Recognise The Early Symptoms Of Gynaecological Cancers

We are so happy to be collaborating with the Australian Gynaecological Cancer Foundation (AGCF) to raise awareness this September around cancers that affect women's bodies.

It’s important for women to be intimately connected to their own bodies, so to be aware of any changes that may present possible symptoms.

This Journal post is for you to use as a guide in monitoring your body with love and care. Learn to recognise early symptoms.

You know your body best.

WHAT ARE THE DIFFERENT TYPES OF GYNAECOLOGICAL CANCERS?

Endometrial cancer

This is the commonest gynaecological cancer and most commonly occurs in post-menopausal women. When it occurs in premenopausal women, it is often associated with the hereditary Lynch Syndrome, which is also associated with hereditary bowel cancer.

The typical early symptom of endometrial cancer is abnormal vaginal bleeding, and the bleeding occurs early in the course of the disease. As most patients are postmenopausal, the bleeding usually causes women to seek medical advice. Most postmenopausal bleeding is caused by either the use of hormone replacement therapy or by atrophy of the vagina from lack of hormones, but endometrial cancer always needs to be excluded.

Some confusion arises when the abnormal bleeding occurs in pre- or perimenopausal women, and both patient and physician delay may occur. Bleeding between periods is usually assumed to be “hormonal” initially, but if it persists, medical advice should be sought.

Menopause should be associated with both decreasing frequency and decreasing volume of menstrual bleeding. Any increase in the frequency or volume of the bleeding should arouse suspicion.

Symptoms:

Abnormal vaginal bleeding

Ovarian cancer

This is the second most common gynaecological cancer and is the most difficult to diagnose early. Much research is ongoing to find a screening test for ovarian cancer.

Unfortunately, without a screening test, the early diagnosis of ovarian cancer is more likely to be related to the aggressiveness of the cancer, than to the early recognition of symptoms. Both early and late stage disease usually present with pelvic or abdominal pain and abdominal swelling (or bloating). With early disease, the abdominal swelling is caused by the large ovarian tumour, whereas with advanced disease, the swelling is caused by a build-up of fluid in the abdomen, called ascites. The ascites usually reflects spread of the cancer to the peritoneum. This usually occurs early in the course of the more common and aggressive ovarian cancers, and the tumour itself is usually still quite small. Other symptoms, such as urinary frequency or urgency, may be caused by pressure on the bladder.

Symptoms:

Abdominal bloating
Increased abdominal size
Pain in the abdomen or pelvis
Loss of appetite
Feeling full quickly after eating
Indigestion
Needing to pee more often, or more urgently
Changes in bowel habits, including constipation
Unexplained weight loss or weight gain
Unexplained fatigue

Fallopian tube cancer

This has now been shown to frequently be the origin of many ovarian cancers, particularly those in women with the hereditary breast and ovarian cancer syndrome. However, tubal cancers can occasionally occur independent of any spread to the ovary. The classical triad of symptoms and signs associated with fallopian tube cancer is watery vaginal discharge, pelvic pain and a pelvic mass.

Symptoms:

swelling of the lower abdomen
A lump in the abdomen
Pain the a abdomen or pelvis
Feeling pressure on the bowel or bladder
Feeling like when you go to the toiler, you can’t empty your bowel or bladder completely
Abnormal bleeding or discharge from the vagina, particularly bleeding after menopause

Uterine cancer

Peritoneal cancer is usually associated with ovarian and fallopian tube cancers. They most commonly occur in women who have had their ovaries or fallopian tubes removed, often many years earlier for hereditary breast/ovarian cancer syndrome.

Symptoms:

Bloody or watery discharge that might smell bad
Discomfort pr pain in the abdomen
Difficulty or pain when bleeding
Pain during sex
Needing between periods, or after menopause

Vulval cancer

Most patients present with a vulvar lump or ulcer. There is often a long history of vulvar itching, which is usually associated with the chronic rash called lichen sclerosus. Being an external organ, it is easy to visualize the cancer, and anyone with lichen sclerosus should be taught to do a monthly inspection of the vulva with a mirror and report any changes. Most cancers occur on the large lips (labia majora), but they may occur anywhere from the clitoris in the front to the perianal area (perineum) at the back. Anyone with frequent rashes should be taught to do a monthly inspection of the vulva with a mirror.

Symptoms:

Itching, burn or pain on the vulva
A lump, sore, swelling or wart-like growth
Thickened or raised patches of skin - could be red, white or brown
A mole that changes colour or shape
A lesion or sore on the vulva
Hard or swiller lymph nodes in the groin

Vaginal cancer

As with cervical cancer, most patients with vaginal cancer present with postcoital bleeding, or with painless vaginal bleeding or a smelly vaginal discharge. As the average of patients is 67 years, most patients present with postmenopausal bleeding. Most cancers occur in the upper one-third of the vagina and should be seen at the time of cervical cancer screening.

Symptoms:

blood stained discharge (not from a period)
Bleeding after sex
Pain in the pelvic area
A lump in the vagina
Difficulty peeing, blood in the pee or needing to pee frequently
Pain in the rectum

Cervical cancer

This disease competes with breast cancer as the commonest cause of death from cancer in women in developing countries, because these countries cannot afford cancer screening. Fortunately, with an organised screening program in Australia since 1991, and Pap smears readily available since the early sixties, most cervical cancers are diagnosed in a precancerous stage called Cervical Intraepithelial Neoplasia (CIN). This precancerous condition produces no symptoms, so is only diagnosed by screening. It can be easily treated, and invasive cancer prevented. The HPV (human papilloma virus) vaccine has also been available in Australia since 2007, and this will markedly reduce the incidence of cervical cancer in the future.

The classical symptom of cervical cancer is bleeding after intercourse (postcoital bleeding). Although postcoital bleeding may be caused by a benign ulcer or polyp on the cervix, cervical cancer must always be excluded when this symptom occurs. In women who are not sexually active, intermenstrual or postmenopausal bleeding may also be due to cervical cancer.

Unlike endometrial cancer which bleeds early, cancer of the cervix can often get quite large before it bleeds spontaneously. Therefore, in women who are not having sexual intercourse, the cancer may become infected, and the first symptom may be a smelly vaginal discharge.

Symptoms:

Bleeding between periods or after sex
Pain during sex
Longer or heavier periods than usual
Unusual discharge
Bleeding after menopause

Tumours of the Placenta

These tumours are called Gestational Trophoblastic Disease, and include benign hydatidiform moles, invasive moles and choriocarcinoma. The placenta, or afterbirth, produces the hormone human chorionic gonadotropin (hCG), which is easily measured in the blood or urine.

Hydatidiform moles, which are benign, occur in about one per 1000 pregnancies in Australia. Almost all present with vaginal bleeding, usually in the late first or early second trimester of pregnancy. Other symptoms include a larger than expected size of the uterus, excessive vomiting and early toxaemia (hypertension). Definitive diagnosis is made by ultrasound and the uterus should be evacuated by suction curettage. There is no baby present in patients with a complete mole.

Invasive moles, in which the trophoblastic tumour invades the muscle of the uterus, occur in about 15% of patients following evacuation of a mole. The hCG levels in the blood should be followed after the mole has been evacuated, and an invasive mole is diagnosed when the levels fail to return to normal.

Choriocarcinomas occur after about 4% of hydatidiform moles but can occasionally occur after a normal full-term or ectopic pregnancy. Choriocarcinomas are associated with widespread metastases, usually to the lungs or vagina, but occasionally to the brain, liver or other organs. Hence, symptoms are varied, and include such things as persistent cough or shortness of breath, abnormal vaginal bleeding, jaundice or neurological symptoms, such as nausea and vomiting, headaches or slurred speech. When the presentation follows a normal or ectopic pregnancy, diagnosis is usually delayed. Fortunately, when managed in expert centres, even patients with extensive metastatic disease have a good cure rate with combination chemotherapy.

Symptoms: