Although many cancers affect both men and women equally, there are several types of cancer that occur only in women. Breast cancer is the most common type of women’s cancer worldwide, but men can also develop breast cancer, and breast malignancies will not be covered here. Instead, this article will provide a simple overview of the common forms of gynecologic malignancy, and a few tips for women to consider in planning their health care.
The cervix is the area where the vaginal canal connects to the uterus, or womb. Cancer of the cervix commonly occurs in younger women, with a peak occurring in women in their 40s. Historically, cervical cancer was one of the most common causes of cancer death in women in the United States. However, that pattern changed dramatically across the 20th century, as the Pap smear came into widespread use. Named for Dr. Georgios Papanikolaou, the pathologist who developed the technique for the test in the 1920s, the Pap smear is an effective way of identifying cervical cancer or pre-cancerous changes of the cervix. This means that more cancers can be identified at an early stage, when they are more likely to be cured with treatment. Since the Pap smear became a standard of medical care within the last 50 years, there has been a 75 percent decrease in the death rate associated with cervical cancer.
Almost all cases of cervical cancer are linked to an infection known as human papilloma virus, or HPV. Testing for HPV infection can be incorporated into the Pap test. Starting in 2006, several types of HPV vaccination have become available. In the U.S., these vaccinations are known as GARDASIL® and GARDASIL 9®. The United State Advisory Committee on Immunization (ACIP) currently recommends that all girls age 11-12 undergo vaccination, and that “catch-up” vaccination be performed for women age 13-26 who did not receive vaccination when they were younger. In years to come, it is expected that routine use of HPV vaccination will further reduce the incidence of cervical cancer.
The ovaries are the parts of the female reproductive system that produce eggs, and are also the primary location at which female hormones (estrogen and progesterone) are produced. Each year in the United States, there are about 22,000 new diagnoses of cancer of the ovary each year, and about 14,000 deaths due to ovarian cancer. Ovarian cancer is more common in women beyond age 60. Unfortunately, this cancer causes few if any symptoms while in its early stages, meaning that the disease has often reached stage III or higher by the time it is diagnosed. Physical examination of the area of the ovaries is routinely performed as part of the process of doing an annual pelvic examination, and this can be followed by ultrasound imaging or other radiographic studies if there is suspicion.
Unlike cervical cancer, risk of developing ovarian cancer is not tied to any form of infection, as best we can tell. However, a woman’s risk can be affected in a small way by several factors, including her age at her first pregnancy and whether or not she received birth control medications. In recent years, we have gained a much better understanding of how the risk for ovarian cancer can run in families. Women who inherit a problem with genes called BRCA1 or BRCA2 have a significantly higher chance of developing ovarian cancer, and the risk is also increased in association with an inherited condition called Lynch Syndrome.
UTERINE (ENDOMETRIAL) CANCER
Cancer of the uterus, or womb, is the most frequently-occurring gynecologic malignancy in the United States, with about 60,000 new cases each year. The lining of the uterus where most cancers develop is called endometrium, so the common form of cancer of the uterus is called endometrial cancer. This type of cancer is most common in women who are post-menopausal, and about 60 percent of all cases are diagnosed in women between the ages of 55 and 75. Physical examination of the uterus, done at the time of most pelvic exams, can help to detect abnormalities that might indicate cancer is developing.
Risk of endometrial cancer can be increased in women who receive certain forms of hormone replacement therapy after menopause. The risk is also higher in women who are significantly overweight, probably because obesity is associated with higher levels of estrogen in the bloodstream. Patients with Lynch syndrome have an increased risk of uterine cancers.
SO, WHAT DOES A WOMAN NEED TO DO TO REDUCE RISK?
First, get regular checkups, starting even in your 20s. Your health care provider can provide annual pelvic examinations that are the most important part of monitoring for female cancers, or can refer you to a gynecologic specialist if needed. Because cervical cancer commonly happens in younger women, it’s important to continue annual checks without fail, even if you feel you’re doing well. It may be okay for many women to stop having regular Pap smears at age 65, but you should not do this on your own without going over your records with your doctor. If you’re below age 27 and did not receive HPV vaccination when you were younger, ask your provider if you’re a candidate for immunization. Most women do not need to undergo genetic workup for BRCA or Lynch syndromes, but reviewing your family medical history with your doctor or nurse practitioner can help determine if this testing needs to be considered. Your health care provider can also make sure that mammography (screening for breast cancer) is done starting around age 40, and that screening colonoscopy is set up around age 50. Cancers can still happen in patients who have regular screening, but those cancers are more likely to be caught at an early stage and, therefore, more likely to be fully cured.
WHAT IF I’M DIAGNOSED WITH A GYNECOLOGIC CANCER?
Gynecologic malignancies are treatable and often can be cured, and it’s important to remember this if you do receive a diagnosis of cancer. Most of the time, treatment involves a Gynecologic Oncology specialist. In the past, north Mississippi patients usually had to travel to Jackson, Birmingham, Nashville or Memphis for this type of surgical care. However, North Mississippi Medical Center has partnered with the specialty team from the University of Alabama at Birmingham to bring Gynecologic Oncology treatment closer to home. UAB specialists now be see patients at NMMC Cancer Care, 961 S. Gloster St. in Tupelo, and many patients who require surgery will be able to have their procedure performed at NMMC.
WHERE ELSE CAN I LOOK FOR INFORMATION?
Keep in mind that there’s a lot of misinformation on the internet. Patients can get trustworthy guidance from the National Comprehensive Cancer Network ( www.NCCN.org/patients) or the American Cancer Society ( www.cancer.org/cancer.html). If you have unanswered questions or think you may have symptoms of a cancer, schedule an appointment with your physician’s office.
By Dr. Paschal Wilson, M.D.
Paschal Wilson, M.D., is a hematologist/oncologist at NMMC Cancer Care in Tupelo.