By Noah Goldman, MD
Each year, more than 100,000 women in the United States are diagnosed with a gynecologic cancer, according to the American Cancer Society.
And with few screening tests available, it is important for women to recognize the warning signs and see their doctor when something doesn’t feel right.
When detected early, most gynecologic cancers can be successfully treated.
The Gynecologic Oncology Program at Penn Medicine Princeton Medical Center offers comprehensive diagnosis and treatment of gynecologic cancer, including genetic counseling, fertility preservation, minimally invasive surgical options, evidence-based chemotherapy regimens, and targeted radiation therapy.
Unique Risk Factors, Varying Symptoms
There are five main types of gynecologic cancer: uterine, cervical, ovarian, vaginal and vulvar, with uterine being the most common and vaginal and vulvar the least.
All women are at risk for gynecologic cancer, and risk typically increases with age.
Further, each type of cancer is unique in its signs and symptoms and has its own set of risk factors.
Uterine cancer. Most cases of uterine cancer are diagnosed in women who are past menopause and are in their mid-60s, according to the American Cancer Society. Other risk factors include family history, being overweight, and irregular hormone levels.
The most common symptom of uterine cancer is abnormal bleeding, which for post-menopausal women, means any bleeding whatsoever.
Symptoms of advanced uterine cancer include abdominal or pelvic pain, bloating, feeling full quickly when eating, and changes in bowel or bladder habits.
Cervical cancer. The main risk factor for cervical cancer is the human papillomavirus (HPV) a very common sexually transmitted virus. Often, your body clears HPV without you even knowing you had it, but in some cases the virus can linger and over time cause damage to the cervical cells.
In its early stages, cervical cancer often has no symptoms. When symptoms do occur, they may include abnormal bleeding, spotting or watery discharge; heavier than normal menstrual bleeding; bleeding after sex; and pelvic pain.
Ovarian cancer. Ovarian cancer is not common, but because it often goes undetected until it has reached an advanced stage, it is the number one cause of deaths from gynecologic cancer in the United States, according to the American Cancer Society.
In addition to age, risk factors for ovarian cancer include family history, a personal history of breast cancer, and genetic mutations — specifically in the BRCA1 and BRCA2 genes.
Symptoms of ovarian cancer are often vague and include bloating or an increase in abdominal size, pelvic or abdominal pain, difficulty eating or feeling full quickly, and urinary incontinence.
Vaginal and vulvar cancers. Vaginal and vulvar cancers are rare, together accounting for about 8% of all gynecologic cancers, according to the Centers for Disease Control and Prevention (CDC).
Risk factors include lingering HPV infection, cervical cancer, having a condition that weakens your immune system, and smoking.
Vaginal cancer may not have any symptoms, but if symptoms do occur, they may include abnormal discharge or bleeding, a change in bathroom habits and pelvic pain.
Conversely, vulvar cancer often has signs and symptoms, which can include persistent itching, burning or bleeding on the vulva; changes to color of the skin on the vulva; vulvar sores, lumps or ulcers that do not go away; and elvic pain, especially with sex or urination.
Diagnosis and Treatment
The signs and symptoms of gynecologic cancer can be associated with many other common medical conditions that are not cancer. However, they should not be ignored or dismissed. The earlier cancer is diagnosed the easier it is to treat.
Diagnosis typically involves a full medical history, pelvic exam, and imaging tests. If cancer is suspected, a biopsy will be performed to confirm the diagnosis.
Treatment for gynecologic cancer depends on the type of cancer and its stage, and may involve a combination of surgery, chemotherapy and radiation.
At Princeton Medical Center, the cancer treatment team includes board certified physicians, oncology nurses, and nurse navigators who are equipped with advanced technology and experienced in diagnosis and treatment of gynecologic cancer. A nurse navigator guides women through their treatment plan, and holistic and support services are also available.
If surgery is necessary, Princeton Medical Center offers minimally invasive options, including robotic assisted surgery as well as fertility preserving procedures.
In addition, because Princeton Medical Center is part of Penn Medicine, women have access to highly advanced treatments, including proton therapy and clinical trials through the Abramson Cancer Center.
Pay Attention to Your Body
Except for cervical cancer, there are no screening tests for gynecologic cancers. In the case of cervical cancer, however, regular Pap tests can detect precancerous changes in the cervix that can be treated before advancing to cancer.
Additionally, cervical cancer can largely be prevented with the HPV vaccine. According to the CDC, the vaccine is recommended for those ages 9-26. HPV vaccination of adults provides less benefit, because more people in this age range were exposed to HPV already. Adults ages 27-45 who were not already vaccinated might choose to get HPV vaccine after speaking with their doctor about their risk for new HPV infections and possible benefits of vaccination.
In general, the best approach to detecting gynecologic cancer early, when it is most treatable, is to go for regular gynecologic exams and pay attention to your body.
Talk to your doctor when troublesome symptoms occur. The sooner they can be diagnosed and treated, the sooner you can get back to your regular life.
To find a physician affiliated with Penn Medicine Princeton Health or for more information, call 888-742-7496 or visit www.princetonhcs.org
Noah Goldman, MD, is board certified in gynecologic oncology and is the medical director of Cancer Programs at Penn Medicine Princeton Health.