Stay informed on female cancers

November marks Female Cancer Awareness Month, with the Cayman Islands Cancer Society planning activities to educate the public on several types of the disease.

The focus will be on cervical, endometrial and ovarian cancer, according to Christine Sanders, education and office manager of the CICS.

Doctors practising in Cayman will assist with presentations along with Dr. Luis Mendez, a Miami gynaecologist-oncologist in private practice, she explained. Dr. Mendez’s trip to Grand Cayman is being sponsored by Kendall Regional Medical Centre in Miami.

The Caribbean has one of the highest incidences of cervical cancer in the world, according to Ms Sanders.

‘Cervical cancer is one of the most common cancers in women worldwide and in many developing countries where the incidence of this cancer is high, it is the leading cause of death from cancer,’ she explained.

The main risk factor for cervical cancer is infection with human papillomavirus (HPV), a sexually transmitted disease which can cause genital warts, Ms Sanders said.

‘Earlier this year, it was announced that a vaccine had been developed that prevented 100 per cent of cervical pre-cancers and non-invasive cervical cancer caused by HPV.

‘However, because of the long lag time between possible infection with HPV and when symptoms of cervical cancer become apparent, it is unlikely that the benefits of this vaccine will be realised for another 25 years,’ she explained.

People should not rely only on this vaccine, which is still several years away from approval for the market, but should take responsibility for their health, she added.

‘If you are sensible about your sexual habits, you can prevent HPV. The bottom line is that there is no reason for women to get cervical cancer,’ Ms Sanders said.

She spoke of other factors related to sexual activity.

‘Other risk factors for cervical cancer are associated with sexual behaviour including age of first intercourse, the number of sexual partners over an individual’s lifetime, the sexual behaviour of a woman’s partners and the number of births,’ she said.

Women with a weakened immune system, are overweight, use birth control pills for more than five years or smoke are also at higher risk of developing cervical cancer.

Pap smears key

In the early stages of this cancer there are usually no obvious symptoms which is why getting a pap smear is so important. Most women should get this test once every two years if they are sexually active and/or over the age of 18, though some may need it more often, depending on their history, Ms Sanders explained.

A pap smear can detect any cell changes in the cervix which could be an early indicator of cancer. The doctor can then treat these precancerous cells, making cervical cancer among the easiest to prevent and/or detect and treat.

Dr. Sook Yin emphasised this point.

‘Realistically, cervical cancer is one of the few cancers that has distinctive stages that we can treat,’ she said.

She also spoke of a relatively new test that has improved detection.

‘The thin prep pap smear is a more accurate test than the pap smear. For women with abnormal bleeding or an abnormal pap smear this would be the recommended test.

‘This also can test for HPV at the same time. This is an important breakthrough from the last few years,’ Ms Yin explained.

Local doctors and gynaecologists, along with the Health Services Authority, have been invited to partner with the society in its pap smear screening programme. This programme involves the provision of vouchers for a free pap smear to women who do not have health insurance coverage for this procedure, Ms Sanders explained.

‘In developed countries, organised screening programmes have successfully led to the reduction of cases of cervical cancer, which is why the cancer society is promoting its screening programme,’ she said.

Symptoms eventually caused by abnormal cell growth are bleeding or pain during intercourse, unusual vaginal discharge or bleeding between menstrual periods.

Treatment options

If cervical cancer is diagnosed, there are several treatment options.

Treatment can involve surgery (a hysterectomy, which may only remove the uterus or include surrounding tissues, organs and lymph nodes), radiation and/or chemotherapy.

The education sessions will also cover endometrial cancer, which is among the most common cancer found in women worldwide, Ms Sanders explained.

This type of cancer starts in the inner lining of the womb, which is called the endometrium.

The risk factors for endometrial cancer are related to the balance of the two female hormones, oestrogen and progesterone, in the body.

During a woman’s menstrual cycle, the balance of these two hormones changes, resulting in monthly periods and keeping the endometrium healthy. If this balance shifts toward more oestrogen, the risk of developing endometrial cancer increases.

The longer the uterus is exposed to oestrogen, the higher the risk of endometrial cancer, therefore early onset of menstruation, late menopause or simply a longer span of menstruation can all raise the chances of getting the disease. Women who have never been pregnant are therefore also at increased risk.

Other risk factors include obesity, a diet high in animal fat, diabetes and age (over 40).

No special tests are available for early detection of this type of cancer but at-risk women can get a yearly endometrial biopsy starting at age 35.

Though endometrial cancer can progress to an advanced stage before the onset of symptoms, signs to look out for include unusual bleeding, spotting or other discharge, and pelvic pain and/or weight loss.

Reducing risks

Ms Sanders advises women to reduce what risk factors they can and if they notice anything abnormal to talk to their doctor.

Endometrial cancer can be treated in several different ways.

In the surgical option, the doctor can remove the uterus along with the cervix, ovaries and fallopian tubes but may also need to excise other surrounding tissue as well as lymph nodes.

Radiation treatment can involve implanting pellets or the patient can receive external radiation.

The patient can also undergo chemotherapy or hormone therapy, the latter involving the use of progesterone-like drugs to slow the growth of cancer cells.

Most women suffering from endometrial cancer have their ovaries removed or these organs may stop working after radiation therapy. The result will be a reduction in the amount of oestrogen produced which also slows cancer growth.

For ovarian cancer, several of the risk factors are the same as for endometrial cancer – obesity, a longer span of menstruation and age (most cases occur after menopause).

Other risk factors include the use of fertility drugs, a family history of the disease and a previous case of breast cancer.

The symptoms of ovarian cancer can be vague and may be caused by other ailments.

These symptoms include swelling of the stomach due to fluid buildup, unusual vaginal bleeding, pelvic pressure, back or leg pain, and problems such as gas, bloating, long-term stomach pain or indigestion.

As with endometrial cancer, early detection is difficult, so women need to be more aware.

‘The main thing is to know your body and if you notice anything abnormal, see your doctor,’ Ms Sanders said.

Treatment is the same as for endometrial cancer – surgery (to remove one or both ovaries), chemotherapy and/or radiation therapy.