Gynaecological cancers are cancers that start in a women’s reproductive system.
They can be divided into five types depending on their location within the pelvic area.
As a group of cancers, gynaecological cancers are the fourth most common form of cancer for all women and the fifth most common form causing premature death in women.
BE AWARE OF WHAT'S HAPPENING DOWN THERE!
YOU know your body better than anyone else.
1. Gynaecological, bladder or bowel changes
2. Ongoing indigestion, flatulence, loss of appetite
3. Abdominal/pelvic pain
4. Pain/bleeding during/after sex
5. Sudden general weight loss or sudden weight gain (especially around the abdomen)
6. Developing a pot belly
Ovarian Cancer is often described as the silent killer as it is often not diagnosed until an advanced stage where prognosis is poor and survival rate less than 40%.
Ovarian cancer usually forms on the outside or skin lining of the ovary. This skin or epithelium is also the skin that lines the inner surface of the abdominal cavity. Rarely cancer can start in this skin beside the ovary, so some patients can have ovarian cancer with normal appearing ovaries. Cysts that form on the ovary can be normal or ovulation cysts, benign cysts or cancer cysts.
Only 5-10% of women who develop ovarian cancer have an hereditary or family component. Most ovarian cancers develop sporadically which means we don’t know why. Each year in New South Wales approximately 364 women develop ovarian cancer and 235 women will eventually die from this cancer.
It is more common as women get older, particularly over the age of 50 and those who have gone through menopause (change of life). Other than age, the next most important risk factor for ovarian cancer is a family history, especially if your family members are affected at an early age. If your mother, sister, or daughters have had ovarian cancer, then you have an increased risk for developing ovarian cancer.
Some women who have a hereditary risk of cancer may also be at risk of developing bowel, breast and uterine cancer as well. Some of the abnormal (mutated) genes that cause hereditary cancer can be identified and some women elect to undergo genetic testing. Remember that just because you have a gene mutation doesn’t mean you are definitely going to get ovarian cancer and likewise just because you test negative for the mutated or abnormal gene, doesn’t mean you are 100% protected.
Women who have had lots of ovulations throughout her life are also statistically at an increased risk of developing ovarian cancer. Starting puberty early, going through the change of life late or not having children or breast feeding and not having used the oral contraceptive pill will increase a women’s risk. There may be a slight increase in the risk in women who have had fertility treatment where drugs were used to stimulate ovulation. For reasons that we cannot fully explain, women who have had a tubal ligation or clipping of the tubes to stop pregnancy have a lower risk of developing ovarian cancer. A fatty diet while increasing your risk of heart disease may also increase your risk of ovarian cancer as well.
Cancer of the cervix can take many years to develop. Before it does, early changes occur in the cells of the cervix. The name given to these abnormal cells, which are not cancerous but may lead to cancer, is cervical intra-epithelial neoplasia (CIN). Some doctors call these changes precancerous, meaning that the cells have the potential to develop into cancer if left untreated. It is important to know that most women with CIN do not develop cancer. CIN may also be referred to as dysplasia.
Most women have regular cervical smears. The smear test is designed to detect early changes in the cells of the cervix, so that treatment can be given to prevent a cancer from developing. The aim of a smear test is to prevent cancer, but it can also sometimes detect a cancer that has already developed, before the patient develops symptoms.
The most common symptom of cervical cancer is abnormal bleeding, such as between periods or after intercourse. There may be a smelly vaginal discharge, and discomfort during intercourse. In women who have had their menopause (who have stopped their periods) there may be some new bleeding. Of course, there are many other conditions that can produce these symptoms, but it is important that you are not shy or embarrassed to see your doctor or nurse about them. The sooner you see your doctor and the diagnosis is made, the better the chance of treatment being successful.
Types of Cervical Cancer
There are two main types of cancer of the cervix. The most common is called squamous cell carcinoma which develops from the flat cells covering the outer surface of the cervix (ectocervix). The second type is called adenocarcinoma, which develops from the glandular cells lining inside the cervical canal (endocervix). Some adenocarcinomas start in the cervical canal and may be more difficult to detect with smear tests.
The pathology report from the biopsy gives other important information, such as the grade (how angry the cells appear under the microscope), and whether there are signs of cancer cells in the lymph or blood vessels which may indicate potential early spread. Some of this information, in addition to the doctor's physical examination and tests, will influence the advice you are given about the best type of treatment for you.
If the tests show that you have cancer of the cervix you will be sent to a gynaecologist specialising in the treatment of cancer, a gynaecological oncologist. You may well have further tests to check your general health and see whether the cancer has spread. These may include blood tests, a chest X-ray and various scans (CT, MRI or PET). These test are painless and can give more information about any possible spread of the cancer.
Uterine cancer begins in the endometrium or uterine lining in about 90% of cases. In 10% of instances malignancy of the body of the uterus arises in the other elements that constitute the uterus, the muscle (myometrium), and other connective tissue (stroma), these are usually termed sarcomas but may be mixed with cancer as carcinosarcoma and other mixed tumors.
Endometrial hyperplasia is a spectrum of changes in the uterine lining, that are recognized as being increasingly likely to progress to endometrial cancer if left untreated.
Uterine or endometrial cancer is more common as women get older, particularly over the age of 50 and those who have gone through menopause (change of life). Other than age, the next most important risk factor for uterine cancer is body weight as a consequence of fat cells making weak oestrogens that stimulate the lining of the uterus. Women with a history of breast cancer also have an increased risk of developing uterine cancer.
Some women who have a hereditary risk of cancer may also be at risk of developing bowel, breast and ovarian cancer as well.
Women who have had many ovulations throughout their life are also statistically at an increased risk of developing uterine cancer. Starting puberty early, going through the change of life late or not having children or breast feeding and not having used the oral contraceptive pill will increase a women’s risk.
Uterine cancer remains one of the most common cancers affecting women in New South Wales.
Unfortunately screening for uterine cancer is not very productive. However women with heavy or irregular bleeding at the time of menopause should be evaluated for the possibility of overgrowth of the endometrium or lining of the uterus and treated appropriately at that time.
The commonest symptom of uterine cancer is post menopausal bleeding, that is any bleeding from the vagina more than twelve months after ceasing menstrual periods. It may also present as heavy irregular periods or as a water or bloody discharge, which may be smelly. Occasionally there is a sensation of pelvic or abdominal discomfort or even a feeling of bloatedness.
Cancer of the vulva can take many years to develop. Before it does, early changes occur in the cells of the vulva. The name given to these abnormal cells, which are not cancerous but may lead to cancer, is vulva intra-epithelial neoplasia (VIN). Some doctors call these changes precancerous, meaning that the cells have the potential to develop into cancer if left untreated. It is important to know that most women with VIN do not develop cancer. VIN may also be referred to as dysplasia, and Bowen’s disease. This condition is diagnosed by tissue biopsy and is characterized by a full thickness disorder of maturation of the squamous epithelium. It is easy to see on examination and may appear as a raised red, white or pigmented patch. A simple biopsy will confirm the diagnosis.
It is best treated by excision or sometimes by laser vaporisation. If a large area is involved and must be removed, then a skin graft can be applied. These premalignant conditions are likely to recur after treatment so continued follow up is a necessity. Another condition that can occur on the vulva and also cause itching and soreness is called lichen sclerosis. It is not a premalignant change, but an atrophy or thinning of the skin. It will not be improved by anti-yeast medications either. It can also be diagnosed by biopsy.
Most women with vulva cancer present to the local doctor with a history of itching and burning. The itch may be present for some time, before the appearance of a lump or bump in the region. Commonly the condition is misdiagnosed as a yeast infection and patients often prescribed a number of creams that are ineffective. Most patients are older; vulva cancer is by no means restricted to this age group. A significant percentage of women will be younger and may have an associated medical condition that causes immune suppression like diabetes.
There is usually an obvious growth on the skin or an ulcerated area. Diagnosis is by simple biopsy. These cancers are usually slow growing and do not spread early. When they do spread it is usually by way of the lymph nodes. The regional lymph nodes are located at the top of the thigh in the groin area.
Types of Vulva Cancer
The most common type of cancer is a skin cancer known as squamous cell carcinoma. There are many other types of cancers of the vulva that are less common and include adeno or gland cancers and melanoma. The type of melanoma that occurs on the vulva is not sun related.
Cancer that forms in the tissues of the vagina (birth canal) is called vaginal cancer.
The vagina leads from the cervix (the opening of the uterus) to the outside of the body.
The most common type of vaginal cancer is squamous cell carcinoma, which starts in the thin, flat cells lining the vagina.
Another type of vaginal cancer is adenocarcinoma, cancer that begins in glandular cells in the lining of the vagina.
A comprehensive resource that covers understanding cancer, who is at risk, symptoms, diagnosis , staging, treatment, preparing for treatment, methods of treatment, side effects of treatment, surgery, radiotherapy, chemotherapy, nutrition, follow up care .... etc., can be found at www.cancer.gov/cancertopics/types/womenscancers