Research tells us that Americans fear cancer more than any other health event, even though heart disease is the leading cause of death. Much of this fear comes from the belief that cancer or cancer death is just a matter of random chance, something we are powerless to prevent. But let’s look at the actual facts about gynecologic cancers.
We refer to any cancer that begins in a woman’s reproductive organs as a gynecologic cancer. About 100,000 women are newly diagnosed with a gynecologic cancer each year, and these cancers cause nearly 40,000 deaths annually. A woman’s risk for gynecologic cancer increases with age. As we see you each year for your well-woman visit, we want to help you understand what you can do to prevent these cancers or discover them early.
Types of Gynecologic Cancer
- What is it? The cervix is the lower, narrow part of the uterus which connects to the vagina. Cells of the cervix can begin to change and become abnormal. Usually the changes happen slowly. Mildly abnormal pre-cancerous cells may continue to become more abnormal and spread beyond the cervix.
- Risk Factors: The most important risk factor for cervical cancer is Human Papilloma Virus (HPV). HPV is usually spread by sexual contact. Herpes infection, smoking, and other factors may increase risk.
- Prevention: The best protections against cervical cancer are the HPV vaccine (given to women younger than 27) and practicing safe sex.
- Early detection: We use an HPV test to look for strains of the HPV virus known to cause cervical cancer. We also use the Pap test to detect abnormal changes in the cells of the cervix. Your doctor will recommend the best testing schedule for your age and risk factors.
- Treatment: Treatment recommendations depend on the stage of the cancer and whether a woman intends a future pregnancy. Conservative procedures to remove only the area of abnormal tissue are often used if the cancer has not spread beyond the cervix. Hysterectomy may be recommended in some cases.
- What is it? The uterus or womb is the pear-shaped organ where the baby grows. The most common cancers of the uterus start in its lining (endometrium/endometrial cancer). Less often, cancer can begin in the deeper tissues or muscle of the uterus.
- Risk Factors: Endometrial cancer risk is age related; the average age is 60. Obesity, diabetes, taking tamoxifen for breast cancer, or taking estrogen without progesterone also increase risk. Occasionally, an individual has genetic risk factors.
- Prevention: Research indicates that long-term use of hormonal contraception (birth control pills, hormonal IUD, etc.) reduces risk. For women who have not had a hysterectomy, hormone replacement therapy for menopausal symptoms should include progesterone. Maintaining a healthy weight and controlling blood sugar levels also reduces risk.
- Early Detection: Recognizing what is not normal for you is very important. See your doctor for abnormal uterine bleeding, especially bleeding or spotting after menopause. Pelvic pain, pain during intercourse, and difficult or painful urination are also signs for concern. An ultrasound examination of the uterus and a biopsy of the uterine lining are office procedures for identifying endometrial cancer. Early detection is very important. Stage I endometrial cancer—where the cancer has not spread much beyond the lining of the uterus—has a cure rate of over 90%.
- Treatment: Hysterectomy—surgical removal of the uterus and cervix—is recommended for a uterine cancer. The choice of a simple hysterectomy or a larger procedure involving the ovaries, fallopian tubes, and lymph nodes depends on the extent of the cancer. More advanced cancers may require chemotherapy or radiation.
Ovarian and Fallopian Tube Cancer
- What is it? These cancers begin in the ovary (the organ that contains a woman’s eggs) or the fallopian tube (that link the ovary to the uterus). We now have evidence that over half of ovarian cancers actually begin in the fallopian tube. Risk for ovarian cancer increases with age; the average age at diagnosis is 62.
- Prevention: About 10 to 15% of ovarian cancers have a genetic cause (BRCA 1 and 2 gene abnormalities). Keep your physician up-to-date about your family medical history. Women with these genetic conditions are offered surgery to remove the ovaries earlier than natural menopause would occur, but after their pregnancy plans are complete. Realizing that many ovarian cancers begin in the fallopian tubes, we offer patients seeking permanent sterilization the option of removing the fallopian tubes as a risk-reducing strategy. The traditional tubal ligation does not remove the tube. Long-term hormonal birth control use, breast feeding, multiple pregnancies, and maintaining a healthy weight also reduce risk.
- Early Detection: These are very serious cancers because we currently have no reliable way to find them early (Stage I). Women may have no symptoms until the cancer is advanced, or symptoms may be such common things that they are overlooked. See your doctor if you experience abdominal or pelvic pain, bloating or feeling full quickly, indigestion, fatigue, pain with intercourse, or other symptoms that seems abnormal to you.
- Treatment: These very serious cancers are treated with surgery and chemotherapy.
Vaginal and Vulvar Cancers
- What is it? These are rare cancers that start in the vagina (birth canal) or the external genital area (the vulva). Women whose mothers were prescribed DES during pregnancy (a medication used in the 1950s to prevent miscarriage) have higher of risk of vaginal cancer. Smoking, having HPV, HIV (AIDS) or a history of cervical cancer or abnormal Pap tests increases risk for vaginal and vulvar cancers.
- Prevention: To reduce risk, avoid smoking, get the HPV vaccine if you are under 27, and practice safe sex.
- Early Detection: Having regular well-woman exams is the best way to find vaginal or vulvar cancer early. See your doctor if you notice unusual symptoms such as pain with intercourse, abnormal bleeding, or a lump in the vagina. Also, see your doctor if you notice skin changes in your genital area (itching or burning that does not go away, change in skin color, lump, wart, rash, ulcer, or sore). A Pap test does not find vaginal or vulvar cancer. Women who have had a hysterectomy, especially if the ovaries and cervix have also been removed, sometimes ask whether an annual gynecologic exam is necessary. Although vaginal and vulvar cancers are rare, your gynecologist is most likely to notice early changes that may signal a possible cancer.
- Treatment: Surgery is the most common treatment.
A Final Word
The demands of your busy life, feelings of embarrassment (we won’t scold you for putting off your exam), and anxiety about the cause of your symptoms make it easy to put off your own healthcare. Irregular bleeding and ANY bleeding or spotting after menopause should be reported to your doctor promptly. Please update your family history each time you come in. As I’ve mentioned, sometimes gynecologic cancers have family tendencies.
But remember, most of the symptoms I have described here are common to many minor conditions and usually do not indicate cancer! If you notice something that is not normal for you, come to see us—and enjoy one less thing nagging the back of your mind. Click on this public service announcement for a little more encouragement.