Gynaecological Tumors

Gynaecological Tumors are tumors affecting the female genital tract including the Uterus, Ovaries, Cervix and Vagina.

Unusual bleeding per vaginum - post menopausal / Intermenstrual or post coital bleeding is the commonest presenting symptom of uterine / endometrial cancer.

An initial Ultrasonography of the pelvis shows a thickened endometrial lining which is biopsied with a Hysteroscopy or Dilatation & Curettage to confirm the diagnosis.

In early stage organ confined endometrial cancers a Laproscopic or open Radical Hystrectomy with Bilateral pelvic and/ or retroperitoneal lymph node dissection is the preferred line of treatment.

Adjuvant Radiation is recommended after surgery if the Histopathology suggests deep infiltration (>50%) into the muscle layer or lymph node involvement by disease.

Ovarian cancers often present with ballooning or distension of the abdomen due to a large swelling of the ovary itself due to a tumor or presence of cancer related free fluid - ascites in the peritoneal cavity.

A Localized solid cystic mass confined to the ovary on radiological imaging - USG / CT scan should ideally not be biopsied as this may cause spillage and upstage the disease.

Such cases are best treated with upfront surgery and removal of the ovarian cyst / mass intact and sent for frozen section / Histopathology for primary diagnosis.

Intra abdominal spillage / morcellation is strictly to be avoided as this upstages the disease.

Tumor markers such as CA 125 are often helpful as corroborative evidence of malignancy when elevated in the presence of an ovarian mass.

In the presence of ascites - aspiration and fluid cytology may also be diagnostic.

When the disease is disseminated at initial presentation upfront chemotherapy is a preferred line of treatment to shrink the disease with subsequent Cytoreductive surgery.

Cervical cancers are ulcerative growths involving the mouth of the uterine cavity.

The presentation is with persistent spotting and the diagnosis is confirmed on a punch biopsy.

CT / MRI pelvis is mandatory for assessing lateral spread of disease and staging.

Chemo radiation is the primary line of treatment for cervical cancers except in the rare presentation at an extremely early stage 1 wherein a radical Wertheim’s surgery may be offered.

Vaginal / Vulval cancers are ulcerative lesions involving the vaginal tract and labia.

The diagnosis is confirmed on punch biopsy and they are treated with surgery.