Gynecologic Cancer

Pelvic gynecologic cancers are relatively less frequent, but still a very significant health problem for women. Cancers of the endometrium (uterus), ovary, cervix, and other areas constitute approximately 70,000 cases each year in the United States, compared to 180,000 women who develop breast cancer. In many countries, however, cervical cancer is the most common, and an even bigger health care problem. Pap smear screenings, which diagnosis precancerous changes on the cervix, are a major factor in limiting this problem in the US.

The survival rate with all cancers depends on the type of malignancy, the stage, and its unique biology. Many gynecologic pelvic malignancies - endometrial/uterine cancer, for example - are cured completely. Surgery alone is curative for most women with endometrial cancer, but radiation and occasionally chemotherapy can be called for. Likewise, cervical cancer is usually cured by surgery and/or radiation. It may be surprising to learn there are many types of ovarian cancer. Some are entirely curable by surgery and chemotherapy while others are not, though treatments for all types of ovarian cancers can greatly extend life, and the quality of life, for years.

Having regular gynecologic examinations is not something anyone looks forward to, but its benefits are substantial in terms of diagnosing cancer at a time when it is early and curable. It is often said that ovarian cancer is the “silent killer” of women because there are no early signs, though there are ongoing efforts to diagnose ovarian cancer earlier. As far as “screening tests” for other gynecologic malignancies, mammography, pap smears and endometrial biopsies (to evaluate any type of abnormal uterine bleeding) are readily available and highly useful.

Genetics plays a significant role in the development of malignancy. One of the cruder assessments of genetic risk is the family history. Long before DNA was understood, it was clear that malignancies of certain types seem to occur more frequently in certain families. Today, a combination of better genetic understanding coupled with family history analysis can be very important. It is well known, for example, that certain breast, ovarian and other gynecologic cancers are associated with both genetic defects and family history, even when those defects are not understood. Women who do have a family history of any of these malignancies should tell their physicians.

Cancer research is ongoing and from all directions, though it is an incredibly complex and diabolical set of diseases. Cancer cells change in ways that often make them resistant to treatments, despite the best efforts. That said, treatments are increasingly effective at managing even the most difficult malignancies, so even if a cure is not possible, an increased quality of life is almost always possible. The most typical gynecologic pelvic malignancies remain curable through increasingly less invasive means and the use of minimally invasive procedures, such as laparoscopy, allow patients to have curative surgery, making recovery easier. Radiation therapy is increasingly more precise, minimizing side effects without reducing overall effectiveness. There also is great optimism about better therapies through both biological agents and new genetic approaches, which may well be standards of care in the next five years.