What Are the Types of Gynaecological Cancer—and Which Is Most Common?

Dr. Rama Joshi

Principal Director, Gynaecology Oncologist at Fortis Hospital, Gurgaon

About Dr. Rama Joshi Gynaecologist

Dr. Rama Joshi has over 25 years of expertise.  She is one of the India's most committed gynaecological cancer surgeons. Dr. Rama was the chief head of the gynaecological branch at Artemis Hospital in Gurgaon, B L Kapur Hospital, and Dharamshila Cancer Hospital in New Delhi, India, before joining Fortis Hospital Gurgaon. She was awarded six gold medals for academic achievement during her schooling, including the esteemed Pfizer Gold Medal in Post-Graduation.

Gynaecological Cancer

Gynaecologic cancer is any cancer that begins in a woman's reproductive system. These cancers occur in various sites in the pelvic area and are classified by type, symptom, treatment, and outlook. This is also called female reproductive system cancers.

Types of Gynaecologic Cancers

Cervical Cancer

• Source: Cervix (lower portion of the uterus)
• Usual Cause: Infection with Human Papillomavirus (HPV)
• Signs: Abnormal vaginal bleeding, pelvic discomfort, pain during sex

Ovarian Cancer

• Source: Ovaries
• Usually Spotted Late as it presents with nonspecific symptoms
• Symptoms: Bloating, abdominal pain, frequent urination, early satiety

Uterine (Endometrial) Cancer

• Origin: Endometrium, the lining of the uterus
• Symptoms: Abnormal bleeding (particularly postmenopausal), pelvic pain

Vaginal Cancer

• Origin: Vagina
• Less common type of gynaecologic cancer
• Symptoms: Vaginal bleeding, discharge, mass or pain

Vulvar Cancer

• Origin: Outer female genitalia
• Less common gynecologic cancer
• Symptoms: Itching, pain, bleeding, lump or sore

Fallopian Tube Cancer (rare)

• Can be related to ovarian cancer
• Symptoms: Pelvic pain, watery vaginal discharge, mass

Gynaecological Cancer Symptoms

All gynaecological cancers are located in a different area of the reproductive system and might have different symptoms. Many of the initial signs are subtle or mistaken for another cause, so awareness is a key.

Cervical Cancer

• Abnormal vaginal bleeding
• Unusual vaginal discharge
• Pelvic pain or pain during intercourse

Ovarian Cancer

• Bloating
• Abdominal or pelvic pain
• Feeling full quickly when eating
• Frequent or urgent need to urinate
• Unexplained weight loss or gain
• Fatigue

Uterine (Endometrial) Cancer

• Postmenopausal bleeding
• Bleeding between periods
• Pelvic pain or pressure
• Unusual vaginal discharge

Vaginal Cancer

• Abnormal vaginal bleeding
• Pain during intercourse
• A mass or lump in the vagina
• Watery vaginal discharge
• Painful or difficult urination

Vulvar Cancer

• Persistent itching or burning
• Pain or tenderness in the vulva
• Changes in skin color or texture
• Lump, wart-like growth, or open sore on the vulva
• Bleeding not related to menstruation

Gynaecologic Cancer Causes

Gynecologic cancers occur in the reproductive organs and may result from the interaction of genetic, environmental, lifestyle, and hormonal factors. Although every form (cervical, ovarian, uterine, vaginal, vulvar and cancer of the fallopian tube) has its own individual risks, there are several causes that are most often found in all or most of these types:

Human Papillomavirus (HPV) Infection

• Principal cause of cervical, vaginal, and vulvar cancers
• Most frequently associated HPV types 16 and 18 with cancer
• Frequently sexually transmitted
• Preventable by HPV vaccine

Age

• Risk with age, particularly over age 50
• Most gynaecologic cancers happen in postmenopausal women

Family History and Genetic Mutations

• BRCA1/BRCA2 mutation has increased risk of ovarian and breast cancer
• Lynch syndrome has elevated risk of uterine and ovarian cancers
• Ovarian, breast, or colon cancer in the family is a red flag

Hormonal Factors

• Estrogen dominance (in the absence of progesterone) has increased risk of uterine cancer
• Early menarche or late menopause = more years estrogen exposure
• Hormone replacement therapy (HRT), particularly estrogen-only, can increase risk

Obesity

• Gives higher estrogen stores in fat, increasing risk of endometrial (uterine) cancer
• Also increases risk of ovarian and cervical cancers

Smoking

• Increases risk of cervical, vulvar, and vaginal cancer
• Also decreases the immune system to fight off HPV infection

Reproductive History

• Never having been pregnant increases risk of ovarian and endometrial cancers
• Infertility treatment and delayed or no childbearing may increase risk slightly

Weakened Immune System

• Women with HIV or immunosuppression are at increased risk of developing HPV-related cancers

Previous Radiation Therapy

• Pelvic radiation has the potential to increase secondary gynecologic cancer risk

Poor Diet and Lack of Exercise

• Linked to obesity and chronic inflammation, furthering cancer risk

Gynaecologic Cancer Treatment

Treatment for gynecologic cancers is based on the type of cancer, its stage, your overall health, and personal preference (e.g. trying to preserve fertility). Most treatment combines one or more of surgery, chemotherapy, radiation, targeted therapy, and/or immunotherapy.

Surgery

Usually the first treatment, particularly if cancer is confined.

• Hysterectomy: Uterus removal (routine in uterine and cervical cancer)
• Oophorectomy: Removal of one or both ovaries (for ovarian or fallopian tube cancer)
• Salpingectomy: Removal of the fallopian tubes
• Lymphadenectomy: Removal of lymph nodes to test for spread
• Debulking surgery: Removes as much cancer as possible (particularly in ovarian cancer)
• Vulvectomy: Removal of part or all of the vulva

Chemotherapy

• Uses medication to destroy cancer cells or prevent them from multiplying
• Usually used for advanced or recurrent cancers
• Common medications: Cisplatin, Carboplatin, Paclitaxel

Radiation Therapy

• High-energy rays to kill cancer cells
• Either external beam or brachytherapy (internal radiation)
• Common for cervical, vaginal, vulvar, and endometrial cancer

Targeted Therapy

• Targets specific proteins or genes in cancer cells
• Commonly used for ovarian cancer
• Examples: Bevacizumab (Avastin), PARP inhibitors such as Olaparib

Immunotherapy

• Activates the immune system to attack cancer
• Used for advanced or recurrent cancers, particularly those with PD-L1 expression or high MSI
• Example: Pembrolizumab (Keytruda)

Hormone Therapy

• Blocks hormones such as estrogen that feed certain cancers
• Most commonly used for endometrial cancer
• Drugs: Progestins, Tamoxifen, Aromatase inhibitors

Uterine Cancer Causes

Cancer of the uterus, which is most frequently endometrial cancer, starts in the lining of the uterus (endometrium). It usually occurs in women who are past menopause but may occur in younger women, particularly those with hormonal imbalances. Although the true cause is not always certain, the following are established causes and risk factors:

• Estrogen Imbalance
• Obesity
• Age
• Diabetes and Insulin Resistance
• Polycystic Ovary Syndrome (PCOS)
• Hormone Therapy
• Family History and Genetics
• Endometrial Hyperplasia
• Nulliparity (Never Having Been Pregnant)
• Radiation Exposure

Treatment of Uterine Cancer

Surgery (Primary Treatment)

The majority of women with uterine cancer will have surgery as the initial treatment.

Types of Surgery:

• Total Hysterectomy: Hysterectomy with removal of the uterus (most common type)
• Bilateral Salpingo-Oophorectomy (BSO): Removal of ovaries and both fallopian tubes
• Lymph Node Dissection: To ensure there is no cancer spread
• Minimally invasive (laparoscopic or robotic) surgery may be utilized in the early stages

Radiation Therapy

• Used post-surgery to reduce the chance of coming back or as an alternative to surgery in women who are not fit for an operation.

Types:

• External Beam Radiation Therapy (EBRT): Aims at cancer from the outside of the body
• Brachytherapy (Internal Radiation): Radioactive materials are put inside the vagina or the uterus

Hormone Therapy

• Used predominantly for early cancer in women who desire to preserve fertility or in advanced/recurrent cancers.

Chemotherapy

• Utilized for advanced, aggressive, or recurrent endometrial cancers, particularly high-grade or non-endometrioid ones such as serous carcinoma.

Targeted Therapy

• Utilized for tumors with unique mutations or genetic makeup.

Immunotherapy

• Utilized for recurrent or advanced endometrial cancers with MSI-H (microsatellite instability-high) or mismatch repair deficiency (dMMR).

Cervical Cancer Causes

Cervical cancer starts in the cervix cells, which is the lower portion of the uterus and attaches to the vagina. It develops gradually, often beginning with precancerous lesions known as cervical dysplasia.

Primary Cause: Human Papillomavirus (HPV) infection

• HPV types that have high risks, particularly HPV types 16 and 18, cause approximately 99% of cervical cancer.
• Spread by sexual contact
• Most HPV infections resolve by themselves, but long-term infection with a high-risk type causes cancer

Other Causes

• Multiple Sexual Partners / Early Sexual Activity
• Weak Immune System
• Smoking
• Long-Term Use of Oral Contraceptives
• Multiple Full-Term Pregnancies
• Lack of Regular Cervical Screening (Pap Test / HPV Test)
• Low Socioeconomic Status
• Exposure to DES (Diethylstilbestrol)

Cervical Cancer Treatment

Surgery

Frequently the first treatment for early cervical cancer (Stage 0 to I)

• Conization: Removal of cone-shaped abnormal cervical tissue (for very early cancers or precancerous changes)
• Trachelectomy: Cervix removal (sparing uterus for childbearing) – applied to early-stage cancers
• Total Hysterectomy: Uterus and cervix removal
• Radical Hysterectomy: Uterus, cervix, lower vagina, and surrounding tissues removal
• Pelvic Lymphadenectomy: Removal of lymph nodes to look for spread

Radiation Therapy

• Used alone or combined with chemotherapy (particularly for Stages II to IV or when surgery is not feasible)

Types:

• External Beam Radiation Therapy (EBRT) – beams are directed at the pelvis externally
• Brachytherapy – radioactive implant inside or close to the cervix

Chemotherapy

• Used with radiation (chemoradiation) or alone in recurrent or advanced cases.

Targeted Therapy

• Used in recurrent or advanced cervical cancer.

Immunotherapy

• Used in recurrent/metastatic cervical cancer with specific biomarkers (e.g., PD-L1)

Ovarian Cancer Causes

Ovarian cancer starts in the ovaries, fallopian tubes, or peritoneum and usually is detected later when symptoms are nonspecific. Even though the cause is uncertain, there are some genetic, hormonal, environmental, and reproductive factors that raise the risk substantially.

• Genetic Mutations (Hereditary Factors)
• Age
• Reproductive History
• Hormone Replacement Therapy (HRT)
• Obesity
• Endometriosis
• Talcum Powder Use
• Smoking
• Personal History of Breast Cancer
• Fertility Treatments

Ovarian Cancer Treatment

Surgery (Initial Treatment)

The majority of ovarian cancer is managed with surgery as the initial treatment, particularly in the early stages or when tumors are very large and need to be extracted.

• Total Hysterectomy: Removal of uterus
• Bilateral Salpingo-Oophorectomy (BSO): Ovaries and fallopian tubes removal
• Omentectomy: Abdominal fatty tissue removal (site of most common spread)
• Debulking Surgery: Resection of as much cancer as can be seen (vitally important in advanced cases)
• Fertility-sparing surgery: Can be done in early cases (Stage I), removing only a single ovary and tube.

Chemotherapy

• Generally reserved after operation, but occasionally before (neoadjuvant chemo) if the tumor is bulky or extent of spread is great.

Targeted Therapy

• With chemo or after chemo in advanced or recurrent disease.

Hormone Therapy

• Reserved for low-grade serous ovarian cancer or hormone-sensitive tumors

Immunotherapy

Remains to be studied in clinical trials, but immune checkpoint inhibitors (such as pembrolizumab) can be utilized for:

• MSI-high tumors
• PD-L1 positive tumors

Types of Ovarian Cancer

Ovarian cancer is not a condition but a collection of varied tumors derived from distinct cell types in the ovary. They are categorized mainly according to the cell of origin.

Epithelial Ovarian Cancer (90% of ovarian cancer cases)

• Derived from the lining (epithelial) cells of the ovary, fallopian tube, or peritoneum.
• High-Grade Serous Carcinoma (HGSC): Most frequent and severe type; associated with BRCA mutations
• Low-Grade Serous Carcinoma (LGSC): Slow growing, in young women
• Endometrioid Carcinoma: Frequently associated with endometriosis; improved prognosis if detected early
• Clear Cell Carcinoma: Uncommon, more resistant to chemo; also associated with endometriosis
• Mucinous Carcinoma: May mimic GI tumors; requires careful differentiation

Germ Cell Tumors (5–10% of them)

• Arise from the cells that form eggs. More prevalent in adolescents and younger women.
• Dysgerminoma: Most frequent germ cell tumor; very curable
• Yolk Sac Tumor (Endodermal Sinus Tumor): Fast-growing; seen in children/young adults
• Teratoma: May be benign (dermoid cyst) or malignant
• Choriocarcinoma: Rare and highly aggressive; may cause very elevated hCG

Sex Cord-Stromal Tumors (<5% of cases)

• Derived from connective tissue that supports the ovary and secretes hormones.
• Granulosa Cell Tumor: Secretes estrogen; can lead to premature puberty or irregular bleeding
• Sertoli-Leydig Cell Tumor: Secretes androgens; may lead to virilization (face hair, deep voice)
• Thecoma, Fibroma: Benign in most cases; thecoma can secrete estrogen

Vulvar Cancer Causes

Vulvar cancer involves the outer female genitalia, such as the labia, clitoris, and vaginal opening. It is an uncommon gynecologic cancer, but awareness of early signs of risk factors will assist in prevention and early diagnosis. 

Primary Cause: Infection of Human Papillomavirus (HPV)

• High-risk HPV types (particularly HPV 16) occur in a majority of vulvar squamous cell carcinoma.
• Spread by sexual contact
• Persistent infection can cause vulvar intraepithelial neoplasia (VIN), a precancerous condition

Other Causes

• Age (50+ years)
• Smoking
• Vulvar Intraepithelial Neoplasia (VIN)
• Weakened Immune System
• Lichen Sclerosus
• Personal History of Cervical or Vaginal Cancer
• Persistent Itching or Irritation

Vulvar Cancer Treatment

Surgery (Main Treatment)

Surgery is the treatment of choice for the majority of vulvar cancers.

• Wide Local Excision: Tumor removal with a border of healthy tissue
• Radical Local Excision: Wider and deeper excision than usual wide local excision
• Vulvectomy: Removing the vulva partially or entirely (for larger or invasive tumors)
• Sentinel Lymph Node Biopsy: Tests whether cancer has spread to lymph nodes (less invasive)
• Inguinal Lymphadenectomy: Groin node removal if cancer has spread

Radiation Therapy

Reserved for:

• The tumor is large
• Lymph nodes are positive for cancer
• Surgery is not an option due to health issues

Chemotherapy

• Reserved for advanced, recurred, or inoperable scenarios
• Often used with radiation (known as chemoradiation)

Targeted Therapy & Immunotherapy (Under Investigation / Rare Use)

In advanced or metastatic vulvar cancer:

• Immune checkpoint inhibitors (such as pembrolizumab) can be applied for tumors with high PD-L1, MSI-H, or HPV-associated markers
• Clinical trials can provide other more focused treatments

Vaginal Cancer Causes

Vaginal cancer is a less common form of gynecologic cancer that starts in the lining of the vagina. Although the exact cause is not always understood, some major risk factors have been identified.

• Human Papillomavirus (HPV) Infection
• Age
• Vaginal Intraepithelial Neoplasia (VaIN)
• Diethylstilbestrol (DES) Exposure
• Smoking
• History of Cervical or Vulvar Cancer
• Weakened Immune System
• Chronic Vaginal Irritation

Vaginal Cancer Treatment

Surgery

Mostly utilized for vaginal cancer in its early stages or for recurring tumors.

• Wide local excision: Small, localized tumor
• Partial or total vaginectomy: For the upper or lower vaginal tumors
• Pelvic exenteration: Rare, for extensive or recurring cancer (vagina, uterus, bladder, rectum, etc.)

Radiation Therapy

• First-line treatment for the majority of vaginal cancers, particularly Stage II–IV or if surgery is not an option.

Types:

• External Beam Radiation Therapy (EBRT) – Treats pelvis and tumor location
• Brachytherapy (internal radiation) – Inserts radioactive sources into the vagina

Chemotherapy

• For use together with radiation (chemoradiation) or for advanced/recurrent disease.

Targeted & Immunotherapy (Experimental / Rare)

• Used primarily for metastatic or advanced vaginal cancers (particularly HPV-related).
• Immunotherapy (e.g., Pembrolizumab) – for PD-L1 positive or MSI-high tumors
• Clinical trials may provide access to new targeted agents

Best Hospital in India for Gynaecologic Cancer

Gynaecologic oncology hospitals in India are:

• Artemis Hospital, Gurgaon
• Medanta-The Medicity, Gurgaon
• Fortis Memorial Research Institute, Gurgaon
• Max Hospital, Saket
• Apollo Hospital, Delhi

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