Care pathway for gynecological cancers

Approximately 1,900 women in Finland are diagnosed with gynecological cancer each year. Gynecological cancer can be located

• in the uterine corpus
• in the cervix
• in the ovary
• in external genitalia
• in the vagina
• in the placenta.

Ovarian cancer and peritoneal cancer are classified as part of the same disease group as ovarian cancer, because the clinical behavior and treatment of these cancers are similar.

Cancer of the uterine corpus, cervical cancer, ovarian cancer, and vulvar cancer account for more than 95% of all gynecological cancers.

• The most common symptom of cancer of the uterine corpus is bloody vaginal discharge in postmenopausal women.
• Symptoms of cervical cancer may include abnormal vaginal discharge, bloody vaginal discharge after intercourse, or pelvic pain.
• Ovarian cancer may be associated with abdominal pain, bloating, and changes in bowel function.
• Common symptoms of vulvar cancer include prolonged itching or burning in the vulva, discharge, a burning sensation when urinating, or a sore or other skin lesion. 

Initial examinations are performed at a physician’s appointment at a health center, a private clinic, or occupational healthcare. Primary healthcare examinations include a gynecological examination and, if necessary, tissue samples from the uterus, cervix, external genitalia, or vagina. If necessary, imaging examinations may also be performed or blood tests taken. 

If your physician identifies symptoms or findings that suggest gynecological cancer, they will refer you to the HUS Gynecological Outpatient Clinic or the Gynecologic Oncology Outpatient Clinic.

We can also refer you for an evaluation from other HUS outpatient clinics or other hospitals if your symptoms or test results suggest a gynecological cancer.

You will receive information about your appointment, as well as imaging and laboratory tests, by mail and in the Maisa Portal. The nurse coordinating your treatment will schedule your appointments and any necessary additional examinations. 

It is a good idea to reserve plenty of time for the appointment day, as you will meet with a gynecologist, nurse and, if necessary, an anesthesiologist. If you wish, you may bring a family member or other support person with you to your appointment. 

Based on your referral, the gynecologist will typically plan the necessary additional examinations, which may include imaging studies and laboratory tests, among other things. 

Before your surgery, you will meet with the gynecologist, who will review your examination results with you and provide more information on your treatment plan.

The purpose of the appointment with the anesthesiologist is to devise an anesthesia regime and pain management suitable for you.

At the nurse’s appointment, you will discuss your treatment plan and receive instructions on how to prepare for surgery.

In some cases, we may administer chemotherapy before surgery. We will assess the need for it in a multiprofessional meeting prior to the gynecologist’s appointment. 

After your surgery, we will plan your follow-up treatment individually in a multiprofessional meeting. Possible adjuvant therapies include chemotherapy, hormone therapy, and radiation therapy. In some cases, we may combine chemotherapy with immuno-oncological treatment. Immuno-oncological drugs are cancer drugs that activate the patient’s own immune system to recognize and destroy cancer cells.

A multiprofessional treatment team is in charge of the treatment of gynecological cancers. You can reach your treatment team in the Maisa Portal and by phone. You will find the contact information for the unit treating you on the invitation letter.

• The Comprehensive Cancer Center helpline at 09 471 74900 is open Monday through Friday from 7:30 a.m. to 4:00 p.m.
• If your condition deteriorates suddenly or your fever rises above 38 degrees Celsius, contact the 24-hour emergency Medical Helpline at 116 117 (toll-free) or the nearest hospital with on-call services.
• In an emergency, always call 112.

We plan your follow-up program in accordance with your tumor type and general physical condition. The duration of the follow-up ranges from six months to five years. The follow-up includes symptom surveys, clinical examinations, and in some cases, imaging examinations or blood tests. In between follow-up visits, you can contact the unit that treated you if you have any questions. 

Once follow-up care at HUS is completed, there is generally no need for regular checkups in primary healthcare.