What You Need To Know About Female Cancers

We might be finding it easier than ever to discuss once-taboo topics like periods and sex, but when it comes female cancers, our lack of knowledge is still costing lives. In light of Gynaecological Cancer Awareness Month, we went to two female health experts to find out more – from symptoms and treatment to the importance of smear tests, here’s what you should know…

There Are Five Types

According to The Eve Appeal, there are five gynaecological cancers – womb, ovarian, cervical, vulval and vaginal – but awareness remains low. Each year in the UK, over 21,000 women are diagnosed with a gynaecological cancer, equivalent to 58 daily diagnoses. Sadly, 21 of these women die every day in the UK. “Gynaecological cancers account for 10% of cancer deaths in the UK and the incidence is rising,” says Dr John Butler, medical director of The Lady Garden Foundation and consultant gynaecologist at The Royal Marsden Hospital. Women’s health expert Victoria Howell adds that a lack of funding in women’s health has created a huge knowledge gap and stigma around these cancers, too: “Public funding in women’s reproductive health research is as little as 2%. Just over half of the UK’s population is female, so with limited funding it impacts on the availability of training, and subsequently, the profile of gynaecological cancers. The more we talk about these cancers, the better we can raise their profile and keep women informed.”

Some Are More Common Than Others

“The most common gynaecological cancer is uterine (also referred to as endometrial) cancer,” says John, with around 9,500 cases each year in the UK and 2,300 deaths. “Ovarian cancer has 7,500 cases and 4,100 deaths; cervical cancer 3,200 cancers and 852 deaths; and vulval and vaginal cancers 1,500 cases with 550 deaths,” he says. According to The Royal Marsden, uterine cancer is the fourth most common cancer in women after breast, lung and bowel cancers and its incidence has increased by over 50% since the early nineties mainly due to increasing obesity rates and an ageing population. “While obesity does play a role, for many patients, gynaecological cancers are caused by hereditary genetic conditions such as BRCA mutation and Lynch syndrome,” John explains, stressing the importance of genetic knowledge. 

Keep An Eye Out For Changes

While each of the five female cancers has its own unique symptoms, there are certain things you should always flag with your GP, says John. “Symptoms of particular concern are vaginal bleeding after the menopause, between periods or after sex, abdominal swelling or bloating, and the presence of any new lumps or ulcers. For most women, there will be non-cancer-related causes to these issues, but it’s always important to get it checked out.” Keep an eye out for the following symptoms, too…

  • OVARIAN CANCER: Persistent bloating or abdominal pain; difficulty eating, feeling nauseous or full quickly; changes in bowel habits; and needing to urinate more frequently.

  • UTERINE CANCER: Bleeding in between periods, after menopause or after sex; heavier periods, and abnormal discharge – pink, watery or brown discharge could be a sign of uterine cancer.

  • CERVICAL CANCER: Bleeding between periods or after sex; pain during sex; and an unpleasant smelling discharge.

  • VAGINAL CANCER: Bleeding between periods, post-menopause or after sex should always be investigated, as should blood-stained discharge; pain during sex; a vaginal lump; or a persistent vaginal itch.

  • VULVAL CANCER: A lasting itch; pain or soreness; thickened, raised, red, white or dark patches of the skin of the vulva; or lumps on the vulva.

Age Plays A Part

“Most gynaecological cancers are diagnosed in women over the age of 55, although we see these types of cancers in all age groups,” John says. Victoria adds that when it comes to ovarian cancer, there is a very low incidence up to the age of 30, with the risk increasing with age and peak cases at 75-79; uterine cancer peaks at 75-79; the risk of vaginal cancer rises from the age of 55; and the risk of vulval cancer increases from 35. When it comes to uterine cancer, the UK’s most common gynae cancer, three-quarters of those diagnosed are aged 40 to 74, while just over one in 100 cases occur in women under the age of 40.

Always Attend Your Smear

The cervical screening test, offered to all women in the UK aged 25 to 64, tests for human papilloma virus (HPV) infection and changes in the cells covering the neck of your womb. These changes could later develop into cervical cancer if they aren’t treated. While screening isn’t a test for cancer, it’s a test for abnormal pre-cancerous changes, which can then be treated to stop cancer developing. There are around 200 different types of HPV – around 40 affect the genital area and are low risk, but 13 HPV types are high risk and two types cause 70% of cervical cancer cases. Cervical screening is highly effective at preventing cervical cancer, saving around 4,500 lives every year in England alone. Worryingly, cervical screening attendance is at its lowest in 21 years in the UK, with recent figures showing one in four women recently skipped an appointment. 

Know The Next Steps

If your cervical screening test comes back negative, no further action will be taken, and you will be called back on the regular three to five year pattern. If, however, your test comes back positive for HPV and abnormal cells, you will require a colposcopy, explains Victoria. “The area that has the abnormal cells is usually treated under local anaesthetic. A small cone-like section of the cervix is removed and sent to histology. Stats show 95-98% of women are cured after a one-off treatment. The process can be uncomfortable, rather like a period pain, and sex should be avoided for six weeks, but this will prevent cells from becoming cancerous.” Victoria also explains a smear test can come back ‘inadequate’, which means there was not enough of a sample to provide a clear reading – in this case, you’ll need to have a repeat test, but it is not a cause for alarm. 

Each year in the UK, over 21,000 women are diagnosed with a gynaecological cancer, equivalent to 58 daily diagnoses.

Understand Knowledge Is Power

When it comes to reducing your risk of gynaecological cancers, John says tackling obesity is imperative. In fact, around one-third of uterine cancer cases are caused by obesity, according to Cancer Research UK. “This would make the greatest difference to gynaecological cancer outcomes – it would not only reduce uterine cancer incidence but also help patients with treatment. For many patients, cancer treatment is trickier to deliver if the patient is obese and suffering from associated health conditions such as heart problems and diabetes.” Getting to know your body and keeping an eye out for symptoms is also vital, says John. “Knowledge is power and I thoroughly recommend using apps to monitor menstrual cycles, weight and exercise. The more in tune we are with our bodies, the more likely we are not only to detect any health problems but also focus on health improvement.”

Prepare For An Appointment

If you’ve noticed any changes in your vaginal health, don’t hesitate to see your GP, and never wait until your next smear to discuss these issues. The experts say it can help to come ready to your appointment with your menstrual history, and the clearer you are with your symptoms, the better. Your GP will want to know how long you’ve been experiencing symptoms, such as irregular bleeding. Apps like Health Mapper can make you more aware of any irregularities. Also find out if there have been cases of ovarian or breast cancer among your female relatives; bowel cancer is also associated with ovarian cancer, so ask about that, too. If you have two first-degree relatives who have had breast or ovarian cancer at an early age, ask your GP if you should be considered for a genetic risk assessment to see if you carry the BRCA gene, which is linked to higher rates of these cancers.

MY OVARIAN CANCER EXPERIENCE: Emily Plane, 25

“Fresh out of university in 2018, I moved to London. I’d been struggling with niggling tummy pains for around a year and had been to the GP countless times. I was finally diagnosed with severe IBS, popping two painkillers a day to cope with the pain. By December 2018, the pain was unbearable, so I checked into A&E. They quickly discovered a mass in my lower abdomen, but, unsure what it was, they consulted with specialists from the Royal Marsden Hospital. At the time, I had no idea the Royal Marsden was the UK’s leading cancer hospital. 

Transferring to the Royal Marsden with a suggestion that ‘it might be cancer’, I met John Butler. He showed me my scans and I stared at the screen – the tumour was there in black and white, the size of a grapefruit growing in my pelvis and pushing my other organs out the way. In January 2019, I was diagnosed with Stage III ovarian cancer and I would need a full hysterectomy as the tumour had impacted my womb and ovaries. I visited a fertility specialist but was told retrieval of my eggs would be too dangerous, as the tumour needed to be removed urgently. I was inconsolable – all I had ever dreamed of was being a mother. This was an unbearably hard pill to swallow.

One week later, John removed the tumour, my ovaries and any other visible signs of cancer which had spread up to my diaphragm and around my liver. Unfortunately, the cancer has also extended into part of my bowel so I had to have a permanent colostomy bag fitted – another devastating blow. The 30cm scar down my tummy I could hide, the hysterectomy I could hide, but this was too much. Everything seemed to crash down around me. 

Recovery was tough. I was unable to even cry, the endless list of worries swirled round in my head, as I tried to make sense of what was going on. My mum and three best friends were by my side every day, holding my hand – they never let me see them upset. They are so much stronger than me and I will forever be in awe of them.

Three weeks later, the first of six rounds of chemo started on Valentine’s Day (in years to come if I'm ever crying over a tub of ice cream about how single I am, I know things can be a lot worse). Two days before, I had the dreaded hair appointment. I shaved my head as a way of taking control over what was happening. I became a passenger on the rollercoaster ride that was cancer, pit stopping for chemo every three weeks. Three days after my 24th birthday, I received the all-clear, and went on a three-week cycle of preventive chemotherapy with scans every three months.

Having just finished this preventative chemo, I recently received the news that two small tumours have been found on my kidneys. While the doctors haven’t confirmed whether it’s cancer or not, the chances are pretty high. I started on tablet medication this week to stunt the growth of the tumours – I’m just so grateful not to be back on chemo for now.

I'm so thankful to every single doctor and nurse at the Royal Marsden, in particular my incredible surgeon John Butler and oncologist Dr Susana Banerjee. Without them I would not be here writing this. The level of care and support I have received is outstanding and it's weird to call a hospital a home, but for me, that’s what the Royal Marsden is. I feel happier than ever, and just continue to put one foot in front of the other."

Some symptoms, like irregular bleeding, are common across all types of gynaecological cancers, whereas others can be more subtle, and often misattributed. Understanding symptoms will save lives; for more information visit LadyGardenFoundation.com, EveAppeal.org.uk and CancerResearch.org. For more information or to book an appointment with Victoria, visit VictoriaHowellHealthAndWellbeing.co.uk

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