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.
The most common gynecologic cancer in the United States is cancer of the uterus (endometrial cancer), followed by ovarian cancer, then cervical cancer. Cervical cancer is not very common in developed countries because screening for cervical cancer is widely available and effective.
Gynecologic cancers can spread in the following ways:
Diagnosis
Regular pelvic examinations and screening for certain gynecologic cancers, especially cancer of the cervix, can lead to the early detection of these cancers. Screening for cervical cancer includes the Papanicolaou (Pap) test and human papillomavirus (HPV) testing. 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 uterus (including the upper two thirds of the vagina and/or tissues outside the uterus) but still within the pelvis‡ |
Spread throughout the pelvis and/or to the lower third of the vagina and/or blocks the ureters and/or causes a kidney to malfunction and/or spreads to the lymph nodes near the aorta (the largest artery in the body) |
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 but is still within the uterus |
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 and/or to abdominal organs (such as the surface of the liver) |
Spread to distant organs |
|
|
Gestational trophoblastic neoplasia (the form of gestational trophoblastic disease that is usually cancerous) |
Only in the uterus |
Spread outside the uterus to the ovary, fallopian tube, vagina, and/or ligaments that support the uterus |
Spread to the lungs |
Spread to more distant sites, such as the brain, liver, kidneys, and/or digestive tract |
|
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 and/or to other parts of the abdomen (such as the surface of the liver or spleen) |
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 (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. |
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† Stage IV is sometimes further classified as A or B depending on where the cancer has spread. |
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‡ 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. |
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Treatment
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 cancer or ovarian cancer, the main treatment is surgical removal of the tumor. Surgery may be followed by radiation therapy or chemotherapy or, for advanced endometrial cancer, hormonal therapy. For ovarian cancer, treatment often starts with chemotherapy, followed by surgery, followed by chemotherapy.
Treatment of cervical cancer may include surgery, radiation therapy, and/or chemotherapy. Radiation therapy may be external (using a large machine) or internal (using radioactive implants placed directly on the cancer) or both. 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 and the type of chemotherapy drug used. 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.
