Gynaecological cancer – How is it diagnosed?

Gynaecological cancer refers to any cancer that affects the female reproductive organs, including the vulva, vagina, cervix, uterus, fallopian tubes, and ovaries. Each type of cancer has its own specific diagnostic procedures and early warning signs.

Cervical cancer

Cervical cancer is the second most common cancer among women and causes more deaths than breast cancer globally. However, it can largely be prevented through vaccination against the human papillomavirus (HPV) and regular cervical screening, starting at age 25. Screening typically involves an HPV test, which helps identify women at higher risk.

If a woman presents with symptoms, such as irregular bleeding, bleeding after sexual intercourse, or abnormal vaginal discharge, further investigation is necessary. The cervix is examined using a speculum, which allows doctors to visualise the area. If any abnormalities are seen, a biopsy is taken on the spot.

If no visible abnormalities are found, cervical screening with HPV testing and cytology (cell examination) is essential. 

If cancer is confirmed, further tests, such as an MRI of the pelvis or a CT scan of the chest and abdomen, may be conducted, depending on resource availability. 

In settings with limited resources, an abdominal ultrasound and chest X-ray can be used instead. Blood tests, including kidney function, haemoglobin levels, and HIV status, are also part of the diagnostic process. These investigations help determine the cancer’s stage and guide the appropriate treatment plan.

Vulvar cancer

Vulvar cancer affects the outer lips of the female genitalia (labia minora and labia majora). It can develop due to an underlying skin condition like lichen sclerosis or as a result of HPV infection. Women who experience persistent irritation or sores in this area should seek medical attention for a biopsy.

The biopsy involves numbing the area with local anaesthetic before removing a small tissue sample for laboratory analysis. If cancer is detected, a CT scan may be ordered to assess its spread. Treatment often involves surgery, radiation, and sometimes chemotherapy.

Vaginal cancer

Vaginal cancer is extremely rare and often presents with symptoms like abnormal discharge or vaginal bleeding. Sometimes, the cancer may originate from another organ, such as the uterus. 

If vaginal cancer is suspected, a biopsy is performed, followed by imaging tests like MRI or CT scans, and routine blood tests.

Ovarian cancer

Ovarian cancer is challenging to diagnose because its symptoms, such as abdominal pain, bloating, and a feeling of fullness, are often mistaken for bowel-related issues. 

Suspicious findings during an ultrasound can indicate potential cancer, but the ovary should never be biopsied unless the cancer has already spread. Performing a biopsy on a potentially cancerous ovary could cause the cancer to spread beyond the ovary.

Blood tests, including tumour markers, kidney function tests, and a complete blood count, are typically ordered. A CT scan of the abdomen and chest is also necessary. The definitive diagnosis of ovarian cancer is made when the ovary is surgically removed and examined under a microscope in a laboratory.

Uterine cancer

Uterine cancer typically presents with abnormal bleeding, particularly in post-menopausal women. Any abnormal bleeding must be investigated. Diagnostic procedures may include a Pap smear and an endometrial biopsy. The biopsy can be done in a doctor’s office using a tool called a Pipelle, or it may involve a more detailed procedure called a hysteroscopy.

During a hysteroscopy, a small camera is inserted into the uterus to take biopsies from the inner lining. If cancer is detected, further imaging, including a CT scan of the chest, abdomen, and pelvis, is necessary to assess the cancer’s spread.

General diagnostic approach

To diagnose gynaecological cancer, healthcare providers (ideally a gynae) typically begin by reviewing your medical history and performing a thorough physical examination. Depending on the symptoms, they may order one or more diagnostic tests, including biopsies, blood work, and imaging studies like CT scans or MRIs, to confirm the presence of cancer and determine its stage.

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