Gynecologic Cancer Screening, Symptoms and Evaluation in Chicago

There are five gynecologic cancers: cervical, uterine (endometrial), ovarian, vulvar and vaginal. They behave differently, they are found in different ways, and only one of them has a screening test that works in women without symptoms. Knowing which is which is the difference between catching something early and waiting on a test that was never going to catch it.

Dr. Adeeb Alshahrour, MD FACOG, provides screening, symptom evaluation, biopsy and diagnostic workup at the Women's Health Center of Chicago on West Fullerton Avenue. When a cancer is diagnosed or suspected, we coordinate referral to gynecologic oncology and stay involved in your care.

Cervical cancer — screenable and largely preventable

Cervical cancer is the exception. It is caused by persistent infection with high-risk types of human papillomavirus, it progresses slowly through precancerous stages, and both the precancer and the virus can be detected before cancer develops.

Screening. Current guidance for average-risk women is cervical cancer screening starting at age 21. From 21 to 29, cytology (a Pap test) every three years. From 30 to 65, the preferred approach is primary HPV testing every five years, with co-testing (HPV plus Pap) every five years or Pap alone every three years as acceptable alternatives. Screening can generally stop after 65 if you have an adequate history of normal results and no history of significant precancer.

Prevention. HPV vaccination prevents the infections that cause the great majority of cervical cancers. It is routinely recommended at ages 11 to 12 and can be given from age 9, with catch-up vaccination through age 26. Between 27 and 45 it is a shared decision — the benefit is smaller because many adults have already been exposed, but for some women it still makes sense. Vaccination does not replace screening.

When results are abnormal. An abnormal Pap or a positive high-risk HPV result is not a cancer diagnosis. Depending on the result and your history, the next step is repeat testing, colposcopy with biopsy, or treatment of a precancerous lesion. We perform colposcopy in the office.

Uterine (endometrial) cancer — no screening, one loud symptom

Endometrial cancer is the most common gynecologic cancer in the United States, and there is no screening test for it in women without symptoms. What it has instead is a symptom that shows up early in most cases: abnormal bleeding.

Postmenopausal bleeding is never normal. Any vaginal bleeding after menopause — a single episode, spotting, pink discharge — needs evaluation. Most causes turn out to be benign, commonly atrophy of the vaginal and uterine lining. But endometrial cancer presents this way most of the time, and evaluating it promptly is how it gets found while it is still confined to the uterus, when treatment is most effective.

Before menopause, the pattern that warrants evaluation is bleeding between periods, unusually heavy or prolonged bleeding, or a persistent change from your own baseline — particularly with risk factors present. See menstrual issues for how we work up abnormal bleeding.

Risk factors center on lifetime exposure to estrogen unopposed by progesterone: obesity, polycystic ovary syndrome, chronic anovulation, never having been pregnant, early menarche and late menopause, tamoxifen use, estrogen therapy without progestin in a woman with a uterus, diabetes, and Lynch syndrome.

Evaluation is usually a pelvic ultrasound to measure the endometrial lining plus an endometrial biopsy, which is done in the office and takes a few minutes. If sampling is inadequate or the picture is unclear, hysteroscopy allows direct visualization and targeted biopsy.

Ovarian cancer — no effective screening, and CA-125 is not a screening test

This is the point most often misunderstood. There is no screening test for ovarian cancer that has been shown to reduce deaths in average-risk women. The USPSTF recommends against screening asymptomatic women who are not known to be at high risk. Screening with transvaginal ultrasound and CA-125 in large trials did not lower mortality, and it produced false positives that led to surgery in women who did not have cancer.

CA-125 is a tumor marker, not a screening tool. It is useful for evaluating a known ovarian mass and for following a diagnosed cancer through treatment. It rises in plenty of benign conditions — endometriosis, fibroids, pelvic inflammatory disease, even normal menstruation — and it is normal in a substantial share of early ovarian cancers. Asking for a CA-125 because you are worried is understandable; it will not reliably reassure you and can send you down a path you did not need.

What does matter is paying attention to persistent symptoms: bloating, feeling full quickly, abdominal or pelvic pain, and urinary urgency or frequency. Alone, each of these is common and usually benign. The pattern that deserves evaluation is symptoms that are new, persistent (roughly daily for more than a few weeks) and different from your normal. Evaluation typically means a pelvic exam and transvaginal ultrasound.

Vulvar and vaginal cancers — found by examination

Both are uncommon and neither has a screening program. They are detected by examining and biopsying anything abnormal.

Vulvar symptoms that need to be looked at: a lump, thickened or raised patch, a color change (white, red or dark), an ulcer or sore that does not heal, and itching or burning that persists despite treatment. Chronic vulvar itching is often treated as yeast for months without anyone looking closely — if it is not resolving, it needs an exam and often a biopsy. Lichen sclerosus, a chronic skin condition of the vulva, carries a small increased risk and needs ongoing follow-up.

Vaginal cancer is rarer still and shares HPV as a risk factor. Abnormal bleeding, particularly after intercourse, and a mass or persistent discharge are the usual presentations.

When genetic assessment is indicated

Genetic testing is not driven by age. It is driven by personal and family history. Assessment for hereditary cancer syndromes — most often BRCA1/BRCA2 and Lynch syndrome — is appropriate when there is:

A personal history of ovarian, fallopian tube or primary peritoneal cancer, at any age
Breast cancer diagnosed at a young age, triple-negative breast cancer, or more than one primary breast cancer
A first- or second-degree relative with ovarian cancer, or with breast cancer at a young age
Male breast cancer in the family
Endometrial or colorectal cancer diagnosed before age 50, or several relatives with Lynch-associated cancers (colorectal, endometrial, ovarian, gastric, urinary tract)
Ashkenazi Jewish ancestry with a family history of breast or ovarian cancer
A known familial mutation already identified in a relative

If your history fits, testing changes what we do. Women with a BRCA mutation are candidates for enhanced surveillance and risk-reducing removal of the ovaries and tubes at an age based on the specific mutation. Lynch syndrome carries a high lifetime endometrial cancer risk and changes the threshold for evaluating any abnormal bleeding, with risk-reducing hysterectomy discussed once childbearing is complete. We take a structured family history at your visit and refer for formal genetic counseling when criteria are met.

What we do here

Cervical cancer screening with Pap and HPV testing, at the correct interval for your age and history
HPV vaccination and counseling
Colposcopy and cervical biopsy for abnormal results
Prompt evaluation of postmenopausal or abnormal bleeding, including office endometrial biopsy
Pelvic ultrasound and assessment of ovarian masses
Vulvar examination and biopsy
Family history assessment and referral for genetic counseling
Diagnostic and surgical procedures including hysteroscopy and laparoscopy
Referral and coordination with gynecologic oncology when needed

Do not sit on a symptom because you are hoping it resolves. Postmenopausal bleeding, a vulvar lesion that will not heal, or weeks of new bloating and early satiety are all reasons to be seen. Book an appointment or see our Chicago location for directions and hours. Routine screening happens at your annual well-woman visit.

Medical disclaimer

This page is for general education and does not constitute medical advice, diagnosis or treatment. Screening intervals and evaluation decisions depend on your individual history, and guidance changes over time. It does not create a physician-patient relationship. If you have symptoms that concern you, contact our office or your own physician. For severe pain, heavy bleeding or any medical emergency, call 911 or go to the nearest emergency department.