Gynaecological Check-up and Gynaecological Cancer Screening

Gynaecological check- up includes an interview between the patient and gynaecologist, to listen to the complaint of the patient (if there is), gynaecological examination both speculum and bimanual and transvaginal ultrasonography. This check-up gives us early diagnosis and also treatment of both benign (fibroids, ovarian cyst, pelvic organ prolapses, and urinary incontinence etc.)  There are four types of gynaecological cancer commonly seen in both developed and also non developed/developing countries and these cancers cause the major mortality in women. These four types are breast, cervix, endometrium and ovarian cancers. Today we have some screening tests for early detection of these cancer and precancerous lesions. As seen in all types of cancers, gynaecological cancers screening gives us the opportunity for early detection and treatment of these cancers or precancerous lesions. Recent literature shows us that gynaecological cancer screening can help to diagnose both preinvasive lesions and also early-stage cancer. All these can contribute to decreasing the incidence of invasive cancers and the cancer related mortality and morbidity.

Screening for Breast Cancer

The most common women cancer type is breast cancer. According to a 2022 worldwide report 2 million new breast cancer cases are diagnosed in a year. It is also calculated and expected that more than 680.000 breast cancer cases die because of breast cancer all around the world. Mammography is an effective screening method for breast cancer screening. It is used all around the world. Mammography screening is reported for both the diagnosis of early-stage breast cancer and permits early treatment of disease and decreases advanced stage breast cancer together with breast cancer related women mortality. Mammography is an x-ray screening method and made easily in the radiology unit of the radiology centres. Mammography is suggested to all women aged 40 and above periodically. We also suggest mammography to all gynaecological check-up cases aged 40 and older as a part of routine gynaecological screening. Mammography is not such a painful test. Each breast a little bit pressed horizontally and x-ray beams are used for imaging of the soft tissues in the breast (Fig. 1)

Mammography is a very easy procedure and it can be done in a few minutes.

 

Screening for cervical cancer

Cervical cancer is an important cancer for women. In a 2019 worldwide report every year more than half million women have diagnosis of cervical cancer and almost 280.000 women die because of this disease. Papanicolaou test was developed for screening of cervical cancer more than 80 years ago. Scientific investigations did show us there is causal relation between Human Papilloma Virus (HPV) and developing of cervical cancer HPV test. This combination so called as co-test.  While cervical smear gives us to diagnose cellular abnormality and cervical pre-malign lesions, HPV test (presence high risk HPV types) gives high risk women for developing cervical cancer). Today cervical smear together with high-risk HPV test accepted as primary screening model and this model has more than 90 percent of sensitivity. We also offer co-test as a part of gynaecological check-up in our clinic. Cervical cancer screening is suggested to all women after their sexually intercourse and until 7th decade.  It is very easy and not painful to take cervical cancer screen. Cervicovaginal smear together with HPV test material is taken at the time of speculum examination, samples is sent to the laboratory and the results is got in a couple of days.

Cervical smear screening is very easy procedure and samples can be done at the time of gynaecological examination.

 

Screening for Ovarian Cancer

Ovarian cancer causes almost 198.000 women death and 294.000 new case worldwide. As seen in breast and cervical cancer unfortunately the is no effective and acceptable screening method for ovarian cancer. Ovarian cancer usually grows silently and when the complaints started, it usually come to advanced stage. Transvaginal ultrasonography and CA-125 may helpful in the early diagnosis of ovarian cancer. This approach may especially help for high-risk women for ovarian cancer. Hereditary breast-ovarian cancer cases and BRCA mutation cases my use this screening method. Although there is no effective screening method for ovarian cancers; transvaginal sonography together with CA-125 may help to early diagnosis of these tumours especially in postmenopausal women. In our practice we also suggest transvaginal sonography and CA 125 especially postmenopausal women at high risk.

Ovarian cancer can be diagnosed and treat by routine gynaecological examination together with transvaginal ultrasonography and serum CA-125 measurement.

References: Bhatla N and Sidnghal S, 2020
Global Burden of Disease 2019 Cancer Collaboration JAMA 2022

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