Symptoms & Risks

Gynecologic Cancer

Cancer Risk Assessment Survey

This confidential, interactive survey, developed by gynecologic cancer experts, will help you to identify your risk level for developing breast cancer, ovarian cancer, endometrial cancer, cervical cancer, vulvar cancer, and vaginal cancer.

For more information about gynecologic cancer please visit: Women’s Cancer Network

To find a Gynecologic Oncologist, click here

Cervical Cancer Risk Factors

There is really no way to know for sure if you’re going to get cervical cancer. Certain factors can make you more likely to get cervical cancer than another woman. These are called risk factors. However, just because you have one or more risk factors does not mean you will get cervical cancer. In fact, you can have all the risk factors and still not get cervical cancer. With cervical cancer, it is rare to get the disease if you have no known risk factors, but it is possible.

These are the main risk factors for cervical cancer.

• Not getting screened regularly with a Pap test
• High-risk human papillomaviruses (HPV), a type of infection spread through sex
• Smoking 
• HIV infection

Some risk factors are out of your control, such as your family history or already having HPV. However, other factors, such as getting regular screenings and doing what you can to prevent high-risk HPV, are ones you can control.

In fact, when it comes to cervical cancer, you can have a good deal of influence over many of the most potent risk factors. Experts have evidence that cervical cancer is highly preventable and curable when you work with your healthcare team. Ask your doctors and your loved ones to help you think of ways that you can succeed to lower your risk of cervical cancer.

If you agree with any of the following bolded statements, you may be at an increased risk for cervical cancer. Each time you agree with a statement below, ask yourself if you are doing all you can to control that risk factor. It may seem difficult, but your efforts can have a big payoff in terms of your health and quality of life.

I have high-risk HPV.

HPV is short for human papillomavirus. It is the most common cause of cervical cancer. An HPV infection is usually harmless and temporary. Anyone who has had sex, both men and women, can get an HPV infection. It is estimated that 3 out of 4 people between the ages of 15 and 49 will get an HPV infection in their lifetime.

Most people with HPV never know they are infected because the virus tends to go away on its own. There are many types of this virus. Only a few high-risk types can cause cervical cancer. The only way to tell if you have a high-risk type of HPV is to be tested.

These facts will help you gain a basic understanding of HPV.

• Both men and women can get HPV.

• There are more than 100 different types of HPV virus.

• About 10 to 30 types of HPV can lead to cervical cancer. These include HPV 16, HPV 18, HPV 31, HPV 33, and HPV 45. HPV 16 and 18 cause about half of all cervical cancers.

If high-risk types of HPV do not go away on their own, they may lead to cervical cancer. Infection with persistent high-risk HPV has been shown to cause virtually all cervical cancers.

I’ve had sexual intercourse at a young age or with multiple partners, or I don’t use protection during sex.

You are at increased risk. You get high-risk HPV by having sex with someone who has the virus. Just because someone doesn’t have any symptoms, doesn’t mean they do not have HPV. Many people have it and don’t even know it. The only sure way to protect yourself is to not have sex at all or to have sex only with a partner who you know does not have HPV. Condoms do not protect you from HPV. But condom use is still very important. Condoms help protect against other sexually transmitted diseases, such as HIV and chlamydia. Some research has linked chlamydia to an increase in the risk of cervical cancer.

I smoke.

If you smoke, you have a higher risk of getting cervical cancer. You are twice as likely to get cervical cancer as women who do not smoke. Chemicals in cigarettes end up in your bloodstream and in the mucus in your cervix.

I have HIV, the virus that causes AIDS.

Women with an HIV infection also have a weakened immune system. If you have HIV, it is harder for you to get rid of a high-risk HPV infection. Therefore, you have a higher risk of developing cervical disease or cervical cancer.

Other Risk Factors

A few other factors have been linked to cervical cancer. If you agree with any of the statements below, ask yourself if you are doing all you can to control that risk factor.

• I have had cervical cancer before. If you’ve had cervical cancer before, you have a higher chance of getting cervical cancer again.
• My mother or sister has had cervical cancer. Some studies show that if you have a mother or sister who has had cervical cancer, this increases your risk for the disease.
• I have had a recent or past chlamydia infection. You can become infected with these bacteria during sex. Some studies show a link between chlamydia and cervical cancer. More studies are needed to confirm this. 
• I don't eat many fruits and vegetables, especially foods with carotene and vitamins A, C, and E. These foods can help lower your risk of cervical cancer.
• I am overweight. Some studies have shown that women who are overweight have a greater chance of getting cervical cancer.
• I use oral contraceptives, also called the pill. Some research has shown that if you take the pill for more than 5 years, you may have an increased risk of cervical cancer. The increased risk is small, however. Also, some women reap benefits from taking oral contraceptives. Therefore, it’s best to discuss your personal risks and benefits with your doctor or nurse when deciding about oral contraceptives.
• I have given birth to several children. If you have had many full-term pregnancies, you may have a greater chance of  getting cervical cancer.
• My mother took the drug Diethylstilbestrol (DES) when she was pregnant with me. Between the years 1940 and 1971, doctors sometimes prescribed this drug to women who had trouble with miscarriages. Of the women whose mothers took DES, 99.9% do not get cervical cancer. Even so, you are at higher risk for cervical cancer if your mother took DES while pregnant with you.
• I can't afford healthcare. Poor women tend to be at higher risk for cervical cancer. Health experts believe that this is because they often do not have access to good healthcare and screenings and also may not be able to afford a well-balanced diet. Ask someone at your local healthcare clinic how to get low-cost or free screenings.

Cervical Cancer Symptoms

Women with precancerous lesions in their cervix usually have no symptoms. A woman usually does not have any symptoms until the cells turn into cancer and invade the deepest parts of the cervix or other pelvic organs. That is why it is important that you have a regular Pap test. This test checks for cells that are cancer or precancer.

In the early stages of cervical cancer, you may have few symptoms. They may not be alarming to you, but it is a good idea to have them checked by a doctor. These are some of the early symptoms.

• Vaginal discharge. Cervical cancer can cause more vaginal discharge than usual. This discharge is often bloody or foul smelling.
• Abnormal vaginal bleeding. If you have cervical cancer, you may have bleeding between your periods or after sexual intercourse. Blood flow during your period may be heavier and last longer than usual.
• Odor. You may notice a strange or unpleasant odor from vaginal discharge. 
• Pain. You may have pain during sex or pain in the pelvic area unrelated to sex or other activities.

If you have a more advanced cancer that has spread, you may have these symptoms. These signs usually mean that the cancer has spread to the tissue around the cervix.

• Pain in the pelvic area
• Heavy bleeding from the vagina
• A single swollen leg

Endometrial Cancer Risk Factors

There is really no way to know for sure if you’re going to get endometrial cancer. Certain factors can make you more likely to get this cancer than another woman. These are your risk factors. However, just because you have one or more risk factors does not necessarily mean you will get endometrial cancer. In fact, you can have all the risk factors and still not get it. Or you can have no known risk factors and still get it.

Most of the risks linked to endometrial cancer come from too much exposure to the hormone estrogen. Estrogen and progesterone are the 2 main types of female hormones. The balance between these 2 hormones in your uterus changes every month during your menstrual cycle. These 2 hormones need to be in the right balance for your uterus to be healthy.

If you agree with any of the following bolded statements, you are at an increased risk for endometrial cancer. Many of these risk factors may be out of your control, such as your age or family history. Some risk factors, such as the types of food you eat, are factors you can control. Ask your healthcare team and your loved ones to help you think of ways that you can succeed at lowering your risk.

Uterine cancer or colon cancer runs in my family. 

If several of your family members have had uterine or colon cancer, you are at greater risk for getting endometrial cancer. You may have inherited a genetic problem called nonpolyposis colorectal cancer (HNPCC). You may wish to talk with your doctor about having genetic counseling and testing. This may help show you if you have a high risk for endometrial cancer.

I have used tamoxifen.

Tamoxifen is a drug that is used to treat women with breast cancer. If you have taken tamoxifen for 5 years or more, you have a higher risk of developing endometrial cancer. If you have used tamoxifen for treating breast cancer, tell your doctor right away if you have any unusual vaginal bleeding.

I use estrogen replacement therapy.

If you take the hormone estrogen alone to help deal with the effects of menopause, your chance of getting endometrial cancer is increased. If you need estrogen replacement therapy, discuss using a combination of estrogen and progesterone with your doctor. This combination helps protect your uterus from developing cancer. Keep in mind, though, that taking estrogen and progesterone together can increase your risk for breast cancer and blood clots. If you use hormone replacement therapy, see your doctor regularly for follow-up care.

I have been exposed to a lot of estrogen over the years.

Exposure to excess estrogen raises your risk for endometrial cancer. You could be exposed to too much estrogen for any of these reasons.

• I am very overweight. Fat cells can change other hormones into estrogen. So having more fat can increase your estrogen level.
• My periods started before I was age 12. If you started menstruating at an early age, your uterus has been exposed to estrogen for longer than average. The total number of years you have menstruated matters, too. If your periods started early, but you went through menopause early as well, your risk of getting endometrial cancer is not increased.
• I went through menopause after age 52. If you went through menopause after age 52, your uterus has been exposed to estrogen for longer than average. The total number of years you menstruated matters, too. If you went through menopause late, but your periods started later in your teens as well, your risk of getting endometrial cancer is not increased.
• I have never been pregnant. During pregnancy, more progesterone is present. This helps protect the uterus from too much estrogen. If you’ve never been pregnant, than your uterus may have been exposed to higher levels of estrogen.

I have diabetes.

If you have diabetes, you have a greater risk of getting endometrial cancer. The reason for this connection is not totally known. Obesity and one kind of diabetes are linked. But even women with diabetes who are not overweight still have higher rates of endometrial cancer.

I have high blood pressure.

High blood pressure has been associated with endometrial cancer, but it is not as strong as some of the other risk factors. The relationship between high blood pressure and endometrial cancer may be due to the fact that many women with hypertension are also obese. And obesity is a very strong risk factor for uterine cancer.

I eat a diet high in fat.

A high-fat diet increases your risk for several cancers, including endometrial cancer. Eating fatty foods is also a quick route to obesity, which is known to increase your risk for endometrial cancer.

I am older than age 50.

As you get older, your risk of getting endometrial cancer increases. Most cases of it occur after menopause.

I have a genetic predisposition to cancer known as Lynch syndrome.

Lynch syndrome is also called hereditary nonpolyposis colorectal cancer (HNPCC). Women with this family history have a 40% to 60% lifetime risk of developing endometrial as well as other cancers. If you are at risk or think you might be at risk for Lynch syndrome, talk with your doctor about seeing a cancer genetic counselor to better determine actual risk of this family syndrome. If you are determined to be at risk you should be   screened for endometrial cancer. Screening involves an endometrial biopsy starting at age 35.

Endometrial Cancer Symptoms

Finding endometrial cancer in an early stage makes it easier to treat.

These are the symptoms that you may notice.

• Unusual vaginal bleeding or discharge. At first, the bleeding may appear watery with a small amount of blood in it. After a while, the bleeding may appear less watery with more blood in it.
• Vaginal bleeding after you have already gone through menopause
• Pain when urinating
• Pain during sexual intercourse
• Pain in the pelvic area or lower abdomen

Many of these may be signs of other health problems. Talk with your doctor right away to find out for sure.

Some women who have endometrial cancer are going through menopause. During this time, a woman stops having menstrual periods. Often, menopausal women do not tell their doctor about unusual vaginal bleeding because they believe it is a symptom of menopause. It is important for you to always tell your doctor about any vaginal bleeding that is unusual for you, even during menopause.

Ovarian Cancer Risk Factors

If you agree with any of the following bolded statements, you may be at an increased risk of developing ovarian cancer. Some risk factors are out of your control, such as your age or family history. Others--like your weight or taking hormones--are factors you can control.

My mother or sister had ovarian, breast, or colon cancer.

A mother or sister is considered a first-degree relative. If you have 2 or more first-degree relatives who have had ovarian cancer, this suggests that heredity may be a cause. If you have a family history of breast or colon cancer, your family may have certain genetic mutations that may also increase the risk for ovarian cancer. These types of ovarian cancer account for 10% of ovarian cancer cases. A family history of epithelial ovarian cancer—the most common type—is one of the most important risk factors.

I have had breast or colon cancer.

A personal history of breast or colon cancer puts you at increased risk for ovarian cancer.

I am a woman older than age 60.

The older you are, the greater your risk for getting ovarian cancer. A woman’s risk for ovarian cancer rises with age and peaks during their 70s. The average age of diagnosis is 63.

I’ve never had children.

Women who have never borne children are at slightly increased risk for ovarian cancer.

I have endometriosis.

Women who have endometriosis have a higher risk of ovarian cancer. This is a painful condition in which tissue similar to that lining the uterus grows elsewhere in the abdominal area.

I am obese.

Being obese means having a body mass index greater than 30. (See http://nhlbisupport.com/bmi/ for how to calculate your body mass index.) Obesity increases risk for ovarian cancer. The more excess weight you have, the more your risk is increased.

I used talcum powder.

Some studies show a relationship between ovarian cancer and use of talcum powder on the genital area. This may be because this powder once contained asbestos. For more than 20 years, the law has required that these powders be free of asbestos.

I have taken estrogen replacement therapy for many years.

If you’ve used estrogen replacement therapy for more than 10 years, you may have a slightly increased risk of ovarian cancer.

I started menstruating at an early age—before age 12.

There may be a relationship between the number of menstrual cycles you have in your lifetime and your risk for ovarian cancer. Women who have late menopause (after age 50) are also at increased risk.

I have not started menstruating and I am 15.

Girls who have not started having periods by age 15 should see a doctor. They may be recommended for chromosome analysis. [2006 State of State, page 11, paragraph 3]

I have used fertility drugs.

If you’ve used fertility drugs, you may be at increased risk for ovarian cancer. Research studies have produced conflicting results.

Ovarian Cancer Symptoms

The Ovarian Cancer Symptoms Consensus Statement

Historically ovarian cancer was called the "silent killer" because symptoms were not thought to develop until the chance of cure was poor. However, recent studies have shown this term is untrue and that the following symptoms are much more likely to occur in women with ovarian cancer than women in the general population 1,2. These symptoms include:

• Bloating
• Pelvic or abdominal pain
• Difficulty eating or feeling full quickly
• Urinary symptoms (urgency or frequency)

Women with ovarian cancer report that symptoms are persistent and represent a change from normal for their bodies. The frequency and/or number of such symptoms are key factors in the diagnosis of ovarian cancer 3. Several studies show that even early stage ovarian cancer can produce these symptoms 2-6.

Women who have these symptoms almost daily for more than a few weeks should see their doctor, preferably a gynecologist. Prompt medical evaluation may lead to detection at the earliest possible stage of the disease. Early stage diagnosis is associated with an improved prognosis.

Several other symptoms have been commonly reported by women with ovarian cancer 2-5. These symptoms include fatigue, indigestion, back pain, pain with intercourse, constipation and menstrual irregularities. However, these other symptoms are not as useful in identifying ovarian cancer because they are also found in equal frequency in women in the general population who do not have ovarian cancer 1.

References

1. Goff BA, Mandel LS, Melancon CH, Muntz HG. Frequency of symptoms of ovarian cancer in women presenting to primary care. JAMA 2004;291:2705-12. Level II-2
2. Olson SH, Mignone L, Nakaraseive C,, Caputo TA, Barakat RR, Harlap S. Symptoms of ovarian cancer. Obstet Gynecol 2001;98:212-7. Level II-2
3. Goff BA, Mandel L, Muntz HG, Melancon CH. Ovarian carcinoma diagnosis: results of a national ovarian cancer survey. Cancer 2000;89:2068-75. Level III
4. Vine MF, Ness RB, Calingaert B, Schildkraut JM, Berchuck A. Types and duration of symptoms prior to diagnosis of invasive or borderline ovarian tumor. Gynecol Oncol 2001;83:466-71. Level III
5. Yawn BP, Barrette, BA, Wollan, PC. Ovarian cancer: the neglected diagnosis. Mayo Clin Proc 2004;79:1277-1282. Level III
6. Goff BA, Mandel L, Drescher CW, Urban N, Gough S, Schurman K, Patras J. Mahony BS, Anderson M. Development of an ovarian cancer symptom index. Cancer 2007;109:221-7. Level II-2

Primary Peritoneal Cancer (PPC)

 Download the new brochure about PPC from the Gynecologic Cancer Foundation

Uterine Cancer Risk

There is really no way to know for sure if you’re going to get uterine sarcoma. Certain factors can make you more likely to get uterine sarcoma than another woman. These are your risk factors. However, just because you have one or more risk factors does not necessarily mean you will get uterine sarcoma. In fact, you can have all the risk factors and still not get uterine sarcoma. Or you can have no known risk factors and still get it.

If you agree with any of the following bolded statements, you are at an increased risk for uterine sarcoma.

I have been treated with radiation in the pelvic area for other cancers.

This increases your risk for uterine sarcoma. Radiation damages even healthy cells, which may make cancer develop easier. When cancers do occur because of this exposure, it is usually 5 to 25 years after the treatment.

I am African-American.

For reasons not understood, African-American women are 2 times more likely to develop uterine sarcoma than Caucasian or Asian women.

I am older than age 50.

As you get older, your risk for getting uterine sarcoma increases.

Is Uterine Sarcoma Hereditary?

Doctors do not know all the risk factors for uterine sarcoma. So they don’t really know if it is hereditary or not. It is known that African-American women are twice as likely as Caucasian or Asian women to develop uterine sarcoma. But whether this tendency is due to an inherited risk or some other factor is as yet unknown.

Uterine Cancer Symptoms

Finding uterine sarcoma while in its early stage makes it easier to treat. These are the symptoms that you may notice.

• Unusual vaginal bleeding or discharge, especially after menopause. At first, the bleeding may appear watery with a small amount of blood in it. After a while, the bleeding may appear less watery with more blood in it.
• Pain or a feeling of fullness in the pelvic area or lower abdomen
• Fibroids that grow quickly, especially after menopause.

Many of these may be signs of other health problems. Talk with your doctor right away to find out for sure.

Vaginal Cancer Risk

There is no way to know for sure if you’re going to get vaginal cancer. And there is no known way to prevent it. Certain factors can make you more likely to get this type of cancer than another woman. These are called risk factors. Unfortunately, doctors do not know what causes vaginal cancer. Most women who develop it have no known risk factors at all. The risk factors that have been found only slightly raise your chances of getting the disease. Still, tell your doctor if you agree with any of the bolded statements.

I am older than 60.

Most women are older than 60 when diagnosed with vaginal cancer.

I have HPV infection that doesn’t go away.

Human papillomaviruses (HPV) are a group of viruses that can cause genital warts or precancerous disease. If you are infected with certain subtypes of HPV, you may be more at risk for vaginal squamous cell carcinoma. Other factors can increase your risk for HPV infection and vaginal cancer. These include having intercourse in your early teens, having many sexual partners, having unprotected sex at any age, having HIV, or having a suppressed immune system after an organ transplant. It is possible that the HPV vaccine may also help to prevent some vaginal cancers, but this will not be known for decades. If you are a young woman or teenager, talk with your doctor about the HPV vaccine.

I have cervical or vulvar cancer.

Having cervical cancer or a precancerous condition of the cervix may increase your risk for squamous cell carcinoma of the vagina. Having vulvar cancer may also increase your risk. This may be true because these cancers and vaginal cancer share similar risk factors.

I smoke.

Just as smoking increases the risk for cervical cancer, it may also increase the risk for vaginal cancer. 

My mother took DES.

If your mother took the drug diethylstilbestrol (DES) when pregnant with you, you may be more at risk for getting clear cell adenocarcinoma of the vagina. DES is a drug that helped prevent miscarriages and was generally taken by pregnant women in the 1940’s to 1960. As time passes, doctors are seeing fewer women who have been exposed to DES as a fetus.

I have vaginal adenosis.

This is a change in the cells lining the vagina. Normally, the cells of the vaginal lining are flat squamous cells. But, in some women, areas of the vagina may develop cells that look more like those found in either the glands of the lower uterus or the upper uterine lining. This is called vaginal adenosis. It happens in almost all women who were exposed to DES in utero. In women with adenosis who were not exposed to DES, the risk for clear cell adenocarcinoma is not known.

Vaginal Cancer Symptoms

• Vaginal bleeding after menopause
• Vaginal bleeding after intercourse
• Abnormal vaginal discharge
• A mass in the vagina that can be felt
• Pain during sex
• Pain when urinating
• Constipation
• Constant pain in the pelvis

These are symptoms of vaginal cancer. But they may also be caused by less serious, noncancerous conditions. If you have any of these symptoms, talk with your doctor.

Vulvar Cancer Symptoms

There are often no symptoms in the early stages of vaginal cancer, before cancer has spread. Many women with invasive vaginal cancer do have symptoms such as these.

• Vaginal bleeding after menopause
• Vaginal bleeding after intercourse
• Abnormal vaginal discharge
• A mass in the vagina that can be felt
• Pain during sex
• Pain when urinating
• Constipation
• Constant pain in the pelvis

These are symptoms of vaginal cancer. But they may also be caused by less serious, non cancerous conditions. If you have any of these symptoms, talk with your doctor.