Gynecologic Cancers

Gynecologic oncology is a specialized field of medicine that focuses on cancers of the female reproductive system, including cervical, uterine, ovarian, vaginal and vulvar cancers.

Uterine cancer is the most common, with ovarian cancer being the most lethal. There have been  improvements made in the treatment of many cancers, but others have continued to increase or remain steady. Deaths from uterine cancer have decreased over time likely due to earlier diagnosis because of screenings such as Pap tests and improved treatment options. Ovarian cancer deaths have slightly risen over time.

These cancers are treated by a team that provides a combination of surgery, chemotherapy, and sometimes radiation.

The three most common gynecologic cancers are cervical, uterine and ovarian cancers. 

Cervical Cancer

Cervical cancer is a cancer of the opening to the uterus or womb. In third world countries where Pap tests are not available, it is the gynecologic cancer that causes the most deaths. It is also one of the easiest cancers to prevent through screening and early vaccination. Cervical cancer is rare in the United States due to women receiving routine Pap tests (or Pap smears) that can detect early changes that might lead to cancer.

Cervical cancer is caused by infection with the Human Papilloma Virus (HPV), a common virus that is transmitted sexually. Rarely does HPV infection actually lead to a case of cervical cancer, partly because of early detection with Pap smears and the body’s own immune system is usually able to fight off the infection. Most patients who are infected with HPV do not have symptoms.

Who is at risk?

Any woman who has ever had sex, women who have had multiple sexual partners, and women who do not get routine Pap tests. It is one of the most preventable cancers. Other risk factors include immunosuppression as seen in those patients who take steroids on a regular basis, women who are organ transplant recipients, are undergoing chemotherapy, or are infected with HIV.

Smoking is another significant risk factor that actually doubles the risk of getting of cervical cancer.

What are the symptoms of cervical cancer?

Usually women with cervical cancer have no symptoms, particularly if the cancer is small.  The common symptoms of cervical cancer are:

  • Bleeding between periods
  • Bleeding or spotting after sexual intercourse
  • Bleeding or spotting in women who have already gone through menopause
  • Unusual, continuous, foul-smelling vaginal discharge

In women with more advanced cervical cancer, additional symptoms may occur, such as:

  • Progressive and ultimately constant pelvic pain
  • One-sided leg pain caused by nerve involvement
  • A pelvic mass
  • Bleeding from the bladder or rectum

Cervical Cancer Treatment

Cervical cancer treatment depends on the stage at the time of diagnosis.  Treatment involves either surgery, chemotherapy or radiation or sometimes a combination of all three. 

Uterine (Endometrial) Cancer

Uterine cancer is the fourth most common cancer affecting women. It is usually diagnosed early due to recognizable symptoms.

Who is at risk?

One of the strongest and most common risk factors for the development of endometrial cancer is obesity. Other associated risk factors include hypertension, diabetes, use of estrogen without progesterone, use of Tamoxifen, and late menopause. Women who have never been pregnant also have a slightly higher risk for endometrial cancer. Some women diagnosed with endometrial cancer have none of these risk factors, while others may have several.

About 75% of women diagnosed with endometrial cancer have already gone through menopause. A small percentage of women develop endometrial cancer due to inheriting a predisposition for this cancer from their mother or father. While rare, these families have a high frequency of endometrial, ovarian and colon cancer. If you have relatives with endometrial, ovarian, and/or colon cancer, you should see a genetics specialist.

What are the symptoms of uterine cancer?

The most common warning sign is vaginal bleeding after menopause. Younger women may also develop endometrial cancer and may notice irregular or heavy vaginal bleeding. When a woman experiences symptoms that could lead to a diagnosis of endometrial cancer, an endometrial biopsy should be performed. It can be done in the physician’s office or in the operating room.  

Uterine Cancer Treatment

The most common treatment for endometrial cancer is a hysterectomy. This is a surgical procedure that includes removal of the uterus and cervix as well as, in most cases, both ovaries and both fallopian tubes. Radiation therapy, chemotherapy, or hormonal therapy have all been used as well.

Ovarian Cancer

Ovarian cancer is the fifth deadliest cancer affecting women and the second most common gynecologic malignancy. Unfortunately, this cancer isn’t usually diagnosed early because symptoms are vague and there aren’t presently good screening tools. Because the symptoms of ovarian cancer are nonspecific, most women (70% to 75%) are diagnosed with stage III/IV disease which is harder to treat.

Who is at risk?

There are a number of factors associated with an increased risk of ovarian cancer including not having given birth. Genetic factors such as a positive family history or BRCA gene mutations also increase risk.

Although controversial, environmental factors such as talc (from powder), a high-fat diet, estrogen-replacement therapy, and even tobacco use have been associated with an increased risk of ovarian cancer.

Oral contraceptive pills reduce risk. Hysterectomy, tubal ligation, and oophorectomy (removal of the ovaries) all reduce the risk as well.

What are the symptoms of ovarian cancer?

A swollen or bloated abdomen is one of the symptoms of ovarian cancer. Some women simply notice that their pants or skirts are getting tight around the waist. The bloating is a sign that fluid, called ascites, is building up in the abdominal cavity in later stage disease. Other symptoms may include:

  • Persistent pressure or pain in the abdomen or pelvis
  • Difficulty eating or feeling full quickly
  • Urinary concerns, such as urgency or frequency
  • Change in bowel habits with new onset constipation and/or diarrhea

Because the symptoms of ovarian cancer are nonspecific, most women (70% to 75%) are diagnosed with stage III/IV disease.

Ovarian Cancer Treatment

Once detected, surgical removal of the as much of the cancer as possible is critical to improve survival. Patients with small-volume residual disease after surgery have improved survival, but tumor biology (inherent sensitivity or resistance to chemotherapy) is still a major predictor of outcome.