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Overview of Female Reproductive System Cancers

By Pedro T. Ramirez, MD, Professor, Department of Gynecologic Oncology and Reproductive Medicine, David M. Gershenson Distinguished Professor in Ovarian Cancer Research, and Director of Minimally Invasive Surgical Research and Education, The University of Texas MD Anderson Cancer Center
Gloria Salvo, MD, Rotating Research Resident, Department of Gynecologic Oncology and Reproductive Medicine, MD Anderson Cancer Center

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.

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

  • Regular pelvic examinations

  • Biopsy

Regular pelvic examinations and Papanicolaou (Pap) tests or other similar tests can lead to the early detection of certain gynecologic cancers, especially cancer of the cervix. Such examinations can sometimes prevent cancer by detecting precancerous changes (dysplasia) before they become cancer. Regular pelvic examinations can also detect early 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.

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.

Staging Cancers of the Female Reproductive System*

Type

Stage I

Stage II

Stage III

Stage IV

Only in the cervix

Spread outside the cervix (including the upper part of the vagina) but still within the pelvis

Spread throughout the pelvis and/or to the lower part of the vagina and/or blocks the ureters and/or causes a kidney to malfunction

Spread outside the pelvis and/or to the bladder or rectum (A) or distant organs (B)

Only in the upper part of the uterus (not in the cervix)

Spread to the cervix

Spread to nearby tissues, the vagina, or lymph nodes

Spread to the bladder and/or intestine (A) and/or distant organs (B)

Only in one or both fallopian tubes

Spread to nearby tissues but still within the pelvis

Spread outside the pelvis to lymph nodes or to abdominal organs (such as the surface of the liver)

Spread to distant organs

Only in one or both ovaries or fallopian tubes

Spread to the uterus, or nearby tissues within the pelvis

Spread outside the pelvis to lymph nodes or to other parts of the abdomen (such as the surface of the liver)

Spread outside the abdomen (for example, to the lungs)

Only in the wall of the vagina

Spread through the wall of the vagina to nearby tissues but still within the pelvis

Spread throughout the pelvis (but not the bladder or rectum)

Spread to the bladder or rectum or outside of the pelvis

Only in the vulva or the area between the opening of the rectum and vagina (perineum)

Spread to nearby tissues, such as the lower part of the urethra or vagina or to the anus but not to nearby lymph nodes

Spread to nearby lymph nodes, with or without spread to nearby tissues

Spread beyond nearby tissues to the bladder, the upper part of the vagina or urethra, the rectum, pelvic bone, more distant lymph nodes, or outside the pelvis

*Simplified from the International Federation of Gynecology and Obstetrics Staging System.

Stage IV is sometimes further classified as A or B depending on where the cancer has spread.

The pelvis refers to the lowest part of the torso, the area below the abdomen and between the hip bones. It contains the internal reproductive organs, bladder, and rectum.

Treatment

  • 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 the cancer if possible (through a single treatment or through a combination of surgery, radiation therapy, and chemotherapy).

Chemotherapy is usually the most effective way to treat any cancer cells that have spread beyond the original site. Using combinations of chemotherapy drugs may help eliminate the original cancer and eliminate cancer cells elsewhere in the body, even when there is no sign of those cells.

For endometrial or ovarian cancer, the main treatment is surgical removal of the tumor. Surgery may be followed by radiation therapy or chemotherapy or, for endometrial cancer, hormonal therapy.

In women with cervical cancer, 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, by mouth, or through a catheter inserted into the abdomen (intraperitoneally). How often chemotherapy is given depends on the type of cancer. Sometimes women have to remain at the hospital while they receive 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. Because end-of-life care has improved, more and more women with incurable cancer are able to die comfortably at home. Appropriate drugs can be used to relieve the anxiety and pain commonly experienced by people with incurable cancer.

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