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Cape Byron Medical Centre

Pink Ribbon – women’s cancers (ovarian, breast, cervical, vulvar, uterine) questions and answers

Introduction

The figures are not good. Approximately 50 women are diagnosed with breast or a gynaecological cancer every single day in Australia. That’s what Pink Ribbon is all about – raising awareness of women’s cancers, and of course, raising much needed funds to help fight them. So what are women’s cancers, how do we test for them, and most importantly, how do we treat them?

Here, we outline what you need to know about the six common women’s cancers.

OVARIAN CANCER
  1. Are there any symptoms?
    The symptoms of ovarian cancer can often be vague, especially in the early stages of the disease. However, it is important to seek medical advice if you are experiencing symptoms that are unusual or persist for longer than normal. Some of these symptoms can include: vague abdominal pain or pressure; feeling of abdominal fullness; gas; nausea and indigestion; sudden abdominal swelling; weight gain or bloating; persistent changes in bowel or bladder patterns; low backache or cramps; abnormal vaginal bleeding, pain during intercourse and unexplained weight loss.
  2. When, who and at what age should women be tested?
    Women aged 18 and older should have a mandatory annual vaginal/pelvic examination to check for ovarian cancer. As well as the pelvic examination, there are two other tests that can performed – a transvaginal ultrasound (TVUS) and the CA-125 blood test.
  3. How are the tests done (blood tests, scans)?
    The TVUS (transvaginal ultrasound) is a test that uses sound waves to look at the uterus, fallopian tubes, and ovaries by putting an ultrasound wand into the vagina.
  4. Who does the testing?
    Your GP will conduct the pelvic examination while blood tests are sent off to pathology for examination and diagnosis. The TVUS ultrasound is performed at a radiologist clinic.
  5. What are the statistics?
    Ovarian cancer is the eighth most common cancer affecting women in Australia. The risk of being diagnosed before the age 85 is 1-in-81. In 2016, there were 938 deaths caused by ovarian cancer in Australia. The five-year survival rate for ovarian cancer is 45 percent. Unfortunately, about 70 percent of patients diagnosed with ovarian cancer will have a recurrence. One of the factors in determining a patient’s risk of recurrence is the stage of the cancer at diagnosis. Patients diagnosed in stage one, have a 10 percent chance of recurrence. So, like all cancers, the earlier the diagnoses, the better the outcome.
  6. Is there more than one type?
    There are three types of ovarian cancer. The common epithelial type (90 percent of cases) arises from the cells on the outside of the ovary; the germ-cell type (around 4 percent of cases) arises from the cells which produce eggs; and the rare stromal type arises from supporting tissues within the ovary.
  7. How is it treated?
    Treatment for ovarian cancer usually involves a combination of surgery and chemotherapy. Radiotherapy may also be considered. The type of treatment women receive de-pends on the type and stage of their ovarian cancer and their general health. Treatment is best managed by a gynaecological oncologist.
  8. Is it hereditary?
    Ovarian cancer can be inherited. About 20 to 25 percent of women diagnosed with the disease have a hereditary tendency to ovarian cancer. The most significant risk factor is an inherited genetic mutation in one of two genes: breast cancer gene 1 (BRCA1) or breast cancer gene 2 (BRCA2). Risk factors also include age, being overweight, using talcum powder, using Hormone Replacement Therapy (HRT), Endometriosis, smoking and diabetes.
  9. Can I do anything to lower my risk?
    Although there is no known way to completely prevent ovarian cancer, research has shown that there are some things that can reduce a woman’s risk of developing the disease. They include: taking oral contraception (birth control pills), breastfeeding and pregnancy, tubal ligation, hysterectomy, prophylactic oophorectomy (surgical removal of one or both ovaries) and of course maintaining a healthy, diet, healthy weight and getting plenty of exercise.
BREAST CANCER

1.Are there any symptoms?
Both women and men can develop breast cancer, although breast cancer is rare in men. Some people have no symptoms and the breast cancer is found during a routine mammogram or by a physical examination by a doctor. If you do have symptoms they can include a lump, lumpiness or thickening of the breast; changes in the size or shape of the breast; changes to the nipple; changes in the skin of the breast such as dimpling or indentation; a rash or scaly appearance; swelling or discomfort in the armpit.

  1. When, who and at what age should women be tested? How are the tests done and who does the testing?
    All woman, regardless of their age, should be aware of how their breasts normally look and feel. Self-examination in the shower is recommended. It is also recommended that women aged between 40 and 44 should have the choice to start annual breast cancer screening with mammograms (x-rays of the breast) if they wish to do so. Women aged between 50–74 years can attend the BreastScreen Australia Program for free two-yearly screening mammograms. An annual breast examination by a GP is also recommended.
  2. What are the statistics?
    Apart from non-melanoma skin cancer, breast cancer is the most common cancer, found in Australian women. It represents 28 per cent of all cancers diagnosed in women. About 17,000 women are diagnosed with breast cancer each year, and one-in-eight will be diagnosed by the age of 85. Breast cancer can occur at any age, but it’s more common in women over the age of 40. Almost 70 percent of breast cancers are diagnosed in women aged 40–69, and about 25 percent are diagnosed in women aged 70 and over.
  3. Is there more than one type?
    There are many types of breast cancer. The most common types include ductal carcinoma in situ; invasive ductal carcinoma and invasive lobular carcinoma. The type of breast cancer is determined by the specific cells in the breast that are affected. Most breast cancers are carcinomas.
  4. How is it treated?
    Breast cancer treatments vary from person-to-person. Treatments can include: neoadjuvant chemotherapy, surgery, chemotherapy, radiotherapy, targeted therapy and hormone therapy.
  5. Is it hereditary?
    You may be surprised to know that 90–95 percent of all breast cancers have nothing to do with family history. While no one actually inherits breast cancer, a small number of women do inherit a genetic predisposition to the disease. Approximately 5–10 percent of breast cancers occur in women whose families have a genetic fault. The BRCA1 and BRCA2 are gene mutations that are connected to hereditary breast cancer. If two or more of your relatives (mother, sister, daughter, grandmother, aunt or niece) on the same side of the family have been diagnosed with breast cancer, there is a chance your family may carry a breast cancer gene mutation. While carrying this mutation increases your risk of developing breast cancer, it does not mean that you will definitely get the disease.
  6. Can I do anything to lower my risk?
    There are many things you can do to lower your risk of getting breast cancer. These include: limit your intake of alcohol, stop smoking, control your weight, be physically active, breastfeed, limit the dose and duration of hormone therapy, avoid exposure to radiation and environmental pollution, have regular check-ups with your doctor and have a mammogram every two years.

 

CERVICAL CANCER
  1. Are there any symptoms?
    The most common signs of cervical cancer include: vaginal bleeding between periods; menstrual bleeding that is longer or heavier than usual; bleeding after intercourse; pain during intercourse; unusual vaginal discharge; vaginal bleeding after menopause; excessive tiredness; leg pain or swelling or low back pain.
  2. When, who and at what age should women be tested? How are the tests done, and who does the testing?
    The HPV vaccine is a vaccine available against specific types of HPV that cause almost all cervical cancers. The vaccines currently available in Australia are Gardasil and Cervarix. Through the National Immunisation Program, most girls in Australia will receive the HPV vaccine around the age of 12. If you have been vaccinated against HPV, it’s recommended that you should have your first Cervical Screening test screening at 25 and then every five years after that. The new Cervical Screening test has replaced the Pap Smear. Under the new program, most women aged 25-74 will be tested every five years. The Cervical Screening test is available from your GP.
  3. What are the statistics?
    In Australia, it is estimated that about 930 women will be diagnosed with the disease this year, and 258 will die. Globally, one woman dies of cervical cancer every two minutes. Cervical cancer death rates in Australia have halved since the National Cervical Screening Program began in 1991. The five-year survival rate for cervical cancer is 73 percent.
  4. Is there more than one type?
    There are two main types of cervical cancer: squamous cell carcinoma and adenocarcinoma. Each one is distinguished by the appearance of cells under a micro-scope.
  5. How is it treated?
    If cervical cancer is detected, it will be classified in stages – from stage 0, which means abnormal cells are found only in the surface layer of cells lining the cervix to stage IV, which means the cancer has spread to nearby organs such as the bladder or rectum or possibly other organs. Treatment depends on the disease stage. For early and non-bulky disease (less than 4cm), treatment is surgery, sometimes with chemoradiotherapy afterwards. If the tumour is small, a cone biopsy may suffice. in some cases a hysterectomy (surgical removal of the uterus) is required. Radiotherapy and chemotherapy are also used and in some cases of cervical cancer, your medical team may talk about palliative care. Palliative care aims to improve your quality of life by alleviating symptoms of cancer.
  6. Is it hereditary?
    Cervical cancer is not thought to be hereditary. In 99.7 percent of cases, cervical cancers are caused by persistent infections with a virus called high-risk human papillomavirus (HPV). HPV is a very common virus transmitted through skin-to skin contact in the genital area.
  7. Can I do anything to lower my risk?
    As with most cancers, a healthy lifestyle that can help re-duce your chances of developing cervical cancer. Other ways to reduce your risk of getting the dis-ease include getting vaccinated against HPV, getting the Cervical Screening test, not smoking and being monogamous (the risk of HPV increases with more than one sex partner).
CANCER OF THE VULVAR
  1. Are there any symptoms?
    Symptoms of vulvar cancer may include itching, burning and sore-ness or pain in the vulva; a lump, sore, swelling or wart-like growth on the vulva; thickened, raised skin patches in the vulva (may be red, white or dark brown); a mole on the vulva that changes shape or colour; blood, pus or other discharge coming from a lesion or sore spot in the vulva and hard or swollen lymph nodes in the groin area. The vulva is difficult to self-examine so if you feel any pain in your genital area or notice any of the symptoms listed above, make sure visit GP.
  2. When, who and at what age should women be tested? How are the tests done and who does the testing?
    The main tests used to diagnose vulvar cancer are a physical examination, a colposcopy, and a tissue biopsy. These tests are usually performed at the same time. Because vulvar cancer is sometimes associated with cervical cancer, the doctor may also check for abnormal cells in your vagina and cervix.
  3. What are the statistics?
    Each year, about 300 Australian women are diagnosed with vulvar cancer. It most commonly affects women who have gone through menopause, and the average age at diagnosis is 67. However, vulvar cancer can occur in younger women. Vulvar cancer can return after treatment, and this is known as a recurrence. It is very important to have regular check-ups. If the cancer recurs, your doctor may consider further treatment such as surgery, chemotherapy or radiation therapy.
  4. Is there more than one type?
    Types of vulvar cancer include Squamous cell carcinomas, Adeno-carcinoma, melanoma, sarcoma and basal cell carcinoma.
  5. How is it treated?
    Vulvar cancer is generally treated by surgery, radiation therapy and chemotherapy.
  6. Is it hereditary?
    Most vulvar cancers occur by chance due to old age or the human papillomavirus infection. However, an inherited condition called Fanconi Anemia is associated with a significantly increased risk for vulvar cancer. This condition is very rare.
  7. Can I do anything to lower my risk?
    There are several things you can do to lower your risk of getting vulvar cancer. These include avoiding the HPV infection, getting vaccinated (vaccines that protect against certain HPV infections are available), don’t smoke and getting regular pelvic check-ups.
UTERINE CANCER
  1. Are there any symptoms?
    The most likely symptoms are abnormal vaginal bleeding or discharge, which occurs in nine-out-of-10 women with endometrial cancer. Before menopause, this means unusually heavy irregular menstrual periods or bleeding between periods.
  2. When, who and at what age should women be tested? How are the tests done and who does the testing?
    Uterine or Endometrial cancer is diagnosed most often in post-menopausal women at an average age of 60. Diagnoses is usually with a pelvic exam, Pap test, ultrasound, and biopsy. Occasionally, CT or MRI may be done to help confirm the diagnosis. Uterine cancer stages (0 to IV) are determined by biopsy, chest X-ray, and/or CT or MRI scans.
  3. What are the statistics?
    One-in-60 women is likely to be diagnosed with uterine cancer by the age of 75. Each year, about 2,500 Australian women are diagnosed with uterine cancer. The majority of these women are over 50. It is the fifth most common cancer diagnosed in Australian women and the most commonly diagnosed gynaecological cancer in Australia.
  4. Is there more than one type?
    Around 95 percent of uterine cancers are Endometrial cancers or the less common uterine sarcoma which accounts for around 4 of all uterine cancers).
  5. How is it treated?
    Uterine cancer is treated in a number of ways including surgery (hysterectomy), radiation therapy, chemotherapy and hormone therapy.
  6. Is it hereditary?
    Uterine cancer may run in families where colon cancer is hereditary. For instance, women in families with Lynch syndrome, also called hereditary non-polyposis colorectal cancer (HNPCC), have a higher risk for uterine cancer.
  7. Can I do anything to lower my risk?
    Unfortunately, there are no proven measures to prevent uterine cancer. However, you may be able to minimise your risk by maintaining a healthy weight and being vigilant about any abnormal vaginal bleeding.