A Comprehensive Guide to Gynecologic Cancer Screenings and Diagnostics
Ongoing comprehensive gynecologic care, including regular exams and screenings, advanced diagnostics, and expert second opinions, is crucial for all gynecologic (GYN) cancers, especially those that lack reliable screening methods. Multidisciplinary teams and innovative technologies provide patients with the thorough, personalized care they need to ensure the best possible results.
GYN Cancers: Current Landscape and Screening Guidelines
Regular screenings are critical for detecting gynecologic cancers early when they’re most treatable, especially cervical cancer. However, not all GYN cancers have reliable screening methods, making awareness of symptoms and access to expert care, like at Moffitt Cancer Center, essential for prevention, pre-malignancy treatment, and early diagnosis.
Cervical Cancer
Cervical cancer is one of the most treatable and preventable cancers due to the effectiveness of screenings like the Pap smear. It’s a slow-growing cancer, with most cases occurring in individuals who are not up to date on regular screenings.
Screening for cervical cancer has made significant strides. The introduction of the Pap smear profoundly reduced cervical cancer incidence and transformed patient outcomes, and screening guidelines have been updated over time to reflect our growing understanding of the disease and advances of modern medicine.
In December 2024, new guidelines introduced the option for women aged 30-65 to self-collect their own samples for HPV testing every five years. This change marks a monumental shift in access and comfort for standard screening, encouraging more women to seek regular screening.
Previous Guidelines
- Ages 21–29: Pap test every three years
- Ages 30–65:
- Pap test every three years
- HPV test or co-testing (Pap and HPV) every five years
- Ages 65 and older: Screening can stop with a history of normal prior results
Updated Options
(Ages 30–65)
- Self-collected vaginal samples in gynecologist’s office for HPV testing every five years
- Clinician-collected Pap test every three years
- Co-testing every five years
(Ages 21–29)
- Clinician-collected Pap smear every three years
(Ages 65 and older)
- Screening can stop with a history of normal prior results
This is the first time self-collection has been recommended in the guidelines. However, note that the recommendations do not apply to women at a higher risk for cervical cancers, including those with a history of the disease or precancerous lesions.
Endometrial Cancer
Endometrial cancer is the most common cancer of the female reproductive organs and the fourth most common cancer among women overall. Rates of diagnosis have steadily increased in recent years, particularly in North America.
While no reliable screening tests exist for endometrial cancer, recognizing symptoms and promptly seeking expert care can increase the chance of early detection. Diagnostic tests can help determine the cause of symptoms or check for the presence of cancer in high-risk patients without symptoms.
Key Symptoms
- Abnormal vaginal bleeding or discharge
- Pelvic pain or pressure
- Pain urinating
- Unexplained weight loss or anemia
Diagnostic Options
- Pelvic examination
- Transvaginal ultrasound to visualize the uterus
- Endometrial tissue sampling via biopsy or D&C
- Genetic and protein testing
Ovarian Cancer
Ovarian cancer is a leading cause of cancer-related death in women, often developing in older individuals. While incidence and mortality rates have declined, it remains a significant health challenge.
Ovarian cancer also lacks effective early screening tools, underscoring the importance of symptom awareness. Women must pay attention to their bodies and know what is normal and abnormal for them. They should see a doctor for the following symptoms for an exam and diagnostic testing.
Key Symptoms
- Persistent bloating
- Pelvic or abdominal pain
- Changes in appetite or urinary habits
Diagnostic Options
- Rectovaginal pelvic exam
- Transvaginal ultrasound
- CA-125 blood test (helpful in some instances)
The Big Picture: What Moffitt’s Experts Are Saying
Including self-collected cervical screenings in updated guidelines is a valuable step toward improving access, but it doesn’t replace the need for comprehensive gynecologic care.
“You can get so much into the weeds that you forget the big picture,” says Dr. Karen Lu, Physician-in-Chief at Moffitt Cancer Center. Regular gynecologic care helps catch cancers early, address symptoms, and improve outcomes. Physicians must look beyond the Pap test, conduct complete screenings, and refer to specialists like those at Moffitt for second opinions, advanced diagnostics or screenings, or for high-risk patients.
Confusion and Declining Screening Rates
New guidelines, while beneficial, can create confusion for both patients and providers. Changes to cervical cancer screening, like extending intervals to five years, can lead to misconceptions about the need for regular gynecologic care. “If screening becomes less routine, people forget to do it,” adds Dr. Lu. This new five-year frequency does not mean women can skip other forms of gynecologic care.
Dr. Anna Giuliano, founder of Moffitt’s Center for Immunization and Infection Research in Cancer, notes, “There are many reasons women aren’t getting screened. It could be a lack of insurance or access to care, lack of understanding for the need to be screened, and screening guideline confusion.” This confusion, compounded by disruptions from the COVID-19 pandemic, has contributed to declining screening rates.
Importance of Comprehensive Care
While Pap smears and HPV tests are powerful for cervical cancer detection, they don’t screen for other gynecologic cancers. “Pap smears will miss the majority of endometrial cancers,” explains Dr. Mian Shahzad, gynecologic oncologist at Moffitt. “But if caught early, it’s fully treatable and, in most cases, curable.”
Similarly, pelvic exams, distinct from Pap smears, remain essential for detecting abnormalities in the uterus and ovaries, especially for women in their 40s and 50s when risks for ovarian and endometrial cancers increase. “We are seeing advanced-stage cervical cancer cases rise,” warns Dr. Monica Avila, a gynecologic oncologist at Moffitt, highlighting disparities in access and understanding.
Moffitt experts stress the importance of building habits around gynecologic care. Vaccination with the HPV vaccine protects against the strains most likely to cause cancer. Regular cervical cancer screenings, along with follow-ups for any abnormal results, help maintain a comprehensive picture of health. Being aware of symptoms like abnormal bleeding or persistent pelvic pain and seeking prompt evaluation is equally important.
“Our biggest way to prevent [cervical] cancer moving forward is for women to show up, get vaccinated, and get screening,” says Dr. Robert Wenham, chair of Moffitt’s Gynecologic Oncology Program. The importance of showing up consistently for regular care holds true for all gynecologic cancers.
Moffitt’s Role in GYN Cancer Screenings, Diagnostics, and Treatment
Moffitt Cancer Center is a leader in gynecologic cancer care, from screenings and advanced diagnostics to innovative treatments and multispecialty expertise. Our comprehensive approach utilizes collaborative efforts and specialists from varying disciplines via weekly tumor boards to ensure patients receive the most accurate and timely assessments and a thorough, customized treatment plan.
Moffitt provides patients with the latest technologies and care from Florida’s foremost cancer experts, delivering outcomes four times higher than the national average. Refer your patients to Moffitt to ensure they can achieve the best possible outcomes in their fight against gynecologic cancers.
To refer a patient with gynecologic cancer or with suspicious tumor findings, please complete our online form or contact a physician liaison for assistance. As part of our efforts to shorten referral times as much as possible, online referrals are typically responded to within 24 - 48 hours.