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Gynecologic cancer awareness

Lankenau Medical Center October 13, 2009 Cancer By Charles Dunton, MD

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 Program

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

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

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

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

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 (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 Menopause and You, 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 health care provider with your specific concerns and questions.

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