Gynecologic cancer is an abnormal or uncontrolled growth of cells that begin in the female reproductive system. This includes any tumors occurring in the ovaries, fallopian tubes, uterus, cervix, vagina and vulva. Every year, more than 90,000 women in the United States are diagnosed with gynecologic cancers. Cervical, ovarian and uterine cancers account for more than 72,000 new cancer cases every year, but gynecologic cancers are still considered “silent killers” because most women are often unaware of their symptoms and will not be diagnosed until it is too late. At least 28,000 cancer-related deaths in the U.S. are due to gynecologic cancers.
Types of gynecologic cancers
Cervical cancer (cancer of the cervix)
Over half of gynecologic cancers begin in the cells that line the cervix, which is located in the lower part of the uterus (womb). In the U.S., more than 12,000 women are diagnosed with cervical cancer every year. There are two major types of cervical cancers: squamous cell carcinoma (80-90 percent of all cervical cancers) and adenocarcinoma (abnormal glandular cells). Most cervical cancers are caused by untreated or persistent infection by Human Papillomavirus virus (HPV) and can be prevented through vaccinating women and young girls before they are sexually active. Routine Pap tests for screening HPV are also critical in early detection of the cancer.
Women usually will not have symptoms of cervical cancer until it has spread to the deepest areas of the cervix or pelvic organs. When symptoms occur, they include:
(a) Abnormal vaginal bleeding.
(b) Vaginal discharge.
(c) Vaginal odor.
(d) Bleeding after sexual intercourse.
Ovarian cancer begins in one or both of the ovaries of the female reproductive system. There are 3 types of ovarian cancers: epithelial ovarian cancer (most common, 85-89 percent of all ovarian cancers), germ cell ovarian cancer and stromal cell ovarian cancer.
Symptoms of ovarian cancer include:
(a) Abdominal or pelvic pain.
(b) Sudden, extreme bloating.
(c) Feeling full quickly or difficulty eating.
(d) Urinary symptoms (frequency or urgency).
While these symptoms are not specific and may indicate other conditions, their frequent and persistent occurrence in women often means ovarian cancer.
Uterine (endometrial) cancer
Uterine cancer, also called endometrial cancer, occurs when cancer cells form or grow in the uterus (womb). Risk factors for the cancer include obesity, hypertension, diabetes, tamoxifen use, later age of menopause, and use of estrogen without progesterone. Any factor such as obesity which increases the amount of circulating estrogen will increase the risk of uterine cancer. Uterine cancer is commonly detected when abnormal vaginal bleeding occurs. Other symptoms include:
(a) Pain during sexual intercourse.
(b) Spotting or vaginal bleeding after menopause.
(c) Abdominal or pelvic pain that last two or more weeks.
(d) A white or watery discharge from the vagina.
(e) Bleeding between periods or heavy menstrual periods.
Vaginal cancer occurs when cancer cells arise in the vagina. It is a very rare form of gynecologic cancers and affects women between the age of 50 and 70.. The cancer is usually associated with HPV and can be prevented by vaccinating young girls and women before they are sexually active. Types of vaginal cancer include squamous cell cancer, sarcoma, melanoma and adenocarcinoma. Vaginal cancer does not show symptoms until it reaches advanced stage. Typical symptoms include:
(a) Abnormal vaginal discharge.
(b) Abnormal vaginal bleeding.
(c) Pain during intercourse.
(d) An obvious mass.
The vulva is the outermost or external part of the female genitals. In rare cases, abnormal growth may occur on the vulva, particularly in elderly women. The cancer, however, is highly treatable when detected early. Protection against HPV infection reduces the risk of vulvar cancer while frequent examination of vulva changes either at home or by a gynecologist can help to detect early-stage (pre-invasive) vulvar cancer.
Symptoms of vulvar cancer include:
(a) A white, rough area on the vulva.
(b) Red, white or pink bumps with wart-like or raw surfaces.
(c) Burning sensation or pain when urinating.
(d) An ulcer or open sore that lasts more than a month.
(e) Persistent itching.
(f) Discharge and bleeding not related to menstruation.
Diagnosis of gynecologic cancers
Diagnosis of gynecologic cancer depends on the type, stage and location of the cancer. Usually, a medical history and physical exam is performed before laboratory tests are ordered. The most common tests used to diagnose gynecologic cancers include pelvic exams, CT scan, MRI, trans-vaginal ultrasound, PET scan, colposcopy and biopsy.
- Pap test: Also called Pap smear or cervical smear, Pap test is a very useful test for screening gynecologic cancers, particularly cervical cancer. During a physical examination, the gynecologist takes a sample from the cervix, which is sent to the laboratory to be examined for abnormal cells. Pap test is recommended annually 3 years after sexual activity begins or after the age of 21. Starting at 30, women with three normal Pap test results in a row may be screened every 2-3 years.
- Colposcopy: A colposcope is a tiny, flexible light tube that is placed through the cervix to evaluate cervical tissue and help diagnose cervical cancer.
- Trans-vaginal ultrasound: High-frequency sound waves are used to produce high-quality moving images of the female reproductive organs such as ovaries and uterus. The ultrasound can help show abnormal growths in the female reproductive system and help diagnose gynecologic cancers.
- Biopsy: To confirm gynecologic cancer, the doctor will collect a sample of abnormal tissue and send to the lab for microscopic examination.
Treatment of gynecologic cancers
The specific treatment recommended for any case of gynecologic cancer depends on the type of cancer, extent (stage) of spread, location in the reproductive system, overall health of the patient and patient’s preferences. A gynecologic cancer patient will receive the most comprehensive care from a team of high-skilled specialists that include a gynecologic oncologist, radiation oncologist, medical oncologist, nurse, social workers and specialty radiologist. Gynecologic oncologist is the surgeon skilled in surgical removal of gynecological cancers, but also may oversee chemotherapy treatment. A radiation oncologist is skilled in treating cancer using radiation, while a medical oncologist specializes in cancer treatment using chemotherapy (drugs).
- Surgery for gynecologic cancer
Surgery is a common, safe and effective treatment for gynecologic cancers. It is used either as a sole treatment or combined with treatments such as radiotherapy and chemotherapy for maximum effect. Gynecologic cancer surgery is typically a minimally invasive procedure for removing tumors or cancer cells and a thin portion of the surrounding tissue. Minimally invasive surgical methods help to spare healthy tissue, minimize bleeding and scarring and accelerate recovery.
The two most common surgical procedures for gynecologic cancers are laparoscopic gynecological surgery and robot assisted gynecological surgery. In laparoscopic surgery, small incisions are made to allow a laparoscope (tiny camera connected to a video cord) and other surgical tools to be inserted into the body. The doctor watches a monitor to see the structures of the cervix, ovary or uterus in order to perform the operation. Robot-assisted gynecological surgery uses robotic computer technology to target tumors with greater precision.
- Chemotherapy for gynecologic cancers
Chemotherapy is the treatment of gynecologic cancer using drugs. The drugs are administered to control the growth of tumor cells, relieve cancer symptoms or cure the cancer. Chemotherapy for gynecologic cancer can be:(a) Adjuvant therapy: Drugs are used after a primary treatment such as radiotherapy or surgery, to prevent spread of the cancer.
(b) Non-adjuvant therapy: Drugs are used before surgery to reduce tumor size.
(c) Primary therapy: Drugs are used alone when another treatment is not indicated or possible.
(d) Radiosensitizer: Drugs are used together with radiotherapy to boost the effectiveness of the radiation.
Chemotherapy drugs typically act by preventing the multiplication of cancer cells and stopping the tumor from spreading. The drugs are given on a schedule over an indicated period of time to boost cell kill and allow normal body cells to recover.
- Radiation therapy
Radiation therapy (also called radiotherapy) is the use of high-energy waves or particles, such as protons, neutrons or X-rays, to damage or destroy cancer cells. Radiotherapy is one of the most frequently used treatments for gynecologic cancers, applied either as the primary treatment or in combination with surgery and chemotherapy. Radiation oncologists are the specialists who use radiation to cure, control or relieve the symptoms of gynecologic cancers. During radiotherapy, cancer cells are damaged, killed and eventually eliminated naturally from the body. Healthy cells may be affected by the radiation, but they are able to repair and recover from the effects of radiation.There are two types of gynecologic cancer radiotherapy: external beam radiotherapy and internal radiotherapy (brachytherapy). External beam radiotherapy is the administration of a series of daily outpatient treatments from a machine located outside the body. The series of daily sessions are run for 5 days (Monday through Friday) a week for 5-6 weeks or more. Techniques such as 3-dimensional conformal radiotherapy (3D-CRT) and intensity modulated radiation therapy (IMRT) are used to deliver an external radiation dose that matches the shape and size of the tumor being treated.
Internal radiation therapy (brachytherapy) is the delivery of treatment from a radioactive source placed surgically in or next to the affected cervix, uterus, vagina or surrounding tissues. You can be admitted in hospital to receive low-dose-rate brachytherapy delivered over a period of 48 to 72 hours, but also can be treated using high-dose-rate brachytherapy which does not require hospital admission and is delivered in less than an hour. Brachytherapy is effective in treating vaginal, uterine and cervical cancers.