Gynecologic Oncology

• Obesity
• Infertility
• Genetics: a strong family history that includes breast and/or ovarian cancer may increase your risk of ovarian cancer. If you have a known BRCA mutation, that also increases your risk of ovarian cancer. 

• Abdominal pain or bloating
• Abdominal weight gain
• Frequent urination
• Feeling full or difficulty eating
• Nausea
• Diarrhea or constipation
• Vaginal bleeding

Early on, ovarian cancer may not produce many symptoms. As the cancer continues to grow, generally the above symptoms are most common. 

Springfield Clinic physicians who suspect ovarian cancer in a patient will order some of the following tests depending on case:

• Imaging: ultrasound or CT scan
• Blood Tests: CA-125 is a tumor marker that can sometimes be helpful in the diagnosis of ovarian cancer
• Biopsy: a procedure in which tissue may be sampled from the ovaries. The only way to definitively diagnose ovarian cancer is through a biopsy or surgery. 

• Surgery:
  • Staging: The first goal is to stage the cancer, which means to see how far the cancer has spread from the ovaries. This typically involves removing the uterus, fallopian tubes and ovaries. Also, the omentum will be removed (omentectomy). The omentum is a layer of fatty tissue that covers the contents of the abdominal cavity and there is a chance the cancer could have spread to this tissue. Some patients accumulate ascites (fluid in the abdomen) prior to surgery. If so, this fluid will be drained during surgery.
  • Debulking: The other important goal for surgery is to remove as much of the cancer as possible, this is called debulking. In some situations, the surgeon may need to remove a portion of the colon that is involved with tumor. If this occurs, there is a possibility that the end result may be a colostomy. A portion of the colon is attached to an opening (stoma) in the skin of the abdomen that allows body wastes to get out. This may be temporary (reversed by a surgery at a later date) or permanent. It may also be necessary to remove your appendix, as it can contain distant metastasis from your ovarian cancer. Debulking may also require removing a portion of the bladder, stomach, pancreas and/or liver if it appears any of these organs have been affected by your cancer.
• Chemotherapy: Another treatment of ovarian cancer is to use chemotherapy. Chemotherapy is a group of medications that is used to kill cancer cells. This can be administered through a vein or through an intraperitoneal (IP) port placed in the abdomen. 

• National Ovarian Cancer Coalition 
• Ovarian Cancer National Alliance 
• Ovarian Cancer Support Group

• Early menarche: starting periods before the age of 12
• Late menopause
• Infertility
• Obesity
• History of Tamoxifen use
• Never having a child
• Obesity
• Genetics: family history of endometrial or colon cancers (Lynch Syndrome)
• History of polycystic ovarian syndrome 

• Post-menopausal bleeding
• Vaginal bleeding after intercourse
• Vaginal bleeding not associated with menstruation
• Pain during intercourse 

Springfield Clinic physicians who suspect Uterine cancer in a patient will perform or order some of the below exams or tests.

• Pelvic exam: helps to determine if the uterus is enlarged or any abnormal masses palpated
• Endometrial biopsy: a biopsy to sample tissue from the lining of the uterus; the tissue can be examined under the microscope to look for cancerous cells; this is a procedure typically done in the office
• Dilation and curettage: this is a minor procedure in which the cervix is dilated to obtain samples of the tissue that lines the cervical canal and uterine lining; this tissue is also examined for cancerous cells
• Transvaginal ultrasound: this helps to understand the size of the uterus and the thickness of the lining of the uterus 

• Surgery: The mainstay of surgery for endometrial cancer is to remove the uterus and cervix as well as the bilateral fallopian tubes and ovaries. It may also be necessary to remove some of the lymph nodes in the pelvis.
• Chemotherapy: It will depend on the stage of your cancer, chemotherapy may be indicated.
• Chemotherapy is a group of medications that is used to kill cancer cells. This can be administered through a vein or through an intraperitoneal (IP) port placed in the abdomen.
• Radiation therapy: It will depend on the stage of your cancer, radiation therapy may be indicated.
  • External radiation (external beam therapy): radiation therapy is used to kill cancer cells and help to shrink the size of the tumor. This type of radiation is used externally to target specific areas within the abdomen and pelvis 
  • Internal radiation (brachytherapy)

• Infection with human papillomavirus (HPV)
• Not having regular Pap tests
• Smoking
• Having many sexual partners
• Diethylstilbestrol (DES): this was a medication used to prevent miscarriage b/t the years 1940 and 1971. Women, whose mothers took this medication while pregnant with them, have a higher susceptibility of developing cervical cancer.  

• Post-menopausal bleeding
• Abnormal bleeding or discharge in between menstrual cycles
• Bleeding after intercourse
• Pain during intercourse 

There are several different types of cervical biopsies that can be used to help diagnose cervical cancer.

• Colposcopy: using a magnifying lens to examine the cervix for abnormalities; a biopsy may also be performed if abnormal areas are identified on the cervix
• Loop electrosurgical excision procedure (LEEP): obtaining a piece of tissue using an electric wire loop
• Endocervical curettage (ECC): scraping the canal of the cervix to obtain a sample of tissue to examine under the microscope
• Cone biopsy: A biopsy that takes a larger cone shape of tissue for evaluation 

• Surgery: a radical hysterectomy may be performed; this is removal of the cervix, uterus and the upper portion of the vagina; the fallopian tubes and ovaries may or may not be removed
• Radiation therapy: this may be internal or external chemotherapy 

• Age: most common in women over 50
• Infection with HPV
• History of vulvar intraepithelial neoplasia (VIN)
• Smoking

• Itching in the vaginal area
• Vulvar bleeding or discharge
• Changes in the appearance of the skin
• Pain or burning
• Open sores or cuts in the vulvar area that won’t heal
• A lump or mass in the vulva

Most cases are diagnosed by taking a biopsy of the tissue and having it evaluated under the microscope. 

• Surgery: the type of surgery depends on the size, depth and spread of the cancer
• Wide local excision: surgical procedure in which the cancer and some of the healthy surrounding tissue is removed
• Radical excision: surgical procedure in which the cancer is removed, along with a wider portion of the healthy tissue surrounding the lesion
• Groin lymph node dissection: it may also be necessary to remove the lymph nodes in either one or both sides of the groin
• Radiation therapy: radiation may be used alone, before, or after surgery