[Previous] [Table of Contents] [Next]

Other Gynecologic Cancers

Eliane Duarte-Franco MD, MPH and Eduardo L. Franco, MPH, DrPH (McGill University)

Health Issue

In 2000, there were more than 4.7 million cases of cancer in women worldwide. Gynecologic tumours, which include cancers of the endometrium, ovaries, vulva, vagina, placenta, and adnexa, encompassed 8% of all female primary tumours worldwide and 45% of all genital cancers (cervical cancer is treated in a separate chapter). In Canada, these diseases account for 11% of all malignant neoplasms (except non-melanoma skin cancers) in women and 81% of all genital cancers. Although the incidence and mortality from vulvar and vaginal cancers are very low, endometrium and ovarian cancer are important public health problems.

Key Findings

Endometrial cancer accounts for 43% of all female genital cancers in Canada. Because diagnosis is typically made at early stages, the prognosis is usually good for most patients with endometrial cancer. Over the past 30 years, however, there has been no appreciable improvement in survival among women with advanced disease.

In Canada, the incidence and mortality rates of ovarian cancer have varied little over the past 15 years. Ovarian cancer is similar to endometrial cancer in its incidence, age distribution, and geographic differences. Unlike the latter, however, the survival of women with ovarian cancer is poor: more than 70% of cases are diagnosed at late stages and fewer than 40% of women with ovarian cancer survive five years or more. Up to 10% of ovarian cancers are linked to familial aggregation.

Cancers of the vulva and of the vagina are very rare. Women with vaginal cancer are less likely to survive than women with vulvar cancer. Both these cancers share many risk factors with cervical cancer, and the recent developments in the study of human papilloma virus (HPV) infection should be applicable to these diseases as well. Of particular interest will be the advent of vaccines for the primary prevention of HPV infection.

Data Gaps and Recommendations

The authors identified the following data gaps and made the following recommendations:

• Modifiable risk factors, such as exposure to unopposed estrogens, obesity, and diet, play an important role in increasing the risk of endometrial cancer. Therefore, public and professional education to prevent this disease should be encouraged and improved. With regard to risk factors, there is good evidence for a protective role for oral contraceptives, and practitioners should take this into consideration when judging the risks of familial ovarian cancer.
• Although several screening methods have been studied, including several tumour markers, none has been found to be particularly useful in reducing the incidence of advanced disease or mortality from ovarian cancer. Thus, further research is needed to develop diagnostic methods capable of diagnosing disease at an early stage. At present, the best available means to diagnose gynecologic malignancies is during the detailed clinical examination provided as part of routine health care, provided that the physician considers the totality of information on potential and proven risk factors, such as age, reproductive health, sexual practices, smoking, and the familial clustering of some of these cancers.
• Modifiable reproductive-related factors, such as oral contraceptive use and tubal ligation, can be responsible for significant protection against ovarian cancer; informing the medical community as well as women at large of these options is thus important.
• Because cigarette smoking increases the risk of first and second vulvar and vaginal cancers, women who smoke should be advised to quit.

Download Full Chapter (PDF)

[Previous] [Table of Contents] [Next]