The ovary, endometrium (uterus) and cervix are the fourth, fifth and sixth most common cancer sites after breast, lung and bowel in women in England and Wales. However, the average GP sees only one new patient with ovarian cancer about every five years, and patients with other gynaecological cancers even less frequently.
Many women do not receive optimal diagnosis, assessment or treatment. Under-treatment leads to reduced survival, whilst over-treatment is wasteful and causes avoidable adverse effects.
Women with ovarian cancer live longer if they are treated by expert multidisciplinary teams, and if surgery is carried out by specialist gynaecological oncologists.
Chemotherapy can extend the lives of women with advanced ovarian cancer. Current evidence suggests that the optimal form is paclitaxel/carboplatin.
Endometrial cancer usually causes vaginal bleeding in post-menopausal women. Transvaginal ultrasound followed by outpatient biopsy offers rapid and accurate diagnosis. If diagnosed and treated early, survival rates are high.
In cervical cancer, adequate pre-treatment assessment is vital. Surgery alone is sufficient for early cancers; radiotherapy is appropriate for later-stage cancers, but is more likely to cause lasting adverse effects.
Simultaneous treatment with cisplatin and radiotherapy may increase survival rates in women with high-risk cervical cancer.