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More than 71,000 women in the United States are diagnosed with a cancer affecting the reproductive organs each year, according to the National Cancer Institute. These cancers can include endometrial, ovarian and cervical among others. Some of these cancers are more difficult to detect and treat than others, but advances are being made to help if you are facing one of these diseases.
Baylor offers a comprehensive approach to diagnosing and treating women with gynecologic cancer. Physicians on the medical staff at Baylor work with other health care specialists to treat and heal the whole woman.
Cancer is when cells in the body change and grow out of control. To help you understand what happens when you have cancer, let's look at how your body works normally. Your body is made up of tiny building blocks called cells. Normal cells grow when your body needs them, and die when your body does not need them any longer.
Cancer is made up of abnormal cells that grow even though your body doesn't need them. In most cancers, the abnormal cells grow to form a lump or mass called a tumor. If cancer cells are in the body long enough, they can grow into (invade) nearby areas. They can even spread to other parts of the body (metastasis).
Cancer that starts in cells of the cervix is called cervical cancer.
The cervix is the lower, narrow part of the womb (uterus). It's located between the bladder and the rectum. It forms a canal that opens into the birth canal (vagina), which leads to the outside of the body.
Precancerous cells on the cervix are the first sign that cervical cancer may develop. These cells can be seen on a Pap test. They are cells that look abnormal, but are not yet cancer. The appearance of these cells may be the first sign of cancer that will grow years later. Treating these precancer cells can prevent cancer from growing. Precancer cells of the cervix often don’t cause pain or other symptoms. This is why regular cervical cancer screening is so important.
Squamous intraepithelial lesions (SIL) is a term that refers to abnormal changes in the cells on the surface of the cervix. Changes in these cells can be divided into 2 categories:
Low-grade SIL. This refers to early changes in the size, shape, and number of cells that form the surface of the cervix. They may go away on their own or, with time, may grow larger or become more abnormal, forming a high-grade lesion.These changes may also be called mild dysplasia or cervical intraepithelial neoplasia 1 (CIN 1).
High-grade SIL. This means there are a large number of precancer cells, and, like low-grade SIL, these changes involve only cells on the surface of the cervix. The cells often do not become cancerous for many months, perhaps years, but without treatment, they will become cancer. High-grade lesions may also be called moderate or severe dysplasia, CIN 2 or 3, or carcinoma in situ.
If abnormal cells on the surface of the cervix are not found and treated, over time they can spread deeper into the cervix, or to other tissues or organs. This is then called cervical cancer, or invasive cervical cancer. Cervical cancer occurs most often in women younger than the age of 50. Most cervical cancer is squamous cell carcinoma or adenocarcinoma.
The death rates for cervical cancer have declined sharply as Pap screenings have become more prevalent. Today, most cervical cancer is found in women who have not had regular screening.
Cervical cancer is one of the few types of cancer that doctors know how to prevent. There are two key ways to prevent cervical cancer:
Get regular Pap tests. These are done to find and treat any precancerous cells as soon as possible.
Prevent precancer cells. You can do this by avoiding contact with the human papilloma virus (HPV), getting an HPV vaccine, and not smoking.
Cervical cancer occurs in the cervix, which is in the lower part of the uterus. It is caused by several types of the human papillomavirus (HPV) that spreads through sexual contact.
The ovaries are female reproductive organs located in the pelvis. There are 2 of them — 1 on each side of the uterus. The ovaries produce eggs and the female hormones estrogen and progesterone. Estrogen and progesterone control the development of female body characteristics (for example, breasts, body shape and body hair) and regulate the menstrual cycle and pregnancy.
Ovarian cancer is a disease in which cancer starts in the cells of the ovary. There are 3 types of ovarian tumors, named for the tissue in which they are found:
Epithelial cell. These are cells that cover the surface of the ovary. Most of these tumors are benign (noncancerous) and account for most cases of ovarian cancer.
Germ cell. These are cells that form the eggs in the ovary.
Stromal cell. These cells form the structural tissue of the ovary and produce female hormones.
EOPPC is a cancer closely related to epithelial ovarian cancer. Its microscopic features and national history of disease and prognosis are identical to epithelial ovarian cancer. It occurs outside the ovary in the peritoneum, which is the lining of the abdomen (belly). Because it occurs outside the ovary, women who have had their ovaries removed can still develop this type of cancer.
EOPPC can mimic ovarian cancer in terms of symptoms and can also cause an increase in the CA-125 tumor marker. Treatment is similar to that for ovarian cancer and includes surgery and chemotherapy.
The cause of ovarian cancer is not yet known because most cases are sporadic. An estimated 21,980 new cases of ovarian cancer are expected in the U.S. in 2014. Ovarian cancer is the ninth most common form of cancer among women.
The cause of ovarian cancer is unknown, but there are certain risk factors that indicate an increase in a woman's chance of developing ovarian cancer. The following have been suggested as risk factors for ovarian cancer:
Age (over the age of 55)
Hormone replacement therapy. Some studies have suggested that women who use hormone replacement therapy after menopause may have a slightly increased risk of ovarian cancer.
Infertility (inability to become pregnant)
Personal history of breast or colon cancer
Family history. First-degree relatives (such as mother, daughter, sister) of a woman who has had ovarian cancer are at risk for developing the disease. The risk increases if 2 or more first-degree relatives have had ovarian cancer. A family history of breast or colon cancer is also associated with an increased risk of developing ovarian cancer.
Certain fertility drugs
Suggested preventive measures include the following:
Healthy diet (high in fruits, vegetables, grains, and low in saturated fat)
Staying at a healthy weight throughout life
Birth control pills
Pregnancy and breastfeeding
Oophorectomy. Surgical removal of ovaries if you're at high risk for ovarian cancer.
Research studies have shown that certain genes are responsible for increasing the risk of ovarian and breast cancer. Genetic counseling can tell you whether you have 1 of these gene mutations. If your family history suggests that you may have 1 of these gene mutations, you might want to talk to your doctor about genetic testing.
The following are the most common symptoms of ovarian cancer. However, each individual may experience symptoms differently. Symptoms may include:
General discomfort in the lower abdomen, including any or all of the following:
Feeling swollen or bloated
A loss of appetite or a feeling of fullness — even after a light meal
Gas, indigestion, and nausea
Diarrhea or constipation, or frequent urination caused by the growing tumor, which may press on nearby organs, such as the bowel or bladder
Feeling very tired all the time
Bleeding from the vagina
Buildup of fluid around the lungs, which may cause shortness of breath
If any of these symptoms occur almost daily or last a few weeks and are new, they should be reported to the doctor. In many cases, symptoms do not occur until the ovarian cancer is in an advanced stage, meaning it has spread beyond the ovary in which it started. The symptoms of ovarian cancer may resemble other medical conditions or problems. Always consult your doctor for a diagnosis.
Diagnosis includes a medical history and physical examination, including a pelvic examination to check the vagina, rectum, and lower abdomen for masses or growths. A Pap test may be done as part of the pelvic examination. The definitive diagnosis is made at the time of surgery. The doctor may also order other tests, such as:
Ultrasound. An imaging technique that uses sound waves to produce an image on a monitor of the abdominal organs, such as the uterus, liver, and kidneys.
Computed tomography (CT or CAT scan). A noninvasive diagnostic imaging procedure that uses a combination of X-rays and computer technology to produce horizontal, or axial, images (often called slices) of the body. The CT scan may indicate enlarged lymph nodes — a possible sign of a spreading cancer or infection.
Lower gastrointestinal (GI) series. X-rays of the colon and rectum using a contrast dye called barium.
Intravenous pyelogram (IVP). X-rays of the kidneys and ureters, taken after the injection of a dye.
Blood test. To measure a substance in the blood called CA-125 (a tumor marker that is often found to be elevated in the blood of women with ovarian cancer). This test is more often used to monitor the progress of treatment than as a screening test since noncancer problems can cause it to be elevated.
Biopsy. A procedure in which tissue samples are removed from the ovary for examination under a microscope. This is done to see if cancer or other abnormal cells are present. The diagnosis of cancer is confirmed only by a biopsy.
Specific treatment for ovarian cancer will be determined by your doctor based on:
Your age, overall health, and medical history
Extent of the disease
Your tolerance for specific medications, procedures, or therapies
Expectations for the course of the disease
Your opinion or preference
It's very important that your particular findings be put into context by an expert. Gynecologic oncologists are subspecialists with advanced training in the diagnosis, treatment, and surveillance of female cancers including ovarian cancer.
Ovarian cancer may be treated with surgery, chemotherapy, radiation therapy, or a combination of treatments.
Surgery. Surgery for ovarian cancer may include:
Salpingo-oophorectomy. Surgery to remove the fallopian tubes and ovaries.
Hysterectomy. Surgical removal of the uterus.
Pelvic lymph node dissection. Removal of some lymph nodes from the pelvis.
Chemotherapy. This is the use of anticancer drugs to treat cancerous cells. In most cases, chemotherapy works by interfering with the cancer cell's ability to grow or reproduce. Different groups of drugs work in different ways to fight cancer cells. The oncologist will recommend a treatment plan for each individual. Usually, chemotherapy is given intravenously. Another way to treat ovarian cancer is through intraperitoneal (IP) chemotherapy. This type of chemotherapy is given directly into the abdomen through a long, thin tube called a catheter. It is only used for women with ovarian cancer that has spread to the inside of the abdomen.
Radiation therapy. Radiation therapy is rarely used for ovarian cancer. Radiation therapy is the use of high-energy radiation to kill cancer cells and to shrink tumors. There are 2 ways to deliver radiation therapy:
External radiation (external beam therapy). A treatment that precisely sends high levels of radiation directly to the cancer cells. Since radiation is used to kill cancer cells and to shrink tumors, special shields may be used to protect the tissue surrounding the treatment area. Radiation treatments are painless and usually last a few minutes.
Internal radiation (brachytherapy, implant radiation). Radiation is given inside the body as close to the cancer as possible. In some cases, a treatment called intraperitoneal radiation therapy is used. A radioactive liquid is given through a catheter into the abdomen. (Internal radiation is very rarely used to treat ovarian cancer.)
Ovarian cancer occurs in the ovaries, the female reproductive organs that produce eggs. It usually occurs in women over 50, but can affect younger women as well.
The uterus, also called the womb, is a hollow, pear-shaped organ located in a woman's lower abdomen (belly), between the bladder and the rectum.
Cervix. This is the narrow, lower portion of the uterus.
Corpus. This is the broader, upper part of the uterus.
Serosa. This is the outer layer that covers the uterus.
Myometrium. This is the middle layer of the corpus, the thick muscle that expands during pregnancy to hold the growing fetus.
Endometrium. This is the inner lining of the uterus.
Cancers that occur in each part of the uterus have their own names, such as cervical cancer or endometrial cancer, but are sometimes broadly defined as uterine cancer because the structure is part of the uterus. Cancer of the uterus spreads through the bloodstream or lymphatic system. According to the American Cancer Society, nearly 50,000 cases of cancer of the uterine corpus (body of the uterus) are diagnosed in the U.S. each year.
Some conditions in the uterus, caused by abnormal, rapid, and uncontrolled division of cells, are not cancer. They are called benign conditions. Three of these benign conditions are:
Fibroid tumors. These are common benign tumors of the uterine muscle that do not develop into cancer. Fibroid tumors of the uterus are very often found in women in their forties. And, although single fibroid tumors do occur, multiple tumors are more common. Symptoms of fibroid tumors, which depend on size and location, include irregular bleeding, vaginal discharge, and frequent urination. For fibroids that press against nearby organs and cause pain, surgery may be necessary. Many times, however, fibroids do not cause symptoms and do not need to be treated. After menstrual periods cease, fibroid tumors may become smaller and may disappear altogether.
Endometriosis. This is is a benign condition of the uterus that is common among women in their thirties and forties, especially women who have never been pregnant. Tissue that looks and acts like endometrial tissue begins to grow in unusual places, such as on the surface of the ovaries, on the outside of the uterus, and in other tissues in the abdomen.
Hyperplasia. This is an increase in the number of normal cells lining the uterus. Although it is not cancer, it may develop into cancer in some women. The most common symptoms are heavy menstrual periods, bleeding between periods, and bleeding after menopause.
The following are risk factors for uterine cancer:
Age. The risk goes up as women get older.
History of endometrial hyperplasia
Estrogen therapy (ET)
Obesity is the leading risk factor for endometrial cancer
History of an inherited form of colon cancer (called hereditary nonpolyposis colon cancer or Lynch syndrome)
History of breast or ovarian cancer
History of taking tamoxifen for breast cancer treatment or prevention
Race. African-American women are affected with uterine sarcoma at a rate twice that of white or Asian women.
History of radiation therapy to the pelvic area
History of polycystic ovary syndrome (PCOS)
Reproductive and menstrual history. An increased risk is linked to never having children, having your first menstrual period before age 12, and/or going through menopause after age 55.
The following are the most common symptoms of uterine cancer. However, each individual may experience symptoms differently. Symptoms may include:
Unusual vaginal bleeding, spotting, or discharge
Vaginal bleeding after menopause
Frequent, difficult, or painful urination
Pain during sexual intercourse
Pain in the pelvic area
Cancer of the uterus usually does not occur before menopause. It usually occurs around the time menopause begins. The occasional reappearance of bleeding should not be considered simply part of menopause. It should always be checked by a doctor.
The symptoms of uterine cancer may look a lot like other conditions or medical problems. Consult a doctor for diagnosis.
When symptoms suggest uterine cancer, the following may be used to make a positive diagnosis:
A detailed medical history--family and personal
A thorough physical exam
Pelvic examination of the uterus, vagina, ovaries, bladder, and rectum (may include a Pap test)
Ultrasound to look at the uterus and nearby tissue and check for tumors
Biopsy. Removal of a sample of tissue to see if the tissue contains cancer cells.
Dilation and curettage (D & C). A minor operation in which the cervix is dilated (expanded) so that the cervical canal and uterine lining can be scraped with a curette (spoon-shaped instrument). The removed tissue is checked to see if it contains cancer cells.
When cancer cells are found, other tests are used to see if the disease has spread from the uterus to other parts of the body. These procedures may include:
Computed tomography (CT or CAT) scans of various sections of the abdomen (belly)
An ultrasound to view organs inside the body
Special exams of the bladder, colon, and rectum
Specific treatment for uterine cancer will be determined by your doctor based on:
Your overall health and medical history
Methods of treatment may include:
Hysterectomy. Surgery to remove the uterus. Sometimes this is done with salpingo-oophorectomy, which is a surgery to remove the fallopian tubes and ovaries. Nearby lymph nodes and part of the vagina may also be removed.
Uterine (Endometrial) cancer is a cancer that occurs in the uterus, an important female reproductive organ.
If your healthcare provider thinks you might have vaginal cancer, certain exams and tests will need to be done to be sure. Diagnosing vaginal cancer starts with your healthcare provider asking you questions. You will be asked about your medical history, your symptoms, risk factors, and family history of disease. Your healthcare provider will also give you a physical exam. This will include an exam of your vagina and other organs in the pelvis to check for tumors or lumps.
You may have one or more of these tests:
Colposcopy. This test uses a tool called a colposcope to closely examine the cervix and vagina. If abnormal tissue is found, a small piece of it may be removed so it can be checked for cancer cells. This is called a colposcopic biopsy.
Pap test. This is also called a Pap smear. A swab is wiped on the cervix to pick up cells. The cells are then checked under a microscope. They’re checked for any signs of cancer or precancer, infection or inflammation.
Computed tomography (CT) scan. This test uses a series of X-rays and a computer to make images of the body. A CT scan is more detailed than regular X-rays. They help show where the cancer is growing and if it has spread to other parts of your body. A CT scan can help find cancer in the chest, abdomen, and pelvis.
Magnetic resonance imaging (MRI). This test uses large magnets, radiofrequencies, and a computer to make detailed images of organs and tissues in the body.
Positron emission tomography (PET) scan. For this test, a radioactive sugar is injected into the bloodstream. Cancer cells use more sugar than normal cells, so the sugar will collect in cancer cells. A special camera is used to see where the radioactive sugar is in the body. A PET scan can sometimes spot cancer in different areas of the body, even when they can’t be seen by other tests. It can also show if cancer treatment is working.
Biopsy. A biopsy is when small pieces of tissue from the vagina are taken and looked at with a microscope. The tissue is checked for cancer.
When your healthcare provider has the results of your tests, he or she will talk with you about next steps. Your provider will talk with you about other tests you may need if vaginal cancer is found. This may include repeating the biopsy or more tests. Make sure you understand the results and what follow-up you need.
Cancer of the vagina is rare and usually occurs in women over 60. An infection of the human papillomavirus (HPV) may also increase your chances of developing vaginal cancer.
The vulva is the external portion of the female genital organs. It includes:
Labia majora. Two large, fleshy lips, or folds of skin.
Labia minora. Small lips just inside the labia majora and surround the openings to the urethra and vagina.
Vestibule. Space where the vagina opens.
Prepuce. A fold of skin formed by the labia minora that covers the clitoris.
Clitoris. A small protrusion of nerve tissue sensitive to stimulation.
Fourchette. Area beneath the vaginal opening where the labia minora meet.
Perineum. Area between the vagina and the anus.
Anus. Opening at the end of the anal canal.
Urethra. Connecting tube to the bladder.
Vulvar cancer can occur on any part of the external organs, but most often affects the labia majora or labia minora. According to the American Cancer Society, about 4,850 cases of cancer of the vulva will be diagnosed in the U.S. in 2014. Cancer of the vulva is a rare disease, which accounts for 0.6% of all cancers in women, and may form slowly over many years. Most vulvar cancers are squamous cell carcinomas. Melanoma is another common type of vulvar cancer, usually found in the labia minora or clitoris. Other types of vulvar cancer include:
Basal cell carcinoma
The following have been suggested as risk factors for vulvar cancer:
Age. Of the women who develop vulvar cancer, over 80% are over age 50, and half are over age 70.
Infection with certain types of human papillomavirus (HPV)
Lichen sclerosus. This can cause the vulvar skin to become very itchy and may slightly increase the possibility of vulvar cancer.
Melanoma or atypical moles on nonvulvar skin. A family history of melanoma and dysplastic nevi anywhere on the body may increase the risk of vulvar cancer.
Vulvar intraepithelial neoplasia (VIN). There is an increased risk for vulvar cancer in women with VIN, although most cases do not progress to cancer.
Other genital cancers
While each woman may experience symptoms differently, the most common symptoms are:
Changes in the color and the way the vulva looks
Bleeding or discharge not related to menstruation
Severe burning, itching, or pain
An open sore that lasts for more than a month
Skin of the vulva looks white and feels rough
The symptoms of vulvar cancer may look like other conditions or medical problems. Consult a doctor for diagnosis.
The cause of vulvar cancer is not known at this time, however, certain risk factors are thought to contribute to development of the disease. Suggestions for prevention include:
Avoid known risk factors when possible
Delay onset of sexual activity
Do not smoke
Have regular physical checkups
Get vaccinated against HPV
Have routine Pap tests and pelvic exams
Routinely check entire body for irregular growth of moles and check your vulva regularly for any signs of vulvar cancer
Vulvar cancer is diagnosed by biopsy, removing a small piece of tissue for exam in a lab by a pathologist.
Specific treatment for vulvar cancer will be determined by your doctor(s) based on:
Treatment for cancer of the vulva may include:
Laser surgery. Use of a powerful beam of light to destroy abnormal cells. The beam can be directed to specific parts of the body without making a large incision (cut). This type of therapy is only used for premalignant (noninvasive) disease of the vulva.
Excision. The cancer cells and a margin of normal tissue around the cancer is removed.
Vulvectomy. Surgical removal of part of all of the tissues of the vulvar. The extent of the tissue removed is based on the size and location of the lesion.
It's very important that your particular findings be put into context by an expert. Gynecologic oncologists are subspecialists with advanced training in the diagnosis, treatment, and surveillance of female cancers including vulvar cancer.
Vulvar cancer is cancer of the vulva, a woman's external genitals. This is a very rare form of cancer.
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