Understanding Treatment Options for
Gynecological Cancers

Once diagnosed, gynecological cancer can be treated in various ways. Whether you have been newly diagnosed, or have been undergoing treatment for a while, it is normal to be confused and have a lot of questions. An important first step is to understand your disease better.

Types of gynecological cancers
Cervical Cancer
This type of cancer begins in a woman’s cervix – which is the narrow, lower end of the uterus or womb.

Ovarian Cancer
Ovarian cancer is a type of cancer that originates in the ovaries, related areas of the fallopian tubes, and the peritoneum – which is the tissue that lines the abdominal wall and covers most of the organs in the abdomen.

Endometrial or Uterine Cancer
Endometrial cancer is a type of cancer that begins in the uterus – which is the hollow, pear-shaped pelvic organ responsible for foetal development.

Vaginal and Vulvar Cancer
Vaginal cancer begins in the vagina, which is the hollow and tube-like channel between the bottom of the uterus and the exterior of the body.

Next, it can be helpful to understand your diagnosis and the stage of your cancer. This information is critical, as it helps determine the treatment options that are available to you. Refer to this section to understand your cancer diagnosis and for more information about how cancer is staged. Read more
Treatments for Gynecological Cancer

Once you have met with your primary physician and clinical care team, it can help to learn more about each of the treatment options they have prescribed for you. There are a variety of methods used to treat gynecological cancer. Some (such as surgery, radiation therapy and chemotherapy) are currently being used for treatment, and some (such as clinical trials) are experimental in nature. Treatments for gynecological cancer can be either:

  • Localized (targeting cancerous cells in one area of the body), or
  • Systemic (targeting cancerous cells throughout the body)
Type of Treatment Nature of Treatment Nature of Treatment
Surgery
Localized
Invasive
Generally performed once
Radiation Therapy
Localized
Can be invasive or non-invasive
Typically administered over many sessions
Chemotherapy
Systemic
Can be invasive or non-invasive
Typically administered over many cycles
Hormone Therapy
Systemic
Can be invasive or non-invasive
    Typically prescribed as:
  • oral tablets to be taken daily for a certain duration, or
  • a series of injections over many cycles, or
  • a specific surgical procedure
Targeted Therapy
Systemic
Non-invasive
Typically administered over many cycles
Immunotherapy
Systemic
Non-invasive
Typically administered over many cycles
Clinical Trials
Depends on the trial
Depends on the trial
Depends on the trial
Localized Treatment Options
Surgery

What to expect

Surgery is the most common form of treatment for gynecological cancer. Prior to surgery, the doctor does a biopsy to confirm the presence of cancerous cells. Once confirmed, the cells are removed through certain surgical procedures, as detailed below. It is advisable to have an in-depth discussion with your primary physician and cancer care team to find the course of treatment that is best suited for you.

  • Simple hysterectomy or total hysterectomy involves the removal of the entire uterus. In this procedure, the tissue around the uterus, tissue connecting the uterus and sacrum, and the vagina remain intact. This procedure can be performed via an incision in the abdomen (abdominal hysterectomy) or through the vagina (vaginal hysterectomy).
  • Radical hysterectomy involves the removal of the entire uterus, the tissues next to the uterus and the cervix, and the upper part of the vagina. Radical hysterectomy can also be performed both abdominally or through the vagina (laparoscopically).
  • Bilateral salpingo-oophorectomy involves the removal of both the fallopian tubes and ovaries, and is usually done at the same time as a hysterectomy.
  • Lymph node surgery is performed to remove the lymph nodes from the pelvis and near the aorta. This helps doctors figure out the surgical stage of the cancer, and if the cancer has spread from the origin area of the tumour. This procedure can be done through the incision in the abdomen, or laparoscopically.
  • Vulvectomy is a procedure where all (or part) of the vulva is removed as part of vulvar cancer treatment. This is further divided into four categories:
    Skinning vulvectomy involves the removal of the top layer of the skin affected by cancer.
    Simple vulvectomy involves the removal of the entire vulva and some tissue under the skin.
    Partial radical vulvectomy removes part of the vulva and the deep tissue
    Complete radical vulvectomy removes the entire vulva and deep tissues, including the clitoris. This procedure is very rarely needed.
  • Trachelectomy: A rare procedure, this refers to the removal of the cervix, upper vagina and tissue surrounding the cervix. The operation is performed either vaginally or using laparoscopy.
Radiation Therapy

What to expect

Radiation therapy uses high-energy x-rays or other types of radiation to remove cancer cells and keep them from growing further. There are two types of radiation therapy:

  • In external radiation therapy, the radiation isadministered from outside the body using a specially designed machine, and is non-invasive.
  • In internal radiation therapy, a radioactive substance is placed directly into or near the cancer through needles, seeds, wires, or catheters. This is an invasive procedure.
Systemic Treatment Options
Chemotherapy

What to expect

Chemotherapy is a drug-based cancer treatment that deploys medication to stop the cancer from growing further, either by killing cancerous cells or by stopping them from dividing. There are two kinds of chemotherapy, depending on the way they are administered:

  • In systemic chemotherapy, the drug is administered either orally or intravenously. The drug enters the bloodstream and targets cancer cells throughout the body. This is the most commonly used type of chemotherapy for cancers.
  • In regional chemotherapy, the drug is administered directly into the cerebrospinal fluid, an organ, or a body cavity such as the abdomen, to ensure the drugs target the cancer cells in those areas more efficiently.

The type of chemotherapy being administered depends on the type and stage of the cancer that is being treated. It is advisable to have an in-depth discussion with your primary physician and cancer care team to find the course of treatment that is best suited for you.

Hormone Therapy

What to expect

Certain types of gynaecological cancers have hormone receptors, which mean that some hormones can aid the growth of cancerous cells. If you have been diagnosed with a type of cancer with hormone receptors, your doctor may prescribe hormone therapy. Hormone therapy is a treatment that removes or blocks hormones and stops the cancer from growing. Hormones are produced by glands present in our body and stimulate certain functions of our body. Your doctor may suggest either drugs, surgery, or radiation therapy to reduce the production of hormones or block them from working.

Targeted therapy

What to expect

Targeted therapy uses drugs or other substances to identify and attack specific cancer cells without harming normal cells. Some of the targeted therapies are:

  • Monoclonal antibodies: This form of targeted therapy uses antibodies made from a single type of immune system cells to identify and attack either cancerous cells themselves, or substances that may them grow.
  • Tyrosine kinase inhibitors are drugs that block signals needed for tumours to grow and may be used with other anticancer drugs as adjuvant therapy
  • Cyclin-dependent kinase inhibitors are drugs that block proteins called cyclin-dependent kinases, which help cancer cells grow
  • Mammalian target of rapamycin (mTOR) inhibitors block a protein called mTOR, which can help cancer cells grow
  • PARP inhibitors block DNA repair and may cause cancer cells to die
Immunotherapy

What to expect

Immunotherapy readies and trains your immune system to fight cancer using substances made by the body or made in a laboratory to boost, direct, or restore the body’s natural defences against cancer. This type of treatment is also called biotherapy or biologic therapy.

Clinical Trials

What to expect

Clinical trials are medical research studies and are used to find out if new cancer treatments are safe, effective or better than the standard treatment protocol. Trials can also look at improving diagnosis or symptom management. Results from clinical trials can improve cancer treatments and help people live longer. For some people, a clinical trial may be the best treatment option. Patients who take part in a clinical trial may receive the standard treatment or be among the first to receive a new treatment. Patients can enter clinical trials before, during, or after starting their cancer treatment.

Alternative Medicine

What to expect

After you have been diagnosed with cancer, you may hear about different forms of alternative medicine through your research orfrom your family, friends or colleagues. Many different areas make up the practice of alternative medicine, and some of these therapies have been practiced for centuries in many parts of the world. Some types of alternative medicine are:

  • Ayurveda
  • Homeopathy
  • Naturopathy
  • Chinese medicine
  • Acupuncture
  • Reiki
  • Hypnosis

While no alternative medicines have been found to cure cancer, they can help cope with side effects of treatment.

It is critical to inform your doctor if you intend to take any of these medicines, or are currently taking them. Sometimes, combining these remedies with the allopathic treatment prescribed by your doctor can be very dangerous. In some cases, the chemicals present in each form of treatment can interact. This can cause reduced efficacy of both types of treatments, or other harmful side effects. It is best to have an open discussion with your doctor about these therapies, and which regimens can be safely combined with your doctor’s care.

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