Screening and Diagnosis of Gynecologic Cancers

Screening tests help your healthcare team identify potential problems before symptoms develop. Since cancer is the easiest to treat and cure in its earliest stages, or before it even becomes a cancer, your physician may recommend various tests to screen for gynecologic cancers, including ovarian cancer, cervical cancer, and endometrial cancer. Screening recommendations are largely determined by your age, family health history, and other risk factors.

It’s important to know which screening tests and exams are available as well as other things you can do to monitor your health for signs of gynecologic cancers.   

Cervical Cancer Screening

Cervical cancer is the only one of the gynecologic cancers with a standardized screening process in place. Cervical cancer usually begins in the cells lining the surface of the cervix. Most often, cervical cancer is caused by human papillomavirus (HPV) which can also cause vulvar cancer, throat cancer, anal cancer, and rectal cancer. Other risk factors for developing cervical cancer include a suppressed immune system, herpes, age, smoking, and possibly oral contraceptives.

For many women, cervical cancer can be stopped before it begins with regular screenings. A screening test called a Pap smear is used to identify evidence of cancerous and precancerous cells. The test is commonly performed during a pelvic exam before removing the speculum. A small wand is used to collect a sample of your cervical cells. The cells are sent to a lab to be tested for cancerous or precancerous changes. The American Cancer Society recommends women between the ages of 21 and 29 get a pap smear and HPV test once every three years as long as Pap test results are normal. Women between the ages of 30-64 should get a Pap smear and HPV test every 3-5 years.

Ovarian Cancer Detection 

Only 19% of women with ovarian cancer are diagnosed while the disease is in its early stages. That's most likely because early stages do not cause symptoms. As the disease progresses, the warning signs are often missed because menstrual changes, abdominal bloating, and pelvic discomfort caused by ovarian cancer can also be caused by many less serious health concerns. Although ovarian cancer is considered rare for women under 40, the disease can strike any woman at any age.

Ovarian cancer begins when the genes regulating cell growth mutate. Abnormal cells multiply rapidly and form a tumor. Since many signs of ovarian cancer mimic the symptoms of other less-threatening health concerns, women with a family history of ovarian cancer are commonly advised to undergo genetic testing. If blood tests show indications of harmful changes to one of the genes that can increase your risk of ovarian cancer, your provider may recommend a testing regimen or removal of the organs at a time before the risk increases.  

If ovarian cancer is suspected, your specialist may also recommend a transvaginal ultrasound to get a better idea of whether there are tumors on or around the ovaries. The test is performed by placing an ultrasound wand into the vagina and displaying the image on a monitor. While this test identifies tumors on the ovaries, a biopsy will be needed to differentiate between cancerous and non-cancerous growths.

Vaginal Cancer Detection

Most types of vaginal cancer cause small lumps (nodules) or sores to develop on the surface of the vagina. Quite often, there are precancerous changes before cancer develops that can be seen during a pelvic exam. Vaginal cancer most often occurs in women 60 years and older but can occur at any age. This type of gynecologic cancer is more likely to affect women previously infected with HPV and can often be cured when identified in its early stages. 

Vaginal cancer is commonly detected by a pelvic examination. If abnormalities are found during the exam, a biopsy may be recommended.  Although certain symptoms may strongly suggest vaginal cancer, a biopsy is the only way to determine if suspicions are correct.

Vulvar Cancer Detection

The vulva is the external area of the female genitalia and includes the opening of the vagina, the labia, and the clitoris. Most vulvar cancers are squamous cell carcinomas that affect the inner edges of the labia. Symptoms can include an area of skin that is lighter or darker, a bump with a wart-like surface, or an open sore that lasts for a month or more. Vulvar melanomas can also start in a mole.

A vulvoscopy is used to screen for vulvar cancer. Your physician will use the same magnifying device as used for a vaginoscopy, a colposcope, to examine the vulvar area. A solution will be applied to make it easier for your doctor to identify abnormal cells. If irregularities are detected, a biopsy may also be performed. 

Endometrial Cancer Detection

Endometrial cancer, also referred to as uterine cancer, is most common in postmenopausal women. The cancer begins in the cells that form the lining of the uterus, the endometrium.  Although other types of cancer can occur in the uterus, endometrial cancer is the most common. Endometrial cancer is often detected in its early stages because it is known to cause vaginal bleeding, which is unusual for women after menopause. When discovered in its early stages, this type of cancer is most often treated by surgically removing the uterus. 

If you notice unusual bleeding, particularly after menopause, schedule an appointment with your gynecologist. He or she will likely perform a physical examination, and may recommend one or more of the following diagnostic tests:

Transvaginal Ultrasound

Your specialist may recommend a transvaginal ultrasound to view the texture and thickness of the endometrium and rule out the possibility of symptoms being caused by conditions other than cancer. A wand-like instrument is inserted into the vagina to deliver sound waves that generate a video image.

Hysteroscopy

During a hysteroscopy, a thin, flexible, lighted tube (hysteroscope) is inserted through the vagina and cervix into the uterus. A fluid is pumped into the womb to make it easier for the doctor to see. A camera on the end of the scope relays an image to a video monitor. Hysteroscopy is also used to investigate fibroids, polyps, postmenopausal bleeding, pelvic pain, and more. Small channels in the hysteroscope allow doctors to perform a biopsy or remove polyps.

Expectations for your doctor’s visit:

• It is important to discuss concerns about cancer risk with your providers. Family history and personal risk factors are important, including smoking history, bleeding concerns, history of any pre-cancers, and prior gynecologic history. Although you can't rely on pelvic exams alone to assess your reproductive health, it is important not to underestimate their value. A pelvic exam is an assessment of your overall gynecologic health and may be performed at your visit to discuss screening. They help your physician identify any number of reproductive health concerns, including ovarian cysts, uterine fibroids, infections, and any growths that may have developed since your last exam.
• The examination is not typically painful or complicated. During a pelvic exam, your provider will discuss the steps and provide guidance during the exam. It is important to remember you, as the patient, can consent or decline any type of exam at any time.   Part of the exam may involve a manual examination of the size and shape of the pelvic organs, and/or viewing the cervix with a speculum and potentially performing a pap test. Depending on the results of your pelvic exam, your doctor may recommend further evaluation.  

Stay Vigilant for Gynecologic Cancer Symptoms

Because screening is not currently available for most types of gynecologic cancer, except cervical cancer, it's important to remain aware when something may feel abnormal. Note any changes or symptoms that may not fall in line with how you usually feel so you can discuss your concerns with your healthcare provider. Be sure to provide a thorough report even if you suspect you are experiencing age-related changes. Discussing your concerns can help you avoid unnecessary delays in cancer diagnosis and treatment.

If screening or diagnostic tests reveal evidence of cancer, your healthcare provider will likely recommend consulting with a gynecologic oncologist, a physician specializing in evaluating and treating cancers of the female reproductive system.

For diagnosis and treatment of gynecologic cancers in Hampton Roads and northeast North Carolina, find a Virginia Oncology Associates location nearest you. We provide unparalleled access to the latest technologies and most advanced treatments while delivering compassionate, personalized care.