Gynecological Oncology

• To provide high quality, evidence based comprehensive and personalised care topatients with a suspected or diagnosed Gynaecological cancer
• To coordinate with social organisations in order to increase awareness ofgeneral public about Gynaecological cancer screening, prevention and earlydetection
• To participate in national and international research in the field of GynaecologicalOncology that will reduce the incidence of gynecologic cancer and improvethe survival and quality of life of patients with gynaecologic cancer
• To offer services with the help of multidisciplinary team from prevention topalliation

Spectrum of diseases treated by Gynecological Oncology unit

• Premalignant Diseases of Vulva and Vagina
• Premalignant Diseases of Cervix
• Cervical Cancer
• Endometrial Cancer
• Ovarian Cancer
• VulvalCancer
• Vaginal Cancer
• Cancer of Fallopian Tube
• Gestational TrophoblsaticNeoplasia

Services provided by Gynecological Oncology unit

The Gynecological Oncology services provide a full-range of womens health care, including Diagnostic, Consultative and Treatment services. Following services are offered by our Gynecological Oncology unit.

• Screening for Cervical Cancer: Pap Smear/Liquid basedcytology/ HPV testing
• Colposcopy Clinic
• Excision Procedures for Premalignant Lesions of Cervix: (LoopElectrosurgical Excision/ Cone Biopsy)
• Evaluation/consultationand Counselling forhigh-risk individuals due to strong family history of Ovarian/Breast Cancers
• Surgical procedures for diagnosed cases of Gynaecological Cancers -

• Surgery for early Ovarian Cancer (Staging Laparotomy)
• Surgery for advanced Ovarian Cancer (Debulking Surgery)
• Radical Hysterectomy (Wertheims Operation )
• Surgery for Endometrial Cancer
• Total Pelvic Exentration
• Anterior/Posterior Pelvic Exentration
• Pelvic/Paraortic (Retroperitoneal) Lymph Node Dissection
• Radical Vulvectomy + Groin Node Dissection
• Radical Vulvectomy + Reconstruction

• Chemotherapy and Target Based Therapy for Gynaecological malignancies
• Radiotherapy including IGRT/IMRT
• Rehabilitation Services
• Counseling and Supportive Care
• Palliative Care

UTERINE CANCER

Uterine cancer, also known as endometrial carcinoma, is the abnormal (malignant) growth of cells that comprise uterine tissue. Currently, we are seeing a rising incidence in endometrial carcinoma cases. Almost 75 per cent of these cancers develop in postmenopausal women, with < 5 per cent of cancers seen in women under 40 years of age.

Warning signs

• Abnormal vaginal bleeding
• Increases vaginal discharge
• Postmenopausal bleeds
• Pelvic pain

Risk factors

• Obesity
• Diabetes/hypertension
• Nulliparity (women who never had children)
• Late menopause (menopause after 55 years)
• Polycystic ovarian syndrome
• Tamoxifen treatment for longer duration
• Family history and lynch syndrome

Progression

• Stage I: Cancer is confined to the uterus, 70-80 per cent of uterine cancers are diagnosed in Stage I
• Stage II/III: Cancer has spread outside of the uterus. As it progresses, it may spread to the pelvic lymph nodes and other pelvic organs
• Stage IV: Cancer has spread to the lymph nodes and on to the lungs, liver, bones, brain, and vagina

Diagnosis

• Primary diagnosis: Ultrasonography to evaluate the lining and thickness
• Secondary diagnosis: Endometrial biopsy, if thickness is above the cut off level–4 mm
• Advanced diagnosis: Once confirmed, MRI/ CT scan to evaluate the size and spread of tumour

Treatment in a nutshell

• Mainstay treatment : As these patients are obese with other medical problems, whenever possible minimally invasive surgery (laparoscopy/robotic) is the best form of treatment. It is important to have frozen section (intra-operative pathology) facilities available during surgery as the extent of surgery and lymph node dissection is based on the frozen section report
• Postoperative treatment: Radiation, chemotherapy and hormonal therapy may be required based on the pathology report

Reported outcome

Top tips

• Have faith. Dont underestimate the role of your spiritual life also has an important role in the healing process
• Stay active. Regular exercise is an essential part of staying healthy
• Eat sufficient amounts of vegetables and moderate amounts of fruit
• Choose organic whenever possible and minimize exposure to pesticide residues
• Consider juicing to easily ingest several servings without feeling too full
• Drink green tea several times a day
• Concentrate on omega-3 fatty acids either through foods or supplements
• Since insulin plays a role in a womens oestrogen balance, lower the intake of refined sugar, processed flours and sugary beverages to keep blood sugar under ideal control
• Limit alcohol consumption
• Avoid harmful radiation, UV light, and carcinogenic chemicals

CERVICAL CANCER

Cervical cancer is a malignant tumour of the cervix, the lowermost part of the uterus. India contributes almost one-third of new cases diagnosed worldwide, and unfortunately 70-90 per cent of cases are diagnosed at an advanced stage. Cervical cancer is preventable, as there is an effective screening test available to detect precancerous changes that can be treated; thus, progression to cancer can be stopped.

Warning signs

• Abnormal vaginal bleeding
• Increased vaginal discharge
• Bleeding after going through menopause
• Pelvic pain

Risk factors

• Sexual intercourse at an early age
• Multiple sexual partners
• Multiple childbirths
• Smoking and weakened immune system

Progression

• Stage I: Cancer has spread from the cervix lining into the deeper tissue but is still just found in the uterus.
• Stage II: Cancer has spread beyond the cervix to nearby areas, such as the vagina or tissue near the cervix, but it is still inside the pelvic area.
• Stage III: Cancer has spread outside the cervix and vagina.
• Stage IV: The cancer has spread to the lungs, liver, spleen, brain, and bone.

Diagnosis

• Primary diagnosis: Biopsy
• Secondary diagnosis : Screening test – Pap Smear, HPV DNA Test
• Advanced diagnosis : Chest X-rays, CT scan, MRI, and a PET scan to determine the spread and extent of cervical cancer

Treatment in a nutshell

• Surgery: Surgery is best suited for patients in whom cancer is restricted to the cervix. For more advanced disease, surgery is not offered
• Radiotherapy or chemotherapy: After surgery, the decision regarding postoperative radiotherapy /chemotherapy is taken depending on the histology findings

Milestone

Youngest girl of 4 years operated for fertility preserving cervical gynae surgery.

Reported Outcome

Top tips

• If ability to have children is your concern, discuss this with your cancer care team. Check with them how the procedures necessary for your care will affect your fertility
• During this stressful time, it is normal for you to be less interested in sex than before. Counselling can help you and your partner adjust and stay physically intimate in other ways
• Check with your surgeon whether your ovaries will also be removed and research this decision carefully
• Ask whether youll be having abdominal surgery or surgery through the vagina, since the procedures have different recovery rates
• Please cooperate when youre asked to walk after surgery. Youll recover faster and wont have as many problems with gas. Avoid lifting heavy objects at home. Dont walk up stairs too soon after surgery
• After treatment, take care to relieve your stress by ensuring regular follow ups and getting a second opinion, if you want to

OVARIAN CANCER

Ovarian cancer is cancer that develops in the female organs that produce eggs–the ovaries. It is the third most common cancer seen in women in India after cervical and breast cancer. The incidence of ovarian cancer in India is 7-9/100,000 women per year; 85-90 per cent of women with ovarian cancer are over 40 years of age with the peak incidence between 55 and 65 years of age. In India, 23,000 - 25,000 new cases of ovarian cancer are diagnosed every year.

Warning signs

• Nausea
• Vomiting
• Indigestion and constipation
• Bloating

Risk factors

• Family history of cancer
• Personal history of cancer
• Infertility
• No breastfeeding
• Hormone replacement therapy

Progression

• Stage I: Cancer is found in one or both ovaries
• Stage II: Cancer has spread to other parts of the pelvis
• Stage III: Cancer has spread to the abdomen
• Stage IV: Cancer is found outside the abdomen

Diagnosis

Early diagnosis is essential for better chances of cure

• Primary diagnosis : Pelvic examination
• Secondary diagnosis : Imaging tests, such as ultrasound or CT scans, blood test, MRI

Treatment in a nutshell

Majority of ovarian cancer patients require surgery and chemotherapy. The decision to perform surgery first is based on imaging findings (CT scan/MRI). The majority of patients are first offered surgery as a treatment option but if the disease is very advanced and surgery is not possible, chemotherapy can be considered; 60-70 per cent of ovarian cancer cases can be operated first.

Reported outcome

Top tips

After treatment, you following tips may help you get rid of some side effects:

• If you have nausea or vomiting problem, try ginger or peppermint tea, gum or candy.
• If diarrhoea is causing trouble, frequent sips of water and bites of salty crackers should help.
• If you have constipation, plenty of water and a fibre-rich food should help.
• Do not use a laxative without consulting your doctor.

Remarkable case

Robotic Radical Trachelectomy

Background and diagnosis : A 29-year-old lady was recently diagnosed with cervical cancer and was advised surgery. This would essentially have rendered her infertile as conventional surgery for cervical cancer requires complete removal of the uterus. However, she wanted to preserve her fertility. Fertility preservation surgery (radical trachelectomy) is an accepted treatment for cervical cancer but there are strict criteria to identify eligible patients. We carried out essential tests after which she was identified as a suitable patient for the procedure.

Treatment : We discussed and counselled the patient and her husband about the surgery and the advantages of using the robotic platform. She underwent robotic radical trachelectomy with a bilateral pelvic lymph node dissection at Kokilaben Hospital.

Outcome : Her postoperative recovery was uneventful and she was discharged from the hospital on the fifth day after her surgery. She will be closely observed for a period of one year; if things remain fine, she can attempt pregnancy.

Kokilaben Hospital has one of the most comprehensive cancer centres, offering all aspects of cancer care from prevention, screening and early detection, advanced imaging (including PET CT) to surgery, radiation and chemotherapy all under one roof. We understand that each woman with Gynaecological Cancer has unique medical and emotional needs. In order to address these needs we have highly qualified experts who specialise in different modalities of cancer care and work as a team, backed up by the cutting edge technology .This multidisciplinary team has a precise stepwise, goal directed approach for evaluation planning and treatment delivery, based on the available evidence. All the members of the team work with one goal To Make a Difference in the Fight with Cancer.