Learn, Listen, and Act

Understanding your risk for gynecologic cancers and seeking early care are key steps in maintaining your gynecologic health.

Foundation for Women’s Cancers foundationforwomenscancer.org

Cancer is a word used to define a collection of diseases that share one unique characteristic: the uncontrolled growth of cells that have the potential to spread (metastasize) to other parts of the body. Gynecologic can­cers grow from a woman’s reproductive organs, including the cervix, uterus, ovaries, fallopian tubes, vagina, and vulva.

Steady progress has been made to lessen the burden of gynecologic cancers through research. Of particular promise is a better understanding of the risks, symptoms, and prevention of the three most prevalent gynecologic cancers: cer­vical, ovarian, and uterine.

Increased emphasis on helping women understand the steps they can take to reduce the risk for these cancers and receive the earli­est possible diagnosis through symptom recog­nition is critical. We urge women to learn about the prevention and early warning signs of these cancers unique to women and listen to their bodies. We all know what is normal for us. And, finally, act to maintain our gynecologic health.

If you suspect or are diagnosed with a gyne­cologic cancer, seek care first from a gyneco­logic oncologist.

Cervical Cancer

Cervical cancer is a cancer that begins in the cervix, the part of the uterus (womb) that opens to the vagina. It is the part of the uterus that dilates and opens fully to allow a baby to pass into the birth canal. The normal cervix has two main types of cells: squamous cells that protect the outside of the cervix and glandu­lar cells, which are mostly inside the cervix and which make the fluid and the mucus commonly seen during ovulation. Cervi­cal cancer is caused by abnormal changes in either of these cell types in the cervix and is the only gynecologic cancer that can be prevented by regular screening and appropriate vaccination.

Learn

  • Cervical cancer can be prevented.
  • Almost all cervical cancer is caused by a persistent infection with the human papillomavirus (HPV).
  • Regular Pap tests and HPV testing when recommended are important in preventing cervical cancer.
  • Cervical cancer usually affects women between the ages of 30 and 55, but younger women also are at risk.

Listen

Listen to your body for these symptoms:

  • Bleeding after intercourse
  • Excessive discharge and abnormal bleeding between periods

Note: Most women will have no symptoms, making vaccination and regular Pap tests plus HPV tests, when recommended, key to preventing cervical cancer.

Act

  • Don’t smoke! Smoking weakens the immune system, and a weakened immune system can lead to persistent HPV infection.
  • Get vaccinated—preferably early: boys and girls can be vaccinated beginning at age 11 or 12.
  • Get Pap tests and HPV tests at the intervals recommended by your healthcare provider, and take the pledge to get an annual well woman’s exam.
  • If your test results say you have cervical pre-cancer or cancer, seek care from a gynecologic oncologist.

Ovarian Cancer

Ovarian cancer, the seventh most common cancer among women, usually starts on the surface of the ovary in epithelial cells. About 85 to 90 percent of ovarian cancers are epithelial ovarian cancers. These cancer cells can implant themselves throughout the abdominal cavity.

Ovarian cancer, fallopian tube cancer, and primary peritoneal cancer (cancer that originates from the lining of the abdomen, called the perito­neum) all have a similar type of growth, and similar treatments are used for each. It is possible for a woman to have primary peritoneal cancer even when her ovaries have been removed.

There is growing scientific evidence to support the idea that ovarian cancer may actually begin in the fallopian tubes.

Learn

  • Ovarian cancer is the leading cause of death among the gynecologic cancers and the fifth leading cause of cancer death in women.
  • Only 15 percent of all ovarian cancer cases are detected at the earliest, most curable stage.
  • One in 71 women will develop ovarian cancer in her lifetime. Learn your individual risk of ovarian cancer.
  • The risk of ovarian cancer increases with age, especially around the time of menopause.
  • A family history of ovarian cancer, fallopian tube cancer, primary peritoneal cancer, or premenopausal breast cancer or a personal history of premenopausal breast cancer—all place women at heightened risk for ovarian cancer.
  • Infertility and not bearing children are risk factors, whereas pregnancy and the use of birth control pills decrease risk.

Note: The Pap test screens only for cervical cancer and does not screen for ovarian cancer.

Listen

Listen to your body for these symptoms:

  • Bloating
  • Pelvic or abdominal pain
  • Difficulty eating or feeling full quickly
  • Urinary symptoms (urgency or frequency)

Note: Women who have these symptoms almost daily for more than a few weeks should see their doctor, preferably a gynecologist.

Act

  • Unfortunately, there is no general screening test for ovarian cancer. Because of this, women need to understand their risk and listen to their bodies for symptoms.
  • If you have symptoms of ovarian cancer that are frequent, persistent, and new to you, ask your doctor to consider ovarian cancer as a possible cause. (Most likely you do not have ovarian cancer.) If ovarian cancer is suspected or diagnosed, seek care first from a gynecologic oncologist.

Uterine Cancer

Most uterine cancers begin in the lining of the uterus, or endometrium. The endometrium is the tissue shed each month with the menstrual cycle. In the most common type of uterine cancer, called endometrial adenocarcinoma, cells in the endometrial lining grow out of control, may invade the muscular wall of the uterus, and sometimes spread outside of the uterus, to the ova­ries, lymph nodes, and abdominal cavity.

Uterine sarcomas represent a type of uterine cancer in which malignant cells form in the muscle of the uterus (known as leiomyosarcoma) or in the network of support cells in the uterine lining (endometrial stromal sarcomas and carcinosarcomas). Accounting for fewer than 5 percent of all uterine cancers, uterine sarcomas are much less common than endometrial cancer, but they have a much more aggressive clinical behavior. These cancers can quickly metastasize (spread) to distant sites.

Learn

  • The most common uterine cancer is endometrial cancer, and it is the most common gynecologic cancer.
  • Uterine cancer usually occurs around the time of menopause, but younger women also are at risk.
  • There is no screening test for endometrial cancer.

Note: The Pap test screens only for cervical cancer and does not screen for uterine cancer.

Risk factors for endometrial cancer include the following:

  • Taking estrogen alone without progesterone
  • Obesity
  • Diabetes
  • Hypertension
  • Use of tamoxifen
  • Late menopause (after age 52)
  • Never becoming pregnant
  • A family history of endometrial or colon cancer

Listen

Listen to your body for these symptoms:

  • Abnormal vaginal bleeding; younger women should note irregular or heavy vaginal bleeding.
  • Bleeding after menopause. Even brown spotting or a single spot of blood from the vagina is abnormal after menopause and should lead to a prompt gynecologic evaluation.

Act

If you experience these symptoms, you should have a biopsy of the endometrium to check for uterine cancer.

You can reduce your risk of uterine cancer by taking these steps:

  • Exercise regularly.
  • Keep your blood pressure and blood sugar under control.
  • Manage your weight.
  • If you have an endometrial biopsy that shows endometrial cancer, seek care from a gynecologic oncologist.

The Foundation for Women’s Cancer

The Foundation for Women’s Cancer is a national nonprofit dedicated to funding research and training, offering educational resources, and raising public awareness about all gynecologic cancers, with a focus on prevention, early detection, and optimal treatment. Founded by the Society of Gynecologic Oncology in 1991, the foundation provides free educational courses for women and supports promising, innovative research. The National Race to End Women’s Cancer 5K/1 Mile Walk in Washington, DC, is the foundation’s major annual awareness and fundraising event. For more information visit foundationforwomenscancer.org.

Hope through Action: Join the Gynecologic Cancer Awareness Movement

By Linda R. Duska, MD

Twenty years ago no one was talking about breast cancer. Today that seems surreal. Breast cancer awareness has gone mainstream, with everyone from Reese Witherspoon to the National Foot­ball League contributing to a nationwide movement. Young people probably cannot imagine a world where the subject is taboo.

Twenty years from now, that is how I want today’s children to think about gynecologic cancers. I want my own four children to come of age in a world where below-the-belt cancer awareness is part of everyday con­versation—a world that’s safer for women.

That is why I am proud to serve as captain of the Surgeons Team for the National Race to End Women’s Cancer 5K, part of a weekend of free educational courses for survivors and other awareness-raising events in Washington, DC, each November, sponsored by the Foundation for Women’s Cancer.

In my practice, I strive to offer my patients hope one by one. The gynecologic cancer awareness movement (GCAM) offers women, their families, and their friends hope as a community.

Gynecologic cancers strike more than 90,000 Ameri­can women each year, forever altering the lives of count­less mothers, sisters, daughters, and friends—and the husbands, brothers, sons, and others who love them. Nearly one-third of those diagnosed will die. The National Race to End Women’s Cancer embodies hope through action, raising awareness, and crucial research funding to fight this fight.

What does the race offer gynecologic cancer survivors and their loved ones? As Tranette Ledford, journalist and member of the 2014 National Race Host Committee and a two-year cervical cancer survivor, says, “Being diag­nosed with a reproductive cancer began a profound, life-altering journey for me, one that I wasn’t initially able to share. Working with the foundation to raise awareness and research funding is how I make sense of what hap­pened to me, and what’s happening to one woman every seven minutes in the United States today.

“We have to fight to get these below-the-belt cancers in the national conversation,” adds Tranette, “so that better prevention, earlier diagnosis, and more-success­ful treatments can be discovered and so women get the support they need as they walk this difficult path.”

This is Tranette’s second year as a national spokesper­son for the Foundation for Women’s Cancer. Her pas­sion and advocacy give new hope to women everywhere. With the foundation, her message for women is to learn the symptoms, listen to their bodies, and act by seeking care from a specialist for the best outcomes.

For my colleagues in gynecologic oncology, these are our patients, our specialty, our movement. I want to build the biggest team this year!

Since the breast cancer movement began 20 years ago, 35 percent fewer patients die from that disease. Our GCAM goal is similar success through greater awareness. You can help by supporting the National Race to End Women’s Cancer.

Don’t worry if you are not a runner—you don’t even have to show up to make a difference! Just registering or donating gives this movement momentum and spreads hope to the countless people affected by gynecologic can­cers. If you can come out and run, I’ll see you there!

Get the Details

WHAT: National Race to End Women’s Cancer 5K

WHEN: Sunday, November 2, 2014, at 9 a.m.

WHERE: Washington, DC

HOW: To register and for more information about the free survivors’ course offered on Saturday, November 1, visit endwomenscancer.org.

Linda R. Duska, MD, is an associate professor with tenure in the University of Virginia’s Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, and director of the UVA Gynecologic Oncology Fellowship Program. She is also captain of the Society of Gynecologic Oncology’s Surgeons Team for the 2014 National Race to End Women’s Cancer.