Gynaecological cancer

Overview

Women's Health Unit at the Epworth

Our Women's Health Unit Nursing team are highly skilled in the treatment and care of women with gynaecological cancers. The Medical Specialists, Gynaecological Clinical Nurse Consultant, Allied Health and Ward staff work closely with patients and families providing expertise, education, and support at this challenging and stressful time.

Types of gynaecological cancer

Learn more about the different types of gynaecologic cancer to inform collaborative treatment decisions with your doctor.

Ovarian cancer

Ovarian cancer occurs when some of the cells in one or both ovaries start to grow abnormally and develop into cancer. There are several different types of ovarian cancers, originating in the ovaries or fallopian tubes. Epithelial ovarian cancer is the most common type of ovarian cancer.

Cervical cancer

There are two main types of cervical cancer; squamous cell carcinoma and adenocarcinoma. Squamous cell carcinoma is the more common type of cervical cancer and starts in the skin-like cells of the cervix. At diagnosis, the cancer is often just within the cervix, but it may spread to tissues around the cervix (the vagina or lymph glands) or other parts of the body.

Uterine/endometrial cancers

Cancer of the uterus is also called cancer of the womb, uterine cancer, endometrial cancer, or cancer of the lining of the womb. There are two main types of uterine cancer. The most common type of uterine cancer is endometrium cancer which starts in the lining of the uterus. The A less common type of uterine cancer grows in the muscle tissue of the uterus, known as a uterine sarcoma.

Vaginal cancer and vulvar cancer are rare in Australia:

Vulvar cancer

Vulvar cancer occurs in any external area of the female genitals, including the anus. Vulvar cancer accounts for less than one per cent of all cancers in Australian women.

Vaginal cancer

Vaginal cancer arises in the tissues of the vagina. There are two main types of vaginal cancer: those that start in the vagina itself (primary vaginal cancer), and those that spread into the vagina from another part of the body (secondary vaginal cancer).

Diagnosis and screening 

Early detection of symptoms and signs can save your life.

Cervical cancer prevention and screening

Most cases of cervical cancer are caused by the human papilloma virus (HPV). This is a common infection which affects the surface of areas of the body such as the cervix, vagina and skin.

HPV can be prevented by HPV vaccine, which protects against seven high-risk types of HPV known to cause 90% of cervical cancers. This vaccine is provided free to children aged 12-13 as part of the national HPV vaccination program.

Who needs to screen?

For people aged 25 and older, the best protection against cervical cancer is screening. The National Cervical Screening Program recommends commencing cervical screening at age 25, then every 5 years up to the age of 74. Whatever gender you identify with, if you have a cervix, you need regular cervical screening tests.

What is a cervical cancer screening?

Screening is testing for cancer before symptoms appear. The cervical screening test finds cancer-causing types of HPV in cells taken from the cervix. This replaced the Pap test in 2017.

To learn more about cervical screening, visit Cancer Council Victoria.

Diagnosing gynaecological cancers

Epworth provides patients with a range of diagnostic tests to thoroughly investigate signs and symptoms of underlying health concerns.

Below is an overview of common cancer tests used to diagnose cervical cancer, ovarian cancer, vaginal cancer, vulvar cancer, or other gynaecological cancers.

Physical examination

Your GP or specialist may perform a general physical examination to understand your current health. This may include an internal pelvic floor examination.

Biopsy

Tissue samples are taken and looked at under a microscope to determine if cancer cells are present. Biopsies may be performed on the Cervix via colposcopy, or taken from the uterine lining via hysteroscopy or lesions in the pelvis or abdomen via laparoscopy or at an open procedure (laparotomy).

Fluid aspiration

A fine tube is placed into the abdomen to collect fluid which is checked under the microscope for cancer cells. A local anaesthetic is given to avoid pain.

Blood Test

Your doctor may order several blood tests to check your overall health and to detect proteins produced by cancer cells. These proteins are called tumour markers.

Ultrasound

An ultrasound may be one of the first tests you encounter following a blood test and physical exam. Ultrasound uses echoes from soundwaves to form a picture of the pelvic organs on a computer.

• Abdominal ultrasound – the sonographer moves a small device (transducer) over your abdominal area.

• Transvaginal ultrasound – a small transducer wand is inserted into the vagina to provide a clearer picture of both ovaries, uterus, bladder and bowel.

Medical imaging

Depending on the types of cancer being investigated, your doctor may order an MRI (magnetic resonance imaging), CT (computerized tomography), or PET (positive emission tomography) scan to be performed.

Upon formal diagnosis, medical imaging will allow your care team to examine and stage cancer.

Staging - Investigating the extent of the cancer

Staging helps your care team and specialists to create a unique treatment plan. During your initial diagnostic tests, your care team may be able to stage your cancer at the same time during a biopsy or CT, MRI, or PET scans.

What does my cancer stage mean?

Staging is a term used to describe the size of the cancer and whether it has spread. Staging helps your care team and specialists to create a unique treatment plan.

Stage 1

Early cancer where the tumour is relatively small and the cancer has not yet spread to other tissue.

Stage 2

Cancerous tumours remains relatively localised but has spread to nearby tissue beyond its origin.

Stage 3

Cancer has spread regionally and affected surrounding tissue, and may have grown.

Stage 4

Sometimes called advanced cancer, stage 4 means cancer has spread to other tissue or organs beyond the region where it originated.

Treatment for gynaecological cancers

At Epworth, our specialised Gynaecology Cancer Centre will provide you with a team of experts who work together to create a treatment plan that considers your needs and circumstances.

Multidisciplinary Team (MDT) Assessment and Plan of Treatment

You will have access to an MDT to plan the management of your cancer. All members of the MDT have a special interest in gynaecological cancer, and include:

• Gynaecological oncologists
• Medical oncologists
• Gynaecologic clinical nurse specialists/oncology liaison nurse
• Gynaecologic histopathologists/cytologists
• Physiotherapists
• Radiologists
• Research staff
• Radiation oncologists
• Genetics counsellors
• Social workers
• Psychiatrist/psychologist
• Pastoral Care

Treatment

Learn more about specific treatment interventions for gynaecological cancers

• Chemotherapy
• Radiotherapy
• Surgery

We’re here to holistically support your treatment journey

As well as providing specialised medical care, we offer a range of support services, including nutritional counselling, spiritual and emotional support, and specialist nurse support. These services are offered through our rehabilitation programs which our patients can access before, during or after treatment.

Gynaecological cancer surgery

Our specialist care team provides comprehensive support and service for the investigation and management of all gynaecological cancers.

Why choose Epworth to perform cancer surgery?

Our gynaecological oncologists perform more than 1,000 major gynaecological cancer operations each year. Epworth was the first private hospital group in Victoria to treat gynaecological cancers using robot-assisted surgery.

Depending on your type of gynaecological cancer, your treatment plan may recommend surgery, chemotherapy prior to or after surgery, or a combination of chemotherapy and radiotherapy. Some cancers are cured with surgery alone and others require a combination of treatments.

Targeted therapies

Targeted therapies are the use of drugs to attack specific weaknesses in cancer cells, killing the cells to prevent the cancer growing.

The role of genetics and gynaecological cancer

Some cancers are known to be inherited. A hereditary cancer is a cancer that develops due to an inherited gene fault (mutation). Approximately 20% of high grade serous ovarian cancers are linked to a faulty gene that stops working as it should (for example: BRCA 1, BRCA 2 genes). If you are diagnosed with high grade ovarian cancer, you will be offered genetic testing following your surgery.

Radiotherapy

Epworth oncologists use radiation to cure, control and reduce gynaecological cancer cells for our patients. 

Everyone's cancer treatment journey is unique. Speak with your Epworth specialist team to understand the best approach to have your gynaecological cancer treated. 

Radiotherapy at the Epworth

Epworth offers patients radiotherapy through our provider, Icon. As Australia’s largest dedicated cancer care provider, Icon has a long history of delivering exceptional cancer care to the Australian community.

Supported by the latest world-class technology and evidence-based techniques, Icon’s highly experienced team of radiation oncologists, radiation therapists, physicists and nurses are committed to providing compassionate, exceptional care for patients and their loved ones.

What is radiotherapy?

Will I need radiotherapy?

Depending on your [type of gynaecological cancer], your treatment plan may recommend radiotherapy. 

What are the side effects of radiotherapy?

Side effect types and duration will vary from person to person, some general side effects may include:

• Fatigue
• Skin irritation
• Feeling weak
• A stinging sensation when urinating
• Diarrhoea

Will I need radiotherapy?

Your oncologist will speak with you to decide whether radiotherapy is the right treatment option for you.

Chemotherapy

Your medical oncologist will oversee your chemotherapy. These specialists work closely with surgeons, radiation oncologists, physicians, nurses, and allied health professionals to ensure that all elements of your care are coordinated.

Your medical oncologist will explain and discuss current treatment recommendations and the opportunity to participate in appropriate clinical trials.

What is Chemotherapy?

Chemotherapy is a common form of treatment that involves the use of anti-cancer drugs to attack cancer cells. Chemotherapy is often used alongside other treatments such as radiotherapy and surgery.

How will I receive my treatment?

The treatment can be given orally, through an intravenous cannula, direct introduction to the affected organ/tissue or as a cream. Chemotherapy is often given in courses or cycles with periods of rest in between, allowing normal cells to recover.

Are there different types of chemotherapy?

Yes, there are many different types of chemotherapy. Your care team will explain which chemotherapy is best for your circumstance.

Will I need chemotherapy?

If you have been diagnosed with gynaecological cancer, your Epworth oncologist will discuss with you if chemotherapy is suitable for your treatment needs.

Will I need targeted therapies?

Drugs targeting defective DNA repair, such as PARP inhibitors, have been approved for advanced ovarian cancer, and drugs targeting angiogenesis have been used in the treatment of advanced or recurrent ovarian and cervical cancers. Immune check-point inhibitors such as anti-PD-1/PD-L1 antibodies have proved successful for mismatch repair-deficient endometrial cancers and HPV-targeted therapies are under development for HPV-related malignancies.

What are the side effects of chemotherapy?

Our team is here to support you throughout your cancer journey and will help you prevent and manage these potential and often temporary side effects.

Side effects may include:

• Nausea and vomiting
• Diarrhoea or constipation
• Fatigue
• Hair loss
• Muscle weakness
• Skin sensitivity to sunlight
• Dry or tired eyes
• Loss of appetite

Epworth Wig salons:

Head wear and wigs are offered to all Epworth patients experiencing hair loss at our convenient on-site salons. This service is provided via the generosity of our Epworth Foundation donors so there is no cost to patients.

Book a free salon style consultation with one of our friendly volunteers or call 03 9516 2425.

How do I prepare for chemotherapy?

The Gynae Clinical Nurse Consultant and Oncology Liaison Nurse Consultant will provide education and a support pack for your information and explain the chemotherapy process. You may be able to use “cold caps” to prevent hair loss or may like to be fitted for a wig prior to starting chemotherapy in case you need it. Recovering from surgery, eating well, staying well hydrated, sleeping and exercising will all play a part in preparing for chemotherapy. You may choose to have your chemotherapy at one of Epworth’s Day Oncology Units or a Unit closer to your home.

If you have children or grandchildren from babies to age 18, you may like to read the Cancer Council book: Talking to Kids About Cancer. The ward team can provide a copy.

Clinical trials and Research

Population, laboratory and clinical research are 3 types of health research. People affected by cancer tend to participate in clinical research, which is conducted to better understand, diagnose, prevent and treat diseases.

A clinical trial tests whether a new approach to prevention, screening, diagnosis or treatment works better than the standard methods and whether it is safe. If the new approach is shown to improve results more than existing treatments, it may be approved for use. For more information: Understanding Clinical Trials and Research, Cancer Council PDF

Gynaecological cancer rehabilitation 

Rehabilitation doesn't just start after your treatment has ended. You may benefit from our holistic rehabilitation programs at any time throughout your cancer journey. Our programs support you to physically and emotionally prepare for treatment or restore your strength and wellbeing.

Who is the program for? 

Rehabilitation doesn't start after your treatment has ended. You may benefit from our holistic rehabilitation programs at any time throughout your cancer journey. Our programs can support you to physically and emotionally prepare for treatment and restore your strength and wellbeing.

What does the cancer rehabilitation program involve?

Before you start

You will meet a rehabilitation doctor and allied health team for a medical, psychosocial, and physical assessment.

Everyone's cancer care journey is different. The assessments will help the team understand your specific needs to develop the right program for you. You will work with the team to develop goals to work towards throughout the program.

During the program

Depending on your assessment and individual needs, you may complete your program:

• as part of a group, with other people, who have been diagnosed with varying cancers
• on your own

Most people will attend as an outpatient, coming to hospital for a few hours once or twice a week, over several weeks. Some people may need to stay overnight in hospital and complete a program over several consecutive days.

Either way, you will receive the same support from our team to address your physical, functional and emotional needs.

Your program may include:

• A physical exercise component to help restore movement, strength and fitness
• An educational component where you will learn about different areas associated with your cancer diagnosis and treatment and how to manage them, including:
  • fatigue
  • pain
  • emotional wellbeing
  • body image and self-esteem
  • work or family challenges
  • relationships
  • late-onset of side effects.

At the end of your program

Our rehabilitation team will keep in touch with your referring doctor and/or treating team throughout the program and our team will keep them informed about your progress.

They will also connect you to local services and support networks so you can leave our program with strength and confidence to live life to your fullest potential.

Who will support me during the rehabilitation program?

Depending on your needs, you may see some or all of our multidisciplinary team which includes:

• Rehabilitation specialist doctor
• Cancer nurse 
• Exercise physiologist
• Physiotherapist
• Psychologist
• Social worker
• Occupational therapist
• Dietician.

How can I access a rehabilitation program?

Referrals

A referral from your specialist or GP is required to participate.

Ask your doctor to complete the referral form at www.epworth.org.au/rehab and return it to us via fax: 03 9982 6696 or email: [email protected]

Locations

Group programs are located at Epworth Camberwell and Epworth Hawthorn.

Individual programs can be accessed at Epworth Brighton, Epworth Camberwell, Epworth Geelong, Epworth Hawthorn or Epworth Richmond Rehabilitation.

Contact us

If you have any questions about our cancer rehabilitation programs, call us on: 1300 345 600.