The more attention we can pay to women especially for gynecologic cancers, the better it is for raising awareness and growing research.Evelyn Fleming, MD
Every five minutes, a woman will be diagnosed with gynecologic cancer. Advancements in research are offering new screening tools, tests and treatments. “It’s heart-breaking when women aren’t aware of gynecologic cancers,” says Evelyn Fleming, MD, a gynecologic oncologist at Norris Cotton Cancer Center who specializes in minimally invasive gynecologic cancer surgery. “The more attention we can pay to women especially for gynecologic cancers, the better it is for raising awareness and growing research. This is so important, as early detection affords the greatest chance for cure.” Here are 10 things you may not know about these cancers.
- “Gynecologic cancer” is actually seven different cancers. The name includes a group of cancers that can begin in any one of the female reproductive organs:
- Cervical cancer
- Endometrial cancer, also called uterine cancer
- Fallopian tube cancer
- Ovarian cancer
- Peritoneal cancer
- Vaginal cancer
- Vulvar cancer
- Each type of gynecological cancer has different symptoms. Some of these, such as bleeding between periods, bloating, pelvic pain, feeling full quickly with eating or issues with bowel or bladder function may be difficult to recognize as they are common and can mean any number of things that are not cancer. Other symptoms such as bleeding after menopause are never normal and should be quickly evaluated by a doctor. “I wish all women knew that post-menopausal bleeding is not normal,” notes Fleming. “A woman who notices an increase in these symptoms should tell her doctor so that further testing can be done.”
- Endometrial (uterine) cancer is the most common gynecological cancer. It is also the most common obesity-associated cancer in women and the fourth most common cancer in US women overall. “Endometrial cancer is unfortunately rising in incidence in the US because of the obesity epidemic and because fewer women now are having hysterectomies (removal of the uterus) for other indications,” says Fleming. “Obesity is also a contributing factor to increased diagnoses in younger women who are still in their child-bearing years.”
- More than 61,000 cases of endometrial cancer are estimated by the National Cancer Institute in 2019.
- Endometrial cancer usually occurs around the time of menopause, but younger women are also at risk.
- The most common sign of an endometrial cancer is vaginal bleeding/spotting after menopause or a significant change in menstrual pattern. “If you experience this, you should have it evaluated as soon as possible,” cautions Fleming.
- 85 percent of women with endometrial cancer survive, because of early detection.
- Women who are taking estrogen as hormone replacement are at increased risk for uterine cancer.
- Risk for endometrial cancer can be minimized by getting to and staying at a healthy weight, engaging in regular exercise and keeping blood pressure and blood sugars under control. “So few women are aware that endometrial cancer is obesity-related,” notes Fleming.
- Of all gynecologic cancers, only cervical cancer has a screening test. A Pap test is a swab of the cervix to detect cancerous cells as well as abnormal cell changes that might become cervical cancer if not treated appropriately. “In addition to screening, knowing what to look for can help with early detection,” notes Fleming. “Regular pelvic exams for women of all ages can help to evaluate cervical and vulvar health and identify precancerous changes.”
- Most cases of cervical cancer are now preventable. Getting the human papillomavirus (HPV) vaccine before becoming sexually active and having your children vaccinated at ages 11–12 can help prevent cervical, vaginal and vulvar cancers in vaccinated individuals. The vaccine is now FDA-approved for women up to age 46 but works best when given before the onset of sexual activity. “Cervix cancer is actually very uncommon in the U.S. because we have Pap smears. Now we have HPV vaccines so it’s becoming even less common,” notes Fleming.
- New diagnoses of cervical cancer dropped by more than 50 percent between 1975 and 2010 for women of all ages in the U.S. “The best way to find cervical cancer early, when it’s most curable, is to have regular Pap tests and HPV tests between ages 21–65 at intervals recommended by your provider,” says Fleming.
- Treatment for gynecologic cancers depends on the kind of cancer and how far it has spread. Common treatments include:
- Surgery – removing cancerous tissues or tumors, or removing the organ that developed the cancer, such as the ovaries.
- Chemotherapy –using drugs to kill the cancerous cells. Chemotherapies can be oral (pill form) or intravenous (infusion).
- Radiation –Using high-energy rays to kill the cancer.
- New treatments and prevention methods for gynecologic cancer are being studied in clinical trials. “There is a lot of active research in gynecological cancer treatment right now. As an NCI-designated cancer center, NCCC has numerous clinical trials available,” notes Fleming, who heads NCCC’s gynecological clinical trials. “Over the years, we’ve had many notable trials to offer our patients including one that uses a patient’s own ovarian tumor to make a tumor-directed vaccine. We also have several immunotherapy trials open now. These drugs have been incredibly successful in treating other solid tumors such as melanoma, and we’re very hopeful to see their impact in gynecologic cancers.” Patients may want to think about taking part in a clinical trial and can enter clinical trials before, during or after starting their cancer treatment.
- Uterine cancer is highly curable when it is diagnosed early. “Robotic or minimally invasive hysterectomy has allowed us to do the necessary surgery for uterine cancer, often as a same-day procedure, with a faster recovery and quicker return to daily activities,” says Fleming.
- Gynecologic cancers are best treated by a gynecologic oncologist. Doctors who specialize in treating cancers of the female reproductive tract are called gynecologic oncologists. From a surgery standpoint, there is data supporting better outcomes for patients who are treated by gynecologic oncology specialists.
Each woman’s genetic makeup, family and medical history, environment, habits and behaviors are different. Your providers can discuss your individual gynecologic cancer risk factors and make recommendations that are appropriate for you.