Women’s Cancer Expert Answers Pressing Questions About Gynecologic Cancers

September is ovarian and uterine cancer awareness month and, unfortunately, these two gynecologic cancers are not well understood. To help raise awareness, Dr. Melissa Frey, Assistant Professor of Obstetrics and Gynecology at Weill Cornell Medicine, outlined what all women should know: the risk factors, signs and symptoms, and preventative screening options for these cancers.

What are the most significant risk factors for gynecological cancers?

Ovarian cancer risk factors: “Family history and genetics are linked to about 20 percent of ovarian cancercases,” said Dr. Frey. “Genetic conditions associated with gynecologic cancers include the BRCA1/2 gene and Lynch syndrome.”

A positive BRCA1/2 test result indicates a mutation in one of the hereditary breast and ovarian cancer genes and, therefore, a significantly higher risk of developing breast cancer and ovarian cancer than someone who does not carry the mutation. However, not everyone with a positive result goes on to develop cancer.

Lynch syndrome is a genetic condition that has a high risk of endometrial and colon cancer, as well as other cancers including ovarian cancer.

Other risk factors for ovarian cancer include:

  • Increasing age
  • History of endometriosis
  • Early menarche and late menopause (longer ovulation)
  • Polycystic Ovary Syndrome (PCOS)

Dr. Frey continued, “Additional risk factors are being studied, such as environmental factors, cigarette smoking, and obesity.”

“On the other hand,” said Dr. Frey, “oral contraceptives, breastfeeding, and prior pregnancy, are all protective measures decreasing risk of ovarian cancer. Women with a genetic predisposition for ovarian cancer should meet with a gynecologic oncology and discuss the option for risk-reducing surgery—meaning the removal of ovaries and fallopian tubes.”

Uterine cancer risk factors: “Obesity is one of the most important risk factors for uterine cancer,” said Dr. Frey. Other risk factors include:

  • Hormone replacement therapy
  • Tamoxifen (for breast cancer)
  • Early menarche and late menopause
  • PCOS
  • Hypertension
  • Diabetes
  • Lynch syndrome

Dr. Frey continues, “Maintaining a healthy weight and prior pregnancy are protective measures against uterine cancer.”

What are the most common signs and symptoms?

Signs of ovarian cancer: This cancer is often referred to as “the cancer that whispers” because the symptoms are so vague, including:

  • Abdominal pain
  • Fluid in the abdominal cavity (called ascites)
  • Abdominal bloating
  • Changes in bowel habits
  • Incontinence
  • Changes in appetite
  • Weight loss or gain
  • Shortness of breath or chest pain

“Unfortunately, because symptoms are often vague, many women are diagnosed with ovarian cancer at an advanced stage, most commonly stage III or IV,” explained Dr. Frey. “If a woman experiences any symptoms that cannot be easily explained, she should consider ovarian cancer. It is also very important that all women have a gynecologist that they see annually.”

Signs of uterine cancer: “With uterine cancer, postmenopausal vaginal bleeding is the primary symptom. Although vaginal bleeding is easy to ignore, it is often the first sign of uterine cancer,” said Dr. Frey. “It is critical to get prompt medical attention because endometrial cancer is almost always curable with surgery.”

How are these cancers diagnosed and treated?

Ovarian cancer diagnosis and treatment: An OB/GYN will do a pelvic exam to assess for a mass. A pelvic ultrasound, CT scan, or MRI may follow. Blood work may indicate elevated CA125, a tumor marker. If the physical exam or test results are concerning, a gynecologic oncologist performs a more specialized evaluation.

Dr. Frey explained, “In order to diagnose ovarian cancer a patient must have either surgical removal of the ovary or a biopsy and a pathologic evaluation, there is not definitive blood or imaging test.” If ovarian cancer is diagnosed, an individualized, multidisciplinary treatment plan is developed that generally includes a combination of surgery and chemotherapy.

Uterine cancer diagnosis and treatment: “Any woman who has vaginal bleeding after menopause should see an OB/GYN. Her doctor will order an ultrasound and perform an endometrial biopsy. The biopsy can usually be performed in the office and surgery not always necessary for diagnosis,” said Dr. Frey. “If the results indicate cancer or pre-cancer, she is then referred to a gynecologic oncologist for more definitive treatment.”

Early evaluation of any postmenopausal vaginal bleeding is critical to successfully treat uterine cancer. Because symptoms present in the early stage of the disease, most women are cured with surgery alone.

What are preventive screening options for these cancers?

Currently, there is no simple and reliable way to screen for ovarian and uterine cancers in women who do not have any signs or symptoms. “Therefore,” Dr. Frey warned, “it’s important for women to understand the symptoms of these cancers.”

Dr. Frey is particularly interested in focusing on preventing these cancers through genetic testing. She shared, “The ideal scenario is to find a way to prevent these cancers through genetic testing and risk-reducing surgeries.”

Dr. Frey advised, “Although guidelines for genetic testing are constantly changing, any woman with a family history of multiple cancers (any type or organ), including breast or ovarian cancer, should speak with her doctor and consider meeting with a genetic counselor. A genetic counselor can help determine if genetic testing is warranted or not.”

“The cost of genetic testing is coming down, and many genes can be evaluated with a single blood or saliva test,” continued Dr. Frey. “Women who test positive for genetic conditions, including the BRCA1/2 genes and Lynch syndrome, should consider risk-reducing surgery to prevent cancer from developing.”

Learn more about the cutting-edge treatments and services offered by the gynecologic oncologists at Weill Cornell Medicine.

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