Cancers of the female reproductive system

Gynaecologist, Dr Sumayya Ebrahim, gives us a brief rundown of the different types of cancer of the female reproductive system.

Cervical cancer

Peak age: Most common cancer in South African women under 40 years of age. Risk factors are smoking, human papillomavirus (HPV) infection and immune compromised states, like HIV/AIDS.

Location: Lowermost part of the uterus or mouth of the uterus – the part of the uterus that dilates during labour.

Screening test: Effective screening test available: Pap smear.

Treatment: Surgery, radiotherapy and occasionally chemotherapy.

Special consideration: With regular screening and surveillance this cancer is preventable.

Endometrial cancer

Peak age: Most common in women after menopause. Risk factors are diabetes, hypertension and obesity.

Location: Endometrial lining of the uterus – the part that is usually shed during menstruation.

Screening test: No large-scale screening tests available. Vaginal ultrasound and endometrial sampling or biopsy is used to make the diagnosis.

Treatment: Mainly surgical with radiotherapy for more advanced stages. Chemotherapy is not used.

Uterine sarcoma

Peak age: Commonest in women in the peri-menopausal age range of between 45-54 years of age. The most common risk factor is any previous radiation to the pelvis for the treatment of any other cancer in this region.

Location: This cancer forms in the muscle layer or connective tissue layer of the uterus. If a uterine fibroid becomes cancerous, it forms into this type of cancer.

Screening test: No effective screening test exists. Diagnosis is often made only once the fibroid is surgically removed and analysed.

Treatment: Surgery is mainly used. Although radiation and chemotherapy are also used; these are less effective.

Ovarian cancer

Peak age: The fifth and sixth decades of life. Most important risk factors are genetic mutations, like BRCA2, family history or obesity.

Location: Anywhere in the ovaries, which are the hormone and egg-producing glands on each side of the uterus. Most normal women will have two ovaries each.

Screening test: Transvaginal ultrasound and a blood test for Ca-125 levels. Not recommended for general screening in low-risk populations.

Treatment: Mainly surgical and chemotherapy. Radiation therapy is not recommended. 

Peritoneal cancer

Peak age: Extremely rare, can sometimes affect men too.

Location: Close relative of epithelial ovarian cancer; can occur anywhere in the pelvic region. The peritoneum is the thin layer of tissue that covers all the pelvic and abdominal organs.

Screening test: No screening test available. Diagnosis is made via CT scan or MRI scan.

Treatment: Mainly surgery and chemotherapy. Newer treatment methods like hormonal therapy, immunotherapy and targeted therapy (drugs that are aimed at killing cancer cells without harming normal cells) are still being researched and studied.

Fallopian tube cancer

Peak age: Very rare. Makes up 1-2% of all gynaecological cancers. More common in Caucasian women between the ages of 50-60 years. Women who carry BRCA1 mutations seem to be at higher risk.

Location: In the fallopian tubes which are connected to the top of the uterus. The fallopian tubes carry the sperm to the egg for fertilisation and then carries the embryo back into the uterus for implantation.

Screening test: Because this cancer is so rare, little is known about it. Ca-125 blood levels can be used for screening but not in low-risk individuals.

Treatment: Is similar to treatment for ovarian cancer; mainly surgery and chemotherapy.

Vaginal cancer

Peak age: Occurs most commonly between 50-70 years of age. Risk factors include smoking, HPV infection, previous radiation therapy, diethylstilbestrol exposure in the uterus (between 1940 and 1971 this drug was prescribed to pregnant women to treat nausea in pregnancy).

Location: The vagina; the muscular tube that connects the uterus to the external genital area.

Screening test: Pelvic examination and Pap smear, biopsies for diagnosis.

Treatment: Surgery, radiation and chemotherapy.

Vulvar cancer

Peak age: More than 50% of these cancers occur in older women: 70 years and up. Risk factors include age, HPV infection, smoking and compromised immunity.

Location: On the outer surfaces of the female genital area. It can start as a lump or an ulcer on the outer or inner labial areas.

Screening test: No simple or reliable screening test. A gynaecological examination and a biopsy is usually diagnostic

Treatment: Surgery, radiation and chemotherapy.

MEET THE EXPERT – Dr Sumayya Ebrahim

Dr Sumayya Ebrahim is a gynaecologist in private practice in Johannesburg, Gauteng. Check out her blog Vaginations by Dr