Cancers of the Female Reproductive Tract
Several types of cancer can affect the female reproductive tract, and a few of these cancers are relatively common.
Cervical Cancer Cancer of the cervix occurs frequently in women in their thirties and even twenties. In the United States, more than 12,000 women are diagnosed with cervical cancer each year; the disease kills more than 4000 women annually.
Cervical cancer is at least in part a sexually transmitted disease (STD). Most cases of cervical cancer stem from infection by the human papillomavirus (HPV), which causes genital warts and is transmitted during unprotected sex. Smoking and prior infection with the STDs herpes and chlamydia may also be risk factors for cervical cancer.
Screening for the changes in cervical cells that precede cancer is done chiefly by means of the Pap test. During a pelvic exam, loose cells are scraped from the cervix and examined. If cells are abnormal but not yet cancerous a condition referred to as cervical dysplasia the Pap test is repeated at intervals. In about one-third of cases, the cellular changes progress toward malignancy. If this happens, the abnormal cells must be removed, either surgically or by destroying them with an ultracold (cryoscopic) probe or localized laser treatment. In more advanced cases, treatment may involve chemotherapy, radiation, or hysterectomy (surgical removal of the uterus).
Because the Pap test is highly effective, all sexually active women and women over the age of 18 should be tested. The recommended schedule for testing depends on risk factors, the type of Pap test performed, and whether the Pap test is combined with HPV testing.
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Cervical cancer can be prevented by avoiding infection with HPV. Sexual abstinence, mutually monogamous sex with an uninfected partner, and regular use of condoms can reduce the risk of HPV infection (see Post 14 for more on HPV and other STDs).
Two HPV vaccines have been approved by the Food and Drug Administration (FDA) for the prevention of cervical cancer. Women who receive a vaccine should continue to receive routine Pap tests because the vaccines do not protect against all types of the virus.
Uterine or Endometrial Cancer Cancer of the lining of the uterus (the endometrium) most often occurs after age 55. Uterine cancer strikes more than 49,000 American women annually and kills more than 8000 women each year. The risk factors are similar to those for breast cancer. Endometrial cancer is usually detectable by pelvic examination. It is treated surgically, as well as by radiation, hormones, and chemotherapy.
Ovarian Cancer Although ovarian cancer is rare compared with uterine cancer, it causes more deaths. There are no screening tests to detect it, so it is often diagnosed late in its development. The risk factors are similar to those for breast and endometrial cancer. Anything that lowers a woman’s lifetime number of ovulation cycles pregnancy, breastfeeding, or use of oral contraceptives reduces the risk of ovarian cancer.
In 2007, the Gynecologic Cancer Foundation announced that scientists had reached a consensus on symptoms of ovarian cancer: bloating, pelvic or abdominal pain, difficulty eating or feeling full quickly, and urinary problems (urgency or frequency). Women who experience these symptoms almost daily for a few weeks should see their physician. Some ovarian cancers are also detected through regular pelvic exams. Ovarian cancer is treated by surgical removal of one or both ovaries, the fallopian tubes, and the uterus.
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