When Screening for Gynecologic Cancer Isn’t Enough

Pap tests and human papillomavirus (HPV) tests are so effective at screening for cervical cancer that mortality from the disease has decreased significantly in the past 30 years. Unfortunately, there are no effective screening tools for other types of gynecologic cancers, says Haider Mahdi, MD, MPH, a gynecologic oncologist at Cleveland Clinic. That’s why watching for symptoms is essential for detecting:

Ovarian cancer. “Most women are diagnosed with late-stage disease because warning signs are nonspecific and often over­looked,” says Dr. Mahdi. Indicators include:

• Low appetite
• Digestion problems
• Unintentional weight loss
• Abdominal distension
• Constipation
• Bladder problems

Endometrial cancer. Postmenopausal bleeding is the most common symptom. Fortunately, bleeding usually occurs in the disease’s early stage, making early diagnosis and cure more feasible.

Vulvar or vaginal cancers. A vulvar mass, vulvar itching or vaginal bleeding are the most common symptoms.

On the front lines

Primary care physicians and Ob/Gyn providers are on the front lines in gynecologic cancer detection. According to Dr. Mahdi, their important role is fourfold:

1. Ensure patients comply with screening guidelines for cervical cancer. “Guidelines changed in 2012,” says Dr. Mahdi. “Inform women age 30 and older that cotesting with a Pap test and HPV test once every five years is preferred to having a Pap test alone every three years for detecting cervical cancer or precancer.”
2. Educate patients on warning signs. Especially for ovarian, endometrial, vulvar and vaginal cancers, patients should know to watch for the symptoms already listed.
3. Identify patients at high risk. Women with a family history of gynecologic cancer, or a personal or family history of breast, pancreatic, colon or other cancers (particularly those with BRCA1 or BRCA2 mutations or Lynch syndrome) are at higher risk. Other risk factors vary by cancer type but include:

• More menstrual cycles over a lifetime (e.g., early menarche, late menopause, never being pregnant)
• History of breast cancer
• Taking certain fertility drugs
• Estrogen therapy
• Obesity
• Diabetes

1. Refer patients quickly. “Even if you’re unsure — refer,” says Dr. Mahdi. “Early referrals may give patients more treatment options, such as primary surgery instead of primary chemotherapy, or laparoscopic surgery instead of open surgery. Options are more limited with metastatic disease.”

Finding advanced treatment options

Dr. Mahdi says that patients diagnosed with gynecological cancers should be referred to treatment centers with advanced capabilities such as:

• Single-incision laparoscopic and robotic surgeries
• Intraperitoneal chemotherapy and hyperthermic intraperitoneal chemotherapy (HIPEC)
• Investigational treatments offered through membership in NRG Oncology, an international research alliance
• Targeted therapy, based on genomic tumor testing
• Genetic testing for hereditary cancers