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Pelvic pain and abnormal vaginal bleeding: Must-know symptoms of gynaecological cancers
Learn about these common women cancers and the new treatment options available
Symptoms of gynaecological cancers include pelvic pain and abnormal vaginal bleeding. PHOTO: GETTY IMAGES
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Breast cancer often comes to mind as the most common cancer affecting women. However, it is just as important to understand gynaecological cancers like endometrial cancer and ovarian cancer. Uterine cancer – its most prevalent form is endometrial cancer – is the fourth most common cancer among Singaporean women, while ovarian cancer is the sixth most common. Consultant medical oncologist Jack Chan sheds light on the two cancers and their treatment options.
Q: What are gynaecological cancers and what are the symptoms of ovarian cancer and endometrial cancer?
Gynaecological cancers are those that originate from a woman’s reproductive system. These include cancers of the uterus and ovaries, with endometrial cancer specifically referring to cancer of the womb’s inner lining.
Most women diagnosed with endometrial cancer experience abnormal vaginal bleeding. For premenopausal women, this includes bleeding between periods and heavy and/or prolonged bleeding. After menopause, any vaginal bleeding – including spotting – is abnormal.
On the other hand, ovarian cancer is sometimes called the “silent killer” because it can be asymptomatic in early stages and may only be noticed when the cancer has become large or advanced. Symptoms to watch for are abdominal bloating, pelvic or abdominal pain, urinary frequency or urgency, and feeling full quickly when eating.
Q: What are the risk factors for ovarian cancer and endometrial cancer and are they preventable?
Risk factors for ovarian cancer include hereditary breast and ovarian cancer syndrome, family history, hormone replacement therapy, more frequent menstrual cycles, and increased age.
Risk factors for ovarian cancer include hereditary breast and ovarian cancer syndrome, family history, hormone replacement therapy, more frequent menstrual cycles, and increased age.
For endometrial cancer, risk factors include being obese, having diabetes, late menopause, oestrogen therapy, having never given birth, lack of exercise and those with Lynch syndrome, which is a hereditary predisposition to certain types of cancer.
Some cases of ovarian cancer and endometrial cancer are genetically linked. Ovarian cancer related to BRCA1/2 gene mutations can be prevented by surgical removal of ovaries and fallopian tubes. The risk of non-genetically linked endometrial cancer can be reduced by maintaining a healthy weight and regular exercise.
Q: How have treatments for ovarian cancer and endometrial cancer evolved over the years and what are some of the latest options?
Surgery remains the main treatment for operable cases of primary ovarian cancer and endometrial cancer. Radiotherapy, with or without intravenous chemotherapy, is given after surgery for endometrial cancer at intermediate to high risk of relapse. Intravenous chemotherapy may also be required after surgery for ovarian cancer, depending on the cancer stage, grade, and subtype.
In patients with stage 3 to 4 ovarian cancer who are not suitable for upfront surgery, chemotherapy can be used first to shrink the cancer before surgery. On the other hand, cancer medicines, including chemotherapy, are the mainstay of treatment for inoperable stage 4 or recurrent cases of ovarian cancer and endometrial cancer.
A newer class of oral targeted medicines, known as Poly (ADP-ribose) polymerase (PARP) inhibitors, has revolutionised ovarian cancer treatment. PARP inhibitors are drugs that prevent the cancer cells from repairing themselves so that they die. These can be used after a patient’s ovarian cancer responds well to platinum chemotherapy to prevent recurrence or prolong control of the cancer.
The latest development in the treatment of advanced or recurrent endometrial cancer is immunotherapy, which harnesses the patient’s own immune system to turn against cancer cells.
Q: What is maintenance therapy and how can it impact a patient’s prognosis and quality of life?
Maintenance therapy is an active drug treatment which is intended to maintain cancer remission or keep the disease under control. Approved maintenance therapies in ovarian cancer include monoclonal antibodies – proteins that mimic human antibodies – as well as PARP inhibitors.
These treatments extend the time that the cancer is kept under control for ovarian cancer patients, and do not reduce patients’ quality of life, when compared to a placebo or no active treatment.
Gynecologic Cancer Group Singapore is a non-profit organisation dedicated to the research of and advocacy for women’s cancer care in Singapore.
Please consult a doctor for medical advice or further information.
NP-SG-AOU-ADVR-230001 | Approved: September 2023
