Most women have had a Pap smear, which is a routine screening test for cervical cancer that’s performed during a check-up with the OB/GYN or general practitioner. Cervical cancer is only one of several cancers that can occur in a woman’s reproductive organs (known as gynecologic cancers). Knowing a bit about these conditions is helpful in keeping them in check.
A woman’s reproductive system is centered on the uterus (including the cervix), which is also known as the womb. The ovaries attach to the top of the uterus, and the vagina connects the uterus to the outside of the body. The external genitals are called the vulva. Gynecologic cancers result from the rapid growth and spread of abnormal cells in one of these organs.
Compared to other types of cancer (like breast or colon cancer), gynecologic cancers are uncommon, occurring in about 100,000 women in the United States each year. That said, all women are at risk for developing gynecologic cancers, and the risk increases with age. It’s important to know the warning signs, as treatments are most effective when the cancer is found at an early stage.
“There are so many different diseases that fall under the umbrella of gynecologic cancer, and each one can be very different in terms of the types of treatments and where we go from the initial diagnosis,” says Gloria Huang, MD, FACOG, a Yale Medicine gynecologic oncologist.
But gynecologic cancers are often treatable. “Some of these present as pre-cancers that are easily treated when detected early,” she says. “Even many early-stage cancers, such as stage I endometrial cancer, are cured just with surgery alone, the vast majority of the time.”
What are the types of gynecologic cancers, and who’s at risk?
There are five major types:
The following factors may increase your risk of developing gynecologic cancer:
- Human papillomavirus (HPV): Cervical, vaginal and vulvar cancers are often linked to HPV, a common sexually transmitted infection. For this reason, practicing safe sex (using a condom) is a key strategy for prevention. An HPV vaccine is available for girls and young women (between the ages of 11 and 26).
- Age: Older age is another known risk factor. For example, the average patient with uterine cancer is 63 years old at diagnosis.
- Genetics: Up to 10% of patients with ovarian cancer have a family history of the disease. A woman whose mother, daughter or sister had ovarian, Fallopian tube or primary peritoneal cancer might choose to undergo genetic testing for mutations in the BRCA1 and BRCA2 genes. (Mutations in these genes can increase your risk for ovarian cancer.)
- Diethylstilbestrol Exposure: Some gynecologic cancers have been associated with in utero exposure to diethylstilbestrol, a synthetic form of estrogen that was prescribed to pregnant women between 1940 and 1971, before it was determined to be unsafe.
What are the symptoms of gynecologic cancers?
Symptoms vary depending on the organ that’s involved and should always be evaluated by your doctor.
Abnormal vaginal bleeding and discharge can occur with any gynecologic cancer. Sometimes, pelvic pain can occur with uterine and ovarian cancer. Similarly, bloating, constipation, and an increased need to urinate can occur with ovarian cancer but not all patients will have those symptoms.
Vulvar cancer causes itching and soreness, along with a visible lesion. An area of skin on the vulva may have a different color than the surrounding skin.
So far, only cervical cancer has routine screening tests (the Pap smear and HPV testing). Because symptoms of early-stage gynecologic cancers are often vague and can also be caused by other, less serious conditions, doctors encourage women to have regular gynecologic exams to check for signs of disease.
How are gynecologic cancers diagnosed?
To diagnose gynecologic cancers, doctors review the patient’s medical history, perform a physical exam, and run one or more diagnostic tests.
- Medical history. The doctor will assess the patient’s medical record, ask about symptoms, and whether the patient has any risk factors for gynecologic cancers.
- Physical exam. During the physical exam, the doctor will look for signs and symptoms of gynecologic cancers and determine the patient’s overall health. The exam may involve a pelvic exam.
Various diagnostic tests are used to diagnose gynecologic cancers. These may include:
- Blood tests. Bloodwork is used to measure the level of tumor markers and other components of the blood that may be indicative of cancer.
- Pap test. In this test, a doctor removes a sample of cells from the cervix for laboratory analysis. A pathologist looks at the cells under a microscope to determine if cancer is present. This test is used in the diagnosis of cervical cancer.
- Imaging tests. These tests produce images of the internal tissues of the pelvis and abdomen, and allow doctors to visually detect tumors and other abnormalities. Commonly used imaging tests in the diagnosis of gynecologic cancers include ultrasounds, magnetic resonance imaging (MRI) studies, and computed tomography (CT) scans.
If a gynecologic cancer is diagnosed, other imaging tests such as a positron emission tomography (PET) scan may be used to determine if the cancer has spread to other parts of the body.
- Biopsy. Biopsy is necessary to confirm the diagnosis of cancer. In a biopsy, a small piece of tissue is removed for laboratory analysis. For gynecologic cancers, biopsies may be performed using an image-guided needle during a minimally invasive procedure, via open surgery, or using other specialized instruments. Once the tissue sample is collected, a pathologist examines it under a microscope to check for the presence of cancer cells.
How are gynecologic cancers treated?
Treatment depends on many factors, including whether the cancer has spread, and whether the patient is young enough to have children.
For more advanced disease, surgery is usually the best option. Hysterectomy (removal of the uterus) is common among patients with cervical, uterine and ovarian cancers. Doctors may also suggest radiation therapy or chemotherapy to prevent the cancer from spreading further.
What is Yale Medicine’s approach to diagnosing and treating gynecologic cancers?
“In our division, all of us have a lot of expertise and experience in minimally invasive surgery,” says Dr. Huang. “We know that patients who can have small incisions, rather than an open abdominal incision, for their hysterectomy are at much lower risk of wound complications, infection and bleeding.”
Patients who have more aggressive types of cancer have a much higher chance of it metastasizing to other areas, even after surgery, she says. “At Yale we have a great deal of expertise in that as well,” she says. “Our doctors understand the biology of these aggressive cancers and how to treat them. In fact, in our division we have published practice-changing research on how best to treat these aggressive cancers.”