Gynaecological cancers refer to malignancies that occur in the female reproductive system, including the cervix, uterus, ovaries, fallopian tubes, vagina, and vulva. In most cases of these malignancies, surgery stands as the first line of defence. This is because early detection and surgical removal prove to be most effective against any further recurrence or metastasis of the cancer. This article is here to review this spectrum of cancers from the viewpoint of a surgical oncologist since it discusses the malignancy through the looking glass of surgical approaches.
The staging of gynaecological cancers
Once a cancer has been diagnosed, it is important to determine the stage of the cancer. Staging is a process of ascertaining the extent of the cancer and how far it has spread. The stage of the cancer will help determine the best course of treatment.
The most common staging system for gynaecological cancers is the International Federation of Gynecology and Obstetrics (FIGO) staging system. The FIGO staging system divides gynaecological cancers into four stages:
- Stage I: The cancer is confined to the organ where it originated.
- Stage II: The cancer has spread to nearby tissues or organs.
- Stage III: The cancer has spread to lymph nodes or other distant organs.
- Stage IV: The cancer has spread to multiple distant organs.
However, a surgical approach is most effective when the malignancy falls in either the first stage or the second stage. This is precisely why a surgical oncologist prioritises early detection and treatment.
Different types of gynaecological cancers and their surgical treatments
Most gynaecological cancers have a surgical remedy when detected early. Let’s overview the most common gynaecological cancers and their possible remedies.
Cervical Cancer
Cervical cancer begins in the cervix and is often detected through Pap smears. Precancerous lesions can be treated with procedures like cone biopsies to remove abnormal tissue. Early-stage invasive cervical cancer is generally treated with radical hysterectomy and pelvic lymph node dissection. Chemoradiation may be recommended for larger tumours. Recurrent cervical cancer may require pelvic exenteration to remove the cervix, uterus, vagina, bladder, rectum and lymph nodes.
Uterine Cancer
Uterine cancer starts in the endometrium (endometrial cancer) or myometrium (sarcoma). Abnormal bleeding is the classic symptom of this cancer. Total abdominal or laparoscopic/robotic hysterectomy and bilateral salpingo-oophorectomy is the standard treatment, with lymph node sampling. Adjuvant radiation or chemotherapy may follow based on risk factors. Advanced or recurrent tumours may require debulking procedures and additional treatments.
Ovarian Cancer
Ovarian cancer often presents at an advanced stage with non-specific symptoms. Staging involves total abdominal hysterectomy, bilateral salpingo-oophorectomy, omentectomy, pelvic/para-aortic lymph node dissection and biopsy. Debulking surgery is crucial for advanced disease and may involve bowel resection, diaphragm stripping, splenectomy or liver resection. Intraperitoneal chemotherapy can follow. Recurrent ovarian cancer typically requires additional debulking.
Fallopian Tube/Primary Peritoneal Cancer
These rare cancers are treated similarly to ovarian cancer. Bilateral salpingo-oophorectomy and hysterectomy are done, followed by staging procedures and debulking. Multi-modal treatment includes chemotherapy. Repeat cytoreductive surgeries are sometimes performed for recurrence.
Vaginal Cancer
Early vaginal cancer is treated with internal radiation therapy. Invasive disease requires radical hysterectomy, vaginectomy, lymph node dissection and possible pelvic exenteration. Chemoradiation is often given post-operatively. Recurrent tumours may need exenteration or additional radiation/chemotherapy.
Vulvar Cancer
Early-stage vulvar cancer is excised surgically, often with sentinel lymph node mapping for staging. The advanced disease requires radical vulvectomy and inguinal/femoral lymphadenectomy. Pelvic exenteration is reserved for recurrent or extensive tumours. Adjuvant radiation or chemotherapy may be warranted depending on risk.
As you can see, the surgical management of gynaecological cancers is complex. Success requires experience, skill, and a multidisciplinary approach. The goal is to balance achieving clear margins and adequate staging while preserving quality of life.
0 Comments
Post a Comment