GYNECOLOGIC CANCERS

There are three main types of gynecologic cancers: Uterine, Cervical, and Ovarian. Uterine and cervical cancers are discussed below. A description of ovarian cancer can be found here.

Uterine Cancer

Uterine cancer is the most common type of gynecologic cancer.

Endometrial cancer, also called adenocarcinoma, begins in the endometrium, the lining of the uterus. Endometrial cancer accounts for about 95 percent of uterine cancers. While it mostly affects postmenopausal women, 25 percent of cases are seen in premenopausal women, with 5 percent of these patients under age 40.

After diagnosis, you may be referred to a gynecologic oncologist, a doctor who’s had specialty training in both the surgical and the chemotherapeutic management of gynecologic cancers. Your doctor will surgically remove the uterus and cervix (a simple hysterectomy) or those organs plus the upper part of the vagina and nearby tissues (a radical hysterectomy). The doctor also may take out nearby lymph nodes, as well as the fallopian tubes and ovaries.

Your doctor will inspect the removed organs to stage your cancer — that is, to determine the extent to which the disease has spread. Since surgery removes the tumor, it not only helps determine the stage of the disease but surgery also may be curative.

Your doctor may use a staging method known as the FIGO (International Federation of Gynecology and Obstetrics) system. Although subdivisions exist, in simple terms, cancer confined to the uterus is stage I; cancer with cervical involvement is stage II; cancer with local spread outside the uterus is stage III; and cancer with spread to the bladder, rectum or other organs is stage IV. Most patients have stage I and II uterine cancers, which have the highest survival rates.

Your doctor also may determine the tumor’s grade after examining tumor cells under a microscope. If the cells appear similar to normal tissue, the tumor is considered low grade. If they don’t look like normal tissue, the tumor is high grade. Low-grade tumors usually grow more slowly than high-grade tumors, which are more likely to spread.

Knowing your tumor’s stage and grade helps your doctor decide whether to recommend further treatment after surgery. Options for further treatment include radiation therapy, hormone therapy and chemotherapy alone or in combination. Your doctor may use these therapies without surgery if your tumor can’t be removed or if health problems prevent surgery. In some cases, radiation therapy shrinks the tumor before surgery.

Cervical Cancer

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Cervical cancer develops in the cervix, the lower part of the uterus that connects the uterus to the vagina. This cancer is most commonly found in women of childbearing age. The most important risk factor for cervical cancer is infection with the sexually transmitted human papillomavirus.

The two main kinds of cervical cancer are:

Squamous Cell Carcinoma. About 80 to 90 percent of cervical cancers are squamous cell carcinomas, which arise from the cells that line the surface of the cervix.
Adenocarcinoma. This less common type of cervical cancer develops in the glandular cells lining the cervical canal. Between 10 and 20 percent of cervical cancers are adenocarcinomas.

The treatment for cervical cancer depends on the stage. Stage I disease is limited to the cervix and is most often treated by radical hysterectomy and removal of the lymph nodes. (A radical hysterectomy involves removing the tissues that attach to and support the uterus; cervical cancer is known to spread to these tissues first.)

A fertility-preserving surgery, the radical trachelectomy, takes out the uterine cervix, the top part of the vagina and the pelvic lymph nodes, but leaves the rest of the uterus.

Radiation may be used instead of surgery to treat small tumors, or it may be used after surgery for patients at high risk of having the cancer return.

In stage II, the cancer has descended to the upper part of the vagina or reached the tissue around the uterus. In stage III, the cancer is in the lower part of the vagina or the pelvic wall and possibly in the pelvic lymph nodes. In stage IV, the cancer has invaded other body parts.

In general, stages II, III and IV are usually treated with a combination of radiation therapy and chemotherapy. Chemotherapy makes the tumor more sensitive to destruction by radiation, and it kills cancer cells outside the radiation field.