Gynecologic Cancers

The most common types of gynecologic cancers are of the cervix, ovary and endometrium (uterine lining). Cancers can also occur in fallopian tubes, vagina, external genitalia (vulva) and uterine body; but these are uncommon. Cancers at each of these sites have different causes, different presenting symptoms and different risk factors.

Approximately 16,000 women are diagnosed with cervical cancer each year in the United States. Risk factors for cervical cancer include having sexual intercourse at a young age, multiple sexual partners, a history of infection with the human papilloma virus and smoking cigarettes. It is thought that infection with certain types of the human papilloma virus initiates changes in cervical cells making them more susceptible to becoming cancerous. Cigarette smoking has been strongly linked to cervical cancer. Symptoms of cervical cancer are abnormal vaginal bleeding or bleeding after intercourse. Because cervical cancer has a well-defined precancerous stage it is also uncommon in woman who have regular Pap smears. If a precancerous lesion is detected on a pap smear it can be treated long before a cancer develops.

Cancer of the uterine lining is called endometrial cancer. It is the most common gynecologic cancer, affecting approximately 37,400 women each year, but has a low mortality rate. Endometrial cancer is most common in postmenopausal women. Risk factors for endometrial cancer include obesity, not ovulating regularly, polycystic ovarian syndrome, endometrial hyperplasia, a personal history of breast, colon or ovarian cancer and a family history of endometrial cancer. Survival rate for endometrial cancer is quite high mainly because it is often found in early stages. The most common symptom of endometrial cancer is vaginal bleeding. Any bleeding after menopause or abnormal bleeding in premenopausal women should prompt a gynecologic evaluation.

Ovarian cancer is the fifth most common cause of cancer deaths in women. It affects an estimated 25,000 women each year. Ovarian cancer has a high mortality rate because, unlike cervical and endometrial cancer, it has few symptoms and no good screening tests. Risk factors for ovarian cancer include a family history of ovarian cancer and never having children. Use of birth control pills, for at least five years, decreases the risk of ovarian cancer (and endometrial cancer) by about 50%. Women who are at higher risk of ovarian cancer should discuss using birth control pills with their physician.

Symptoms of ovarian cancer, such as persistent pelvic pain, bloating and a sense of abdominal fullness, are vague and non-specific. This is partly why it is often in advanced stages when diagnosed. There has been much interest in a screening test for ovarian cancer. Patients often ask about a CA-125 blood test. Unfortunately this test is neither sensitive nor specific enough to be used as a general screening test. Half of all women with an early stage cancer will have a normal CA-125. Conditions other than cancer (such as endometriosis or uterine fibroids) can also cause an elevation in CA-125 levels.

Cancer of the vulva is most often found in elderly women. If found in early stages it is curable with a combination of surgery and radiation. It usually presents with persistent vulvar itching or a non-healing sore. Either of these conditions should prompt a gynecologic evaluation and possible biopsy to evaluate for the presence of a cancer.

Gynecologic cancers affect almost 80,000 women each year. Many of these cancers can be cured if found in early stages. A yearly gynecologic evaluation is important for all women. Symptoms such as abnormal bleeding, persistent itching or persistent abdominal discomfort should prompt a visit to your physician. For more information about gynecologic cancers visit the Women’s Cancer Network at www.wcn.org.