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.
Locating the Internal Female Reproductive Organs
The most common gynecologic cancer in the United States is cancer of the uterus (endometrial cancer), followed by ovarian cancer, then cervical cancer. The cervix is the lower part of the uterus, but cancer of the cervix is usually called cervical cancer, and cancer of the body of the uterus is called uterine cancer (or endometrial cancer). Most cervical cancers are caused by human papillomavirus (HPV) infection. Cervical cancer is less common in high-resource than in middle- or low-resource countries because, in high-resource countries, screening for cervical cancer, HPV testing, and the HPV vaccine are widely available, which often allows treatment of abnormal cells before cancer develops.
Gynecologic cancers can spread in the following ways:
Directly invade nearby tissues and organs
Spread (metastasize) through the lymphatic vessels and lymph nodes (lymphatic system) or through the bloodstream to distant parts of the body
Diagnosis of Female Reproductive System Cancers
Regular pelvic examinations
Biopsy
Regular pelvic examinations and screening for certain gynecologic cancers, especially cancer of the cervix, can lead to the early detection of these cancers. Screening for cervical cancer includes the Papanicolaou (Pap) test and HPV testing. Such examinations can sometimes prevent cancer by detecting precancerous changes (dysplasia) before they become cancer. Regular pelvic examinations can also detect cancers of the vagina and vulva. However, cancers of the ovaries, uterus, and fallopian tubes are not easy for doctors to detect during a pelvic examination.
If cancer is suspected, a biopsy can confirm or rule out the diagnosis. A sample of tissue from the affected organ is removed, examined under a microscope, and analyzed. For some cancers, such as ovarian cancer, surgery must usually be done to make the diagnosis.
Staging
If cancer is diagnosed, one or more procedures may be done 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 positive emission tomography (PET). Doctors often determine the stage of cancer after they remove the cancer and biopsy the surrounding tissues, including lymph nodes.
Staging a cancer helps doctors choose the best treatment.
For all gynecologic cancers, stages range from I (the earliest) to IV (advanced). For most cancers, further distinctions, designated by letters of the alphabet, are made within stages.
Treatment of Female Reproductive System Cancers
Usually, surgical removal
Sometimes radiation therapy and/or chemotherapy
Cancer treatment may include surgical removal, radiation therapy, and chemotherapy, depending on the type and stage of cancer. When cancer is first diagnosed, the main goal of treatment is to remove or stop the growth of the cancer if possible.
Chemotherapy is usually the most effective way to treat any cancer cells that have spread beyond the original site. Chemotherapy may be given by injection, by mouth, or through a catheter inserted into the abdomen (intraperitoneally).
Radiation therapy is usually given if a tumor has spread to surrounding tissues that are next to the original tumor, such as spread of a tumor of the uterus to the bladder.
For some gynecologic cancers, hormone therapy or hormone blockers are given as additional treatment, usually after surgery, chemotherapy, and/or radiation therapy have been completed. Hormone therapy works by stimulating or blocking hormone receptors to stop growth of any tumor cells that have spread from the original site.
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. Because end-of-life care has improved, more and more women with incurable cancer are able to die comfortably at home. Appropriate medications can be used to relieve the anxiety and pain commonly experienced by people with incurable cancer.
