How to avoid delaying the diagnosis of gynaecological cancer

Most gynaecological cancers are curable if caught early. Sadly, in some cases, the diagnosis is delayed. Sometimes this is due to patients not wanting to trouble their doctor with symptoms that they think are unimportant, or that they might be embarrassed about. Going for cervical smears regularly, watching your weight and telling your doctor about certain symptoms are the best ways of avoiding a delayed diagnosis.  Cervical cancer  The best way to avoid cervical cancer is to go for your cervical smears whenever asked to do so. Women aged between 24 and 50 years are invited for smears every three years, and those aged 50-64 years are invited every five years. Even if you go for smears regularly, it’s important not to ignore symptoms. Abnormal bleeding (i.e. bleeding between periods, after sex, or after the menopause), or an abnormal discharge are usually due to benign and easily-treatable causes, such as infections. Occasionally, they may be due to cervical cancer. The first step in checking for the cause of your symptoms is a vaginal speculum examination of the type used when a smear is taken. Remember that even if you are young enough to have received the ‘HPV’ vaccine at school, this does not prevent all cervical cancers, or other types of infection, so you should not ignore symptoms.  Who’s at risk? Risk factors for cervical cancer include: 

• Not having regular smears
• Smoking 
• A poor immune system (e.g. someone with HIV or someone taking certain strong drugs used to suppress the immune system to treat a medical problem; never stop these drugs without discussing first with your doctor) 

Ovarian cancer  Ovarian cancer is relatively rare, but its symptoms are common, so it’s not surprising that patients and their families frequently complain of long delays in diagnosis. The key is persistence/worsening of symptoms in the tummy. If you suffer from the following on most days for at least three weeks, see your GP to discuss these symptoms and to rule out ovarian cancer:  

• Pelvic/lower tummy pain 
• Tummy swelling/bloating 
• Feeling full quickly after eating/nausea  
• More rarely, ovarian cancer symptoms can include change in bowel and bladder habit (e.g. how often you need to go to the toilet, or a change in your bowel motions) and lower back pain 

Your GP may do a blood test for you called ‘CA125’, but a normal CA125 result does not rule out ovarian cancer, so if your symptoms still persist, your GP can arrange an ultrasound scan of your abdomen and pelvis to investigate this further.   Who’s at risk? Ovarian cancer is rare, but more common in the following groups: 

• Postmenopausal women (women who no longer get periods as a result of natural ageing) 
• Women with a family history of ovarian/breast cancer especially at young ages (<50 yrs). This family history suggests they may have an inherited mutation in the BRCA1 or BRCA2 genes, which cause some breast and ovarian cancers. If you have a family history of these cancers (on your mother’s or father’s side), ask your GP whether you need to be referred to a Clinical Geneticist
• Women with Ashkenazi (Eastern European) Jewish heritage (up to 1 in 40 such women may carry inherited BRCA1 and BRCA2 gene mutations)[1] 

Womb cancer This type of cancer is increasing in the UK, mainly because many cases are due to being overweight, and more women in the UK are getting more overweight every year. Bleeding after the menopause (i.e. more than one year after your last period) is abnormal and must be investigated by your doctor as it could be a sign of cancer of the womb. Womb cancer before the menopause can easily be overlooked. In women over 40 years old, it can cause persistent bleeding between periods. If this happens to you, don’t assume it is normal and due to approaching menopause. Talk to your GP and ask them if they think your bleeding pattern is concerning or not. It is normal to get longer-lasting, less-frequent bleeds coming up to the menopause, but persistent bleeding between periods should be investigated.  Due to changes in the womb-lining thickness, which occur normally as part of the menstrual cycle, ultrasound scans are not able to rule out womb cancer in women who have yet to go through the menopause. Therefore, in women over 40 years old or in younger women with risk factors (see below), a sample of the womb lining should be obtained if there is concern about the bleeding pattern. This is usually done as a simple out-patient procedure by a gynaecologist.    Who’s at risk? Risk factors for womb cancer include: 

• ‘Polycystic ovary syndrome’ (PCOS)
• Obesity  
• Taking tamoxifen for treatment or prevention of breast cancer 
• Taking certain types of hormone replacement therapy (HRT) 
• Family history of bowel (especially if aged <50yrs), ovarian and womb-lining cancer. This suggests possible Lynch Syndrome; your GP should check how extensive your family history is and consider referring you to a Clinical Geneticist. Lynch Syndrome is under-recognised. It has been estimated that up to 1 in 500 of the population carry a mutation in one of the Lynch Syndrome genes[2]

Vulval cancer Having itchy skin in the vulva (the area surrounding the opening of the vagina) is a relatively common problem and can be due to ‘thrush’ (an easily-treated non-sexually transmitted yeast infection). However, rarely the itch may be due to skin cancer or pre-cancer in the area. If you have persistent itching or if you notice any changes in the appearances of your vulval skin, especially colour changes, lumps, bumps or ulcers (‘punched out’ holes in the skin), then insist your doctor examines you. Do not feel embarrassed about going to your doctor with this problem; remember it’s their job to examine patients with symptoms like these and they would far rather be able to reassure you that everything looks OK than miss a serious diagnosis.  Who’s at risk? Risk factors for vulval cancer include: 

• Previous precancerous changes on the vulva, cervix, vagina, or anus 
• Smoking   
• A poor immune system (e.g. someone with HIV or someone taking certain strong drugs used to suppress the immune system to treat a medical problem; never stop these drugs without discussing first with your doctor) 
• Certain ‘auto-immune’ conditions, especially those affecting the skin e.g. lichen sclerosus 

Remember… None of the gynaecological cancers are common. Most of the symptoms described above are usually due to much less serious conditions, but you should never ignore persistent symptoms as occasionally they could be due to cancer.  References

This article is for information only and should not be used for the diagnosis or treatment of medical conditions. myHealthSpecialist makes no representations as to the accuracy or completeness of any of the information in this article, or found by following any link from this article. Please consult a doctor or other healthcare professional for medical advice.

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Mr Adam Rosenthal, Consultant Gynaecologist