September is Gynecologic Cancer Awareness Month, an opportune time to shed light on cancers that uniquely affect women, including cervical, uterine, and ovarian cancers.

These cancers impact thousands of lives each year, but by understanding the risks, recognizing the symptoms, taking preventive measures, and listening to their bodies, women can protect their health and improve outcomes.

The Gynecologic Oncology Program at Penn Medicine Princeton Medical Center (PMC) offers comprehensive diagnosis and treatment of gynecological cancer and related conditions.

Cervical Cancer

Cervical cancer originates in the cells of the cervix, the lower part of the uterus that connects to the vagina. The vast majority of cervical cancers are caused by the human papillomavirus or HPV, a common sexually transmitted infection.

The American Cancer Society estimates that 13,820 new cases of invasive cervical cancer will be diagnosed in 2024, and about 4,360 women will die from the disease.

Early-stage cervical cancer often has no symptoms. However, as the disease progresses, symptoms may include:

• Abnormal vaginal bleeding (between periods, after intercourse or post-menopause).

• Unusual vaginal discharge.

• Pelvic pain or pain during intercourse.  

Fortunately, cervical cancer can be detected early — when it’s most treatable — with regular screening tests, including a Pap test and HPV test. The American Cancer Society recommends that women should begin screening at age 25.

In addition, the HPV vaccine can protect against the HPV strains most commonly linked to cervical cancer and thereby prevent the cancer from ever developing. 

The American Cancer Society recommends:

• HPV vaccination of children between the ages of 9 and 12. 
• Children and young adults aged 13 through 26 who have not been vaccinated, or who haven’t gotten all their doses, should get the vaccine as soon as possible. Vaccination of young adults will not prevent as many cancers as vaccination of children and teens.
• Not getting the HPV vaccination if you are older than 26 years. (However, the HPV vaccine is approved for use up to 45 years old.)

The key to preventing HPV is to get vaccinated before becoming sexually active.

Uterine Cancer

Uterine cancer, also known as endometrial cancer, begins in the lining of the uterus, and is the most common gynecologic cancer in the United States.

About 67,880 new cases of uterine cancer will be diagnosed in 2024, according to the American Cancer Society, and the disease will claim an estimated 13,250 lives this year.

The incidence of uterine cancer has been rising in the United States, particularly among postmenopausal women. Though the exact cause is unknown, researchers have identified certain risk factors, particularly obesity and hormone imbalance, that are strongly linked to the disease.

Symptoms of uterine cancer include:

• Unusual vaginal bleeding, spotting or other discharge. The American Cancer Society notes that 90% of women with uterine cancer experience abnormal vaginal bleeding.
• Pelvic pain or pressure.
• Unexplained weight loss.

There is no surefire way to prevent uterine cancer, but there are steps you can take to reduce your risk:

• Maintain a healthy weight through diet and exercise.
• Manage conditions like diabetes and hypertension.
• Talk with your gynecologist about hormone therapy.
• Go for regular gynecologic check-ups.

Ovarian Cancer

Ovarian cancer begins in the ovaries, the reproductive glands that produce eggs. It can be especially challenging to detect early because of its vague symptoms and a lack of effective screening tools.

That’s why most ovarian cancers are diagnosed at an advanced stage, making it the deadliest of all gynecologic cancers. According to the American Cancer Society, approximately 19,680 new cases are expected this year, with an estimated 12,740 deaths.

However, fewer women are dying from the disease than in years past, in part because of advances in treatment.

The risk for ovarian cancer increases with age. Other risk factors include:

• Being overweight or obese.
• Having children later or never having a full-term pregnancy.
• Family history of ovarian cancer, breast cancer or colorectal cancer.
• Inherited mutations in the BRCA1 or BRCA2 genes.

Though there is no screening test for ovarian cancer, genetic testing for BRCA1 and BRCA2 mutations can help identify women at higher risk. 

Symptoms of ovarian cancer are often subtle and can be mistaken for other conditions. The most common symptoms include:

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

See Your Gynecologist

If you are concerned about your risk for gynecologic cancer or are experiencing symptoms, see your gynecologist. They may refer you to a gynecologic oncologist for an accurate diagnosis.

The Gynecologic Oncology Program at PMC offers a range of advanced diagnostic and treatment tools for gynecologic cancer, including:

• Genetic counseling.
• Complex pelvic surgery.
• Minimally invasive surgical options, including robotic surgery.
• Targeted radiation therapy.
• Fertility preservation.

Care is provided by a multidisciplinary team comprising board certified gynecologic oncologists, oncology certified nurses and nurse navigators, and other experts.

Moreover, as part of Penn Medicine, PMC provides access to highly advanced treatments through the Abramson Cancer Center, a world leader in cancer research and patient care. Specialized care is available, including proton therapy and clinical trials.

Gynecologic cancer can pose a significant health threat to women. One of the best things you can do to protect your health is listen to your body. Don’t ignore symptoms and be sure to see your gynecologist annually.

For more information or to find physician affiliated with Penn Medicine Princeton Health, call (888) 742-7496 or visit www.princetonhcs.org.

Noah Goldman, MD, is board certified in gynecologic oncology and is the Medical Director of Cancer Programs at Penn Medicine Princeton Health.

The human papillomavirus (HPV) is the most common sexually transmitted disease in the United States.

In fact, the virus is so widespread that a majority of sexually active men and women will get it at some point in their lives if they do not receive the HPV vaccine.

And though most cases of HPV will resolve on their own without complications, persistent infection can lead to severe health complications later in life, including cancer.

Parents of adolescents — both girls and boys — should talk to their pediatrician about protecting their children from HPV and its potential complications before they become sexually active.

About HPV

The Centers for Disease Control and Prevention (CDC) estimates that more than 42 million people are infected with HPV nationwide and that about 14 million new cases are diagnosed each year.

The virus spreads through intimate skin-to-skin contact, most often through vaginal, anal and oral sex with someone who is infected.

HPV typically does not have any symptoms and most people don’t even know they have it. In 9 out of 10 cases, the body’s immune system clears the virus within two years, according to the CDC.

However, if the HPV virus lingers, it can lead to serious health problems, such as:

• Genital warts
• Cervical cancer
• Cancer of the vagina and vulva
• Cancer of the penis
• Anal cancer
• Oropharyngeal cancer, which includes the back of the throat, base of the tongue and tonsils

Vaccination is Critical

Every year, HPV causes an estimated 36,000 cases of cancer in both men and women, according to the CDC.

The majority of cervical, vaginal, vulvar, penile and anal cancers are caused by HPV, and up to 70% of oropharyngeal cancer may be linked to the virus.

That is why vaccination is critical.

Vaccinating children before they are sexually active and ever exposed to the virus is the best way to protect them from infection and guard against cancer.

The CDC recommends that boys and girls who are 11 to 12 years old should get two shots of the HPV vaccine 6 to 12 months apart. The vaccine can be given to children as young as 9.

Teens and young adults who start the vaccination series later, between ages 15 and 26, will need three doses of the vaccine. Vaccination is typically not recommended for adults over age 26 because by this point, they likely have already been exposed to the virus.

However, through shared decision making with a health care provider, a patient may be vaccinated up to the age of 45 if there is an increased risk of acquiring the virus.

HPV vaccination has proven safe and effective. Like any medication, the vaccine can cause side effects, such as swelling, redness and soreness where the shot was given, but they normally go away within a day or two.

It is important to note that according to the CDC there is no evidence that the HPV vaccine has any effect on future fertility. Moreover, research has shown that that the HPV vaccine does not make kids more likely to start having sex.

In addition to the vaccine, individuals can further reduce their risk for HPV by using condoms during intercourse and limiting their number of sexual partners.

Screening and Early Detection

There is no blood or urine test to screen for HPV. Women, however, may have an HPV test as part of screening for cervical cancer, which may also include a Pap test.

In both tests, cells are taken from the cervix for evaluation. A Pap test looks for abnormal cells in the cervix that could indicate precancer or cancer. An HPV test looks for infection from the virus.

The American College of Obstetricians and Gynecologists offers the following guidelines for cervical cancer screening:

• If you are younger than 21, you do not need screening.

• If you are 21 to 29, have a Pap test alone every three years. HPV testing alone can be considered for women who are 25 to 29, but Pap tests are preferred.

• If you are 30 to 65, you can choose one of three options:
  • Have a Pap test and an HPV test (co-testing) every five years
  • Have a Pap test alone every three years
  • Have an HPV test alone every five years

• If you are 65 or older, you do not need screening if you have no history of cervical changes and either three negative Pap test results in a row, two negative HPV tests in a row, or two negative co-test results in a row within the past 10 years. The most recent test should have been performed within the past three or five years, depending on the type of test.

Keep in mind that even if you have been vaccinated for HPV, you still need screening. Moreover, even if you are not due for screening, you should still see your gynecologist annually for a routine checkup.

Vaccinating against HPV is the best way to prevent cervical and other types of cancer. Protect your daughter or son before they are exposed to the virus so they can reduce their risk for disease as they grow into adulthood.

To find a physician with Penn Medicine Princeton Health, call (888) 742-7496 or visit www.princetonhcs.org.

Michael B. Resnick, MD, is board certified in obstetrics and gynecology and is a member of the medical staff at Penn Medicine Princeton Health.