Genitourinary Cancer Screening

Over 100,000 gynecologic cancers are diagnosed each year in the United States. These include cancers originating from the uterus, endometrium (lining of the uterus), ovary, cervix, vagina and vulva. Being proactive in taking care of yourself, noting persistant/unusual symptoms, and annual exams all increase the likelihood of early cancer detection and successful treatment.

  1. Endometrial cancer: this is the fourth most common cancer in women however accounts for only 4% of cancer related deaths. The average age of diagnosis is 63. Risk factors include family history, Lynch syndrome, obesity, tamoxifen use, diabetes, high blood pressure and history of irregular periods. In fact, we know that 3 in 5 uterine cancers could have been prevented by being at a healthy weight and being active. Prevention of endometrial cancer includes such things as regulating weight, regulating abnormal periods, and referral to geneticist in some cases for testing. The most common presenting symptom is abnormal bleeding. For this reason, women with abnormal bleeding should be evaluated. This is commonly done using ultrasound and office biopsy of the endometrium. The treatment for uterine cancer is hysterectomy with removal of tubes and ovaries, as well as lymph nodes in some cases.
  2. Cervical cancer: the human papilloma virus (HPV) is the cause of the vast majority of cervical cancers. Recommendations are for vaccination in boys and girls ages 9-26. New recommendations also suggest vaccination up to age 45 even in patients with a known history of HPV. Screening with Pap smears should start at age 21 and continue until age 65. The frequency of pap smear testing depends on a woman’s history/risk factors. Screening should continue longer in women who have a history of severe precancerous lesions, history of cervical cancer, or compromised immune system. Similarly, women who have had a hysterectomy need Pap smears of the top of the vagina if there is a history of cervical cancer/precancerous lesions or poor immune system. Women still should have periodic pelvic exams regardless of age or history of HPV past age 65.
  3. Ovarian cancer: this is the 5th most common cause of cancer death but is the 10th most common diagnoses cancer in women. Risk factors include BRCA gene mutation, Lynch syndrome, older age, early first menses, late menopause, no deliveries, family history of ovarian cancer, endometriosis. Oral contraceptives and removal of fallopian tubes lower an individual’s risk of ovarian cancer. Symptoms can be very subtle and include such things as bloating, poor appetite, urinary frequency, abdominal or pelvic pain. Screening for ovarian cancer remains a challenge. Using ultrasound and the Ca-125 tumor marker can be helpful in select cases. Some preventive treatments include oral contraceptives, referral to a genetic counselor in high risk patients for testing, no smoking, healthy weight management, and removing fallopian tubes.
  4. Vulvar cancer: accounts for less than 1% of cancers in women. Occurs most often in patients mid 60’s and older. Risk factors include smoking, history of HPV, history of lichen sclerosus, and poor hygiene. Patients will often present with vulvar itching or a non-healing vulvar lesion. Diagnosis is made by biopsy and treatment is surgical removal of the lesion. Five-year survival is over 90% when the cancer is stage 1.

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