A cancer diagnosis completely changes a person’s life, and the mental and physical toll of treatment and hospitalisations can be a debilitating experience. It is like a thief who sneaks into a home, however, imagine catching it before any damage is done. This underscores the importance of early cancer detection. In the case of gynaecologic cancers, which often develop without any clear signs or symptoms, prevention and survival hinge on early detection.
Prevalence, screening and detection
Gynaecologic cancers comprise cancers that affect women’s reproductive system such as cervical cancer, ovarian cancer, uterine or endometrial cancer, vaginal cancer, and vulvar cancer. Of the total cases in India, 32.26% are cervical cancer, 15.24% ovarian cancer, 3.19% uterine cancer, 2.12% vulvar cancer, and 1.06% vaginal cancer. Early detection is key to improving the chances of survival. Here are some of the advanced screening and detection techniques used for different gynaecologic cancers:
Pap smear and HPV testing: These tests are used for the detection of cervical cancer, which is the fourth most common cancer affecting women worldwide. The main risk factor of cervical cancer is a human papillomavirus (HPV) infection. A pap smear helps detect this cancer and can reduce its incidence by nearly 80%. An HPV test is more effective and can detect 90% of cervical precancers and cancers.
Genetic testing: Genetic testing plays a key role in ovarian cancer prevention, which is the sixth most common cancer among women. Genetic counselors use the multi-gene panel test to check a patient’s DNA for mutations in genes linked to hereditary ovarian and breast cancer, including BRCA1 and BRCA2. Normally, these genes help prevent cancer. A mutation in these genes causes them to stop working like they should, which raises the risk for ovarian and breast cancer. A positive test result will help guide prevention, screening and treatment options and alert family members to consider taking the genetic test.
Advanced imaging: Uterine or endometrial cancer is most common among postmenopausal women (≥60 years). Pelvic exam, a computed tomography (CT) scan, a magnetic resonance imaging (MRI), and positron emission tomography (PET) imaging can aid in diagnosis and staging of endometrial cancer. Additionally, the doctor may carry out an endometrial biopsy and a hysteroscopy. These techniques have refined the detection of these cancers.
Treating gynaecologic cancers
The treatment for gynaecologic cancers varies based on the type and stage of the disease, and warrants consideration of stage as well as molecular features to guide treatment and achieve the best outcomes.
Cervical cancer: Early-stage cervical cancer can often be treated with surgery, such as a radical hysterectomy performed with minimally invasive techniques like robotics and laparoscopy. It may be combined with chemotherapy, radiation therapy, or both. In the case of radiation treatment, doctors often combine external-beam radiation therapy (EBRT) with internal high-dose brachytherapy. Brachytherapy delivers high doses of radiation directly to the tumour. Advanced techniques like intensity-modulated radiation therapy (IMRT) are now used to precisely target tumours, sparing healthy tissue and minimizing side effects, making the treatment more effective and safer. Recent studies have demonstrated pembrolizumab combined with chemoradiotherapy and then continued as monotherapy led to better survival rates than just administering chemoradiotherapy in patients with newly diagnosed, previously untreated, high-risk locally advanced cervical cancer.
Ovarian cancer: Our doctors analyze the molecular profile of each person’s tumor to recommend a treatment plan involving targeted therapy and/or chemotherapy. Targeted therapies include PARP inhibitors, which are oral drugs that help fight cancers caused by inherited mutations in the BRCA1 and BRCA2 genes, as well as other genetic alterations that can impair a cell’s ability to repair DNA. Bevacizumab is another targeted therapy and is administered to block the growth of blood vessels that nourish the tumor. Surgery and advanced techniques such as cytoreductive surgery (reduces tumour size) and hyperthermic intraperitoneal chemotherapy (HIPEC) may also be utilised.12
Uterine (endometrial) cancer: Recent development in surgical techniques has transformed the treatment of uterine cancer, resulting in greater precision and fewer complications. Minimally invasive surgeries include hysterectomy and robot-assisted laparoscopy, and treatment is based on stage and molecular profile for endometrial cancer. For more early stage and locally advanced endometrial cancer, intensity-modulated radiation therapy (IMRT), brachytherapy, and chemotherapy. In IMRT, the external radiation treatment is given over several weeks. It uses thin beams of radiation that can be adjusted in strength and precisely shaped to match the size and outline of the tumour, protecting the nearby healthy tissue. Brachytherapy in uterine cancer involves placing tiny tubes with radioactive material directly into any remaining vaginal tissue after surgery and can be used in combination with IMRT for greater efficacy. For patients with advanced stage endometrial cancer three recent large clinical trials have demonstrated that combining immunotherapy with chemotherapy increased how long people lived without the cancer progressing. Other options for patients with advanced endometrial cancer include hormonal therapy and other targeted therapies based on molecular profile.
Challenges of early screening
While there has been remarkable progress in the screening and detection of gynaecologic cancers, challenges persist. The lack of access due to geographical and economic barriers is one such challenge. Furthermore, the level of education and awareness also determine how likely women would undergo screening. There is also a stigma or fear of discrimination associated with these screening programmes that exacerbates the problem. Addressing these challenges requires continued research, better access to screening, and public education.
Diagnosis and early detection methods for gynaecologic cancers are continuously evolving. For instance, in cervical cancer, the combination of Pap smear and HPV testing has proved effective. However, for ovarian and endometrial cancers, effective screening methods are still under development. Recently available tools offer more precise, non-invasive options for women, ultimately paving the way for personalised treatment approaches and better survival rates. As research continues, the future of gynaecological cancer screening looks more promising, with the potential to save more lives through early intervention.
Authored by: Dr. Vicky Makker , MD, Gynaecologic Oncologist , Memorial Sloan Kettering Cancer Center, New York, US.
