Gynaecologic Oncology and Screening in Jaipur

What gynaecologic oncology and screening means

Gynaecologic oncology is the branch of medicine that deals with cancers of the female reproductive system.

This includes:

• Cervix
• Uterus
• Ovaries
• Fallopian tubes
• Vulva and vagina

At Jaipur Hospital our surgical team sees women for screening, diagnosis and treatment of cervical, ovarian and endometrial cancers. Screening means looking for early changes before you have any symptoms. The aim is to find pre-cancerous cells or early cancer when treatment is most effective.

The uterus is a hollow, pear-shaped organ in the pelvis. The top part is called the body or corpus and the lower end is the cervix, which opens into the vagina. The inner lining of the uterus is the endometrium. Most uterine cancers start in this lining and are called endometrial cancer. Cancer of the cervix is a separate disease. Ovarian cancer begins in the ovaries, which produce eggs and hormones.

Endometrial cancer is the most common gynaecological cancer in many countries. It makes up about 95 percent of all uterine cancers. Cervical cancer is the second most common cancer in women in India after breast cancer. Ovarian cancer is the leading cause of death from gynaecological cancer. In India, over 122,000 women are diagnosed with cervical cancer every year and about 67,000 die from it.

Cancer starts when cells acquire changes in their DNA that make them grow out of control. In the cervix, high-risk types of human papillomavirus (HPV) cause most cases. In the endometrium, the exact trigger is not always known, but long exposure to oestrogen without enough progesterone is a key factor. These abnormal cells can form a mass called a tumour. If not treated, they can invade nearby organs or spread to distant parts of the body.

Symptoms and warning signs that need same-day care

The most common symptom of endometrial and uterine cancer is abnormal vaginal bleeding. This means bleeding between periods if you still have periods, or any bleeding or spotting after menopause.

Other signs can include:

• Unusual vaginal discharge
• Pelvic pain or pressure
• Pain during intercourse
• A feeling of fullness in the lower abdomen

Ovarian cancer often causes vague symptoms that are easy to miss.

These can include:

• Bloating
• Feeling full quickly when eating
• Pelvic or abdominal pain
• Needing to pass urine more often or more urgently

Cervical cancer in early stages may cause no symptoms at all. Later it can cause bleeding after sex, between periods or after menopause, watery or bloody discharge with a foul smell, and pelvic pain.

You should seek medical attention the same day if you have heavy vaginal bleeding that soaks a pad in an hour, severe pelvic or abdominal pain that does not settle, fainting or dizziness with bleeding, or sudden shortness of breath. These can signal a serious problem such as a ruptured cyst, severe infection, or advanced disease needing urgent care.

If you notice any unusual bleeding, spotting or persistent pelvic symptoms, contact your healthcare provider without waiting for your next routine visit. Early reporting is the main reason endometrial cancer is often found at an early stage.

Causes and who is at higher risk

The cause of cervical cancer is well established: persistent infection with high-risk HPV types. HPV is spread through sexual contact. Most people clear the virus naturally, but in some it persists and leads to pre-cancerous changes that can become cancer over years.

For endometrial cancer, the exact cause is not fully known. Researchers know that something creates changes in endometrial cells, making them grow out of control and form a tumour. Hormones play a central role. Oestrogen makes the endometrium thicken; progesterone makes it shed.

When oestrogen acts without enough progesterone, the lining can become too thick, a condition called hyperplasia, which may turn into cancer.

Risk factors for endometrial cancer include obesity, which raises risk two to four times because fat tissue raises oestrogen levels. Other hormonal factors are polycystic ovarian syndrome (PCOS), taking oestrogen-only hormone replacement therapy, and tamoxifen use.

Age is a factor: more than 95 percent of cases occur in women 40 and older, and nearly 80 percent are diagnosed at 55 or older. Never having been pregnant, early periods before age 12, and late menopause also increase risk.

Diabetes, personal or family history of endometrial, ovarian or colon cancer (which may indicate Lynch syndrome), and previous pelvic radiation are additional risk factors.

For ovarian cancer, risk factors include:

• Increasing age
• Inherited gene mutations such as BRCA1 and BRCA2
• Family history of ovarian or breast cancer
• Endometriosis
• Never having been pregnant

Cervical cancer risk is increased by early sexual activity, multiple sexual partners, smoking, a weakened immune system, and not having regular screening.

How gynaecologic cancers are diagnosed: examination and tests

Diagnosis starts with a detailed history and a pelvic examination. Your doctor will ask about your symptoms, menstrual history, and any risk factors. If abnormal bleeding or a suspicious finding is present, further tests are needed.

For cervical screening, the main tests are the Pap smear and HPV testing. The Pap smear collects cells from the cervix to look for abnormal changes. HPV testing checks for the presence of high-risk virus types. In studies, HPV testing detected more high-grade lesions than cytology or visual inspection methods. Self-collected HPV samples show good agreement with clinician-collected samples and can be an option for some women.

If screening is abnormal, the next step is usually colposcopy. This is a magnified examination of the cervix using a special microscope called a colposcope. The doctor applies a dilute vinegar solution to highlight abnormal areas and may take small biopsies.

For endometrial cancer, there is no routine screening test for women without symptoms. Diagnosis relies on investigating abnormal bleeding. The standard test is endometrial biopsy, where a thin tube is passed through the cervix to take a sample of the lining. A pathologist examines the tissue to confirm cancer.

Sometimes a dilation and curettage (D&C) is done under anaesthesia to get a larger sample. Imaging such as transvaginal ultrasound, MRI or CT scan helps assess the extent of disease.

For ovarian cancer, there is also no effective population screening test. Diagnosis usually involves a pelvic exam, blood tests such as CA-125, and imaging (ultrasound, CT or MRI). A definitive diagnosis often requires surgery to remove the ovary or take biopsies.

Staging describes how far the cancer has spread. Uterine cancers are staged from I to IV. Stage I means cancer is confined to the uterus; Stage IV means it has spread to distant organs. In some cases the exact stage is only known after surgery.

Non-surgical treatment options and when surgery is advised

Treatment depends on the type of cancer, its stage, your overall health and whether you wish to preserve fertility. Your surgeon will discuss the options that apply to you.

For cervical pre-cancerous changes (cervical intraepithelial neoplasia), procedures such as LEEP (loop electrosurgical excision procedure) or cone biopsy can remove the abnormal tissue. These are usually done under local or general anaesthesia and take 30 to 90 minutes. Recovery is typically one to four weeks.

For early cervical cancer, radical hysterectomy with lymph node removal is the standard surgery. This can be done by open or laparoscopic approach. For more advanced cervical cancer, the primary treatment is usually chemoradiation — a combination of chemotherapy and radiation therapy.

For endometrial cancer, surgery is the primary treatment for most women. This usually means a hysterectomy (removal of the uterus and cervix) along with removal of both fallopian tubes and ovaries, and often lymph node dissection. In selected early, low-risk cases, fertility-sparing surgery may be possible. If cancer has spread to nearby organs, a more extensive operation called multivisceral resection may be needed.

Radiation therapy uses high-energy X-rays directed at the tumour site. It may be given after surgery to reduce the risk of recurrence, or as the main treatment if surgery is not possible. Chemotherapy uses drugs that travel through the bloodstream to kill cancer cells. It is often used for ovarian cancer, advanced endometrial cancer, or when cancer has spread.

Drugs may be given as tablets or intravenous infusions. For ovarian cancer, chemotherapy is sometimes given directly into the abdominal cavity.

Targeted therapies such as anti-angiogenic drugs (for example bevacizumab) and PARP inhibitors (such as olaparib and niraparib) are used in certain advanced or recurrent ovarian cancers, often as maintenance after chemotherapy. Hormone therapy may be used for some endometrial cancers to slow growth or prevent recurrence.

Surgery is advised when cancer is confined to the pelvis and can be completely removed, or when tissue is needed for accurate staging. For ovarian cancer, most women with advanced disease have surgery followed by platinum-based chemotherapy. The decision is always individualised. Your surgical team at Jaipur Hospital will explain the benefits, risks and expected recovery for each option.

Preparing for gynaecologic oncology surgery at Jaipur Hospital

Before any procedure, your surgical team will review your medical history and current medicines. Bring a list of every tablet, supplement, or injection you use, including blood thinners, hormone therapy, or diabetes medication. Your surgeon will tell you which medicines to stop and when, usually a few days before surgery.

You may need blood tests, a chest X-ray, an ECG, or imaging such as an ultrasound or CT scan to plan the operation. These tests are done at the in-house diagnostic laboratory and radiology department. If you are having general anaesthesia, you must not eat or drink for at least six hours before the scheduled time.

For local anaesthesia, light food may be allowed; your anaesthetist will confirm. Pack comfortable clothes, personal hygiene items, any regular medicines in their original packets, and a phone charger. An attendant can stay with you in the ward.

If you are covered under RGHS, MAA Yojana, CGHS, or a private insurer on the hospital panel, carry your card and any pre-authorisation letters.

How gynaecologic oncology surgery is done at Jaipur Hospital

The operation you have depends on the condition, its stage, and your overall health. Your surgeon will explain which technique suits you. For cervical screening abnormalities, a colposcopy lets the doctor examine the cervix with a magnifying instrument and take a small biopsy.

If pre-cancerous cells are found, a LEEP or cone biopsy removes the affected area using a thin heated wire loop or a scalpel. For early cervical or endometrial cancer, a radical hysterectomy with lymphadenectomy may be advised. This removes the uterus, cervix, upper vagina, surrounding tissue, and pelvic lymph nodes.

The surgery can be done through an open abdominal incision or by laparoscopy, where instruments go through small cuts. The approach is chosen based on tumour size, spread, and your fitness. Procedures take 30 to 90 minutes. Anaesthesia is local or general, depending on the operation. The hospital has modular operation theatres and a 24×7 critical care unit for safety.

On the day, you will be admitted, prepared in the pre-operative area, taken to the theatre, and moved to the recovery room afterwards. Nursing staff monitor vital signs until you are stable for the ward.

Risks and possible complications of gynaecologic oncology surgery

All surgery carries risks. Common short-term risks include bleeding, infection, pain, and reactions to anaesthesia. After a radical hysterectomy, there is a risk of injury to the bladder, ureters, or bowel because these organs lie close to the uterus. Nerve damage can cause bladder or bowel dysfunction. Lymph node removal may lead to lymphoedema, which is swelling in the legs.

In studies of advanced ovarian cancer, moderate bone marrow toxicity was observed with certain maintenance drugs. For endometrial cancer, the most serious complication is death. Other complications include side effects from surgery such as wound problems, blood clots, or urinary issues. Uterine cancer is fatal when it goes undiagnosed and spreads.

Your surgical team takes steps to reduce these risks, such as giving antibiotics, using compression devices for clot prevention, and monitoring you closely in the intensive care unit if needed. Discuss your personal risk factors with your surgeon before you decide.

Recovery and aftercare after gynaecologic oncology surgery

Recovery time ranges from 1 to 4 weeks depending on the procedure. After day-care procedures such as colposcopy or LEEP, you may go home the same day with mild cramping or spotting. After a radical hysterectomy, a hospital stay of up to 5 nights is typical.

In the first days, you will have a urinary catheter, intravenous fluids, and pain relief. Nurses will help you sit up and walk short distances to prevent clots. The catheter is usually removed once you can pass urine on your own.

At home, avoid heavy lifting, strenuous exercise, and sexual intercourse for about 4 to 6 weeks or until your surgeon clears you. Keep the wound clean and dry. If the ovaries were removed and you have not yet reached menopause, you will go through surgical menopause. Your doctor may discuss hormone options. Attend all follow-up visits. During these, the team will do a pelvic exam, ask about symptoms, and check for any sign of recurrence.

Call the hospital or visit the 24×7 emergency department if you have:

• Heavy bleeding
• Fever above 38°C
• Severe pain not relieved by prescribed medicine
• Foul-smelling discharge
• Leg swelling
• Difficulty passing urine or stool

Results of gynaecologic oncology surgery: how well it works in studies

Outcomes depend on the cancer type, stage at diagnosis, and treatment received. In a large Indian screening study, HPV testing reduced the detection of advanced cervical cancer by 53% compared with no screening, and cervical cancer mortality fell by 31% in the screened group.

For endometrial cancer, when the disease is found early and has not spread outside the uterus, the five-year survival rate is as high as 95%. The overall five-year survival rate for endometrial cancer is 81%. If cancer has spread to distant organs, the five-year survival rate drops to 17%.

For ovarian cancer, most women with advanced disease relapse within 3 years after standard surgery and platinum-based chemotherapy. Maintenance therapy with certain drugs has shown longer progression-free survival in trials, for example a median of 21.0 months versus 5.5 months in patients with a BRCA mutation. However, the benefit of such maintenance in newly diagnosed disease remains uncertain.

In early-stage disease, surgery can be curative for most patients. For women whose disease continues to respond to platinum-based drugs, control for 5 years or more is often possible. Your surgeon will discuss what the evidence means for your situation.

Cost and insurance for gynaecologic oncology surgery at Jaipur Hospital

The typical price range for these procedures in India is ₹10,000 to ₹3,50,000.

The final cost depends on:

• Type of surgery
• Whether it is open or laparoscopic
• Length of hospital stay (day care to 5 nights)
• Anaesthesia used
• Any intensive care needs
• Histology and imaging tests
• Medicines

Jaipur Hospital is a NABH-accredited multispeciality hospital established in 1991. It accepts RGHS, MAA Yojana, CGHS, and a panel of private insurers and TPAs. The in-house pharmacy, diagnostic laboratory, and radiology keep investigations and medicines on site. The 24×7 emergency department and ambulance service are available if needed. Ask the admissions desk for an estimate based on your planned procedure and insurance coverage.