All types of gynecologic cancers are the result of complex changes in DNA that lead to uncontrolled growth of abnormal cells. These cancers start in female reproductive organs in the pelvis. Like most cancers, each is named for the location where the cancer started.
The main types of gynecologic cancers are:
- cervical cancer
- uterine cancer
- ovarian, fallopian tube and primary peritoneal cancer
- vaginal cancer
- vulvar cancer
- gestational trophoblastic disease
Numerous factors lead to the development of gynecologic cancers. For instance, almost all cervical cancers are caused by a virus known as HPV, or Human Papillomavirus. Uterine cancers are linked to the excess estrogen produced by obesity. Hereditary cancer syndromes can increase the risk of developing cancer too.
Gynecologic Cancer Symptoms
All women are at risk for developing a gynecologic cancer. Some of these cancers do not have any symptoms so it is important to get regular checkups with your MedStar Health gynecologist. Some key symptoms which should prompt you to call your doctor or make an appointment include:
- unexpect vaginal bleeding such as bleeding after menopause, bleeding between periods, or bleeding after sexual intercourse
- persistent abdominal, pelvic or lower back pain
- bowel or urine irregularities, including bloating, constipation, difficulty eating or feeling full quickly
- urinary symptoms, particularly frequency or urgency
- vulvar or vaginal itching, lumps or sores
If you have any of these symptoms for two weeks or more, it’s important to see your MedStar Health gynecologist.
Gynecologic Cancer Treatment
Studies show women with gynecologic cancers have the best outcomes when they are cared for by a gynecologic oncologist. This type of cancer specialist is a doctor who has completed extra training in women’s reproductive cancers. During their fellowship training, they received specialized education in all aspects of cancer care such as surgery, chemotherapy, radiation and clinical trials.
At MedStar Washington Cancer Institute, our gyn oncologists are experts in their field. They collaborate closely with other specialists to ensure patients receive the personalized care they need. A patient care team may include medical oncologists, radiation oncologists, pain specialists, oncology nurses, social workers and other support staff. The team members work hand in hand on the individual care plans created for each patient based on their medical history, needs and wishes.
Cervical Cancer Risks
Cervical Cancer Risks
Almost all cervical cancers are caused by HPV, a very common virus that can be passed from one person to another during sex. There are many types of HPV. Some HPV types cause genital or skin warts, others can cause cervical dysplasia or cancer. Cervical dysplasia is a group of abnormal cells on the cervix which, if left untreated, can become cervical cancer.
HPV is so common that most people get it at some point in their lives. HPV usually causes no symptoms. For most women, HPV will go away all by itself. However, if it does not, there is a chance that over time it may lead to cervical cancer.
Some other issues also can your overall risk of developing cervical cancer:
- HIV (the virus that causes AIDS)
- autoimmune diseasetaking medications which suprress the immune system
- having several sexual partners
Causes of Cervical Cancer
Cervical cancer is the third most common type of cancer in women worldwide. It is much less common in the U.S. because of the routine use of Pap smears (cervical cytology) and HPV testing. Pap tests take cells from the cervix to be examined for the presence of precancerous or cancerous cells. HPV testing assesses for the presence of the virus in the cells of the cervix.
Cervical cancers start in the surface cells of the cervix. It begins as a pre-cancerous condition or abnormal growth of cells called dysplasia. This precancerous condition can be detected by Pap smears and can be treated. That is why it is critical for women to get regular Pap smears and HPV testing. With regular cervical cancer screening and follow-up, cervical cancer is usually preventable and treatable. Undetected, pre-cancerous changes can develop into cervical cancer and spread throughout the body.
HPV and Cervical Cancer
Almost all cervical cancers are caused by HPV (Human Papilloma Virus). HPV is a common virus that is spread through human contact. There are many different types of HPV. Some strains lead to cervical cancer, others may cause genital warts, and others do not cause any problems at all.
Other risk factors for cervical cancer include:
- Having sex at an early age
- Multiple sexual partners
- Women whose mothers took the drug DES (diethylstilbestrol) during pregnancy in the early 1960s to prevent miscarriage
- Weakened immune system
Many factors influence the outcome of cervical cancer. These include:
- Whether the cancer has spread (stage of the disease)
- The age and general physical condition of the woman
Pre-cancerous conditions are curable with proper treatment and follow-up. The chance of being alive in five years (five-year survival rate) if the cancer has not spread outside the cervix, is about 92 percent. However, the five-year survival rate falls steadily if the cancer spreads into other areas.
Cervical Cancer Symptoms
Most of the time, early cervical cancer has no symptoms. Symptoms that may occur can include:
- Vaginal discharge, which may be pale, watery, pink, brown, bloody or foul-smelling
- Vaginal bleeding between periods, after intercourse or after menopause
- Periods that become heavier and last longer than usual
Symptoms of advanced cervical cancer may include:
- Loss of appetite or weight
- Pelvic, back or leg pain
- Heavy bleeding from the vagina
- Leaking of urine or feces from the vagina
Cervical Cancer Diagnosis
Regular cervical cancer screening does not confirm a diagnosis of cervical cancer. If abnormal cells are seen, the cervix is examined using a microscope. This is called colposcopy. A biopsy may be taken during this procedure.
Other tests may include:
- Endocervical Curettage (ECC)- to examine the cervical canal
- LEEP(loop electrosurgical excision procedure) - uses cautery to remove abnormal cervical tissue
- Cervical Cone Biopsy- procedure in the operating room to remove a portion of the cervix
If a diagnosis of cervical cancer is confirmed, the health care provider may order more tests to find out if the cancer has spread. This is called staging.
Tests may include:
- PET Scan
- CT (computed tomography) scanMRI (magnetic resonance imaging)
- Cystoscopy (examination of the bladder and urethra)
- Proctoscopy (examination of the rectum)
Cervical Cancer Treatments
Treatment for cervical cancer will depend on the individual patient and the stage of the cancer. Surgery, chemotherapy and/or radiation may be utilized for treatment.
When detected at an early stage, invasive cervical cancer is one of the most successfully treatable cancers with a five-year survival rate of 92 percent for localized cancers (those that have not spread to other organs).
Treatment for early cervical cancer may include:
- Radical hysterectomy, which removes the uterus, cervix, surrounding tissues (parametria), and upper part of the vagina. Learn more about radical pelvic/reconstructive surgery. Our surgeons may suggest fertility sparing surgery, if possible, depending on whether it is right for you.
- Lymphadenectomy is the removal of lymph nodes to determine if the cancer has spread.
- Combination chemotherapy and radiationmay be recommended for cervical cancers where the size or spread of the tumor is not appropriate for surgical removal.
- Treatment for metastatic cervical cancer(spread outside the pelvis) involves chemotherapy.
Uterine Cancer Risks
Uterine cancer can arise from the lining of your uterus (endometrium) or from the muscle of the uterus (myometrium). When the cancer arises from the endometrium it is call an endometrial cancer. When the cancer arises from the myometruim it is called a sarcoma.
Symptoms of uterine cancer include:
- bleeding after menopause
- for premenopausal women a change in your usual bleeding, for example new clots, heavier flow, or bleeding between periods
Ovarian Cancer Risks
Ovarian cancer is very difficult to detect. The symptoms are vague, often very mild, and quite common. If the symptoms persist for more than two weeks, they may be a sign of something serious.
These are potential signs and symptoms of ovarian cancer:
- pelvic or abdominal pain
- trouble eating or feeling full quickly
- feeling the need to urinate urgently or often
- upset stomach or heartburn
Vaginal Cancer Risks
This type of cancer occurs in your vagina, the canal to your cervix and uterus. A woman’s risk for getting vaginal cancer increases with her age. Most women who are diagnosed with the disease are older than 60.
Additional risk factors for vaginal cancer include the following:
- history of HPV
- women whose mothers took a drug called diethylstilbestrol (DES) while pregnant in the 1950s have an increased risk of a certain type of vaginal cancer called clear cell adenocarcinoma
- multiple sexual partners
- early age at first intercourse
- HIV infection
Vulvar Cancer Risks
This cancer involves the vulva which consists of the outer part of the female genitalia. The vulva includes the opening of your vagina, the inner and outer skin folds (labia) and the clitoris. Most often, this type of cancer occurs on the inner or outer skin folds which are referred to as the labia or lips around the vagina. The risk of vulvar cancer increases as you get older mainly, but can occur at any age.
Other vulvar cancer risk factors include:
- history of HPV
- HIV infection
- history of precancerous conditions of the vulva
Fertility Sparing Surgeries
Our surgeons may offer the option of fertility sparing surgery if it is appropriate for you. The gynecologic oncologists at MedStar Washington Hospital Center specialize in fertility sparing surgeries, which treat the cancer, and leave the uterus in place, so the possibility of having a baby in the future remains.
Radiation and Chemotherapy for Cervical Cancer
Radiation may be used to treat larger tumors or cancer that has returned. Radiation therapy is either external or internal.
- Internal radiation therapyuses a device which is placed inside the woman's vagina to deliver the radiation directly to the tumor. The device is removed before she goes home.
- External radiation therapybeams radiation from a large machine into the body where the cancer is located. It looks similar to an X-ray machine.
Chemotherapy is delivered into the blood via an IV and uses drugs to kill cancer.
Some types of cervical cancer do not respond well to treatment. The cancer may come back after treatment. Therefore it is important to continue to followup with your doctors after you have completed treatment.
Recurrent Cervical Cancer Treatment with Total Pelvic Extenteration
Exenteration is an extensive surgery in which the organs of the pelvis, including the bladder and rectum, are removed. A new bladder and rectum are made. This procedure is performed on women who have recurrent cervical cancer, meaning the cancer has returned after treatment. Exenteration is performed only in cases where the recurrent disease is limited to the pelvis. The good news is that 50 percent of patients who have exenteration are cured with the procedure.