World Cancer Day 2021: Gynaecological Cancer and Fertility, A Tightrope Walk

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The term gynaecological cancer refers to the growth of tumour cells in the reproductive organs of a woman’s body. The most common forms of this category of cancer are uterine cancer, cervical cancer, and ovarian cancer. The rarer gynaecological cancers include vulvar cancer, vaginal cancer, and gestational trophoblastic tumour. Due to their intimate nature, gynaecological cancers are a cause of great concern as women either miss the first signs or are hesitant and therefore late in reporting them. According to the data fetched from the National Cancer Institute, All India Institute of Medical Sciences (NCI-AIIMS), every 8 minutes, one woman in India dies of cervical cancer. Alarmingly, India has witnessed 1 lakh new cases of cervical cancer every year since 2016. This is unfortunate as most of the gynaecological cancers are preventable with the help of awareness about precautions, knowledge of symptoms and timely diagnosis. 

Know Your Symptoms:

• Abnormal vaginal bleeding or discharge – a common symptom for all gynaecological cancers, except vulvar cancer.

• Pelvic pain or pressure; frequent need to urinate and/or constipation – common for ovarian and uterine cancers.
• Vaginal odour and bleeding after sexual intercourse – common for cervical cancer.
• Feeling full too quickly or difficulty in eating, bloating, and abdominal or back pain – common for ovarian cancer.
• Itching, burning sensation, pain, or tenderness of the vulva, and changes in colour of vulva or skin irritation, such as a rash, sores, or warts – happens in vulvar cancer.

Gynaecological cancer and fertility

Treatment of gynaecological cancers can significantly impact the aspirations of parenthood of the recovered cancer patients. Surgery, chemotherapy, and radiotherapy – the mainstays of ovarian, cervical and endometrial cancers – can impact the uterus and ovaries. The treatment modalities of gynaecological cancers can affect the reproductive organs of a woman anatomically or functionally. Besides, cancer treatment is often a prolonged affair that weakens the sexual function and psychological wellbeing of patients: mental conditions such as anxiety, depression and impaired quality of life are relevant aspects of patient care that have a say on their fertility too. In fact, the fact that cancer treatment can result in loss of fertility potentially could be severely distressing.

Reduce the risk of cancer for healthy you and family

It is a sad reality of India that gynaecological cancers are completely preventable through routine screening and preventive vaccinations. Pap smear tests and getting vaccinated against human papillomavirus, that causes cervical and vaginal cancer, are the best way to keep a tab, especially if the woman has a history of cancer in her family. HPV vaccines are recommended more for teenagers between 11 and 12 years of age as it helps build immunity better and faster. In older girls, it will necessitate more shots. If HPV vaccine is administered before age 15, a two-dose schedule is recommended while those past their 15thbirthday will need three shots.  Practising safe sex using a condom, maintaining personal hygiene and being aware of the warning signs are equally vital for timely diagnosis. Lifestyle modifications such as quitting tobacco and alcohol and taking a plant-based diet with no extra sugar and salt also play an important role in preventing cancer and improving fertility. 

- written by Dr Gauri Agarwal, IVF & Infertility Specialist, and Founder, Seeds of Innocence & Genestrings Lab