Services
The department of Gynecologic Oncology at Fletcher Allen Health Care provides evaluation and care for all types of gynecologic cancers.
Following are a few of the most common types of cancer we treat:
Ovarian Cancer
What is it?
About 90% of ovarian cancers are epithelial ovarian carcinomas. In this type of cancer, a malignant tumor originates in the surface epithelium tissue, which is the lining on the outside of the ovary. The risk of epithelial ovarian cancer increases with age, especially after the age of 50.
Germ cell tumors account for approximately 5% of all ovarian cancers and originate in the egg-producing cells found within the ovary. This type of ovarian cancer can occur in women of any age, but approximately 80% are diagnosed in women under the age of 30.
About 25% of ovarian cancers are found at an early stage. Early detection improves the chances that ovarian cancer can be treated successfully. When ovarian cancer is found early at a localized stage, about 90% of patients live longer than 5 years after diagnosis.
Symptoms:
Early cancers of the ovaries tend to cause symptoms that are relatively vague. These symptoms include abdominal swelling, unusual vaginal bleeding, pelvic pressure, back pain, leg pain, and digestive problems such as gas, bloating, indigestion, or long-term stomach pain. Most of these symptoms can also be caused by other less serious conditions. Nonetheless, prompt attention to symptoms can improve the odds of early diagnosis and successful treatment. If you have any of these symptoms, report them to your primary care provider right away.
Risk Factors:
Age
Most ovarian cancers develop after menopause. Two-thirds of women who develop ovarian cancer are over 55 years old.
Obesity
A study from the ACS found a higher rate of death from ovarian cancer in obese women. The risk was increased by 50% in the heaviest women.
Reproductive history
Women who started menstruating at an early age (before age 12), had no children or had their first child after age 30, and/or experienced menopause after age 50 may have an increased risk of ovarian cancer.
Family history of ovarian cancer, breast cancer, or colorectal cancer
Your ovarian cancer risk is increased if your mother, sister, or daughter have (or have had) ovarian cancer. If there is a family history of cancer caused by an inherited mutation (change) of the breast cancer gene BRCA1 or BRCA2, you have a very high risk of ovarian cancer. Also, a mutation leading to inherited colorectal cancer can increase the risk of ovarian cancer. Many cases of familial epithelial ovarian cancer are caused by inherited gene mutations that can be identified by genetic testing.
Personal history of breast cancer
If you have had breast cancer, you also have an increased risk of developing ovarian cancer.
Talcum powder
It has been suggested that talcum powder applied directly to the genital area or on sanitary napkins may be carcinogenic. Most, but not all, studies suggest a slight increase in risk of ovarian cancer in women who used talc on the genital area.
Estrogen replacement therapy and hormone replacement therapy
Some studies suggest women using estrogens after menopause have an increased risk of developing ovarian cancer, but other studies have not found any effect on ovarian cancer risk. A recent study suggested that using estrogen replacement therapy (ERT) increases the risk of developing ovarian cancer, and that the risk increases with continued use. The risk among women who used ERT for longer than 10 years was almost double that of women who had never used it, and the risk among those who used it for 20 years or more was tripled. (Remember, however, that the average lifetime risk for ovarian cancer is only about 2%.) Most of these findings have been for women taking estrogen alone, not for those taking combined progesterone and estrogen. The increased risk is less certain for women taking both drugs.
Treatment:
The choice of treatment depends largely on the type of cancer and the stage of the disease.
Factors that could play a part in choosing the best treatment plan might include your general state of health, whether you plan to have children, and other personal considerations. Age alone is not a determining factor since several studies have shown that older women tolerate ovarian cancer treatments well. Be sure you understand all the risks and side effects of the various therapies before making a decision about treatment.
The main treatments for ovarian cancer are surgery, chemotherapy, and radiation therapy. In some cases, more than one treatment will be recommended.
Uterine Cancer
What is it?
In the United States, cancer of the uterus is the most common cancer of the female reproductive system. It accounts for six percent of all cancers in women in this country.
The most common type of cancer of the uterus begins in the lining (endometrium). It is called endometrial cancer, uterine cancer, or cancer of the uterus. This type of cancer happens when cancer begins in the tissue lining the uterus (endometrium).
Uterine sarcomas occur when cancer grows in the muscles or other supporting tissues in the uterus. Uterine sarcomas account for only a small portion of cancers of the uterus.
Symptoms:
Uterine cancer usually occurs after menopause. But it may also occur around the time that menopause begins. Abnormal vaginal bleeding is the most common symptom of uterine cancer. Bleeding may start as a watery, blood-streaked flow that gradually contains more blood. Women should not assume that abnormal vaginal bleeding is part of menopause.
A woman should see her doctor if she has any of the following symptoms:
- Unusual vaginal bleeding or discharge
- Difficult or painful urination
- Pain during intercourse
- Pain in the pelvic area
These symptoms can be caused by cancer or other less serious conditions. Most often they are not cancer, but only a doctor can tell for sure.
Risk Factors:
Age
Cancer of the uterus occurs mostly in women over age 50.
Endometrial hyperplasia
The risk of uterine cancer is higher if a woman has endometrial hyperplasia. This condition and its treatment are described above.
Hormone Replacement Therapy (HRT)
HRT is used to control the symptoms of menopause, to prevent osteoporosis, and to reduce the risk of heart disease or stroke. Women who use estrogen without progesterone have an increased risk of uterine cancer. Long-term use and large doses of estrogen seem to increase this risk. Women who use a combination of estrogen and progesterone have a lower risk of uterine cancer than women who use estrogen alone. The progesterone protects the uterus.
Obesity and related conditions
The body makes some of its estrogen in fatty tissue. That's why obese women are more likely than thin women to have higher levels of estrogen in their bodies. High levels of estrogen may be the reason that obese women have an increased risk of developing uterine cancer. The risk of this disease is also higher in women with diabetes or high blood pressure (conditions that occur in many obese women).
Tamoxifen
Women taking the drug tamoxifen to prevent or treat breast cancer have an increased risk of uterine cancer. This risk appears to be related to the estrogen-like effect of this drug on the uterus. Doctors monitor women taking tamoxifen for possible signs or symptoms of uterine cancer.
Race
White women are more likely than African-American women to get uterine cancer.
Colorectal cancer
Women who have had an inherited form of colorectal cancer have a higher risk of developing uterine cancer than other women.
Other risk factors are related to how long a woman's body is exposed to estrogen. Women who have no children, begin menstruation at a very young age, or enter menopause late in life are exposed to estrogen longer and have a higher risk.
Treatment:
Women with uterine cancer have many treatment options. Most women with uterine cancer are treated with surgery. Some have radiation therapy. A smaller number of women may be treated with hormonal therapy. Some patients receive a combination of therapies.
Cervical Cancer
What is it?
Cervical cancer begins in the lining of the cervix. This cancer does not form suddenly. First, some cells begin to change from normal to pre-cancer and then to cancer. This can take a number of years, although sometimes it happens more quickly. These changes are referred to by several terms, including dysplasia. For some women, these changes may go away without any treatment. More often, they need to be treated to keep them from changing into true cancers.
There are two main types of cancer of the cervix. About 80% to 90% are squamous cell carcinomas. The other 10%-20% are adenocarcinomas. If the cancer has features of both types it is called mixed carcinoma. If you have cervical cancer, ask your doctor to explain exactly what type of cancer you have.
Symptoms:
Early cervical pre-cancers or cancer often have no signs or symptoms. That's why it's important for women to have regular Pap tests. Symptoms usually appear when the cancer is further along.
You should report any of the following to your doctor right away:
- any unusual discharge from the vagina (not your normal period)
- blood spots or light bleeding other than your normal period
- bleeding or pain after sex, douching, or after a pelvic exam
Of course, these symptoms do not mean that you have cancer. They can also be caused by something else. But you must check with your doctor to find out.
Risk Factors:
HPV: For cervical cancer, the most important risk factor is infection with HPV (human papillomavirus). HPV is passed from one person to another during sex. Having unprotected sex, especially at a young age, makes HPV infection more likely. Also, women who have many sexual partners (or who have sex with men who have had many partners) have a greater chance of getting HPV.
The Pap test can find changes in the cells of the cervix caused by HPVs. While there is no cure for HPV, the abnormal cell growth they cause can be treated.
Even though HPV is an important risk factor for cervical cancer, most women with this infection do not get cervical cancer. Doctors believe other factors must come into play for this cancer to develop. Some of these factors are listed below.
Smoking: Women who smoke are about twice as likely as those who don’t to get cervical cancer. Tobacco smoke can produce chemicals that may damage the DNA in cells of the cervix and make cancer more likely to occur.
HIV infection (human immunodeficiency virus): HIV is the virus that causes AIDS (it is not the same as HPV). It can also be a risk factor for cancer of the cervix. Being HIV positive makes a woman's immune system less able to fight both the virus and early cancers.
Chlamydia infection: This is a rather common kind of bacteria that can infect women’s sex organs. It is spread by having sex. Many women do not know they have it unless samples taken at the time of their Pap test are looked at for the bacteria. Some studies suggest that women who have this infection (or have had it in the past) are at greater risk for cancer of the cervix.
Birth control pills: Long-term use of birth control pills increases the risk of this cancer. Some studies show a higher risk after 5 or more years of use. You should talk to your doctor about the pros and cons of birth control in your own case.
Having many pregnancies: Woman who have had many full term pregnancies have an increased risk of this cancer.
Low income: Poor women are at greater risk for cancer of the cervix. This may be because they cannot afford good health care, including Pap tests.
Family history: Recent studies suggest that women whose mother or sister has had cervical cancer are more likely to get the disease themselves. This could be because they are less able to fight off HPV than other women.
Treatment:
The three main types of treatments for cervical cancer are surgery, radiation, and chemotherapy. Sometimes the best approach is to use two or more of these methods. If a cure isn’t likely, the goal may be to remove or destroy as much of the cancer as possible to keep it from growing for as long as possible.
