How more personalised treatment can change gynaecological cancer care

This article is authored by Dr Kanika Batra Modi, director and clinical lead, gynae-oncology, Max Saket Hospital, New Delhi.

For decades, the diagnosis of gynaecological cancer, which affects women’s reproductive organs, came with a difficult reality. Women often reach a health care professional only when the disease has reached advanced stages. The delay in recognising symptoms, limited awareness, cancer-related stigma and barriers to accessing health care come in the way of timely and appropriate treatment, impacting the chances of survival and quality of life.

Cancer

Gynaecological cancers are a group of cancers which are emerging as a significant public health concern. GLOBOCAN 2024 estimates indicate a significant burden of gynaecological cancers, with 79,360 new cases of cervical cancer, 45,566 cases of ovarian cancer, and 28,308 cases of corpus uteri (endometrial) cancer reported during the year.

The outlook, however, is beginning to change with advances in diagnosis, specialised testing and personalised treatment. All these advances are transforming how gynaecological cancers are understood and managed.

The journey from noticing a symptom to receiving a diagnosis and starting treatment needs to be as timely and coordinated as possible. For example, endometrial cancer commonly presents symptoms such as postmenopausal bleeding, pelvic pain and abnormal uterine bleeding, whereas ovarian cancer may cause persistent bloating, pelvic discomfort, abdominal swelling, feeling full after eating small amounts, or changes in urinary habits.

Delays at any stage may affect the treatment options available and the possible outcome. This is where the role of a specialist comes in.

A gynaecological oncologist specialises in cancers of the female reproductive organs. These specialists are trained to diagnose and treat cancers of the cervix, ovaries, uterus, vagina and vulva and also manage other conditions, including pelvic masses, fibroids and endometriosis.

An appropriate specialist can help bring diagnosis, surgery and treatment planning together. Depending on the patient’s condition, treatment may include less invasive or robotic surgery, procedures that aim to preserve fertility, or steps to reduce the risk of cancer. Genetic counselling may also be considered for women who could have an inherited risk of cancer.

While treatment options are available, it is important to remember that not every patient will need every type of treatment or test. The course of care will depend on the type and stage of cancer, the characteristics of the tumour, the woman’s overall health and her individual needs. This is where biomarker discovery and molecular profiling begin to change the way cancer is understood and managed.

Firstly, it is important to understand that two women may be diagnosed with the same type of cancer, but their tumours may not respond the same way to treatment.

Today, specialised tests can help doctors look more closely at the individual features of a tumour. These tests, often called biomarker or molecular testing, look for changes or characteristics in the cancer that may provide additional information about how it is likely to behave and which treatments may be suitable.

For example, in endometrial cancer, which begins in the lining of the uterus, testing the tumour may provide useful information to support treatment decisions. In ovarian cancer, doctors may recommend tests such as BRCA and homologous recombination deficiency, or HRD, testing. BRCA testing may also help determine whether there is an inherited genetic change relevant to the patient and, in some cases, to members of her family.

As understanding of tumour biology deepens, cancer care is moving beyond a one-size-fits-all approach. Molecular and biomarker-based insights help clinicians better understand the unique characteristics of an individual's disease, enabling more precise diagnosis, more informed treatment decisions and aid in removing treatments that are unnecessary.

Scientific progress can only improve outcomes if women are able to access it. Across India, many women continue to face economic and social-cultural difficulties in accessing healthcare, including challenges and discomfort in travel, particularly alone, the distance from treatment centres, dependence on others for permission or support, and the limited availability of female health care providers.

From earlier recognition of symptoms and timely referral to biomarker testing and precision-led or specialised therapies, the journey from gynaecological cancer diagnosis to treatment is becoming increasingly personalised. The opportunity now lies in building ecosystems that ensure that these advances translate into accessible, informed and equitable care for women across India.

(The views expressed are personal)

This article is authored by Dr Kanika Batra Modi, director and clinical lead, gynae-oncology, Max Saket Hospital, New Delhi.