Introduction
Cancers can occur in any part of the female reproductive system--the vulva, vagina, cervix, uterus, fallopian tubes, or ovaries. These cancers are called gynecologic cancers.
Gynecologic cancers can directly invade nearby tissues and organs or spread (metastasize) through the lymphatic vessels and lymph nodes (lymphatic system) or bloodstream to distant parts of the body.
Diagnosis
Regular pelvic examinations and Papanicolaou (Pap) tests or other similar tests (see Section 22, Chapter 242) can lead to the early detection of certain gynecologic cancers, especially cancer of the cervix and uterus. Such examinations can sometimes prevent cancer by detecting abnormalities (precancerous conditions) before they develop into cancer.
If cancer is suspected, a biopsy can usually confirm or rule out the diagnosis. If cancer is diagnosed, one or more procedures may be performed to determine the stage of the cancer. The stage is based on how large the cancer is and how far it has spread. Some commonly used procedures include ultrasonography, computed tomography (CT), magnetic resonance imaging (MRI), chest x-rays, and bone and liver scans using radioactive substances.
Staging a cancer helps doctors choose the best treatment. Doctors often determine the stage of cancer after they remove the cancer and perform biopsies of the surrounding tissues, including lymph nodes. For cancers of the uterus and ovaries, stages range from I (the earliest) to IV (advanced). For the other gynecologic cancers, stage 0 is the earliest stage, when the cancer is confined to a surface of the affected organ. For some cancers, further distinctions, designated by letters of the alphabet, are made within stages.
 See the table Staging Cancers of the Female Reproductive System.
Treatment
The main treatment of gynecologic cancer is surgical removal of the tumor. Surgery may be followed by radiation therapy or chemotherapy. Radiation therapy may be external (using a large machine) or internal (using radioactive implants placed directly on the cancer). External radiation therapy is usually given several days a week for several weeks. Internal radiation therapy involves staying in the hospital for several days while the implants are in place.
Chemotherapy may be given by injection or by mouth. Chemotherapy is given for 5 days to 6 weeks (depending on the drugs) followed by a recovery period of several weeks without chemotherapy. The cycle may be repeated several times. A woman may have to remain at the hospital while she receives chemotherapy.
When a gynecologic cancer is very advanced and a cure is not possible, radiation therapy or chemotherapy may still be recommended to reduce the size of the cancer or its metastases and to relieve pain and other symptoms. Women with incurable cancer should establish advance directives (see Section 1, Chapter 9). Because end-of-life care has improved, more and more women with incurable cancer are able to die comfortably at home (see Section 1, Chapter 8). Appropriate drugs can be used to relieve the anxiety and pain commonly experienced by people with incurable cancer.
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