
• Almost all uterine cancers (95 times out of 100) occur after the age of 50.

• 748 new cases of ovarian cancer³.
• Ovarian cancer usually develops in women over the age of 55, but it can occur at any age.

• Cancers of the vagina, labia and fallopian tubes are much less common.

Cervical cancer

Cervical cancer is the 3^th most common cancer in women worldwide. It is the most common gynecological cancer.

Cervical cancer is no longer as common in Belgium thanks to screening programs with smear and vaccination against HPV virus.

How to recognize them?

A large number of gynecological tumors do not cause symptoms.

You may suffer from:

• Bloody or smelly vaginal discharge;
• Irregular periods ;
• Bleeding after intercourse;
• Bleeding after menopause.

In the case of a advanced tumor, you may have the following symptoms:

• Weightloss ;
• Fever ;
• Stomach aches ;
• Weakness ;
• Tired ;
• Bloated stomach.

How is the diagnosis made?

• The doctor can perform a smear for detect cervical cancer.
• Uterine cancer can be diagnosed by taking a piece of tissue from the uterus to analyze it (biopsy).
• Likewise, ultrasound is an important test, for example to detect ovarian cancer.
• If the results are not normal, the doctor may do other tests, such as a CT scan or MRI belly.

What can you do ?

Smear

• Ask for a smear from the general practitioner, every 3 to 5 years, between 25 and 65 years old.
• the smear is included in the national screening program in order to detect cervical cancer at an early stage.
• Unless contraindicated, women vaccinated against HPV should also be track down every 3 to 5 years.

HPV vaccination

• THE’infection with HPV (human papillomavirus) is the leading cause of cervical cancer (98 times out of 100).
• HPV vaccination is part of the basic vaccination program.
• The HPV vaccine is given free of charge by the school doctor to girls and boys during the first years of secondary school, unless parents refuse it.
• HPV vaccination should preferably be given before young people start their active sexual life.

What can your doctor do?

Cervical cancer

Diagnostic

• The doctor makes the diagnosis of cervical cancer on the basis of a smear abnormal and a HPV DNA test.
• In the majority of cases, a biopsy is necessary to confirm the diagnosis.
• A ultrasound or a MRI can determine the extent of cancer.

Processing

Treatment varies depending on the stage of the cancer.

• The doctor can remove the cervix in part or in whole, with or without the lymph nodes and surrounding tissue.
• If the tumor is too large, a chemotherapy can reduce it. And the doctor can then remove the tumor.
• Sometimes the operation is no longer possible and the tumor must be irradiated (radiotherapy).

Uterus cancer

Diagnostic

• The doctor takes a piece of tissue from the lining of the uterus (endometrium) (biopsy).
• He makes the diagnosis of uterine cancer on the basis of this biopsy.
• The doctor (gynecologist) decides on the need for a biopsy based on the thickness of the uterine lining.
• A ultrasound, an examination of the interior of the uterus using a small camera (hysteroscopy) and / or a MRI can determine the extent of cancer.

Processing

• Doctor remove the uterus during an operation (hysterectomy), with or without the surrounding tissue.
• Occasionally, chemotherapy or a radiotherapy is necessary.

Ovarian cancer

Sometimes ovarian cancer goes without symptoms for a long time. In 3 out of 4 cases, the tumor is not discovered until when it has already spread to a membrane that lines the inside of the belly and the organs located there (peritoneum), to the diaphragm, to the intestines or lymph nodes.

Diagnostic

The doctor makes the diagnosis of ovarian cancer on the basis of a ultrasound and or CT scan or MRI and biopsies.

Processing

• Doctor took of at a time uterus, the ovaries and the lymph nodes and fabrics surrounding areas. This is the treatment of first choice.
• Chemotherapy can be administered before or after the operation.

Vaginal cancer

Proper treatment of the precursors of this cancer, by laser treatment or by surgery, can prevent their development into cancer.

Diagnostic

Your doctor can diagnose vaginal cancer using a biopsy.

Processing

Treatment for vaginal cancer consists of surgery.

Lip cancer

A burning sensation, itching, and pain in the vulva may suggest lip cancer.

Diagnostic

The doctor makes the diagnosis on the basis of a biopsy.

Processing

Treatment consists of surgery, possibly followed by chemotherapy or radiation therapy.

Fallopian tube cancer

The diagnosis and treatment of fallopian tube cancer is the same as described for ovarian cancer (see above).

Want to know more?

• Anatomy of the female reproductive system (image) – Larousse

• What is the Papillomavirus? (video) – LoveAttitude
• Modes of transmission of STIs – Depistage.be
• Protecting yourself against STIs – PPS – AIDS prevention platform
• The external condom – Mon Contraceptif – O’Yes

• Cervical cancer – Foundation against cancer
• Uterine cancer – Cancer Foundation
• Ovarian cancer – Cancer Foundation
• Vulvar cancer – Cancer Foundation

• Screening for cervical cancer (smear, colposcopy) – Fondation contre le cancer
• Colposcopy – Erasme ULB Hospital
• General gynecology exams – UZ Brussels

• For the vaccine, I hesitate … Is it serious doctor? – Health question
• Human papillomavirus (HPV) infections – Vaccination-Info.be

• Chemotherapy – Foundation against cancer
• Radiotherapy – Foundation against cancer

Are you looking for more specialized help?

• Approved family planning centers in Wallonia and Brussels – LoveAttitude

Sources

• https://kankerregister.org/en
• 1 Cancer Fact Sheet – Belgian Cancer Registry – Cervical cancer
• 2 Cancer Fact Sheet – Belgian Cancer Registry – Uterine cancer
• 3 Cancer Fact Sheet – Belgian Cancer Registry – Ovarian cancer
• Cancer Fact Sheets, Belgian Cancer Registry, Year of incidence 2018, Brussels 2019 (https://kankerregister.org/Cancer_Fact_Sheets_FR_versie)
• Foreign clinical practice guide ‘Gynecological cancers’ (2013), updated on 08/10/2017 and adapted to the Belgian context on 04/14/2019 – ebpnet