Pelvis cancer does not refer to one specific disease. Instead, it alludes to the many types of cancer that arise from structures within the pelvis. As the pelvis contains the sex and reproductive organs, pelvis cancer varies greatly between men and women.
Pelvis cancer symptoms and treatment options depend on the type and stage of cancer. As with most types of cancer, early detection is key. Patients diagnosed at an earlier stage, with stage I or localized disease, generally have better survival outcomes compared to those with distant disease. This is demonstrated by statistics published by the National Cancer Institute.
Here, we’ll delve more into the different types of pelvis cancer, symptoms and signs to look out for, treatment options, and what you can do to be proactive about your health.
Firstly, to understand which cancers arise from the pelvis and how they present, let's review the anatomy.
The pelvis refers to the area just below the abdomen — the pelvic area incorporates the hip bone and the structures within. In both men and women, this includes the urinary system (bladder, ureters, and urethra), rectum, lower part of the large bowel, and a section of the small bowel. The pelvis also contains blood vessels, lymph nodes, and nerves.
In females, the pelvis also contains the ovaries, fallopian tubes, vagina, vulva, and cervix. In males, the pelvis contains the prostate, the testicles (which sit outside the pelvic area in the scrotum) and the penis.
Numerous cancers can arise in the pelvis, and these vary between men and women. Cancer can occur in the organs and structures as well as the pelvic bone. It must be noted that primary bone cancer is rare but serious. Cancer in the pelvic bone can also present as metastases from a distant site, such as from primary breast cancer or lung cancer.
Here are different types of cancers that arise in the pelvis and their symptoms.
In bladder cancer, cancer cells develop in the bladder’s lining. Types of bladder cancer include urothelial carcinoma (previously known as transitional cell carcinoma) and squamous cell carcinoma. Urothelial carcinoma is the most common type of bladder cancer in the U.S.
Moreover, bladder cancer is four times higher in men than women. The reason for this is not fully understood but gender differences (such as androgens, exposure to carcinogens, and protective effects of the X chromosome gene) are thought to play a role. It’s also a cancer mainly affecting older people.
Symptoms of bladder cancer include:
The ureters are the tubes that connect the kidneys to the bladder, and the urethra is the tube that connects the bladder to the outside of the body and allows urination. As these structures are lined with urothelial or transitional cells, patients with bladder cancer can also have tumors at these sites or develop cancer after being previously treated. Smoking is also a risk factor for ureter and bladder cancer.
Symptoms are similar to those of bladder cancer but can also include:
Urothelial cancer can also arise in the kidneys in an area called the renal pelvis.
Rectal cancer occurs in the cells that line the rectum, which is the last part of the large intestine and ends at the narrow canal called the anus. The term “rectal cancer” is often used in conjunction with colon cancer and is referred to as colorectal cancer, one of the most common types of cancer.
The five-year survival rate (88.5%) is significantly higher in patients with localized disease compared to 15.9% in those with distant disease. Screening with a colonscopy is recommended for those between 45 to 75 years of age or younger if at high risk.
Symptoms of rectal cancer include:
Helpful tip: Learn more about the early warning signs of colon cancer.
Osteosarcoma is a rare cancer that forms from the cells that make bones. It more commonly arises in the long bones such as the femur (thigh bone). However, occasionally, it can form in the pelvic bone. Despite being rare, osteosarcoma is the most common primary bone tumor, with most incidences in adolescence.
Osteosarcoma of the pelvis poses a significant challenge to clinicians. Symptoms often present late, meaning the disease has frequently spread (metastatic) at the time of diagnosis. Additionally, due to the anatomy of the pelvis and the critical structures it contains, wide surgical excision of the tumor is difficult. For these reasons, pelvic osteosarcoma has poor survival outcomes. Statistics published by the American Cancer Society report that five-year relative survival is just 10.1% in those over 60, 27.5% in patients aged 25-60 years, and 32.9% in those aged 10-24.
Symptoms of osteosarcoma include:
Prostate cancer occurs in the prostate — the small gland that produces seminal fluid to help transport sperm. Some cancers are slow-growing and remain confined to the prostate, rarely causing problems. Other types are aggressive and spread quickly. As prostate cancer may not cause symptoms in the early stages, screening may be beneficial.
Currently, no standard screening test for prostate cancer exists, and research is ongoing. However, a blood test called PSA may be useful. MRI of the prostate has shown to be promising as an effective screening tool, increasing accurate diagnosis. Ezra has developed an AI to help radiologists review prostate images — learn more about the Ezra prostate MRI.
Symptoms of prostate cancer can include:
Ovarian cancer arises from the cells of the ovaries, which are the reproductive glands that produce eggs and are the main source of hormones estrogen and progesterone. However, recent evidence suggests that many ovarian cancers may arise from the cells in the end part of the fallopian tubes, which connect the ovaries to the uterus.
Epithelial ovarian cancer is the most common, making up 85-90% of malignant ovarian tumors. Rarer types of ovarian cancer include germ cell tumors, which can be benign (non-cancerous) or malignant. Germ cells are the cells that go on to become eggs. Germ cell tumors tend to occur in younger women, whereas epithelial ovarian cancer tends to occur in older women. Patients can often present late as the symptoms are nonspecific and can mimic other causes. Greater awareness of ovarian cancer symptoms is required to ensure a timely diagnosis.
Symptoms of ovarian cancer may include:
The most common type of uterine cancer is endometrial cancer, which arises from cells in the inner lining of the uterus or womb. It typically occurs in postmenopausal women, with the average age of diagnosis being 60 years. Five-year survival rates are favorable for those with localized disease (95%) compared to distant disease (18%). It’s crucial for post-menopausal women to be educated on the symptoms of endometrial cancer so they seek medical attention promptly and increase the chance of early detection and survival.
Symptoms of endometrial cancer include:
Cervical cancer occurs when the cells of the cervix, which connects the body of the uterus to the vagina, grow uncontrollably. Persistent infection with human papillomavirus (HPV) has been shown to cause cervical cancer. As such, the Centers for Disease Control and Prevention recommend the HPV vaccination for children between the age of 11-12 years. A screening program is also in place for cervical cancer, and women aged 25 should begin screening with Pap smears. This means early changes can be picked up and treated before they become cancerous.
Symptoms of cervical cancer can include:
Treatment options are available for all types of cancer that arise from the pelvis. Thanks to clinical trials and cancer research, there have been significant developments in recent years, with the introduction of targeted therapies and immunotherapy. As with many types of cancer, treatment depends on the stage of cancer at diagnosis as well as other factors.
The oncologist will formulate a treatment plan appropriate for the specific patient and consider factors relating to the disease and the patient's general health and fitness. If the disease is localized, surgery often has a role in the first instance. Systemic treatment is then frequently given, which can include radiation therapy, chemotherapy, immunotherapy, and targeted therapies. The treatments often have side effects, which are always discussed before commencing therapy.
Due to the varied nature and presentation of these many types of cancer occurring in the pelvic region, prognosis is variable. A constant trend, however, is that survival outcomes are significantly worse if the disease has spread. The National Cancer Institute has published statistics demonstrating worse survival outcomes for patients with distant disease compared to localized disease for bladder cancer, rectal cancer, and ovarian cancer, to name a few.
This highlights the need for early detection and cancer screening. Awareness of common signs and symptoms of these cancers is also key. If you have experienced any of the symptoms mentioned above, consult a healthcare professional to arrange further assessment.
The pelvis gives rise to many important organs and structures that vary in men and women. Pelvic symptoms, particularly in women, can be vague and non-specific and mimic other conditions. As such, screening is vital for early cancer detection and leads to improved outcomes.
While structured screening programs are available for some types of cancer in the pelvic area (such as cervical cancer), they don’t exist for all of them. Some types of cancer — including prostate, ovarian, and bone — can be asymptomatic in the earlier stages, so screening can be helpful.
Ezra offers a Full Body MRI that screens up to 13 organs in just one hour. It could help detect early changes that can be promptly investigated and treated. Be proactive and consider booking a scan today.
