Tumor diseases and follow-up care
Cancer diseases in gynecology affect the female reproductive organs. They can affect the ovaries, fallopian tubes, uterus, cervix, vagina, or vulva. Early diagnosis and treatment are crucial to increase the chances of cure and avoid complications.
Malignant tumors in gynecology
Breast carcinoma
Breast carcinoma is the medical term for Breast cancer. It is a malignant tumor that develops in the cells of the breast tissue. Breast cancer remains the most common cancer in women – around 70,000 women in Germany are diagnosed with it annually. Changes in breast tissue can be harmless but may also indicate precancerous conditions (precanceroses). Thanks to modern examination methods, these precursors can often be well recognized by small calcifications. Nevertheless, it is important to know: these precursors do not always necessarily develop into breast cancer.
In 70–80 percent, the Breast cancer originates from the milk ducts. In these cases, it is called ductal carcinoma. In lobular carcinoma, breast cancer originates in the milk glands. Lobular carcinoma accounts for 10–15 percent of breast cancer cases. Typical symptoms of carcinoma include changes in breast size or shape, lumps or hardening in the breast or armpit, skin indentation (dimpling), or changes in the nipple.
Diagnosis of Carcinoma
The first step is the doctor examining the breast and armpit. During a mammography – the standard method of early detection – X-rays of the breast are taken. In addition, particularly dense breast tissue can be examined by ultrasound. An MRI may also be ordered if there is a family history or unclear findings. During a biopsy, tissue samples are taken for histological examination to ultimately confirm the diagnosis of breast cancer.
Therapy of Carcinoma
The goal of conservative surgery (breast conservation therapy, BCT) is to remove only the tumor. In contrast, mastectomy involves the removal of the entire breast. In sentinel lymph node biopsy, the first lymph node is removed to check for possible spread of new metastases. Radiation therapy is usually used after breast-conserving surgery to minimize recurrence (risk of relapse).
In systemic therapy, various therapeutic approaches are used, for example a Chemotherapy for aggressive tumors or hormone therapy for hormone-dependent breast cancer. Depending on the stage and type of tumor and the time of diagnosis, the chances of cure are quite good. In the early stages, the 5-year survival rate is 90 to 95 percent, in advanced stages up to 50 percent.
Cervical cancer
Cervical cancer is often caused by an HPV infection. Symptoms include intermenstrual bleeding, unusual discharge, or contact bleeding during intercourse. Diagnosis is made through a gynecological examination, Pap test, HPV test, or colposcopy with tissue biopsy.
If cervical cancer is detected at an early stage, the doctor may opt for a conization (cone-shaped excision of the cervix) or a simple hysterectomy (removal of the uterus). In advanced stages, a radical hysterectomy (removal of the entire uterus), radiation therapy, or chemotherapy may be considered.
Endometrial cancer
Endometrial cancer is a malignant tumor that arises in the lining of the uterus (endometrium) and primarily affects Women after menopause are affected. The disease is often detected early as it frequently manifests with vaginal bleeding. Endometrial cancer is divided into two main types: Type I cancer is caused by an excess of estrogen, usually develops from hyperplasia of the endometrium (excessive growth of glandular cells), but grows very slowly and has a better prognosis for cure.
Type II cancer, on the other hand, is not hormone-dependent and occurs as a more aggressive form with a higher risk of metastasis. It is diagnosed through a gynecological examination, ultrasound, endometrial biopsy, hysteroscopy, or tumor markers. In advanced stages, radiation therapy or chemotherapy is promising, while in the early stages, the affected tissue is usually only removed surgically.
Ovarian cancer
Unfortunately, this malignant tumor of the ovaries is often diagnosed late because the symptoms are quite nonspecific: abdominal pain, bloating and increased urination. However, it can be well diagnosed with ultrasound, CT, or MRI. Ovarian cancer is always surgically removed, very often in combination with chemotherapy.
Fallopian tube carcinoma (fallopian tube cancer)
Fallopian tube carcinoma is a malignant tumor of the fallopian tubes (tubae uterinae). It is a rare gynecological cancer, accounting for about 1–2% of all malignant tumors in the female genital area. It is often diagnosed late because the symptoms are nonspecific and can go unnoticed for a long time.
Fallopian tube carcinoma is similar in its biology and spread to ovarian cancer (ovarian carcinoma) and is often treated together with it. Nevertheless, there are symptoms such as irregular bleeding, lower abdominal pain, or abdominal swelling that may indicate fallopian tube carcinoma. This type of cancer is detected through a transvaginal ultrasound, tumor markers in the blood, imaging techniques, or a biopsy. The treatment of fallopian tube carcinoma follows the therapy for ovarian carcinoma.
Vulvar carcinoma
A vulvar carcinoma is a rare cancer of the external genital organs. Behind the term, there may be various types of cancer originating from different cells in the genital area. Most commonly affected are the labia majora, less frequently the labia minora or the clitoral region. However, vulvar carcinoma usually only becomes symptomatic when it is clinically visible. At that point, palpable lumps or ulcers with a cauliflower-like surface are present.
Early symptoms of vulvar cancer and its precursors are often non-specific or absent; usually, this type of cancer manifests through itching, pain, and skin changes. It is diagnosed by biopsy. The therapy always involves surgical removal of the tumor, and in advanced stages, radiation therapy is also used.
Vaginal carcinoma
Vaginal carcinoma is a rare malignant tumor of the vagina. It accounts for less than 3% of gynecological cancers and primarily occurs in women over 60 years old. Vaginal carcinoma can either originate primarily in the vagina or be a metastasis (secondary tumor) of another tumor (e.g., cervical cancer). Risk factors for vaginal carcinoma include infection with human papillomaviruses, particularly high-risk types 16 and 18, a history of cervical cancer, and older age.
In its early stages, vaginal carcinoma often causes no symptoms, and symptoms usually appear only in advanced stages, such as unusual bleeding or discharge, vaginal pain, or problems with urination or bowel movements. It is diagnosed by colposcopy, biopsy, or imaging techniques. There are three options for treatment: Radiation therapy is very common, especially in advanced stages. In surgical therapy, either partial resection of the vagina can be performed; alternatively, total removal of the vagina and lymph node removal, if they are affected. Chemotherapy can be used in addition to radiation therapy.
The prognosis strongly depends on the stage of the carcinoma at diagnosis: In the early stages, good chances of recovery are expected, while the prognosis is much worse in advanced stages, especially with lymph node involvement or distant metastases.
Oncological follow-up in gynecology
Oncological follow-up care includes regular medical check-ups and measures that are carried out after the treatment of a cancerous disease. The goal of follow-up care is to detect relapses (recurrences) early, treat possible long-term effects of therapy, and improve the quality of life of patients. In gynecology, follow-up care mostly concerns breast cancer (breast carcinoma), uterine cancer (endometrial carcinoma), ovarian cancer (ovarian carcinoma), and cervical cancer (cervical carcinoma).
The contents of oncological follow-up care include various points: During the anamnesis, current complaints, such as pain or bleeding, are recorded. Possible side effects of therapies are also discussed, as well as fears or problems in coping with the disease. The physical examination depends on the type of cancer (palpation of the breast, lower abdomen, groin), imaging techniques – including mammography, ultrasound, or CT – monitor the course of recovery, and laboratory diagnostics can determine tumor markers, hormone status, and provide general laboratory values to control organ functions through blood tests.
However, counseling on lifestyle changes (e.g., healthy nutrition, exercise or stress management), family planning after gynecological cancers or hormone replacement therapy is also part of the follow-up care. Moreover, psycho-oncological care is particularly important, i.e., support with psychological stress, fears or depression.
