What Every Woman Must Know to Decrease Risk of Gynaecological Cancers

Gynaecological cancers are cancers involving the uterine body, cervix, ovaries, Fallopian tubes,vagina and vulva. Along with breast cancer, they contribute toalmost 50% of all cancers affecting women. Despite being preventable to a large extent and highly curable in early stages, these cancers continue to have worse outcomes in our population due to lack of awareness and presentation at late stages. The aim of this article is to provide basic information about common gynaecological cancers and to guide the readers on the risk reduction endeavours.

Cervical Cancer:

Cervical cancer is the most common gynaecological cancer in India. It is caused by a virus called Human Papilloma Virus which is acquired by sexual activity. For most women, this virus clears off from their body by natural immune mechanisms, but can become persistent for some, which can then lead on to development of cancer after several years.

Since this cancer comes from a sexually transmitted infection, it goes without saying that safe sex practices and good genital hygiene are of paramount importance in preventing it. In addition, now we have a vaccine that targets the HPV virus (like the one now developed for corona virus). The vaccines which we have in India can provide 70% protection against the infection. However, a newer vaccine which is yet to be available here is supposedly 90% protective. The vaccines are ideally given for girls aged between 9 to 15 in 2 doses, 6 months apart. Catch-up vaccination can be given up to 26 years of age,to those who haven’t had the vaccination early albeit with lesser efficacy because of the possibility of contracting the virus before the vaccination.

It takes several years for an HPV infection to cause cancer. In the intervening years it causes minor aberrations or precancerous changes in the cells which can be picked up by a simple test called the PAP smear. A Pap test is a simple and painless test done in the outpatient department.Detecting the precancerous changes enable us to treat it before it develops into cancer.Hence, it is of utmost importance that women between 25 and 65 years are screened for these abnormalities. The ideal screening test would be a Pap smear done every 3 years from 25 to 30 years and a co-test (which is a combined HPV test and a Pap smear) to be done every 5 years for women between 30 and 65. Cervical cancer screening would be a must for all women even if they were previously vaccinated.

So, remember to have your girls vaccinated and make sure you are up-to-date on your cervical cancer screen. By ensuring these two simple interventions, you decrease your cervical cancer risk phenomenally.

Endometrial Cancer:

Endometrial cancer is a cancer type that develops in the body of the uterus. Unlike cervical cancer which is showing a decreasing trend globally, there is a marked increase in the incidence of endometrial cancer worldwide. There is a threefold increase in the number of incidental cases in the last decade alone.

This cancer is a life style related cancer. Obesity, sedentary lifestyle, polycystic ovarian syndrome and low parity have all contributed to its tremendous increase. Of particular note is obesity which leads on to a chronic state of hormone imbalance,which in turn triggers cancer development.Having regular menstrual cycles, being pregnant and having a normal body mass index are all protective factors against endometrial cancer.

Hence, keeping a check on your weight and adopting a healthy life style with proper diet and exercise will prevent endometrial cancer to a large extent.

We see a lot of young girls coming to us with irregular periods. Some of them do not get their periods for months together. This can be particularly dangerous because it gives time for the already imbalanced and disproportionately high estrogen to act on the endometrium and slowly change it to a precancerous state. It is important that these girls seek medical intervention along with lifestyle changes to decrease their future risk of endometrial cancer.

Even if we do not have a vaccine or a screening tool like cervical cancer, it is satisfying to know that endometrial cancer presents itself at the early stages. The most common presentation is a heavy menstrual flow or watery discharge. Hence, it is important that women positively consult with their gynaecologistsif they have any of these symptoms.

Ovarian Cancer:

Ovarian cancer is also a common gynaecological cancer and is the most lethal of the lot. It usually presents at late stages when the prognosis is often not too good. It also does not have an effective screening test available which can enable early detection.

So, unlike cervical and endometrial cancers, there are fewer interventions that can be done for ovarian cancer. Nevertheless, there are certain things you can still do to decrease its risk.

Firstly, if you belong to a family where there is a high prevalence of cancers, especially breast and ovarian cancers, please contact your doctor to assess whether you could have the possibility of a genetic mutation in the family. For those who test positive for the mutation, there are several risk reduction strategies.

Secondly, use of combined oral contraceptive pills significantly reduces the risk of future development of both ovarian and endometrial cancers. Hence, these can be considered for short-term contraception when needed.

Thirdly, in India, women are used to undergoing tubal sterilisation procedures after child bearing. Now, there is new evidence to state that majority of the high-grade ovarian cancers actually arise from the tubes. So, at the time of sterilisation, if the entire tube is removed instead of a small part of it (we call it opportunistic salpingectomy) then her risk of ovarian cancer decreases drastically. This can be done opportunistically along with other abdominal surgical procedures as well.

Along with these interventions, it is also important that any new onset dyspeptic symptom, abdominal bloating or lower abdominal pain must be evaluated without delay. Women who already have conditions like endometriosis or have had ovarian cysts in the past must have a very low threshold for ultrasound examination and get evaluated with the slightest symptoms.

As you can see, there are several things that can be done to decrease your gynaecological cancer risk. Of course, adopting a healthy lifestyle with a diet rich in vegetables and fibre, regular physical activity, maintaining a normal BMI, avoiding smoking and alcohol and most importantlys destressing yourself in your own way will go a long way in preventing most chronic diseases including cancer.