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.

What Is the Pelvis?

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 includes the hip bone and its surrounding structures. 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 nerves².

In women, the pelvis also contains the ovaries, fallopian tubes, vagina, vulva, and cervix. In men, the pelvis contains the prostate, the testicles (which sit outside the pelvic area in the scrotum), and the penis.

What Are the Different Types of Pelvic Cancer? 

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. Cancer in the pelvic bone can also arise 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.

Bladder Cancer

In bladder cancer, cancer cells develop in the lining of the bladder. 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 UK³. 

Moreover, bladder cancer is three to four times higher in men than women⁴. 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 role⁵. It’s also a cancer mainly affecting older people.

Symptoms of bladder cancer include⁶:

• Blood in the urine, which may appear bright red or the colour of cola. Sometimes it’s painless, may not be visible, and is picked up on a lab test
• Painful urination
• Frequent urination
• Back pain
• Fatigue

Ureter Cancer and Urethral Cancer

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 urination⁷. As these structures are lined with urothelial or transitional cells, patients with bladder cancer can also have tumours at these sites or develop cancer after being previously treated⁸. Smoking is also a risk factor for ureter and bladder cancer⁹.

Symptoms are similar to those of bladder cancer but can also include¹⁰:

• Difficulty initiating the flow of urine
• Interrupted or weak flow of urine
• Increased frequency of urination
• Discharge from the urethra
• A lump or thickness in the perineum or penis
• A painless lump or swelling in the groin

Urothelial cancer can also arise in the kidneys in an area called the renal pelvis¹¹.

Rectal Cancer

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 anus¹². 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 per cent) is significantly higher in patients with localised disease compared to 15.9 per cent in those with distant disease¹³. Screening with a colonoscopy is recommended for those between 45 and 75 years of age or younger if at high risk.

Symptoms of rectal cancer include¹⁴:

• Bleeding from the rectum or blood in the stool
• A change in bowel habits, such as diarrhoea or constipation
• Narrower stool
• Abdominal pain
• A feeling of incomplete bowel emptying
• Unexplained weight loss
• Weakness or fatigue

Helpful tip: Learn more about the early warning signs of colon cancer.

Pelvic Bone Cancer (Osteosarcoma)

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 tumour, with most incidences in adolescence¹⁵. 

Osteosarcoma of the pelvis poses a significant challenge to clinicians. Symptoms often present late, meaning the disease has frequently spread (metastasised) at the time of diagnosis¹⁶. Additionally, due to the anatomy of the pelvis and the critical structures it contains, wide surgical excision of the tumour is difficult. For these reasons, pelvic osteosarcoma has poor survival outcomes. Five-year survival rates for pelvic osteosarcoma are lower than at other sites, with international cohorts reporting survival rates in the range of 18 to 38 per cent^17,18.

Symptoms of osteosarcoma include¹⁹:

• Bone pain that worsens over time and persists at night
• Swelling or a lump over or near a bone
• Redness over a bone

Prostate Cancer

Prostate cancer occurs in the prostate, the small gland that produces seminal fluid to help transport sperm²⁰. Localised prostate cancers are slow-growing and remain confined to the prostate, rarely causing problems²¹. 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 is promising as an effective screening tool, increasing accurate diagnosis²². Ezra has developed an AI to help radiologists review prostate images.

Symptoms of prostate cancer can include²³:

• Difficulty maintaining the stream of urine
• Difficulty initiating the stream of urine
• Erectile dysfunction
• Blood in the urine
• Blood in the semen
• Bone pain
• Unexplained weight loss

Ovarian Cancer

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 uterus²⁴.

Epithelial ovarian cancer is the most common, making up ~90 per cent of malignant ovarian tumours²⁵. Rarer types of ovarian cancer include germ cell tumours, which can be benign (non-cancerous) or malignant and sex cord stromal tumours²⁶. Germ cells are the cells that go on to become eggs. 

Germ cell tumours tend to occur in younger women, whereas epithelial ovarian cancer tends to occur in older women^27,28. 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:

• Abdominal or pelvic pain
• Persistent abdominal bloating or increased abdominal size
• Difficulty eating, feeling full quickly, or feeling nauseous
• Urinary symptoms such as frequency or urgency

Uterine Cancer

The most common type of uterine cancer is endometrial cancer, which arises from cells in the inner lining of the uterus or womb²⁹. It occurs most commonly in women aged between 50 and 64³⁰. Five-year survival rates depend on the stage of cancer³¹. 

• Stage 1: More than 90 per cent survival rate.
• Stage 2: ~75 per cent survival rate.
• Stage 3: ~50 per cent survival rate.
• Stage 4: 15 per cent survival rate.

Post-menopausal women should be informed about the symptoms of endometrial cancer so they seek medical attention promptly and increase the chance of early detection and survival.

Symptoms of endometrial cancer include³²:

• Abnormal vaginal bleeding
• Post-menopausal bleeding
• Bleeding in between periods
• Change to periods
• Abnormal vaginal discharge
• Pain in the pelvis
• Mass or swelling in the pelvis
• Unexplained weight loss

Cervical Cancer

Cervical cancer occurs when the cells of the cervix, which connect the body of the uterus to the vagina, grow uncontrollably. Persistent infection with human papillomavirus (HPV) has been shown to cause cervical cancer³³. As such, the NHS recommends the HPV vaccination for children between the ages of 12-13 years³⁴. A screening program is also in place for cervical cancer, and women aged 25 should begin screening with Pap smears³⁵. This means early changes can be picked up and treated before they become cancerous. 

Symptoms of cervical cancer can include³⁶:

• Pain during sex
• Abnormal vaginal bleeding, including bleeding after sex, bleeding in between periods, bleeding after menopause, or a change to periods
• Abnormal vaginal discharge, which may be bloody
• Pelvic pain

Treatment and Prognosis of Pelvis Cancer

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 localised, 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 localised disease for bladder cancer, rectal cancer, and ovarian cancer, to name a few^13,37,38.

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.

Take Action Before Symptoms Arise

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 an MRI Scan with Spine that screens up to 14 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.

References

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