A Pap smear does not screen for cancers of the uterus (endometrial cancers) and ovaries

MSK gynecologic surgeon Ginger Gardner talked about some common misconceptions about gynecologic cancers.

Postmenopausal bleeding

After menopause, “it doesn’t matter if it’s a brown spot, a pink spot, a dot, a smear — it shouldn’t be there,” Dr. Gardner says. If you have any postmenopausal bleeding, head to your doctor as soon as you notice it. It may be a sign of cancer, and cancer is most treatable when it’s caught early. “Sometimes patients will say, ‘It happened once and it went away for a year,’” Dr. Gardner explains. “While it could have been a benign issue, it also means there could have been abnormal cells there a year ago.”

Pap smear screens

“A Pap smear does not screen for all gynecologic diseases,” Dr. Gardner says. Its main job is to use a sampling of cells from the cervix to detect the human papillomavirus (HPV) and/or cancerous or precancerous cells. But cancers of the uterus (endometrial cancers) and ovaries begin farther up in the female reproductive tract, in areas that a Pap smear can’t reliably test. We don’t yet have foolproof screening tools for ovarian cancer and uterine cancer, so it’s important to discuss any unusual pelvic pain or irregular vaginal bleeding with your doctor.

HPV can lead to cervical cancer and head and neck cancers

The vast majority of women will be exposed to HPV, which can lead to cervical cancer and head and neck cancers. “Our immune system keeps [HPV] in check, but our immune system changes over a lifetime,” says Dr. Gardner. HPV is commonly diagnosed in a woman’s 30s, but it can show up at any age — even into the golden years. Minimize your risk by practicing safe sex and getting regular Pap smears.

What is a hysterectomy?

By definition, a hysterectomy is the removal of the uterus. The cervix is part of the uterus, so it’s commonly taken out in a hysterectomy as well. In some cases, the cervix is left intact — what’s referred to as a partial hysterectomy. A hysterectomy does not involve the ovaries. In fact, “you can remove the uterus and still preserve the ovaries — and the hormones they produce — depending on the reason for the hysterectomy procedure,” Dr. Gardner says.

Here are some other terms to know:

  • A surgery to remove one or both ovaries is called an oophorectomy.
  • A surgery that removes one or both fallopian tubes is called a salpingectomy.
  • A surgery that removes an ovary and a fallopian tube is called a salpingo-oophorectomy.
  • A surgery that removes both of each organ is called a bilateral salpingo-oophorectomy.

At MSK, most gynecologic surgeries are done minimally invasively, which means that the abdominal incisions are small. This allows for fewer stitches and faster recovery. “To me, every case is a minimally invasive case until proven otherwise,” Dr. Gardner says.

Ovarian cancer have symptoms

Although it’s often referred to as “the silent killer,” ovarian cancer does have symptoms — they’re just nonspecific ones like bloating, cramping, and/or a change in bowel or bladder function. Of course, not every bellyache is a sign of cancer. Dr. Gardner advises women who notice new symptoms that persist or increase over a few weeks to ask their doctor for a pelvic ultrasound, which takes pictures of the ovaries. Besides eating right, exercising, and not smoking, women can slash their risk of ovarian cancer a whopping 50% by taking birth control pills for several years. Check in with your doctor to see if this type of contraception is right for you.