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Gynaecological cancer affects the tissue and organs of the female reproductive system.

These include the cervix, uterus, vagina, vulva or other areas of the pelvis. Approximately 5000 women are diagnosed with gynaecological cancer each year in Australia, and almost a third of these will not survive this disease.

Gynaecological cancers have not been researched as well as other cancers, such as breast cancer.

Little is known about the support that women need during and after treatment. More research is needed to establish what the best treatments are, how we can prevent this deadly disease and ultimately, to find a cure.

Ovarian cancer

Ovarian cancer begins in one or both ovaries, a pair of solid, oval-shaped organs producing hormones and eggs (ova). Recent research suggests that certain ovarian cancer types might even start in the Fallopian tubes.

Every year in Australia, 1200 women are diagnosed with ovarian cancer, primary peritoneal cancer or fallopian tube cancer. 800 patients will die of their disease. Risk factors include genetic conditions (BRCA1, BRCA2, Lynch/HNPCC). The oral contraceptive pill reduces the risk of ovarian cancer by 50%. Prophylactic, risk-reducing surgery (removal of ovaries and fallopian tubes) protects from ovarian cancer by 80% to 90%.

Due to the lack of early symptoms and inefficiency of screening, two out of three patients are diagnosed at advanced stages (stage three or four). Patients with early stage disease (stage one or two) require surgical removal of the tubes and the ovaries, as well as a staging procedure to determine the extent of cancer spread. Patients with advanced stage ovarian cancer require surgical removal of as much cancer as possible.

This may include removal of uterus, tubes, ovaries, omentum, bowel, spleen, diaphragm and abdominal peritoneum. The size of the tumour left behind after surgery determines the prognosis to a large extent. If large scale surgery is not feasible, patients will have some chemotherapy upfront, followed by delayed surgery and more chemotherapy thereafter. Virtually all patients require chemotherapy, to which 85% of patients respond well. However, the majority of patients with advanced ovarian cancer will relapse.

Current research focuses on the development of new markers indicating the earliest possible stage of ovarian cancer. Diagnosing and commencing treatment of ovarian cancer early might result in better survival outcomes. Other research addresses the selection of patients for advanced surgery as well as measures to improve recovery from treatment.

Cervical cancer

Cervical cancer begins in the cervix, the lower, cylinder-shaped part of the uterus. Its upper margin is connected to the uterus, while its lower margin is connected to the vagina.

Approximately 700 women are diagnosed with cervical cancer every year in Australia. Of those, 200 will die of their disease. Cervical cancer develops on the basis of an infection with one or more strains of HPV (Human Papilloma Virus) through early age at intercourse, multiple sexual partners and smoking. Cervical cancer develops through pre-cancerous stages (cervical dysplasia, CIN) over many years. The introduction of the PAP smear screening has reduced the incidence of cervical cancer dramatically in countries of the developed world. While the incidence of cervical cancer in USA, Australia and Europe is low, its incidence in countries of the developing world is very high.

Australia was one of the first countries to roll out a national cervical cancer immunisation campaign using Gardasil. Gardasil is a vaccine that protects young women from the strains of human papillomavirus (HPV) that cause 70% of cervical cancers. Vaccination with Gardasil is most effective when given to females before they are likely to be exposed to HPV. Four out of five people will be exposed to HPV during their lifetime and exposure to HPV from a single lifetime partner can still be enough to result in an infection that can lead to cervical cancer.

Treatment depends on the stage of disease. Very early cervical cancer (microinvasive) can be treated by a cone biopsy or a ‘simple’ hysterectomy. Patients with cervical cancer limited to the uterine cervix require a radical hysterectomy, at which a safety margin around the cancer is taken. These patients also require removal of lymph nodes along the large blood vessels in the pelvis. Patients with advanced disease (stage 2+) require a combination of chemotherapy (weekly) plus radiotherapy (daily) for four to six weeks. Survival depends on the stage of disease with more than 75% of patients surviving stage 1.

Endometrial cancer

Endometrial cancer begins in the main body of the uterus, a hollow organ about the size and shape of an upside-down pear. The uterus is where the baby grows when a woman is pregnant.

Approximately 1600 women are diagnosed with uterine cancer (also called endometrial cancer) each year in Australia. Due to an early warning symptom (abnormal uterine/vaginal bleeding) the vast majority of patients with uterine cancers are diagnosed at an early stage. Obesity, hypertension and older age increase the risk of uterine cancer.

Standard treatment is a full hysterectomy, removal of both fallopian tubes and the ovaries. The extent of the disease will be determined by preoperative imaging and removal of lymph nodes along the large blood vessels in the pelvis. Most patients do not require post-operative treatment. However, patients at higher risk of relapse are recommended to have chemotherapy, radiotherapy or a combination of both, depending on the cell type and extent of the disease.

Outcomes are generally excellent with more than 90% of patients with stage one disease surviving the five year mark. Patients with high-risk uterine cancer (e.g. uterine papillary serous carcinoma) have a worse outcome.

Current research focuses on less invasive surgical techniques, which may lead to improved recovery from surgery with equal chances for survival. For patients with high-risk uterine cancer, cancer centres such as the Queensland Centre for Gynaecological Cancer try to find combinations of treatment (including new biological agents) to improve survival.

Uterine cancer

Uterine cancer begins in the main body of the uterus, a hollow organ about the size and shape of an upside-down pear. The uterus is where the baby grows when a woman is pregnant.

Approximately 1600 women are diagnosed with uterine cancer (also called endometrial cancer) each year in Australia. Due to an early warning symptom (abnormal uterine/vaginal bleeding) the vast majority of patients with uterine cancers are diagnosed at an early stage. Obesity, hypertension and older age increase the risk of uterine cancer.

Standard treatment is a full hysterectomy, removal of both fallopian tubes and the ovaries. The extent of the disease will be determined by preoperative imaging and removal of lymph nodes along the large blood vessels in the pelvis. Most patients do not require post-operative treatment. However, patients at higher risk of relapse are recommended to have chemotherapy, radiotherapy or a combination of both, depending on the cell type and extent of the disease.

Outcomes are generally excellent with more than 90% of patients with stage one disease surviving the five year mark. Patients with high-risk uterine cancer (e.g. uterine papillary serous carcinoma) have a worse outcome.

Current research focuses on less invasive surgical techniques, which may lead to improved recovery from surgery with equal chances for survival. For patients with high-risk uterine cancer, cancer centres such as the Queensland Centre for Gynaecological Cancer try to find combinations of treatment (including new biological agents) to improve survival.

Vaginal cancer

Vaginal cancer begins in the vagina (also called the birth canal), a muscular tube-like channel that extends from the cervix to the external part of the females sex organs (vulva).

Vaginal cancer is rare. We see less than 20 patients with vaginal cancer every year in Australia. Due to its rareness, knowledge about risk factors is sparse. While most cancer is of “skin” type (squamous cell carcinoma, melanoma), some cancers are very aggressive arising from stromal tissue (sarcomas) or from glandular tissue (adneocarcinomas). Treatment involves surgical excision for very early cancers and radiotherapy, chemotherapy or a combination of both for more advanced cancers.

Vulval cancer

Vulval cancer begins in the vulva, the outer part of the female reproductive system. It includes the opening of the vagina, the inner and outer lips (also called labia minora and labia majora), the clitoris and the mons pubis (soft, fatty mound of tissue, above the labia).

Approximately 150 women are diagnosed with vulval cancer every year in Australia. Elderly patients with a history of other vulval skin disorders or younger patients exposed to the Human Papilloma Virus (HPV) are at risk of developing vulval cancer.

Treatment includes surgical removal of the involved vulval skin sometimes requiring plastic surgery to cover the skin defects. Vulval cancer may spread to the lymph nodes in the groins and therefore they need surgical exploration as well. Selected patients require radiotherapy to the vulva, the groins or both. Survival of vulval cancer is generally good, but the side effects from treatment are significant (wound break down, lymphoedema).

Current research focuses on new techniques with which research centres aim to diagnose lymphoedema earlier. The earlier lymphoedema is diagnosed, the more successful treatment will be.