In Portugal, and in most European countries, the most common gynecological cancer is endometrial cancer. The incidence of endometrial cancer has been increasing, largely due to the obesity epidemic. On the other hand, the incidence of cervical cancer has been decreasing due mainly to screening programs, greater access to information about this disease and HPV vaccination. Ovarian cancer is the one with the highest mortality rate among all gynecological cancers due to the lack of effective screening. This means that many cases are advanced at the time of its diagnosis. Gynecological cancer does not always have to have a fatal prognosis. Careful prevention, regular follow up and attention to signs can prevent problems and help resolve those that arise before they become serious. Dulce, 60 years old, diagnosed with endometrial cancer and treated by João Casanova at Hospital da Luz Lisboa: I had blood loss and had been in menopause for about 4 years. I immediately thought this must be a sign of something. I immediately sought help: I made an appointment with a specialist and, from then on, I was diagnosed, treated and continue to be monitored, under surveillance. I'm a healthcare professional and, perhaps that's why, at the first warning sign, I sought help. On the other hand, I was prepared to value the symptoms, as I had some family history of this type of cancer: my mother died of ovarian cancer at the age of 80, my sister had breast cancer... For many years I had been aware of the fact that anything could happen to me too. As for blood loss, it is important to be clear that we are not talking about a hemorrhage as if you were menstruating again. It was a small loss, which happened once. I immediately thought that something was wrong, some hormonal variation, for example. I thought about several things. The first time it appeared and disappeared within 24 hours. On the second, it persisted for two or three days. It was an insidious loss, not a large amount. And then I really got scared. When I received the diagnosis and Dr. João explained to me that the treatment would be surgical, I thought: I want to get rid of this as quickly as possible! There is always a lot of fear associated with these situations. And I had a previous history of a surgery that ended up being hell. It was a laparoscopic gallbladder surgery, which didn't go well and because of which I had to have three more open abdominal surgeries. It turned into a nightmare, and I had a really bad time. Worse: my abdomen was very traumatized, so having surgery on that part of my body again scared me a lot. I just thought: what if the same thing happens to me again? It had happened 20 years ago, it's true, but these are things you never forget. So, I was scared, I confess. What reassured me was above all the attitude of the two gynecologists I met on that occasion. Especially from Dr. João Casanova. He explained things to me in scientific terms understandable by everyone and in an extremely effective and logical way. I understood, not only the need for surgery, but the surgical procedure itself. I underwent minimally invasive surgery using robotics. My friends and colleagues, who came to visit me at home a week later, said they couldn't believe I had actually had surgery. I spent 24 hours in the hospital after surgery. And I got out on my own. I had no pain, just some discomfort. But the recovery was great and quick, despite the surgery having removed the uterus, ovaries, tubes and two lymph nodes. I also quickly returned to my normal life. And today I've resumed my bike rides! Furthermore, I have to maintain medical supervision, by the oncological gynecologist, for the rest of my life. But everything is ok. At this stage, what is expected is a follow up appointment every three months, to carry out blood tests and some other follow-up diagnostic tests. After two years of diagnosis, surveillance becomes less intense, but I'm not there yet. Dr. João Casanova will tell me at the time.
