The Cayman Islands Cancer Society
is observing September as Gynaecological Cancers Awareness Month.
In the first of a series of
articles this month, we will discuss ovarian and endometrial cancers, both cancers
of the female reproductive system.
Endometrial cancer is often
referred to as uterine cancer. The body of the uterus, often referred to as the
womb, has an inner lining known as the endometrium and this is the most common
place for cancer of the uterus to start. Early signs of endometrial cancer
include abnormal vaginal bleeding or discharge and pain during sexual
The ovaries are located one on
either side of the uterus and they are the main producers of the female
hormones oestrogen and progesterone. One of the main concerns with ovarian
cancer is that it can quickly spread to other parts of the body via the
lymphatic system as there are lymph nodes in close proximity to the ovaries.
Ovarian cancer used to be called
the “silent killer” because it was a commonly held belief that there were no
signs or symptoms of the disease until it was in its advanced stages. In recent
years, by studying women diagnosed with ovarian cancer, doctors have been able
to develop an ovarian cancer symptom checklist. Symptoms of ovarian cancer
include bloating or increased abdominal size, pelvic or abdominal pain, eating
difficulty or feeling full too quickly. Many women experience these symptoms
but if any of them began within the last 12 months and have been experienced nearly
every day, then it may signal ovarian cancer and they should consult with their
doctor for tests. This may include a transvaginal ultrasound and CA125 blood
There are some common risk factors
for both ovarian and endometrial cancer and many of these can be attributed to
increased levels of oestrogen in a woman’s body over the course of her life
time. Factors such as never having been pregnant, the early onset of having
menstrual cycles and/or the late onset of menopause can increase risk. Obesity
is also a risk factor as increased amounts of fat tissue can change some
hormones into oestrogen thereby increasing levels in the blood.
Family and personal medical history
are contributing factors to developing both of these cancers and there are
inherited genetic risk factors for both. The genes most commonly associated
with breast cancer – the BRCA1 and BRCA2 gene are also the ones most commonly
associated with ovarian cancer.
Persons diagnosed with diabetes
should take note that endometrial cancer may be as much as four times more
common in women with diabetes. As with other types of cancer, if a close family
relative was diagnosed with the disease, you are at greater risk for developing
ovarian or endometrial cancer.
Screening tests for a disease are
performed on persons with no symptoms of the disease they are being screened
against. At this time there are no recommended screening tests for either
ovarian or endometrial cancer.
Women can lower their risk by
preventing the onset of obesity by eating both a low-fat diet and exercising on
a regular basis. Women who have been pregnant, women who have breast-fed their
children and women who have used the oral contraceptive pill for a number of
years may have a lower risk of developing the disease. It should be remembered
that “the pill” can increase your risk of other types of cancer and you should
always consult with your doctor before starting or stopping the pill and other
Cervical Cancer – a preventable disease?
Cervical cancer is one of the most
commonly diagnosed cancers in women in the Caribbean and one of the leading
causes of death from cancer in women in the region. Often these women are in
the prime of their lives with families to take care of. This begs the question
– are many of these deaths needless?
Almost 100 per cent of all cases of
cervical cancer can be attributed to one cause – exposure to a sexually
transmitted form of the human papilloma virus. Most people who have ever
experienced intimate sexual contact with another person will have been exposed
to this virus and will have had an “active” HPV infection at some point in
their lives. For most people, the body’s immune system kicks into action and
the infection is eliminated from the body often without the infected person ever
knowing they had the virus. In a few people, sometimes because their immune
system is otherwise compromised, the virus persists and remains. It is in
persons with persistent HPV infections that cancer can develop, often 10 – 20
years after the initial infection.
The risk factors for cervical
cancer are therefore similar to the risk factors for HPV – early age of sexual
exploration and intimate sexual contact, multiple sexual partners over a
lifetime especially if those partners have also had multiple partners.
The more times a woman has been
pregnant the more likely she is to develop cervical cancer especially if more
than one man is the father of her children. Additionally women who smoke are
twice as likely to develop the disease as are women who have had a mother or
sister diagnosed with cervical cancer. Long-term use of the oral contraceptive
pill will also increase risk.
Women can therefore substantially
lower their risk by abstaining from initial sexual contact for as long as
possible, remaining in a monogamous relationship and avoiding tobacco products.
Women can also lower their risk by having a Pap smear on a regular basis – at
least once every two years to three years (or more frequently if recommended by
The cells on the surface of the
cervix can become abnormal before they become malignant (cancerous), a
condition known as cervical dysplasia. A Pap smear can identify these changes
allowing treatment to occur at a stage before cancer has developed.
Should cervical cancer develop, it
often does so without any early warning signs or symptoms. As the disease
progresses signs that you might notice are abnormal bleeding e.g. between
periods or after sexual intercourse, or for those people who no longer have a
period, there may be new bleeding. You may also observe an abnormal discharge
that might have an odour associated with it. Symptoms that you might feel are
discomfort during intercourse and pelvic pain. It is important to remember that
these are also signs and symptoms of other medical conditions, so consult your
doctor if you notice any of them.
Well Woman Gynaecological Check-ups
There are several tests that a
woman should have as part of a well woman gynaecological routine. In this
article we discuss some of these tests.
The Pap smear is perhaps the test
that most women have heard of and screens for cervical cancer. Screening
guidelines vary between countries. According to the American College of
Obstetricians and Gynaecologists, women should have their first Pap test age 21.
According to the American Cancer Society, if a woman is sexually active she
should begin having Pap tests three years after she starts having sex (vaginal
intercourse) or by age 21, whichever comes first.
Women up to the age of 30 should
have a Pap test every two years as they have a higher likelihood of acquiring
high-risk types of human papilloma virus that may cause precancerous cervical
Women age 30 and older can discuss
with their doctor having a combined Pap test and HPV DNA test. If their Pap
test is normal and their HPV test is negative they may be able to wait 3 years
before having to repeat the combined test. However, women with a history of
moderate or severe dysplasia, women infected with the human immunodeficiency
virus, women with a weakened system (i.e. if she had an organ transplant or
chemotherapy) and women who were exposed to diethylstilbestrol (DES) before
birth should continue to be screened every two years. Women who are older than
30 and choose to have a Pap test only should discuss screening intervals with
There are two types of Pap test
available. Both tests require a woman to undress from the waist down and lie
down. They both require the doctor or nurse collecting the sample to insert an
instrument called a speculum into the vagina to widen it and collect a sample
of cells from the cervix with a special brush or wooden spatula-like
A woman should avoid scheduling the
test when she has her period and should avoid sexual intercourse and the use of
tampons, douches and vaginal creams for 48 hours prior to the test.
The conventional and less expensive
way of handling the sample is to place it on a glass slide and look at the
slide under a microscope but there are some limitations to this method. A newer
but more expensive way of handling the sample is to place it in a liquid
solution. The advantage to this method is that the sample can also be used to
test for HPV.
HPV DNA test
HPV is the virus that causes
cervical cancer. Almost all sexually active beings have been exposed to a
sexually transmitted strain of this virus at some point in their life. Testing
for the virus can identify if a person has an active infection at the time of
the test but it cannot identify which strain of the virus a person is infected
with. HPV testing is recommended for women over the age of 30.
It is important to understand that
the Pap smear tests for precancerous changes to the cells of the cervix and
cervical cancer only whereas the HPV test checks for HPV infection only.
Like the Pap smear and HPV test,
the pelvic exam requires a woman to be undressed from the waist down and be in
a lying position. During the pelvic exam, the medical practitioner will check
the organs of the reproductive system, particularly the ovaries and uterus
(womb) for any abnormality in their size or shape. This is done by inserting
two gloved fingers into the vagina while feeling from the outside for lumps or
tenderness. The pelvic exam is usually done when a woman visits the doctor for
a Pap smear. It is usually considered as a “screening” tool for ovarian and
However, it is not recommended as
an independent screening method for either ovarian or endometrial (uterine)
cancer. It should also be remembered that a pelvic exam is not a test for
CA-125 blood test
Many women ask for a CA-125 blood
test when they visit their doctor for a gynaecological check-up as they believe
it to be a non-invasive and reliable way to screen for ovarian cancer. CA-125
is a protein that is a so-called tumour marker which is a substance that is
found in greater concentration in tumour cells. However there are a number of
medical conditions that can cause a woman to have elevated CA-125 levels (e.g.
endometriosis, other types of cancer). There are also circumstances in which
this test can appear to be normal and cancer is indeed present. For these
reasons the CA-125 test is not recommended as a screening test for women. It is
however useful if a woman presents herself to the doctor with symptoms of
ovarian cancer as a part of the diagnostic work-up or to evaluate how a woman
diagnosed with ovarian cancer is responding to treatment.
For more information on
gynaecological cancers or HPV contact the Cayman Islands Cancer Society at
949-7618 or email [email protected]