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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.
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.
Talking with healthcare providers about cancer can be overwhelming. It can be hard to take in all of the information. It helps to be prepared. Make a list of questions and bring them to your appointments. Write the answers down in a notebook. Make sure you ask how the treatment will change your daily life, including your diet, and how you will look and feel after treatment. Ask how successful the treatment is expected to be, and what the risks and possible side effects are. You may also want to ask a friend or family member to go with you. He or she can take notes and write down the answers, and also ask questions you may not think of. You can also ask your healthcare provider if you can record the conversation.
Below are some questions to ask during your appointments.
What kind of vulvar cancer do I have?
What is the grade and stage of my cancer?
Has the cancer spread anywhere else in my body?
What are my treatment choices?
What treatment do you think is best for me? Why?
What side effects should I expect?
How long will side effects last?
Will treatment affect my sex life? How? For how long?
Will I be able to have children after treatment?
What are the goals of the treatment you’re recommending?
What is the success rate of this treatment for my type and stage of vulvar cancer?
What is the life expectancy for someone with my stage of cancer receiving this treatment?
Are there any clinical trials that I can apply for?
Will my health insurance cover treatment?
Will there be costs I have to pay?
What can I do to get ready for treatment?
Will I have to stay in the hospital? For how long?
How long will the surgery take?
What will you do during the surgery?
Will you have to take out lymph nodes?
What will recovery be like? How long will it take?
What is the length of the treatment period?
How long will each treatment take?
Where do I have to go for the treatment?
Who will give me the treatment?
Does someone need to go with me during treatments?
Can I take my other medicines during treatment?
Are there side effects that I need to call you about?
How do I reach you after hours and on weekends?
What can I do to ease the side effects?
Should I change my diet? What foods can't I eat?
Will I be able to go to work and be around my family?
Are there support groups nearby that I can join?
How will I feel after the treatment?
How will my body look and work after treatment?
What type of follow-up will I need after treatment?
Who will I need to see for my follow-up care?
What long-term side effects do I need to watch for?
How will we know if treatment worked?
What are the risks of the cancer coming back?
Vulvar cancer is cancer of the vulva, a woman's external genitals. This is a very rare form of cancer.
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