DEAR MAYO CLINIC: I've heard that many symptoms of gynecologic cancers can mimic menstrual or menopausal changes, such as bleeding and pelvic pain. What symptoms should never be ignored, and when do I know it's time to see a healthcare professional?
ANSWER: Pay attention to changes that are new, persistent, worsening or simply different from what is typical for your body. Many gynecologic cancer symptoms also can have noncancerous causes, but certain changes deserve medical evaluation rather than automatically considering them a natural part of menstruation, menopause or another common condition.
There are five types of gynecologic cancers: ovarian, endometrial, cervical, vulvar and vaginal. Their warning signs can overlap with expected changes across a woman's life, which is why the pattern of a symptom — whether it's new, persistent or progressing — matters.
Symptoms that should prompt a conversation with a healthcare professional include:
- Postmenopausal bleeding. Menopause means going 12 months without a menstrual period. Any bleeding after that point should be evaluated.
- Bleeding after intercourse. Cancer isn't the only possible cause, but bleeding after intercourse should be checked.
- Pelvic pain that's new or getting worse. If you usually have discomfort with menstrual periods but notice that the pain is becoming progressively worse, that change deserves attention.
- Persistent bloating or feeling full quickly. Feeling full soon after starting to eat is called early satiety. Bloating and early satiety can occur with ovarian cancer, particularly when symptoms are new or worsening.
- Changes in bowel or bladder habits. When changes develop or get worse, they should be looked into rather than considered only as a gastrointestinal or urinary condition.
- New or persistent vulvar changes. A new lump or lesion, bleeding, itching, burning or irritation on your vulva should be examined. A biopsy may be recommended, particularly if symptoms persist or don't improve with treatment.
The key is to know your own baseline. A symptom doesn't have to be severe, but if it's unusual for you or continues, it should be evaluated.
One common misconception is that a Pap test means a woman has been screened for all gynecologic cancers. A Pap test only screens for cervical cancer and cervical precancer. It doesn't screen for ovarian, endometrial, vulvar or vaginal cancers.
For cancers without routine screening tests, recognizing symptoms and seeking diagnostic evaluation if you become concerned is especially important.
Screening and diagnostic evaluation are different. Screening is performed in people who don't have symptoms. Diagnostic evaluation, such as imaging or a biopsy, is prompted by a symptom or other concern, and it may involve additional testing depending on each person's situation.
Risk of gynecological cancers differs by cancer type, but several factors may be important:
- Aging puts people at greater risk of these cancers.
- Obesity is a risk factor for a common type of endometrial cancer.
- Inherited conditions, including BRCA1 and 2 and Lynch syndrome, can increase the risk of certain ovarian or endometrial cancers.
- Family history of cancers, such as breast, ovarian or colon cancer, can be important when assessing inherited risk.
- Human papillomavirus, or HPV, is associated with cervical and vulvar cancer risk. Smoking can make it more difficult to clear up an HPV infection, increasing the chance that it will persist.
Knowing your family history and discussing relevant risk factors with a healthcare professional can help guide appropriate care.
Earlier detection can reduce the challenges of treatment and may improve outcomes. In some cases, cancer found earlier may be treated with surgery without the need for additional treatments like chemotherapy or radiation therapy. For some younger patients, earlier diagnosis also may allow them to consider fertility-preserving treatment options.
The goal isn't to assume that every episode of bleeding, pelvic pain or bloating means cancer. It's to recognize when a change deserves an explanation.
If something is new, persistent, worsening or simply doesn't feel right for your body, have it evaluated. You know your body best, and speaking up when something feels different is an important part of protecting your health.
Shariska Harrington, M.D., Obstetrics & Gynecology, Mayo Clinic, Rochester, Minnesota