By: Dr. Azuka Ezeike, MBBS, FWACS (Obstetrics and Gynaecology), FMCOG, MSc (Public Health)
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A gathering of African women.
When cancer affects organs in a woman’s reproductive system, it is referred to as gynaecological cancer. These organs include the uterus (womb), cervix, ovaries, fallopian tubes, vagina and vulva. (See figure 1)
Figure 1: Anatomy of the female reproductive system. The organs in the female reproductive system include the uterus, ovaries, fallopian tubes, cervix, and vagina. The uterus has a muscular outer layer called the myometrium and an inner lining called the endometrium. Image credit: US NIH. National Cancer Institute (NCI)
The story of cancer in Africa is beyond statistics. It is about real people and real faces. Many families in Africa have lost important members to cancer because low- and middle-income countries account for about 70% of cancer deaths.
Cancer is a disease that results from the abnormal and unregulated growth of cells. These cells grow beyond their boundaries to affect nearby organs. They can also travel through the blood and the lymphatic vessels to distant organs from the site of origin. This is referred to as metastasis.
Lymph vessels are a network of tubular channels in the body that, like veins, drain a clear fluid called lymph from the body into the heart. Lymph helps to fight infections and plays a part in maintaining normal fluid balance in the body.
"Cancer" is a word that often evokes fear due to its association with suffering and death. However, awareness of prevention and early detection can significantly reduce the risk of dying from the disease. Early detection also lowers the cost of treatment.
Unfortunately, in Africa, many women are diagnosed with cancer at advanced stages when it may no longer be curable. Raising awareness about gynecological cancers is crucial to minimize the devastating impact of this disease
This article aims to provide you with accurate information on the different gynaecological cancers and how they are prevented and managed.
The three most common gynaecological cancers are:
Other cancers like vaginal, vulva, choriocarcinoma (a cancer that starts in a tissue that will later become the placenta in a pregnancy), fallopian tube cancer and uterine sarcoma are rare.
Cervical cancer is cancer that affects the mouth of the womb (cervix). This is the part that connects the womb with the birth canal. [1] Worldwide, it is the fourth most common cancer in women. It is the most common cancer affecting the reproductive organs in African women. [2, 3]
About 99% of cervical cancer is linked to infection by the Human Papilloma Virus (HPV). This is a sexually transmitted virus that is found in almost all sexually active women. It is a large family of viruses with about 80 subtypes. Some of the subtypes are low-risk and are not linked to cancer, but a few are considered high-risk HPV. Of the high-risk types, HPV 16 and 18 cause up to 70% of cervical cancer.
HPV infection usually clears within two years. In some women, the infection may persist for years. This persistence of the high-risk HPV causes a change in the cells making them behave abnormally. This is called dysplasia. This is the precancerous stage of the disease. These abnormal cells over some years change to cancer cells.
Cervical cancer is unique among reproductive organ cancers because of this precancerous stage, which is treatable. However, once it progresses to full-blown cancer, particularly in the later stages, treatment becomes much more difficult.
Any sexually exposed woman is at risk of cervical cancer. However, your risk is higher if you have;
At the very early stages, cervical cancer may not have any symptoms, however, symptoms develop as the disease progresses. [4]
Some of these symptoms are:
In advanced disease, the following symptoms may develop:
It is the cancer of the egg-producing part of the reproductive tract, the ovaries. A normal female has two ovaries, one on either side of the womb. Ovarian cancer is the most deadly of all gynaecological cancers. This means that someone diagnosed with ovarian cancer is more likely to die sooner compared to someone with other types of gynaecological cancers. Data from studies shows that it is the second most common gynaecological cancer in African women. [2, 3] This is partly because the disease is usually diagnosed at advanced stages.
Unlike cancer of the cervix, cancer of the ovary does not have a precancerous stage, therefore the role of screening is limited. In addition, the early disease may not have any symptoms so the diagnosis is often delayed.
You are at risk of cancer of the ovary if you:
Ovarian cancer is suspected to be related to the number of ovulations in a woman. However, the link between it and ovulation induction (use of medications to cause the ovaries to release eggs) for infertility treatment is still not established. [5]
Ovarian cancer typically presents with no or non-specific symptoms at the early stages and can be confused with other conditions.
The initial symptoms include:
Late symptoms are:
Uterine cancer is cancer of the inner lining of the womb. It is the most common gynaecological cancer in the Western world. [6] In Africa, it is the third most common gynaecological cancer. [2, 3]
These include:
Early symptoms
In advanced stages
To reduce your risk of gynaecological cancers, it is essential that you undertake measures among others, that help you to detect precancerous conditions or early stages of cancer. Preventive strategies are particularly effective for cervical cancer because it has a treatable precancerous stage.
I. Cancer of the Cervix
Prevention involves primary, secondary, and tertiary measures
Primary prevention involves:
Health education
Providing community education on the need to:
HPV vaccination
Vaccination against HPV is most effective before sexual exposure. It is recommended primarily for girls who are 9-14 years of age. It can also be given up to 45 years if considered to be necessary, however, this may not be very effective since exposure to the virus may have already occurred.
This involves the screening for cancer. The screening aims to detect the precancerous stage of the disease.
Two major methods are utilised:
In low-resource settings, other methods like the visual inspection with acetic acid or Lugol’s iodine may be used. These methods involve naked eye examination of the cervix. They are not generally recommended because they may be associated with errors in diagnosis.
Pap smear
This test involves taking a smear from the cervix. This is examined under the microscope for the presence of abnormal cells. The test is recommended from age 25 and will be continued at recommended intervals till age 65.
High-risk HPV DNA
The presence of high-risk HPV indicates the need for further tests to rule out the presence of abnormal cells. The World Health Organization recommends the HPV DNA test as the preferred screening test. This should commence at the age of 30 years. For women living with HIV, screening should commence at 25 years.
Depending on the locality, these two tests can be done individually or in combination.
This involves early detection and treatment of cervical cancer.
II. Ovarian and Uterine (womb) Cancer
These cancers do not have a precancerous stage, so they are more difficult to prevent. While some factors like genetics cannot be controlled or modified, some other factors can be modified to reduce the risk:
Factors that may reduce the risk include:
No screening modality has been shown to reduce the risk of death from these two cancers. [7, 8]
However, those at high risk may periodically check for the presence of the disease using:
Early detection is crucial to successful treatment of cancer. If you have irregular menstrual bleeding or bleeding after menopause, in addition to any of the described symptoms, you need to see your doctor.
Cancer treatment depends on the:
The aim of treatment is either:
The treatment options include:
This involves the removal of the cancer tumours through a surgical operation. In most cases, it involves the removal of the organ of origin of the cancer. Treatment by surgery is most useful when the disease is still confined to the organ of origin. If the disease has spread to nearby or distant organs, surgery may not be possible, even when possible it may not result in cure. This is why early diagnosis is important.
This is the use of medications to kill cancer cells. There are many classes of anti-cancer drugs and more are still being developed. These drugs can kill cancer cells while sparing the normal cells. They must be used under your doctor's instructions as they may have side effects. Chemotherapy is employed when the cancer has spread to other parts of the body. It is commonly utilised in the treatment of cancer of the ovary.
This is the use of high-energy rays like X-rays to treat cancer cells. These rays can either kill cancer cells or halt their growth.
They are of two types:
External radiation: The rays are generated through a source outside the body. This involves the use of special machines like the linear accelerator.
Internal radiation: The radiotherapy source is delivered from a source inserted into the body. This is also called brachytherapy.
Radiotherapy is used at the advanced stages of cancer disease. It is the most common modality for the treatment of cervical cancer in Africa, This is because most patients present late for treatment in this part of the world.
Some cancers are linked to the presence of hormones. Agents that counteract the effect of these hormones are sometimes used for the treatment of these cancers. Hormonal therapy can either halt or slow down the growth of cancer cells. Hormonal therapy is sometimes used in the management of cancer of the womb.
Your immune system is made to fight infection and foreign agents. In the same way, the immune system can be activated to destroy cancer cells. Immunotherapy is a new method of treatment, therefore it is not widely used like the other modalities.
Before commencing treatment your doctor would:
Whichever treatment option you choose will be done under close monitoring by your doctor and other health workers.
Africa has a high percentage of cancer-related deaths due to late presentation and challenges in treatment. These challenges include:
Gynaecological cancers represent a significant health challenge for women in Africa, where late-stage diagnosis is common, leading to high death rates. Awareness and early detection are crucial in changing this narrative. While cancers like cervical cancer offer opportunities for prevention and early treatment, others like ovarian cancer require vigilance due to their often late presentation. It's essential for women to be informed about their risks and to seek regular medical check-ups, especially if they have symptoms or risk factors
1. National Cancer Institute. What is cervical cancer? - NCI [Internet]. Updated June 15, 2023. [Cited 2024 Sep 2]. Available from here.
2. Gebretsadik A, Bogale N, Dulla D. Descriptive epidemiology of gynaecological cancers in southern Ethiopia: retrospective cross-sectional review. BMJ Open, 2022 Dec 29;12(12):e062633. Available from here.
3. Zoure AA, Bayala B, Bambara HA, Sawadogo AY, Ouedraogo C, Lobaccaro JMA, et al. Epidemiological situation and medical management of gynaecological and breast cancers from 1998 to 2018 in West Africa: a systematic review. Asian Pacific Journal of Cancer Biology. 2020 Dec 7;5(4):211–9. Available from here.
Cancer Research UK. Cervical cancer [Internet]. Last reviewed 04 Sept. 2023. [Cited 2024 Aug 31]. Available from here.
5. Diergaarde B, Kurta ML. Use of fertility drugs and risk of ovarian cancer. Curr Opin Obstet Gynecol. 2014 Jun;26(3):125–9. Available from here.
6. Mahdy H, Casey MJ, Vadakekut ES, Crotzer D. Endometrial cancer. In: StatPearls [Internet]. Treasure Island (FL), StatPearls Publishing; 2024. Last update: 20 April 2024. [Cited 2024 Sep 2]. Available from here.
7. National Cancer Institute. Endometrial cancer screening - NCI [Internet].26 June 2023. [Cited 2024 Sep 3]. Available from here.
8. National Cancer Institute. Ovarian, fallopian tube, & primary peritoneal cancers screening - NCI [Internet]. 2023 [cited 2024 Sep 3]. Available from here.
Related:
Cervical Cancer: What African Women Need to Know
Cervical cancer screening information for African women
Cervical cancer treatment and the challenges for African women
Challenges of cervical cancer prevention and care In Africa
Nigeria to vaccinate 7.7 million girls against leading cause of cervical cancer
More sexual partners ups your reproductive cancer risks, study says
Published: December 9, 2024
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