Gynaecological cancer: symptoms and treatments
Advice on how to minimise risk, prevent, manage and treat all 5 types of Gynae cancers by Dr Zahra Ameen - Consultant Gynaecologist.
September is Gynaecological Cancer Awareness month. This is a good time for you to be encouraged to learn more about the 5 types of gynae cancers.
You can all learn what these gynaecological cancers are as well as their symptoms. Equally you can be educated and become aware of when you need to ask for help.
In this article, I will walk you through the 5 types of Gynaecological cancer you should be aware of which are:
Starting from the beginning: What are gynaecological cancers?
Cancers that originate in a woman’s reproductive system are called gynaecological cancers. They have different symptoms and treatments that will be tailored according to which organ cancer originates in.
Cervical Cancer Symptoms, Prevention and Treatment
According to the Cancer Research UK, cervical cancer is the 14th commonest type of cancer in women in the UK, with a total of 3100 cases in 2017 and it is easily prevented by taking a simple smear test.
When abnormal cells in the lining of the cervix (neck of the womb) grow in an uncontrolled manner they eventually form a lump called a tumour.
If not caught early enough this cancer can grow into surrounding tissues, or even spread into other areas of the body.
Sadly, most new cases are diagnosed in young women aged 30-34 years.
HPV and Cervical Cancer
The women most at risk of developing Cervical Cancer are those infected with Human papillomavirus (HPV), as nearly all cervical cancers are associated with HPV infection. However, it is very important to remember that the majority of women with HPV do not develop cervical cancer.
Fortunately, in most cases your immune system will help you clear the HPV virus, and you will most likely not experience any symptoms of HPV infection.
What is cause Cervical Cancer?
Other lifestyle factors that can contribute to the development of cancer include:
- Immunosupressant drugs (organ transplant recipients)
- Diseases that suppress immunity like HIV
Smear test: the best way to reduce your risk to develop a cervical cancer
The best way to protect yourself is to attend your cervical screening test when invited by your GP. The NHS cervical screening programme invites all women between the ages of 25-64 years to attend cervical screening, however, we see many patients taking a smear test once a year for extra reassurance.
Attending cervical screening can detect HPV virus or cells in the cervix when they are abnormal, early enough, before they have had time to progress to cancer.
The cervical screening test is easy and quick. It may cause brief mild discomfort but most importantly is the best way to protect yourself from cervical cancer.
If you are between 25 -49 years you are invited to do your smear test every 3 years on the NHS. Between the ages of 50 -64 years, it is recommended every 5 years. Cervical screening will usually stop at the age of 65 years (unless you have previously had abnormal smears).
If it is reassuring you can decide to keep having smears even after 65 years or have these more regularly privately.
The HPV vaccine is available to boys and girls in school from the ages of 11-13 years in Scotland and 12-13 years in the rest of the UK.
Cervical Cancer Symptoms
The red flag symptoms for possible cervical cancer are:
- Bleeding in between periods or after sex
- Bleeding after menopause
- Pain during sex
- Unpleasant smelling vaginal discharge
If you have experienced any of these symptoms you must see your GP who will examine you and take a smear. They are likely to refer you on for further assessment by a gynaecologist in a hospital if either examination and or smear findings are abnormal
Alternatively, you may wish to see a private gynaecologist direct.
Your gynaecologist may perform a procedure called a colposcopy where your cervix will be visualised using a magnifying microscope to look for abnormal cells. This is performed in the clinic and a small biopsy may be taken or if abnormal cells are detected then a procedure called a large loop excision
of the transformation zone (LLETZ) may be carried out. LLETZ procedures are usually performed under local anaesthetic.
Samples taken will be examined under microscope to detect if there are pre-cancer or cancer cells. In the majority of cases this is all the treatment that is required if pre cancer cells are detected.
Cervical Cancer Treatments
The exact treatment for cervical cancer will be decided by a multidisciplinary team of doctors and nurses (gynaecologists, histopathologists, oncologists, radiologists, specialist nurses), and will depend on the stage at which the cancer is diagnosed.
Different treatments are:
- LLETZ procedure can remove pre-cancerous cells
a) Radical Trachelectomy, this type of specialist surgery is reserved for cases of cervical cancer caught early enough. It involves removal of all of the cervix and the surrounding tissue, including the upper part of the vagina. This surgery preserves the womb for childbearing.
b) Hysterectomy, involves removal of the uterus (womb)and cervix
c) Pelvic exenteration, this radical surgery is advised for women in which the cervical cancer has recurred after previous treatment. Other surrounding organs in addition to the cervix are removed, including the vagina, uterus, ovaries fallopian tubes, and sometimes even the bladder and rectum.
- Radiotherapy: It should be remembered that the chance of a complete cure is good for cervical cancer detected at an early stage. If the cancer has spread into surrounding tissues or other organs then the rate of cure will be unfortunately lower.
Endometrial/Womb Cancer Symptoms, Prevention and Treatments
This is the fourth most common cancer in women in the UK. The cancer of the womb is the most common of the 5 gynaecological cancers. According to Cancer Research UK, in 2017, there were 9,377 new cases of womb cancer diagnosed.
The most common type of womb cancer is found in the cells that line the inside of the womb (endometrial cancer).
What is the cause of Womb Cancer?
Lifestyle factors that can increase the risk of endometrial cancer include:
- Obesity , carrying excess fat around the waist, and a lack of exercise.
- Age – the risk increases as you get older, with the average age of women diagnosed being 60 years. The peak rate of womb cancer cases is in the 75-79 age range. Most women diagnosed with womb cancer are post -menopausal, however it is important to note that 1 in 4 women diagnosed are pre-menopausal.
- Oestrogen only Hormone Replacement Therapy (HRT): For many years it has been known that there is an association between taking HRT and increasing the risk of breast, womb and ovarian cancers. However, this increased risk is only slight – in the UK, around 1,400 cases of cancer per year are thought to be preventable by minimising HRT use.
It is worth noting that a woman’s exact risk is dependent on the type of HRT being taken (oral, patch, topical), how long it is taken for and how high the dose is.
This should be balanced with the fact that HRT has many benefits for women, in improving symptoms of menopause (such as hot flushes, night sweats) thereby having a significant impact on the quality of life for perimenopausal and post – menopausal women. Finally, there is evidence that HRT can reduce the risk of bowel cancer and osteoporosis in women.
- Tamoxifen treatment – whilst this medication significantly reduces the risk of recurrence of receptor positive breast cancer (and lowers the risk of diagnosis of a second breast cancer), it can stimulate the lining of the womb to grow and so can increase the risk of endometrial cancer. This risk is fortunately low, only 1% increased risk per year. You should be guided by the advice of your breast surgeon and oncologist with regards to taking tamoxifen and ultrasound screening tests whilst on this.
- Starting periods early and or having a late menopause can increase your risk.
- Other medical conditions, for example raised blood pressure, and diabetes.
This type of cancer can be related to your family history as well. It may be useful to take a genetic test if you want to be aware of your hereditary situation.
You can also reduce your risk of womb cancer:
- By not smoking
- Maintaining a healthy weight and regularly exercising
- Healthy diet: wholegrains, vegetables, fruit and beans
We see that simple habits like not smoking, exercise and following a healthy diet are helpful to us for many health conditions.
Womb Cancer Symptoms
Red flag symptoms for womb cancer are:
- Abnormal vaginal bleeding, in particular post-menopausal vaginal bleeding.
- Bleeding in between periods
- Heavier periods
- Abnormal vaginal discharge – brown / pink stained
Most women (about 80%) that are urgently referred to gynaecologists with these red flag symptoms will not have cancer. However, it is very important that if you experience any of these symptoms that you see your GP urgently with a view to being referred to a gynaecologist so that you can be investigated thoroughly.
Alternatively, you may wish to refer yourself privately directly to a Gynaecologist.
Investigations for Abnormal Vaginal Bleeding
Abnormal bleeding is a symptom of three out of the five gynae cancers: Womb, cervical and vaginal.
Unfortunately, this symptom is also often ignored by women. Research says that 80% of women will not get an unexpected bleed checked immediately. This is a sad percentage and funding research companies are constantly trying to increase awareness on this topic. Eve Appeal for example has decided that this September is GoRed to raise awareness on this important topic.
If you are experiencing abnormal bleeding the following investigations are useful to detect causes:
A transvaginal scan is performed to assess the thickness of your womb lining. This involves gently placing a probe into the vagina to obtain good images of the uterus (womb).
If the lining of the womb is thickened (more than 4 mm), or if you have recurrent unexplained vaginal bleeding then you will be offered a camera test to look directly inside the womb (called a hysteroscopy). The vast majority of hysteroscopies can be carried out under local anaesthetic in specialised gynaecology clinics, and are very well tolerated by women. However, if we are unable to get adequate views of your womb lining or if you feel that you would prefer a general anaesthetic then this can also be arranged.
A small sample of the lining of the womb / biopsy will be taken and looked at under a microscope in order to make a final diagnosis.
If womb cancer is diagnosed, then an MRI scan will be carried out in order to determine how extensive the cancer has grown into the muscle of the womb and/ or surrounding tissues i.e the stage of the cancer.
It is important to note that a cervical smear test only checks for abnormal cervical cells and HPV infection. It does not diagnose womb cancer.
Womb Cancer Treatments
Again this will depend on the decision taken by the multidisciplinary team of specialist doctors and nurses.
If it is diagnosed early enough, then a full hysterectomy (removal of the womb, cervix, and ovaries ) can be curative. Sometimes radiotherapy and chemotherapy may also be advised alongside surgery.
Ovarian Cancer Symptoms, Prevention and Treatments
Ovarian cancer is the 6th most common cancer in women, in the UK about 7500 women per year are diagnosed.
You have two ovaries, that are connected to your womb by fallopian tubes, which during your child-bearing years produce an egg each month during ovulation. Your ovaries are also responsible for producing female hormones oestrogen and progesterone.
There are different types of ovarian cancers; epithelial (the most common), germ cell and stromal. The majority of ovarian cancers are derived from epithelial tissue in the ovary
If ovarian cancer is not diagnosed early enough then the cancer cells can spread in the abdomen and pelvis.
What causes Ovarian Cancer
The risk factors associated with ovarian cancer are:
- Age 80 % of cases are in women over the age of 50 years
- Taking the oral contraceptive pill is thought to reduce the risk of ovarian cancer as it limits the number of times you ovulate.
- Family history, including inheritance of BRCA 1 and 2 genes which increase the risk of ovarian and breast cancer
“Every ovarian cancer patients ( as well as breast cancer patients ) with a BRCA1 or BRCA2 mutation detected after diagnosis, is a missed opportunity to prevent cancer” Prof Mary-Claire King, the researcher who found the BRCA gene in the 1990s
Current clinical guidelines globally recommend genetic testing for high-risk women, for example, if they fulfil certain clinical criteria or if there is a strong family history of breast or ovarian cancer. However, over 50% of BRCA carriers do not meet these criteria so are not tested, and over 97% of BRCA carriers in the UK population remain unidentified.
Take proactive action by genetic testing, which can be life-changing for you and those you love.
Ovarian Cancer Symptoms
Unlike other types of gynaecological cancers, the symptoms for ovarian cancer can be non-specific and difficult to recognise in the early stages, which is why it is unfortunately diagnosed late.
Symptoms to be alert for:
- Persistent abdominal bloating, abdominal size may increase
- Loss of appetite (feeling full quickly after a small meal), nausea
- Unexplained weight loss
- Pelvic / abdominal pain
- Urinary symptoms – urgency / frequency
- Change in bowel habit
How is ovarian cancer diagnosed?
If you experience any of the red flag symptoms you must see your GP immediately who will refer you urgently to be seen by a gynaecologist . You can also choose to see a private gynaecologist directly.
An ultrasound scan will be carried out and if there is any evidence of a suspicious mass on the ovaries or within the pelvis, then a blood test called a CA 125 (tumour maker) will be taken. If these are abnormal then a CT scan of your chest, abdomen and pelvis will be carried out.
A CT guided biopsy may also need to be carried out to confirm the diagnosis-
Ovarian Cancer Treatments
A decision will be made by the multidisciplinary specialist team responsible for your care.
- A combination of chemotherapy and surgery will usually be required to treat cancer.
- Surgery will take the form of total abdominal hysterectomy (removal of womb and cervix) and bilateral salpinoophrectomy (removal of both ovaries and fallopian tubes).
- Sometimes the surgeon may need to remove fat from around the stomach (omentum) or other structures that have been involved by the cancer (such as parts of the bowel).
Vaginal Cancer Symptoms, Prevention and Treatments
Vaginal Cancer is very rare, only 250 cases diagnosed in the UK per year and the vast majority of cases are diagnosed in women over the age of 60 years.
Risk factors for vaginal cancer are indeed:
- age (more than 60 years)
- infection with HPV can be associated with the development of vaginal cancer ( just like cervical cancer)
- Previous diagnosis of pre -cancerous cervical lesions (cervical intraepithelial neoplasia , CIN) and pre-cancerous vaginal lesions (vaginal intraepithelial neoplasia, VAIN)
Vaginal Cancer Symptoms
Red flag symptoms for vaginal cancer are:
- Post menopausal bleeding (bleeding after menopause)
- Bleeding during or after sex
- Unpleasant smelling vaginal discharge
- Bleeding in between periods
- A persistent lump / itch in the vagina
- Dysuria (pain during passing urine)
If you experience any of these symptoms please see your GP with a view to being referred urgently to a gynaecologist in a specialist clinic. You may also choose to see a gynaecologist urgently directly.
How is Vaginal Cancer Diagnosed?
When you are reviewed by the gynaecologist in clinic, you will be examined by them with a speculum (similar to when you have a smear test). In particular they will be examining your vulva, vagina and cervix and looking for any masses or skin changes that might need to be biopsied.
A colposcopy may be used to get a closer look at the vagina and an examination under anaesthetic may be required.
If the histology from the biopsy confirms vaginal cancer, then an MRI or CT may be carried out.
How is Vaginal Cancer Treated?
Like for every gynaecological cancer, the decision is taken by the multidisciplinary team and the exact treatment will depend on the exact location of the vaginal cancer and how far it has spread into surrounding tissues (stage of the cancer).
Radiotherapy is the commonest treatment, involving high energy rays, either as external beam radiation therapy or intracavity brachytherapy but surgery may be advised (to remove part of or all of the vagina, and removal of pelvic lymph nodes).
Vulval Cancer Symptoms, Prevention and Treatments
Cancer of the vulva is one of the rarer forms of cancers with around 1300 new cases per year in the UK.
The vulva refers to a woman’s external genitals and vulval cancer forms when abnormal cells in the vulva, proliferate/ grow in an uncontrolled manner.
The risk factors for vulval cancer are:
- Age over 60 years (about 80% of women are diagnosed over 60 years of age, however sadly more frequently as gynaecologists we are now diagnosing some women at a younger age).
- Pre-existing skin conditions of the vulva VIN(pre-cancerous cells) or lichen sclerosis (a skin condition that causes itchy white patches on the genitals and other surrounding areas).
- Like with cervical cancer HPV infection is associated with an increased risk of vulval cancer. About 40 % of women diagnosed with vulval cancer are positive for HPV.
- And again, Smoking.
The reasons why smoking can be so damaging for your health increasing your possibility to develop cancer is that it can weaken your immune system and so impact on the ability of your body to clear HPV.
Vulval Cancer Symptoms
Red flag symptoms for vulval cancer are:
a persistent vulval itch
pain or soreness in the vulval area
thickened, raised, red, white or dark patches on the vulval skin
an open sore or growth visible on the vulval skin
a mole that changes shape or colour on the vulva
a lump on the vulva
Other symptoms include:
- burning pain during urination
- discharge or bleeding, not related to your periods
- a lump or swelling in the groin
It is advisable that you check your own vulva on a regular basis, for example, every 3 months, and in particular note any skin changes, lumps, ulcerated or itchy areas of skin. You may want to use a mirror to do this.
If you notice any suspicious areas or if you have any concerns you must see your GP urgently for referral to a gynaecologist and further assessment.
How is Vulval Cancer Diagnosed?
When you are reviewed by the gynaecologist they will want to do a full inspection of the vulval area and an internal examination using a speculum. If there are any suspicious areas than a biopsy will be taken and sent to the lab for a histopathologist to look at under the microscope.
Vulval Cancer Treatments
Most cases of vulval cancer will be treated with surgery. The gynaecologist will aim to remove all the abnormal tissue with a margin of normal cells (at least 1 cm) around the cancer to be removed as well, to ensure that treatment is complete
Small parts of the labia (partial vulvectomy) or all of the vulva (radical vulvectomy) may need to be carried out depending on the stage at which the cancer is diagnosed.
So you can see there are so many different gynaecological cancer symptoms you should be aware of. Learning to understand, preserve and inspect our own body can make an important difference for our gynaecological health and life.
The most important thing to remember is that there is no reason to be afraid or embarrassed in asking for help. Any questions or doubts you may have are important to be clarified and any suspected symptoms/bleeding are worth checking further with your GP or gynaecologist.
Don’t hesitate to leave your comments/question below. I hope you have found this article useful and if it is please let me know in the comments. Your feedback is important to me!
This article has been written by Dr Zahra Ameen Consultant Obstetrician and Gynaecologist at The Women’s Wellness Centre.
Our Consultant Gynaecologists at The Women’s Wellness Centre offer a range of services dealing with female health concerns. If you wish to know more about our Private Gynaecology Services, please contact us on 020 7751 4488 or book an appointment online here.
Consultant Obstetrician and Gynaecologist BSc MBBS MRCOG
Dr Zahra Ameen is an experienced Consultant Gynaecologist with over 10 years clinical experience. 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.