For many years, gynecologic cancers have held an erroneous reputation for being “silent” — the types of cancer that are not preventable or detectable until it’s too late and only limited treatment options are available. However, with the advent of modern testing, screening and genetic discovery, physicians and researchers have found that detection is possible and that many forms of gynecologic cancer can even be prevented.

Rebecca Stone, M.D., a Johns Hopkins gynecologic oncologist and surgeon, explains gynecologic cancer risks, the best forms of prevention for you and your loved ones, and possible signs and symptoms.

Know Your Risk

Gynecologic cancer represents any cancer that begins in a woman’s reproductive organs. Thus, any woman is at risk for developing gynecologic cancer. In the United States alone, approximately 100,000 women are diagnosed with gynecologic cancer each year. The following are important risk factors:

• Family History: The strongest known risk factor for ovarian cancer is family history. We now estimate that one in five cases of ovarian cancer is due to mutations that occur in ovarian cancer susceptibility genes, such as BRCA1 and 2, which are passed down from generation to generation. Endometrial cancer also runs in some families, most often in association with Lynch syndrome. Lynch syndrome is a hereditary cancer syndrome known for increased risk of endometrial, ovarian and colon cancer.
• Obesity: With obesity on the rise in the United States, physicians have seen a significant increase in endometrial cancer in particular. Stone says, “Obesity causes an increase in estrogen production and chronic inflammation, which can affect the lining of the uterus (the endometrium), leading to a greater risk of this cancer.”
• Age: For the majority of gynecologic cancers, a woman’s risk is highest over the age of 60.
• HPV: HPV is a sexually transmitted disease that has very strong ties to gynecologic cancer. Nearly all cases of cervical cancer are caused by HPV, and many strains of the disease can also cause vaginal and vulvar cancer.

Preventing Gynecologic Cancer

Knowing your risks for gynecologic cancer is very important, as is undergoing the recommended testing, screening and vaccines that are available for prevention.

• Pap Tests: The Pap test is the most valuable cervical cancer screening tool available, particularly when combined with HPV testing. Pap tests and HPV testing can lead to the detection of precancerous changes in the cervix before they become a cancer. There is great interest in determining how we may be able to use the Pap test to detect ovarian and endometrial cancers. Scientists are actively investigating this.
  • For women 21 to 29, Pap tests are recommended every three years.
  • For women 30 and older, Pap tests combined with HPV testing (known as co-testing) are recommended every five years.
  • Screening may stop for women over 65 if they’re considered low risk.
• Healthy Diet and Lifestyle: With obesity identified as a significant risk factor for endometrial cancer, maintaining a healthy diet and lifestyle is important. For women interested in achieving short-term and long-term weight loss goals, the Johns Hopkins Weight Management Center offers a Concierge Endoscopic Weight Loss Program to help you reach and sustain a healthy weight.
• Genetic Testing: There are many indications for genetic counseling and testing, and women should review their family history with their doctors on a regular basis to understand their own personal need for this. In general, women with a family history of ovarian cancer or premenopausal breast cancer (breast cancer before the age of 45), as well as women with a history of endometrial or colon cancer before the age of 50, should see a genetic counselor. “That being said, many women at increased genetic risk for developing these cancers have no identifiable family history, and hopefully, genetic testing will be made available to all women as a preventive health service in the near future,” explains Stone.
• HPV Vaccine: The HPV vaccine has been a valuable tool in preventing cervical cancer. In a landmark study recently published by the American Academy of Pediatricians, vaccination has reduced the rate of HPV in teenage girls by 63 percent and by 34 percent for women ages 20 to 24. Reducing the rate of HPV will in turn reduce the incidence of cervical cancer by over 3,000 cases per year in the United States.
  • The HPV vaccine is recommended for men and women between the ages of 11 and 26.

Potential Signs and Symptoms

“There are many signs of gynecologic cancer that women can observe: abnormal bleeding, pelvic pain and bloating, to name a few,” says Stone. “Unfortunately, though, these can often be symptoms of other, more benign conditions, so it’s important not to be alarmed. Once you feel something, though, you should say something to your physician.”

• Cervical Cancer: Abnormal bleeding (any vaginal bleeding that is not related to your menstrual period), heavier and/or longer menstrual bleeding than normal, bleeding after menopause, pain and bleeding during intercourse
• Endometrial Cancer: Abnormal bleeding, postmenopausal bleeding, difficult or painful urination, pain during intercourse, pain and/or mass in the pelvic area
• Ovarian Cancer: Feeling swollen or bloated in the lower abdomen; loss of appetite; gas, indigestion and nausea; frequent urination; abnormal vaginal bleeding
• Vaginal Cancer: Abnormal bleeding, difficulty urinating, pain during intercourse, pelvic pain, constipation, a mass that you can feel
• Vulvar Cancer: Constant itching; change in the color of your vulva; bleeding or discharge not related to menstruation; palpable nodule, mass or sore

Awareness of your risk factors, maintaining a healthy lifestyle, undergoing routine testing and screening, and looking for potential signs and symptoms can help you prevent and detect gynecologic cancers.

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