Early Detection of Gynecological Cancers Means Better Outcomes

Breast cancer gets a lot of coverage in health news, but the three gynecologic cancers—cervical, endometrial (uterine), and ovarian—are also deserving of your attention. For all of these types of cancer, the earlier they are diagnosed, the easier they are to treat successfully. However, only cervical cancer has a screening test that is routinely advised for all women; there are no reliable, accurate screening tests that can definitively detect the other two types. For this reason, it’s important to know if you are at higher risk of these cancers, as well as the symptoms associated with them.

Cervical Cancer

The recommendation for cervical cancer screening for women ages 30 to 65 is for a Pap test every three years, or a Pap test combined with human papillomavirus (HPV) testing every five years.

“Once a woman reaches age 65, as long as she has had prior regular screenings that have all been negative, she can stop screening. If the Pap test is abnormal or an HPV infection is present, the woman should undergo further evaluation, which may include cervical biopsies and/ or a colposcopy. A woman with an abnormal Pap test or a positive HPV test will likely need screening more frequently than every five years and may not be able to safely stop screening at age 65,” explains Melissa Frey, MD, a gynecologic oncologist at Weill Cornell Medicine.

Early cervical cancer is often asymptomatic; however, as the disease progresses, symptoms can include heavy vaginal bleeding, irregular vaginal bleeding, or bleeding after intercourse. More advanced cervical cancer may produce pain in the pelvis or back, changes in bowel or urinary habits, or blood in the urine or stool. If you experience any of these symptoms, especially if they are persistent, see your gynecologist as soon as possible. If you don’t have a gynecologist, see your primary care physician or another health-care provider.

Ovarian Cancer

There is currently no recommendation for ovarian cancer screening, and the U.S. Preventive Services Task Force (USPSTF) recommends against screening in asymptomatic women. However, the task force does advise that women who have family members with breast, ovarian, fallopian tube, or peritoneal cancer be evaluated to see if they have increased risk of a mutation in the BRCA1 or BRCA2 gene in their family history. If they do, then genetic testing may be advised.

“For women with an elevated lifetime risk of ovarian cancer, either due to a family history of ovarian cancer or a mutation in the BRCA1 or BRCA2 gene, a gynecologist can consider screening with pelvic ultrasound and a blood test for a tumor marker called CA125. However, the woman and her gynecologist must discuss the limitations of such ‘screening,’ as we currently have no evidence that sonograms or blood tests can reliably detect ovarian cancer in its early stages,” explains Dr. Frey. “Women with a BRCA1 or BRCA2 mutation should discuss the option of removal of the fallopian tubes and ovaries as a possible way to avoid ovarian cancer.”

In the early stages, ovarian cancer is often asymptomatic. Symptoms of advanced ovarian cancer include pain in the pelvis, abdomen, or back, bloating, changes in bowel or urinary habits (especially urinary urgency and frequency), and feeling full quickly when eating.

“If a gynecologist suspects a pelvic mass on exam or if a woman has any symptoms of ovarian cancer, she should undergo further evaluation,” says Dr. Frey.

Endometrial Cancer

Endometrial cancer, which is cancer of the innermost layer that lines the uterus, is the most common of the gynecologic cancers in the U.S.

“There is no recommendation for routine screening for endometrial cancer unless a woman has a strong family history of endometrial cancer or a known genetic mutation such as Lynch syndrome. Women at increased risk of endometrial cancer can consider sonograms of the uterus and endometrial biopsies. For all other women, screening is only recommended if there is a suspicion for endometrial cancer,” explains Dr. Frey.

The most common symptom of endometrial cancer is abnormal uterine bleeding. This can include bleeding after menopause or heavy or irregular bleeding in women who are still menstruating.

“Other symptoms of endometrial cancer can include a palpable uterine mass and abdominal pain or bloating,” notes Dr. Frey. (A palpable mass is a lump that can be felt when someone presses on it.)

If you experience any of the symptoms mentioned for a period of two or more weeks, and they are a departure from how you normally feel, see your gynecologist or other health-care provider and have it checked out. If you do have cancer, the sooner you find out, the sooner you can proceed with a treatment plan that may save your life.

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