While gynecologic cancers can affect all women, there is an increase
in their incidence in menopausal women. This is particularly true of
ovarian and uterine cancer. Dr. Charles Dunton clearly outlines
the latest information on these diseases. — Beverly
Vaughn, MD, Medical Coordinator, Menopause and You
Gynecologic cancers are those originating in the female reproductive
organs, including the ovaries, uterus, vagina, cervix, vulva, and
fallopian tubes. Any woman is at risk for these cancers, depending on
age and other factors. Because many of the symptoms are similar to those
that menopausal and postmenopausal women experience, women of menopausal
age need to be aware of these cancers.
Ovarian cancer is usually the most serious of the gynecologic cancers,
causing more deaths than the others.
The symptoms of ovarian cancer include: changes or discomfort in the
pelvis area, including a feeling of pressure or of fullness, even after
eating just a small meal; abdominal bloating; indigestion or nausea; and
changes in bowel or bladder habits.
Your risk for ovarian cancer increases as you grow older, especially
from the time of menopause. Other factors include your family history,
infertility, not having borne children, and having had breast cancer.
Your risk is reduced by 50 percent, though, if you have taken birth
control pills for five or more years.
Unfortunately, there is no screening available yet for ovarian cancer.
But for certain women who have significant risk factors, ultrasound and
a blood test (CA 125) may be offered. Genetic counseling and testing may
also be appropriate for some women. In addition, prophylactic removal of
the tubes and ovaries may be recommended for women with a genetic
predisposition or a higher risk of developing ovarian cancer.
Uterine (Endometrial) Cancer
Uterine cancer is the most common gynecologic cancer, with an excellent
cure rate, if detected early. If you have unusual vaginal bleeding
before menopause, or bleeding that occurs after menopause, these could
be symptoms of uterine cancer. The bleeding in these cases is watery
with only a small amount of blood at first, and then becomes less
watery. Other symptoms of uterine cancer include pain in the pelvic area
or lower abdomen when you urinate or have intercourse. Because these
symptoms can be confused with those of menopause, many women do not
mention them to their doctor. If you have such symptoms, do not assume
they are simply menopause-related; make an appointment with your
gynecologist. You are at risk for uterine cancer if you are obese or
have hypertension or diabetes. In addition, if you use estrogen
replacement without progesterone or Tamoxifen, your risk increases. Late
menopause and not having borne children are two more risk factors for
uterine cancer. As with ovarian cancer, there is no screening test
available yet for uterine cancer. However, recognizing the symptoms can
lead to an early diagnosis.
Vaginal cancer is rare, accounting for three percent of the cancers of
the female reproductive organs. The only noticeable symptom of vaginal
cancer is abnormal bleeding. But because this bleeding can be the result
of other factors, you need to consider whether you are at particular
risk for vaginal cancer. Such risk factors include being over 50 years
old, having had cervical cancer, smoking, and having HPV (human
papillomavirus) infection. The good news is that Pap smears can discover
vaginal (as well as cervical) cancer. But in certain cases, Pap smears
may no longer be recommended. In cases where a hysterectomy has been
performed for benign reasons, screening may be omitted. If you are over
70 and have had normal smears in the past, you and your physician may
decide to stop screening.
Cervical cancer can be prevented by having regular screenings. If you
bleed after intercourse, or have abnormal bleeding or excessive
discharge between menstrual periods, you need to discuss the possibility
of cervical cancer with your doctor. If you have had a persistent HPV
infection, you need to be aware that it is a primary cause of cervical
cancer. Other risk factors of cervical cancer include smoking, HIV
infection, having had first intercourse at an early age, and lack of
regular screening. A Pap test or Pap test with HPV DNA for women over 30
is the way to determine whether you have cervical cancer. Make sure you
follow your doctor’s recommendations concerning frequency and scheduling
of these tests. Recommendations for the HPV vaccine should also be
discussed with your gynecologist.
Vulvar cancer is a rare gynecologic cancer, occurring mostly in women in
their 60s. Specific symptoms of vulvar cancer include itching in the
vulvar area; change in skin color or feel of the vulvar area; and a red,
white, or wart-like bump on the vulva. An additional symptom is if you
have pain or a burning sensation when you urinate. As with other
gynecologic cancers mentioned above, HPV infection is a risk factor. HIV
infection and VIN (vulvar intraepithelial neoplasia) are factors, as are
smoking, diabetes, and chronic vulvar irritation. No standard screening
test exists for vulvar cancer, but some cases have been discovered after
Pap tests and pelvic exams. A biopsy may be recommended for conclusive
diagnosis of the lesion.
Fallopian Tubes Cancer
Fallopian tubes cancer is very rare, accounting for less than one
percent of female reproductive cancers. The symptoms of fallopian tubes
cancer are similar to those of the other reproductive organ cancers
listed: abnormal vaginal bleeding post menopause, abdominal pain or
feeling of pressure in the abdomen, and abnormal vaginal discharge.
Women with BRCA 1 or 2 mutations are at higher risk for both ovarian and
fallopian tube cancers. As of yet, there is no screening test available.
What You Can Do
If you experience any of the symptoms listed above, contact your doctor.
Menopausal and postmenopausal women ought not to assume that their
symptoms are due to menopause alone. Because not much screening exists
for these cancers, early detection can only be made through awareness
and yearly exams. To assess your own risk for these cancers, you can log
onto the Women’s Cancer Network website (www.wcn.org)
and fill out their risk assessment questionnaire. The more aware you are
of these cancers and your own risk factors, the better your chances of
having a gynecologic cancer detected early.
This article is part of the Menopause and You library,
a Web-based program sponsored by Women’s Health Source.
It is intended as an information resource providing guidelines for
women. As always, check with your own healthcare practitioner with your
specific concerns and questions.
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