It can strike the lives of any women and as a woman ages, her risk of developing it increases.
The ‘it’ is gynecological cancer, which includes cancer of the cervix, ovaries, uterus, vagina, or vulva – the female reproductive organs.
The Foundation for Women’s Cancer stated that, in 2015, there were an estimated 98,280 women diagnosed with a gynecological cancer, and 30,440 deaths from it. Of these, uterine cancer was the most commonly diagnosed form, with 54,870 cases. Ovarian cancer, however, led to the most deaths: 14,180 cases.
The important thing to know about these cancers is to know your risks, look for the signs, be seen by a provider if you see any signs, and get treated, said Margaret Nordell, MD, an OB/GYN with Trinity Health.
Uterine, ovarian, and cervical cancer are the three most common gynecological cancers. Vaginal cancer – cancer that develops in the lining of the vagina – is rare, with about one of every 1,100 women developing vaginal cancer in her lifetime. Vulvar cancer accounts for only 4 percent of cancers of the female reproductive organs and 0.6 percent of all cancers in women. Women have a one in 333 chance of developing vulvar cancer at some point during their life, the American Cancer Society states.
Uterine (endometrial) cancer
Uterine (endometrial) cancer, which affects the uterus, is the fourth most common cancer for women in the United States.
Endometrial cancer is the most common cancer of the uterine corpus and is the most common of all gynecologic cancers. In 2016, an estimated 61,380 women in the United States were diagnosed with uterine endometrial cancer, the American Cancer Society said. It was also estimated that there would be 10,920 deaths from endometrial cancer, making it the sixth most common cause of cancer death among women in the United States.
Symptoms of endometrial cancer include postmenopausal bleeding, spotting, or cramping or persistent irregular bleeding at any age. As these symptoms are investigated early, high survival rates occur. Other symptoms can include abnormal, non-bloody vaginal discharge, pelvic pain, painful intercourse (dyspareunia), or unintended weight loss.
“Surgery is the best option,” Nordell said. It is also the most common initial treatment. Surgery would include a hysterectomy, the removal of the uterus.
Ovarian cancer is the second most common of gynecologic cancers. The American Cancer Society (ACS) estimates that in 2017, about 22,440 women will be diagnosed with ovarian cancer, and about 14,080 women would die from it. According to the ACS, ovarian cancer accounts for 5 percent of cancer deaths among women, causing more deaths than any other gynecologic cancer.
About 20 to 25 percent of women diagnosed with ovarian cancer have a hereditary tendency to develop the disease, with the breast cancer gene 1 (BRCA1) or breast cancer gene 2 (BRCA2) responsible for about 10 to 15 percent of all ovarian cancers, the Ovarian Cancer Research Fund Alliance (OCRFA) states.
“Women with a grandmother, mother, daughter, or sister with ovarian cancer but no known genetic mutation still have an increased risk of developing ovarian cancer,” OCRFA states on their website. “The lifetime risk of a woman who has a first degree relative with ovarian cancer is five percent. The average woman’s lifetime risk is 1.4 percent.”
Symptoms are nonspecific and often mimic those of other more common conditions. It can often be misdiagnosed as irritable bowel syndrome, gall bladder disease, stress, or symptoms attributed to menopausal changes. Signs of ovarian cancer can be identified by persistent and/or worsening signs and symptoms, such as abdominal pressure, fullness, swelling, bloating, urinary urgency, or pelvic discomfort or pain.
Treatment options for ovarian cancer include surgery, which could be the removal of both ovaries, fallopian tubes, and the uterus, as well as nearby lymph nodes. This is followed by chemotherapy or radiation.
Cervical cancer, a specific form of uterine cancer, is the third most common of the gynecologic cancer. Its commonality is chiefly due to the effective and improving cancer screenings and technology.
The American Cancer Society estimates that in 2017, about 12,820 new cases of invasive cervical cancer would be diagnosed. About 4,210 women would also die from it.
The Papanicolaou test, colloquially known as a Pap smear, is a method of cervical screening used to detect potentially pre-cancerous and cancerous processes in the cervix. The Foundation for Women’s Cancer states that since its conception in the 1940s, the Pap smear has reduced deaths from cervical cancer by more than 70 percent. “It is hoped with wide-spread vaccination and improved screening strategies, fewer and fewer women will be affected by cervical cancer and pre-cancers in the future,” the organization stated on its website. (The ACS adds on their website that cervical cancer “was once one of the most common causes of cancer death for American women.”)
According to the Foundation for Women’s Cancer, early vaccination along with regular Pap tests and HPV testing when recommended is now the best way to prevent cervical cancer. The vaccination referred to is an HPV vaccine called Gardasil. The Centers for Disease Control and Prevention (CDC), the Advisory Committee on Immunization Practices, and the North Dakota Department of Health recommend routine HPV vaccination for all 11- to 12-year-old girls. Catch-up vaccination is also recommended for females ages 13 to 18, and for adults 19 to 26 who were not previously vaccinated.
Since 2012, the American Cancer Society recommends that cervical cancer screenings, such as Pap smears, should first be performed at the age of 21 years old. The previous guideline was 18 years of age but, as Nordell noted, young women who were still going through the maturation process would be tested and given false positives, leading to unnecessary surgeries.
After the first Pap smear, women are encouraged to get one every three years from between the ages of 21 to 29, unless recommended otherwise. From the ages of 30 to 65, the testing would be done every three years or every five years if combined with HPV testing. From the age of 65, recommendations suggest against screening for those women who are not at a high risk for cervical cancer.
Regardless of the three-year guideline, Nordell said that a lot of women aren’t comfortable “waiting that long,” especially as women are generally conditioned, given the previous guidelines, to get one annually.
According to the Centers for Disease Control and Prevention, risk factors for cervical cancer include smoking, having HIV or another condition that makes it hard for your body to fight off health problems, using birth control pills for a long time (five or more years), having given birth to three or more children, or having several sexual partners.
“HPV virus causes the most of these cervical problems,” Nordell said. It wasn’t until the 1980s that HPV was identified in cervical cancer tissue, implicating it in virtually all cervical cancers. “We don’t know how the HPV virus is out there, but the way to take care of cervical cancer is to get a Pap smear and treat it accordingly.”
As cervical cancer progresses, symptoms can include vaginal bleeding after intercourse, between periods, or after menopause; watery, bloody vaginal discharge; and pelvic pain or painful intercourse (dyspareunia).
Depending on its stage, treatment for cervical cancer can vary.
Risk factors for gynecological cancer
According to the Betty Allen Gynecologic Cancer Foundation, cancer can be acquired or inherited. “If the changes are acquired, they are caused by environmental factors and things people do, such as smoking,” the Foundation says on their website.
“Smoking is the worst thing anyone can do,” Nordell added.
Knowing your family’s medical history, when cancer is concerned, is also important. A Risk Assessment for Lynch Syndrome and Hereditary Breast and Ovarian Cancer Syndrome, which asks if the patient and/or a family member has been diagnosed with colon, uterine, breast, and/or ovarian cancer, is completed by patients; this can help determine the familial risk.
If you show any of the symptoms related to a gynecological cancer, or are concerned about the possibility of gynecological cancer, the OB/GYN team at Trinity Health would be happy to see you to address these issues.
OB/GYNs Margaret Nordell, MD; Jessie Fauntleroy, MD; Carol Schaffner, MD; and midwife Gloria Berg, CNM, are based at Health Center – Town & Country, Suite 102, 831 South Broadway, Minot. For an appointment, call 857-5703. David Billings, MD, is also located at that location; for an appointment, call 857-7394.
OB/GYNs Heather Bedell, MD; Tim Bedell, MD; Lori Dockter, PA-C; and Jennifer Johnson, MD, are based at Health Center – Medical Arts, 400 Burdick Expressway East, Minot. For an appointment, call 857-7397. OB/GYN J. David Amsbury, DO; and midwives Erica Riordan, CNM, and Kerena Saltzgiver, CNM, are also located at that location; for an appointment, call 857-7385.