Gynecologic cancers in young women: a gynecologic oncologist’s perspective
Cancer in young people: Part of a series on diagnosing and treating young adults
Expert takeaways from: Caitlin Farabaugh, MD, gynecologic oncologist
Gynecologic cancers such as cervical, uterine/endometrial and ovarian cancer are more common in postmenopausal women, but we do see cancers in premenopausal women as well. With regular screening and gynecologic care, many of these cancers can be diagnosed early when they are more treatable or even prevented entirely.
Symptoms and risk factors
Changes in bleeding
You should be evaluated by your healthcare clinician if you have any abnormal bleeding. This includes:
- Bleeding between menstrual periods
- Heavier periods than usual
- A period lasting longer than seven days
- Any bleeding after menopause
Abnormal bleeding can be a sign of cervical, ovarian or endometrial cancer in young women. It's important to see your healthcare clinician for exams that include Pap tests to check for cervical cancer. Risk factors for gynecologic cancers include obesity, irregular periods and family history of cancer, so abnormal bleeding in someone at risk is especially concerning*.
*If you are experiencing abnormal bleeding and have any of these risk factors, talk with your clinician about a biopsy.
Ovarian cancer symptoms
Ovarian cancer is very treatable when caught early, but we don't usually see it until it has spread or metastasized. As we don't yet have a good screening test for it, it's important to mention the following possible ovarian cancer symptoms to your clinician:
- Feeling full quickly or difficulty eating
- Abdominal bloating
- Digestive symptoms like gas, diarrhea or constipation
- Back, belly or pelvic pain
- Feeling like you have to pee all the time
- Fatigue
Cancer due to HPV
Most cervical cancers are caused by human papilloma virus (HPV) which is preventable through the HPV vaccine. The HPV vaccine is recommended for males and females:
- Starting between ages 9 and 12 years old
- Between ages 13 to 26 as catch-up, if not adequately vaccinated when younger
- Up to age 45 in some cases, based on shared discussion-making with your healthcare clinician
Lifestyle risk factors
Risk factors for cervical and ovarian cancer include:
- Obesity
- Smoking
Smoking affects the immune system which makes it harder to clear HPV. If you smoke, see your healthcare clinician each year.
Screening for gynecologic cancers
We used to recommend Pap smears or tests when someone became sexually active. Now the recommendation is to start at age 21 because HPV usually clears up on its own.
Home HPV tests are becoming available. These may be a good option for someone who has experienced sexual trauma or those who are transgender and uncomfortable seeing an Ob/Gyn. But home testing shouldn't replace a visit to your clinician.
The best protection for anyone with a cervix comes from both vaccination and routine screening where we can do a physical exam to check the HPV status as well as the:
- Cervix
- Uterus
- Ovaries
Gynecologic cancer treatment and prevention
A healthcare clinician will discuss the best treatment options for young adults with gynecologic cancers which may include:
- Hormone therapy
- Chemotherapy
- Targeted therapy
- Immunotherapy
- Radiation
- Surgery
When possible, we use laparoscopic or robotic surgery for increased precision while minimizing trauma to surrounding tissues. This results in shorter hospital stays, less discomfort and a quicker recovery.
Advances in ovarian cancer prevention
It's now known that ovarian cancers come from cells at the ovarian end of the fallopian tube. According to recent data, removing the fallopian tubes, known as salpingectomy, reduces the risk of ovarian cancer by 65 percent over a lifetime. Because of this cancer risk reduction, people who are finished having children may want to consider elective salpingectomy when deciding between tubal ligation vs vasectomy.
Main Line Health is participating in a clinical trial for patients age 35 to 50 who have a BRCA1 gene mutation. The study is to evaluate how well salpingectomy reduces the risk of ovarian cancer compared to salpingo-oophorectomy (the removal of both the fallopian tubes and ovaries which is known to be effective in patients with genetic risk factors for ovarian cancer). The trial offers people the option to remove their fallopian tubes while preserving ovarian function. This can be a significant benefit for premenopausal women who want more time to weigh fertility decisions.
Genetic testing for gynecologic cancer
Knowing your family history is very important and many people are not aware of the connection between various types of cancer. Often, we only discover a genetic predisposition for gynecologic cancers when a relative is diagnosed with cancer.
Since recommendations for genetic testing for gyn cancers has expanded, insurance will often cover the cost of testing if you have a family member with any of the following cancers:
- Breast
- Colorectal
- Pancreatic
- Prostate
- Ovarian
While genetic testing can be beneficial at any age, it can be especially helpful for younger people because:
- If testing finds you are more likely to have BRCA or Lynch syndrome, we can take steps to prevent gynecologic and other closely linked cancers
- You may qualify for increased cancer screenings or screening starting at a younger age
Impact of gynecologic cancer on fertility and quality of life
When treating gynecologic cancers, we try to preserve fertility and ovarian function. For those who may want to start a family later, what we try depends on the cancer treatment:
- For surgeries, we aim to avoid surgical menopause
- For chemotherapy:
- Before starting chemo, sometimes egg retrieval and freezing are options
- During chemo, ovarian suppression can help retain ovarian function through a temporary chemical menopause
Main Line Health's Advanced Gynecology Program can help improve quality of life after treatment, especially for those with pelvic pain from radiation.
Care team to help and support you
Support resources are important for young patients as cancer impacts their life stages differently than it does for older women. Along with cancer, young people may be dealing with:
- Starting families
- Going to school
- Building careers
- Dating
Support groups and social media groups can help with connections who have similar cancers. They also provide practical information related to younger patients' life stages and issues like financial toxicity since cancer treatment can mean time out of work.
Main Line Health's oncology nurse navigators and social workers are here to help walk you through every aspect of your diagnosis and treatment. While gynecologic cancer can leave you feeling alone and frightened, use the resources that are available to you and your loved ones.
Understanding cancer in young people
Main Line Health's clinicians and care team have additional insights on their approaches to diagnosing, treating and supporting young people with cancer.
Next steps
Learn more about Caitlin Farabaugh, MD
Learn more about cancer care at Main Line Health
Learn more about the Genetics and Risk Assessment Program at Main Line Health
Related posts
Cervical cancer myths answered by a doctor
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