Guide to Common Gynecological Cancers

Gynecological cancers are cancers that start in a woman's reproductive organs. There are five main types, each with its own characteristics, risk factors, symptoms, and treatment approaches.

According to Dr. Angela Coscio, oncologist at the Dan L Duncan Comprehensive Cancer Center at St. Luke’s Health-The Woodlands Hospital, “Understanding these distinctions is crucial for early detection and effective management of the various types of gynecological cancer. If you experience any of these symptoms, we recommend you reach out to a medical provider immediately - as it could make a life-saving difference.”

Read further for an in-depth overview of the five types of gynecological cancer - including key characteristics, risk factors, symptoms and detection/prevention.

Cervical Cancer

What it is: Cervical cancer originates in the cervix, the lower, narrow part of the uterus that connects to the vagina. It most commonly develops slowly over time.

Key Characteristics:

• Cause: Almost all cases (over 99%) are caused by persistent infection with certain types of Human Papillomavirus (HPV). HPV is a common sexually transmitted infection.
• Precancerous Changes: Before cancer develops, cells in the cervix undergo precancerous changes called dysplasia or cervical intraepithelial neoplasia (CIN). These changes can be detected and treated early.
• Metastasis: If left untreated, cervical cancer can spread to nearby tissues (vagina, uterus, bladder, rectum) and distant organs (lungs, liver, bones).

Risk Factors:

• HPV infection (the primary risk factor)
• Not receiving the HPV vaccine
• Multiple sexual partners
• Early age at first sexual intercourse
• Weakened immune system (e.g., HIV infection)
• Smoking
• Long-term use of oral contraceptives (though the risk is small)
• Giving birth to many children

Common Symptoms:

• Abnormal vaginal bleeding (after intercourse, between periods, after menopause)
• Unusual vaginal discharge (often watery, bloody, or foul-smelling)
• Pelvic pain or pain during sexual intercourse (in advanced stages)
• Leg swelling (in advanced stages)

Detection & Prevention:

• Screening: Pap tests (Papanicolaou test) and HPV tests are highly effective screening tools for detecting precancerous cells and HPV infection.
• Prevention: HPV vaccination (recommended for adolescents) is very effective in preventing HPV infections that cause most cervical cancers.

Ovarian Cancer

What it is: Ovarian cancer begins in the ovaries, two small organs located on each side of the uterus that produce eggs and female hormones (estrogen and progesterone).

Key Characteristics:

• Types: There are several types, but the most common is epithelial ovarian cancer, which starts in the cells on the outer surface of the ovary. Others include germ cell tumors and stromal tumors.
• Silent Killer: Ovarian cancer is often diagnosed at advanced stages because early symptoms are vague and easily mistaken for other conditions, making it difficult to detect early.
• Metastasis: It often spreads within the abdomen, affecting the peritoneum (lining of the abdominal cavity), bowel, bladder, and distant organs.

Risk Factors:

• Older age (risk increases after menopause)
• Family history of ovarian or breast cancer (BRCA1 and BRCA2 gene mutations significantly increase risk)
• Endometriosis
• Never having been pregnant or difficulty getting pregnant
• Obesity
• Long-term use of fertility drugs
• Certain inherited syndromes (e.g., Lynch syndrome)

Common Symptoms (often subtle and non-specific, especially early on):

• Bloating
• Pelvic or abdominal pain
• Difficulty eating or feeling full quickly
• Urinary symptoms (urgency or frequency)
• Fatigue
• Back pain
• Constipation or changes in bowel habits

Detection & Prevention:

• Currently, there is no effective routine screening test for ovarian cancer for the general population.
• For individuals with high genetic risk, regular monitoring (CA-125 blood tests, transvaginal ultrasounds) and prophylactic surgery (removal of ovaries and fallopian tubes) may be considered.
• Some ovarian tumors can be detected by your gynecologist during a well woman examination, but a normal exam does not exclude the possibility of cancer

Uterine (Endometrial) Cancer

What it is: Uterine cancer, specifically endometrial cancer, starts in the endometrium, the inner lining of the uterus. It is the most common gynecological cancer.

Key Characteristics:

• Most Common Type: Endometrial adenocarcinoma accounts for the majority of cases.
• Early Detection: Unlike ovarian cancer, endometrial cancer often presents with clear symptoms early on, leading to earlier diagnosis and a better prognosis.
• Hormone-Related: It is often linked to an imbalance of hormones, particularly excess estrogen without sufficient progesterone to balance its effects.

Risk Factors:

• Obesity (increases estrogen levels)
• Older age (post-menopausal women are at higher risk)
• Estrogen therapy without progesterone (unopposed estrogen)
• Early menstruation or late menopause
• Never having been pregnant
• Tamoxifen use (for breast cancer treatment)
• Polycystic ovary syndrome (PCOS)
• Family history of endometrial, colon, or ovarian cancer (Lynch syndrome)
• Diabetes

Common Symptoms:

• Abnormal vaginal bleeding is the most common symptom, especially post-menopausal bleeding
• Bleeding between periods (for pre-menopausal women)
• Unusual vaginal discharge
• Pelvic pain or pressure (in advanced stages)

Detection & Prevention:

• There is no routine screening for endometrial cancer for the general population.
• Diagnosis typically involves transvaginal ultrasound and endometrial biopsy.
• Maintaining a healthy weight, managing diabetes, and appropriate hormone therapy can help reduce risk.

Vaginal Cancer

What it is: Vaginal cancer is a rare cancer that originates in the vagina, the muscular tube connecting the uterus to the outside of the body.

Key Characteristics:

• Rarity: It is one of the rarest gynecological cancers.
• Types: Squamous cell carcinoma (SCC) is the most common type, originating in the flat cells lining the vagina. Adenocarcinoma is less common.
• HPV Link: Many cases of vaginal SCC are linked to HPV infection.
• Metastasis: Can spread to nearby pelvic organs and lymph nodes.

Risk Factors:

• HPV infection
• History of cervical cancer or precancerous changes
• History of abnormal Pap tests
• Age (risk increases with age, most common in women over 60)
•  Smoking
• Weakened immune system
• Chronic vaginal irritation
• History of pelvic radiation therapy

Common Symptoms:

• Abnormal vaginal bleeding (after intercourse, after menopause, between periods)
• Unusual vaginal discharge
• A lump or mass in the vagina
• Pain during intercourse
• Pain during urination or bowel movements (in advanced stages)
• Pelvic pain

Detection & Prevention:

• Regular pelvic exams and Pap tests can sometimes detect precancerous changes or early cancers.
• HPV vaccination can help prevent HPV-related vaginal cancers.

Vulvar Cancer

What it is: Vulvar cancer is a rare cancer that forms on the vulva, the outer part of the female genitals, which includes the labia (lips), clitoris, and opening of the vagina.

Key Characteristics:

• Types: Squamous cell carcinoma (SCC) is the most common type, usually developing slowly over many years. Melanoma can also occur on the vulva.
• Visible Lesions: Unlike some other gynecological cancers, vulvar cancer often presents as a visible lump, sore, or change in skin.
• HPV Link: Similar to cervical and vaginal cancers, a significant number of vulvar cancers are linked to HPV infection. Some forms are not HPV-related and associated with chronic inflammatory conditions.

Risk Factors:

• HPV infection
• Older age (most common in women over 65)
• History of vulvar intraepithelial neoplasia (VIN)
• Smoking
• Weakened immune system
• Lichen sclerosus (a chronic skin condition affecting the vulva)
• History of cervical cancer

Common Symptoms:

• Persistent itching (pruritus) in the vulva
• A lump, sore, or wart-like growth on the vulva
• Pain, tenderness, or burning in the vulva
• Changes in skin color or texture (e.g., thickening, redness, white patches)
• Abnormal bleeding or discharge not related to menstruation

Detection & Prevention:

• Regular self-examination of the vulva and prompt reporting of any changes to a doctor are crucial.
• Pelvic exams can detect vulvar abnormalities.
• HPV vaccination can help prevent HPV-related vulvar cancers.

General Considerations for All Gynecological Cancers

• Early Detection is Key: For most of these cancers, early detection significantly improves treatment outcomes and survival rates.
• Listen to Your Body: Don't dismiss persistent or unusual symptoms. If you experience any concerning changes, especially abnormal bleeding or persistent pain, consult a healthcare provider promptly.
• Regular Check-ups: Routine gynecological exams, which may include Pap tests and pelvic exams, are vital for preventive care and early detection.
• HPV Vaccination: The HPV vaccine offers protection against the types of HPV that cause the majority of cervical, vaginal, and vulvar cancers, and is a powerful tool for prevention.

This overview provides general information. For personalized advice, diagnosis, and treatment, always consult with a qualified healthcare professional.

To learn more about our programs to assist in the treatment of gynecologic cancers, please visit commonspirit.org/cancer.