Preparing for your smear test as a survivor of sexual violence
How to spot the warning signs of gynaecological cancer
More than 21,000 women are diagnosed with a gynaecological cancer each year in the UK, but how many of the types and symptoms could you actually name?
This September, for Gynaecological Cancer Awareness Month, charity The Eve Appeal is calling for cancer education to become part of the Relationships, Sex and Health Education curriculum in schools. Knowledge of gynaecological anatomy, and awareness of gynaecological cancer symptoms, are crucial to early detection and treatment. If you're feeling clueless, here's the charity's Ask Eve nurse Tracie Miles with your need-to-know guide.
Womb cancer, also known as uterine cancer or endometrial cancer, is the most common of the five gynaecological cancers, and the fourth most common cancer affecting women in the UK - with more than 9,300 diagnosed every year. Womb cancer primarily - but not exclusively - affects women in their postmenopausal years (typically age 50+) and, Miles says, is very curable if caught early.
"The biggest sign is bleeding when you're not expecting to," Miles explains.
In postmenopausal women, this means that any vaginal bleeding at all should be checked out - although postmenopausal bleeding may simply be caused by vaginal atrophy. If you're pre-menopausal, bleeding between periods, or any bleeding outside of your normal pattern, could be an early sign of womb cancer. Again, there may be another, more benign cause, but it's always worth getting checked at the first sign of unusual bleeding.
It's also important to remember, Miles points out, that 'bleeding' can constitute anything from a thick, browny sludge to a pinky coloured mucus - not necessarily fresh red blood on a snow white panty liner.
Ovarian cancer, or cancer of the ovary, is the sixth most common cancer amongst women, and 7,300 women in the UK are diagnosed with it every year. Like womb cancer, ovarian cancer usually affects postmenopausal women, but can and does also affect younger women.
The symptoms can be tricky to identify and, Miles says: "Ovarian cancer used to be known as the 'silent killer'. Actually though, if you listen, it does whisper."
The signs to look out for include persistent changes to your normal bowel habits - constipation or diarrhoea - and a persistent bloating or widening of the waistline that doesn't go away.
"By persistent, we mean any symptom that lasts for three weeks or more," Miles explains. "You might also have a feeling of fullness, so you're not feeling hungry and therefore eating less, but still getting bigger, and you might have some tummy or pelvic pains." Needing to pass water more often, along with persistent nausea or new indigestion, should also be checked out.
Understandably, these symptoms are often mistaken for irritable bowel syndrome (IBS) or gut problems but, Miles says, IBS doesn't typically present as a new condition in women over 50 so it's always worth seeing your GP.
"It may not be ovarian cancer - it may be a gut problem - but either way it's definitely something to be checked."
Women may also have a genetic predisposition to ovarian cancer if they carry the BRCA gene. Speak with your family to find out if there's any family history which may place you in a high-risk group.
Cervical cancer affects the neck of the womb (the cervix), and mainly affects women aged 30-45. It's best prevented through regular cervical screening (smear tests), which can detect abnormal or pre-cancerous cells.
"Cervical cancer is another cancer that declares itself with a bleed - that's usually the first signal," Miles says. "It's a bleed when you're not expecting it, often caused by a collision with the area, such as penetrative sex."
Again, Miles points out, bleeding after sex may also be caused by more benign cervical conditions like an ectropion, but any persistent abnormal bleeding - either after sex or between periods - should be checked out.
Other symptoms of cervical cancer can include pain, particularly a sort of dull backache; pain and discomfort during sex; and an unpleasant-smelling discharge - "basically anything that's not your normal," Miles adds.
Vulval cancer is a relatively uncommon gynaecological cancer, with around 1,000 cases diagnosed each year in the UK. It's a skin cancer affecting the lips around the vagina and, Miles says, "a lot of women are surprised to learn you can get cancer there. I'd been a nurse for 25 years before I came into cancer nursing, and even I was surprised!"
As with the other gynaecological cancers, Miles says the important thing is to know your normal.
"Every vulva is different, so the only way to know when something is different is to know your own normal, and the only way to do that is to touch it - perhaps in the bath or shower, feel what the skin's like, get a mirror out and have a look," she says. "Then, if you get an itch, a change in colour or appearance, a raised area, or a lump or a bump, you can take that to your GP and describe what has changed."
In most cases, Miles says, vulval changes are probably nothing to worry about, but it's worth getting treated anyway so you're not uncomfortable.
"There are lots of skin conditions of the vulva, and lots of them are inflammatory, so they can be really miserable, itchy and sore," she explains. "Some of these, like lichen sclerosis, can also become an early cancer if left untreated. If your GP isn't sure, they can refer you to a dermatologist or a gynaecologist but, if it is vulval cancer, it can be treated really easily as long as it's caught early."
The final, and rarest, gynaecological cancer is vaginal cancer, which affects the skin of the vagina. Around 250 women in the UK are diagnosed with vaginal cancer each year, and it is most common in women over 60. As this is an internal skin cancer, Miles points out, detecting it can be a bit trickier.
"However good your mirror is, unless you've got a miner's lamp and loads of unusual equipment, you're just never going to be able to see what your vaginal skin looks like," she says.
"For a woman who's sexually active, your partner might tell you that your vagina feels different - lumpy or bumpy - so get that checked out. Or you might feel a change when you're putting a tampon in," Miles says. "The key is having the confidence to self-examine and see if anything feels odd."
However, she adds, "if you've had children - particularly if you've vaginally delivered - you might feel lumps and bumps when you put your fingers into your vagina. These are likely to be prolapses of either your bladder, your womb, or your bowel into the vaginal wall, and that's entirely normal. But if you get a discharge or bleeding, or any change that doesn't feel normal, then that's worth getting checked."
Essentially, Miles says: "The key with detecting any possible signs of gynaecological cancer is to know your own normal, and the only way you can do that is to check yourself out. Feel yourself, look at yourself, know what's normal for your cycle, and share that checking with a partner if you have one."