As an obstetrician gynecologist, I see women of all ages who are at risk for gynecologic cancers. I would like to give an overview of gynecologic cancers affecting women, and how best to avoid them or detect them when they occur.
Although breast cancer can occur in men, women are by far the most affected. And, unfortunately, women can develop breast cancer even in their 20s. There are models to determine your risk of breast cancer. The Gail model is commonly used. Most women should start mammography screening at age 40, but if at high risk, screening may be started earlier. You should discuss your risk of breast cancer with your health care provider who may recommend genetic counseling for certain high-risk women. Be aware of how your breasts feel, including the arm pit area where lymph nodes can develop from breast cancer. Report any changes such as a new lump or change in skin texture.
Endometrial cancer (cancer of the uterine lining)
Endometrial cancer is the second most common gynecologic cancer in women. It often presents later in life but can present in the 30s. You may be at higher risk for this cancer if you started your menstrual cycle very early or entered menopause late. Having irregular periods throughout your life and being overweight can also increase your risk. You should report irregular bleeding or very heavy bleeding. If your periods are consistently lasting longer than normal, or if you are bleeding in between periods, these patterns should also be reported. Once your periods stop and you are in menopause, any spotting or bleeding thereafter also could be a sign of endometrial cancer.
Unfortunately, ovarian cancer is hard to detect in its earliest stages. This makes it one of the most feared gynecologic cancers. There are no current recommended tests or screening that can be performed to detect ovarian cancer in women who have no added risk factors for getting ovarian cancer, like a family history of ovarian cancer. Symptoms such as bloating or abdominal pain may be later findings in ovarian cancer. Having been on birth control pills some time in your life may decrease your risk of getting ovarian cancer.
Ovarian-like cancer may start in the Fallopian tubes. If you are considering tubal ligation for birth control or having a surgery such as hysterectomy, your doctor may suggest completely removing your fallopian tubes. This is a good cancer prevention strategy. Fallopian tube cancer can cause excessive watery vaginal discharge.
Thankfully, with the advent of the Pap smear decades ago, women who undergo regular Pap smear screening rarely develop cervical cancer. Physicians often do Pap smear screening and HPV (Human Papilloma Virus) testing together. There are high risk HPV types that are associated with cervical cancer. HPV is a sexually transmitted virus that can cause genital warts in men and women. When it infects the cervix, it may cause cervical pre-cancer changes that can lead to cervical cancer. There is now a vaccine against HPV that can be given to teens and young adults. This vaccine can clearly prevent cervical cancer by preventing women from getting HPV and should be included in recommended vaccines. It can be effective even if sexual activity does not occur until years after getting the vaccine.
Vaginal cancer is rare. It affects the skin of the vagina. It may be detected in a woman with abnormal spotting or bleeding by doing an examination. Or it can be detected on a normal annual examination by looking inside the vagina. HPV is also a cause of vaginal cancer.
The vulva is the external area outside the vagina that includes the labia (lips) around the vaginal opening. You may detect this type of cancer by noting a red, possibly raised area that may feel irritated. It may cause itching or bleeding. You should use a mirror to examine this area so that you can report any abnormal appearing skin areas. HPV may also be associated with this type of gynecologic cancer. HPV is also a cause of vaginal cancer.
Smoking increases your risk of getting most all of these cancers, so women have even more good reasons to stop smoking.