By Dr, Elise Dubuc
When breast cancer is included, about 2 million gynecological cancers arise yearly, representing about 50% of female cancers.
Cancer of the Uterus
Uterine cancer is the 4th most common cancer diagnosed in women and the most diagnosed cancer of the reproductive system. A woman’s lifetime risk of being diagnosed with uterine cancer is 1 in 36. Uterine cancer is usually diagnosed early, and the 5-year survival is quite good at 84%. After age 40 (or age 35, depending on risk factors), if you have abnormal heavy uterine bleeding, your doctor will advise an endometrial biopsy to analyze the tissue inside the uterus and diagnose precancerous and cancerous changes. Risk factors for this cancer are chronic inability to ovulate, which can be caused by untreated polycystic ovary syndrome or obesity, having started menstruating before age 12 and late menopause after age 55, and failure to give birth. The use of Tamoxifen in the treatment of breast cancer is also a risk factor. Diabetes, physical inactivity and specific genetic syndromes (Lynch Syndrome, Cowden) are risk factors. Most of the time, treatment for this cancer involves a hysterectomy (removal of the uterus), fallopian tubes and ovaries. Depending on the stage, the specialist may offer radiotherapy, chemotherapy, or hormone therapy.
Approximately 2,800 women will be diagnosed with ovarian cancer yearly in Canada, making it the 8th most diagnosed. It is difficult to diagnose because its symptoms are rather unspecific and can appear only at an advanced stage of the disease, making ovarian cancer particularly deadly, with a 5-year survival rate of 44%. Some ovarian cancers can also occur in childhood, but the good news is that these childhood cancers are usually treatable with surgery on the affected ovary only. Risk factors for ovarian cancer include a history of a first-degree relative (mother, sister, daughter) with ovarian cancer, BRCA1 and 2 gene mutations or Lynch syndrome, a personal history of breast cancer, never having given birth, endometriosis, smoking, being overweight and obesity, and physical inactivity. Other factors, such as taking combined hormonal contraception for more than five years, reduce the risk of ovarian cancer by 50% and has had a bilateral salpingectomy (removal of the tubes) because it is believed that the precancer epithelial of the ovary comes from the end of the fallopian tubes.
No systematic screening exists for ovarian cancer for women who are not known to have a genetic mutation favouring this type of cancer. Symptoms to look out for are bloating, pelvic heaviness or pain, and abnormal uterine bleeding. In children, this cancer can present as precocious puberty.
Women with a known genetic mutation will be offered closer monitoring and risk-reduction surgery.
Approximately 1,500 Canadian women will be diagnosed with cervical cancer each year. Of these women, 73% will still be alive five years later. Cervical cancer is more likely to occur in younger women than uterine and ovarian cancer. The median age of a woman at diagnosis is 47. The vast majority of cervical cancers are caused by the human papillomavirus, transmitted through sexual contact. Unfortunately, a condom does not protect against transmission since the virus is found in the entire genital area. Fortunately, this is only cancer for which vaccines exist. Vaccination programs now exist across Canada and aim to ensure that children are vaccinated before being exposed to the virus.
Despite the vaccination, screening for cervical cancer by pap test or looking for HPV in the genital area is still necessary. If a pap abnormality is detected, colposcopy should be performed. The gynecologist inspects the cervix under a microscope and performs targeted biopsies during this examination. Usually, cervical cancer can be prevented with regular screening and the precancerous changes treated.
Often, women who develop cervical cancer have not had a screening for many years or have bleeding during sex, between periods or after menopause.
If cervical cancer is detected early, surgery can be performed to treat it. In cases of more advanced cancer, The specialist will offer a combined chemotherapy and radiotherapy treatment.
Cancer of the vagina and vulva
Vaginal and vulvar cancers are rarer and usually occur in older women. They are typically caused by the human papillomavirus, like cervical cancer. There is no screening. However, if a lesion or ulcer is noted in the vulva, it is essential to discuss it with your healthcare professional. Women affected by lichen sclerosus, a skin disease of the vulva, are at higher risk of developing vulvar cancer and should have regular follow-ups for this disease. Any bleeding after menopause should also be evaluated by gynecological examination. Early-stage vulvar or vaginal cancers can be treated with surgery, while advanced-stage cancers will be treated with chemo and radiation therapy.
What you can do to reduce your risk of gynecological cancer
- Get vaccinated against HPV.
- Do your gynecological screening exams regularly.
- Have a healthy point and be physically active.
- Do not wait to consult if you have abundant abnormal uterine bleeding, intermenstrual, after sexual intercourse, after menopause, or if you notice a lesion on your vulva.