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 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.
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