The most frequently seen cancers of female genital system are endometrium (Uterus), cervical, ovarian, vulvar (external genital organs) and vaginal cancers. Endometrial cancer is the most common cancer in women after breast, lung and colorectal cancer and ranks first among gynecological cancers. Vaginal and vulvar (external genital organs) cancers account for 2-5% of all female genital system cancers, although it ranks third in its prevalence, ovarian cancer is the first leading cause of death. Because 2/3 of ovarian cancers are most often diagnosed at an advanced stage.

Risk factors in female genital system cancers?
All gynecologic cancers meet different criteria for risks factors.
In cervical cancer, sexual activity at an early age, having multiple sexual partners, HPV (Human papilloma virus) infection  are the leading causes of increasing risk of the disease. Again, the number of births and smoking habits increase the risk of cervical cancer.

Endometrial cancer increased by 3 times among women with early menarche, advanced menopausal age (52 years and later), infertile women and who did not give birth.

The endometrial cancer incidence is 6 times higher in women who used unopposed estrogen (without progesterone) during premenopausal and postmenopausal period, correlates with duration of use (> 5 years). The increase in endometrial cancer in overweight (obesity), diabetic women has been observed significantly.

In ovarian cancer, the density in the genetic profile (the presence of ovarian, endometrium and breast cancer in family history), smoking, the presence of infertility, genetic mutations and the use of talc increase the incidence. The role of HPV stands out in vagen and vulvar cancers.

Is it possible to avoid gynecological cancers?
The benefit of HPV vaccines in cervical cancer is discussed. Based on the 3 and 4-valent vaccines in use, 9 combined HPV vaccines have been authorized for use in the USA since 2015. Again, avoiding smoking, eating a diet rich in vitamin B, beta-carotene and folate (vitamin B9) reduce the risk of cervical cancer.

In preventing endometrial cancer, maintaining the ideal body weight, reducing intake of foods with high fat component, avoiding unopposed estrogen replacement are the first measures to be applied. Women who have a BRCA1 or BRCA2 gene mutation and high risk of ovarian cancer profile in family can reduce their risk of ovarian cancer by having surgical removal of the ovaries and fallopian tubes after childbearing is completed.

Although the positive effects of the above approach and measures are clearly seen, none of them are conclusive. Therefore, early detection of the disease is crucial and cancer-causing deaths can be prevented by diagnosing cancer at the treatable stage. Female genital system cancers can be diagnosed at an early stage only with appropriate scans. In addition to annual gynecological examination and pelvic ultrasonography, cervical cytological examination (pap smear) is important.

The periodicity of follow-ups can be extended in the patients who have three consecutive normal cytology results. The patients who has bleeding after sexual activity, bloody discharge not associated with menstruation and perpetual cyclical irregularities should see the doctor without waiting the time for routine appointment. The approach for HPV scanning will improve the sensitivity of pap smear assessment.

Investigation of bleedings after menopause regardless of its color and amount, and transvaginal ultrasound examinations in peri and postmenopausal women will be performed if necessary and  endometrial biopsies will help  to detect endometrial cancer at an early stage. Tumor markers such as CA 125, CA 19-9, alpha photo protein, CEA  with 6-month and annual transvaginal ultrasonography have an important role and serve as a guidance in detection  of high ovarian cancer risk in women with BRCA1 and BRCA2 genetic mutations.

At the polyclinic level, detection of the tumor is possible with some routine examinations, which include: Routine genital examination and trans vaginal ultrasonography Outpatient examinations without the need of radioactive ion  make routine screenings possible and feasible at the outpatient clinic settings.
- Routine genital examination and transvaginal ultrasound
- Cervical vaginal cytological examination (pap smear)
- HPV screening and typing
- Colposcopy and colposcopic biopsy
- Endometrial Biopsy

In all gynecological cancers, individualized approach to each patient and application of the most appropriate treatment model are determined by accurate staging. Correct staging not only ensures that the patient receives the most accurate primary treatment, but also ensures to remain on the right medical platform in terms of the course and follow-up of the disease.

Correct staging and confirming homogeneity index enable to apply appropriate protocol of treatment. Again, the correct staging ensures the method and adequacy of the surgical approach, as well as the protection of the patient from an unnecessary aggressive radical approach. CT, MRI and PET scan have taken their place in diagnostic practice in accordance with confirming the stage, monitoring the effectiveness of the treatment, detection of distant metastases and early observations of recurrence.

Assoc. Prof. Ömer ÇOBANOĞLU, M.D.
Head of Department of Obstetrics and Gynecology, Bayındır Söğütözü Hospital

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