Medically reviewed by Kevin Elias, MD
Today, cervical cancer is the only type of gynecologic cancer for which there is a routine screening test. The lack of such tests for endometrial and ovarian cancer — the most common gynecologic cancers — makes it especially important that women and their doctors be attuned to the symptoms of these diseases. The earlier they’re detected, the more successfully they can be treated.
Scientists are working to increase the options for women by developing new early-detection tests, particularly for ovarian cancer, which often isn’t diagnosed until it has reached an advanced stage. Researchers at Dana-Farber, for example, are working on a blood test (described below) that uses microRNA molecules to detect early-stage ovarian cancer.
Here is a look at the screening exams and symptoms for each gynecologic cancer.
The standard screening test for cervical cancer is a Pap smear, in which cells from the cervix are examined under a microscope for abnormalities that may indicate cancer or pre-cancer. It has become more common in recent years for women to be tested for infection with the human papilloma virus (HPV) — the cause of most cervical cancers — either as a standalone test or in combination with a Pap test. It’s a common misconception that a Pap smear is used to screen for all gynecologic cancers, doctors say, when in fact it is used only for cervical cancer.
Endometrial (uterine) cancer
The vast majority of women diagnosed with endometrial cancer have abnormal vaginal bleeding. Fortunately, the disease is usually diagnosed at an early stage, when it is most treatable.
Kevin Elias, MD, a gynecologic oncology surgeon and researcher at the Dana-Farber/Harvard Cancer Center, notes that post-menopausal bleeding should prompt a woman to visit her doctor. In pre-menopausal women, changes such as bleeding between menstrual periods or longer or heavier bleeding are reasons to schedule an appointment with one’s physician.
Without a screening test for this disease, the symptoms to be aware of are:
- An increase in waist size, particularly if accompanied by a loss of appetite and a sense of feeling full more quickly when eating
- Persistent bloating
- An increase in the frequency of urination
- Pelvic pain
These symptoms warrant a visit to one’s physician, particularly if they continue for more than two weeks. While these symptoms mimic those associated with some gastrointestinal conditions, Elias recommends that women experiencing them should also ask their doctor whether it makes sense to have an ultrasound of the ovaries.
“When symptoms such as digestive problems or acid reflux arise in a woman who hasn’t had them in the past — particularly if she’s post-menopausal — and they don’t improve in a few weeks, a visit to a physician is in order,” Elias remarks.
Often, a gynecological evaluation can be done in parallel with a gastrointestinal work-up.
Early detection is critical
The need for a reliable screening test for ovarian cancer is particularly pressing because symptoms like weight gain or pelvic pain often arise only after the disease has reached an advanced stage. Elias observes that only 20% of women with ovarian cancer have the earliest stage — stage 1 — of the disease at the time of their diagnosis, compared to 80% of women with endometrial cancer. The stage at which the disease is diagnosed is crucial: 95% of patients diagnosed with Stage 1 ovarian or endometrial cancer are alive five years after diagnosis; of those diagnosed with stage 3, 25% are alive five years later.
To help physicians diagnose ovarian cancer at an earlier stage, Elias and his colleagues at Dana-Farber and Brigham and Women’s Hospital have devised a blood test that probes for microRNA molecules as markers of the disease. The test has proven able to detect most stage 1 ovarian cancers in women who have not developed symptoms of the disease. Researchers still have to determine how far in advance the test can find evidence of disease.
Researchers are now exploring how these biomarkers change over time as early-stage ovarian cancer progresses to advanced-stage. Doing so means testing thousands of banked blood samples for the biomarkers and seeing whether the results correlate with the progression of the disease.
Within a year, the investigators hope to begin using the test as part of a clinical research study. If the test proves accurate and reliable for women at high risk and average risk for the disease — if it doesn’t miss early-stage cancers or “find” cancers that don’t exist — researchers expect it can be used as a screening tool in conjunction with genetic tests.
Testing for recurrence
For women who have been treated for gynecologic cancers, follow-up care involves periodic visits to their oncologist and physical exams. The symptoms that might signal a return of the disease are basically the same as those associated with a first-time diagnosis:
- Vaginal bleeding for endometrial and uterine cancer
- Pelvic pain
- Gastric problems for ovarian cancer
Because Pap smears may be less reliable after cervical cancer treatment, researchers at Dana-Farber and elsewhere are exploring whether tests that look for cancer-related DNA in the blood are feasible for detecting a recurrence.
For patients treated for ovarian cancer, the CA 125 test, which was developed at Brigham and Women’s Hospital and Dana-Farber in the 1980s and measures the amount of the CA 125 protein in the blood, is often used to monitor for recurrence.