Gynecologic Cancers

Gynecologic cancers affect the reproductive organs and genitalia of women. The American Cancer Society (ACS) estimates approximately 78,290 women will be diagnosed with a gynecologic cancer this year.

Endometrial Cancer

Endometrial cancer is the most common gynecologic cancer. Although the lining of the uterus, or endometrium, accounts for about 70% of these cancers, the muscular wall can also develop a type of cancer known as sarcoma. Endometrial cancer affects primarily postmenopausal women, although 25% of cases are seen in premenopausal women, with 5% of these under age 50. Risk factors include obesity, late or heavy menopause, taking estrogen without also taking progesterone, hypertension, diabetes and a pre-cancerous overgrowth of the endometrium. Most worrisome, however, is the three- to 10-fold increase in risk for women 30 to 50 pounds overweight, making obesity the most significant risk factor. Symptoms include postmenopausal or heavy/irregular premenopausal bleeding, pelvic pain and a foul vaginal discharge.

Bleeding abnormalities are seen in approximately 90% of patients, often very early in the development of the disease. It is important to report this to your doctor immediately. He or she should refer you to an OBGYN for evaluation. If cancer is diagnosed, you should see a gynecologic oncologist, a physician with extensive training in gynecologic cancers. The gynecologic oncologist will perform surgical staging, removing the uterus, fallopian tubes, ovaries, cervix and lymph nodes. Surgery helps determine the “stage” or extent of the spread of the disease and, by removing the tumor, may also be curative. In simple terms, cancer confined to the uterus is Stage I, cervical involvement Stage II, local spread outside the uterus Stage III and cancer involving the bladder, rectum or further spread is Stage IV, although subdivisions exist. After surgery, additional treatment depends on stage and may include radiation, chemotherapy or a combination of both. Most patients appear with Stage I and II cancers, where survivals are highest. Reporting symptoms, especially abnormal bleeding, when they’re first recognized is important.

Ovarian Cancer

The most common type of ovarian cancer, approximately 70-80%, involves the surface of the ovary. Less common types arise from its structural or hormone-producing components. Ovarian cancer is the fourth leading cause of cancer deaths, according to the ACS. In fact, more women who develop ovarian cancer will die from their disease than women who develop breast cancer by almost three to one. Its lethal nature is attributable to delays in diagnosis, as there are no effective screening methods for easy detection. Most cases are found with advance stage disease, where survival rates are poor. Risk factors include age, family history, lack of or delay in child bearing, infertility, early onset of menstrual cycles or late menopause and a history of cancer.

Symptoms include irregular menstrual cycles, frequent urination, constipation, pelvic pressure, bloating, nausea/vomiting, weight loss, decrease or loss of appetite and distention or swelling of the abdomen. Your doctor will often feel a mass in your abdomen or pelvis upon examination. A gynecologic oncologist will perform surgical staging, similar to that for endometrial cancer discussed above, although more extensive. An additional goal of surgery is to remove as much of the cancer as possible. Studies show that removing all visible disease significantly improves survival. Disease limited to one or both ovaries is Stage I, local spread to the pelvis is Stage II, spread to the abdomen is Stage III and distant spread is Stage IV. After surgery, when the stage is known, intravenous chemotherapy is most commonly given.

Patients with Stage I disease have five-year survival rates in the 90% range, compared to Stage III and IV, where survivals are lower by two-thirds. Recurrences are not uncommon and can be treated with chemotherapy, radiation and additional surgery in certain cases. The best thing to do is to have a yearly physical, including a thorough pelvic exam by an OBGYN, and report any of the above symptoms as they develop, especially if they persist.

Cervical Cancer

Cervical cancer develops most commonly in women of reproductive age. Additionally, it is largely attributable to a sexually transmitted virus, Human Papilloma Virus (HPV). Seventy percent of cervical cancers arise from cells covering the cervix called squamous cells. The Papanicolaou (Pap) smear for screening has drastically improved early diagnosis and decreased the number of deaths. Most patients found to have cervical cancer have not had a Pap smear in the two years before diagnosis. Risk factors include smoking, multiple sexual partners, early age of first sexual activity, a high-risk partner and HPV.

Patients often develop vaginal bleeding, especially after intercourse, and sometimes with urinary frequency and pelvic pain or pressure. The diagnosis is many times made by Pap smear, which may reveal abnormal cells. A biopsy is performed, often times using a colposcopy, which magnifies the cervix to better show abnormalities. The biopsy may show dysplasia, which is a pre-cancer abnormality, or cancer. Dysplasia, if untreated, can progress to invasive cervical cancer. Treatment for cervical cancer is very stage dependent. Stage I disease, limited to the cervix, is most often treated by radical hysterectomy and removal of lymph nodes. The radical part of the hysterectomy removes tissues attached to and supporting the uterus, where the cancer first spreads. In general, Stages II, III and IV are treated with a combination of radiation and chemotherapy. As with all cancers, Stage I patients have excellent five-year survival, which decreases with higher stages. Recurrence may be treated by surgery, chemotherapy, radiation or any combination thereof. Early diagnosis by getting a yearly screening and reporting symptoms is very important. A new vaccine called Gardasil may help prevent HPV. Using Latex condoms can also prevent transmission of HPV.

Gynecologic cancers, like all cancers, can be treated. But, the best chance for long-term survival is based on early diagnosis. You can help by getting an annual physical examination, including a thorough pelvic exam and a Pap smear, and reporting any unusual symptoms without delay to your doctor. Your survival also improves with a referral to a gynecologic oncologist. For more information, visit the Gynecologic Cancer Foundation, www.thegcf.org.