By Dr. Janey M. Purvis, Summit Medical Group Oregon Family Medicine
Cancer is the second most common cause of death in women in the United States, and gynecologic cancers make up a significant part of cancer diagnoses. Each year, approximately 100,000 women are diagnosed with cancer of the uterus, ovaries, cervix, vagina or vulva. Of these, 30,000 will die of the disease. The risk factors and symptoms of each type of gynecologic cancer vary, but all are treatable if found at an early stage. Since most types of gynecologic cancers, other than cervical cancer, do not have good screening tests, it is important for women to be aware of risks and symptoms so that early detection is possible.
Here are the different types of gynecologic cancers:
Cervical cancer occurs on the cervix, the structure that connects the uterus and vagina. The good news is that there are intervention screening tests that can not only detect cancer early but also detect precancerous changes that can help prevent cancer altogether. Approximately 12,000 women are diagnosed with cervical cancer each year, and out of those diagnosed, 4,000 will die. Regular Pap smears and HPV (human papillomavirus) tests have decreased cervical cancer diagnoses by 80 percent over the past 50 years. These tests, conducted at preventive physical examinations, detect precancerous changes, allowing early treatment often before cancer develops. Almost all cervical cancers are linked to the HPV virus, which per the Centers for Disease Control and Prevention (CDC), most sexually active women (and men) will get at some point in their lives. Abnormal vaginal bleeding, vaginal discharge, and painful intercourse may be early symptoms of pre-cancer or cancer of the cervix. Smoking increases the risk. The HPV vaccine is highly effective in preventing disease from the HPV virus, and widespread HPV immunization, now recommended for males age 11-26 and females age 11-45 years, will markedly reduce cervical cancer diagnoses in future generations. Other gynecologic cancers have no screening tests. Therefore, it is essential for women to get vaccinated and get regular screenings
Uterine cancer is the most common gynecologic cancer, occurring in 60,000 women per year. It is most often diagnosed in women over the age of 50 after menopause, but there are increasing diagnoses in women between age 40 and 50 during the menopausal transition. Women who are obese, have a family history of uterine cancer, or who have been on estrogen without progesterone are at higher risk. Abnormal vaginal bleeding, vaginal discharge, pelvic pain or pressure, and changes in bowel or urinary habits may be early warning signs. Most uterine cancers are detected in early stages and treatment outcomes are often favorable.
Ovarian cancer is the deadliest gynecologic cancer. Again, women over 50 are at higher risk, as are women who have a history of other cancers, have had no pregnancies, or have family history of genetic mutations. The symptoms are often vague, such as pelvic pain, bloating, as well as vaginal bleeding or discharge. Only one-fifth of ovarian cancers are detected in the early stages, making the outcomes less favorable.
Vaginal cancers are less common, diagnosed in 6,000 women per year. These cancers are also related to HPV, often found in women who have had cervical cancer or pre-cancerous changes. Vaginal bleeding, pain, or discharge are early symptoms.
Vulvar cancers are diagnosed in 6,000 women per year and are HPV related, usually in women who are over 50. Burning, itching, ulcerations, sores or bleeding on the outside of the vaginal opening should prompt a medical visit, as biopsies are often necessary to rule out these cancers. The HPV vaccine can help reduce risk of vaginal and vulvar cancers also.
Other than cervical cancer which is often found in very early stages thanks to screening tests, gynecologic cancers are most often detected when symptoms appear. Abnormal vaginal bleeding, vaginal discharge, pelvic pain, bloating, and changes in bowel or bladder habits are symptoms that should be taken seriously. A thorough evaluation by your primary care or gynecologic care provider could increase the chance for early gynecologic cancer diagnosis and in turn, a more successful treatment outcome.
Yearly preventive examinations provide an opportunity to discuss your risks of gynecologic cancers, get needed screenings and vaccinations, and allow decision making time for the appropriate course of action to ensure early detection and treatment.