Taiwan, cancer is the top ten causes of death. Uterine cancer, ovarian cancer and
cervical cancer are the most common gynecological cancers among women, also
ranking within the top ten of Taiwanese women cancers.
to the government cancer screening program, the incidence of cervical cancer
has been going down over the years. Women over the age of 30 are eligible to
receive an annual Pap smear screening test. Because of the Pap smear screening
program, early detection and treatment of precancerous lesions, the incidence
of cervical cancer has gradually decreased.
addition to the Pap smear, human papilloma virus (HPV) testing is also a kind
of cervical cancer screening test. Most cervical cancers are related to HPV
infection, but most of them are asymptomatic after infection. The HPV test can check
whether high-risk HPV types are found in cervical cells.
Unlike cervical cancer, the
incidence of uterine cancer and ovarian cancer have not decreased over the
years. Uterine cancer and ovarian cancer do not have standard screening tools.
According to the Taiwan Cancer Registry Center data, women aged between
forty-five to sixty-five years old are the most common age group for uterine
cancer, and there is a trend toward the younger age. Uterine cancer can be
divided into endometrial cancer and malignant uterine sarcoma. The most common
type of uterine cancer is endometrial cancer.
The most common symptom of
endometrial cancer is abnormal vaginal bleeding or postmenopausal bleeding.
Although most causes of postmenopausal bleeding are due to benign lesions, but endometrial
cancer can also be the cause. If early investigations are performed for postmenopausal
bleeding, most of the cancers are found in the early stage. The prognosis of
early endometrial cancer is excellent, and the curative rate is also very high.
The five-year survival rate for stage I of endometrial cancer is as high as
ninety percent. Therefore, I would like to appeal to the public, please don’t
think as "rejuvenation" when bleeding after menopause, and should
seek medical attention as soon as possible for further examination and
According to the 2020 National
Cancer Registration Report released by the National Health Administration,
ovarian cancer stands the top seventh of Taiwanese women deaths, and the
seventh most common cancer among Taiwanese women. The normal ovarian position is
in the pelvic cavity and it cannot be palpated by ourselves. When you can feel it
on your abdomen, the tumor is already very large. The symptoms of early ovarian
cancer are not specific and often similar to gastrointestinal symptoms, hence
most ovarian cancers are diagnosed in an advanced stage.
The blood test we usually perform
during health care examination for ovarian cancer is CA-125, but there are many
reasons that will influence the CA-125 value, and some ovarian cancers do not
have elevated CA-125 values. Hence CA-125 cannot be used as a screening tool
for ovarian cancer. Therefore, if middle-aged women have lower abdominal
discomfort, unexplained gastrointestinal symptoms, or abdominal distension,
they should come to the gynecological clinic. We can provide pelvic examination
and ultrasonography to exclude any abnormal masses in the ovaries. Further investigations
can be arranged for diagnosis and treatment if an abnormal pelvic mass is
Introduction of Gynecological
In recent years, the treatment of
cancer has been progressively improved, and in gynecological cancer as well. Gynecological
cancer treatment includes surgery, chemotherapy, radiation therapy and
immunotherapy, etc. Here, we would like to introduce some new techniques and
treatment of gynecological cancer in our Far Eastern Memorial Hospital.
agents are administered intravenously. Intraperitoneal chemotherapy is that chemotherapeutic
agents are infused directly into the abdominal cavity, allowing the drug to directly
contact the tumor cells and then the remaining drug is absorbed into the body
through the peritoneum barrier. The drug concentration in the peritoneal cavity
will be 20-1000 times that in the blood. Theoretically, the longer the contact
time between chemotherapeutic drugs and tumors, the better the local cytotoxic effect.
Studies showed it is effective in patients with stage III ovarian cancer with debulking
surgery. Some studies have also found that it is also effective for endometrial
cancer with abdominal metastasis. In Taiwan, very few medical centers (only two
centers) have such a technique. We has reported that the therapeutic efficacy
of intraperitoneal chemotherapy is superior than weekly intravenous
lymph node mapping
procedures include tumor resection and lymph node dissection. But the lymph
node dissection would result in surgical complications: such as severe lymphedema
of the legs, lymphocele, nerve injury and infection, etc. The sentinel lymph
node mapping technique is to identify the sentinel lymph node which is the
first node where the tumor drains. When there is lymph node metastasis, the
sentinel lymph node is often the first site of lymph node metastasis. Hence,
the sentinel lymph node mapping and excision of the sentinel lymph nodes can greatly
reduce the side effects related to total lymph node dissection. The utilization
of sentinel lymph node mapping technique did not compromise the survival
outcome. This technique has been widely used in the surgery of gynecological
cancer, such as vulvar cancer, cervical cancer and endometrial cancer. Our oncogynecological
team also proved the superiority of sentinel lymph mapping technique.
It is well known that
chemotherapeutic agents are given before or after surgery. In fact, there is a
technique where a chemotherapeutic drug is given intraoperatively, which is
called Hyperthermic Intraperitoneal Chemotherapy (HIPEC). The temperature of
the chemotherapy perfusion solution is increased about 42°C and directly
infused into the abdominal cavity, using high temperature and chemotherapeutic
drugs to kill the cancer cells on the surface. Studies reported HIPEC is
effective for ovarian cancer treatment. We mainly used in the treatment of advanced
ovarian and peritoneal cancer.
Not only hyperthermic intraoperative
chemotherapy, but also intraoperative radiation therapy (Intra-operative
Radiotherapy, IORT) can be performed during surgery. After tumor resection, the
tumor bed is irradiated directly, which can provide maximal tumor control with
irradiation and minimize side effects. This is a new technology of radiation
therapy. In gynecological cancer, we have published the feasibility of
intraoperative radiotherapy in the treatment of recurrent endometrial cancer
and cervical cancer.
Precision medicine is tailoring the
treatment by using molecular testing, such as genes, proteins and metabolic
testing, to analyze and compare the human genetic database, to determine the
most suitable treatment for individual people to achieve the maximum treatment
effect. It is a personalized medicine. Studies have shown that ovarian cancer
is related to the loss of homologous recombination repair gene (HRD).
Homologous recombination repair gene is one of the important genes of human DNA
repair. The BRCA gene is also one of them. In recent years, there is an emerging
of corresponding targeted medicine (PARP inhibitors) for the treatment of such
patients. Far Eastern Memorial Hospital has the service of genetic testing,
including HRD and BRCA gene mutations, and can provide related targeted therapy.
The discovery of immune check
points PD-1 and CTLA-4 has brought a breakthrough in cancer treatment. By
blocking these two immune checkpoints, immune T cells can be activated to kill
cancer cells. At present, in gynecological cancer, immunotherapy has been
proven to be effective against cervical cancer, endometrial cancer, and ovarian
cancer. We also use immune check point inhibitors to treat our patients.
The treatment policies of the gynecological
cancer team of Far Eastern Memorial Hospital are patient-centered, continuously
improving the treatment of gynecological cancer, and providing high-quality