Any woman who is concerned about her health should not just research on breast cancer alone. Gynecologic cancers, which are cancers that affect a woman’s reproductive organs, should also be a concern. These cancers are all treatable especially if detected early.
There are five types of gynecologic cancer:
- Cervical cancer
- Ovarian cancer
- Uterine cancer
- Vaginal cancer
- Vulvar cancer
All of these cancers share one specific characteristic – they occur more often in women 40 years old and above, with the risk increasing with age.
Majority of cancers of the cervix and some malignancies of the vulva and vagina are caused by infection with the Human Papillomavirus (HPV). In the other types, the cancer has been attributed to the abnormal function of oncogenes and tumor suppressor genes, which promote cancer growth and spread instead of suppressing it.
Early detection through self-examination and regular doctor’s screening is the key to the prevention and treatment. Many women can prevent cancer from developing through diet, exercise and lifestyle modifications.
For those who have been diagnosed with any of these cancer types, treatment should be done under the care of a specialist, preferably a gynecologic oncologist. The current treatment modalities for gynecologic cancers include surgery, chemotherapy and/or radiation therapy.
Cervical Cancer
Cervical cancer is the most common type of gynecologic cancer, wherein the cancer originates from the cervix, which is situated at the lower portion of the uterus. It is the connection between the fundus (upper, hollow part) of the uterus and the vagina.
Among the gynecologic cancer, cervical cancer is the only one that can be easily detected through routine screening and follow up, as well as the only cancer that is preventable.
Risk Factors
There are a number of factors that will increase your risk of cervical cancer…
- Infection with Human Papillomavirus (HPV). Risk increases if infection is recurrent.
- Smoking
- HIV or other conditions that compromise the immune system
- Prolonged intake of birth control pills
- Given birth to three or more children
- Exposure to Diethylstilbestrol (DES) while still in the mother’s womb
Symptoms
In its early stages, cervical cancer will not present with any signs and symptoms. It is only in the later stages wherein you can find abnormal vaginal discharge or bleeding (after sex).
Screening
New guidelines on cervical cancer screening have been released in 2012. Whether you have the risk factors or not, it is highly recommended that you observe the following updated guidelines…
- No screening for women before 21 years of age
- Pap test screening alone for women age 21-29 every three years. HPV testing is NOT INCLUDED in this age group.
- Pap test AND HPV testing for women 30 years old and above every five years. An alternative is continued Pap test (without HPV testing) every three years.
- No screening for women above age 65 with at least three consecutive negative Pap tests and at least two negative HPV tests during the last 10 years, the most recent test having been done in the last five years. In contrast, women in this age group with a history of cervical cancer (CIN2 or more severe cell abnormalities) must continue all routine screening for 20 years at least, even going beyond age 65.
- No screening for women who have undergone a total hysterectomy
An important reminder. If you will be having a check up with your doctor, make sure that you ask him/her if he/she performed a Pap test with your pelvic exam. Some doctors will do a pelvic exam without doing a Pap test. Upon receiving your results, have your doctor explain the findings to you. In the event that there are abnormal findings, a colposcopy and biopsy needs to be done so that problem areas in the cervix can be pinpointed and specimens taken so that the type and stage of cancer can be determined. On the other hand, HPV testing is necessary in order to identify the type of HPV infection is present. There are 14 high rise HPV types, with HPV 16 and HPV 18 being the ones specifically identified by the test.
Prevention and Treatment
Cervical cancer is the only cancer with a vaccine for prevention. The first vaccine Cervarix is approved for girls and women between the ages of 9 and 25 and specifically targets HPV 16 and HPV 18. Two other vaccines, Gardisil and Gardisil 9, not only prevent cervical cancer. They are also found to be effected in preventing vulvar, vaginal and anal cancers and pre-cancers, and genital warts. Both are given to women at ages 9 to 26.
If a woman is diagnosed with cancer, she may need to have surgery, chemotherapy, radiation therapy, or a combination of any of these depending upon the stage. Targeted therapy with Bevacizumab has also been proven effective in the treatment of cervical cancer by attacking the cancer cells directly while causing little damage to normal cells.
Ovarian Cancer
Ovarian cancer is the abnormal growth and spread of cells originating in the ovaries. It is the second most common gynecologic cancer, next to cervical cancer.
Risk Factors
Women who are at risk of developing ovarian cancer are the following…
- Age above 40, with the greater incidence occurring in women 60 years old and above.
- Family history of ovarian cancer
- Previous history of breast, uterine, or colorectal cancer
- Of Eastern European Jewish/Ashkenazi background
- Women who had difficulty getting pregnant or have never given birth at all
- Prolonged intake of estrogen alone for 10 years or more
- Diagnosed with Endometriosis (condition wherein endometrial tissue – the tissue that lines the inside of your uterus – grows outside the womb, causing pain)
- Positive test for BRCA1 or BRCA2 = in these cases, genetic testing may be advised
Presence of any of these risk factors should prompt advice from your doctor.
In contrast, there are factors that will LOWER YOUR RISK for ovarian cancer. These are…
- Use of birth control pills for five years or more
- Given birth
- History of tubal ligation, oophorectomy (surgical removal of both ovaries), or total hysterectomy
Signs and Symptoms
You may suspect that you have ovarian cancer if you experience the following signs and symptoms…
- Vaginal bleeding, described as heavy bleeding, irregular periods, or bleeding that develops after menopause
- Abnormal vaginal discharge
- Pain or pressure situated in the pelvic or abdominal regions
- Back pain
- Feeling of bloatedness or fullness while eating
- Change in toilet habits, including frequent urination that is of greater urgency than before, diarrhea or constipation
Screening and Treatment
Pap test is not a screening method for ovarian cancer. However, in the presence of symptoms, a doctor may discover ovarian enlargement on pelvic exam and fluid in your abdomen (ascites). For the more conclusive diagnosis, transvaginal ultrasound and CA-125 test are performed followed by a biopsy.
Ovarian cancer is presently treated by surgery and chemotherapy. During the course of chemo, tumor markers like human chorionic gonadotropin (HCG), alpha-fetoprotein (AFP) and CA-125 are used to determine the effectivity of treatment. If the levels of these protein markers are low, it means the treatment is working.
Uterine Cancer
Uterine cancer is the abnormal growth and spread of cells that begins at the uterus.
Risk Factors
While all women are at risk of developing uterine cancer, the greatest incidence is found among women who are presently menopausal or have already gone through menopause. Other risk factors for uterine cancer include the following…
- Above 50 years of age
- Obese
- Intake of solo estrogen as hormone replacement therapy during menopause. (Estrogen should always be taken in combination with progesterone)
- Less than five menstrual periods in year at any time in life prior to menopause
- Difficulty in getting pregnant
- Intake of tamoxifen, the targeted therapy drug used in the treatment and prevention of breast cancer
You are at LOW RISK of developing uterine cancer if you had a total hysterectomy.
Screening and Treatment
Pap test is not a screening method for uterine cancer, although sometimes, the Pap test may reveal abnormal glandular cells of uterine cancer. Uterine cancer is best imaged through transvaginal ultrasound, CT or MRI scan. Specimens are obtained via dilatation & curettage (D&C) or by endometrial biopsy.
Treatment options include surgery, chemotherapy, radiation therapy, and hormone therapy with high dose progesterone or with aromatase inhibitors (same drugs used in the treatment of breast cancer).
Vaginal Cancer
Vaginal cancer is the abnormal growth and spread of cancer cells originating from the vagina, which is also known as the birth canal. It is one of the rare gynecologic cancers.
Risk Factors
There are six identified risk factors for this disease…
- A current or recurrent infection of HPV
- History of abnormal Pap test with results revealing abnormal cervical cells
- History of cervical cancer
- Have HIV or other immune-compromising disease
- Exposure to DES while still in the womb
- Smoking
Signs and Symptoms
Vaginal cancer does not usually present with symptoms. If symptoms do occur, they include the following…
- Abnormal vaginal discharge
- Abnormal vaginal bleeding (such as very heavy, occurs between periods, of long duration, or bleeding after menopause)
- Blood in urine or stool
- Changes in toilet habits, including frequent urination or constipation
- Pain in the pelvis or abdomen while urinating or having sex
Diagnosis and Treatment
Pap test is not a screening method for vaginal cancer. However, a doctor may find lumps or changes in the vagina via pelvic exam. In these cases, the doctor performs a biopsy and takes a specimens from suspicious lumps or areas.
Treatment of vaginal cancer is dependent upon the location of the cancer and how far it has spread. It commonly involves radiation therapy, surgery (partial or complete removal of the vagina), and chemotherapy.
Vulvar Cancer
Vulvar cancer is the uncontrolled, abnormal growth and spread of cancer cells from the vulva, including the vagina’s inner and outer lips, the vaginal opening and its glands, and the clitoris.
Risk Factors
Women who are at high risk of developing vulvar cancer are…
- Women 50 years old and above
- Those with a current or recurrent HPV infection
- History of abnormal Pap test with results revealing abnormal cervical cells
- History of cervical cancer
- Have HIV or other immune-compromising disease
- Chronic vulvar itching or burning
- Smoking
Diagnosis and Treatment
Pap test is not a screening method for vulvar cancer.
But a doctor can perform a pelvic exam to take a look for any skin changes or any other abnormalities in your vulva. He will then acquire specimens through biopsy to determine if vulvar cancer is present.
Depending upon the stage of the cancer, your doctor may choose between surgery, chemotherapy or radiation therapy, or a combination of any of these treatment modalities. However, these treatments may cause major side effects, including poor body image (because of the removal of the tumor and some parts of the vulva where cancer was detected), disruption of bladder, rectal and sexual function, and chronic edema of the lower limbs.
Screening and Early Diagnosis are the Keys to Gynecologic Cancers
As with all other cancers gynecologic cancers are best detected early through screening methods so that treatment could be started right away.
Make sure that you annually visit your gynecologist for check-ups. Aside from the pelvic exam, have a Pap test done routinely based on the guidelines mentioned earlier. If you develop symptoms which you believe might be indicative of a cancer, schedule an appointment with your doctor.
What is most important is that you be screened thoroughly by your physician so that with an early gynecologic cancer, you can find be cured of this disease.
