Gynaecological cancers

'Gynaecological cancer' refers to the five cancers that start in a woman's reproductive system - ovarian cancer, womb cancer (also known as endometrial or uterine cancer), cervical cancer, vaginal cancer and vulval cancer. Professor Manyonda and Dr Talaulikar consider womb and cervical cancer.

Some women are affected by gynaecological cancers before the menopause. Menopause does not cause cancer, but the risk of developing cancer does increase as one gets older.

Prevention

Leading a healthy lifestyle can help to prevent cancers. During and after menopause is no different. The following can help reduce the risk of cancer:

• participating in the cervical and breast screening programmes;
• eating a healthy diet;
• exercising regularly;
• not smoking and avoiding second-hand smoke;
• maintaining a healthy body weight.

Uterine cancer is the most common gynaecological cancer. The endometrium is the lining of the womb, where most womb cancers start. Any woman presenting with vaginal bleeding after menopause is recommended to have tests (such as pelvic ultrasound) to check the lining of the womb. The most common symptom of womb cancer is abnormal bleeding from the vagina, especially in women who have stopped having periods. Abnormal bleeding can be: vaginal bleeding after the menopause; bleeding that is unusually heavy or happens between periods; or vaginal discharge (from pink and watery to dark and foul smelling). About 9 out of 10 womb cancers (90%) are picked up because of post-menopausal or irregular vaginal bleeding.

Uterine cancer most often occurs in women over 50. The average age at diagnosis is 60. Uterine cancer is not common in women younger than 45.

Fatty tissue in women who are overweight produces additional oestrogen, a sex hormone that can increase the risk of uterine cancer. This risk increases with an increase in Body Mass Index (BMI), which is the ratio of a person's weight to height. About 70% of uterine cancer cases are linked to obesity. White women are more likely to develop uterine cancer than women of other races / ethnicities. However, black women have a higher chance of being diagnosed with advanced uterine cancer. Black women and Hispanic women also have a higher risk of developing aggressive tumours.

Uterine cancer may run in families where colon cancer is hereditary. Women in families with Lynch syndrome, also called hereditary non-polyposis colorectal cancer (HNPCC), have a higher risk for uterine cancer. It is recommended that all women under the age of 60 with endometrial cancer should have their tumour tested for Lynch syndrome, even if they have no family history of colon cancer or other cancers. The presence of Lynch syndrome has important implications for women and their family members. About 2% to 5% of women with endometrial cancer have Lynch syndrome. Women have an increased risk of uterine cancer if they have diabetes, which is often associated with obesity. Women who have had breast cancer, colon cancer, or ovarian cancer have an increased risk of uterine cancer. Also, women taking the drug tamoxifen to prevent or treat breast cancer have an increased risk of developing uterine cancer.

Extended exposure to oestrogen and / or an imbalance of oestrogen is linked to uterine cancer. This is related to the following:

• women who started having their periods before age 12 and / or go through menopause later in life;
• women who take long-term cyclic hormone replacement therapy (HRT) after menopause (continuous bleed free HRT with daily progesterone reduces the risk); and
• women who have never been pregnant.

Research has shown that certain factors can lower the risk of uterine cancer: taking birth control pills;

1. using a progestin-secreting intrauterine device as a form of birth control (Mirena coil, for example);
2. using continuous combined HRT rather than cyclic HRT;
3. maintaining a healthy weight; and
4. ensuring good diabetic control.

Depending on the stage of cancer, the potential side effects, general health and preferences, one or more of the following treatments are offered for womb cancer: surgery; radiotherapy; chemotherapy; and hormone therapy.

Cervical cancer affects the cells of the lining of the cervix (the neck of the womb), which is the opening from the womb to the vagina and also the canal that connects the womb to the vagina. Every year in the UK, over 3000 women will be diagnosed with cervical cancer. Cervical cancer is the most common cancer in women aged 35 and under. Almost all cases of cervical cancer (99.7%) are caused by infections with certain types of human papilloma virus (HPV). HPV is a very common infection that four out of five sexually active adults will come into contact with in their lives. It is contracted through any skin-to-skin contact, including genital-to-genital contact, anal, vaginal and oral sex.

Symptoms related to cervical cancer include: abnormal bleeding during or after sexual intercourse or between periods; post-menopausal bleeding; unusual vaginal discharge; discomfort or pain during sexual intercourse; and lower back pain.

Practicing safe sex through the regular use of condoms can help reduce the risk of being infected with high-risk HPV, though it will not completely eradicate the risk as HPV lives on the skin in and around the whole genital area. Attending cervical screening (smear test) when invited (25-64 years) can help to find cervical abnormalities and HPV infections before they are able to develop into cervical cancer. Also, getting the HPV vaccination can protect from the high-risk HPV types 16 and 18 that cause 70% of all cervical cancers. Depending on the stage of cancer, the potential side effects, general health and preferences, the treatment of cervical cancer consists of one of the following: surgery; radiotherapy; chemotherapy.

Being diagnosed with cancer, and the treatment that follows, can be a very difficult thing to cope with. The support of family, friends, healthcare professionals and other people with similar experiences can be invaluable at this time.

For more information, you can contact Professor Manyonda and Dr Talaulikar at the Menopause Clinic, London