Gynecologic Cancer

If you've been recently diagnosed with gynecological cancer, you and your family might be overwhelmed with questions and concerns. Your first decision is where to get treatment.

You want a place where you can get the most advanced treatment options available. A place where you are supported by a team of compassionate experts. A place where you are treated as a whole person.

MultiCare Regional Cancer Center is that place. We have the region’s best health care providers in the field of oncology. Our world-class treatment facility offers cutting-edge technology in a welcoming and positive healing environment.

Learn about our comprehensive treatment approach, our cancer care teamor more about gynecologic cancer in the tabs below.

Cervical Cancer

Cervical cancer is the rapid growth of abnormal cells on the cervix. Fortunately, when detected at an early stage, cervical cancer is highly curable. Regular pap tests are the most important tool for preventing cervical cancer because it can detect abnormal cell changes before they become cancerous.

What Causes Cervical Cancer?

Most cervical cancer is caused by a virus called human papillomavirus, or HPV. You can get HPV by having sexual contact with someone who has it. There are many types of the HPV virus and not all types cause cervical cancer. Some of them cause genital warts, but other types may not cause any symptoms.

You can have HPV for years and not know it. It stays in your body and can lead to cervical cancer years after you were infected. This is why it is important for you to have regular Pap tests.

Symptoms

Abnormal cervical cell changes rarely cause symptoms. But you may have symptoms if those cell changes grow into cervical cancer. Symptoms of cervical cancer may include:

• Bleeding from the vagina that is not normal, or a change in your menstrual cycle that you can't explain
• Bleeding when something comes in contact with your cervix, such as during sex or when you put in a diaphragm
• Pain during sex
• Vaginal discharge that is tinged with blood

Cervical Cancer Diagnosis

During a Pap test the doctor scrapes a small sample of cells from the surface of the cervix to look for cell changes. If a Pap test shows abnormal cell changes, your doctor may do other tests to look for precancerous or cancer cells on your cervix.

Tests to confirm a diagnosis of cervical cancer include:

• Colposcopy and Cervical Biopsy: To find out whether and where cancer cells are on the surface of the cervix.
• Endocervical Biopsy (curettage): To find out whether cancer cells are in the cervical canal.
• Cone Biopsy or Loop Electrosurgical Excision Procedure (LEEP): These tests are sometimes recommended to remove cervical tissue for examination under a microscope.
• If you are pregnant, a colposcopy and cervical biopsy can be done to confirm cervical cancer.

Tests to determine the extent (stage) of cervical cancer include:

• Cone Biopsy or Loop Electrosurgical Excision Procedure (LEEP): These tests are sometimes recommended to determine the spread of the gynecological cancer in cervical tissue.
• Cystoscopy: To look at the interior lining of the bladder and the urethra to determine whether the cancer has spread to the urinary system.
• Proctoscopy: To look at the lower part of the large intestine (colon) to determine whether the cancer has metastasized.
• Intravenous Pyelogram: To see whether there is any blockage of a kidney.
• Chest X-ray: to check for cancer cells that have spread from the cervix.

Ovarian Cancer

Ovarian cancer occurs when abnormal cells grow in one or both of your ovaries. Ovarian cancer is often cured when it is caught early. But often, it has already spread by the time it is found. This particular gynecological cancer is relatively rare; fewer than 22,000 women were diagnosed with ovarian cancer in 2010.

Ovarian Cancer Causes

Experts do not know exactly what causes ovarian cancer. But they do know that DNA changes play a role in many cancers.

You have a higher chance of developing ovarian cancer if you:

• Are unable to become pregnant (infertility)
• Have never had a baby
• Have not used hormonal birth control methods. Hormonal methods change the normal cycle of the female hormones, estrogen and progesterone, so ovulation does not occur each month.
• Have a family history of ovarian or breast cancer

Ovarian Cancer Symptoms

The most common symptoms of ovarian cancer include:

• Recent, frequent bloating
• Pain in your belly or pelvis
• Difficulty eating or feeling full quickly
• Urinary problems, such as an urgent need to urinate or urinating more often than usual

If you have one or more of these symptoms, and it occurs almost daily for more than two or three weeks, talk with your doctor.

These symptoms are common for some women, and they may not mean that you have ovarian cancer. But the early symptoms of ovarian cancer follow a specific pattern:

• They start suddenly
• They feel different than your normal digestive or menstrual problems
• They happen almost every day and don't go away

Ovarian Cancer Diagnosis

There are no reliable screening tests for ovarian cancer.

Some initial exams and tests are done before surgery if ovarian cancer is suspected. These tests include:

• Your Medical History: To check what symptoms you have and what your chance of developing ovarian cancer is.
• A Physical Exam: Including a pelvic exam and Pap test. An ovarian lump may be felt during a pelvic exam. A rectovaginal exam may also be done to feel the pelvic organs.
• Complete Blood Count (CBC): To check for anemia and other abnormal blood values.
• Chemistry Screen: To check for liver and kidney problems.
• Human Chorionic Gonadotropin (hCG) Level: Which may be done to rule out pregnancy or an ectopic pregnancy.
• Cancer Antigen 125 (CA-125) Level: To measure a protein found on the surface of many ovarian cancer cells.
• Pelvic and Transvaginal Ultrasound: To look for an ovarian lump.

More tests may be done before surgery to determine if other areas of the body are involved. These tests include:

• Pelvic or abdominal CT scan or MRI to check for the spread of cancer.
• Chest X-ray to check for the spread of cancer.
• Surgery, usually a laparotomy, is done to confirm that cancer is present, to provide initial treatment and to stage the cancer.

Uterine Cancer

Uterine cancer is the rapid and uncontrolled growth of cells in the endometrium, the lining of the uterus. It usually occurs in women older than 50. The good news is that it is usually cured when it is found early. And most of the time, the cancer is found in its earliest stage, before it has spread outside the uterus.

Uterine Cancer Causes

The most common cause of uterine cancer is having too much of the hormone estrogen compared to the hormone progesterone in the body. This hormone imbalance causes the lining of the uterus to get thicker and thicker. If the lining builds up and stays that way, then cancer cells can start to grow.

Women who have this hormone imbalance over time may be more likely to get endometrial cancer after age 50. This hormone imbalance can happen if a woman:

• Is obese. Fat cells make extra estrogen, but the body doesn't make extra progesterone to balance it out.
• Takes estrogen without taking a progestin.
• Is taking tamoxifen.
• Has polycystic ovary syndrome, which causes hormone imbalance.
• Starts her period before age 12 or starts menopause after age 55.
• Has never been pregnant or had a full-term pregnancy.
• Has never breast-fed.

Uterine Cancer Symptoms

The most common symptoms of uterine cancer include:

• Bleeding or vaginal discharge not related to your period (menstruation)
• Difficult or painful urination
• Pain during sexual intercourse
• Pelvic pain

Diagnosis

Most cases of uterine cancer are diagnosed in an early stage, when women who have reached menopause go to their doctors when they have vaginal bleeding. Your doctor will conduct a pelvic exam and Pap test to check your symptoms.

An endometrial biopsy is needed to confirm a diagnosis of endometrial cancer. A biopsy removes a small sample of the lining of the uterus (endometrium) for examination under a microscope.
Additional tests may include:

• A transvaginal pelvic ultrasound, which uses sound waves to create images of the uterus. The images can show how thick the endometrium is. A thick endometrium can be a sign of cancer in postmenopausal women. Ultrasound also can help show whether cancer has grown into the uterine muscle (myometrium).
• A hysteroscopy, which allows your doctor to view the inside of the uterus and obtain an endometrial tissue sample.
• Dilation and curettage (D&C), which is done to obtain a sample of tissue from the inside of the uterus. A D&C is sometimes done at the same time as a hysteroscopy.

Treatments

After diagnosis and staging of your gynecological cancer, you and your doctor will work together to determine the best cancer treatment options for you.

You will also meet with a nurse navigator to help guide you through the process and to answer any questions you have. They are a crucial part of your MultiCare Regional Cancer Center team; your point guard, in essence. They can connect you with financial information, education and resources as well as provide emotional support on your healing journey.

Gynecological Cancer Surgery

MultiCare is the first health care system in Pierce County to offer robotic-assisted surgery using the da Vinci® Surgical System. This breakthrough technology enables surgeons to operate with greater precision and control, while making smaller incisions. This minimizes the pain and risk associated with traditional surgeries, offers excellent success rates and an easier, faster recovery.

Radiation

Radiation therapy is often the most effective treatment for gynecological cancers at any stage of development. A leader in providing the most advanced gynecological cancer treatments and therapies available, MultiCare Regional Cancer Center offers intensity modulated radiation therapy (IMRT) an external radiation therapy that more precisely targets a cancerous tumor while sparing the healthy surrounding tissue.

MultiCare Regional Cancer Center also provides internal radiation treatment called brachytherapy. In brachytherapy, radiation is directed into the vagina and uterus. This treatment can be given in the outpatient setting.

Chemotherapy

Chemotherapy drugs are designed to work by interfering with the rapidly dividing cancer cells in your body. Your doctors may suggest chemotherapy as form of gynecological cancer treatment before or after surgery. Chemotherapy is usually administered intravenously (through the vein) or orally in the form of pills. Your doctor may recommend additional medications to help alleviate chemotherapy-related side effects.

Supportive and Integrative Therapies

In addition to the therapies described above, we offer integrative therapies such as nutritional therapy, physical therapy, yoga, massage and emotional counseling. Many of these therapies are remarkably effective in addressing the side effects of chemotherapy, surgery and radiation by easing tension, reducing pain and improving quality of life.

Managing Side Effects of Gynecological Cancer

During and after your treatment for cervical, ovarian or uterine cancer, there are things you can do at home to help manage the side effects.