[2022-09-20] World Gynecologic Oncology Day

While scrolling through my Instagram feed today, I came across a World Ovarian Cancer Coalition post for World GO Day. Not familiar with World GO Day, I clicked on @worldgoday and learned that GO is short for gynecologic oncology. I also learned that gynecologic cancers include the following five types: cervical, ovarian, uterine (endometrial), vulvar and vaginal.

I was curious about the frequency of such cancers in Canada. While I've become aware of a few women who have or had ovarian cancer, I personally know only one person diagnosed with uterine (endometrial) cancer, and no one diagnosed with one of the other gynecologic cancers. That could be because these aren't common cancers, but it could also be that people impacted by these diseases have chosen not to speak very publicly about them (which I understand).

So how common are they? According to the Canadian Cancer Society, the projected incidence for these cancers in Canada in 2022 is:
  • Uterine cancer - 8,100 cases
  • Ovarian cancer - 3,000 cases
  • Cervical cancer - 1,450 cases
As a point of reference, the projected incidence of breast cancer in Canada in 2022 is 28,900 cases. That makes breast cancer 3½ times more common than uterine cancer, almost 10 times more common than ovarian cancer, and almost 20 times more common than cervical cancer. Perhaps this greater incidence, less stigma and better marketing have made all of us more aware of breast cancer, including screening for the disease and the symptoms to watch for.

Statistics for vulvar and vaginal cancers are not tracked separately but are instead included in the general category other female genital organ cancers. The most recent data I could find, also from the Canadian Cancer Society, were for 2018. In that year, 1,075 Canadians were diagnosed with other female genital organ cancers.

The Ovarian World Cancer Coalition used the occasion of World GO Day to remind people that there is no reliable screening test for ovarian cancer. Because of this, the majority of cases of ovarian cancer are diagnosed in later stages, making this cancer the most deadly among the five gynecologic cancers. The Canadian Cancer Society statistics project that 1,950 people will die of ovarian cancer in 2022, compared to 1,500 of uterine cancer, even though the incidence of uterine cancer is more than 2½ times greater than the incidence of ovarian cancer.

That said, there is no reliable screening test for uterine cancer, just as there is no such test for ovarian cancer. It's thus important for people to know the signs and symptoms of uterine cancer. The Canadian Cancer Society writes:

The most common symptom of uterine cancer is abnormal vaginal bleeding. This includes a change in menstruation (heavier periods, periods that last longer or periods that occur more often than normal), bleeding between periods, bleeding after menopause or spotting.

Other symptoms include:
  • unusual vaginal discharge, which can be foul-smelling, pus-like or blood-tinged
  • pain during intercourse
  • pelvic pain or pressure
  • pain or feeling of pressure in the pelvis, lower abdomen, back or legs
  • pain during urination, difficult urination or blood in the urine
  • pain during bowel movements, difficult bowel movements or blood in the stool
  • bleeding from the bladder or rectum
  • buildup of fluid in the abdomen (called ascites) or in the legs (called lymphedema)
  • weight loss
  • lack of appetite
  • difficulty breathing
The Canadian Cancer Society notes that someone with uterine cancer may exhibit different signs and symptoms as the cancer grows, and that other health conditions can cause the same symptoms as uterine cancer. If in doubt, see your doctor.

Just as for ovarian and uterine cancers, there is no reliable screening test for vulvar and vaginal cancers. On its webpage for Vaginal and Vulvar Cancers: What Should I Know About Screening?, the US Centers for Disease Control and Prevention makes a helpful distinction between screening tests and diagnostic tests, which I didn't clearly understand before:

Screening is when a test is used to look for a disease before there are any symptoms. Cancer screening tests are effective when they can find disease early, which can lead to more effective treatment. Diagnostic tests are used when a person has symptoms. The purpose of diagnostic tests is to find out, or diagnose, what is causing the symptoms. Diagnostic tests also may be used to check a person who is considered at high risk for cancer.

On its webpage Vaginal and Vulvar Cancers: What Are the Symptoms? the CDC identifies these symptoms of vaginal cancer:
  • Vaginal discharge or bleeding that is not normal for you. The bleeding may be abnormal because of how heavy it is, or when it happens, such as bleeding after you have gone through menopause; bleeding between periods; or any other bleeding that is longer or heavier than is normal for you.
  • A change in bathroom habits, such as having blood in the stool or urine, going to the bathroom more often than usual, or feeling constipated.
  • Pain in your pelvis, the area below your stomach and in between your hip bones, especially when you pass urine or have sex.
It identifies these symptoms for vulvar cancer:
  • Itching, burning, or bleeding on the vulva that does not go away.
  • Changes in the color of the skin of the vulva, so that it looks redder or whiter than is normal for you.
  • Skin changes in the vulva, including what looks like a rash or warts.
  • Sores, lumps, or ulcers on the vulva that do not go away.
  • Pain in your pelvis, especially when you urinate or have sex.
The US National Cancer Institute notes that infection with the human papillomavirus causes about two-thirds of all vaginal cancers and about half of all vulvar cancers.

That leaves cervical cancer, the only one of the five gynecologic cancers for which a reliable screening test exists. The Canadian Cancer society webpage on Screening for cervical cancer says:

Screening means checking for a disease in a group of people who don’t show any symptoms of the disease. Screening tests help find cervical cancer before any symptoms develop. When cervical cancer is found and treated early, the chances of successful treatment are better.

If you’ve ever been sexually active, you should start having regular Pap tests by the time you’re 21. You’ll need a Pap test every 1 to 3 years, depending on your previous test results.

I'm grateful to the World Ovarian Cancer Coalition for posting on World GO Day, as it led me to delve into the subject of gynecologic oncology and thereby increase my knowledge of the five gynecologic cancers.

The website for World GO Day states:

Ovarian, uterine, cervical, and other gynecological cancers are among the most common cancers affecting women. However, they are not very well known by the general public nor by policy-makers and other stakeholders. Women themselves may be unaware of the (sometimes vague) symptoms or may be too embarrassed to consult a doctor, and a stigma associated with these diagnoses lingers.

Writing this post was eye-opening. More and more, I'm convinced of the need to monitor our bodies, to avail ourselves of screening tests where they exist (cervical and breast cancer), to learn the signs of cancers for which no reliable screening tests exist (ovarian, uterine, vaginal and vulvar cancers), to push for diagnostic tests at the earliest opportunity if symptoms emerge, and to help spread the word about cancer so that it's detected as early as possible.

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