Learn About Cancer

Knowledge is Power: Learn the Facts About Gynecological Cancer

What is gynecological cancer?

Gynecological cancer is any cancer that starts in a woman’s reproductive system. There are five main types of gynecological cancer and they each have their own unique set of signs, symptoms and risk factors.

The five main types of gynecological cancer are:

Cervical Cancer
Ovarian Cancer
Endometrial/Uterine
Vulvar/Vaginal
Trophoblastic Disease

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Cervical Cancer

What is the cervix?

The cervix is the opening of the uterus at the top of the vagina.  It is sometimes referred to as the “neck” of the uterus. The narrow opening of the cervix is called the os.

What is cervical cancer?

The cervix is covered by a thin layer of tissue made up of squamous cells (also known as the ectocervix). In healthy women, these cells grow, divide and get replaced frequently – especially when we are younger.  The most common form of cervical cancer is squamous cell cancer. Since the squamous cells change so frequently, they can be more susceptible to interference in the normal cell cycle. When the normal cell cycle is disrupted, abnormal cells can be formed. Once abnormal cells are formed they can progress to cancer and tumors can form. Cervical cancer generally develops over many years.

When a doctor or nurse performs a Pap Test, they are taking a sample of these cells to determine if they are normal or abnormal. For more information about the Pap Test, please scroll down to “Prevention”.

What causes cervical cancer?

Human Papilloma Virus (HPV) causes almost all cervical cancer. HPV is the most common sexually transmitted virus. It is easily spread by skin-to-skin contact during sexual activity with another person. Most people will not experience signs or symptoms of the virus, so it is possible to unknowingly spread HPV to another person.

Approximately 50% of sexually active women will be infected with HPV at some point in their lifetime, although most women’s immune systems will “clear” the virus and will not get cervical cancer.  Still, when the virus does not go away, it can lead to many health problems including cervical cancer.

There are over 70 types of HPV, but only the 16 “high-risk” types will lead cervical cancer.  70% of all cervical cancer is caused by types 16 and 18. There are two vaccines available that can offer you protection from both of these types (link to our info on HPV vaccine).

Remember: Not all HPV infections will become cervical cancer. But, almost all cervical cancer was caused by HPV.

Who is at risk for cervical cancer?

Any woman who has been infected with one of the high-risk types of HPV is at risk of developing cervical cancer. It is very important to visit your doctor for regular pap tests. You can also ask your doctor for a HPV test to determine if you have high-risk HPV. If you test positive, your doctor will recommend the best course of action to monitor the HPV.

Using a latex condom the correct way every time you have sex and being in a mutually monogamous sexual relationship are the best ways to reduce your risk of infection.

How can I prevent cervical cancer?

Cervical cancer is a highly preventable disease. For prevention, follow these steps:

  • Get a Pap test at least every 3 years
  • Visit your doctor annually for a check-up
  • If appropriate, get the HPV test (ask your doctor)
  • If appropriate, get the HPV vaccine (ask your doctor)

Smoking, medications, or lifestyle choices that suppress the immune system can increase the risk of developing cervical cancer. Don’t smoke and take care of yourself with regular exercise and a healthy diet.

Women who get routine pap tests and follow up as needed can identify problems before cancer develops. Prevention is always better than treatment.

What is a pap test?

The pap test is a screening tool that indicates whether further evaluation is needed. All women over the age of 21 should have a pap test at least every three years to prevent cervical cancer. Pap smears should begin at age 21 and done every three years until age 30. At age 30, it is recommended to receive both a pap smear and a test for high-risk HPV.

At your pap test appointment, you will lay down on a table and put your feet into stirrups with your knees spread apart. Next, a speculum is inserted into your vagina to hold your vaginal walls open so your doctor or nurse can view the inside of the vaginal walls and cervix.  They will insert a long cotton swab into your vagina and gently swab against your cervix so that a sample of cervical cells is retrieved. It takes only a few minutes to complete. The sample is then sent to a lab for evaluation by a pathologist and your test results are returned to your doctor or nurse. If your doctor or nurse contacts you to discuss the results, it is very important that you return the call to learn your results.

Before cervical cancer develops, a pap test can detect dysplasia. Dysplasia (an abnormal pap test result) can lead to the development of cancer cells. Dysplasia is easily treated when identified early. Treatment will prevent the abnormal cells (dysplasia) from developing into cancer. It is important to get screened regularly and know your results so that you can be treated early before dysplasia progresses to cervical cancer.

It is also important to remember that an abnormal pap smear does not mean a diagnosis of cervical cancer. There are many steps an abnormal cell must progress through in order to become cancerous. However, an abnormal paper smear does mean that you should follow your doctor’s instructions for follow-up to ensure that the abnormal cells are properly monitored and treated. Cervical cancer is generally slow growing and can take up to ten years to develop.

What is the HPV vaccine? Who should get it?

For cervical cancer prevention, the HPV vaccine is recommended for females ages 9 through 26 years.

The two most common types of HPV that can cause cervical cancer are types 16 and 18. There are two vaccines available that are effective in preventing these types of HPV. These vaccines are Cervarix (made by GlaxoSmithKline) and Gardasil (made by Merck).

In Hong Kong, the vaccine requires three doses given as shots over a period of 6 months. The first dose is followed one month later by a second dose. The third dose is given 6 months after the second dose. In some parts of the world, there is now a two-dose vaccine available.

The vaccines can only protect against these HPV types if you have not yet been infected. Once you have acquired HPV type 16 or 18, the vaccine cannot protect you. It is important to be immunized before sexual activity begins, but getting vaccinated at any time can still help prevent infection with high–risk HPV and the development of cervical cancer.

Being vaccinated with either the Gardasil or Cervarix vaccine dramatically decreases your risk of developing cervical, vaginal, and vulvar cancer. Consult your doctor as soon as possible about receiving Gardasil or Cervarix for yourself or your daughter.

The US Center for Disease Control offers comprehensive information about the the HPV vaccines:

http://www.cdc.gov/hpv/vaccine.html

Ovarian Cancer

What are the ovaries?

The ovaries are located in the lower abdomen. There are two ovaries and each one lies just outside the fallopian tubes. The ovaries are responsible for producing an ovum (egg) each month. The ovum is released from a follicle (a fluid filled bubble) on the surface of the ovary. The ovum then travels through the fallopian tube to meet a sperm and either become fertilized or expelled with the woman’s next menses. The ovaries also produce several hormones including estrogen and progesterone. This function defines the ovaries as endocrine glands (hormone producing glands).

What is ovarian cancer?

Ovarian cancer results from the growth of abnormal cells into a cancerous tumor on one or both of the ovaries. Ovarian cancer is the deadliest gynecological cancer in women. It is often called “the silent killer,” because its symptoms can be vague and difficult to detect.  Some symptoms may mimic other conditions such as gastrointestinal diseases.  Symptoms can include: abdominal pressure, fullness, swelling or bloating; pelvic discomfort or pain; persistent indigestion, gas or nausea; changes in bowel habits, such as constipation; changes in bladder habits, including a frequent need to urinate; loss of appetite or quickly feeling full; increased abdominal girth or clothes fitting tighter around your waist; a persistent lack of energy; and/or lower back pain.

What causes ovarian cancer?

There is no known cause of ovarian cancer. However, some types of ovarian cancer can arise from being born with a gene that predisposes a woman to develop ovarian cancer.

Who is at risk for ovarian cancer?

Risk factors for ovarian cancer include: age; family history of ovarian cancer; personal history of breast, colon, rectal, or uterine cancer; or never having been pregnant.

How can I prevent ovarian cancer?

There is no known prevention for ovarian cancer. The best approach is having regular gynecological exams and to know your normal. If you don’t feel like yourself and have any of the symptoms above, seek care early.

Breast and ovarian cancer are often linked in families, with similar mutations associated with both cancers. If you have a family history of breast and/or ovarian cancer make sure your health care provider is aware and consider genetic testing.

Endometrial/Uterine (Womb) Cancer

What is the uterus and endometrium?

The uterus, also known as the womb, is a muscular organ located in the pelvis behind the pubic bone. The lower part of the uterus is the cervix and it extends into the upper part of the vagina. The uterus is approximately the size of a pear. Each month the lining of the uterus (the endometrium) grows to prepare for the possibility of an embryo implanting. If an embryo is produced the fetus will continue to develop within the uterus. If no embryo is produced the outer layer of the endometrium will shed at the end of the cycle as the woman’s menses.

What is endometrial/uterine cancer?

Endometrial cancer is the most common gynecological cancer in both Hong Kong and the United States. Endometrial cancer is the development of cancerous cells in the lining of the uterus. A less common type of cancer can occur in the muscle of the uterus.

What causes endometrial/uterine cancer?

There is no known cause of endometrial/uterine cancer but there are several known risk factors for developing the disease.

Who is at risk for endometrial/uterine cancer?

There are several important risk factors for developing endometrial cancer. These factors include: conditions that affect the balance of estrogen related to progesterone in your body such as Polycystic Ovarian Syndrome and diabetes; obesity; certain genetic syndromes; some medications taken for the treatment and prevention of recurrence of breast cancer; and inappropriate use of estrogen – only hormone replacement therapy.

How can I prevent endometrial/uterine cancer?

The good news is there are several ways you can decrease your risk of developing endometrial cancer. Maintain a healthy weight and eat a healthy diet low in sweets and other simple carbohydrates such as white bread. Regular exercise is also important in preventing the development of endometrial cancer. These healthy lifestyle choices not only decrease the likelihood you will become obese but also decrease your risk of diabetes and decrease the severity of Polycystic Ovarian Syndrome. If you have not had your uterus removed due to a hysterectomy and you are considering hormone replacement therapy (HRT) your doctor will prescribe HRT with both estrogen and progesterone. If you have any abnormal vaginal bleeding after the age of 35 see your gynecologist immediately. If you are being treated for breast cancer DO NOT stop taking your medications but do alert your doctor if you have any unusual vaginal bleeding.

Vulvar and Vaginal Cancer

What is the vulva and vagina?

The vulva is the outer area of the female organs. The vulva starts at the mons pubis and includes the labia, clitoris, and opening to the vagina. The vagina continues internally and extends to the bottom of the uterus. The cervix (bottom segment of the uterus) can be accessed through the vagina.

What is vulvar or vaginal cancer?

Vulvar cancer is the growth of cancerous cells on any area of the vulva. Vaginal cancer is the growth of cancerous cells within the vagina.

What causes vulvar or vaginal cancer?

According to the National Cancer Institute in the United States approximately 50% of vulvar and vaginal cancers are caused by HPV (Human Papilloma Virus). HPV is also the cause of cervical cancer.

Who is at risk for vulvar or vaginal cancer?

Women who are infected with a high – risk type of HPV are at increased risk of developing vulvar or vaginal cancer. According to the American Cancer Society other risk factors for vulvar cancer include: age, smoking; history of melanoma or other skin cancer; history of lichen sclerosis (a skin condition); history of other gynecologic cancers; and HIV (human immunodeficiency virus). Additional risk factors for vaginal cancer include: DES (Diethylstilbestrol) exposure in utero; smoking; age; and history of cervical cancer.

How can I prevent vulvar or vaginal cancer?

Schedule an annual visit with your gynecologist for a pelvic exam. Inspection of the vagina for areas that look abnormal will alert your doctor to the need for a biopsy to determine if the area is pre-cancerous and needs to be removed.

The HPV vaccines can also help prevent vulvar and vaginal cancer (http://www.cdc.gov/hpv/vaccine.html).

Trophoblastic Disease

What is trophoblastic disease?

Trophoblastic disease is rare. Hydatidiform Mole is the most common form of trophoblastic disease. According to the National Cancer Institute trophoblastic disease starts when “a tumor develops inside the uterus from tissue that forms after conception (the joining of sperm and egg). This tissue is made of trophoblast cells and normally surrounds the fertilized egg in the uterus. Trophoblast cells help connect the fertilized egg to the wall of the uterus and form part of the placenta (the organ that passes nutrients from the mother to the fetus)”.

What causes trophoblastic disease?

There is no known cause of trophoblastic disease.

Who is at risk for trophoblastic disease?

Asian women are at higher risk for trophoblastic disease than other ethnic groups. Age and previous molar pregnancy (hydatidiform mole) are also risk factors.

How can I prevent trophoblastic disease from progressing to cancer?

If you are pregnant, seek prenatal care early and report any unusual symptoms such as severe nausea and vomiting or concerns that you look “further along” than you actually are. If you are diagnosed with trophoblastic disease it is VERY important to follow your doctor’s recommendations. Frequent follow up is required and you must wait a substantial amount of time before you attempt another pregnancy. Do not attempt another pregnancy until your doctor tells you to. Make sure you use a very reliable form of birth control.

Prevention

Pap Smear:

The Pap smear is an important screening test for cervical abnormalities and cervical cancer performed by a doctor or nurse. After Dr. George Papanicolaou introduced the Pap smear in the United States during the 1940’s, cervical cancer incidence dropped by over 60%. Before the use of the Pap smear in the United States, cervical cancer was a leading cause of death for women. There is no doubt that Pap smear’s save lives by detecting cervical abnormalities or cancer early.

I’ve never had a Pap Smear. What should I expect?

The Pap Smear is simple and only takes a few minutes. First, you will typically be asked to remove your clothing from the waist down and be provided with a gown or blanket. You will lie down on the examination table or chair. You may be asked to slide to the end of the table and place your feet into “stirrups” which hold them comfortably while your doctor or nurse performs the brief exam. Next, the doctor or nurse will insert a speculum into your vagina so that they will be able to see your cervix (the lower segment of your uterus). A speculum is generally metal or plastic. It is smooth with no sharp edges. All skilled medical professionals can insert the speculum without causing any pain for the patient. During the exam the doctor or nurse will also examine your vulva, vagina, and cervix for any abnormalities.

The Pap smear is done by using a small, soft brush and a small plastic spatula or  “broom”. These instruments gently collect cells that the practitioner will transfer to a bottle of solution that will be sent to a laboratory for analysis. Once the sample is collected, your Pap smear is done. You will generally be asked to get dressed and your doctor or nurse will inform you when your results will be available, generally within a couple of days.
The Pap smear test has many potential results. Most results are NOT a diagnosis of cancer. What is important to know about the Pap smear is that it is a simple test that can detect abnormal cells on the cervix years before they can become cancer. The abnormal cells can be easily treated so that they will not progress to cancer.

When should women have a Pap smear?

Pap smears should begin at age 21 and be done every three years until age 30.

At age 30, it is recommended to receive both a pap smear and a test for high-risk HPV. If the test for high-risk HPV is negative and the Pap smear is normal you can continue to receive your pap smear every three years. It is also recommended to repeat the high – risk HPV test every five years. Pap smears can be discontinued after age 65 if there is no history of abnormalities. You can find more information about these guidelines on the US Centers for Disease Control website:

http://www.cdc.gov/cancer/cervical/pdf/guidelines.pdf

Human Papilloma Virus (HPV) Vaccine

There are currently two vaccines that can protect against infection with the human papilloma virus (HPV). These vaccines are called Gardasil and Cervarix. Both the Cervarix and Gardasil vaccinations require three injections: initial, second at 1 – 2 months later, and third at six months after the initial injection.

Cervarix protects against HPV types 16 and 18. Gardasil protects against four types of HPV: high risk types 16 and 18 as well as types 6 and 11 that can cause genital warts. HPV types 16 and 18 cause 75% of all cervical cancer, 70% of vaginal cancers, and 50% of vulvar cancers. HPV types 6 and 11 cause 90% of all genital wart cases.

Who should receive the vaccine?

The recommended age to receive the Gardasil or Cervarix vaccine is ages 11 – 12 but it can be given anytime between ages 9 – 26. The best time to receive the vaccine is before sexual activity begins, but the vaccine can be initiated at any time. Gardasil is approved for both boys and girls. Cervarix is approved for girls.

Receiving either the Gardasil or Cervarix vaccine dramatically decreases your risk of developing cervical, vaginal, and vulvar cancer. Consult your doctor as soon as possible about receiving Gardasil or Cervarix for yourself, your daughter or son.

Pelvic Exam

The pelvic exam is an important tool in detecting gynecological cancers. A pelvic exam should be performed annually. Even if you are not scheduled for a Pap smear, a pelvic exam is still recommended.

During the pelvic exam, the doctor will inspect the vulva, vagina, and cervix for any abnormalities. The doctor will also evaluate for any problems with the ovaries and uterus by inserting two fingers into your vagina and gently pressing on your lower abdomen. This procedure will allow the doctor to determine if the uterus and ovaries are the normal size and shape. If the doctor suspects any abnormalities she may order additional testing such as a biopsy, pelvic ultrasound, or pelvic MRI to collect more information to make sure you receive.

Diagnosis and Treatment

Diagnosis of gynecological cancer generally takes several steps:
• The first step is presenting to your doctor with a symptom (such as abdominal pain or vaginal bleeding) or an abnormal screening test (such as a pap test result that suggests cancerous cells).
• Further testing will be ordered. For example, an ultrasound or MRI may be ordered for more information about abdominal/pelvic pain. A colposcopy may be performed for an abnormal Pap smear result. An endometrial biopsy may be performed for abnormal vaginal bleeding.
• When your doctor suspects there may be a cancerous tumor based on preliminary testing, he may then perform surgery. Surgery is important for a definitive diagnosis of cancer and to understand how much the cancer has progressed or to determine its “stage”.
• Diagnosis and staging is decided by pathological evaluation of biopsies (samples of the tumor) taken during surgery. The surgeon will also evaluate how large an area the cancer covers.

• Staging will help your doctor determine the treatment for your cancer. A stage 4 cancer will require more treatment than a stage 1 cancer. It is always important to see your doctor as soon as possible with any worrisome symptoms and to schedule appropriate screening tests. If a cancer is diagnosed early the 5-year survival rate is much higher than if the cancer is diagnosed at a later stage.
• Cancer treatment can include surgery, radiation, and chemotherapy. These treatments either remove or “kill” the cancer cells.
• Unfortunately, cancer can spread further than the original tumor. For example, if the cancerous tumor starts in the ovary, cancer cells from the ovary can spread through the bloodstream to the liver, lungs, or brain. This process is called metastasis. Chemotherapy drugs can help eliminate the cancer cells that may spread to other parts of the body.
• A cancer may be classified as terminal if there are no further traditional options for treatment. At this point a patient may be eligible for clinical trials.
• Clinical trials are experimental cancer treatment programs that may help prolong the life of cancer patients. However, clinical trials are still experimental so the outcomes and side effects may not be known.

 

Remember:

Fighting cancer is a team effort. You, your family and friends, and your healthcare team work together to fight cancer and promote health.

• Take care of yourself. Make sure you eat a healthy diet and get plenty of rest.
• Don’t hesitate to ask for help. Ask friends and family to help with childcare, cooking and housework. People are generally happy to have a way to help.
• Share your feelings. Talk to friends and family. Join a support group.

• Educate yourself. Below, you will find some recommended websites where you can learn more about gynecological cancer.

• Finally, one of the most important things you can do as a patient is to ASK QUESTIONS. You are a partner in your own care and it is critical that you understand your diagnosis and treatment to ensure you are able to make choices that are best for you and your family.

 

Resources:

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These statements do not reflect professional opinions, diagnoses,  treatment, or services to you or any other individual. The information  provided on this page is not a substitute for medical or professional  care, and you should not use the information in place of a visit to your healthcare provider. Karen Leung Foundation is not liable or responsible for any advice,  course of treatment, diagnosis, or any other information or services you obtain through this page.