Managing Your Cancer Risk
Gynecological screening for women with Lynch syndrome refers to endometrial cancer and ovarian cancer screening. Since women suffering from Lynch syndrome have a heightened risk of developing both these cancers, appropriate screening is essential for early detection and treatment.
Endometrial Cancer Screening
Since endometrial cancer usually has symptoms such as vaginal bleeding at an early stage, the cancer is typically caught before it has progressed. While there is no standard screening test for endometrial cancer, pap tests, transvaginal ultrasounds, and endometrial samplings may provide some benefit in detecting endometrial cancer1.
- A Pap or Pap smear test utilizes a piece of cotton or small wooden stick to gently scrape cells from the cervix and vagina. These cells are later viewed under a microscope to look for any abnormalities. Test results may sometimes reveal irregularities in the endometrium and help detect the cancer after follow-up testing.
- A transvaginal ultrasound or endovaginal ultrasound examines the vagina, uterus, bladder, and fallopian tubes. This procedure uses a probe that is inserted into the vagina and utilizes ultrasound (high-energy sound waves) to make echoes. The ultrasound’s echoes create an image of body tissues, which is referred to as a sonogram.
- Endometrial sampling or biopsy is performed by inserting a brush or tube through the cervix and into the uterus. The goal is to scrape a small amount of tissue from the endometrium and examine the tissue under a microscope to look for signs of cancer.
- Risks of endometrial cancer screening include discomfort, bleeding, infection, and puncture of the uterus.
Ovarian Cancer Screening
Studies have shown ovarian cancer screening does not improve patient survival in Lynch syndrome patients. However, there are screening tests available that help detect the cancer early such as pelvic exams, transvaginal ultrasounds, and CA-125 assay2.
- Physicians and nurses use pelvic exams to inspect the vagina, cervix, uterus, fallopian tubes, ovaries, and rectum. There are three parts to a pelvic exam. One includes the insertion of a speculum into the vagina to look for any abnormalities. Additionally, a physician or nurse inserts one or two lubricated and gloved fingers into the vagina while placing the other hand over the suprapubic region in order to determine the size and position of the uterus and ovaries. Lastly, a gloved and lubricated finger is inserted into the rectum to detect any lumps or abnormalities.
- In addition to detecting endometrial cancer, a transvaginal ultrasound is also used to detect ovarian cancer. A transvaginal ultrasound or endovaginal ultrasound examines the vagina, uterus, bladder, and fallopian tubes. The ultrasound’s echoes create an image of the ovaries and surrounding tissues.
- CA-125 assay refers to a blood test that measures the amount of CA-125 in the blood. CA-125 is a biomarker that is used to look for signs of cancer or other conditions. Elevated levels of CA-125 may indicate the presence of ovarian cancer.
- Disadvantages of ovarian cancer screening include that finding ovarian, fallopian tube, and primary peritoneal cancer may not improve patient outcome especially if found in an advanced stage.
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