An Overview of Gynaecological Cancers

Gynaecological cancers are cancers of the reproductive organs of women, which include the ovariesFemale reproductive organs situated one on either side of the uterus (womb). They produce egg cells (ova) and hormones in a monthly cycle., fallopian tubesTwo tubes that transport the egg from the ovary to the uterus., uterusThe womb, where embryo implantation occurs and the growing foetus is nourished. (wombThe uterus.), cervixAny neck-like structure; most commonly refers to the neck of the uterus. (neck of the womb), vagina  (birth canal), and vulvaThe external part of the female genitalia. (external genitals).

These cancers are not common, particularly in the UK. If we add all the gynaecological cancers that occur each year together, they account for less than half of the cases of breast cancer. However, women may be concerned about the possibility of gynaecological cancers because, unlike breast cancer, the gynaecological organs are not easily visible. It is therefore important for women to be aware of the various screeningA way to identify people who may have a certain condition, among a group of people who may or may not seem to programmes for gynaecological cancers that exist and to also be aware of the symptoms so that the disease can be detected early where full cure is usually possible. Women should also understand that although gynaecological cancers are more common in older women who have usually gone through the menopauseThe time of a woman’s life when her ovaries stop releasing an egg (ovum) on a monthly cycle., they can occur in younger women also.

Contents

• Awareness of the symptoms of gynaecological cancers
• What are the symptoms of gynaecological cancer?
  • Abnormal vaginal bleeding
    • Post-menopausal bleeding
    • Post-coital bleeding
    • Intermenstrual bleeding
  • Abnormal vaginal discharge
  • Abdominal swelling
  • Itchy vulva
• Conclusion

Awareness of the symptoms of gynaecological cancers

Research has shown that women do not have a great awareness of the symptoms or causes of gynaecological cancer. For example, the Eve Appeal Charity (www.eveappeal.org.uk) carried out a survey into the extent of women’s knowledge of cervicalRelating either to the cervix (the neck of the womb) or to the cervical vertebrae in the neck (cervical spine). cancer in 2010. This was immediately following the considerable publicity surrounding celebrity Jade Goody, when cervical cancer was very much in the news. They found that

• 40% of women were unaware of the signs  and symptoms of cervical cancer
• 61%of women could not recognise 3 key symptoms
• This percentage increased to 75% in the under 25 year olds
• 46% of women were unaware of the link between cervical cancer and HPVAn abbreviation for human papilloma virus, a sexually transmitted virus that can cause genital warts and may also have a role in the development of various cancers.

It is clear that we, as women, should have a duty to ourselves to be aware of the symptoms of gynaecological cancer and to seek medical advice immediately if any of the symptoms develop.

What are the symptoms of gynaecological cancer?

There are four main gynaecological cancers (cancer of the ovariestwo small organs that are part of the female reproductive system where eggs mature, womb, cervix and vulva) and the symptoms vary according to the type.  There are however some common symptoms which should prompt you to see your doctor. Although it is not possible to list every single symptom that might indicate a gynaecological cancer the list below may help to guide you.

Abnormal vaginal bleeding:

Bleeding from the vagina should always be considered abnormal if it happens when you are not having a period. I have set out below the number of different types of abnormal vaginal bleeding:

i) Bleeding after the menopauseThe time when a woman's periods permanently cease. has taken place (post-menopausal)

Most women will go through the menopause around the age of 50. If you develop bleeding after your periods stop, you must let your doctor know. Although in the vast majority of cases, (9 out of 10), the cause of the bleeding will be benignNot dangerous, usually applied to a tumour that is not malignant. (non-cancerousMalignant, a tumour that may invade surrounding tissues or spread to distant parts of the body.) it is nevertheless a symptom of cancer of the lining of the womb (endometrial cancer), and so it should not be ignored. You should immediately arrange to see your doctor. Even if you do have a cancer, it can be cured if it is detected early enough. (please link to endometrial cancer article)

Post-menopausal bleeding may also be a symptom of cervical cancer, although cervical cancer is much less common in the UK. Again, as long as it is detected early enough this cancer can be cured (link to cervical cancer article.)

Cancer of the vulva (the skin-covered area between the legs on the outside of the vagina) can also cause post-menopausal bleeding but this is often associated with a lump or an ulcerAny abnormal break in the epithelium, the outer layer of cells covering the open surfaces of the body. on the vulva.

ii) Bleeding after sex - post-coital bleeding

There are many causes for bleeding after sex, the majority of which are benign (non-cancerous). It can be due to infectionInvasion by organisms that may be harmful, for example bacteria or parasites. with chlamydiaA bacterial infection that can cause eye disease and sexually transmitted infections. (a sexually transmitted infection), polypsGrowths on the surface of a mucous membrane (a surface that secretes mucous), lining any body cavity that opens to the outside of the body. (these are like skin tagsSmall flaps or growths of excess skin, often occurring in skin folds, possibly due to rubbing. They may also occur around the anus after haemorrhoids (piles).) or injury. However, it is also an early warning sign for cancer of the cervix. You must let see a doctor immediately if you develop this symptom, even if you have had a recent normal smear test. The doctor will examine the cervix with a strong magnifying device called a colposcopeA binocular microscope with an attached light source, used to examine the cervix of the uterus. and will tell you know if other tests are needed. 

iii) Bleeding between periods (intermenstrual bleeding)

Bleeding between periods can vary from a light spotting to heavy, prolonged bleeding. If the bleeding occurs mid-cycle (halfway between periods), it may be due to ovulationWhen one or more eggs are released from the ovary.. Ovulation is when the egg is shed from the ovary, ready to be fertilised to become a pregnancythe period from conception to birth. Some women get an ovulatoryAssociated with ovulation. bleed each cycle. This is nothing to worry about and is simply a variation of normal. However, if you experience mid-cycle bleeding for the first time, speak to your doctor. It may be necessary for some further tests to make sure that nothing more serious is going on.

Intermenstrual bleeding may also be due to polyps in the lining of the womb. Polyps are small, fleshy growths, rather like skin tags that some people get on their faces or other parts of their body. They are mostly benign. If your doctor suspects a polyp, he/she will organise an ultrasound scanThe process of using high-frequency sound waves to produce internal images of the body.. If a polyp is detected, you will be advised to have this removed. This involves a procedure called hysteroscopyExamination of the inside of the uterus by endoscopy, using an instrument called a hysteroscope inserted through the vagina and cervix., where a small telescope is passed through the vagina into the womb via the cervix (neck of the womb). This is an easy procedure and can sometimes be done as an outpatient. The polyp is removed and sent to the laboratory to be inspected so that cancer or other more serious conditions can be ruled out.

Intermenstrual bleeding can also be a warning sign for a cancer of the lining of the womb (endometrial cancer), particularly when it occurs in women in their mid to late forties. You should see your doctor if you get this symptom. The doctor will organise an ultrasoundA diagnostic method in which very high frequency sound waves are passed into the body and the reflective echoes analysed to build a picture of the internal organs – or of the foetus in the uterus. scan of your pelvisThe bony basin formed by the hip bones and the lower vertebrae of the spine; also refers to the lower part of the abdomen. and may recommend a hysteroscopy if the lining of the womb appears unduly thick. As long as it is detected sufficiently early, endometrial cancer can be successfully treated. 

Abnormal vaginal discharge

All women will experience vaginal discharge that varies during the menstrual cycleThe monthly sequence by which a woman’s body prepares for potential fertilisation of an egg released from the ovaries, involving thickening of the uterus lining and then shedding of the lining when pregnancy does not occur.. This type of discharge is clear and does not smell. It may be particularly noticeable during ovulation (when the egg is shed from the ovary). Most women will be familiar with their own usual vaginal discharge and you should report any discharge that is different from normal to your doctor.

Vaginal discharge may be caused by infection. One of the most common causes of abnormal vaginal discharge is caused by thrushA common yeast infection of the vagina.. Thrush occurs due to an overgrowth of a fungus called candidaA type of yeast or fungus. The term is sometimes also used to describe the infection resulting from it (candidiasis). The most common is Candida albicans, which causes thrush infections, most often of the vagina or mouth that normally lives in the gut. It is not a sexually transmitted infection. It is more common in pregnancy, in women on the pill or in women with diabetesA disorder caused by insufficient or absent production of the hormone insulin by the pancreas, or because the tissues are resistant to the effects.. Taking antibioticsMedication to treat infections caused by microbes (organisms that can't be seen with the naked eye), such as bacteria. can also cause thrushA common name for the fungal infection candidiasis. and some women get thrush before each period. It usually causes a thick yellowish discharge which looks like cottage cheese. It also causes itching and soreness. You can treat it with anti-fungal preparations that you can buy over the chemist counter. If it comes back frequently you should tell your doctor so that tests for diabetes or other conditions can be carried out.

Other infections, including sexually transmitted infections, can also cause an abnormal vaginal discharge. You should go to your local sexually transmitted diseases clinic if you think you are at risk of a sexually transmitted infection.

A smelly, thick, bloodA fluid that transports oxygen and other substances through the body, made up of blood cells suspended in a liquid.-stained discharge may be a symptom of cervical or endometrial cancer. Again you must seek help immediately if you develop this symptom.

Abdominal swelling

All women will experience abdominal bloating and swelling at some point in their lives. Common minor bowelA common name for the large and/or small intestines. disorders such as irritable bowel syndrome can cause this symptom. However, if you are a woman in her late forties or older and experience this symptom for the first time, it may be due to ovarianrelating to the ovaries cancer. The ovaries are small, almond-shaped organs that sit on either side of the womb. The eggs from which babies are produced are stored in the ovaries. From the time a woman starts her periods one egg is released each month. This is known as ovulation. If the egg is fertilised then a pregnancy results. If the egg is not fertilised the woman has a period about two weeks after ovulation. Ovarian cancer is known as the ‘silent killer’ because women often do not experience symptoms until the disease is advanced and more difficult to treat. However, following discussions with my ovarian cancer patients, it has become clear to me that women often experience symptoms for several months before their cancer is detected. You must therefore report any new bloating or swelling to your doctor. Your doctor will organise an ultrasound scan to check the ovaries. If they are enlarged or appear abnormal, you will need further tests to check if you have ovarian cancer. 

Itchy vulva

The vulva is the skin-covered area between your legs. The skin on the vulva can be quite sensitive and itching is quite common, particularly in older women. Itchy skin on the vulva can be due to dryness, eczemaAn inflammation of the skin, usually causing itching and sometimes scaling and blisters. or psoriasisA chronic skin disease causing red, scaly patches that may be intensely itchy. It is sometimes associated with arthritis (psoriatic arthritis)., all common skin conditions. It is important however that you do not ignore itching, especially of it does not go away after simple remedies, as it may be a sign of vulval cancer. Vulval cancer usually causes a lump or an ulcer but itching can also be a symptom.

Like all gynaecological cancers, vulval cancer is easily treated if it is detected early. If your doctor suspects cancer, a small sample of skin, known as a biopsyThe removal of a small sample of cells or tissue so that it may be examined under a microscope. The term may also refer to the tissue sample itself. will be removed and sent to the laboratory for analysis. This can be done in the clinic with local anaestheticA medication that reduces sensation in a part of the body.. If the biopsy shows cancer then treatment involves an operation to remove the cancerous area. The treatment is highly successful in early cancer. However, in at least a third of women, the cancer is quite advanced when it is detected. This is because women may be embarrassed to tell their doctor about their symptoms. There is nothing to be embarrassed about; the specialist will treat you with care and sensitivity.

Conclusion

Women should be aware of the symptoms that may indicate the presence of gynaecological cancer. This article does not cover every single symptoms and my advice is please visit your doctor if you are in any way concerned.