When we talk about cancer in women, the most common answer will be breast cancer. This is mainly because of the alarming rate of breast cancer cases yearly. While this common knowledge is a good thing, only a handful of people know about other cancers that solely women experience. These are gynecological cancers. To provide awareness of these diseases, we will discuss each and the recent developments in their treatment or prevention. Specifically, we will explore cancers of the cervix, ovary, endometrium, vagina, and vulva. We will use this chance to talk about the extremely rare cancer of the fallopian tube.
Screening and Treatment Developments on Gynecological Cancer
Gynecological cancer refers to the cancer of the female reproductive system. This system consists of different organs that spring up from stem cells when a person is still in their mother’s womb. gynecological cancer
These stem cells continuously renew the tissues in the organs throughout the lifetime of a woman. Because of this constant production of new cells, these organs are vulnerable to mutations that may lead to tumors. These mutations are more likely as people age. As such, gynecological cancers most often occur in postmenopausal and elderly women.
Among the types of gynecological cancer that we are going to discuss, the most prominent ones are the cancer of the cervix, endometrium, and the ovaries. Vaginal and vulvar cancers are less prominent, consisting of around one percent and three percent of the incidence rates of gynecological cancer, respectively. Less than one percent of the incidence rate falls under fallopian tube cancer. However, even with those low number of incidence rates, awareness of its existence is still crucial.
While lung and breast cancer continues to be the leading cause of cancer deaths among women, in 2019, cervical cancer ranked as the 2nd leading cause of cancer deaths in women aged 20 to 39 years old.
The major cause of this deadly cancer lies in human papillomavirus, usually referred to as HPV. The FDA had already approved the first HPV vaccine. However, the current numbers of cervical cancer cases show the continuing threat of the virus.
In 2018, the World Health Organization (WHO) finally called for a strategic plan to eliminate cervical cancer. This plan involves scaling up HPV vaccination drives, cervical screenings, and cervical cancer treatment. The WHO will particularly target low and middle-income countries. They presented their concrete plans at the 2020 World Health Assembly.
As the WHO has presented, they may face several challenges in executing the plan. These are the following challenges:
- Manufacturing, supply, delivery pipelines for the vaccine
- Cervical screening collection, evaluation, acceptability, and effectiveness of precancer treatment
- Appropriate referral, treatment services, and palliative care for women who may have cervical cancer
- Effective financing of vaccination and screening services on a large scale
Another one of the most common gynecological cancers is endometrial cancer. While cervical cancer has its root cause from the HPV, endometrial cancer has the important risk factor from estrogen exposure. Therefore, recent bodies of research are moving towards hormonal therapy against endometrial cancer.
In this 2019 systematic review of the use of anti-estrogen treatment for endometrial cancer, researchers examined 16 studies on the use of estrogen receptors. As a conclusion, the recommended treatment from the research is tamoxifen or a combination of this and progestin. This conclusion came from the similar response rates of these drugs when compared to first line treatment. Additionally, the toxicity of the drugs is low.
In 2020, ovarian cancer remained to be the gynecological cancer that has caused the most deaths each year in industrialized countries. The conventional treatment for this deadly disease is a combination of surgeries and systemic therapy. However, lately, scientists see that more options are seemingly becoming feasible.
According to a 2020 update from Obstet Gynecol, targeted therapy is one of the newer options currently seeing applications. However, this requires immense specificity as tumor cells are often located near healthy cells. Currently, antiangiogenics and poly ADP-ribose polymerase inhibitors have potential as targeted therapies.
We are now moving away from the more common gynecological cancer. Usually, vaginal cancer exists as a metastatic consequence of another primary site of cancer. These sites include the common gynecological cancers discussed above. This means that we will rarely see a diagnosis where vaginal cancer is the primary site.
In the case that vaginal cancer does occur, the usual treatments are surgery, radiation therapy, and chemotherapy. One prospective care treatment being studied is palliative electrochemotherapy. This involves administering electrical pulses to a patient after chemotherapy. While the study is still small in scale, results showed a tumor response or stabilization in 83% of the patients.
This disease is another uncommon gynecological cancer that requires a very specific and multidisciplinary evaluation. This is because the disease can come from different sites, and each patient has their unique condition. Although, the usual cases of vulvar cancer involve elderly women.
The following treatments that doctors may perform are methods similar to vaginal cancer with the addition of immunotherapy. Of the following treatments, one of the most promising is radiotherapy. As reviewed in a 2021 journal article from Cancers, radiotherapy is a relevant method for vaginal cancer before the primary treatment or even as the exclusive primary treatment of the disease.
Fallopian Tube Cancer
As previously stated, this disease is one of the rarest among gynecological cancers. In 2014, the International Federation of Gynecology and Obstetrics incorporated ovarian, fallopian tubes, and peritoneal cancer in the same system. This is mainly because of the relevant pathways each undertakes as part of the female reproductive tract.
Because of the specificity and the rarity of this type of cancer, targeted therapy is one of its potential treatments. Particularly, there is ongoing research on exploring MEK inhibitors for targeted therapy. However, the response rate for this method is still unsatisfactory.