Cancers can occur in any part of the female reproductive system—the vulva, vagina, cervix, uterus, fallopian tubes, or ovaries. These cancers are called gynecologic cancers.
Locating the Internal Female Reproductive Organs
The most common gynecologic cancer in the United States is cancer of the uterus (endometrial cancer), followed by ovarian cancer, then cervical cancer. The cervix is the lower part of the uterus, but cancer of the cervix is usually called cervical cancer, and cancer of the body of the uterus is called uterine cancer (or endometrial cancer). Most cervical cancers are caused by human papillomavirus (HPV) infection. Cervical cancer is less common in high-resource than in middle- or low-resource countries because, in high-resource countries, screening for cervical cancer, HPV testing, and the HPV vaccine are widely available, which often allows treatment of abnormal cells before cancer develops.
Gynecologic cancers can spread in the following ways:
Directly invade nearby tissues and organs
Spread (metastasize) through the lymphatic vessels and lymph nodes (lymphatic system) or through the bloodstream to distant parts of the body
Diagnosis of Female Reproductive System Cancers
Regular pelvic examinations
Biopsy
Regular pelvic examinations and screening for certain gynecologic cancers, especially cancer of the cervix, can lead to the early detection of these cancers. Screening for cervical cancer includes the Papanicolaou (Pap) test and HPV testing. Such examinations can sometimes prevent cancer by detecting precancerous changes (dysplasia) before they become cancer. Regular pelvic examinations can also detect cancers of the vagina and vulva. However, cancers of the ovaries, uterus, and fallopian tubes are not easy for doctors to detect during a pelvic examination.
If cancer is suspected, a biopsy can confirm or rule out the diagnosis. A sample of tissue from the affected organ is removed, examined under a microscope, and analyzed. For some cancers, such as ovarian cancer, surgery must usually be done to make the diagnosis.
Staging
If cancer is diagnosed, one or more procedures may be done to determine the stage of the cancer. The stage is based on how large the cancer is and how far it has spread. Some commonly used procedures include ultrasonography, computed tomography (CT), magnetic resonance imaging (MRI), chest x-rays, and positive emission tomography (PET). Doctors often determine the stage of cancer after they remove the cancer and biopsy the surrounding tissues, including lymph nodes.
Staging a cancer helps doctors choose the best treatment.
For all gynecologic cancers, stages range from I (the earliest) to IV (advanced). For most cancers, further distinctions, designated by letters of the alphabet, are made within stages.
Staging Cancers of the Female Reproductive System*
Type | Stage I | Stage II | Stage III | Stage IV† |
|---|---|---|---|---|
Only in the cervix | Spread outside the uterus (including the upper two thirds of the vagina and/or tissues outside the uterus) but still within the pelvis‡ | Spread throughout the pelvis and/or to the lower third of the vagina and/or blocks the ureters and/or causes a kidney to malfunction and/or spread to the lymph nodes near the aorta (the largest artery in the body) | Spread outside the pelvis and/or to the bladder or rectum or distant organs | |
Only in the body of the uterus (not in the cervix, which is the lower part of the uterus) | Spread to the cervix but is still within the uterus | Spread to nearby tissues, the vagina, or lymph nodes | Spread to the bladder and/or intestine and/or distant sites | |
Only in the body of the uterus | Spread outside the uterus to the ovary, fallopian tube, vagina, and/or nearby tissues | Spread to the lungs | Spread outside the lungs and uterus to distant sites, such as the brain, liver, kidneys, and/or digestive tract | |
Fallopian tube cancer Peritoneal cancer | Only in one or both ovaries or fallopian tubes | Spread to the uterus or nearby tissues within the pelvis or cancer only on the peritoneum (the tissue that lines the pelvis and abdomen)‡ | Spread outside the pelvis to lymph nodes and/or to other parts of the abdomen (such as the surface of the liver or spleen) | Spread to distant sites (for example, to the liver or lungs) |
Only in the vagina | Spread through the wall of the vagina to nearby tissues but still within the pelvis‡ | Spread throughout the pelvis and/or to lymph nodes and/or blocks the ureters and/or causes a kidney to malfunction | Spread to the bladder or rectum or outside of the pelvis | |
Only in the vulva | Spread to nearby tissues (the lower part of the urethra or vagina or to the anus) | Spread to the upper part of nearby structures and/or lymph nodes | Spread to distant sites or lymph nodes in the groin, forming sores or becoming stuck together or attached to bone | |
* Based on the International Federation of Gynecology and Obstetrics Staging System. | ||||
† Stage IV is sometimes further classified as A or B depending on where the cancer has spread. | ||||
‡ The pelvis refers to the lowest part of the abdomen, the area below the abdomen and between the hip bones. It contains the internal reproductive organs, bladder, and rectum. | ||||
Treatment of Female Reproductive System Cancers
Usually, surgical removal
Sometimes radiation therapy and/or chemotherapy
Cancer treatment may include surgical removal, radiation therapy, and chemotherapy, depending on the type and stage of cancer. When cancer is first diagnosed, the main goal of treatment is to remove or stop the growth of the cancer if possible.
Chemotherapy is usually the most effective way to treat any cancer cells that have spread beyond the original site. Chemotherapy may be given by injection, by mouth, or through a catheter inserted into the abdomen (intraperitoneally).
Radiation therapy is usually given if a tumor has spread to surrounding tissues that are next to the original tumor, such as spread of a tumor of the uterus to the bladder.
For some gynecologic cancers, hormone therapy or hormone blockers are given as additional treatment, usually after surgery, chemotherapy, and/or radiation therapy have been completed. Hormone therapy works by stimulating or blocking hormone receptors to stop growth of any tumor cells that have spread from the original site.
When a gynecologic cancer is very advanced and a cure is not possible, radiation therapy or chemotherapy may still be recommended to reduce the size of the cancer or its metastases and to relieve pain and other symptoms. Women with incurable cancer should establish advance directives. Because end-of-life care has improved, more and more women with incurable cancer are able to die comfortably at home. Appropriate medications can be used to relieve the anxiety and pain commonly experienced by people with incurable cancer.
