Gynecologic Cancers Background Information
Overview
What are gynecologic cancers?
Gynecologic cancers are the uncontrolled growth and spread of abnormal cells originating in the female reproductive organs, including the cervix, ovaries, uterus, fallopian tubes, vagina, and vulva.
What causes gynecologic cancers?
There are many factors that cause gynecologic cancers. Medical research has discovered that some classes of genes, called oncogenes and tumor suppressor genes promote the growth of cancer. The abnormal function of these genes can be acquired (e.g., through smoking, aging, environmental influences) or inherited. Almost all cervical cancers and some cancers of the vagina and vulva are caused by a virus known as HPV, or Human Papillomavirus.
Can gynecologic cancers be prevented?
Screening and self-examinations conducted regularly can result in the detection of certain types of gynecologic cancers in their earlier stages, when treatment is more likely to be successful and a complete cure is a possibility. Diet, exercise, and lifestyle choices play a significant role in the prevention of cancer. Additionally, knowledge of family history can increase the chance of prevention or early diagnosis by determining if someone may have a gene which makes them susceptible to cancer.
Who should treat gynecologic cancers?
Gynecologic cancers should be treated by a gynecologic oncologist. A gynecologic oncologist is a board-certified obstetrician/gynecologist who has an additional three to four years of specialized training in treating gynecologic cancers from an American Board of Obstetrics and Gynecology-approved program. This subspecialty program provides training in the biology and pathology of gynecologic cancers, as well as in all forms of treatment for these diseases, including surgery, radiation, chemotherapy and experimental treatments.
How are gynecologic cancers treated?
Gynecologic cancers are treated by using one or more of the following; surgery, radiation therapy or chemotherapy. The choice of therapy depends on the type and stage of the cancer.
Who is at risk?
Every woman is at risk for developing a gynecologic cancer. This year, over 78,000 women in the United States will be diagnosed, and over 28,000 will die from gynecologic cancer.
Cervical Cancer
Cervical cancer is cancer that begins in the cervix, the part of the uterus or womb that opens to the vagina. Cervical cancer is caused by a virus that blocks the function of important cancer preventing genes. Cervical cancer usually affects women between the ages of 30 and 55 but has been found as early as the teen years.
It is the only gynecologic cancer that can be detected with regular screening which includes a Pap test. Also, the first FDA-approved cancer vaccine should be used in young women for whom the vaccine is recommended in order to increase the chance that a woman is protected. Symptoms: Most women with cervical precancer lesions report no symptoms, thus it is important to get regular screening before symptoms are present. When a woman develops cervical cancer, she often has bleeding after intercourse and excessive discharge or abnormal bleeding between periods.
Risk factors: Persistent infection with persistent high-risk Human Papillomavirus (HPV) has been shown to be the cause of virtually all cervical cancers. Factors that increase a woman's risk of developing cervical cancer include smoking, HIV infection and early age of first intercourse. Routine screening can detect cervical cell changes prior to their development into cancer, thus offering effective treatment. Women who do not receive regular examinations have a higher risk of developing later stage cervical cancer when it is more difficult to treat.
Screening/prevention: Over the last 50 years, routine use of the Pap test to screen for cervical cancer has reduced deaths from the disease by 74 percent. A Pap test is the standard way physicians check to see if there are cervical cell changes that might cause concern. The Pap test involves looking at a sample of cells from the cervix under a microscope to see if there are any cells that are abnormal. It is a good test for finding not only cervical cancer cells, but also cells that might become cancerous in the future.
Usually, health care providers perform the Pap test as part of a routine pelvic exam. It is important for women to know if a Pap test was performed because it's possible to have a pelvic exam without a Pap test. It is also important that women know and understand the meaning of their Pap test results, and follow through with any recommendations made by their health care provider.
In March 2003, the Food and Drug Administration (FDA) approved a new approach to cervical cancer screening for women 30 years of age and older - the use of the HPV test in combination with the Pap test. This test combines a Pap test with the test for cancer-causing, or high-risk, HPV. This test is useful because if both the Pap test and HPV tests are negative, then the next Pap test does not have to occur for three years. The HPV test can also be performed to help interpret an equivocal Pap test result, ASCUS, which stands for "atypical squamous cells of undetermined significance." If the HPV test is positive in a woman with an ASCUS Pap result, she should undergo further testing for precancerous cells with something called a colposcopy examination.
A new vaccine to prevent cervical cancer was approved by the FDA in June 2006. For the first time ever we now have a tool to prevent cancer. The guidelines for its use follow:
- Routine vaccination is recommended for all 11 and 12 year old girls.
- The vaccination series can be started for girls as early as age 9.
- Ideally, the vaccine should be given before first sexual contact, but females up to age 26 who are sexually active should still be vaccinated.
- Vaccination is recommended for girls and women ages 13 to 26 who have not been previously vaccinated. However, a decision about whether to vaccinate a woman aged 19 to 26 should be made based on an informed discussion between the woman and her healthcare provider regarding her risk of previous HPV exposure and potential benefit from vaccination.
Because the current vaccine only protects against the types of HPV that account for about 70% of cervical cancer, it is very important that women who are vaccinated continue to be screened for cervical cancer using a Pap test and HPV testing when recommended by their healthcare provider.
Incidence: It is estimated that there will be about 11,150 new cases diagnosed and approximately 3,670 deaths from invasive cervical cancer in the United States. in 2007.
Ovarian Cancer
Ovarian cancer, the seventh most common cancer among women, usually starts on the surface of the ovary in cells that are called epithelial cells. About 85 to 90 percent of ovarian cancers are epithelial ovarian cancers.
Symptoms: Bloating, pelvic or abdominal pain, difficulty eating or feeling full quickly and/or urinary symptoms (urgency or frequency).
Risk factors: The risk of epithelial ovarian cancer increases with age, especially around the time of menopause. A family history of epithelial ovarian cancer is one of the most important risk factors. Infertility and not bearing children are also risk factors for getting ovarian cancer, while pregnancy and the use of birth control pills decrease the risk.
Screening/prevention: Currently, there is no widely accepted and effective screening test for epithelial ovarian cancer. High-risk women may be candidates for screening using transvaginal ultrasound and CA 125 blood tests on an annual or biannual schedule, though the benefits of such screening is unproven. For most women, ultrasound and CA 125 screening is not presently advised due to problems with false positive results leading to unnecessary surgery.
Incidence: Ovarian cancer ranks fifth in cancer deaths among women and causes more deaths than any other reproductive cancer. It is estimated there will be more than 22,430 new cases diagnosed and approximately 15,280 deaths from ovarian cancer in the United States during 2007.
Uterine Cancer: Endometrial
Most uterine cancers begin in the lining of the uterus which is also called the endometrium. Uterine cancer occurs when cells in the endometrium grow out of control and invade the muscle of the uterus or spread to other places in the body.
Symptoms: Any bleeding after menopause, or irregular vaginal bleeding before menopause.
Risk factors: Obesity, hypertension, diabetes, estrogen use without progesterone taken at the same time, tamoxifen use and late menopause. Women who have not been pregnant also have a slightly higher risk for endometrial cancer.
Screening/prevention: There are no screening tests for endometrial cancer, but most cancers are found in the early stages when women report their symptom of abnormal bleeding to their doctor and have a biopsy that shows the cancer. Exercising regularly, eating a healthy diet and maintaining a healthy weight all can lower a woman's risk of getting uterine cancer. Women with postmenopausal bleeding or heavy, prolonged or unexpected bleeding during the menstruating years should have an endometrial biopsy to check for endometrial cancer. A Pap test does not screen for endometrial cancer.
Incidence: Cancer of the endometrium is the most common reproductive cancer. It is estimated that 39,080 new cases will be diagnosed and approximately 7,400 deaths will happen because of uterine cancer in 2007.
Vaginal Cancer
Vaginal cancer is cancer that starts in the cells lining of the vagina.
Symptoms: Vaginal cancer, especially early or precancerous vaginal cancer, may not produce any signs, but bleeding or abnormal discharge may be symptoms of this type of cancer.
Risk factors: Risk factors for vaginal cancer include being age 60 and older, HPV infection, smoking and cervical cancer.
Screening/prevention: Precancer of the vagina and early vaginal cancer can be diagnosed through routine pelvic exams and Pap tests. Although the HPV vaccine was not approved by the FDA to prevent vaginal cancer, being vaccinated against HPV may help prevent this disease.
Incidence: Vaginal cancer is very rare. In 2007 it is estimated that 2,140 women will be diagnosed with vaginal cancer and 790 women will die of this cancer. Vaginal cancer accounts for about 3 percent of cancers of reproductive cancers.
Vulvar Cancer
Vulvar cancer is caused by growth and spread of abnormal cells of the skin that covers the genital area of a woman called the vulva.
Symptoms: Itching, burning, bleeding, pain, or a new lump or ulcer in the vulvar or clitoral area.
Risk factors: Risk factors include HPV infection, HIV infection, being age 70 or older and chronic vulvar irritation.
Screening/prevention: Examination of the vulva for changes by a woman at home or during her yearly pelvic exam may lead to early detection, and although not approved by the FDA to prevent vulvar cancer, getting the HPV vaccine may help prevent this disease.
Incidence: Vulvar cancer is not a common cancer. In 2007 about 3,490 women will be diagnosed with vulvar cancer in the U.S. and about 880 women will die of this cancer. Vulvar cancer is usually diagnosed in the early stages and is usually cured with surgical treatment.
Familial Breast-Ovarian Cancer Syndrome
Familial or inherited cancer happens when gene mutations are passed from generation to generation in a family. Gene mutations mean genes form in such a way that they change the original function of that gene. This may lead to cancer.
There are two known breast cancer genes, BRCA1 and BRCA2. Approximately 1 out of every 500 people has a mutation in one of the known breast cancer genes. Both men and women can carry these mutations and have a 50 percent chance of passing the mutation on to each of their children.
Familial breast-ovarian cancer syndrome is caused by these gene mutations .In the U.S., approximately 10 percent of women will develop breast cancer and almost 2 percent of women will develop ovarian cancer sometime in their lifetime.
However, women with familial breast-ovarian cancer syndrome have up to an 80 percent lifetime risk of developing breast or ovarian cancer. Women with BRCA1 or BRCA2 mutations should consider more intense clinical monitoring, including mammograms, pelvic ultrasounds and CA 125 testing, and be informed about protective measures including medication, lifestyle changes and preventive surgery.
Women with a strong family history may have multiple family members with breast and/or ovarian cancer, often with an early age at diagnosis. For such women, genetic counseling and genetic testing may be recommended.
Genetic testing uses a blood sample to look for specific genes. Genetic testing generally begins with a family member who has been diagnosed with breast or ovarian cancer.
If testing reveals a mutation in either of the known breast cancer genes, other family members can then be tested to see if they also inherited the same mutation and are at increased risk for breast and ovarian cancer.
For women who have a strong family history of cancer, or a positive gene test, a number of preventive and treatment options exist:
- mammograms and breast MRIs
- a blood test called CA 125
- pelvic ultrasounds
- medications
- lifestyle changes
- preventive surgery
