Gynaecological cancers: risks and symptoms
While many of us are guilty of presuming any minor health niggle means we have a serious disease, for the majority of us the problem is usually something minor. However, if you have ever missed a period, or had a funny pain in your vagina, or an odd kind of stomach ache, you may, for a moment, have presumed the worse. In actual fact, gynaecological cancers, that is, cancers affecting any part of a woman’s reproductive system are actually very rare.
However, just because something is rare, it doesn’t mean it doesn’t pay to be aware of the symptoms. Pharmacist Thorrun Govind says that they are trained in how to spot symptoms that could be something serious, so if you have a concern, however minor, and are struggling to get a doctors appointment, you can always go to your pharmacy first, and they will be able to advise you or even contact your GP surgery for you.
The key symptoms Thorrun, and other pharmacists, are trained to look out for are unique for each kind of cancer. If someone comes in thinking they may have thrush or cystitis, Thorrun will ask about any itching or burning, any changes in bathroom habits, abnormal bleeding or discharge, and pelvic pressure. “As pharmacists we have a very good general knowledge of symptoms,” she adds, “so we know the things we need to keep an eye out for. If we spot an issue we will refer someone to the doctor.”
So what exactly are the key symptoms of the gynaecological cancers?
Roughly 3,200 women are diagnosed with cervical cancer in the UK each year, and it is more common in younger women under the age of 45.* The most common cause of cervical cancer is the HPV virus, which normally gets cleared by the immune system if you contract it. There are numerous strains of HPV, some of which cause cancer, some of which cause genital warts, and some of which don’t seem to cause any symptoms at all.
“Obviously, cervical cancer is a bit higher profile than the other gynaecological cancers,” says Thorrun. “Normally I would refer you if you mention symptoms such as pain in the pelvis or vaginal discharge, pain during sex, bleeding after sex, bleeding after menopause, or abnormal vaginal bleeding.” In fact, bleeding at odd times in the menstrual cycle, including during or after sex, is the most common symptom of cervical cancer.
“Once cervical cancer gets more advanced it can cause other symptoms such as loss of bladder control, changes to bowel habits, bone pain, and loss of appetite, which of course leads to weight loss,” adds Thorrun.
Other symptoms of cervical cancer can include pain in the pelvis, pain or discomfort during sex or between the hip bones, and vaginal discharge that smells unpleasant. These symptoms can be indicative of a whole host of less serious conditions, so shouldn’t cause concern, but should be investigated nonetheless.
Around 7,400 women in the UK are diagnosed with ovarian cancer each year, with 53% of cases falling in the 65 and over age group. While it is not known what causes it, scientists believe that getting older, inherited faulty genes, and having had breast cancer previously may all play a part.
Symptoms of ovarian cancer are difficult to spot, but things to look out for include if your symptoms are new, severe, and don’t come and go. Women with very early stage cancer may not have any symptoms, but if they do these can include lower stomach pain, and a bloated feeling in the abdomen, like feeling full. If the cancer has progressed outside the ovary, symptoms can include irregular periods or bleeding after menopause, lower stomach pain, and pain in the back. You may also need to pee more often than normal, be constipated, have pain during sex, a swollen stomach, and feel full, or lose your appetite.
“When it comes to ovarian cancer, we look for nausea, pain during sex, a change in bowel habits, back pain, and feeling tired,” says Thorrun. “Unintentional weight loss, along with vaginal bleeding, or bleeding after menopause are also signs.”
If the cancer has spread further, you may notice, on top of previously mentioned symptoms, that you are experiencing shortness of breath, tiredness, and nausea.
While experiencing one or more of these symptoms doesn’t necessarily mean you have cancer it is important to get them checked out, particularly if they are occurring most days for three weeks or more, if you are over fifty, or if you have a family history of breast or ovarian cancer.
Womb cancer can also be referred to as uterine cancer, or endometrial cancer, with endometrial being the most common type (affecting the endometrium, the lining of the womb). Roughly 9,300 women are diagnosed with womb cancer in the UK each year, and it is the 4th most common cancer in women in the UK. The majority of women with womb cancer are aged 40 to 74, with just over 1% of cases occurring in women under 40%. Those with a gene fault, called Lynch syndrome, are more likely to develop endometrial cancer at a younger age. Women with endometrial hyperplasia, or PCOS, are also more likely to develop womb cancer, and daughters of women with womb cancer have double the risk of women in the general population.
The most common symptom of womb cancer is abnormal vaginal bleeding, particularly in postmenopausal women. Abnormal bleeding also includes unusually heavy bleeding, bleeding that occurs between periods, or vaginal discharge that can be anything from bloody, or pink and watery, to dark, with a foul smell. In fact, 90% of womb cancers are picked up because of women noticing abnormal bleeding.
Less common symptoms of womb cancer include having blood in your urine combined with either anaemia, high platelet count, or a high blood sugar level. Your doctor may also be able to feel that your womb is larger than normal, or they be be able to feel a lump in your tummy or pelvis.
Symptoms in early vaginal cancer are rare, and 20 per cent of women diagnosed with vaginal cancer don’t have symptoms at all. Signs of abnormal cell changes in the vaginal lining can occasionally be picked up during routine cervical screenings, but many vaginal cancers don’t cause symptoms until they are in the advanced stages.
Around 80 out of 100 women with vaginal cancer will have with one or more symptoms. These can include bleeding between periods, postmenopausal bleeding, bleeding after sex, vaginal discharge that smells, or has blood in it, pain during sex, a lump in the vagina, or an itch.
Symptoms that can occur with advanced vaginal cancer include constipation, pain when peeing, swelling in the legs, or pain in the general pelvic area that won’t go away.
Cancer of the vulva can start in any part of the female external sex organs, but occurs most commonly on the inner edges of the labia (both outer and inner). It can occur in the perineum, clitoris, or two glands either side of the vagina, called the Bartholin’s glands. It usually forms slowly, with cells first becoming abnormal, before they may or may not go on to develop cancer.
Vulval cancer is extremely rare, with 1,300 cases being diagnosed in the UK each year. It counts for less than one in every 100 cancers diagnosed in women and it is more common in older women. This being said, 15% of cases are in women under the age of 60.
Symptoms of vulval cancer include a lasting itch, pain or soreness, thickened, raised, red, white, or dark patches on the skin of the vulva, or an open sore or growth. Women with vulval cancer may experience a burning pain when peeing, discharge or bleeding, a mole on the vulva that changes shape or colour, a lump or swelling in the vulva, or a lump in the groin.
In short, if you are experiencing any symptoms which are out of the ordinary, it is best to get checked out to be on the safe side. The same applies if you, for example, are having what you think is recurring thrush.
“If you come to us with gynaecological symptoms, such as if you have traces of blood in your discharge, or blisters or sores or ulcers, or ‘thrush’ that hasn’t responded to treatment after about a week, any stomach or lower abdominal pain, then I would refer you to the doctors,” says Thorrun. “On top of that if you have had an STI in the past I would encourage you to be wary.”
Being aware of the symptoms, adds Thorrun, and noticing any changes you may have in that region is one of the main things. “If you spot something which seems out of the ordinary you can go and see the pharmacy for free,” she says. “It would be silly sitting at home worry, or ignoring any symptoms, when there is an expert on the high street who can even contact your GP for you and get you an appointment sooner if needs be.”
*All statistics were taken from the Cancer Research UK website