Gynaecological cancers include cancer of the womb or uterus, cervix (neck of the womb), ovary, vulva and vagina.
The cervix is the lower part of the womb (uterus) and is often called the neck of the womb. The womb is a muscular, pear-shaped organ at the top of the vagina. The lining of the womb is shed each month, and results in bleeding called a period. These periods stop temporarily during pregnancy and will normally continue until a woman has the 'change of life' or menopause
Risk factors and causes of cervical cancer
Cervical cancer is caused, in the majority of cases, by infection with the high risk human papilloma virus (HPV). Many women are aware that having sex at an early age and having several sexual partners can increase the risk of developing cervical cancer.
It's important to remember that although these factors can increase the chances of catching HPV , many women who have only had one sexual partner have HPV, and may go on to develop CIN or cervical cancer. So there's no reason for yourself or others to feel that you're to blame for having cervical cancer.
A weakened immune system may also allow CIN to develop into a cancer. The immune system can be weakened by smoking, poor diet, and infections such as HIV/AIDS.
Long-term use of the contraceptive pill (more than 10 years) can slightly increase the risk of developing cervical cancer, but the benefits of taking the pill outweigh the risks for most women.
Cancer of the cervix is not infectious and can't be passed on to other people.
Preventing cervical cancer
Having routine smear tests can reduce the risk of cervical cancer, as early changes in the cells of the cervix are picked up
Symptoms of cervical cancer
The most common symptom of cervical cancer is abnormal vaginal bleeding, usually between periods or after sex. Often there is also a bad-smelling vaginal discharge, and discomfort during sex. Women who have had their menopause (who are no longer having periods) may have some new bleeding.
There are many other conditions that can also cause these symptoms, but it's important that you see your doctor or practice nurse about them. It can be embarrassing to talk about these symptoms, but the sooner you see your doctor and a diagnosis is made, the better the chance of treatment being successful
The womb, or uterus, is the place in a woman's body where a baby grows before being born. It is a muscular, pear-shaped organ at the top of the vagina. The lining of the womb is called the endometrium and is shed each month, as a period. These periods stop temporarily during pregnancy, but will normally continue until a woman has the menopause. Cancer that starts in the womb lining is called endometrial or womb cancer.
Cancer that starts in the muscle layers of the womb is called uterine sarcoma; (link to sarcoma web site)
The lower part of the womb is called the cervix, or sometimes 'the neck of the womb'.
Symptoms of womb cancer
The most usual early symptom of cancer of the womb is abnormal vaginal bleeding. This may occur as:
- bleeding which starts after the menopause (in post-menopausal women)
- bleeding between periods
- heavier periods than normal (in pre-menopausal women)
- abnormal vaginal discharge.
Abnormal vaginal bleeding may be due to many causes other than cancer, but you should always see your GP about it.
Having had a recent normal cervical screening test (smear test) does not mean that you do not have cancer of the womb. A smear test involves a scrape of cells from the surface of the cervix. The cervix is the lower part womb. Occasionally a smear test may show signs of a cancer of the lining of the womb, but this is unusual.
Other symptoms of womb cancer might be:
- pain in the lower abdomen (tummy), back or legs
- discomfort or pain during sexual intercourse.
Who gets Womb Cancer?
This type of cancer is much more common in woman who have gone through the menopause. Less than 5% occurs in pre-menopausal women. It is more likely to occur in women who have not had children and is associated with diabetes and high blood pressure. Obesity (body mass index>25) is known to cause endometrial cancer.
Ovarian cancer is the fourth most common cancer in women in the UK.
It usually affects women who have reached their menopause - about 90% of women diagnosed are over the age of 45, though it can occur in younger women.
The commonest type of ovarian cancer is known as Epithelial Ovarian Cancer and the information contained in this section refers to this type of cancer.
Most women with ovarian cancer are treated with a combination of surgery and chemotherapy.
The ovaries are small, oval-shaped organs - about the size and shape of an almond - that are part of the female reproductive system. Each woman has two ovaries, one on either side of the womb, in the lower part of the abdomen (pelvis). The ovaries produce eggs and female hormones, which make menstruation (periods) and pregnancy possible.
Each month, in women of childbearing age, one of the ovaries produces an egg. The egg passes down the fallopian tube to the womb (uterus). If the egg is not fertilised by a sperm it passes out of the womb and is shed, along with the lining of the womb, as part of the monthly period. The ovaries also produce the female sex hormones, oestrogen and progesterone. As a woman nears the menopause ('change of life') the ovaries make less of these hormones, and periods gradually stop.
Symptoms of ovarian cancer
Most women with early-stage cancer of the ovary are not aware of symptoms. This is because the symptoms can be quite vague or may not occur until the cancer is at a later stage. When symptoms occur they may include any of the following:
- loss of appetite
- vague indigestion, nausea, excessive gas (wind) and a bloated, full feeling
- unexplained weight gain
- swelling in the abdomen - this may be due to a build up of fluid (ascites), which can cause shortness of breath
- pain in the lower abdomen
- changes in bowel or bladder habits, such as constipation, diarrhoea or needing to pass passing water (urine) frequently
- lower back pain
- pain during sex
- abnormal vaginal bleeding, although this is rare.
Diagnosis & tests:
If you see your GP with the symptoms described above, he may suspect that you have ovarian cancer and will often send you for an ultrasound scan and blood tests. This may not occur immediately as these symptoms may suggest other more common and non-cancerous diseases such as irritable bowel syndrome (IBS). Thus your GP may initially treat you with laxatives or other medication. It is important that you return to the GP if the symptoms do not improve. Remember, the average GP sees one patient with ovarian cancer every five years so do not be afraid to discuss it with your GP if you are concerned about ovarian cancer.
Your GP will refer you to a rapid access cancer clinic or to a cancer centre to be seen by a specialist gynaecology cancer team for the tests and for specialist advice and treatment. The rapid access clinic may be at your local unit hospital. If the doctor there thinks you have ovarian cancer, you will be referred to the Gynaecological Cancer Centre at UCLH for specialist treatment.
Your first appointment at the Gynaecological Cancer Centre will be at the Joint Oncology Clinic (JOC - please link) After talking to you and examining you, the doctor may order some tests such as a CT scan and blood tests, such as the Ca125 test.
CA125 is a protein that most women have in their blood. The level may be higher in women with ovarian cancer, as it is sometimes produced by ovarian cancer cells. However, CA125 is not specific to ovarian cancer, and the level can also be raised in women who have other non-cancerous conditions. Therefore, other tests are needed to make a diagnosis.
Staging and grading of ovarian cancer
The stage of a cancer is a term used to describe its size and whether it has spread beyond where it started in the body. Knowing the stage of the cancer and how quickly it's likely to grow (the grade) helps the doctors to decide on the most appropriate treatment, and it may also give an idea of the outlook.
Like many cancers, ovarian cancer is grouped into four stages, Stages 1-4. For each stage, there are also sub-stages, which further describe the size and extent of the cancer. It's often not possible to stage an ovarian cancer before a laparotomy (a type of operation) is done and the results of any biopsies are known.
A commonly used staging system is described below.
Borderline tumours are made up of low-grade cells that are unlikely to spread. They are usually completely cured by surgery and rarely need further treatment.
Stage 1 ovarian cancer only affects the ovaries. This stage is divided into three sub-groups:
- Stage 1a The cancer is only in one ovary
- Stage 1b There are tumours in both ovaries.
- Stage 1c The cancer is either at stage 1a or 1b, and there are cancer cells on the surface of one of the ovaries, or in the fluid taken from within the abdomen during surgery, or the ovary has burst (ruptured) before or during surgery.
Stage 2 ovarian cancer has begun to spread outside the ovaries within the pelvis. There are three sub-groups:
- Stage 2a The cancer has spread to the womb or fallopian tubes.
- Stage 2b The tumour has spread to other structures within the pelvis, such as the rectum or bladder.
- Stage 2c The cancer is either at stage 2a or 2b, and there are cancer cells on the surface of one of the ovaries, or in the fluid taken from within the abdomen during surgery, or the ovary has burst (ruptured) before or during surgery.
The cancer has spread beyond the pelvis to the lining of the abdomen (a fatty membrane called the omentum), and/or to abdominal organs such as the lymph nodes in the abdomen, or the upper part of the bowel.
- Stage 3a The tumours in the abdomen are very small and cannot be seen except under a microscope.
- Stage 3b The tumours in the abdomen can be seen but they are smaller than 2cm.
- Stage 3c The tumours in the abdomen are larger than 2cm.
The cancer has spread to other parts of the body such as the liver, lungs , or distant lymph nodes (for example in the neck).
If the cancer comes back after initial treatment this is known as recurrent cancer.
Grading refers to the appearance of the cancer cells when they are looked at under the microscope. The grade gives an idea of how quickly the cancer may develop. There are three grades: grade 1 (low-grade), grade 2 (moderate-grade) and grade 3 (high-grade).
Low-grade means that the cancer cells look very like the normal cells of the ovary. They usually grow slowly and are less likely to spread.
Moderate-grade means that the cells look more abnormal than low-grade cells.
High-grade means that the cells look very abnormal. They are likely to grow more quickly and are more likely to spread.