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September is observed as Gynecological Cancer Awareness Month (GCAM), a period dedicated to increasing public understanding of the cancers that can develop in the female reproductive organs, recognising survivors, remembering those who have died, and pushing for better prevention, early detection, treatment and support. The Foundation for Women’s Cancer says the observance began in 1999 and has grown from an awareness initiative into a broader campaign focused on education, action, and advocacy.
What are gynecological cancers?
Gynaecological cancers are cancers that begin in the female reproductive organs. They are often grouped together because they affect related organs, but they are not one disease and should not be treated as such. The five main types are cervical cancer, ovarian cancer, uterine cancer, vaginal cancer and vulvar cancer. The US Centres for Disease Control and Prevention (CDC) identifies these as the five main gynaecological cancers, while noting that cancer of the fallopian tube is an additional, very rare type. Each cancer originates in a different part of the reproductive system.
Why does a whole month need to be dedicated to them?
One reason is simply the scale of the problem. Cancer remains one of the world’s major causes of illness and death. According to the International Agency for Research on Cancer (IARC), there were almost 20 million new cancer cases and close to 10 million cancer deaths globally in 2022. Gynecological cancers form part of that global burden, affecting women across different ages and regions.
The colour Teal is frequently seen during gynecological cancer awareness campaigns, including in Nigeria, but there is an important note worth making. Teal is particularly associated with cervical cancer awareness and elimination campaigns. WHO’s 2025 World Cervical Cancer Elimination Day campaign explicitly described teal as the colour of cervical cancer elimination, with landmarks around the world illuminated in teal. Nigeria’s National Assembly was among those landmarks. However, no single colour represents every gynecological cancer; awareness colours can differ by cancer and by the organisation running the campaign.
The Five Gynecological Cancers: What Women Need to Know
The phrase gynecological cancer can make these diseases sound like variations of the same illness; they are not. Cervical, ovarian, uterine, vaginal and vulvar cancers affect different organs, develop through different biological processes and have different risk factors, warning signs, screening options and treatments. Some have strong links to preventable infections such as human papillomavirus (HPV); others are more closely linked to age, genetics, hormonal exposure, or other factors. Here is what women need to know about each one.
- Cervical cancer
Of the five major gynecological cancers, cervical cancer is arguably the clearest example of what can happen when prevention and early detection work and what happens when women cannot access either. Cervical cancer develops in the cervix, the lower part of the uterus that connects the uterus to the vagina. Almost all cervical cancer cases are linked to persistent infection with high-risk types of HPV, a very common virus transmitted through sexual contact.
WHO estimates that approximately 99% of cervical cancers are linked to high-risk HPV infection. That does not mean that every woman who acquires HPV will develop cervical cancer. HPV infections are extremely common, and in most people the immune system clears the infection naturally. WHO estimates that about 90% of HPV infections are controlled by the body’s immune system without causing lasting problems. The concern arises when a high-risk HPV infection persists. Over time, persistent infection can cause abnormal changes in cervical cells. Some of these changes can become precancerous lesions and, if they are not detected and treated, eventually progress to invasive cancer.
There are opportunities to intervene at several points: HPV vaccination can prevent infection with cancer-causing HPV types; cervical screening can identify HPV infection or abnormal cervical changes before invasive cancer develops; and precancerous lesions can be treated before they become cancer. WHO’s current global strategy for cervical cancer elimination is built around three targets known as 90–70–90: 90% of girls fully vaccinated against HPV by age 15, 70% of women screened with a high-performance test by age 35 and again by age 45, and 90% of women identified with cervical disease receiving appropriate treatment.
What does cervical cancer look like?
Early cervical cancer may cause no noticeable symptoms, which is precisely why screening matters. When symptoms occur, they can include bleeding after sexual intercourse, bleeding between periods, unusually heavy or prolonged periods, bleeding after menopause, unusual or foul-smelling vaginal discharge, pelvic pain and pain during sex. More advanced disease can cause problems with urination or bowel movements, blood in the urine or rectum, back or abdominal pain, swelling of the legs and fatigue.
Importantly, these symptoms do not automatically mean a woman has cervical cancer. Do not dismiss persistent or unusual bleeding and other concerning changes. When a screening result or symptoms raise concern, diagnosis can involve a pelvic examination, HPV testing or cytology, colposcopy and biopsy, among other investigations. A biopsy is used to examine tissue and establish whether cancer is actually present.
Treatment depends on the type and stage of the cancer and can include surgery, radiation therapy, chemotherapy, targeted therapy and, in some cases, combinations of these approaches. The earlier cervical cancer is detected and appropriately treated, the better the prospects for successful treatment.
Ovarian cancer
Ovarian cancer begins in the ovaries, the reproductive organs that produce eggs and hormones. However, the phrase ovarian cancer encompasses several different diseases. Some cancers traditionally classified as ovarian cancer are closely related to cancers of the fallopian tubes and the primary peritoneum, the lining of the abdominal cavity. These cancers can arise from similar tissues and, particularly in the case of epithelial ovarian, fallopian tube and primary peritoneal cancers, are often treated similarly. Ovarian cancer is particularly challenging because it can be difficult to detect early.
According to the National Cancer Institute (NCI), early ovarian cancer may produce few or no symptoms, and by the time symptoms become noticeable, the disease may already be advanced. Symptoms can include persistent bloating, abdominal or pelvic pain, difficulty eating or feeling full unusually quickly, and changes in urination or bowel habits. It is not about frightening women into assuming that ordinary bloating means ovarian cancer. It is about recognising when a change is persistent, unusual or different from a woman’s normal pattern and deserves medical assessment.
Who is at greater risk?
Ovarian cancer risk can be influenced by age, family history and inherited genetic changes. Women with close relatives who have had ovarian cancer may have an increased risk, particularly when several relatives are affected. Inherited changes in genes such as BRCA1 and BRCA2 can substantially increase the risk of ovarian cancer. Lynch syndrome is another inherited condition associated with increased risk. Endometriosis is also recognised as a risk factor. Having a risk factor does not mean that a woman will develop ovarian cancer, just as having none of these known risk factors does not make someone completely immune.
- Uterine and endometrial cancer
The uterus is the muscular organ in which a pregnancy develops. It has several layers, including the endometrium, the inner lining that thickens and sheds during the menstrual cycle. Endometrial cancer has a somewhat different risk profile from cervical cancer. Rather than being primarily driven by HPV, risk is strongly associated with age, hormones, prolonged exposure of the endometrium to oestrogen, and metabolic and genetic factors.
Risk factors include obesity, metabolic syndrome, type 2 diabetes, endometrial hyperplasia, taking tamoxifen, exposure to oestrogen-only hormone replacement therapy after menopause, early menstruation, later menopause, polycystic ovary syndrome (PCOS), having never given birth, a family history of uterine cancer and inherited conditions such as Lynch syndrome.
One of the most important features of endometrial cancer is that it can produce a warning sign that should not be ignored: abnormal vaginal bleeding. This may include bleeding between periods, unusually heavy or irregular bleeding, or bleeding after menopause; pelvic pain can also occur. Bleeding after menopause deserves particular attention because menstruation has stopped after menopause, so vaginal bleeding at that stage is not something that should simply be assumed to be a normal period returning.
Diagnosis of endometrial cancer generally requires investigation of the endometrium, often including an endometrial biopsy. Once diagnosed, treatment depends on the cancer’s type and stage. Surgery is the most common treatment for endometrial cancer and may involve removal of the uterus and cervix, often alongside removal of the fallopian tubes and ovaries.
Depending on the stage and characteristics of the cancer, treatment may also involve radiation therapy, chemotherapy, hormone therapy or targeted therapy.
Because treatment can involve removal of reproductive organs, uterine cancer also raises questions that go beyond simply keeping someone alive. Fertility, hormonal changes, sexual health and quality of life can all become significant parts of the cancer experience
- Vaginal cancer
Vaginal cancer begins in the vagina, the muscular canal that connects the cervix to the outside of the body. It is considerably less common than cervical or uterine cancer, but rare does not mean irrelevant. Rare cancers can still have profound consequences for the women who develop them, and their relative rarity can itself contribute to delayed recognition.
According to NCI, older age and HPV infection are among the risk factors associated with vaginal cancer. HPV is believed to cause approximately two-thirds of vaginal cancer cases. A history of hysterectomy has also been associated with vaginal carcinoma in some studies, although the relationship is complex and does not mean that having had a hysterectomy causes vaginal cancer.
Vaginal cancer may cause no symptoms in its early stages. When symptoms do occur, they can include bleeding or discharge unrelated to menstruation, bleeding after sexual intercourse, pelvic pain, pain during sex, a mass or lump in the vagina, pain during urination, constipation.
Diagnosis may involve a pelvic examination, imaging and biopsy, depending on what is found. Treatment depends on the tumour’s location and stage and can involve surgery, radiation therapy and, in selected cases, chemotherapy or other approaches.
Vulva cancer
The vulva refers to the external female genital structures. It includes the inner and outer labia, clitoris, vaginal opening, urethral opening and surrounding tissue. Vulva cancer therefore does not mean cancer of the vagina; the two cancers have different sites of origin.
Vulva cancer often develops slowly over a period of years. NCI notes that abnormal cells can remain on the surface of vulvar skin for a long time before progressing to cancer. One such precancerous condition is vulva intraepithelial neoplasia (VIN). HPV is involved in a substantial proportion of vulvar cancers. NCI estimates that HPV infection causes approximately half of all vulvar cancers.
Vulvar cancer can cause external changes, including a lump or growth, a wart-like or ulcer-like lesion, persistent vulvar itching, bleeding unrelated to menstruation, and vulvar pain; changes in the colour or texture of the vulvar skin can also be significant.
The problem is that women may spend a long time treating persistent vulvar itching or irritation as though it must be thrush, an allergic reaction, an infection or simply a normal irritation.
Diagnosis generally requires examination of the vulva and, when an abnormal area is identified, a biopsy to determine what the cells are. Treatment depends on the type and stage of the cancer and may include surgery, radiation therapy, chemotherapy or chemoradiation.
Looking at these cancers side by side makes one thing particularly clear: gynaecological cancer is a category, not a general diagnosis.
Recognising the Warning Signs:
One of the most dangerous things about gynaecological cancers is not that women never experience symptoms. It is that many symptoms can look ordinary at first. Gynecological cancers do not all present in the same way, but unusual bleeding or discharge is an important warning sign. Women should also pay attention to persistent pelvic or abdominal pain, bloating, feeling full unusually quickly, urinary or bowel changes, and persistent itching, pain, bleeding or skin changes around the vulva.
These symptoms do not automatically mean cancer, but they should not simply be dismissed, especially when they are new, persistent or unusual for the individual. The problem is that many women are taught to tolerate pain, heavy bleeding and changes to their bodies as ordinary parts of being female. In Nigeria, barriers to seeking care can include embarrassment, concerns about privacy and confidentiality, financial constraints, stigma, and discomfort with examinations. These barriers matter because late diagnosis is not simply a story about individual women failing to pay attention. It can also reflect whether healthcare is affordable, accessible, respectful and equipped to investigate symptoms properly.
Women in Nigeria mostly have access to pharmacies and mushroom medicine shops, which are often more accessible than formal healthcare facilities; it can feel right to buy medication for a familiar symptom and move on. But repeatedly treating a symptom without establishing why it is happening can delay diagnosis when the underlying problem requires something else.
The Nigerian problem: Women are not always the only ones delaying diagnosis. There is an important feminist point that often disappears from discussions about cancer awareness. When women present with advanced cancer, the story is frequently framed around what the woman failed to do, like ignoring the symptoms, not going for a screening, or waiting too long. Some women undoubtedly delay seeking care, but late presentation is not always a simple story of an individual woman making a bad decision.
Nigeria’s healthcare system can also create delays. A Nigerian study examining late presentation among women with breast and cervical cancers at Lagos University Teaching Hospital found that 72.8% of the women studied presented at a late stage. Importantly, the researchers identified not only patient-level factors such as fear, misconceptions and preference for alternative medicine, but also health system factors including misdiagnosis and prolonged investigation time.
Research examining barriers to cervical cancer screening in Nigeria has documented concerns around modesty, embarrassment, fear of the procedure, financial constraints, confidentiality, stigma and discrimination. Some women have also reported concerns about being examined by male healthcare workers and fears that screening could expose them to sexually transmitted infections or other forms of judgement.
For a woman who has been taught from childhood that discussing her vagina, menstruation, sex or reproductive organs is shameful, walking into a clinic and voluntarily having a pelvic examination can require considerable psychological effort.
Prevention: What Can Actually Reduce the Risk of Gynecological Cancer?
Talking about prevention during Gynecological Cancer Awareness Month matters, but it also requires precision. No single lifestyle, supplement, food, or medical test can prevent every gynaecological cancer. The five cancers do not have the same causes, and the measures that significantly reduce the risk of one may have little or no effect on another. For cervical cancer, however, there is an unusually clear prevention pathway. Human papillomavirus (HPV) vaccination can prevent the infections that cause most cervical cancers, while cervical screening can identify precancerous changes before they develop into invasive cancer.
For ovarian, uterine, vaginal and vulva cancers, prevention is less straightforward. Some risk factors can be modified, some can be monitored, and others, including age, inherited genetic mutations and aspects of reproductive history, cannot simply be changed.
HPV vaccination: one of the strongest prevention tools available
HPV is central to the prevention of three of the five major gynaecological cancers: cervical, vaginal and vulva cancer. Persistent infection with certain high-risk types of HPV can cause cellular changes that may eventually become cancer. The virus is extremely common, and infection does not mean that someone has cancer or will necessarily develop it. The HPV vaccine works by preventing new infections with the HPV types responsible for most HPV-related cancers. It does not clear an HPV infection that someone already has, nor does it treat existing HPV-related disease. This is why vaccination is most effective when administered before exposure to the virus.
The vaccine is not a treatment for cervical cancer, and it does not eliminate the need for cervical screening later in life. A vaccinated woman can still develop cervical cancer from an HPV type not covered by the vaccine, or from an infection acquired before vaccination; checking and screening remains necessary.
WHO recommends HPV vaccination for girls between nine and 14 years old, with one or two doses depending on the applicable schedule and circumstances. Its global cervical cancer elimination strategy sets a target of having 90% of girls fully vaccinated against HPV by age 15. HPV vaccination is important in Nigeria because cervical cancer remains a major cause of cancer illness and death among Nigerian women.
If HPV vaccination is the first major opportunity to prevent cervical cancer, screening is the next. Cervical cancer generally develops gradually. Persistent high-risk HPV infection can cause abnormal changes in cervical cells, and these changes can become precancerous before invasive cancer develops. Screening provides an opportunity to identify those changes and treat them before they progress. Several screening methods exist, including HPV testing, cytology (the Pap test), and visual inspection with acetic acid (VIA). They do not all work in exactly the same way.
Screening: What women are actually being screened for
Screening is different from diagnostic testing. Screening is offered to people without symptoms to detect disease or precancer early. Among the five main gynaecological cancers, cervical cancer is the one for which established population screening is recommended. Depending on the health system, screening may use HPV testing, HPV self-sampling, cytology (Pap testing) or visual inspection methods. There is currently no reliable routine screening test for ovarian, uterine, vaginal or vulvar cancer among women without symptoms. Tests such as pelvic examination, ultrasound or CA-125 may be used when a woman has symptoms or is being assessed because of particular risks, but they are not equivalent to a proven population screening programme. A normal screening result should therefore never be used to dismiss new or persistent symptoms.
Beyond Awareness
Awareness campaigns are useful only if the knowledge they create can lead somewhere. Telling women to know the signs of cancer means little if the nearest screening service is too far away, a diagnostic test is unaffordable, pathology results take too long, or treatment is unavailable. Cancer care requires more than awareness: it requires functioning primary healthcare, trained health workers, laboratories and pathology services, and oncology teams,
In Nigeria, awareness should lead to practical access: HPV vaccination for girls, affordable and accessible cervical screening, prompt investigation of warning signs, accurate diagnosis and timely treatment. It should also lead to better public understanding that cancer is not a moral failure and that delayed diagnosis cannot simply be blamed on women. Awareness should not leave women simply better informed about cancer; it should help create the conditions in which that knowledge can actually save the lives of women.
