Gynecologic Cancers

Posted: Oct. 1, 2004

Here is an overview of six gynecologic cancers:

Ovarian Cancer appears on the surface of the ovaries.
Most common symptoms: Pressure or fullness in the pelvis, abdominal bloating, changes in bowel and bladder patterns that are constant and progressive, vague but persistent gastrointestinal complaints, frequency or urgency of urination, constipation, abnormal bleeding, fatigue, pain during intercourse.

Uterine Cancer begins on the lining of the uterus and can grow and spread out of control into the muscle of the uterus.
Most common symptoms: Abnormal bleeding after menopause or other irregular vaginal bleeding before menopause.

Cervical Cancer reveals itself as abnormal cell changes in the cervix.
Most common symptoms: Bleeding after intercourse, excessive discharge, abnormal bleeding between periods.

Vulvar Cancer appear as lesions on the surface of the vulva or labia.
Most common symptoms: Itching in the vulvar area.

Vaginal Cancer is very rare.
Most common symptoms: Abnormal bleeding, usually in elderly women.

Tubal Cancer is cancer of the fallopian tubes.
Most common symptoms: Similar to ovarian cancer.

Gynecological exams and early detection
Each October our attention turns to breast cancer awareness as the nation spotlights Breast Cancer Awareness Month. But for most women, the only time to think about gynecologic cancer is when it’s time to make that often-dreaded phone call for their yearly pelvic exam.

“As far as early detection is concerned,” said David Hoogerland, M.D., a gynecologic oncologist at Columbia St. Mary’s, “I encourage patients to be assertive with their gynecologic health management and push physicians to perform complete pelvic exams, all the time.”

More than likely, you would be referred to someone like Dr. Hoogerland by your obstetrician/gynecologist (OB/GYN) after cancer had been detected in one of the GYN Cancer areas; ovarian, uterine, cervical, vulvar, vaginal or tubal. These types of cancer are usually treated by surgery, radiation therapy or chemotherapy. A gynecologic oncologist is a board certified OB/GYN with additional training as a cancer specialist.

Of the six types of GYN cancer, the “big three,” are ovarian, uterine and cervical, with the others being a bit more rare and treatable. When abnormal cells in one of those areas show uncontrolled growth, and are diagnosed as cancer, Dr. Hoogerland steps in to establish a path of treatment and management. But, he emphasizes, prevention, health and early detection are the most important aspects of his field.

“When you experience unusual symptoms, be sure to have them checked out,” he said. “A pelvic exam should be part of every evaluation. If your doctor won’t do it, find another doctor.”

Dr. Hoogerland also said, however unpleasant, a rectal exam is the most important part of a pelvic exam, and one of the only ways to detect ovarian cancer. “I always tell my patients, ‘if your doctor isn’t doing one, you’re not getting your money’s worth!’”

Doctor’s orders
There are some very simple ways to contribute to your gynecological health and life:

• Don’t smoke – linked with cervical cancer, smoking can increase your chances of abnormal cells becoming cancerous.
• Avoid multiple partners – statistics show that the risk of getting Human Papilloma Virus (HPV), the most common cause of cervical cancer, is distinctly higher with multiple sexual partners.
• Watch your weight – obesity has been directly linked to uterine cancer.
• Have children – women who have been pregnant lower their chances of uterine and ovarian cancers.

Symptoms to watch
“The foremost symptom of many GYN cancers is abnormal bleeding associated with intercourse, between periods or after menopause,” said Dr. Hoogerland. “Unfortunately, with ovarian cancer the symptoms are far more vague and can present as a different problem. It doesn’t lend to early diagnosis and we don’t yet have good diagnostic techniques.”

In terms of the “big three,” uterine cancer is the most common of the female reproductive malignancies and ovarian is the most serious. Cervical cancer, frequently referred to as a sexually transmitted disease, is often caused by (HPV). If diagnosed early, it can usually be taken care of by a simple procedure in the doctor’s office.

Uterine, or endometrial, cancer can be caused by too much estrogen in the system. Women who have never been pregnant, are overweight and are age 60 to 65 years old are its primary target.

Ovarian cancer presents additional challenges because the cells start to grow inside the abdominal cavity, which, in women, is accessible to cancer-causing materials (carcinogens) from outside the body. “Men don’t have anything similar to ovarian cancer,” said Dr. Hoogerland. “It’s a completely different cell type.”

Today, there are blood tests that can determine whether a woman has the gene that causes ovarian and breast cancer. Ninety percent of the women with that gene are vulnerable to this cancer. Dr. Hoogerland suggests you talk with your obstetrician/gynecologist to see if you are at risk and what tests are appropriate for you.

From Milwaukee Journal Sentinel, “Healthbeat” Oct. 2002

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