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Overview of Female Reproductive System Cancers

by Pedro T. Ramirez, MD, David M. Gershenson, MD

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.

Gynecologic cancers can directly invade nearby tissues and organs or spread (metastasize) through the lymphatic vessels and lymph nodes (lymphatic system) or bloodstream to distant parts of the body.


Regular pelvic examinations and Papanicolaou (Pap) tests or other similar tests (see Gynecologic Examination) 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. 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—see Positron Emission Tomography (PET)).

Staging a cancer helps doctors choose the best treatment. Doctors often determine the stage of cancer after they remove the cancer and biopsy the surrounding tissues, including lymph nodes. 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*


Stage I

Stage II

Stage III

Stage IV

Endometrial (uterine) cancer

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 but still within the pelvis

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

Ovarian cancer

Only in one or both ovaries

Spread to the uterus, fallopian tubes, or nearby tissues within the pelvis

Spread outside the pelvis to the lymph nodes, the surface of the liver, the small intestine, or the lining of the abdomen

Spread outside the abdomen or to the inside of the liver

Cervical cancer

Only in the cervix

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

Spread throughout the pelvis (including the lower part of the vagina), sometimes blocking the ureters and/or causing a kidney to malfunction

Spread to the bladder or rectum (A) or distant organs (B)

Vulvar cancer

Only in the vulva and/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 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, or more distant lymph nodes

Vaginal cancer

Only in the vagina

Spread to nearby tissues but still within the pelvis

Spread throughout the pelvis

Spread to the bladder or rectum or outside of the pelvis

Fallopian tube cancer

Only in one or both fallopian tubes

Spread to nearby tissues but still within the pelvis

Spread to abdominal organs (such as the intestine and liver) or nearby lymph nodes

Spread to distant organs

*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 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.


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

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 (see Advance Directives). Because end-of-life care has improved, more and more women with incurable cancer are able to die comfortably at home (see Hospice Care). Appropriate drugs can be used to relieve the anxiety and pain commonly experienced by people with incurable cancer.

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