Gynaecological Cancer

There are many types of gynaecological cancers, often called womens’ cancers. The three most common gynaecological cancers are:

endometrial (womb lining) cancer
ovarian cancer
cervical cancer (cancer of the neck of the womb)

Cancer of the vulva, cancer of the vagina and cancer of the fallopian tube/ peritoneal cancer are rare.

Cancer is a disease of the cells in the body. The body is made up from millions of tiny cells. There are many different types of cell in the body and there are many different types of cancer which arise from different types of cell. What all types of cancer have in common is that the cancer cells are abnormal and multiply ‘out of control’.

A malignant tumour is a lump or growth of tissue made up from cancer cells which continue to multiply. Malignant tumours invade into nearby tissues and organs, which can cause damage. Malignant tumours may also spread to other parts of the body. This happens if some cells break off from the first (primary) tumour and are carried in the bloodstream or lymph channels to other parts of the body. These small groups of cells may then multiply to form ‘secondary’ tumours (metastases) in one or more parts of the body. These secondary tumours may then grow, invade and damage nearby tissues and can spread again.

Some cancers are more serious than others, some are more easily treated than others (particularly if diagnosed at an early stage), some have a better outlook (prognosis) than others. So, cancer is not just one condition. In each case it is important to know exactly what type of cancer has developed, how large it has become and whether it has spread. This will enable you to get reliable information on treatment options and outlook.

Symptoms of Cancers

Symptoms can vary depending on the type of cancer:ovarian cancer, endometrial cancer, cervical cancer, cancer of the vagina, cancer of the fallopian tube/peritoneal cancer

For more information on symptoms of cancer, please follow the link below. You may also find a brief information on the other cancers, and further links on this site.

http://www.guysandstthomas.nhs.uk/Search/search.aspx?SearchKey=s5o0fmn%2fxCQJHymh4dF6pBFTxFc%3d&search_keywords=gynaecological%20cancers

Ovarian Cancer

Ovarian cancer (cancer of the ovary) is the fifth most common cancer in the UK. It is more common than cervical cancer (cancer of the cervix). About 7,000 women are diagnosed with it every year in the UK. The majority of cases are in women aged over 50 years, although it can occur in younger women

Women have two ovaries, one on either side of the uterus (womb) in the lower abdomen. Ovaries are small and round, each about the size of a walnut. The ovaries make eggs. In fertile women, each month an egg (ovum) is released from one of the ovaries. The egg passes down the Fallopian tube into the uterus where it may be fertilised by a sperm. The ovaries also make hormones including the main female hormones – oestrogen and progesterone. These hormones pass into the bloodstream and have various effects on other parts of the body, including regulating the menstrual cycle.

Causes of Ovarian Cancer

Most cases of ovarian cancer (cancer of the ovary) develop in women over the age of 50. The cause is not clear. Some ovarian cancers can be cured. In general, the more advanced the cancer (the more it has grown and spread), the less chance that treatment will be curative. A cancerous tumour starts from one abnormal cell. The exact reason why a cell becomes cancerous is unclear. It is thought that something damages or alters certain genes in the cell. This makes the cells abnormal and multiply out of control. In most cases, the reason why an ovarian cancer develops is not known. However, there are factors which are known to alter the risk of ovarian cancer developing. These include:

Age. Most cases occur in women over the age of 50 years.
Ovulation factors. Factors that reduce the number of times a woman will ovulate slightly lower the risk. For example, taking the combined oral contraceptive pill (COCP), having children and breast-feeding. In contrast, not having children and having a late menopause slightly increases the risk.
Being overweight or obese increases the risk.
Taking hormone replacement therapy (HRT) may slightly increase the risk.
Sterilisation or hysterectomy (removal of the uterus) appears to reduce the risk slightly.
Taking the COCP provides some protection from ovarian cancer. This protection seems to continue for many years after stopping the pill.
Genetic factors – see below.

Family history and genetic testing

Most cases of ovarian cancer are not due to genetic or hereditary factors. Around one in twenty cases is due to faulty genes which increase the risk of cancer of the breast and ovary. Some women are referred for genetic testing if a faulty gene is suspected on the basis of a strong family history of cancer. The most common genes are BRCA1 and BRCA2. For example, if you have two or more close relatives who have had ovarian or breast cancer at a young age (or certain other cancers), you may benefit from genetic testing. If this applies to you then it is advised that you see your GP to talk it through to establish if you should be referred for genetic testing. In addition, if you are eligible for enhanced breast screening due to a family history of breast cancer, you should be aware of the early symptoms of ovarian cancer (see below).

Types of Ovarian Cancers

There are various types of ovarian cancer. The treatments and prognosis (outlook) are different for each type of ovarian cancer They are classified by the type of cell from which the cancer originates:

Epithelial ovarian cancer is the most common type (about 9 in 10 cases). This type of cancer develops from one of the cells that surrounds the outside of each ovary. This outer layer of cells is called the germinal epithelium of the ovary. Epithelial ovarian cancer mainly affects women who have had their menopause – usually women aged over 50. It is rare in younger women. There are various subtypes depending on the exact look of the cells causing the cancer (which can be seen under the microscope).
Germ cell ovarian cancer develops from germ cells (the cells that make the eggs). About 1 in 10 cases of ovarian cancer are germ cell cancers. They typically develop in younger women. Again, there are various subtypes depending on the exact look of the cells causing the cancer. Most cases of germ cell ovarian cancer are curable, even if diagnosed at a late stage, as it usually responds well to treatment.
Stromal ovarian cancer develops from connective tissue cells (the cells that fill the ovary and produce hormones). This type of cancer is rare.

Symptoms of (epithelial) Ovarian Cancer?

In many cases, no symptoms develop for quite some time after the cancer first develops. Symptoms may only be noticed when the cancerous tumour has become quite large. As the tumour grows, the most common early symptoms include one or more of the following:

Constant pain or a feeling of pressure in the lower abdomen (pelvic area).
Bloating in the abdomen that does not go away (not bloating that comes and goes). There may also be an actual increase in size of your abdomen.
Difficulty eating, and feeling full quickly.
Loss of appetite.
Weight loss.
Pain in the lower abdomen when having sex.
Passing urine frequently (as the bladder is irritated by the nearby tumour).
Change in bowel habit such as constipation or diarrhoea.
A more marked swelling of the abdomen. This is caused by ascites, which is a collection of fluid in the abdomen. It is caused by the growth and spread of the cancer to the inside of the abdomen which causes fluid to accumulate.

All of the above symptoms can be caused by various other conditions. Also, when symptoms first start they are often vague for some time, such as mild discomfort in the lower abdomen. These symptoms may be thought to be due to other conditions. The possibility of ovarian cancer may not be considered for some time until the symptoms get worse. In particular, one condition that is often mistaken for ovarian cancer is irritable bowel syndrome (IBS). But, it is uncommon for IBS to first develop in women over the age of 50. (IBS typically first develops at a younger age – but may persist into later life). So, if you have not had IBS type symptoms in the past but then develop them aged over 50, then ovarian cancer should be considered and ruled out (usually by tests) before making a diagnosis of IBS. If the cancer spreads to other parts of the body, various other symptoms can develop

For further information on Ovarian Cancers, follow the link below:
http://www.patient.co.uk/health/ovarian-cancer#section_2

Endometrial Cancer

Most cases of uterine cancer (cancer of the uterus) arise from the inside lining of the uterus (the endometrium). This is called endometrial cancer. About 4500 women in the UK develop endometrial cancer each year. Most cases develop in women in their 50s and 60s. It rarely develops in women under the age of 50.

The uterus (womb) is in the lower abdomen behind the bladder. The inside of the uterus is where a baby grows if you become pregnant. The inside lining of the uterus is called the endometrium. This builds up and is then shed each month as a ‘period’ in women who have not yet gone through the menopause. The thick body of the uterus is called the myometrium and is made of specialised muscle tissue. The lowest part of the uterus is called the cervix which pushes just into the top part of the vagina. At the top of the uterus are the right and left fallopian tubes which carry the eggs released from the ovaries to the inside of the uterus.

Type and grade of endometrial cancer

Most cases of endometrial cancer are called ‘endometrioid adenocarcinomas’. These arise from cells which form the glandular tissue in the lining of the endometrium. A sample of cancer tissue can be looked at under the microscope. By looking at certain features of the cells the cancer can be ‘graded’.

Grade 1 (low grade) – the cells look reasonably similar to normal endometrial cells. The cancer cells are said to be ‘well differentiated’. The cancer cells tend to grow and multiply quite slowly and are not so ‘aggressive’.
Grade 2 – is a middle grade.
Grade 3 – the cells look very abnormal and are said to be ‘poorly differentiated’. The cancer cells tend to grow and multiply quite quickly and are more ‘aggressive’.

There are also some rarer types of endometrial cancer.

Causes of Endometrial Cancer

A cancerous tumour starts from one abnormal endometrial cell. The exact reason why a cell becomes cancerous is unclear. It is thought that something damages or alters certain genes in the cell. This makes the cells abnormal and multiply ‘out of control’. There are ‘risk factors’ which are known to increase the risk of endometrial cancer developing. These include the following:

Increased exposure to oestrogen.Oestrogen is the main female hormone. Before the menopause the changing level of oestrogen together with another hormone, progesterone, cause the endometrium to build up each month and then be shed as a period. It is thought that factors which lead to prolonged higher than usual levels of oestrogen, or increased levels of oestrogen not being ‘balanced’ by progesterone, may somehow increase the risk of endometrial cells becoming cancerous. These include:
- If you have never had a baby. (Your uterus has never had a ‘rest’ from the cyclical rise of oestrogen every month.)
- If you are overweight or obese. (Fat cells make a certain amount of oestrogen.)
- If you have certain rare oestrogen producing tumours.
- If you have a late menopause (after the age of 52) or started periods at a young age.
Endometrial hyperplasia. This is a benign (non cancerous) condition where the endometrium builds up more than usual. It can cause heavy periods or irregular bleeding after the menopause. Most women with this condition do not develop cancer, but the risk is slightly increased.
Tamoxifen. This is a drug which is used in the treatment of breast cancer. The risk of developing endometrial cancer from tamoxifen is very small – about 1 in 500. However, the benefits of taking tamoxifen usually outweigh the risks.
Diabetes. There is a small increased risk in women with diabetes.
Polycystic ovary syndrome. There is a very slight increased risk in women with this condition.
Diet. There are much fewer cases of endometrial cancer in certain eastern countries and dietary factors may be the reason. A western diet high in fat may be a contributing factor.
Genetic factors. Most cases are not due to genetic or hereditary factors. However, in a small number of cases, a ‘faulty’ gene which can be inherited may trigger the disease. This disorder is called hereditary nonpolyposis colon cancer (HNPCC).

Women who take the combined oral contraceptive pill have a lower risk of developing endometrial cancer.

Symptoms of Endometrial Cancer

In most cases the first symptom to develop is abnormal vaginal bleeding such as:

Vaginal bleeding past the menopause. This can range from ‘spotting’ to more heavy bleeds. This is the most common symptom of endometrial cancer.
Bleeding after having sex (post coital bleeding).
Bleeding between normal periods (intermenstrual bleeding) in women who have not
gone through the menopause.

Early symptoms that occur in some cases are: pain during or after having sex, vaginal discharge, and pain in the lower abdomen.

All of the above symptoms can be caused by various other common conditions. However, if you develop any of these symptoms, you should see your doctor.

Note: a cervical screening test does not screen for endometrial cancer.

In time, if the cancer spreads to other parts of the body, various other symptoms can develop.

For further information on Endometrial Cancer, please follow the link below:

http://www.patient.co.uk/health/uterine-endometrial-cancer#section_4

Cervical Cancer

Cervical cancer (cancer of the cervix) is cancer of the neck of the womb. The cervix is the lower part of the uterus (womb) which extends slightly into the top of the vagina. Most cases develop in women in their 40s to 60s. If cervical cancer is diagnosed at an early stage, there is a good chance of a cure. Regular cervical screening tests can detect ‘pre-cancer’ which can be treated before cancer develops

A narrow passage called the cervical canal (or endocervical canal) goes from the vagina to the inside of the uterus. This is normally kept quite tightly shut, but allows blood to flow out from the uterus during a period, and sperm to travel inside if you have sex. It opens very wide during labour if you have a baby. The surface of the cervix is covered with skin-like cells. There are also some tiny glands in the lining of cervical canal which make mucus.

There are two main types of cervical cancer:

Squamous cell cervical cancer is the most common. This develops from a skin-like cell (a squamous cell) that covers the cervix which becomes cancerous.
Adenocarcinoma cervical cancer is less common. This develops from a glandular cell (a cell that makes mucus) within the cervical canal which becomes cancerous.

Cervical cancer is the second most common type of cancer in women in the UK. It kills just over 1,000 women every year in the UK. However, the number of cases diagnosed each year has fallen over recent years. This is because cervical cancer can be prevented by regular cervical screening tests (see Cervical Screening and Colposcopy).

Causes of Cervical Cancer?

In the case of cervical cancer, the cancer develops from a cell which is already abnormal. In most cases, abnormal cells are present for years before one of the abnormal cells becomes cancerous and starts to multiply out of control into a cancerous tumour. The initial ‘pre-cancerous’ abnormality of cervical cells is usually caused by a prior infection with the human papilloma virus.

Human papilloma virus (HPV) and cervical cancer

There are many strains of HPV. Two types, HPV 16 and 18, are involved in the development of most cases of cervical cancer. (Note: some other strains of HPV cause common warts and verrucas. These strains of HPV are not associated with cervical cancer.) The strains of HPV associated with cervical cancer are nearly always passed on by having sex with an infected person. An infection with one of these strains of HPV does not usually cause symptoms. So, you cannot tell if you or the person you have sex with are infected with one of these strains of HPV.

In some women, the strains of HPV that are associated with cervical cancer affect the cells of the cervix. This makes them more likely to become abnormal which may later (usually years later) turn into cancerous cells. Note: within two years, 9 out of 10 infections with HPV will clear completely from the body. This means that most women who are infected with these strains of HPV do not develop cancer.

The HPV vaccine has recently been introduced for girls from the age of 12 in the UK. Studies have shown that the HPV vaccine is very effective at stopping cancer of the cervix developing. The vaccine has been shown to work better for people who are given the vaccine when they are younger, before they are sexually active, compared to when it is given to adults. However, even if you have had the HPV vaccine you must attend for cervical screening. This is because the vaccine does not guarantee complete protection against cervical cancer.

Other factors

Other factors that increase the risk of developing cervical cancer include the following:

Smoking. Chemicals from cigarettes get into the bloodstream and can affect cells throughout the body. Smokers are more likely than non-smokers to develop certain cancers, including cervical cancer. In particular, if you smoke and have HPV infection, the risk is compounded.
A poor immune system. For example, people with AIDS or people taking immunosuppressant medication have an increased risk. (If your immune system is not working fully then you are less able to deal with HPV infection and abnormal cells and you are more at risk of developing cervical cancer.)
There is a possible link between the combined oral contraceptive pill (“the pill”) and a slight increased risk of cervical cancer if the pill is taken for more than eight years.

Symptoms of Cervical Cancer

You may have no symptoms at first when the tumour is small. As the tumour becomes larger, in most cases the first symptom to develop is abnormal vaginal bleeding such as:

Bleeding between normal periods (intermenstrual bleeding).
Bleeding after having sex (post coital bleeding).
Any vaginal bleeding in women past the menopause.

An early symptom in some cases is a vaginal discharge that smells unpleasant, or discomfort or pain during sex. All of the above symptoms can be caused by various other common conditions. But if you develop any of these symptoms, you should have it checked out by a doctor. In time, if the cancer spreads to other parts of the body, various other symptoms can develop.

For further information on Cancer of the Cervix, please visit:

http://www.patient.co.uk/health/Cancer-of-the-Cervix.htm#section_3

Vulva Cancer

Vulval cancer (cancer of the vulva) is an uncommon cancer. It usually affects women over 55 although it can also affect younger women. The commonest symptoms are a persistent itch or pain in the vulval area. Many vulval cancers start as a sore or lump in the vulva. Vulval cancer is usually treated by an operation to remove the cancer. Most vulval cancers can be cured. The outlook is good in women who have small cancers that have not spread.

Vulval cancer can occur on any part of the vulva. It most commonly develops on the inner edges of the labia majora and the labia minora. It can also sometimes affect the clitoris or the Bartholin glands (small glands on each side of the vagina). It can also occasionally start on the perineum (the skin between the vulva and the anus).

Most vulval cancers are squamous cell cancers. This means they have developed from the skin cells in the outer layer of the vulva. Around 4 in 100 cases of vulval cancers are due to a melanoma which develops from cells in the skin that cause pigmentation.

Causes of Vulval Cancer

Vulval cancer is an uncommon cancer. There are around 1000 new cases each year in the UK. It usually affects women between the ages of 55 and 75. However, it is becoming more common in younger women. In many cases, the reason why a vulval cancer develops is not known. However, there are factors which are known to alter the risk of vulval cancer developing. These include:

Age. Most cases develop in people over the age of 55.
A condition called VIN (vulval intraepithelial neoplasia) can occur in the skin of the vulva. The most common symptom of VIN is a persistent itch. Areas of skin affected by VIN can look thickened and swollen, with red, white or dark coloured patches. Around one third of vulval cancers develop in women who have VIN.
Human papilloma virus (HPV). This is an infection which is passed between people during sex. Some types of HPV, including types 16, 18 and 31 can lead to VIN developing. However, more that half of all vulval cancers are not related to HPV infection.
Lichen sclerosus and lichen planus. These are two conditions that cause long-term inflammation of the skin in the vaginal area. Although almost two-thirds of vulval cancers occur in women who have lichen sclerosus, only between one and two in a hundred women who have lichen sclerosus will develop vulval cancer.
Genital herpes. Infection with the genital herpes virus type 2 increases the risk of vulval cancer. However, most women who have genital herpes do not develop vulval cancer.
Smoking. Smoking increases the risk of developing both VIN and vulval cancer.

Note: vulval cancer is not an inherited condition and does not usually run in families.

Symptoms of Vulval Cancer

The symptoms of vulval cancer can vary between women. They may include:

A persistent itch.
Pain or soreness in the vulval area.
Thickened, raised, red, white or dark patches on the skin of the vulva.
An open sore or growth that does not improve.
Burning pain when you pass urine.
Vaginal discharge or bleeding.
A lump or swelling in the vulva.
A mole on the vulva that changes shape or colour.

Note: All these symptoms can be caused by other conditions which are not cancer. If you have any of these symptoms, then you should see your doctor.

Vulval cancer can take many years to develop as it usually grows slowly. As with other cancers, it is easier to treat and cure if it is diagnosed at an early stage.

For more information on Vulva Cancers, please follow the link below:

http://www.patient.co.uk/health/vulval-cancer#section_3