We define cancer as the uncontrolled and persistent growth of a group of cells that may appear in any of the tissues of the female genital tract and which endangers the patient’s life. Today, early diagnosis is considered the most important factor in providing the best treatment with the highest chance of success. We must bear in mind that there is no diagnostic 100% certain technique, however, the association of various techniques may increase the number of correct diagnoses. Surgical pathology allows for definitive diagnosis.
Cancer located in different parts of the body have specific characteristics, which we discuss below:
This is a rare cancer that accounts for 3-5% of all cancers of the female genital tract. The highest incidence is in older women and signs usually include growths that look like a wart or ulcer. Treatment is based on a surgery called vulvectomy +/- lymphadenectomy and chemotherapy in specific cases.
Primary vaginal cancers are very rare and represent only 1-3% of gynaecological cancers. Secondary vaginal cancer resulting from extension (mainly from cervix cancer) is more common. It is associated with the HPV virus, treatment with immunosuppressants, local radiation, and chronic irritation. The most common symptoms are vaginal bleeding and vaginal discharge. Signs are exophytic or ulcerated masses in the vaginal mucosa. The most common location is in the upper third and back of the vagina. Vaginal cancer is diagnosed by biopsy. These treatments can be extremely mutilating and thus vaginal cancer treatment requires individualisation. Exocavitary and endocavitary radiotherapies are also used.
This is the fourth most frequent gynaecologic cancer and the seventh of all cancers in women worldwide. But in the developed countries it is the most frequent gynaecologic cancer with a higher incidence in increasingly younger age groups and a higher incidence of intraepithelial neoplasia. The main risk factor is human papillomavirus (HPV) infection, which is considered a necessary cause; but there are other factors such as promiscuity, tobacco use, immunosuppression, oral contraceptives, multiparity, alcoholism, low socioeconomic status, etc. conisation will be performed in early treatment but in most cases cervical cancer will require radical surgery.
It currently represents the most common gynaecological cancer in women in developed countries after breast cancer. Its highest incidence is in postmenopausal women around 60 years old. The main cause is too much of the hormone oestrogen compared to the hormone progesterone, as in patients being treated with long-term HRT, obesity during menopause, and treatment with tamoxifen for breast cancer. Other risk factors include late menopause, nulliparity, patients with polycystic ovaries, hereditary in 18%, radiotherapy in the area, etc. symptoms are varied and the patient may show signs of blood loss or “foul-smelling” leucorrhoea in postmenopause or endometrium hypertrophy may be observed in the ultrasound performed during a pelvic exam. Overall prognosis is very good and in many cases may only require very limited surgery and subsequent chemotherapy.
It is the fourth most frequent gynaecological cancer in developed countries with an incidence of 15/100,000 women. Main risk factors include: 50-60 years of age, family or genetic history (HNPPC, BRCA 1 and 2), nulliparity, premature menarche and late menopause, high fat diet. There are no symptoms of ovarian cancer until it is advanced, thus making early diagnosis very difficult. As diagnosis in many cases is made after the disease has advanced, surgery will be reductive and intensive chemotherapy will be required.
Breast cancer (BC) is the most frequently diagnosed noncutaneous malignant disease in women worldwide, with rates on the rise in all western countries. It can currently be considered a health problem of epidemic proportions, as one to two out of every ten women will develop breast cancer during their lives. It is also the leading cause of death among women worldwide. Given the high incidence of breast cancer, early diagnosis (screening campaigns and annual reviews) and huge advancements in current diagnosis and treatment mean that the survival rate of breast cancer is high. Early diagnosis is crucial for increasing the possibility of breast-conserving treatment and cure. The treatment and monitoring of breast cancer is multidisciplinary and coordination between the surgeon (gynaecologist), oncologist, radiologist and radiation therapists is fundamental.