September is gynaecological cancer awareness month Cervical cancer
Cervical cancer is the fourth most common female cancer in the world with over 250,000 deaths and over 500,000 new cases worldwide. In St Vincent and the Grenadines 70 women died between 2000 and 2008.
It consists of two types of cancer squamous and glandular.
Squamous is the most common and usually occurs in older women, glandular is less frequent but higher incidence in younger women.
The introduction of the screening programme has decreased deaths by 60% in the UK by picking up early cervical abnormalities which are treated in colposcopy clinics. This trend should also be seen in St Vincent and the Grenadines.
A patient can have no symptoms at all, however symptomatic women can have a watery bloody discharge and bleeding which can be post-menopausal, in-between periods and after sexual intercourse or lower tummy and back pain in advanced disease.
In the UK, ovarian cancer is the sixth most common cancer in women, with over 6500 women diagnosed each year, in St Vincent and the Grenadines it is the fifth commonest cause of cancer death in women.
Most cases occur in women who are postmenopausal and are usually aged over 50, but younger women can also be affected.
It has the highest mortality of all gynaecological cancers, accounting for 6% of all cancer deaths.
The reason why ovarian cancer develops is unknown.
Symptoms can be present for more than a year and occurring more than 12 times per month and include persistent abdominal distension, bloating, early satiety and/or loss of appetite, pelvic or abdominal pain, and increased urinary urgency and or frequency, postmenopausal bleeding; unexplained weight loss; fatigue or changes in bowel habit.
The patient can also present with a pelvic or abdominal mass
A family history of ovarian or breast cancer increases the risk.
Factors that decrease risks include taking the oral contraceptive pill, being pregnant or breastfeeding. The risk increases slightly in women who have not had children and who have a late menopause.
Uterine cancer is the sixth most common female cancer worldwide.
The commonest type of uterine cancer is Endometrial cancer whose incidence has increased by around 50%. It should be noted that 78% of women with adult uterine cancer are predicted to survive ten or more years.
This increase is likely due to increasing obesity, life expectancy and treatment with tamoxifen for breast cancer.
Uterine cancer is the third highest cause of cancer death in women in St Vincent and the Grenadines.
Women mostly present with postmenopausal bleeding (PMB). The probability of endometrial cancer when presenting with PMB is 5–10% but 90% of endometrial cancers present with post-menopausal bleeding.
An unscheduled bleed whilst on HRT.
Younger women may present with bleeding between periods or prolonged bleeding, often with a background of irregular menstruation.
Women on tamoxifen for breast cancer if they have any bleeding should be referred for outpatient hysteroscopy and biopsy and not biopsy alone.
In summary early diagnosis is key and knowing how these cancers present can be life saving.
Dr John Barker Bsc MBBS MRCOG, Dip (Risk Management) is an Obstetrician/Gynaecologist at Arnos Vale Medical Center, Consultant Obstetrician/Gynaecologist UK
He has completed the Advanced Training Skills Module in Gynaecological Oncology in the UK and runs gynaecological oncology clinics for diagnosis and management of suspected and confirmed female genital cancers.