GYNAE CANCER

Risk factors

The risk factors for gynaecological cancer include: being post-menopausal, with a family history of ovarian cancer or cancers of the uterus, colon or breast, infertility problems or having had no children, in women who are overweight, smokers or those with comorbidity such as hypertension or diabetes, not engaging in cervical screening or persistent HPV, taking tamoxifen or unopposed oestrogen, first intercourse before sixteen, having multiple sexual partners or women who are HIV positive. 

Signs and symptoms

Abnormal vaginal bleeding is a common sign of most gynaecological cancers. The signs and symptoms may be different for every woman however abnormal vaginal bleeding is a common sign of all gynaecological cancers except vulval cancer. Women who report feeling full or a difficulty eating, feeling bloated, and abdominal or back pain are all common symptoms with ovarian cancer. Pelvic pain or pressure symptoms are common with ovarian and uterine cancers. Women report an urgent need to urinate or with constipation are commonly associated with ovarian and vaginal cancers. Itching, burning, tenderness or pain of the vulva, and changes in vulva colour or skin, such as a vulval ulceration, rash or warts, are found only in vulval cancer. If you identify any red flags, you should consider a suspected cancer pathway referral (for an appointment within 2 weeks).

Main types of gynaecological cancer

Ovary

Ovarian cancer can affect women at any age but is rare under the age of 30 and more common in women after 65. It can start in the ovary, fallopian tube or peritoneum. Approximately 300 women are diagnosed every year in New Zealand. Ovarian cancer divides into subtypes of which some are more common than others. The most common subtype is epithelial ovarian cancer which comes from the cells on the surface of the ovary. Diagnosis is often delayed because women present with non-specific abdominal symptoms which can be confused for other conditions such as IBS. CT scans and abdominal ultrasound are used to confirm the diagnosis. Ovarian cancer is associated with an increased level of a tumour marker called CA125. Treatment is with chemotherapy and surgery including hysterectomy and removing the ovaries, appendix and omentum. Women who carry the BRCA1 and BRCA2 gene are at increased risk from developing the disease and may consider prophylactic ovary removal to decrease their cancer risk.

Endometrium (lining of the womb)

Endometrial cancer is rare in women under 40 and becomes more common after 55. Approximately 700 women are diagnosed annually in New Zealand. At least 1 in 3 womb cancers may be caused by obesity and lack of exercise. Other causes include exposure to oestrogen and a rare genetic condition called Lynch Syndrome. The most common symptom is irregular vaginal bleeding and bleeding after the menopause. Diagnosis includes biopsy of the endometrium, abdominal ultrasound and CT scan. Treatment includes hysterectomy and ovary removal, external beam pelvic radiotherapy and internal brachytherapy.

Cervix

Cervical cancer can affect women at any age. There are two main types of cervical cancer, the most common is squamous cell cancer, the other is adenocarcinoma. The main risk factor is infection from the Human Papilloma virus (HPV) other risk factors include a weak immune system caused by conditions such as HIV and smoking. Symptoms include abnormal vaginal bleeding, offensive discharge and lower back pain. Diagnosis is made by a biopsy from the cervix, MRI, CT and Positron emission tomography (PET) CT.  Early stage cancers are treated with a Large Loop Excision of the Transformation Zone (LLETZ), Needle Excision of the Transformation Zone (NETZ) and cone biopsy. More advanced cancers are treated with surgery, chemotherapy and radiotherapy. There is a national screening programme to detect pre-cancerous changes to the cervix which can treat abnormalities at an early stage.

Vulva

Cancer of the vulva is rare. It is most common in women over 65 only 15% develop vulvar cancer under 50. It can affect any part of the external female sex organs but the most common are the inner edges of the labia majora and any part of the labia minora. There are several different types of which the most common is squamous cell cancer which affects 90% of all diagnoses.