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Ask A Doctor: Should I Be Worried About Gynecologic Cancer?

March 3, 2021

The idea of being diagnosed with a gynecologic cancer – be it endometrial, ovarian, cervical, vulvar or vaginal - can be terrifying. Screening and early detection are vitally important, as each type of cancer originating in the pelvic region has different risk factors, treatments and outcomes. To find out more about the prevention, detection and treatment of gynecologic cancers, we spoke with Dr. Janhvi Sookram, a Gynecologic Oncologist at Jefferson Health – New Jersey.

Look Out for Warning Signs

The most common gynecologic cancers in the U.S. include endometrial cancer, which occurs in the lining of the uterus; ovarian cancer; and cervical cancer, occurring in the lowermost part of the uterus. Each type of gynecologic cancer, including the less common vulvar and vaginal cancers, have slightly different symptoms – some of which can be vague or hard to pinpoint.

“Abnormal bleeding or a sudden change in menstrual cycles are usually warning signs that something is wrong. If you’re experiencing any of those symptoms, you must make an appointment with your gynecologist,” says Dr. Sookram.

Other warning signs for potential cancer in the pelvic area include:

● Extremely heavy, frequent or long menstrual cycles

● Gastrointestinal symptoms like bloating, loss of appetite, nausea or change in bowel movements (specifically an indicator of ovarian cancer)

● Pain or difficulty with urination

● Pain or bleeding during and after sex

● Pain or mass felt in the vagina or pelvic area

● Post-menopausal spotting or bleeding

“If you’re experiencing anything that doesn’t feel right, talk to your doctor about it right away. The sooner we address symptoms, the sooner we can figure out what is going on. It may not be cancer, but if it is, it’s easier to treat when we catch it early,” says Dr. Sookram.

Consider Your Risk Factors

There are various risk factors associated with each type of gynecologic cancer. 

For endometrial cancer, the biggest risk factor is obesity: “This is because fatty tissue in the body converts androgen—a testosterone-based hormone—to estrogen, which thickens the lining of the uterus,” says Dr. Sookram. There are also certain genetic factors that may come into play when considering your risk for endometrial cancer, so it is important to take note of your family history.

In addition, any individual who has an endometrium is at higher risk of developing endometrial cancer, as are those who experience their first menstrual period early or go through menopause in later years. Other risk factors include the use of hormone replacement therapy or the medication tamoxifen, a drug occasionally given to those with a history of breast cancer or those at extreme high risk for breast cancer.

Those most at risk for ovarian cancer have a family history of breast or ovarian cancer. These women usually have the BRCA1 or BRCA2 gene mutation. “If you have a family history of breast or ovarian cancer, it’s important for you to undergo genetic counseling and testing to see if you have a BRCA gene mutation,” says Dr. Sookram.

Other risk factors for ovarian cancer may include:

● No personal history of pregnancy or full-term pregnancy

● Obesity

● Personal history of endometriosis or breast cancer

● Postmenopausal age, especially for those older than 63, who make up half of all cases

● Use of hormone replacement therapy

Cervical cancer may sound familiar to many people because of the development and promotion of the human papillomavirus (HPV) vaccine in the last 15 years. “The biggest risk factor for cervical cancer is exposure to HPV, which is the most common sexually transmitted disease. However, because of the vaccine, it’s the only cancer of the pelvic region that is theoretically preventable,” says Dr. Sookram.

Another risk factor for cervical cancer is smoking. As Dr. Sookram explains, “smoking dampens the immune system. While many of those who develop HPV will be able to fight it off on their own, those who smoke are more likely to develop a persistent HPV infection, cervical dysplasia and cervical cancer.” Additionally, those with HIV or another condition that affects the immune system can be more at risk for developing cervical cancer.

Take Preventive Measures

The most important preventive step for gynecologic cancer is an annual visit to your gynecologist. “A yearly pelvic exam can ensure that we catch any abnormalities, masses or other symptoms early on,” says Dr. Sookram. Your gynecologist will make recommendations on how often you should receive a Pap or HPV test, whether you’re still eligible for the HPV vaccine, and if you should seek genetic counseling based on your family medical history.

Overall, maintaining a healthy lifestyle reduces your risk of developing any cancer. “Eating healthy food and exercising regularly can go a long way,” says Dr. Sookram. “Your primary care physician and your gynecologist are both there to guide you through living a healthy life. So if you ever have questions about lifestyle changes or concerns about symptoms you’re experiencing, we’re here to talk you through it and come up with a plan.”

Dr. Sookram can be reached at: 856-557-6400. For more information about cancer care at Jefferson Health – New Jersey, go to: jeffersonhealth.org/NJCancer