Gynecologic oncology is a specialized field of medicine that focuses on cancers of the female reproductive system, including ovarian cancer, uterine cancer, vaginal cancer, cervical cancer, and vulvar cancer. As specialists, they have extensive training in the diagnosis and treatment of cancers. In the United States, 82,000 women are diagnosed with gynecologic cancer annually. In 2013, an estimated 91,730 were diagnosed. In 2022 an estimated 144,000 women were diagnosed with GYN cancers in US. There is low quality evidence which demonstrates women with gynaecological cancer receiving treatment from specialized centres benefit from longer survival than those managed in standard care. A meta analysis of three studies combining over 9000 women, suggested that specialist gynaecological cancer treatment centres may prolong the lives of women with ovarian cancer compared with general or community hospitals. In addition, a meta‐analysis of three other studies which assessed over 50,000 women, found that teaching centres or specialized cancer centres may prolong women's lives compared to those treated in community or general hospitals. Gynecological cancers comprise 10-15% of women's cancers, mainly affecting women past reproductive age but posing threats to fertility for younger patients. The most common route for treatment is combination therapy, consisting of a mix of both surgical and non-surgical interventions (radiotherapy, chemotherapy).
Signs and symptoms Signs and symptoms usually vary depending on the type of cancer. The most common symptoms across all gynecological cancers are abnormal vaginal bleeding, vaginal discharge, pelvic pain and urination difficulties.
Vulvar cancer
Pruritus: persistent itch in the vulva Vulvar bleeding Vulvar pain, soreness or tenderness Burning sensation when urinating A visible wart-like mass or sore on the vulva
Risk factors
Obesity Obesity is associated with an increased risk of developing gynecologic cancers such as endometrial and ovarian cancer. For endometrial cancer, every 5-unit increase on the BMI scale was associated with a 50-60% increase in risk. Type 1 endometrial cancer is the most common endometrial cancer. As many as 90% of patients diagnosed with Type 1 endometrial cancer are obese. Although a correlation between obesity and ovarian cancer is possible, the association is predominantly found in low-grade subtypes of the cancer.
Genetic mutations Genetic mutations such as the BRCA1 and BRCA2 have been strongly linked to the development of ovarian cancer. The BRCA1 mutation has been shown to increase the risk of developing ovarian cancer by 36% - 60%. The BRCA2 mutation has been shown to increase the risk of developing ovarian cancer by 16% - 27%.
Human Papilloma Virus (HPV) Human Papilloma Virus (HPV) is a common sexually transmitted disease that has been associated with some gynecologic cancers, including those of the cervix, vagina, and vulva. A clear link between human papilloma virus and cervical cancer has long been established, with HPV associated with 70% to 90% of cases. Persistent human papilloma virus infections have been shown to be a driving factor for 70% to 75% of vaginal and vulvar cancers.
Smoking Smoking has been found to be a risk factor for the development of cervical, vulvar and vaginal cancer. Current women smokers are twice as likely to develop cervical cancer compared to their non-smokers counterparts. Several mechanisms have been researched to understand how smoking plays a role in the development of cervical cancer. The cervical epithelium's DNA has been shown to be damaged due to smoking. DNA damage levels in the cervix cells were higher in smokers when compared to non-smokers. It has also been postulated that smoking can lower the immune response to HPV as well as amplify the HPV-infection in the cervix. Through similar mechanisms, women smokers have also been found to be 3 times more likely to develop vulvar cancer. Smoking has also been associated with an elevated risk for vaginal cancer. Woman smokers are at double the risk for developing vaginal cancer when compared to women non-smokers.
Infertility Infertility is a common disease affecting young adults. Some studies have shown that 1 in every 7 couples will fail to conceive due to infertility problems. Infertility is a known risk factor for gynecologic cancers. Infertile women are at a higher risk of developing ovarian cancer and endometrial cancer when compared to fertile women.
Diagnosis
Treatments
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