Gynecologic Cancer

There are several risk factors that could raise your chances of developing cervical cancer. A risk factor for a disease doesn’t mean you’ll develop it. It just means your risk is greater. The most common risk factor for cervical cancer the human papillomavirus (HPV), a sexually transmitted infection.

Additional risk factors for cervical cancer include:

• Giving birth to three or more children
• Having a weakened immune system
• Having many sexual partners
• Having sex at an early age
• Smoking
• Taking birth control pills for five or more years

Pap tests (also called Pap smears) look for signs of cervical cancer. HPV tests look for the human papillomavirus, which can cause cells to change, leading to cervical cancer. It used to be common to have a Pap test once a year, but guidelines have changed. Today, the American College of Obstetricians and Gynecologists (ACOG) and the Centers for Disease Control and Prevention (CDC) recommends the following:

• 21-29: Pap test every three years, as long as the results are normal
• 30-65: Talk to your healthcare provider to help you choose between the following three options:
  
  • Pap test only every three years, if the results are normal
  • HPV test only every five years, if the results are normal
  • Pap test along with an HPV test every five years, if the results are normal (this is called co-testing)
• 65-plus: Talk to your healthcare provider. If your test results have been normal, there’s typically no need to continue screening.

You may not experience any symptoms with early cervical pre-cancers or cancers. Once the cancer grows large enough to cause symptoms, they can be similar to premenstrual syndrome (PMS) symptoms. 

Common cervical cancer symptoms include:

• Abnormal vaginal bleeding — this includes spotting or bleeding between periods, bleeding after sex, bleeding after menopause or bleeding after douching
• Menstrual periods that are heavier or longer than normal
• Pelvic pain
• Pain while having sex
• Unusual vaginal discharge

Your doctor will likely recommend diagnostic testing if you are experiencing cervical cancer symptoms, or you have an abnormal test result from cervical cancer screening.

Cervical cancer diagnostic tests may include:

• Biopsy: During a colposcopy or other procedure, our surgeons will remove abnormal tissue.
• Colposcopy: This test allows us to take a better look at your cervix.
• Imaging tests: Our specialists may order imaging tests, including an X-ray, CT scan, MRI or PET scan. 

Our team of specialists will factor in the type and stage of your cervical cancer to determine the best kind of treatment or combination of treatments.

Common cervical cancer treatments include:

• Chemotherapy, which uses chemical substances to help kill cancer cells 
• Immunotherapy, which helps your immune system kill cervical cancer cells
• Radiation therapy, which uses high doses of radiation to kill cancer cells
• Surgery, which can treat the disease or determine if and how much it has spread
• Targeted therapy, which relies on medicine to attack chemicals in cervical cancer cells, causing them to die

Risk factors raise your risk of developing ovarian cancer. Having a risk factor doesn’t mean you’ll develop ovarian cancer. Some risk factors can be changed. Others, like aging, can’t be changed. It’s also possible to develop ovarian cancer without one of these risk factors.

Risk factors for ovarian cancer include:

• Aging
• Obesity
• Early or later menstruation
• Endometriosis
• Family or personal history of ovarian or breast cancer
• Hormone replacement therapies (HRT)
• Trouble getting pregnant, never having children or having children after the age of 35

Mutations of certain genes can also increase your ovarian cancer risk. Genetic testing can help determine your ovarian cancer risk. If genetic testing reveals a mutation in the BRCA1 and BRCA2 genes, preventive surgery to remove the ovaries may be an option. If you are at a high risk for developing ovarian cancer, talk with your doctor about a CA-125 test, which can detect early signs.

You are more likely to experience ovarian cancer symptoms if the cancer has spread. However, it’s possible to experience symptoms during the early stages of ovarian cancer, too.

Common ovarian symptoms include:

• Back pain
• Bloating
• Constipation
• Fatigue
• Feeling full soon after eating or having trouble eating
• Pain during sex
• Pain or discomfort in the pelvic or abdominal area
• Urinary-related problems, including urgency and having to go frequently
• Unintended weight loss

Your doctor will likely recommend several tests to diagnose ovarian cancer and gather information about the disease.

Ovarian cancer diagnostic tests may include:

• Biopsy: Biopsies help diagnose cancer. One of our radiologists or surgeons will remove a small piece of tissue to determine if it’s cancerous.
• Blood tests: Your doctor may order different blood tests to evaluate your general health and how well your organs function.
• Genetic testing: If you have a certain type of ovarian cancer, your doctor may recommend that you get genetic testing to better inform treatment options and potential risk related to additional cancers. 
• Imaging tests: Your doctor may order imaging tests, such as an ultrasound, CT scan or MRI scan to get a better picture of your ovaries.
• Laparoscopy: This procedure allows your doctor to view your organs through a small incision in your abdomen.
• Pelvic exam: During this exam, a doctor will check for signs of fluid in your abdomen or an enlarged ovary by feeling inside your vagina while also pressing on your stomach.

Our team of specialists will talk to you about your treatment options and tell you exactly what to expect. Your treatment will depend on your stage of ovarian cancer.

If ovarian cancer is caught early and hasn’t spread, it may be possible to only remove one ovary, preserving the ability to have children. Sometimes, both ovaries and the uterus will need to be removed. If only the ovaries are removed, and not the uterus, pregnancy can still be possible with your own frozen embryos or eggs from a donor. Advanced cancer may require more extensive surgery, called debulking. Debulking removes as much of the tumor as possible.

Treatments for ovarian cancer include:

• Chemotherapy, which helps kill cancerous cells with chemical substances, and may be done before or after surgery
• Hormone therapy, which may help slow or stop the growth of cancer
• Immunotherapy, which stimulates an immune response to help fight the disease
• Surgery, which may involve removing one or both ovaries, the uterus or as much of the tumor as possible
• Targeted drug therapy, which uses specific medicine to interfere with a cancer cell’s ability to grow

Having a risk factor could raise your risk of developing uterine cancer. It’s important to know that having a risk factor doesn’t mean you’ll develop the disease. It just means your risk is greater.

While some risk factors can’t be helped, understanding the risk factors for uterine cancer can help you modify the ones you can. Risk factors for uterine cancer include:

• Aging
• Diabetes
• Difficulty getting pregnant or not getting pregnant
• Early menstruation or late menopause
• Family history of uterine, colon or ovarian cancer
• Fewer than five periods in a year before starting menopause
• Obesity
• Polycystic ovary syndrome (PCOS)
• Taking estrogen after menopause
• Taking Tamoxifen for breast cancer
• Using an intrauterine device (IUD)
• Using birth control pills

According to ACS, about 90 percent of people with endometrial cancer will experience unusual vaginal bleeding. 

Uterine cancer symptoms include:

• Pain during sex
• Pelvic pain
• Vaginal discharge or bleeding not related to your period

If you or your doctor suspects uterine cancer, several different diagnostic tests can help us gather more information. 

Some of the tests may include:

• Biopsy: A gynecologist may remove tissue from the uterus for further examination.
• Blood tests: Our doctors may use a complete blood count (CBC) to see if you have anemia, which is when your red blood cell counts are low. Because endometrial cancer can result in a high blood level of a substance called CA-125, we may test for that as well.
• Dilation and curettage (D&C): During this procedure, the cervix is enlarged and a gynecologist scrapes tissue from the lining of the uterus. 
• Imaging tests: Imaging tests, such as a transvaginal ultrasound, also help us look for signs of cancer. Additional imaging tests, such as a CT scan, MRI or PET scan, can help us see if your cancer has spread.
• Pelvic exam: A pelvic exam allows our specialists to look for signs of uterine cancer.

Our specialists will recommend a personalized treatment plan depending on the type of uterine cancer you have.

Uterine cancer treatment options may include one or several of the following:

• Chemotherapy, which helps kill cancer cells with strong medication
• Hormone therapy, which, if the cancer has spread beyond the uterus, uses medicine to lower hormone levels the cancer cells rely on to live
• Immunotherapy, which uses medicine to boost your immune system to help fight the disease
• Radiation therapy, which uses strong doses of radiation to kill cancer cells
• Surgery, which may include a hysterectomy (an operation to remove your uterus) or the removal of your fallopian tubes, ovaries, certain lymph nodes or cancer from other areas of the body, if it has spread (called debulking)
• Targeted therapy, which uses drugs to block chemicals, causing your cancer cells to die

Having a risk factor can increase your vaginal cancer risk. It’s important to remember that vaginal cancer is rare and that having a risk factor doesn’t mean you’ll develop the disease. According to ACS, nearly half the cases of vaginal cancer occur in people who are 70-plus years old.

Vaginal cancer risk factors include:

• Aging 
• Drinking alcohol
• Exposure to DES, a medicine to prevent miscarriage, while your mother was pregnant with you (DES was used between 1940 and 1971)
• Exposure to the Human papillomavirus (HPV), a sexually transmitted disease
• History of cervical cancer
• History of abnormal cells in the cervix
• Human immunodeficiency virus (HIV)
• Smoking
• Using a device called a pessary to help keep the uterus in place for cases of uterine prolapse

In the early stages, vaginal cancer may not cause symptoms. But as the cancer grows and spreads, you may begin to notice symptoms.

Vaginal cancer symptoms include:

• A lump in the vagina
• Bleeding or discharge not related to menstrual periods
• Constipation
• Pain during sex, in the pelvic or back areas or when urinating

If you or your doctor sees suspects vaginal cancer, we’ll likely recommend diagnostic tests to gather more information. 

Some of the tests we may recommend include:

• Biopsy: This procedure allows us to remove a tissue sample for further testing.
• Colposcopy: This test allows us to take a better look at the walls of your vagina and your cervix.
• Imaging tests: These tests may include an X-ray, CT scan, MRI or PET scan.
• Physical exam: A gynecologist may perform a pelvic exam to look or feel for abnormal areas. Your doctor may also check for enlarged lymph nodes in your groin area.

Pre-cancerous lesions or pre-cancers of the vagina are called vaginal intraepithelial neoplasia (VAIN). For these, your doctor may recommend laser ablation, a process that uses a laser beam to dissolve abnormal lesions. Your doctor may also recommend topical therapy, which are drugs that are put onto vaginal lesions. If surgery is required, it may be possible to rebuild the vagina, which is a procedure called vaginal reconstruction.

For more advanced vaginal cancer, we recommend: 

• Chemotherapy, which uses chemical substances to kill cancerous cells
• Immunotherapy, which uses medicine to help your own immune system kill cancer cells
• Radiation therapy, which uses high doses of radiation to kill cancer cells and shrink tumors, and can be done outside the body or inside the vagina
• Surgery, which may involve removing the cancer, part or all of the vagina, the cervix, the uterus, pelvic lymph nodes or other organs that have been affected
• Targeted therapy, which uses targeted drugs to help control the cancer cells

A risk factor may increase your chance of getting a disease. It’s possible to have a vulvar cancer risk factor and not develop vulvar cancer. According to ACS, more than half of vulvar cancer occurs in women over 70. 

Vulvar cancer risk factors include:

• Aging
• Smoking
• Exposure to the Human papillomavirus (HPV), a sexually transmitted disease
• History of cervical cancer
• Lichen sclerosus, which causes the skin around the genitals to become thin and itchy 
• Personal or family history of melanoma or atypical moles
• Vulvar intraepithelial neoplasia (VIN), pre-cancerous changes in the surface of the skin

You may not experience any symptoms of vulvar cancer, depending on the kind of vulvar cancer you have. For example, if you have vulvar intraepithelial neoplasia, you may not have any symptoms; if you do, it may only be itching.

Symptoms of more advanced vulvar cancer may include:

• A lump or growth on the vulva
• Bleeding not related to menstrual periods
• Color changes in the vulvar skin or growths that look like warts or ulcers
• Itching in the vulvar area that does not go away
• Tenderness in the vulvar area

If our specialists suspect vulvar cancer, we’ll recommend a few tests to gather more information. 

Some of the diagnostic tests we offer for breast cancer include:

• Biopsy: We may remove abnormal tissue for further examination. Biopsies can be performed in different ways. Our specialists will recommend the appropriate kind of biopsy for you.
• Blood tests: These tests can tell us how well certain organs operate.
• Imaging tests: These tests may include an X-ray, CT scan, MRI or PET scan.
• Physical exam: Your doctor may perform a pelvic exam to look and feel for abnormalities. During this exam you may also have a Pap test and an HPV test.

Pre-cancers, sometimes called vulvar intraepithelial neoplasia (VIN), may be treated with medicine such as an ointment or cream that is applied directly to the pre-cancer.

If you have more advanced vulvar cancer, we may recommend the following, while also being mindful of quality of life (such as the ability to have sex) after surgery:

• Chemotherapy, which uses chemical substances to kill cancerous cells
• Radiation therapy, which uses high doses of radiation to kill cancer cells and shrink tumors, and is often done in conjunction with chemotherapy (called chemoradiation)
• Surgery, which may include laser surgery, excision (in which the cancer along with skin around and fat below are removed), a vulvectomy (in which part or all of the vulva is removed) or a pelvic exenteration (which includes a vulvectomy as well as the removal of lymph nodes and other organs)