Gynaecologic cancers represent a significant health concern for women worldwide, with varying symptoms that can often go unnoticed until advanced stages. In an effort to raise awareness and improve outcomes, Prof. Siriwan Tangjitgamol of MedPark Hospital outlines the crucial warning signs and symptoms associated with these cancers. By focusing on the entirety of the female reproductive system, from the vulva to the ovaries, this comprehensive overview seeks to empower women with the knowledge necessary for early detection and prompt treatment.
In women, reproductive organs are classified as either external or internal genitalia. The external components include the vulva, while the internal genitalia encompass the vagina, cervix (lower portion of the uterus or womb), uterine body, and adnexa, which consists of the fallopian tubes and ovaries.
Any part of the female reproductive system can be affected by gynaecologic cancer. The location of the lesion determines the signs and symptoms, which can often be subtle and easily missed. Early detection, when cancer is still pre-invasive or in its early stages, dramatically improves the chances of curative treatment.
The dynamic and progressive changes in hormonal levels during the reproductive age and post-menopausal phase are often deemed physiological. However, certain fluctuations could indicate underlying pathology or abnormalities. Women who experience any warning signs or symptoms are advised to consult their doctor for a thorough medical history review, physical examinations, and appropriate laboratory tests.
Below are the warning signs and symptoms to be aware of:
Vulvar cancer may present through anomalies such as changes in colour, thickening or nodules, persistent itching, or ulcers. Despite its external location, the vulva differs from its male counterpart (the penis) in that it is not easily visible without the aid of a mirror or inspection by others. Hence, it is crucial to perform self-palpation during bathing and be attentive to any soreness, burning sensation, chronic itching, swelling, irregularities in the skin or mucosal tissue, or the presence of nodules or lumps. Any of these changes should be promptly addressed.
While vaginal cancer is rare, it shares common risk factors with cervical cancer, notably the primary cause being human papillomavirus (HPV), particularly the high-risk strains. Although HPV vaccination protects against this viral infection, women beyond the age covered by government provisions may not have received it due to a lack of information or financial constraints. The challenge with both cancers lies in their often subclinical or asymptomatic nature. Therefore, regular check-ups are strongly advised. Alongside routine pelvic examinations and cancer screening tests (cytology and HPV testing) for detecting subclinical cancer, any woman experiencing abnormal symptoms should seek medical consultation. These symptoms may include chronic or increased vaginal discharge with an unpleasant or unusual odour, changes in colour, or vaginal bleeding occurring outside the normal menstrual cycle, such as post-coital bleeding, inter-menstrual bleeding (bleeding between periods), or post-menopausal bleeding.
Uterine cancer involves the abnormal growth of either endometrial tissue, known as endometrial cancer, or mesenchymal tissue, referred to as uterine sarcoma. Typically occurring during the peri- or post-menopausal period, endometrial cancer can manifest at a younger age in women with specific risk factors. These risk factors include obesity, metabolic disorders such as diabetes mellitus, dyslipidaemia, hypertension, and chronic anovulation leading to irregular and prolonged menstrual cycles, prolonged use of estrogenic supplements, hormonal therapy for breast cancer, and a family history of cancers like colon, breast, or ovary. Most women with endometrial cancer present with abnormal uterine bleeding, including heavy or prolonged menstrual bleeding or post-menopausal bleeding. Routine annual pelvic examinations, with or without ultrasonography, may be sufficient for women without specific risk factors. Additional investigations, such as ultrasonography combined with endometrial sampling or tumour marker testing, may be warranted for women deemed to be at higher risk.
In the context of uterine sarcoma, women may be more familiar with its benign counterpart, known as fibroid tumours. However, it is crucial to be mindful of the potential for malignancy when certain characteristics are present. These include a large mass, the rapid growth of the mass, the persistence of the mass even after menopause, when oestrogen levels naturally decline, as well as symptoms such as frequent urination, constipation, and pelvic pain, which may suggest invasion of neighbouring organs. Additionally, systemic symptoms like weight loss, loss of appetite, and coughing should raise awareness of the possibility of malignancy.
Ovarian cancer is often referred to as a "silent killer" because it tends to exhibit subtle or nonspecific symptoms until it reaches an advanced stage. There are two primary types of ovarian cancer. The first originates from epithelial cells lining the surface of the ovarian capsule, known as ovarian carcinoma. This type typically occurs in older women, often after menopause, although it can manifest at any age. In the early stages of ovarian cancer, a woman may experience no symptoms or only nonspecific symptoms due to a small tumour, such as gastrointestinal discomfort like dyspepsia. As the tumour grows larger, it may exert pressure on surrounding organs, leading to symptoms like early satiety, frequent urination, constipation, pelvic pain, etc. Systemic symptoms, including weight loss, fatigue, and respiratory symptoms, may also develop as the cancer progresses.
The other form of ovarian cancer arises from germ cells, or ova, known as malignant germ cell tumours. The common counterpart is the benign dermoid cyst, which contains hair or fat. Malignant germ cell tumours are more prevalent in young girls or adolescents and are often self-palpable or noticeable by parents while bathing their daughters. Due to their rapid growth, these tumours may lead to acute presentations characterised by pain or other complications, such as rupture.
While some of these symptoms may be attributable to benign lesions, maintaining awareness of the potential for cancer is crucial. Prompt and timely medical evaluation is essential, as it can detect early-stage cancer, allowing for appropriate management and potentially increasing the chance of a cure. Therefore, any concerning symptoms should be taken seriously, and individuals should seek medical attention promptly to ensure thorough evaluation and proper treatment.
In conclusion, the importance of recognising the early warning signs and symptoms of gynaecologic cancers cannot be overstated. As Prof. Siriwan Tangjitgamol emphasises, awareness and vigilance are key to ensuring that these potentially life-threatening conditions are detected and treated in their earliest stages. Women are encouraged to be proactive in their health care, seeking medical advice when any concerning symptoms arise. Through education and awareness, we can improve the prognosis for women diagnosed with gynaecologic cancers, moving closer to a future where these diseases are no longer a major threat to women's health.
Author: Prof. Siriwan Tangjitgamol, MD, Obstetrician and Gynaecologist, specialised in Gynaecologic Oncology Obstetrics and Gynaecology Clinic, MedPark Hospital. Tel. +66 2023 3333.
Series Editor: Katalya Bruton, Healthcare Content Editor and Director, Dataconsult Ltd. Dataconsult’s Thailand Regional Forum at Sasin provides seminars and extensive documentation to update business on future trends in Thailand and the Mekong Region. Contact: info@dataconsult.co.th Tel: 662-233-5606/7
