September is set aside to raise awareness of gynecological cancers.  GYN cancers affect women’s reproductive organs including the cervix, endometrium, uterus, fallopian tubes, vagina, vulva, and ovaries.

In 2009 there will be an estimated 80,720 new cases of GYN cancers and 28,120 deaths.

Women with Lynch syndrome (also known as hereditary non-polyposis colon cancer or HNPCC)  have a high lifetime risk of endometrial cancer, reaching 71 percent by the age of 70.  This is much higher than the general population whose risk is less than 2 percent.

Lynch syndrome women also have a 10 to 12 percent lifetime risk of ovarian cancer, again larger than the other women with a risk is about 1.5 percent.

Women who have been identified as carrying one of the Lynch syndrome genes — MLH1, MSH2, MSH6, or PMS2 — should plan annual screening for both ovarian and endometrial cancer beginning about age 30 to 35.  A pelvic-rectal examination, transvaginal ultrasound, CA-125 blood test, and endometrial biopsy should be part of that exam.

On the other hand, women who are diagnosed with endometrial cancer before menopause or the age of 50 are at high risk for Lynch syndrome and colorectal cancer.  They should consider genetic counseling and testing.  Tumor testing may identify older women who need further genetic testing, as well.

Symptoms of endometrial cancer that should prompt a visit to a gynecologist and endometrial biopsy include:

• Abnormal vaginal bleeding:  heavier than usual menstrual periods, bleeding between periods, or prolonged periods.
• Vaginal bleeding after menopause.

Symptoms of ovarian cancer can be subtle, but according to the Ovarian Cancer National Alliance, they are more likely to occur in women with ovarian cancer than other women.  They exist even in early stages.  When symptoms are persistent and are a change from a woman’s normal patterns, they should be investigated.  Symptoms include:

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

Cervical cancer is not part of the Lynch syndrome.  However, all women should schedule regular pap smears to detect changes in cells that may lead to cervical cancer.  Such screening can prevent cervical cancer. However, pap smears do not detect or prevent ovarian or endometrial cancer.

In 2008 nearly 22,000 women will be diagnosed with ovarian cancer and more than 15,500 will die.

Sometimes called the disease that whispers, ovarian cancer symptoms are often not recognized until its late stages when it is most deadly.  Found early, ovarian cancer is 90 percent curable but most cases are found after the cancer is already advanced.

President Bush has proclaimed September 2008 ass National Ovarian Cancer Awareness Month.  During September, advocates will be working to raise awareness of ovarian cancer, let women know about its symptoms, and work toward early detection and effective treatment.

Although there is no screening test for ovarian cancer, being aware of its symptoms and following up with a CA-125 blood test, transvaginal ultrasound, and rectal/vaginal pelvic exam can find ovarian cancer early when it is most treatable.  Pap smears are not a test for ovarian cancer, and the CA-125 blood test does not effectively screen for it alone.

Symptoms of ovarian cancer include

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

When these occur for more than two weeks and are a new occurrence for a woman, a visit to a gynecologist for further testing can help find ovarian cancer so it can be treated.

Recent research has found that combining a simple four point questionnaire about symptoms combined with the CA-125 blood test will find 80 percent of early stage ovarian cancer and 95 percent of late-stage disease.

Women with Lynch syndrome (hereditary non-polyposis colon cancer or HNPCC) have about a 10 percent lifetime risk for ovarian cancer.  Guidelines suggest that women with a Lynch syndrome mutation begin annual screening for ovarian cancer between 25 and 35 years of age and consider preventive removal of their ovaries and uterus after they finish childbearing.

More information about ovarian cancer is available from:

• National Cancer Institute: Ovarian Cancer
• National Ovarian Cancer Coalition including a short video.
• Ovarian Cancer National Alliance
• Marsha Rivkin Center for Ovarian Cancer Research

If you have more questions about ovarian cancer you can call the SHARE Ovarian Cancer Hotline at (866)537-4273.

Kicking off National Ovarian Cancer Awareness month, the Seventh Biennial Ovarian Cancer Research Symposium will be held in Seattle on September 4-5, 2008 at the Marsha Rivkin Center.

“Symptoms and Risks” fact sheet (PDF)
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People come to an initial medical work-up for colon or rectal cancer from different places. They may have had a suspicious polyp or cancer found during a routine screening. They may be experienced symptoms that might be caused by colorectal cancer. Getting an accurate diagnosis is critical because treatment for colorectal cancer depends on the diagnosis. For example, treatment for colon cancer is different than treatment for rectal cancer, and treatment for cancer which has spread outside of the colon is different than treatment for cancer which is limited to the colon. Getting an accurate diagnosis can take time and many different tests. It may require surgery, and examination of surgically-removed tissue to determine whether the cancer has spread. This process can involve several health professionals including:

• The gastroenterologist who will perform a colonoscopy if it has not been already done and remove tissue for biopsy. The gastroenterologist may remove suspicious polyps for pathology or, if they are large, leave them in place for later surgical removal.
• Pathologists who will examine biopsies under the microscope to identify precancerous cells or cancer (malignancy.)
• Radiologists who will perform CT-scans or other x-ray tests to see if the cancer has spread to other parts of your body.
• A general surgeon or colorectal surgeon who will give you a physical examination and ask about your medical history, order blood tests, review reports from gastroenterologist, radiologist, and pathology, and help decide on an initial treatment plan.
• If necessary, a medical oncologist who deals with chemotherapy treatment or a radiation oncologist may be involved at this point or they may join the treatment team after surgery. Specialized surgeons may also be called in to examine you if there is a possibility that the cancer has spread beyond your colon.

Choosing a medical team is an important initial step in getting an accurate diagnosis, especially if rectal surgery is involved. Work with your medical team to make sure that your evaluation, diagnosis, and staging are done carefully and thoroughly.. Get a second opinion if there is uncertainty about issues such as what tests are necessary, if surgery is the right first step, and whether staging is accurate. A second opinion at a large cancer center, particularly a National Cancer Institute designated cancer cancer or a member of the National Comprehensive Cancer Network can be valuable even early in the diagnostic process.

• Locate an NCI Cancer Center in your state.
• Locate an NCCN Comprehensive Cancer Center

Where Can You Go for More Information?

American Cancer Society How is Colorectal Cancer Diagnosed? Cancer.Net When the Doctor Says Cancer along with a podcast can help you learn questions to ask about your cancer and its diagnosis and how to understand and manage the information you get from your doctor.

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