What Women Need to Know About Gynecologic Cancers

Thanks to the Pap test, cervical cancer is no longer the leading cause of cancer death for women in the United States. Since it was introduced in the 1940s, the number of cases is down 70 percent and deaths 90 percent. But the Pap test only screens for cancer of the cervix, not other gynecologic cancers, for which there aren’t good screening tests. That’s why it’s vitally important for women to know possible warning signs. You know your body better than anyone and you know when something isn’t right. Pay attention.

Gynecologic Cancers

  • Uterine (most common form is in the lining of the uterus or endometrium)
  • Ovarian
  • Cervical
  • Vaginal
  • Vulvar

Dr. Hector Tarraza, chief of obstetrics and gynecology at Maine Medical Center, is a gynecologic oncologist. In other words, his specialty is gynecologic cancer. With his guidance and some additional facts from the CDC, I will pass along information that could save your life. We’ll begin with uterine cancer, which is the most common gynecologic cancer, and the fourth most common cancer overall in women — after colon, lung, and breast cancer.


Signs and symptoms

  • Abnormal vaginal discharge
  • Abnormal bleeding
    • Heavier than usual
    • In between periods
    • Longer than usual
    • After menopause
  • Pain or pressure in your pelvis

Dr. Tarraza stresses that women should not bleed once they have gone through menopause and that it’s critical not to ignore that symptom. “Seventy percent of women who bleed after menopause will not have cancer,” he says, “but you can’t tell, so any woman who has post menopausal bleeding needs a biopsy.”

Risk factors

  • Age (being over 50)
  • Obesity
  • Taking estrogen alone during menopause
  • Reproductive and menstrual history
    • Never had children
    • First period before age 12
    • Menopause after age 55
  • Diabetes
  • High blood pressure
  • High fat diet
  • Taking Tamoxifen, a drug used to treat some breast cancers
  • Family history of uterine, colon or ovarian cancer

What may lower your risk

  • Maintaining a healthy weight
  • Being physically active
  • If you are on estrogen during menopause, adding progesterone
  • Eating a low fat diet
  • Birth control pills


Signs and symptoms

  • Abnormal vaginal discharge
  • Abnormal bleeding
  • Bleeding after menopause
  • Pain or pressure in the pelvis or abdomen
  • Back pain
  • Bloating
  • Feeling full quickly while eating
  • Change in bathroom habits
    • Need to urinate badly or often
    • Constipation or diarrhea

“The problem with ovarian cancer,” says Dr. Tarraza, “is that there are no good screening tools, it is very difficult to diagnose, and is often discovered too late.”

The tests generally used to diagnose it are transvaginal ultrasound, blood tests, including the CA-125, and pelvic exam. It is just as challenging to treat as it is to diagnose. “Treatment requires a comprehensive approach with surgery, chemotherapy, and in certain cases, radiation,” explains Dr Tarraza.

Risk factors

  • Age (40 and older)
  • Family history of ovarian cancer on either side of the family
  • Personal history of breast, uterine or colorectal cancer
  • Eastern European Jewish background
  • Never had children or had trouble getting pregnant
  • Endometriosis

What may lower your risk

  • Being on birth control pills for more than five years
  • Tubal ligation
  • Removal of both ovaries
  • Hysterectomy
  • Giving birth


Signs and symptoms

  • Early stages may have no signs or symptoms
  • Advanced stages may cause abnormal bleeding or discharge

“The Pap smear is the most important test to detect cervical cancer,” says Dr. Tarraza. “The vast majority of cases are caused by the human papilloma virus (HPV). There is a vaccine to protect you against HPV and in certain situations you can also test for HPV.”

Risk factors

  • Having HPV
  • Smoking
  • Having a compromised immune system
  • Using birth control pills for five or more years
  • Giving birth to three or more children
  • Being the daughter of a woman who took DES during pregnancy increases the risk of clear cell adenocarcinoma of the cervix

What may lower your risk

  • Getting vaccinated against HPV
  • Getting a regular Pap test between the ages of 21 and 65
  • Proper follow up if Pap test is abnormal
  • Not smoking
  • Using condoms during sex
  • Limiting the number of sexual partners

If you have a low income or are not insured, you may qualify for free or low-cost Pap tests and mammograms through the Maine Breast and Cervical Health Program. The program is also available nationally.


Signs and symptoms of vaginal cancer

  • Abnormal discharge or bleeding
  • Change in bathroom habits
    • Blood in the stool or urine
    • Needing to go more than usual
    • Feeling constipated
  • Pain in the pelvis or abdomen, especially when you urinate or have sex

Signs and symptoms of vulvar cancer

  • Itching, burning or bleeding of the vulva that doesn’t go away
  • Color changes on the skin of the vulva
  • Skin changes on the vulva, including what looks like a rash or warts
  • Sores, lumps or ulcers on the vulva that don’t go away
  • Pelvic pain, especially when you urinate or have sex

Risk factors for vaginal and vulvar cancer

  • Have HPV
  • Had cervical cancer or precancer
  • Have a compromised immune system
  • Smoke
  • Have chronic itching or burning of the vulva
  • Being the daughter of a woman who took DES during pregnancy increases the risk of clear cell adenocarcinoma of the vagina

What may lower your risk

  • HPV vaccine, recommended for females between ages 9 and 26
  • Limiting your number of sexual partners
  • Not smoking

You can learn more about gynecologic cancers from the Centers for Disease Control and Prevention (CDC) or the National Cancer Institute.

And please, share this important information with other women. Too often, the signs and symptoms are ignored or missed. If you have any, they may mean nothing, but why take the chance?


Diane Atwood

About Diane Atwood

For more than 20 years, Diane was the health reporter on WCSH 6. Before that, a radiation therapist at Maine Medical Center and after, Manager of Marketing/PR at Mercy Hospital. She now hosts and produces the Catching Health podcast and writes the award-winning blog Catching Health with Diane Atwood.