While significant strides have been made in breast cancer survival rates, gynecological cancers are often more difficult to detect and treat. We talked to Jennifer Williams, M.D., a gynecologist and obstetrician at Piedmont Atlanta Hospital, to learn more about this group of cancers and their prognosis.
“Gynecologic cancers include cervical, ovarian, uterine, vaginal and vulvar cancers,” Dr. Williams explains.
The prognosis varies for each disease. For example, cervical cancer is often easy to detect because it can be found during a routine Pap smear. Ovarian cancer, on the other hand, often presents no symptoms until it is in stage III or IV, which often means a grim prognosis for the patient.
“Ovarian cancer can grow very large before it causes any symptoms at all,” she says. “Unfortunately, there is no good screening for ovarian cancer. The tests aren’t very specific – many conditions besides ovarian cancer can cause blood tests to be positive.”
Women who have a family history or have BRCA gene mutations are at higher risk for ovarian and breast cancer, so gynecologists tend to screen these groups more closely with a physical exam as well as a blood test and ultrasound on a yearly basis.
“Ovarian cancer definitely goes along with breast cancer [and can be genetic],” explains Dr. Williams.
It has the highest mortality rate of all gynecologic cancers because by the time it is detected, it has frequently spread to other areas of the body.
Cancers that have progressed to later stages and spread throughout the body are frequently treated with surgery and chemotherapy or radiation.
“Uterine cancer most commonly presents in abnormal uterine bleeding between menstrual cycles or after menopause, and is related to a family history of colon cancer,” says Dr. Williams. “If this happens more than once or twice a year, you need to be seen by a gynecologist. We’ll do an ultrasound and biopsy to look for abnormal cells.”
Uterine cancer can also be detected in its precancerous stage and is treated with medicine. In early stages of uterine cancer, it can be cured with a hysterectomy.
”Uterine cancer is related long history of abnormal periods and a family history of colon cancer,” she adds.
The gynecologic cancer with the best prognosis is cervical cancer because it is often caught very early or even in precancerous stages.
“If caught early, cervical cancer has a high survival rate,” she says. “Abnormal cells seen on Pap tests are precancerous [not cancerous] the vast majority of the time.”
Precancerous cells can be removed through large biopsies, allowing patients to lead completely normal lives.
“We know cervical cancer is caused by HPV [human papilloma virus], so we screen for it at your annual well-woman exam,” she says. “Screening regimen recommendations have recently changed because we understand you have to have high-risk HPV to get cervical cancer. A Pap smear is a way for us to look for abnormal cells. If the cells are normal, we follow up with a test for HPV. You can still carry it and have normal cells.”
HPV is a sexually transmitted disease that approximately 80 percent of women will contract at some point in their lifetime.
“Most women get it in their 20s, but few keep it their whole lives. Very few women will develop cervical cancer from it.”
For patients in their 20s, Dr. Williams recommends Pap tests every two to three years. For patients over the age of 30, Pap tests and HPV screenings are generally recommended every three to five years.
Vaginal and Vulvar Cancer
Both vaginal and vulvar cancers are fairly uncommon. Vaginal cancers can be caused by HPV and detected on Pap smears if cells are abnormal.
“If you carry HPV, we can see if there are changes in vaginal tissue. If vaginal cancer has progressed, it can present with painless vaginal bleeding.”
Vulvar cancer typically has noticeable symptoms, such as itching and changes in skin texture. If this occurs, a biopsy can be taken to determine if cells are abnormal.
“Vaginal cancer is so rare it depends on stage of detection, while vulvar cancer is usually detected in the precancerous stage and is therefore more treatable.”
The five-year survival rate for vaginal cancer is 50 percent because it is often not found until the later stages. Vulvar cancer is easier to detect and has a 75 percent five-year survival rate.
Preventing Gynecologic Cancers
There are several factors associated with an increased risk of cancer, including smoking and being overweight, as well as ways you can decrease your chances of gynecologic cancer.
“We know that birth control pills decrease a woman’s chances of ovarian cancer in the long run, although not enough that you should be on them just to prevent cancer,” notes Dr. Williams.
Preventing or treating HPV is a crucial component of gynecologic cancer prevention.
“Unfortunately, condoms don’t protect you. Even not having intercourse can’t protect you – any intimate contact could put you at risk,” she says. “Some strains cause warts, skin changes or even no symptoms at all. High-risk strains cause cancer.”
Gardasil, the most commonly-given HPV vaccine, protects against the two strains that cause 90 percent of warts and the two strains that cause 75 percent of cervical cancer cases.
“For anybody under the age of 26, I recommend the vaccine,” says Dr. Williams. “The earlier you get vaccinated, the better, because you don’t have to have intercourse to get HPV. Many pediatricians are offering it to their patients.”
When to See a Gynecologist
So what symptoms should women be aware of?
- Irregular bleeding
- Abnormal changes of skin on the vulva that don’t resolve over week or two
- A large increase in abdominal girth
- Significantly decreased appetite
- Early satiety or feeling full quickly
- A change in stool
- Significant weight loss
“Women should still get yearly well-woman exams,” she says. “You may not need a Pap smear every year, but we check your uterus and ovaries to make sure they feel normal, and conduct a breast exam to check for masses. Many of these conditions are very treatable if caught early.”
For more information about gynecologic cancers, visit the Piedmont Cancer Center.
HealthWatchMD recently interviewed an ovarian cancer survivor with a genetic predisposition to ovarian cancer and a stage IV ovarian cancer survivor who beat the odds with help from Dr. John McBroom. Learn more about how Dr. McBroom treats ovarian cancer with robotic surgery.