By Charlotte Marcus, M.D.
Nearly 90,000 women across the United States are diagnosed with gynecologic cancer each year, according to the American Cancer Society. Many are able to make a full recovery after treatment, including women of childbearing age who wish to preserve their fertility.
The gynecologic oncology program at the Edward & Marie Mathews Center for Cancer Care at Penn Medicine Princeton Medical Center offers advanced diagnostic and treatment tools for gynecologic cancer so women can resume their normal lives.
Five Main Types
Gynecologic cancer is any type of cancer that starts in a woman’s reproductive organs, and while all women are at risk for gynecologic cancer, the risk generally increases with age.
The five main types of gynecologic cancer are:
- Uterine cancer. Each year, an estimated 50,600 women in the United States are diagnosed with uterine cancer. All women – except those who have had their uterus removed – are at risk for the disease, especially those older than age 50. Additionally, women who suffer from obesity or have a family history of uterine, colon or ovarian cancer are at greater risk. Taking estrogen by itself for hormone replacement without a prior hysterectomy, taking tamoxifen to prevent or treat breast cancer or having trouble getting pregnant are also factors that can slightly increase the risk for uterine cancer.
- Ovarian cancer. Ovarian cancer accounts for more deaths than any other gynecologic cancer, claiming the lives of approximately 14,000 women a year, according to the American Cancer Society. Age is one of the main risk factors for ovarian cancer, with the greatest number of ovarian cancers occurring in women aged 60 years or older. Other risk factors include family history; prior breast, uterine or colorectal cancer; Eastern European (Ashkenazi) Jewish background; having never given birth; endometriosis and having tested positive for a mutation in the BRCA1 or BRCA2 genes, or a gene associated with Lynch syndrome. There are no screening tests for ovarian cancer, however if you have a family history of breast or ovarian cancer, your doctor may recommend genetic testing to help determine if you have an increased risk.
- Cervical cancer. Cervical cancer begins in the cervix, the lower, narrow end of the uterus. Approximately 12,000 women in the United States are diagnosed with cervical cancer annually, according to the Centers for Disease Control and Prevention. Almost all cervical cancers are caused by the human papilloma virus, a sexually transmitted infection that can be prevented through a vaccine that is recommended for females and males from 9-26 years old. Additionally, regular Pap tests can identify precancerous changes that can be treated before they turn into cancer.
- Vulvar cancer. Though vulvar cancer is rare, affecting approximately 4,900 in the United States each year, all women are at risk. Having HPV can increase the risk for vulvar cancer as can prior history of cervical cancer, smoking and HIV.
- Vaginal cancer. Like vulvar cancer, vaginal cancer is rare. The American Cancer Society estimates that 1,300 women in the United States are diagnosed with vulvar cancer annually. The risk factors for vaginal cancer are the same as vulvar cancer, and as with vaginal cancer, the HPV vaccine can protect against the disease.
Additional types of gynecologic cancer also exist, including gestational trophoblastic disease – a group of rare tumors developing from cells in the uterus that would normally develop into the placenta.
When to See Your Doctor
Though the signs and symptoms for gynecologic cancer vary depending on the type, at least one thing remains the same: If you experience any bleeding after menopause or two or more months of abnormal bleeding, see your doctor. Abnormal bleeding can be associated with a range of conditions that once properly diagnosed can often be easily treated.
Additionally, see your doctor if you have any other troublesome symptoms that last for more than two weeks. Often, symptoms may be subtle, especially in the case of ovarian cancer. Symptoms associated with ovarian cancer include bloating, pelvic pain or pressure; feeling full too quickly or difficulty eating; changes in how clothes fit, constipation; urinary frequency or urgency, and abdominal or back pain.
Depending on your symptoms and a physical exam, your doctor may recommend further testing, including imaging tests, to accurately diagnose your condition.
Minimally Invasive and Fertility Sparing Treatment Options
Treatment for gynecologic cancer depends on its type, but generally involves a combination of surgery, radiation and chemotherapy.
At Penn Medicine Princeton Medical Center, surgeons are performing robotic-assisted complex hysterectomy to treat gynecologic cancers, offering women a minimally invasive surgical option typically with less pain and quicker recovery.
However, not all gynecologic cancers require hysterectomy.
For women of childbearing age who still wish to have children, fertility sparing treatment options, such as certain medications and hormonal treatments, may be an option. Further, certain advanced surgical techniques can be used to treat cancer while preserving the uterus and the ovaries.
While the incidence of gynecologic cancer increases with age, if you are a woman, you are at risk. Preventative measures such as the HPV vaccine and regular gynecologic exams, can help reduce that risk. Be mindful of symptoms and unusual bleeding and see your doctor if you are concerned.
For more information or to find physician affiliated with Penn Medicine Princeton Health, call 888.742.7496 or visit www.princetonhcs.org.
Charlotte Marcus, M.D., is board certified in obstetrics and gynecology and gynecologic oncology. She is a fellow of the American Congress of Obstetricians and Gynecologists and is a member of the medical staff of Penn Medicine Princeton Health.