Gynaecological Cancer Awareness Month 2022: Questions & Answers

Answers from Dr Zahra Ameen – Consultant Obstetrician and Gynaecologist at The Women’s Wellness Centre

September is Gynaecological Cancer Awareness Month and is used as an opportunity to encourage women to become more aware about cancers of the cervix, vagina, vulva, ovaries, and uterus including early detection and prevention.

There are five gynaecological cancers – ovarian, uterine/endometrial, cervical, vulval and vaginal – but awareness levels of these cancers are very low.

Each year in the UK, over 22,000 women are diagnosed with a gynaecological cancer.

Here at The Women’s Wellness Centre, we want to help every woman to understand the symptoms and minimize the risk of serious health effects from gynaecologic cancers.

For Gynaecological Cancer Awareness Month, our consultant Gynaecologist Dr Zahra Ameen answers your questions around the topic.

Q: Are there any other gynaecologic cancer tests that I need, based on my personal health and family cancer history? If so, what are they? Why do I need them? How do they work?  

A: All women must have minimum a 3 yearly smear test (if between ages of 25-49 years) and 5 yearly (if between ages of 50 – 65 years), regardless of whether you are experiencing any worrying symptoms. More frequent smear tests, starting earlier and continuing later can be requested and we can offer these.

If you have a family history of ovarian cancer, sadly there is no proven screening test for this, however it may be beneficial to have yearly scans and CA 125 blood tests ( a blood tumour marker that can increase In ovarian cancer) along with other health checks . The timing of when to start this and how frequently can be tailored for each woman and her specific needs.  If you are unsure which tests to book, we are happy to see you for consultation and guide you as to which package would be most appropriate and beneficial for you.

Q: What is the first test that will be useful to do if a problem with the ovaries is suspected? 

A: If you have persistent pelvic pain, particularly if it is cyclical (timed with the week before and week of your period, persistently over 3 months), then I would advise seeing your GP or your gynaecologist who will carry out in the first instance an ultrasound scan and some blood tests.

If you experience any red flag symptoms such as significant bloating, tense abdomen and nausea, loss of appetite, unexplained weight loss, then you should arrange to see your gynaecologist immediately who will arrange and urgent ultrasound to visualise the ovaries, and a blood test called a CA 125.  A full clinical history will be taken and examination carried out.

Q: Can a blood test detect ovarian cancer? 

A: To detect ovarian cancer a full history, clinical examination must be carried out by a gynaecologist, along with a blood test called CA 125.  There is no single blood test that will detect ovarian cancer, and the CA 125 itself is a non -specific test when used alone as it can be raised in other conditions (apart from ovarian cancer ) such as endometriosis, diverticular disease and sometimes uterine fibroids.

Q: What does bloating from ovarian cancer look like?

A: The abdomen can look tense, and ovarian cancer patients will report a feeling of tightness or distension around the abdomen, which can sometimes be accompanied by nausea and vomiting.  Often ovarian cancer patients despite the bloating may describe unexplained weight loss in other areas of the body such as arms and legs.

Q: Should I visit my gynaecologist regularly for check up even if I have no symptoms?

A: Yes all women must have a minimum 3 yearly smear test (if between ages of 25-49 years) and 5 yearly (if between ages of 50 – 65 years), regardless of whether they are experiencing any worrying symptoms.  This can be done at your GP who will usually send out a letter inviting you to come in for a smear test.

Furthermore it can be beneficial to check in with your gynaecologist every 12-18 months for a general health check up . This will include a thorough examination where the vulva , vagina, cervix , uterine size and surrounding area can be inspected and palpated ( felt) . ) More frequent smears can be performed and an ultrasound requested . A scan can confirm normal appearance of ovaries, uterus (womb) and endometrium ( lining of the womb) This may detect or result in early pick up of any of the cancers before symptoms occur. This can be combined with sexual health check up to exclude silent infections such as chlamydia or well-being blood tests (eg checking for blood count anaemia, glucose and cholesterol).

Q: If I get persistent bleeding after sex should I be worried ?

A: Persistent bleeding after sex (post-coital bleeding) should be investigated by your gynaecologist.

This is a red flag symptom Sometimes it can be caused by simple benign conditions such as cervical ectropion (when red glandular cells usually inside the cervix can grow outside of the cervix) or cervical polyps (skin tags on the cervix).  However sometimes it can be a symptom of cervical pre-cancer or cancer and so should be fully investigated with examination by a specialist, a smear test and if needed a colposcopy (use of a microscope to assess the cervix).

Q: If I get bleeding whilst I am on HRT is this worrying and how quickly should I see a doctor ?

A: Some women can experience bleeding in the first 3 months after starting an HRT (hormone replacement treatment )regime (of either tablets, patches , or gel preparations).  However, if you experience bleeding persistently more than 3 months after commencing HRT then you should seek a specialist gynaecological opinion immediately.  The vast majority of patients that review in fast track clinics (about 98%), will have a benign cause for their bleeding, however you must be investigated if you have persistent post-menopausal bleeding, in order  to rule out cancer of the lining of the womb (endometrial cancer).

Please note any bleeding after the menopause Is abnormal ( post menopausal bleeding )and a red flag symptom. Please see a gynaecologist immediately as this needs to be checked to exclude endometrial ( lining of the womb) cancer or one of the rarer vaginal or vulval cancer. Your gynaecologist will perform thorough examination and arrange a scan.

Q: If I have had the HPV vaccine do I still need to have regular smear tests?

A: The HPV vaccine covers you for the subtypes of HPV most commonly associated with cervical cancer (HPV 16 and 18).  However this only gives you about 70 % protection, as there are many other subtypes which can also cause cervical cancer and so you must attend your regular smear tests when invited by your GP, or arrange them privately more frequently if you wish.  Therefore since some cervical cancers will not be prevented by the vaccine, it will be important for women to continue getting screened for cervical cancer.

This article has been written by Dr Zahra Ameen, Consultant Obstetrician and Gynaecologist at The Women’s Wellness Centre.

Our Private Consultant Gynaecologists at The Women’s Wellness Centre are experienced in dealing with women health concerns, including endometriosis and pelvic pain, contraception, irregular bleeding, vulval disorders abnormal cervical smears, painful intercourse, fibroids, ovarian cysts, ovarian cancer and any other general gynaecological conditions. If you wish to know more about our Private Gynaecology Service please contact us on 020 7751 4488 or book an appointment online here.

Dr Zahra Ameen is an experienced Consultant Gynaecologist with over 10 years clinical experience and a demonstrated history of working in the hospital and health care industry. She covers services including Obstetrics, Gynaecology, and Medical Education.

Zahra graduated from Guy’s,King’s and St Thomas’ Medical School with a BSc in Pharmacology, and Bachelor of Medicine, Bachelor of Surgery (MBBS).

Zahra’s special interests include ambulatory gynaecology, and acute gynaecology and early pregnancy scanning. Her skills include expertise in ultrasound scanning, management of general gynaecological conditions, management of miscarriage, and outpatient hysteroscopy.

She is passionate about global health, having worked with and consulted for the WHO in Geneva, making Zahra an advocate for women’s health education and rights.