Facing the possibility of a gynecologic cancer diagnosis can be frightening. Learning as much as you can about the disease can help you prepare to speak with doctors about your condition, possible treatment, and care.
Gynecologic cancer is the group of cancers that affect female reproductive organs, including the cervix, ovaries, uterus, vagina, and vulva. All women with these organs are at risk.
Below is a breakdown of the 5 main types of gynecologic cancers to be aware of:
5 Main Types of Gynecologic Cancer And Their Presenting Symptoms
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Type of Cancer |
Presenting Symptoms* |
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Abnormal vaginal bleeding or discharge |
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Abnormal vaginal bleeding or discharge, pelvic pain or pressure, abdominal or back pain, bloating or changes in bathroom habits i.e., diarrhea or constipation, frequent urination, changes in weight |
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Abnormal vaginal bleeding or discharge and pelvic pain or pressure |
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Abnormal vaginal bleeding or discharge and changes in bathroom habits |
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Pelvic pain or pressure, itching or burning of the vulva (the outer part of the female genitalia), and changes in vulva color or skin (rash, sores, or warts) |
Cervical Cancer
The cervix is the lower narrow end of the uterus (aka womb). It connects the vagina (birth canal) to the upper part of the uterus. Although all women are at risk of cervical cancer, it occurs most often in women over 30. The main known cause is infection with certain types of human papillomavirus—a common virus that can be sexually transmitted. According to the CDC, most sexually active people will have HPV at some point in their lives, but few women will get cervical cancer.
Cancer of the cervix can be preventable for those with access to screening and a vaccine to prevent human papillomavirus (HPV). When found early, it is highly treatable and associated with long term survival and good quality of life.
There is currently a vaccine approved by the US Food and Drug Administration to prevent HPV infections. The vaccine specifically targets nine high-risk types of HPV which cause the majority of cervical cancers and genital warts. It is recommended for boys and girls/men and women from ages 9 through 26. Adults between the ages of 27 through 45 should have a discussion with their physicians as to whether or not HPV vaccination is appropriate for them.
Risk factors
Almost all cervical cancers are caused by HPV, a virus so common that most people get it at some time in their lives. There are usually no visible symptoms of HPV, so it is difficult to tell if you have it. In most cases, it will go away on its own, but over time, it may cause cervical cancer.
Before actual cancer cells develop, the cells in the cervix undergo precancerous changes, dysplasia. At this early precancer stage, these cells can be removed in an out-patient procedure.
Detection and Diagnosis
A Pap smear or liquid-based cytology test screens for cervical dysplasia (precancer) and cervical cancer. These types of tests are an effective way to detect any changes and understand what’s happening in your cervix so that quick action can be taken to stop any more growth or changes in the tissue.
During a Pap smear, a sample of cells is taken from the vagina using an instrument that gently scrapes the surface of the cervix. The test isn’t usually painful, although some women experience minor discomfort. Getting regular Pap smears helps your doctor detect any changes in the cells of your cervix, including the presence of the HPV virus. Early detection can affect your treatment options if cancerous changes are detected in the cervix. Even women who have been vaccinated against HPV should get regular Pap smears.
Treatment
Treatment for cervical cancer varies depending on several factors, including whether the cancer has spread beyond the cervix, and can include chemotherapy and/or radiation therapy, and sometimes surgery, targeted therapy, and immunotherapy.
Ovarian/Fallopian Tube/Primary Peritoneal Cancer
Ovarian cancer is the second most common gynecologic cancer in the US.
The ovaries are the almond-sized organs that produce eggs, as well as the two primary female hormones, estrogen and progesterone. A similar cancer can also develop in the fallopian tube or the peritoneum, the tissue lining the wall and covering the organs of the abdomen, and all are treated in a similar way.
Risk Factors
Risk factors for ovarian cancer include:
- Family history of ovarian or breast cancer
- Personal history of breast cancer prior to age 40
- Personal history of breast cancer diagnosed prior to age 50, as well as one or more close relatives diagnosed with breast or ovarian cancer at any age
- Two or more close relatives diagnosed with breast cancer prior to age 50, or with ovarian cancer diagnosed at any age
- Ashkenazi Jewish heritage and a personal history of breast cancer prior to age 50
- Ashkenazi Jewish heritage and a first- or second-degree relative diagnosed with breast cancer prior to age 50, or with ovarian cancer at any age
You are at high risk—one in five or higher—if you inherited certain mutations in genes that are involved in cell growth, division, and DNA repair:
- BRCA1 or BRCA2 genes: the relative risk for ovarian cancer is greater than six times that of the general population
- A mismatch repair gene mutation associated with a hereditary cancer syndrome known as Hereditary Non-Polyposis Colon Cancer (HNPCC)/Lynch syndrome
Other factors that can generally increase risk for ovarian cancer include:
- Early menstruation or late menopause
- Endometriosis, a condition that involves tissue from the lining of the uterus growing outside the organ
Symptoms of ovarian cancer are more varied and vaguer than other types of gynecological cancer and are usually constant and represent a dramatic change from how you normally feel. The symptoms of ovarian cancer can include:
- abdominal bloating or swelling
- pain in the abdomen or pelvis
- difficulty eating, or feeling full quickly
- lack of appetite
- feeling an urgent need to urinate
- needing to urinate frequently
- change in bowel habits (constipation or diarrhea)
- change in menstrual periods
- vaginal bleeding between periods
- back pain
- weight gain or loss
Symptoms also worsen as the cancer progresses. If you experience any of these symptoms daily, for more than two to three weeks, speak with your doctor and mention your specific concern about ovarian cancer.
Detection and Diagnosis
If you’ve been experiencing the above symptoms persistently, or if you have risk factors for ovarian cancer, please arrange for an exam. Your doctor will likely perform a pelvic exam to feel for lumps or changes in and around the ovaries, and order additional tests.
Treatment
Treatment depends on the stage of the disease. Surgery and chemotherapy are the main treatments for ovarian cancer. Immunotherapy may also be an option.
Uterine (Endometrial) Cancer
Uterine (endometrial) cancer is the most common gynecologic cancer. It tends to develop after menopause in women between ages 50 and 60.
The uterus is a muscular, pear shaped organ where a baby grows during pregnancy. There are several different types of uterine cancer forming in various areas of the uterus, but most develop in the inner lining of the uterus—the endometrium—becoming endometrial cancer. More rare forms can develop within the muscle of the uterine wall; this is called uterine sarcoma and is managed differently.
Risk Factors
An increase in estrogen increases a woman’s risk of uterine cancer. Factors that raise a woman’s estrogen level include:
- Obesity
- Ovarian tumors
- Polycystic ovarian syndrome
- Estrogen therapy
- Starting menstruation early or menopause late
- Taking tamoxifen to prevent and treat breast cancer
Similarly, a decrease in estrogen decreases a woman’s risk of uterine cancer, and factors that lower a woman’s estrogen level may lower her risk. Some of these factors include:
- Birth control use
- Pregnancy
In addition to a woman’s hormone levels, other risk factors may increase a woman’s chance of developing uterine cancer. These include:
- Diabetes
- A family history of uterine cancer
- Atypical endometrial hyperplasia
- Pelvic radiation therapy
Treatment
Surgery is the mainstay of treatment for uterine cancer. Minimally invasive operations allow women to go home the same or the following day. For women whose cancers are more advanced, additional treatment with chemotherapy and novel drug and drug combinations and/or radiation treatment may be used.
Vaginal and Vulvar Cancer
While all women are at risk for vaginal and vulvar cancers, very few will get them. According to the CDC, these cancers are very rare. Together, they account for 6% to 7% of all gynecologic cancers diagnosed in the US.
The vagina, also called the birth canal, is the hollow, tube-like channel between the bottom of the uterus and the outside of the body. The vulva is the outer part of the female genital organs. It has two folds of skin, called the labia. Vulvar cancer most often occurs on the inner edges of the labia.
Although some women get these cancers without being at high risk, there are risk factors, including:
- Certain HPV infections over a long period of time (smoking may prevent the body’s immune system from getting rid of the HPV infection)
- History of cervical cancer or precancer (cell changes that might become cancer if they are not treated appropriately) or vulvar or vaginal precancer
- Weakened immune system, such as with HIV infection or chronic steroid use
- Chronic vulvar itching or burning
If one or more of these things is true for you, it does not mean you have or will get vaginal or vulvar cancer. But you should speak with your doctor to see if she recommends more frequent exams.
What Can I Do To Reduce My Risk of Gynecological Cancer?
Vaccination
The HPV vaccine protects against the types of HPV that most often cause cervical, vaginal, and vulvar cancers. HPV vaccination is recommended for preteens aged 11 to 12 years, but can be given starting at age 9. HPV vaccine also is recommended for everyone through age 26 years, if they are not vaccinated already.
If vaccination is started before age 15, a two-dose schedule is recommended, with the doses given 6 to 12 months apart. For people who start the series after their 15th birthday, the vaccine is given in a series of three shots.
HPV vaccination prevents new HPV infections but does not treat existing infections or diseases. This is why the HPV vaccine works best when given before any exposure to HPV. You should get screened for cervical cancer regularly, even if you received an HPV vaccine.
Screening
Since there is no simple and reliable way to screen for any gynecologic cancers except cervical cancer, it is especially important to recognize warning signs and learn if there are things you can do to reduce your risk. In addition to keeping up with your annual check-ups, talk with your doctor if you believe that you are at increased risk for gynecologic cancer. Ask what you might do to lower your risk and whether there are tests that you should have.
If you have a family history of cancer, talk with your physician about whether genetic counseling or testing may be appropriate as the results may change your screenings for certain cancers.
Click here to learn more about gynecologic cancer care at Capital Health.
