Also called gynecologic cancers, women’s reproductive cancers are characterized by an overgrowth of abnormal cells in the reproductive system. Endometrial cancer, which starts in the inner lining of the uterus (womb), is the most common female reproductive cancer. Other types of female reproductive cancer include ovarian cancer, cervical cancer, vaginal cancer, vulvar cancer and uterine carcinoma.

The cause of women’s reproductive cancers remains unknown. However, several risk factors have been identified, such as smoking, use of birth control pills and certain types of human papillomavirus (HPV). Except for cervical cancer, there is no recognized method for preventing gynecologic cancers. Women can often decrease their odds of developing this group of diseases by avoiding known risk factors and obtaining regular gynecological examinations.

The symptoms of women’s reproductive cancers vary depending on the type, location and severity of the cancer. One of the most common first symptoms is abnormal uterine bleeding. Other symptoms may include irregular vaginal discharge and abdominal or pelvic pain.

Some early female reproductive cancers can be detected through routine screening tests, such as the Pap smear. However, many of the cancers do not have any early screening tests and may not be detectable until the cancer has progressed to a more advanced stage.

Women experiencing symptoms of reproductive cancers should immediately notify their physician. Diagnosis of all women’s reproductive cancers begins with a medical history, followed by a pelvic examination. A gynecologist, a physician who specializes in the female reproductive system, often performs these examinations. The gynecologist examines the uterus, ovaries and surrounding organs for potential problems.

In most cases of suspected cancer, a biopsy (the surgical removal of tissue for microscopic analysis) follows the examination. Other tests that may be used to diagnose reproductive cancers include an x-ray, colposcopy and ultrasound. Possible treatments for women’s reproductive cancers include surgery, radiation therapy and chemotherapy.

Each year, about 78,000 women in the United States are diagnosed with cancers affecting the reproductive organs, according to the American Cancer Society. The prognosis for women’s reproductive cancers depends on the type of cancer, location, and severity of the disease. Other factors that affect the outlook for recovery include the woman’s age, general health and risk factors.

Cancers that originate in the female reproductive system are called women’s reproductive or gynecologic cancers. Cancer occurs when damaged DNA promotes growth of malignant cells in a particular site in the body. For instance, endometrial cancer, the most common female reproductive cancer, is caused by the abnormal growth of cancerous cells in the endometrium (the inner lining of the uterus). Other women’s reproductive cancers include:

• Ovarian cancer
• Cervical cancer
• Vaginal cancer
• Vulvar cancer
• Uterine sarcoma

In addition to being named according to their primary site (the organ or tissue in which cancer first appears), cancers are further classified by the cell’s appearance under a microscope. For instance, the two main types of cervical cancer include:

• Squamous cell carcinoma. Cancer composed of cells that resemble the thin, flat squamous cells that line the endocervix (the part of the cervix that is closest to the uterine body).
  
  
• Adenocarcinoma. Cancer that develops from the gland cells that produce mucus in the endocervix.

Each year, approximately 78,000 women in the United States are diagnosed with cancers affecting the reproductive organs, according to the American Cancer Society.

Cancer can affect any of the following parts of the reproductive system:

• Ovaries. Two female reproductive organs that produce eggs (ova) and the reproductive hormones estrogen and progesterone.
  
  
• Uterus. Commonly called the womb, the uterus is the major female reproductive organ in which the fetus lives during gestation.
  
  
• Endometrium. The inner lining of the uterus.
  
  
• Cervix. The lower end of the uterus that opens into the vagina.
  
  
• Vagina. Also called the birth canal, the vagina is a flexible, muscular tube that connects the uterus to the vulva.
  
  
• Vulva. The female external genital organs that open into the vagina.

The prognosis (predicted outlook for survival) of cancer depends on the type, location and stage of the cancer. The stage indicates the extent of the disease, or how widespread the cancer is in the body.

A cancer specialist such as a gynecological oncologist is best equipped to treat gynecologic cancers. This is a board-certified obstetrician-gynecologist (ObGyn) who has an additional three to four years of specialized training in treating gynecologic cancers.

When choosing an ObGyn oncologist, patients should inquire if this specialized training was received from an American Board of Obstetrics and Gynecology-approved program. Such programs include training in the biology and pathology of gynecologic cancers. They also include training in the various forms of treatment for these diseases, including surgery, radiation, chemotherapy and experimental treatments.

The three most common reproductive cancers in women are:

• Endometrial cancer. This type of female reproductive cancer occurs when the cells of the endometrium, the inner lining of the uterus (womb), grow out of control. According to the American Cancer Society (ACS), endometrial cancer is the most common female reproductive cancer in the United States. In 2007, there will be nearly 40,000 newly diagnosed cases of endometrial cancer and the disease will cause about 7,400 deaths. Obesity is one of the greatest risk factors for developing endometrial cancer.
  
  

  

  Endometrial cancer usually affects women between 60 and 70 years old. This condition is commonly called uterine cancer. However, it is important to note that endometrial cancer is merely a type of uterine cancer and that other, less common uterine cancers, such as uterine sarcoma, do exist. When detected and treated at an early stage, endometrial cancer has a very high (up to 94 percent) recovery rate.
  
  
• Ovarian cancer. This type of female reproductive cancer originates in a woman’s ovary, and may affect both ovaries. The ovaries are two female reproductive organs that produce the hormones estrogen and progesterone as well as eggs (ova). They are located in the pelvis on either side of a woman’s uterus. The ovaries contain three types of tissue: the epithelial, germ cell and stromal. The majority of ovarian cancers begin in the epithelial cells located in the tissue that covers the ovaries. This cancer is known as epithelial ovarian cancer.
  
  Ovarian cancer is the eighth leading cancer among women, and the fifth leading cause of female cancer deaths, according to the ACS. Ovarian cancer claims more lives than any other women’s reproductive cancer. An estimated 22,500 new cases of this disease will be diagnosed in the United States in 2007 and the disease will be responsible for about 15,000 deaths.
  
  When detected and treated at an early stage, the five-year survival rate of ovarian cancer is 94 percent. However, the disease is difficult to detect and less than 20 percent of all cases are detected in the earliest stage. In most cases, ovarian cancer is diagnosed only after the tumor growth has spread to tissues and organs beyond the ovaries.
  
  
• Cervical cancer. This type of female reproductive cancer is characterized by the presence of many abnormal, malignant (cancerous) cells in the cervix (the bottom part of the uterus). The human papillomavirus (HPV), a sexually transmitted disease (STD), is responsible for the majority of cervical cancer cases. More than 90 percent of cervical cancers originate in the lining of the cervix. These cells do not appear suddenly. Rather, healthy cervical cells develop unusual precancerous changes over time, which can eventually turn into cancer.
  
  Cervical cancer typically occurs during midlife, with half of patients diagnosed between the ages of 35 and 55 years. The ACS estimates that approximately 11,000 cases of invasive cervical cancer will be diagnosed in the United States in 2007. It was once a leading cause of death among females, but only 3,600 American women are expected to die of this disease in 2007. Certain populations, such as Vietnamese American, black and Hispanic women, have an increased likelihood of developing cervical cancer, according to the Centers for Disease Control and Prevention (CDC). The five-year survival rate of cervical cancer is 73 percent. When the disease is detected and treated in the early stages, the five-year survival rate increases to 92 percent.

Other, less common types of gynecologic cancers include:

• Vaginal cancer. This type of female reproductive cancer occurs when the cells of the vagina grow out of control. There are many different types of vaginal cancer. However, approximately 85 to 90 percent of these cancers are squamous cell carcinomas that originate in the vagina’s epithelial lining. These cancers, which typically occur near the cervix in the upper part of the vagina, do not appear suddenly. Instead, healthy cells develop unusual precancerous changes over time, which can eventually turn into cancer.
  
  Vaginal cancer is rare. According to the ACS, it accounts for only 3 percent of all gynecological cancers. An estimated 2,100 new cases of this disease will be diagnosed in 2007 in the United States. The disease is expected to claim nearly 800 lives in the same year. If detected and treated in its beginning stages, the five-year survival rate for vaginal cancer is 73 to 96 percent.
  
  
• Vulvar cancer. Also called cancer of the vulva, this type of female reproductive cancer typically affects the inner edges of a woman’s labia majora or minora (folds of tissue that surrounds the vagina). Occasionally, vulvar cancer originates on the clitoris (a very sensitive tissue in the vagina that swells with blood when sexually stimulated) or inside Bartholin glands (small glands that produce mucus and are located on both sides of the vaginal opening). According to the ACS, more than 90 percent of vulvar cancers are squamous cell carcinomas, which typically form slowly over the course of several years.
  
  Vulvar cancer accounts for 4 percent of gynecological cancers and 0.6 percent of all female cancers in the United States, according to the ACS. The ACS estimates that approximately 3,500 vulvar cancers will be diagnosed and nearly 900 patients will die of this condition in the United States in 2007. When detected early, vulvar cancer is highly curable. When the lymph nodes have not been affected, the five-year survival rate of this disease is 90 percent.
  
  
• Uterine sarcoma. Cancers that originate in the connective tissues of a woman’s uterus are called uterine sarcomas. Connective tissues may include fat, muscle, bone and fibrous tissue (the material that composes ligaments and tendons). The most common type of uterine sarcoma is carcinosarcoma, which begins in the endometrium and has features of carcinomas and sarcomas. It is important to note that noncancerous tumors called benign uterine fibroid tumors may also develop in the connective tissues of a woman’s uterus. These masses are not related to uterine sarcomas.
  
  Although the ACS estimates that 40,000 new cases of uterine cancer will be diagnosed in 2007 in the United States, uterine sarcomas will only account for 2 to 4 percent of the new cases. Endometrial cancers will account for the remainder of new cases.

According to the ACS, the estimated number of new cases of women’s reproductive cancers in 2007 is as follows:

Although the exact cause of women’s reproductive cancers is unknown, there are certain risk factors that may increase a woman’s likelihood of developing these diseases. Common risk factors of female gynecological cancers include:

• Age. This is a significant risk factor for most female reproductive cancers. According to the American Cancer Society (ACS):
  
  
• Seventy percent of endometrial cancers affect women age 40 or older.
  
  
• Half of all ovarian cancers affect women over age 63.
  
  
• More than half of vaginal squamous cell carcinomas affect women age 60 or older.
  
  
• Nearly 85 percent of women with vulvar cancer are older than 50 years old.
  
  
• Uterine sarcomas tend to effect women who are middle-aged or elderly.
  
  
• Smoking. Tobacco use is a risk factor for cervical, vaginal and vulvar as well as many non-reproductive cancers.
  
  
• Oral contraceptives (birth control pills). Women who take oral contraceptives are more likely to develop some reproductive cancers (e.g., cervical cancer) than those who rely on other methods of contraception. This is because birth control pills raise a woman’s estrogen levels, thereby increasing the risk of developing certain cancers.
  
  
• Race. Ethnicity also plays a role in many female reproductive cancers. For instance, white women have the greatest likelihood of developing endometrial cancer, according to the ACS, whereas African-American women are nearly twice as likely to develop uterine sarcomas as Asian or white women.
  
  
• Human papillomavirus (HPV) infection. HPVs are a collection of more than 100 types of viruses called papillomaviruses, which cause noncancerous tumors (masses of excess tissue) called papillomas (warts). HPV infections can be transmitted from skin-to-skin contact, and certain HPVs may increase an individual’s risk of developing some female reproductive cancers, such as cervical, vaginal and vulvar cancers. A vaccine is now available for certain HPVs that have been linked to cervical cancer. The vaccine is now recommended for all 11- and 12-year-old girls.
  
  
• Reproductive history. Factors that compose a woman’s reproductive history include her age at menarche and menopause (e.g., early menstruation or late menopause), whether or not she can or has given birth to a child and the age at which she gave birth to her first child. Reproductive history also includes the total number of pregnancies a woman has had and her use of oral contraceptives. These factors elevate estrogen levels and may increase the risk of certain reproductive cancers, such as cervical and ovarian cancers as well as uterine sarcoma.
  
  
• Being overweight or obese. Having excess body weight can increase a woman’s risk of endometrial and cervical cancer and uterine sarcoma.
  
  
• Inadequate nutrition. Poor dietary habits and excess consumption of fat can increase the likelihood of developing endometrial and cervical cancer.

Signs and symptoms vary depending on which type of female reproductive cancer is present. However, abnormal uterine bleeding may be a symptom of any type of gynecologic cancer. Abnormal uterine bleeding may occur between menstrual periods or following menopause. Menstrual bleeding that is heavier or lasts longer (menorrhagia) than usual may also be considered abnormal. Patients should immediately report this symptom to their physician.

Other common symptoms of gynecologic cancers include:

• Unusual vaginal discharge
• Pelvic mass and/or pain
• Painful intercourse (dyspareunia)
• Pain during urination (dysuria)
• Constipation

These symptoms may be caused by other medical conditions not necessarily linked to cancer. Being aware of the signs and symptoms of women’s reproductive cancers – and discussing them with a physician in a timely manner – may help with early detection. Generally, the earlier a gynecologic cancer is treated, the better the patient’s prognosis (predicted outlook for survival).

Diagnosis of all women’s reproductive cancers begins with a complete medical and family history, followed by a thorough pelvic examination. During a pelvic exam, the physician, often a gynecologist, will check the cervix, uterus, ovaries and surrounding organs for any potential problems.

The gynecologist may also perform a Pap smear. This routine screening test identifies changes in the cervix before cervical cancer develops. Although a positive Pap smear indicates the presence of abnormal cells, it does not necessarily mean cancer. A pathologist will determine the type of cells and level of abnormality. If a patient’s Pap smear result indicates abnormal changes, a repeat Pap smear may be recommended in six months.

Further tests or treatment may be ordered sooner depending on the extent and severity of the pathology report. Due to earlier detection, Pap smears have greatly decreased the death rate from cervical cancer over the past 40 years.

It is important to note that early screening tests are not used to detect all gynecologic cancers. For instance, tests for endometrial cancer are typically administered only after a patient reports symptoms of the disease to her physician. Other tests that may be used to diagnose reproductive cancers include:

• Colposcopy. A colposcopy is a procedure that enables the gynecologist to examine the abnormal cervical cells more closely. It may be performed if the results of a Pap smear reveal abnormal cells. During a colposcopy, the gynecologist coats the patient’s cervix with a vinegar solution that causes the irregular cells to turn white. The gynecologist then views these regions with a small microscope-like instrument called a colposcope.
  
  
• Biopsy. A biopsy is a procedure that is commonly used to diagnose women’s reproductive cancers. It involves removing a sample of tissue from a suspected area for examination under a microscope. Biopsies differ according to cancer type. A biopsy for suspected cervical cancer involves the removal of cervical tissue whereas a biopsy for suspected endometrial cancer involves the removal of endometrial tissue. A tissue biopsy is the only procedure that can definitively diagnose gynecological cancers.
  
  
• Hysteroscopy. This procedure often accompanies a biopsy. During a hysteroscopy, a lighted instrument called a hysteroscope is inserted into the uterus through the vagina and cervix. This allows the gynecologist to examine the inside of the patient’s uterus without making an abdominal incision. General anesthesia is typically administered prior to this procedure, which takes approximately 30 to 45 minutes.
  
  
• Ultrasound. This imaging test creates a video image using sound waves. During an ultrasound, a small probe is placed on the patient’s abdomen or inside her vagina (transvaginal ultrasound). The probe releases sound waves that echo as they enter bodily organs. This test is often useful in identifying tumors because healthy tissue and tumors reflect sound waves differently. Ultrasound is helpful in determining whether a tumor is solid or filled with fluid. However, ultrasound has its limits. For instance, transvaginal ultrasound cannot accurately detect if a mass in an ovary is malignant (cancerous) or benign (noncancerous).
  
  
• Cystoscopy and proctosigmoidoscopy. During a cystoscopy, the physician examines the patient’s bladder and urethra using a thin tube with a light and a lens. A proctosigmoidoscopy allows the physician to view the rectum through a lighted tube called a sigmoidoscope. Both of these procedures can help detect cancer that has spread (metastasized) to other sites.

Treatment for women’s reproductive cancers depends on a variety of factors, such as the type and stage of the cancer. There are a number of standard approaches for treating gynecologic cancers. When a patient is diagnosed with a reproductive cancer, her surgeon, oncologist or gynecologic oncologist (a physician who specializes in treating cancers of the female reproductive system) may recommend any of the following treatment methods. In many cases, patients may receive a combination of the therapies including:

• Surgery. Recommended surgical procedures differ according to the location, type and stage of the cancer. Minor surgery may include procedures such as laser therapy, which is often used to treat early cervical and vulvar cancers and precancers. This surgical technique vaporizes abnormal cancer cells with a focused laser beam. Other, more involved procedures may include:
  
  
• Unilateral or bilateral ovariectomy (oophorectomy). The surgical removal of one or both ovaries.
  

  

• Unilateral or bilateral salpingectomy. The removal of one or both fallopian tubes (the tubes that transport the eggs from the ovaries to the uterus).
  
  
• Simple hysterectomy. The surgical removal of the cervix and the body of the uterus. Simple hysterectomy requires general or regional anesthesia, and normally requires a three- to five-day hospitalization. Complete recovery from this procedure typically takes about four to six weeks. Simple hysterectomy  results in the inability to become pregnant.
  
  
• Radical hysterectomy. The surgical removal of the entire uterus as well as surrounding tissues and part of the vagina. This procedure is generally used to treat cancers that may have invaded or spread (metastasized) to other parts of the body, and typically requires a five- to seven-day hospitalization. Women who have a radical hysterectomy will be unable to become pregnant.
  
  
• Radiation therapy. Physicians  may choose to kill cancer cells with high-energy radiation. Radiation intended to destroy abnormal cells may be used to treat any of these gynecologic cancers either alone or in conjunction with chemotherapy. Depending on the type and stage of cancer, women may receive external radiation therapy or brachytherapy (implanted radiation pellets) to destroy cancer cells. Radiation therapy may be provided before or after surgery or chemotherapy.
  
  
• Chemotherapy. This form of treatment uses powerful drugs to destroy cancer cells. It is typically administered orally or intravenously (into a vein). However, it can also be administered in cream form for vaginal cancer.  Once the drugs enter the patient’s bloodstream, they begin to travel throughout the body. Therefore, chemotherapy is useful in treating cancer that has spread to other sites in the body. In certain cases, multiple drugs or combination chemotherapy may be more effective in treating cancer than a single drug alone. Chemotherapy may cause infertility in some patients.
  
  
• Clinical trials. Patients may choose to participate in studies involving promising new or experimental treatment methods for reproductive cancers. A woman’s oncologists can best determine if she is a candidate for clinical trials and recommend appropriate studies.

Other procedures are reserved for treating specific cancers. These may include:

• Cryotherapy (also called cryosurgery) is often used to treat cervical cancer and precancerous lesions of the cervix. This procedure uses a metal probe chilled by immersion in liquid nitrogen to eliminate abnormal cells.
  
  
• Dilation and curettage (D&C) is sometimes used to treat women with endometrial cancer. During this outpatient procedure, the cervix is dilated and tissue is scraped from the inside of the uterus using a special surgical instrument. The tissue sample is then analyzed under a microscope for abnormalities.
  
  
• Vulvectomy may be used to treat some cases of vulvar cancer. There are several variations of this operation, in which part or the entire vulva is removed.

In some cases, women find that treatment for reproductive cancers presents challenges in regard to sex and intimacy. This is particularly true when treatment involves surgery, such as:

• Hysterectomy (removal of the uterus)
• Bilateral salpingectomy-oophorectomy (removal of the fallopian tubes and ovaries)
• Vaginal resection (removal of the vagina)

Some women find the abdominal scars caused by incisions make them less comfortable with their bodies, and hinders intimacy. In other cases, physical changes – such as a vaginal canal shortened by a hysterectomy – may make women less comfortable during intimacy.

Women should speak to their physician about ways to overcome such challenges. With the support of a loving partner, most women can continue to have fulfilling sex lives.

Although there is no definitive method for preventing female reproductive cancers, women can often reduce the likelihood of developing most gynecological cancers by having annual (or more often if necessary) gynecological screenings, including Pap smears and pelvic examinations. Women can also reduce their risks by avoiding or reducing preventable risk factors such as smoking, poor nutrition, multiple sexual partners and infection by the human papillomavirus (HPV). Immunization against certain forms of HPV is now available through a vaccine approved by the Food and Drug Administration (FDA). The FDA recommends that the vaccine be given to girls age 11 to 12, preferably before they are sexually active. However, the vaccine may be given to older females (13 to 26 years old) because of its protective benefits.

Although most female reproductive cancers are not easily detected in their precancerous stages, the American Cancer Society (ACS) has issued the following guidelines for early detection of cervical cancer:

• All women should be screened (tested) for cervical cancer when they reach 21 years of age, or three years after they first start having vaginal intercourse.
  
  
• Starting at age 30, patients who have had three normal consecutive Pap smears should be screened every two to three years. Women with risk factors for cervical cancer, such as the human immunodeficiency virus (HIV), should continue to be tested annually. A woman’s gynecologist can determine the appropriate screening schedule.
  
  
• Women over age 30, without cervical cancer risk factors, may choose to have a Pap smear every three years in conjunction with an HPV DNA test, which determines whether the patient has HPV.
  
  
• Women age 70 or older who have had three normal, consecutive Pap smears and no abnormal results in the past 10 years may choose to stop being screened for cervical cancer unless they have a history of cervical cancer or risk factors for the condition.
  
  
• Patients who have had a total hysterectomy (surgical removal of the uterus and the cervix) may also choose to stop being screened for cervical cancer, unless the hysterectomy was performed because of cervical precancer or cancer. Those who had a simple hysterectomy (surgical removal of the uterus) should follow the guidelines detailed above.

Preparing questions in advance can help patients have more meaningful discussions with their physicians regarding their conditions. Patients may wish to ask their doctor or healthcare professional the following questions related to reproductive cancers:

1. What cancer screening tests are necessary for me?
   
   
2. How often should I receive necessary screening tests?
   
   
3. Do I have any risk factors that place me at higher risk for reproductive cancers?
   
   
4. Does one type of gynecological cancer make me more prone to developing another type of cancer?
   
   
5. Should I receive any additional tests if there is a family history of cancer?
   
   
6. How will I know if I have ovarian cancer if there are no real signs?
   
   
7. Do certain birth control pills increase my risk of gynecologic cancers?
   
   
8. If I have an abnormal Pap smear, what is the next step?
   
   
9. How will I receive a biopsy if necessary?
   
   
10. Should I consider any genetic tests for reproductive cancers?
    
    
11. How will my diagnosis impact my ability to have children?
    
    
12. If I develop a gynecological cancer, are my daughters at greater risk for the disease?
    
    
13. Should I have the HPV vaccine? When should my daughters receive the vaccine?