Cancer of the endometrium is a cancer of the inner lining of the uterus. This is the part of the uterus which is shed away every month during a menstrual period in reproductive years. This is the most common gynaecological cancer and accounts for 6% of all cancers in women. The lifetime risk of endometrial cancer in Australia is 4%. The majority of cases are diagnosed at an early stage and are amenable to treatment with surgery alone. Patients with advanced stage or more aggressive types of endometrial cancer will require radiation and/or chemotherapy for optimal outcomes.

The most common type of endometrial cancer (endometrioid) is strongly associated with obesity. Our fat cells are capable of producing the hormone oestrogen and it is this excess oestrogen that causes abnormal growth of the endometrium. These types of cancers are most often early stage and low grade cancers and generally have a good prognosis. There are other types of endometrial cancer that are high grade and behave more aggressively. There has been significant progress made in the last decade in our understanding of the genetic characteristics of endometrial cancer and how this affects its growth and response to available treatments.

The cervix is the bottom part of, and opening to, the uterus and is contiguous with the body of the uterus. It is a roughly cylindrical, fibro-muscular organ about 3 – 4 cm in length. Part of the cervix called the portio is visible on vaginal inspection. There is a narrow canal extending from the vaginal aspect of the cervix to the endometrial cavity called the endocervical canal. The vaginal opening to the endocervical canal is called the external os, and the opening to the endometrial cavity is called the internal os.

The cervix is lined by two types of cells: squamous cells on the outer aspect, and columnar, glandular cells along the inner canal. The transition between squamous cells and columnar cells is an area termed the squamo-columnar junction. Most of precancerous and cancerous changes arise in this area. Cervical cancer can arise from either of these cell types. Squamous cell cancer is the most common type of cervical cancer (75%) and arises from the squamous cells of the outer part of the cervix. Cancer that arises from the endocervical or glandular cells is called adenocarcinoma (25%).

Vulva cancer accounts for about 5% of gynaecological cancers. Vulval cancers often cause itch or pain and as the vulva is an external organ, an skin abnormality such as a lump or growth will usually be visible or felt. Vulval cancers are often a hard ulcer or lump, but can be more subtle skin change and arise in background abnormal vulval skin conditions called vulvar intra-epithelial neoplasia (VIN) or lichen sclerosus.

Any vulval symptoms or concerns about a vulval abnormality should be discussed with your doctor. An examination should be performed and on-referral to a specialist if there are concerns or any uncertainty around a diagnosis.

Vaginal cancer is cancer that starts in the vagina (primary vaginal cancer).

Pre-cancerous conditions may develop into cancer if left untreated.

Ovarian, fallopian tube and primary peritoneal cancer are best considered together because their clinical features, histological appearances and treatment are essentially identical. The fallopian tubes, particularly the fimbrial ends sit right adjacent to the ovaries, and cancer arising in this vicinity is difficult to determine whether it started in the ovaries or the fallopian tubes. Recent evidence suggests the most common subtype of ‘ovarian cancer’ actually indeed arises from the from the fallopian tubes. Primary peritoneal cancer relates to cancer arising from the lining of the abdominal cavity called the peritoneum. These cancers are actually called epithelial cancers – which arise from the lining of the ovaries, fallopian tubes and abdominal cavity, to distinguish them from less common cancer that arise from the egg cells or the stromal cells (main body) of the ovary. Since 2000, all the big international research organizations have considered epithelial cancers arising from ovary, fallopian tube or the peritoneum as essentially one entity for trial purposes.

Colposcopy is a procedure used to look closely at the cervix, vagina and vulva to help locate abnormal cells to direct treatment.

Laparoscopy is a type of surgical procedure that allows a surgeon to access the inside of the abdomen and pelvis without having to make large incisions in the skin.