Cancers can occur in any part of the female reproductive system—the vulva, vagina, cervix, uterus, fallopian tubes, or ovaries. These cancers are called gynecologic cancers.

Gynecologic cancers can directly invade nearby tissues and organs or spread (metastasize) through the lymphatic vessels and lymph nodes (lymphatic system) or bloodstream to distant parts of the body.

Diagnosis

Regular pelvic examinations and Papanicolaou (Pap) tests or other similar tests (see Symptoms and Diagnosis of Gynecologic Disorders: Gynecologic Examination) can lead to the early detection of certain gynecologic cancers, especially cancer of the cervix and uterus. Such examinations can sometimes prevent cancer by detecting abnormalities (precancerous conditions) before they develop into cancer.

If cancer is suspected, a biopsy can usually confirm or rule out the diagnosis. If cancer is diagnosed, one or more procedures may be performed to determine the stage of the cancer. The stage is based on how large the cancer is and how far it has spread. Some commonly used procedures include ultrasonography, computed tomography (CT), magnetic resonance imaging (MRI), chest x-rays, and bone and liver scans using radioactive substances.

Staging a cancer helps doctors choose the best treatment. Doctors often determine the stage of cancer after they remove the cancer and perform biopsies of the surrounding tissues, including lymph nodes. For cancers of the uterus and ovaries, stages range from I (the earliest) to IV (advanced). For the other gynecologic cancers, stage 0 is the earliest stage, when the cancer is confined to a surface of the affected organ. For some cancers, further distinctions, designated by letters of the alphabet, are made within stages.

Staging Cancers of the Female Reproductive System* Type Stage 0 Stage I Stage II Stage III Stage IV Endometrial cancer — Only in the upper part of the uterus (not the cervix) Spread to the cervix Spread to nearby tissues but still within the pelvic area A: Spread to the bladder or rectum B: Spread to distant organs Ovarian cancer — Only in one or both ovaries Spread to the uterus, fallopian tubes, and/or nearby tissues within the pelvis Spread outside the pelvis to the lymph nodes or other organs in the abdomen (such as the surface of the liver or intestine) Spread outside the abdomen or to the inside of the liver Cervical cancer Only on the surface of the cervix Only in the cervix Spread to nearby tissues but still within the pelvic area Spread throughout the pelvic area, sometimes blocking the ureters A: Spread to the bladder or rectum B: Spread to distant organs Vulvar cancer Only on the surface of the vulva Only in the vulva and/or the area between the opening of the rectum and vagina (perineum); ¾ inch (2 centimeters) or smaller In the vulva and/or perineum, but larger than ¾ inch In the vulva and/or perineum and spread to nearby tissues and/or lymph nodes Spread beyond nearby tissues to the bladder, to the intestine, or to more distant lymph nodes Vaginal cancer Only in the lining of the vagina Only in the vagina but deeper (in the wall) Spread to nearby tissues but still within the pelvic area Spread throughout the pelvic area and possibly to nearby organs and lymph nodes A: Spread to the bladder or rectum B: Spread to distant organs Fallopian tube cancer Only in the lining of the fallopian tubes Only in the fallopian tubes but deeper (in the wall) Spread to nearby tissues but still within the pelvic area Spread throughout the pelvic area and possibly to nearby organs and lymph nodes Spread to distant organs *Simplified from the International Federation of Gynecology and Obstetrics staging system.

Treatment

The main treatment of gynecologic cancer is surgical removal of the tumor. Surgery may be followed by radiation therapy or chemotherapy. Radiation therapy may be external (using a large machine) or internal (using radioactive implants placed directly on the cancer). External radiation therapy is usually given several days a week for several weeks. Internal radiation therapy involves staying in the hospital for several days while the implants are in place.

Chemotherapy may be given by injection or by mouth. Chemotherapy is given for 5 days to 6 weeks (depending on the drugs) followed by a recovery period of several weeks without chemotherapy. The cycle may be repeated several times. A woman may have to remain at the hospital while she receives chemotherapy.

When a gynecologic cancer is very advanced and a cure is not possible, radiation therapy or chemotherapy may still be recommended to reduce the size of the cancer or its metastases and to relieve pain and other symptoms. Women with incurable cancer should establish advance directives (see Legal and Ethical Issues: Advance Directives). Because end-of-life care has improved, more and more women with incurable cancer are able to die comfortably at home (see Death and Dying: Introduction). Appropriate drugs can be used to relieve the anxiety and pain commonly experienced by people with incurable cancer.

Last full review/revision February 2003