Gynecological cancers

According to the Canadian Cancer Society, 3,600 cases of endometrial, or uterine, cancer were detected in Canada in 2002. While the most prevalent, it's not the biggest killer of the gynecological cancers. The one that claims the most lives is ovarian cancer, a condition for which there is no screening test available. "If you have a family history [of gynecological cancer], get checked," says Dr. Al Covens, gynecologic oncologist at Sunnybrook Regional Cancer Centre in Toronto.

The following is a guide to the seven types of gynecological cancer:
Endometrial or uterine, ovarian, cervical, vaginal, vulvar, gestational trophoblastic disease and choriocarcinoma, and fallopian tube.

Endometrial or uterine
Description: The most common gynecologic cancer, it begins in the cellular lining of the uterus.
Risk factors: Risk increases after menopause and for those who never give birth. Obesity, high blood pressure, menstrual problems, exposure to high levels of estrogen, diabetes or tamoxifen therapy are also risk factors.
Screening: Fortunately, says Covens, the symptom of abnormal bleeding occurs very early on, unlike with Ovarian cancer, which can grow considerably before any symptoms appear. If warning signs are detected early, when the cancerous cells have not spread passed the uterus, survival rate is high after undergoing a hysterectomy. An endometrial biopsy may be conducted as well as an ultrasound.

Ovarian
Description: The biggest killer of the gynecologic cancers. The cancerous cells commonly begin on the surface of the ovary.
Risk factors: The majority of women with ovarian cancer have no risk factors, but the indicators may include being over 40, family history, breast cancer, early menstruation, late menopause, high-fat diets, and the use of fertility drugs.
Screening: No screening exam exists, but the Ovarian Cancer Alliance Canada suggests an annual bimanual rectovaginal exam, to identify ovarian abnormalities. Testing may also include a CA 125 blood test and a transvaginal or pelvic ultrasound scan.

Cervical
Description: About 85 per cent of cases develop in the cellular lining of the cervix, but can enter the cervix and spread. The human papilloma virus (HPV), transmitted during sexual intercourse, could be the cause of this cancer.
Risk factors: Any woman who has been sexually active is at risk, says Covens. Risk increases the younger a woman is when she first has sexual intercourse and with the more partners she's had.
Screening: According to Health Canada, up to 90 per cent of cases of cervical cancer could be prevented by getting a Pap Smear -- which can detect the cancer early in its development and be successfully treated. Covens suggests yearly screenings.

Vaginal
Description: Possibly caused by HPV, vaginal cancer destroys the vaginal lining and causes sores that can bleed and become infected.

Risk factors: Being between 60 and 80 years of age. "Vaginal cancer is very rare and tends to mostly affect women who have had hysterectomies," says Covens. Risk also increases if women have had cervical cancer or precancerous cells on the cervix.
Screening: Symptoms include bleeding or discharge, painful intercourse or urination, and pain in the pelvic area. An annual Pap smear is recommended. 

Vulvar
Description: A skin cancer around the opening of the vagina, it accounts for about three to four per cent of reproductive cancers.
Risk factors: Risk increases for post-menopausal women. Symptoms include: vulvar itching or bleeding and changes in the colour or feel of the vulva.
Screening: According to Covens, no screening is available. A biopsy may be performed to determine if the skin is cancerous.

Gestational trophoblastic disease and choriocarcinoma
Description: Tumors in the placenta and within the uterus are caused by abnormal cellular growth in the tissues. It can develop in any pregnant woman.
Risk factors: While extremely rare, it is more common in Asia. It is also more common in people with poor nutrition. Once you've had GTD, risk of a repeated occurrence increases tenfold with every pregnancy, says Covens.
Screening: Abnormal bleeding early in a pregnancy is a common symptom. Doctors may conduct a pelvic exam, ultrasound and HCG blood test.

Fallopian tube
Description: The rarest of gynecologic cancers, it is similar to ovarian cancer in appearance and treatment.
Risk factors: "It may have the same risk factors as ovarian cancer," says Covens. "In some of the studies where they've taken women at high risk for ovarian cancer, they found a high incidence of fallopian tube cancer."
Screening: There are no screenings, says Covens.

Online resources
For more information about gynecological cancers, visit the following Web sites:

The Society of Gynecologic Oncologists of Canada

Health Canada's Women's Health Bureau

Ovarian Cancer Centre Alliance

Women's Cancer Network

Canadian Cancer Society

Society of Obstetricians and Gynaecologists of Canada

OBGYN.net