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.

Diagnosis

Regular pelvic examinations and Papanicolaou (Pap) tests or other similar tests (see Diagnosis of Gynecologic Disorders: Screening for Cervical Cancer) 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 bone scans using a radioactive substance.

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.

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Staging Cancers of the Female Reproductive System* Type Stage I Stage II Stage III Stage IV† Endometrial (uterine) cancer Only in the upper part of the uterus (not 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 nearby tissues 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 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) and 3/4 inch (about 2 centimeters) or smaller Only in the vulva and/or perineum, but larger than 3/4 inch In the vulva and/or perineum and spread to nearby tissues and/or lymph nodes Spread beyond nearby tissues to the bladder, the intestine, 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 (A) or distant organs (B) 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. Staging Cancers of the Female Reproductive System* Type Stage I Stage II Stage III Stage IV† Endometrial (uterine) cancer Only in the upper part of the uterus (not 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 nearby tissues 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 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) and 3/4 inch (about 2 centimeters) or smaller Only in the vulva and/or perineum, but larger than 3/4 inch In the vulva and/or perineum and spread to nearby tissues and/or lymph nodes Spread beyond nearby tissues to the bladder, the intestine, 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 (A) or distant organs (B) 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.

Treatment

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

Last full review/revision November 2008 by David M. Gershenson, MD; Pedro T. Ramirez, MD