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PREVENTATIVE
MEDICINE

d.) Vaginal cancer: Often pres-
ents like cervical cancer with
painless vaginal discharge,
vaginal bleeding or bleeding
after intercourse. With disease
progression, these symptoms
can include urinary symptoms such
as dysuria, urinary retention or hema-
turia. Continuing disease progression can
lead to gastrointestinal issues such as colonic ob-
struction or bloody stools.
e.) Vulvar cancer: Vulvar cancer often presents with an enlarg-
ing vulvar bump or lump that can be pigmented, or ulcerated
and it can itch, burn or bleed.

4.) Can cancer risk be reduced, if so, how?
Women with a strong family history of breast and/or ovarian cancer
who have genetic testing and found to have a high-risk genetic muta-
tion (such as BRCA1/2, Lynch syndrome, RAD51C/D, BRIP1) can
undergo risk reducing surgery with removal of the ovaries and fallopian
tubes to markedly reduce the risk of developing ovarian, fallopian tube
or primary peritoneal cancer. Patients with obesity and irregular peri-
ods can reduce the risk of developing endometrial cancer by losing
weight and taking contraceptives that promote regular periods. Certain
patients, such as those with Lynch syndrome should undergo risk re-
ducing surgery to remove the uterus and cervix, along with the ovaries
and fallopian tubes when they are done with childbearing but usually
no sooner than age 35-40 to reduce the risk of endometrial and ovarian
cancer. HPV vaccination of young girls can reduce the risk of develop-
ing cervical cancer, vaginal cancer or vulvar cancer as these are often as-
sociated with HPV infection.

References
1.) ACOG Practice Bulletin on Hereditary Breast and Ovarian Cancer
Syndromes
2.) ACOG Practice Bulletin on Lynch Syndrome
3.) Onstad MA, Schmandt RE, Lu KH. Addressing the Role of Obe-
sity in Endometrial Cancer Risk, Prevention, and Treatment. J Clin
Oncol. 2016;34(35):4225-4230. doi:10.1200/JCO.2016.69.4638
4.) Eskander, R. N., & Bristow, R. E. (2014). Gynecologic Oncology:
A Pocketbook (2015th ed.). Springer.

Jaron Mark, MD is a Gynecologic Oncologist Surgeon with
the START Center. He is a member of the Bexar County
Medical Society.

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