Looking closely at the 8 gynaecological cancers

Professor Neville Hacker talks to us about each of the 8 gynaecological cancers, where they arise, how common they are and some of the symptoms that may occur.

When we talk about a gynaecological cancer, we are referring to a cancer that arises from the female reproductive organs – together with cancers from the placenta, or afterbirth. These cancers are all treated by a multidisciplinary team of doctors, nurses and paramedical personnel, which is usually headed by a gynaecological oncologist.

As a professor of gynaecological oncology, one of the questions I am asked is: how many gynaecological cancers are there? I can understand the confusion. Some organisations state there are 5, some say 6 and others – like the AGCF – talk to all 8 of the gynaecological cancers that women can experience. 

The female reproductive organs from the outside in are the vulva, vagina, cervix (neck of the womb), uterus (womb), fallopian tubes and ovaries. That is 6 organs in which cancer may arise. We then add two more cancers that may potentially happen related to this area: peritoneal cancer that may occur in the peritoneum (lining of the abdomen), which has the same cells as the covering of the ovaries, and gestational trophoblastic disease, which arises from the placenta.

In total, these make up the 8 gynae cancers that the AGCF want to find new ways to screen, treat and cure so that all women have hope for a brighter future. Here’s a brief overview of each of them. 

Vulva cancer

Vulva cancer is uncommon, with about 400 cases diagnosed each year in Australia. It is mainly a disease of older women, where it often follows a long history of itching and irritation related to lichen sclerosis. However its incidence is rising in women under 60 years, where it is usually related to infection with the human papilloma virus (HPV). Most cancers are squamous cell carcinomas, which means they arise in the tissue that forms the surface of the skin. The disease is usually treated surgically, and the overall cure rate is about 70%.

Vaginal cancer 

Vaginal cancer is even less common, with only about 100 new cases diagnosed in Australia each year. Most vaginal cancers are squamous cell carcinomas, and about 70% are caused by the sexually transmitted human papilloma virus (HPV). Because of the vagina’s close proximity to the rectum and bladder, most vaginal cancers are treated with radiation therapy. The chances of curing vaginal cancer are about 50%.

Cervical cancer 

Cervical cancer is the most common cause of death from cancer in women in many developing countries – however in countries with good cervical screening programs, the incidence is quite low. In Australia in 2021, it is estimated that 913 new cases will be diagnosed. Virtually all cases of cervical cancer are caused by human papilloma virus (HPV), and with the introduction of the HPV vaccination program for all schoolgirls and boys – together with our successful National Cervical Screening Program – it has been estimated that we could eliminate the disease by 2035. Screening for cervical cancer has recently changed from a Pap smear every 2 years to an HPV test every 5 years.

Uterine or endometrial cancer

By uterine cancer we mean cancer arising in the lining of the uterus – which is called the endometrium. Endometrial cancer is the most common gynaecological cancer, there being about 2500 new cases diagnosed each year in Australia. It mainly affects older women, and the most common symptom is abnormal vaginal bleeding. Because postmenopausal bleeding is always an alarming symptom, most cases are diagnosed before they have spread beyond the uterus. However, it can also affect premenopausal women, when diagnosis may be delayed because the bleeding is usually initially thought to be due to “hormonal” causes. Obesity is the major risk factor for endometrial cancer, but in younger women, it may occur as part of the hereditary Lynch syndrome, which is also associated with hereditary bowel cancer. Cancers can also arise in the muscle of the uterus. Benign uterine muscle tumours are called fibroids, and are extremely common, but the malignant variant, called a leiomyosarcoma, is very uncommon. The chances of curing endometrial cancer are about 80%.

Cancer of the fallopian tube 

Cancer of the fallopian tube is the rarest of the gynaecological cancers, there being less than 100 cases diagnosed each year in Australia. The classical triad of symptoms and signs is watery vaginal discharge, pelvic pain and a pelvic mass.  The cause is unknown, but some are associated with the hereditary breast-ovarian cancer syndrome, particularly with the BRCA 1 mutation.

Ovarian cancer 

Ovarian cancer is the second most common gynaecological cancer in Australia, with about 1700 new cases diagnosed each year. It is sometimes known as the “silent killer” because there is no screening test for the disease, and it is usually in an advanced stage at the time of diagnosis. 

The symptoms are vague, such as abdominal pain, abdominal swelling, lethargy and indigestion. About 15-20% of ovarian cancers are hereditary. The most common form of hereditary ovarian cancer is the breast-ovarian cancer syndrome, which is associated with inheritance of the BRCA1 or BRCA2 genes. 

Some cases also occur as part of the Lynch syndrome, which is associated with a number of hereditary cancers, most commonly bowel and endometrial, but also ovarian and stomach cancer. Ovarian cancer carries the worst prognosis of all of the gynaecological cancers, with a 5-year survival of only about 49%.

Primary peritoneal cancer 

Primary peritoneal cancer is a rare cancer, although the peritoneum (lining of the abdomen) is a common site for spread from tubal and ovarian cancers. It is usually quite advanced at the time of diagnosis, and often presents with abdominal swelling due to excessive peritoneal fluid production, which is called ascites. This cancer looks like ovarian or tubal cancer under the microscope and is staged and treated in the same way as these cancers. It can occasionally develop even after the tubes and ovaries have been removed, particularly in women who have the hereditary breast-ovarian cancer syndrome.

Cancer of the placenta

The eight gynaecological cancer is called gestational trophoblastic disease, and it arises from the placenta during pregnancy. The most common form of the disease is the benign hydatidiform mole, which occurs in about 1 per 1200 pregnancies in Australia. It is usually discovered during the first 3-4 months of pregnancy, and often presents as a miscarriage. The most malignant form of the disease is called choriocarcinoma. It forms from cells that were part of the placenta during pregnancy. About 50% of cases follow a hydatidiform mole, and the other half occur months after a normal pregnancy, an abortion or an ectopic pregnancy. A choriocarcinoma is a rare but aggressive type of cancer, which commonly spreads to other parts of the body, such as the lungs, liver or brain. Fortunately it is very sensitive to chemotherapy and most women will be cured of their disease.

Our hope for the AGCF is that we will be able to fund research into all 8 of these gynaecological cancers, finding new ways to screen, treat and cure them so that no woman has to lose their life. You can support us by raising awareness of all gynae cancers or donating to the AGCF so that we can keep supporting our brilliant scientists and their life-changing work.