TREATMENTS FOR CANCER
A wide variety of gynecologic cancers can affect a woman’s reproductive system, which consists of the uterus, vagina, ovaries and fallopian tubes. The uterus is a hollow, muscular organ that holds a baby as it grows inside a pregnant woman. The fallopian tubes and ovaries are located on either side of the uterus.
The most common types of gynecologic cancers are cervical, endometrial (uterine) and ovarian cancer. The specific type of cancer a woman has and how advanced it is, will determine her available treatment options. Women with early stage gynecologic cancer are often treated with hysterectomy – the surgical removal of the uterus. In this procedure, the doctor may also remove the ovaries, fallopian tubes and/or select lymph nodes. Hysterectomy is the second most common surgical procedure for women in the US., and an estimated one third of all U.S. women will have a hysterectomy by age 60.
If you have a gynecologic cancer – such as cancer of the uterus or cervix – hysterectomy may be your best treatment option. The type of hysterectomy you have will depend upon your medical history and health, as well as the extent of the cancer growth. This section will explore some of the potential treatment options for each of the following types of cancer.
What is Cervical Cancer?
The neck of the uterus, called the cervix, is lined with cells which, under ordinary circumstances grow, divide and are replaced on an ongoing basis. This process called mitosis occurs throughout the body to ensure that the health and function of the cells, tissues and organ systems are maintained at optimal levels.
However, when cells divide, the good, the bad, and the ugly are replicated in the subsequent daughter cells. Cervical cancer results from a mutation in the cellular lining of the cervix, which spreads via mitosis to normal tissues and organs. Should this abnormal cell division go undetected and/or untreated, tumors will form and extensive spreading of the cancer (metastasis) will likely occur.
What Causes Cervical Cancer?
Most illnesses, including cancer, originate as a result of multiple factors working in concert. In the case of cervical cancer, there is no single cause. Rather, the initial cellular mutation is most likely triggered by one or a combination of conditions. Below are the primary causes of cervical cancer:
- Smoking: Women who smoke are twice as likely as those who don’t to get cervical cancer. Smoke from tobacco products is carcinogenic and is linked to cellular mutation in the cervical lining and is a contributing cause of cervical cancer.
- Age: Although cervical cancer can occur in women of any age, it occurs predominantly in women over 40 and rarely in women under 21. Therefore, advancing age may considered a risk factor, or one of the many contributing causes of cervical cancer.
- Human Papillomavirus (HPV): A very common infection, the human papillomavirus (HPV), is a frequent precursor to abnormal cell growth (dysplasia) and is considered a primary cause of cervical cancer. Many women experience at least one HPV infection in their lifetime. Of the 100+ HPV strains, many are non-cancerous (benign), but others are known to cause cervical cancer (malignancy).
- Compromised Immune System: A compromised immune system may compound the effects of the above and is considered to be a cause of cervical cancer, particularly in: 3 Patients who have undergone organ transplant surgery, immunosuppressive therapies are prescribed in order to stave off the body’s rejection of the implanted organ. Unfortunately the resultant suppression of the immune system also hampers the body’s ability to protect itself from disease.
- Patients with HIV/AIDS: Patients with rare congenital syndromes that adversely affect their immune systems
- Birth Control Pills: Long-term use (5+ years) of birth control pills is a contributing cause of cervical cancer. 4You should talk to your doctor about the pros and cons of various types of birth control in your own case.
- Multiple Pregnancies: Multiple full-term pregnancies are a contributing cause of cervical cancer No one really knows why this is, but it has been proven beyond doubt by large studies.
- Diet: Diets low in fruits and vegetables are linked to an increased risk of cervical and other cancers. Also, women who are overweight are at a higher risk.
Signs and Symptoms of Cervical Cancer
Cancer of the cervix rarely exhibits early symptoms. By the time advanced cervical cancer symptoms are apparent, the cancer has likely metastasized 7 – in other words, it has likely replicated and spread to other parts of the body. When they do present, symptoms of advanced cervical cancer may include:
- Any unusual discharge from the vagina
- Bleeding or spotting beyond your normal period
- Pain after sex, douching or a pelvic exam
However, these symptoms of cervical cancer can also be indicative of many other conditions, most of them benign. Always consult your doctor for professional diagnosis of any medical condition.
Although most cervical cancer and early symptoms are seemingly invisible, there may be signs at the cellular level. These early signs are detectable via Pap tests administered in standard pelvic examinations. In fact, Pap tests can identify suspicious cellular activity long before it becomes a threat to a woman’s health.
Benign cells may become misshapen and divide abnormally and at an accelerated rate. This may sound like a symptom of cervical cancer, as described earlier, but in fact the cervical cells may be benign or precancerous.
Precancerous cells often behave like cancer cells. Indeed, they may turn into cancer cells if they are not treated. Typically, it takes several years for precancerous cells to mutate into cancer cells. So, rather than watching for symptoms of cervical cancer, your gynecologist will look for suspicious cell activity early during regular pelvic exams.
Scheduling regular pelvic exams is an important step women can take in order to prevent cervical cancer from ever presenting.
Endometrial (Uterine) Cancer
In the United States, approximately 42,000 women each year are diagnosed with uterine cancer – the most common malignancy of the female genital tract and the fourth most common cancer in women.
Uterine cancer forms in tissues of the uterus, which is a pear-shaped organ in the pelvis where a fetus grows. The cervix is at the lower, narrow end of the uterus, and leads to the vagina. Uterine cancer can appear in cells lining the uterus (endometrium) and in muscle or other tissues in the uterus (uterine sarcoma).
Signs & Symptoms of Uterine Cancer
Possible signs of uterine cancer include unusual vaginal discharge or pain in the pelvis (uterus pain). Other conditions may cause the same symptoms. You should contact your health care provider if you experience any of the following symptoms:
- Bleeding or discharge not related to menstruation (periods)
- Bleeding after menopause
- Irregular bleeding in between menstrual cycles or after sexual intercourse
- A mass in the vagina
- Frequent, difficult or painful urination
- Pain during sexual intercourse
- Increasing or different pelvic pain or cramping
- A thin white (or pink) watery discharge from the vagina
- Increased pelvic pressure, particularly if associated with changes in bladder or bowel patterns
Tests that examine the uterus are used to detect and diagnose uterine cancer. Some of the tests that may be performed include a physical exam and history, a pelvic exam, a Pap test (or Pap smear), colposcopy (looking at the cervix with a microscope), cervical biopsy, endometrial biopsy, ultrasound, dilation & curettage (D&C) and hysteroscopy.
Ovarian Cancer
Cancer occurs when cells in the body begin changing and multiplying out of control. These cells can form lumps of tissue called tumors. Cancer that starts in the ovaries is called ovarian cancer.
Ovarian cancer can spread from the ovaries to other parts of the body. This spread is called metastasis. The more cancer spreads, the harder it is to treat.
Understanding the Ovaries
The ovaries are a pair of walnut-sized organs in a woman’s pelvic area. They are located on either side of the uterus (the organ that holds the baby when a woman is pregnant). Ovaries make and release the eggs which, when combined with a man’s sperm, can grow into a baby. The ovaries also make the female hormones progesterone and estrogen.
When Ovarian Cancer Forms
There are three different types of ovarian tumors:
- Epithelial tumors form in the cells that cover the outer surface of the ovaries. This is the most common type of ovarian cancer.
- Germ cell tumors form in the cells inside the ovary that produce eggs. These rare tumors are most common in women in their teens and early twenties.
- Stromal tumors grow from the cells that make female hormones. This is one of the least common forms of ovarian cancer.
Hysterectomy Options
In the U.S., doctors perform approximately 600,000 hysterectomies a year, making it the second most common surgery for women. While this figure is lower in many other parts of the world, hysterectomy is still a common procedure.
Fortunately, there are more choices than ever before for the type of hysterectomy as well as the surgical approach.
Hysterectomy is the surgical removal of the uterus. A hysterectomy may be recommended to treat many uterine conditions, such as:
- Endometriosis
- Heavy menstrual bleeding
- Fibroid tumors
- Pelvic prolapse
- Cancer
Types of Hysterectomy
All hysterectomies involve removal of the uterus but other reproductive organs may or may not also need to be removed. The type of hysterectomy your doctor recommends will depend on your specific condition. Keep in mind, if your hysterectomy involves removing the ovaries and you have not started menopause, removing the ovaries will cause menopause to begin. Your doctor may therefore recommend hormone replacement therapy if your ovaries are removed.
Types of hysterectomy include:
Total hysterectomy
A total hysterectomy refers to the removal of the uterus and the cervix only. This is the most common type of hysterectomy.
Partial or subtotal hysterectomy
A partial hysterectomy is also known as a supracervical hysterectomy. This procedure involves removing the upper part of the uterus, but leaving the cervix intact. The decision to keep the cervix is often based on patient preference.
Radical hysterectomy
A radical hysterectomy is the removal of the uterus, the tissue on both sides of the cervix, and the upper part of the vagina. This procedure is most often performed when cancer is present.
When a hysterectomy is performed for cancerous conditions – such as uterine, cervical, or ovarian cancer – the surgeon will remove the cancerous organ and certain lymph nodes. This is often referred to as a lymph node dissection or lymphadenectomy. Lymph nodes will be removed in certain areas based on the location and extent or stage of the cancer.
Your fallopian tubes and ovaries may or may not be removed during your hysterectomy. This will depend on several factors including your condition and age. Removal of the ovaries is called an oophorectomy. Removal of fallopian tubes and ovaries is called a salpingo-oophorectomy.
Approaches to Hysterectomy
Just as there are several types of hysterectomies, there are also several ways your doctor can perform the procedure, including:
Open hysterectomy
The uterus is removed through a large abdominal incision. The majority of hysterectomies are performed using this “open” approach. When both the uterus and cervix are removed, this is known as a TAH – Total Abdominal Hysterectomy. The main limitations of an open hysterectomy are the long incision required and lengthy recovery of 4-6 weeks.
Vaginal hysterectomy
The uterus is removed through the vagina. There are no abdominal incisions but the surgeon makes a small cut in the vagina to remove the uterus. This approach is often used if the patient’s condition is benign (non-cancerous), limited to the uterus, and the uterus is a normal size. When the uterus and cervix are removed through an incision deep inside the vagina, it is known as a TVH – Total Vaginal Hysterectomy, and is often used to treat pelvic prolapse (falling).
The primary limitation of a vaginal hysterectomy is the surgeon’s limited view of the pelvic organs. This procedure can also be challenging if the patient has severe endometriosis or had prior pelvic surgeries such as a C-section that caused adhesions. Recovery from a vaginal hysterectomy can take 3-4 weeks.
Laparoscopic hysterectomy
The uterus is removed minimally invasively using instruments inserted through a few small incisions in the abdomen. One of the instruments is an endoscope – a narrow tube with a tiny camera – which allows the surgeon to see the target anatomy on a 2D monitor. When only the uterus is removed, the procedure is called LSH – Laparoscopic Supracervical Hysterectomy. When the uterus and cervix are removed, this is known as TLH – Total Laparoscopic Hysterectomy.
Laparoscopic hysterectomy can be challenging during complex procedures because of the long-handled, rigid instruments used, and recovery can take 3-4 weeks.
da Vinci Hysterectomy
Fortunately, there is a minimally invasive option for treating gynecologic conditions designed to overcome the limitations of traditional surgery – da Vinci Surgery.
If your doctor recommends a hysterectomy to treat your condition, you may be a candidate for da Vinci Surgery. Using state-of-the-art technology, a da Vinci® Hysterectomy requires only a few tiny incisions, so you can get back to your life faster.
The da Vinci System enables your doctor to perform a minimally invasive hysterectomy even for complex conditions with enhanced vision, precision, dexterity and control. da Vinci offers women many potential benefits over traditional surgery, including:
- Less pain
- Fewer complications
- Less blood loss
- Shorter hospital stay
- Low risk of wound infection
- Quicker recovery and return to normal activities
The da Vinci System is a state-of-the-art surgical platform with 3D, high-definition vision and miniaturized, wristed surgical instruments designed to help doctors take surgery beyond the limits of the human hand. By helping doctors to overcome the challenges of traditional open and laparoscopic surgery, da Vinci is changing the experience of surgery for women around the world.
If you have been putting off treatment for a gynecologic condition, it’s time to ask your doctor about da Vinci Surgery.
As with any surgery, these benefits cannot be guaranteed since surgery is specific to each patient, condition and procedure. It is important to talk to your doctor about all treatment options, including the risks and benefits. This information can help you to make the best decision for your situation.