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Reproductive Cancers

What is it?

Cancer of the uterus accounts for 13% of all cancers in women. It occurs most often in those between 55 and 79 years old. Cancers of the cervix are more common in younger women. Endometrial cancer is the third most common cancer in women. Ovarian cancer occurs mostly in women over 50. Vulvar cancer is a rare disease that occurs mainly in elderly women. Women with any of these cancers are more likely to recover if the cancer is diagnosed and treated early.

Cervical Cancer is a disease in which the cells of the cervix become abnormal and start to grow uncontrollably, forming tumors. Cervical cancer is one of the most common cancers affecting women. Cervical cancer is usually preceded by dysplasia, precancerous changes in the cells on the surface of the cervix. These abnormal cells can progress to invasive cancer. Once the cancer appears, it can progress through four stages. The stages are defined by the extent of spread of the cancer. The more widely the cancer has spread, the more extensive the treatment is likely to be.

Endometrial Cancer (also called uterine cancer) develops when the cells of the endometrium become abnormal and grown uncontrollably. The endometrium is the tissue forming the inner lining of the uterus. Endometrial cancer is a common type of cancer among women.

Ovarian Cancer is a disease in which the cells in the ovaries become abnormal and start to grow uncontrollably, forming tumors. Ninety percent of all ovarian cancers develop in the cells that line the surface of the ovaries and are called "epithelial cell tumors".

Vulvar Cancer refers to an abnormal, cancerous growth in the external female genitalia.

Who gets it and what are its causes?

Cervical Cancer-In the United States, cervical cancer accounts for 6% of all cancers in women. It usually affects women between the ages of 50 and 55 years. Worldwide, cervical cancer is the second most common cancer among women with over 400,000 new cases diagnosed each year. The incidence is very high in developing countries. In the last 40 years there has been a 75% decrease in the number of deaths due to cervical cancer in the United. The main reason is the use of the "pap test" as a screening tool.

The cause of cervical cancer is not known, however, certain factors are believed to increase one’s risk of developing cervical cancer. Engaging in sexual activity at a young age is one such factor. The cells lining the cervix do not fully mature until the age of 18 and, therefore, are more susceptible to cancer causing-agents and viruses.

More than 90% of women with cancer of the cervix are infected with the human papilloma virus (HPV). HPV is the single most important factor for cervical cancer. HPV usually causes warts in the genital area. The viruses are passed from one person to another during unprotected sex. Having multiple sexual partners increases one’s risk of getting this cancer, because the greater number of sexual partners, the greater is the risk of acquiring HPV infection. Even if a woman has only one sexual partner, but the man has several partners, he is considered a "high-risk male" and can transmit HPV to the women.

Smoking is considered a risk factor, possibly because smoking causes some abnormal changes in the cells and these cells have a higher likelihood of becoming cancerous. There are also some statistical studies that have suggested that long-term use of oral contraceptives may put a woman at a slightly higher risk of developing this cancer.

Endometrial Cancer-This cancer is a common type of cancer among women. The incidence of the disease is higher in Caucasian women than in African-American women. This type of cancer generally occurs in women who have gone through menopause and are 45 years old or older. The average age of a woman when she is diagnosed is 60 years old.

Although the exact cause of Endometrial cancer is unknown, there are several factors that increase a woman’s risk of developing this particular cancer.

Age-The risk is considerably higher in women who are over the age of 50 and have gone through menopause.
Obesity-Being overweight is thought to be a very strong risk factor for this cancer. Fatty tissue can change other normal body chemicals into estrogen, which can promote endometrial cancer.
Estrogen Replacement Therapy-Studies have shown that a woman receiving estrogen supplements after menopause can have a 12 times higher risk of getting endometrial cancer if she is not taking progesterone at the same time.
Diabetes-A diabetic has twice the risk of getting this cancer compared to normal women. At present, it is not very clear if this risk is due to the fact that many diabetics are also obese and hypertensive.
Hypertension-Having high blood pressure (or hypertension) is also considered a risk factor for uterine cancer. Again, as with diabetes, it is not very clear if hypertension alone is responsible for increasing the risk of endometrial cancer or if the risk is related to the fact that hypertensive women are also generally obese.
Irregular menstrual periods-During a women’s menstrual cycle, there is interaction between the hormones estrogen (which can encourage endometrial cancer development and progesterone (which can offer protection from endometrial cancer). Women who do not ovulate regularly are exposed to high estrogen levels for longer periods of time. If a woman does not ovulate regularly, this delicate balance is upset and may increase her chances of getting uterine cancer.
Early first menstruation or late menopause-For unknown reasons, having a first period at a young age and going through menopause at a late age seem to put women at a slightly higher risk for developing endometrial cancer.
Tamoxifen-This drug is used to treat breast cancer and it increases a woman’s chance of developing endometrial cancer. In many cases, however, the value of tamoxifen for treating breast cancer and for preventing the cancer from spreading far outweighs the small risk of getting endometrial cancer from using the drug.
Family history-Some studies suggest that endometrial cancer runs in certain families. However, research needs to be done to prove that there is a hereditary link.

Endometrial cancers have a good chance of being cured because there are symptoms that are evident very early on in the disease. The most common symptom of endometrial cancer is usually bleeding or discharge. Especially in women who have gone through menopause, any vaginal bleeding should be brought to the attention of the doctor immediately. Any abnormal vaginal discharge should also be reported. Pain in the pelvic region and the presence of a lump (mass) are symptoms that occur late in the disease.

Ovarian Cancer is the fifth most common cancer among women in the United States. It accounts for 4% of all cancers in women. However, the death rate due to this cancer is higher than that of any other cancer among women. Ovarian Cancer can develop at any age, but more than half of the cases are among women who are 65 years or older.

The incidence of the disease is higher among white women. Only 50% of the women who are diagnosed with ovarian cancer will survive five years after initial diagnosis. This is because at the time of initial diagnosis, the cancer is usually in an advanced stage. It is difficult to diagnose ovarian cancer early, because often there are no warning symptoms and the disease grows relatively quickly. In addition, the ovaries are situated deep in the pelvis and, therefore, small tumors cannot be detected during a routine physician examination.

Vulvar cancer is a rare disease that occurs mainly in older women. The vulva refers to the external female genitalia, which includes the labia, the opening of the vagina, the clitoris, and the space between the vagina and anus (perineum). Vulvar cancer can affect any part of the female genitalia, but usually affects the labia. Most vulvar cancers are squamous cell carcinomas. Squamous cells are the main cell type of the skin. Squamous cell carcinoma often begins at the edges of the labia majora or labia minora or the area around the vagina. This type of cancer is usually slow growing and may begin with a precancerous condition referred to as vulvar intraepithelial neoplasti, or dysplasia. This means that precancerous cells are present in the surface layer of skin.

Other less common types of vulvar cancer are melanoma, basal cell carcinoma, adenocarcinomas, Paget’s disease of the vulva and tumors of the connective tissue under the skin. Melanoma, a cancer that develops from the cells that produce the pigment that determines the skin’s color, can occur anywhere on the skin, including the vulva. It’s the second most common type of vulvar cancer, and account for about 4% of cases. Basal cell carcinoma, which is the most common type of cancer that occurs on parts of the skin exposed to the sun, very rarely occurs on the vulva. Adenocarcinomas develop from glands, including the glands at the opening of the vagina that produce a mucus-like lubricating fluid.

Vulvar cancer is most common in women over 50 years of age. Additional risk factors for vulvar cancer include having multiple sexual partners, cervical cancer, and the presence of chronic vaginal and vulvar inflammations. This type of cancer is often associated with sexually transmitted diseases.

What are the symptoms?

Cervical Cancer-Early cervical cancer causes no symptoms, though bleeding or spotting between periods or after intercourse can be a symptom of cervical cancer. Most women have no symptoms. The cancer is usually detected at the time of the annual Pap smear and pelvic exam. This is why women should start having Pap smears and pelvic exams as soon as they become sexually active. Healthy young women who have never been sexually active should have their first annual pelvic exam by age 21.

Eventually, a woman who has cervical cancer will notice abnormal vaginal bleed or bloodstained discharge at unexpected times, such as between menstrual periods, after intercourse or after menopause. Abnormal vaginal discharge may be cloudy or bloody or may contain mucus. In advanced stages there may be pain.

Endometrial Cancer-Some women appear to be at a greater risk for developing this cancer than others. These include women who never had sexual intercourse or had few or no children, women who began to menstruate early or had a late menopause, and women who had estrogen replacement therapy without progesterone for menopausal symptoms. Symptoms include vaginal bleed after menopause, bleeding after sexual intercourse, bleeding between periods in pre-menopausal women.

Ovarian Cancer-This has no specific signs or symptoms in the early stages of the disease. There may be some vague, non-specific symptoms, which are often ignored. However, if any of the symptoms persist, it is essential to have them evaluated by a doctor immediately. Only a physician can assess whether the symptoms are an indication of early ovarian cancer. The patient may experience symptoms such as pain or swelling in the abdomen, bloating and general feeling of abdominal discomfort, constipation, nausea or vomiting, loss of appetite, fatigue, unexplained weight gain (generally due to an accumulation of fluid in the abdomen) and vaginal bleeding in post-menopausal women.

Vulvar Cancer-If squamous cell vulvar cancer is present, it may appear as a raised red, pink or white nodule. Itching, pain, bleeding, vaginal discharge and painful urination often accompany it. Malignant melanoma of the vulva usually appears as a pigmented, ulcerated growth. Other types of vulvar cancer may appear as a distinct mass of tissue, sore and scaly areas, or cauliflower-like growths that look like warts. Any abnormalities should be reported to a gynecologist for examination.

Medical Treatment

Cervical Cancer-Most cases of cervical cancers can be prevented, since they start with easily detectable pre-cancerous changes. One of the best ways to prevent cervical cancers is by having regular Pap tests. If pre-cancerous changes are detected, appropriate treatment can prevent them from developing into invasive cancers.

Another way to prevent cervical cancers it to avoid the risk factors. Abstaining from sexual relations when one is very young, and using appropriate precautions when engaging in sexual activity will help to avoid HPV infections. Quitting smoking will also help to reduce the risk for cervical cancers.

Endometrial Cancer-If your physician suspects endometrial cancer, they will conduct a series of tests to confirm the diagnosis. A complete personal and family medical history will be taken. A physician examination will be done, which will include a thorough pelvic examination.

Your physician may request an endometrial biopsy. This can be performed in the physician’s office. A very thin, flexible tube is inserted into the uterus through the cervix. A small piece of endometrial tissue is removed. If an adequate amount of tissue was not obtained by the endometrial biopsy, or if the biopsy tissue looks abnormal and confirmation is needed, your physician may perform a procedure known as a D & C (dilatation and curettage).

Standard treatments available for endometrial cancer are surgery, radiation therapy, hormonal therapy and chemotherapy.

Ovarian Cancer-Since there is no known cause for ovarian cancer, it is not possible to prevent the disease. Nevertheless, there are ways to reduce one’s risk of developing the disease. Currently, genetic tests are available which can help to determine whether a woman who has a family history of breast, endometrial or ovarian cancer has inherited the mutated gene that predisposes her to these cancers.

There are no simple tests or screening procedures to detect ovarian cancer in its early stages. High-risk women are therefore advised to undergo periodic screening with the transvaginal ultrasound or a blood test for CA125 protein.

Vulvar Cancer-The risk of cancer of the vulva can be decreased by reducing the risk factors for the cancer, most of which involve lifestyle factors. Specifically, to reduce the risk of vulvar cancer, women should not smoke and should refrain from engaging in risky sexual behavior. Good hygiene of the genital area to prevent infection and inflammation may also reduce the risk of vulvar cancer.

Regular examinations are necessary to detect precancerous conditions that can be treated before the cancer becomes invasive. Since some vulvar cancer is a type of skin cancer, the American Cancer Society also recommends self-examination of the vulva using a mirror.

Surgical Treatment

Cervical Cancer-Treatment for cervical cancer depends on the stage of the disease and the extent of its spread. Three standard modes of treatment are surgery, radiation therapy and chemotherapy.

A radical hysterectomy removes the entire uterus, the ovaries and the upper of the vagina that is next to the cervix and the lymph nodes from the pelvic region.

Radiation therapy, which involves the use of high energy x-rays to kill cancer cells, can also be used for treatment of cervical cancer. In external radiation therapy, the rays are focused on the pelvic area from a source that is outside the body. Alternatively, a pellet of radioactive materials may be placed internally, near the tumor. This is called brachytherapy or interstitial radiotherapy. However, radiation therapy to the pelvic region has many effects. It could cause a narrowing of the vagina that makes intercourse painful. It may also stop the ovaries from releasing eggs and producing the female hormone estrogen. When this happens, it causes premature menopause in young women and they will need estrogen replacement therapy. Many women are treated with both surgery and radiation therapy.

Chemotherapy, or the use of anticancer drugs to kill the cancer cells, is not a common form of treatment for cervical cancer because it is not as effective as other methods. Nevertheless, the effectiveness of combination chemotherapy is being tested in clinical trials.

When a woman is diagnosed with recurrent cervical cancer, an operation known as pelvic exenteration is performed. In this operation, besides the uterus, cervix and vagina, the urinary bladder, part of the colon and the rectum are also removed. In such cases, new openings will have to be created for the urine and the feces to pass out of the body. A new vagina may also be surgically created.

Endometrial Cancer-Surgery is the best option when endometrial cancer is diagnosed in its very early stages. At this time, the location and the stage of cancer make removal easy. Sometimes patients are treated with a combination of surgery and radiation therapy. There are several surgical procedures that can be used and the choice of which procedure is used depends on the type and stage of the cancer.

Almost all women with endometrial cancer (except those with advanced or stage IV) are treated with a hysterectomy. They may also receive additional treatment. A simple hysterectomy involves the removal of the uterus, making the woman unable to have children. In a procedure known as bilateral salpingo-oophorectomy, both ovaries, the fallopian tubes and the uterus are removed. This may be necessary because endometrial cancer often spreads to the ovaries first.

Radiation therapy can be used. Sometimes radioactive pellets are placed inside the body near the tumor. This is called brachytherapy or internal radiation therapy. Fatigue, upset stomach, diarrhea and nausea are also common complaints of women having radiation therapy.

Chemotherapy uses anticancer drugs to kill the cancer cells. The drugs are given orally or intravenously. They enter the bloodstream and can travel to all parts of the body to kill cancer cells. Generally, a combination of drugs is given since it is more effective than a single drug in treating cancer. Side effects of this treatment include stomach upset, vomiting, appetite loss, hair loss, mouth or vaginal sores, fatigue, menstrual cycle changes and premature menopause.

Hormonal therapy uses drugs like progesterone that will slow the growth of endometrial cells. These drugs are usually available as pills. This therapy is usually reserved for women with advanced or recurrent disease.

Ovarian Cancer-The treatment of choice for ovarian cancer is surgery. It is aimed at removing as much of the cancer as possible. Chemotherapy is usually administered after the surgery to destroy any remaining cancer. Radiation therapy is not routinely used for ovarian cancer.

The type of surgery depends on the extent of spread of the disease. In most procedures, the ovaries, uterus and fallopian tubes are completely removed. In rare cases, if the cancer is not very aggressive and the woman is young and has not had children, a more conservative approach may be adopted. Only one ovary may be removed, and if possible, the fallopian tubes and the uterus may be left intact.

Occasionally, in addition to the female reproductive organs, the appendix may also be removed. The liver and the intestine will be examined for signs of cancer and may be biopsied. Ovarian cancer spreads contiguously, which means that it moves to the organs that are next to it. The entire surface of the abdominal cavity will be examined for the cancer. If cancer is found, extensive surgery may be needed to remove as much of the disease as possible.

Vulvar Cancer-Treatment for this cancer will depend on its stage and the patient’s general state of health. The primary treatment is surgery to remove the affected area and possibly the associated lymph nodes. The surgery may be done by laser, to burn off a minimal amount of tissue, or scalpel to remove more of the tissue. The choice will depend on the severity of the cancer.

If a large area of the vulva is removed, it is called a vulvectomy. A vulvectomy may require skin grafts from other areas of the body to cover the wound. Surgery may also be followed by chemotherapy and radiation therapy to kill additional cancer cells. All three of these procedures have risks associated with them, which should be discussed with the caregiver.

Physician's Who Treat Ovarian Cancer

This information has been designed as a comprehensive and quick reference guide written by our health care reviewers. The health information written by our authors is intended to be a supplement to the care provided by your physician. It is not intended nor implied to be a substitute for professional medical advice.

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