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Gynecologic Cancer
Gynecologic cancers attack a woman’s reproductive organs, including the cervix, uterus, ovaries, endometrium, fallopian tubes, vagina and vulva. Every woman is at risk for developing a gynecologic cancer. The American Cancer Society estimates that 116,760 new cases of gynecologic cancer will be diagnosed and approximately 34,080 deaths will occur in the United States in 2021:
2021 Gynecologic Cancers Statistics (American Cancer Society)
| Cancer | Estimated New Cases | Estimated deaths |
| Cervical cancer | 14,480 | 4,290 |
| Ovarian cancer | 21,410 | 13,770 |
| Uterine cancer | 66,570 | 12,940 |
| Vaginal cancer | 8,180 |
1,530 |
| Vulvar cancer | 6,120 | 1,550 |
What are Common Symptoms of Gynecologic Cancer?
Women with the following symptoms should consult a gynecologic oncologist:
- A change in bowel or bladder habits
- A sore in the pelvic area that does not heal
- Unusual vaginal bleeding or discharge
- A thickening or lump that either causes pain or can be seen in the pelvic area
- Pain or pressure in the pelvic area
What is a Gynecologic Oncologist?
A gynecologic oncologist is a physician who is first trained in obstetrics and gynecology and then has three to four additional years of training in gynecologic cancer. These specialists combine their knowledge of gynecology with their expertise in detecting and treating cancers of the female reproductive system.
Cleveland Clinic gynecologic oncologists are among the approximately 1,000 U.S. gynecologists whom the American Board of Obstetrics and Gynecology has board-certified in both gynecologic oncology and obstetrics and gynecology.
Ovarian Cancer
Cancer of the ovary is the second most common gynecologic malignancy. The American Cancer Society estimates that 22,280 cases of ovarian cancer will be diagnosed and 14,240 deaths will occur in American women in 2019. When found in its earliest stages, ovarian cancer can be cured 90 to 95 percent of the time, but early ovarian cancer can be hard to detect. Many cases of ovarian cancer are found after the cancer has spread to other organs
What are the Symptoms of Ovarian Cancer?
There are no specific symptoms of early ovarian cancer, and signs can be subtle. Women typically seek medical care when they notice abdominal swelling due to the fluid that accumulates in the abdomen from ovarian cancer. Women may also notice urinary changes such as increased frequency or discomfort with urination.
Many women with ovarian cancer also complain of abdominal bloating, gas, heartburn, or intolerance to certain foods before diagnosis. When these symptoms occur, the tumor has often already spread outside of the ovary. Unfortunately, there is no reliable screening test for ovarian cancer.
How is Ovarian Cancer Treated?
Most women suspected of having ovarian cancer have a mass on examination, ultrasound or CT scan. Any woman with a new mass should then undergo a pre-operative workup, including a blood test for CA-125 and a CT scan (if not done previously). The main treatments for ovarian cancer usually involve a combination of surgery and chemotherapy (medicine given through an IV to help kill cancer cells). In some cases, surgery is performed before chemotherapy and in others, chemotherapy happens before surgery.
Surgery
Surgery for ovarian cancer is complex. In most cases, surgical treatment involves removal of the uterus, both ovaries, the fallopian tubes, nearby lymph nodes and the omentum (a fatty apron attached to the large intestines). The surgeon will remove as much of the tumor as possible, a process known as debulking.
These highly complex procedures are best done at high-volume programs, or “Centers of Excellence,” such as Cleveland Clinic. This procedure can be done in the traditional manner (through an incision in the abdomen), and in certain cases, laparoscopically (through a small incision, using a laparoscope). The ability to perform comprehensive staging and removal of the largest bulk of tumor has been shown to be best performed by a gynecologic oncologist.
In young women with low grade tumors and who still want to have children, only the diseased ovary may be removed. The remaining ovary is then watched closely for signs of cancer using imaging, labs and physical examination. If the tumor has spread throughout the abdominal cavity, women sometimes require removal of part of the intestines to remove as much visible tumor as possible.
Chemotherapy
Following surgery, chemotherapy is used to treat cancer cells left behind and microscopic disease that may be elsewhere in the body. Most women with ovarian cancer will have chemotherapy after surgery unless their tumor is low-grade (occurs only within the ovary with cells that do not look aggressive under the microscope).
Typically two drugs are given in combination at set intervals. The most common approach is to give carboplatin and paclitaxel intravenously every three weeks for six to eight treatments. Access to the latest innovations in surgery and chemotherapy is available at Cleveland Clinic.
Egg Freezing Extends Fertility
Women facing life-saving but fertility-damaging treatments for cancer at Cleveland Clinic have the option to rapidly freeze eggs, preserving the egg quality for future use, much the way men bank sperm.
Egg freezing is a spin-off of in vitro fertilization (IVF). Before starting chemotherapy, patients are given fertility shots to increase production of eggs. The eggs are retrieved just as if they were undergoing IVF. However, if the woman has no partner, the eggs are frozen rather than being fertilized.
Cleveland Clinic’s Fertility Center in Beachwood has demonstrated that the procedure works. They have successfully used frozen eggs to achieve pregnancy and now offer the option to cancer patients.
Cervical Cancer
Cancer of the uterine cervix, also called cervical cancer, is the second most common cancer among women worldwide. Despite the dramatic decrease in cervical cancer in the United States, the American Cancer Society estimates that in 2019, 13,170 cases will be diagnosed, resulting in 4,250 deaths.
What are the Symptoms of Cervical Cancer?
The most common symptom is vaginal bleeding (following intercourse or between menses) and vaginal discharge. However, precancerous changes of the cervix (abnormal Pap smears, dysplasia, precancer) usually do not cause pain or any symptoms. Therefore, it is very important that all women be screened by a pelvic exam and a Pap test since precancerous changes are usually asymptomatic.
How is Cervical Cancer Treated?
Surgery
Hysterectomy (removal of the uterus and cervix) is the treatment choice for early stage cervical cancer that has not yet spread beyond the cervix. Surgery can be performed in most situations up to stage IB2.
Surgery has the advantage of sparing the ovaries from radiation, preserving ovarian function in premenopausal women. A radical hysterectomy (complete surgical removal of the uterus, upper vagina, parametrium with pelvic lymph nodes) is the usual treatment.
For women who wish to preserve their fertility, radical trachelectomy (surgical removal of the cervix, upper vagina and surrounding tissues, and pelvic lymph nodes) can be performed instead of a radical hysterectomy. The body of the uterus and the ovaries are not removed. This option is usually reserved for women with small lesions that haven’t spread.
Chemoradiation
In certain situations, despite having an early stage tumor, your surgeon may recommend radiation instead of surgery. In recent years, cisplatin-based chemotherapy given along with radiation, called chemoradiation, has emerged as the new standard of care for treating locally advanced or high-risk early stage cervical cancer. This is cancer that has spread from the cervix into areas such as the lower vagina, or lymph nodes, or distant sites.
This combination has improved response rates and survival compared to prior therapy with radiation alone. Radiation treatments are given as five weeks of daily external radiation treatments that target the tumor and lymph nodes of the pelvis and sometimes the lymph nodes in the lower abdomen. During radiation, chemotherapy is typically given one day a week as outpatient therapy. This is followed by a few treatments with internal radiation therapy (brachytherapy) that is inserted directly into the uterus and cervix.
Uterine Cancer
What are the Symptoms of Uterine Cancer?
The symptoms of uterine cancer include vaginal bleeding between normal periods in pre-menopausal women; vaginal bleeding or spotting in post-menopausal women; lower abdominal pain or pelvic cramping; thin white or clear discharge in post-menopausal women; and extremely long, heavy or frequent vaginal bleeding episodes in women over 40. That is why it is important to have any abnormal vaginal bleeding evaluated by a physician.
How is Uterine Cancer Treated?
Surgery
Like ovarian cancer, surgery for uterine cancer is complex. In most cases, surgical treatment involves removal of the uterus, both ovaries, the fallopian tubes and nearby lymph nodes. This procedure can be done in the traditional manner (through an incision in the abdomen), through the vagina, or laparoscopically (through a small incision, using a laparoscope). In advanced cases, the surgeon will remove as much of the tumor as possible, a process known as debulking.
Depending on the stage of the disease and the overall medical condition of the patient, radiation therapy, hormone therapy and chemotherapy also may be effective.
Radiation therapy
Radiation works by damaging the DNA, or backbone, of the cancer cells. High-energy X-ray beams, similar to those used in CT scans or chest X-rays, are used to kill cancer cells and prevent them from multiplying while minimizing damage to healthy cells.
Radiation may be delivered by special equipment that can send radiation from outside of the body into the pelvis (external beam radiation therapy) or from a device placed into the uterus or vagina that delivers radiation directly into the tumor (internal radiation). Using radiation therapy as the primary mode of therapy (without surgery) is reserved for patients who have multiple medical problems and are not considered fit enough to undergo abdominal surgery.
Some patients will be found to have intermediate or high risk for recurrence after pathologic review of their surgical specimens. Your physician may offer you internal vaginal radiation to decrease the chance of a recurrence at the top of the vagina. Alternatively, you may be offered targeted external beam radiation therapy via 3-D-conformal, intensity-modulated radiation therapy or image-guided radiation therapy to decrease the risk of recurrence in the pelvis or at the top of the vagina.
Chemotherapy
Chemotherapy is sometimes used for the treatment of endometrial cancers and is given to kill or slow the growth of cancer cells. Patients offered chemotherapy usually include those with spread of cancer to the lymph nodes, spread outside of the pelvis, clear cell or papillary serous types of endometrial cancer, or patients with recurrence of their cancer. Chemotherapy regimens may be given in addition to or in place of radiation therapy.
Hormonal therapy
Occasionally patients with advanced stage disease or early spread of tumor will be treated with hormonal therapy. Most commonly this is done with progestins, a female hormone that helps block growth of the endometrial cells. Drugs that block the binding or production of estrogen can also be used alone or in combination with progesterone. Tumors of lower grade tend to respond better to hormonal therapy than high-grade tumors. However, responses have been seen in patients with all grades of endometrial cancer.
Appointments & Locations
Ready to Schedule an Appointment with a Specialist?
To schedule an appointment with a specialist in the Ob/Gyn & Women's Health Institute, please call 216.444.6601, or toll-free 800.223.2273, ext. 46601.
Virtual Second Opinion
If you cannot travel to Cleveland Clinic, help is available. You can connect with Cleveland Clinic specialists from any location in the world via a phone, tablet, or computer, eliminating the burden of travel time and other obstacles. If you’re facing a significant medical condition or treatment such as surgery, this program provides virtual access to a Cleveland Clinic physician who will review the diagnosis and treatment plan. Following a comprehensive evaluation of medical records and labs, you’ll receive an educational second opinion from an expert in their medical condition covering diagnosis, treatment options or alternatives as well as recommendations regarding future therapeutic considerations. You’ll also have the unique opportunity to speak with the physician expert directly to address questions or concerns.
Cleveland Clinic Cancer Care Locations
Cleveland Clinic Cancer Specialists are located in Cleveland, regionally throughout Northern Ohio and in Florida. View a complete list of cancer care locations.
Why Choose Us?
Cleveland Clinic offers Leading-Edge Cancer Care
Through a multidisciplinary approach, Cleveland Clinic gynecologic oncologists explore all medical, surgical and radiation options to ensure that our cancer treatment program results in the best possible outcome for each patient.
While you have many treatment options, you should consider the experience of the program where you will receive your care.
Our physicians have pioneered many treatment methods and have a large experience in treating gynecologic cancers. Each year, women with cervical, ovarian and other cancers of the female reproductive system make approximately 12,600 visits to Cleveland Clinic gynecologic oncologists.
Our oncologists work closely with gynecologic pathologists, radiation oncologists, radiologists, nurse practitioners and physician assistants. Together, they provide a careful blend of accurate diagnosis, surgical skill, leading-edge radiation therapy, advanced chemotherapy and compassionate care.
Our membership in NRG Oncology, an international cooperative research group funded by the National Cancer Institute, offers patients access to investigational treatments through a wide range of ongoing clinical trials. Additional studies give patients access to other new treatments under investigation.
The Cleveland Clinic gynecologic oncology team understands the fear and uncertainty a diagnosis of cancer brings. Our specialized services and supportive care are here to help, providing access to support groups and home care arranged by clinical nurse specialists who also provide counseling.
For your convenience, we have several locations across Northeast Ohio.
Did you know? Women who seek the care of a specially trained gynecology oncology specialist before any surgical or medical treatment increase their odds for total cure.
What Cleveland Clinic Offers
- Access to the latest techniques in gynecologic cancer management, including the newest drug treatments and National Clinical Trials Network trials available through NRG Oncology.
- Minimally invasive surgery (robotic-assisted laparoscopic surgery), used in the management of some early cervical, uterine and ovarian cancers, including lymph node dissections and other staging procedures.
- Chemotherapy units, conveniently located throughout the region staffed by specially trained nurses.
- The latest, most sophisticated radiation therapy equipment and gynecologic cancer treatments, such as interstitial therapy (allowing for custom-designed delivery of radiation), intensity-modulated radiation therapy, and image-guided radiation therapy.
- Color Doppler flow imaging, studies that identify blood flow changes associated with early ovarian cancer tumors.
- Specialized imaging, including MRI, PET, PET/CT, PET/MR.
Robots Improve Treatment
Cleveland Clinic gynecologic oncologists strive to provide the best care for patients, using minimally invasive procedures when possible. The advent of robotic-assisted laparoscopy has prompted an increase in the use of minimally invasive procedures by gynecologic subspecialists. Cleveland Clinic gynecologic oncologists are among the most experienced in the country with robotic-assisted surgeries.
What is robotic-assisted surgery?
This type of surgery uses a computer-enhanced surgical system that:
- Offers a 3-D view of the surgical field, including depth, magnification and high resolution;
- Utilizes instruments that are designed to mimic the movements of the human hands, wrists and finger, allowing an extensive range of motion and more precision;
- Provides master controls that allow the surgeon to manipulate the instruments, translating the surgeon’s natural hand and wrist movements into corresponding, precise movements.
Robotic assistance decreases blood loss, complications and hospital stays, and speeds recovery.
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