Women's Cancer

Symptoms of gynaecological cancer vary, depending on the type and stage of the cancer. Some common symptoms may include abnormal or persistent vaginal bleeding or discharge, pelvic pain or pressure, bloating or swelling in the abdomen, changes in bowel or bladder habits, pain during sex, itching, burning, or soreness in the genital area, or lumps, sores or warts. These symptoms may be caused by other conditions, so it is always important to consult your doctor. 

Symptoms can often be vague and non-specific. Patients know themselves better than anyone else – if they are experiencing persistent symptoms, they should see their GP. Writing symptoms in a diary and bringing it to an appointment can be helpful for both the patient and health care professionals. 

Risk factors vary with specific types of gynaecological cancer, but generally include: 

• getting older 

• a family history 

• a genetic mutation relating to certain cancers 

• having had cancer previously 

• certain benign conditions 

• early or late menopause 

• exposure to hormones or certain chemicals 

• viral infection such as human papillomavirus (HPV) 

• lifestyle factors such as smoking, obesity or poor diet. 

Depending on your personal and family history, you may need to have some screening tests or genetic tests to check your risk of developing gynaecological cancer. Screening tests can help detect cancer early when it is easier to treat. Genetic tests can help identify inherited mutations that increase the risk of certain cancers. Some of the tests that may be recommended for you are: 

• Cervical Screening Test (CST): This test checks for the presence of HPV, a virus that can cause cervical, vaginal and vulvar cancers. CST testing is recommended for all people with a cervix aged 25-75 every five years. CSTs can be performed by a health professional or by the patient themselves using a self-collect swab.  

• Pelvic exam: This external and internal exam involves the doctor feeling the uterus, ovaries and other pelvic organs for any abnormalities. It can help detect ovarian, uterine, vaginal and vulvar cancers.  

• Transvaginal ultrasound: This test uses sound waves to create images of the pelvic organs. It can help detect ovarian, uterine or fallopian tube cancers. It may be done if you have certain symptoms, abnormal pelvic exam results or a family history of ovarian cancer. 

• Endometrial biopsy: This test involves taking a small sample of tissue from the lining of the uterus (endometrium) and examining it under a microscope. It can help diagnose endometrial cancer or precancerous changes. It may be done if you have abnormal vaginal bleeding, especially after menopause. 

• CA-125 blood test: This test measures the level of a protein called CA-125 in the blood. CA-125 is often elevated in women with ovarian cancer but can also be affected by other conditions. The test may be done to monitor ovarian cancer treatment, check for recurrence or screen high-risk women. 

• BRCA1 and BRCA2 gene tests: These tests look for mutations in the BRCA1 and BRCA2 genes, which produce proteins that help repair damaged DNA and prevent tumour growth. Women who inherit these mutations have a higher risk of developing breast, ovarian and fallopian tube cancers. These tests may be done if you have a strong family history of these cancers or if you belong to certain ethnic groups, such as Ashkenazi Jews. 

• Lynch syndrome gene tests: These tests look for mutations in genes involved in DNA mismatch repair. People who inherit these mutations have a higher risk of developing colorectal, endometrial, ovarian and other cancers. These tests may be done if you have a family history of these cancers, or if you have endometrial cancer at a young age. 

Adult women of all ages are encouraged to perform breast self-exams at least once a month. The purpose of a breast self-exam is to become familiar with the way your breasts normally look and feel, so that you can identify any changes or abnormalities in your breasts, such as a new lump or skin changes. Breasts will change depending on a women’s cycle, which is why it is encouraged “same time of the month” breast checks. One way to remember is to do a breast check on the first of every month.  

Any changes in your breasts discovered during a breast self-exam should be reported to your doctor right away. 

How your breasts look after treatment/surgery depends on the type of treatment/surgery you have, as well as the size of your breast and your body shape. 

Some possible outcomes are: 

• After breast-conserving surgery, the size and position of the scar will depend on how much tissue is removed. The scar will usually be less than 10cm. The breast may change shape or size slightly, but it will usually look similar to how it did before surgery. 

• After a mastectomy, the scar will be across the skin of the chest. If you have surgery to the lymph nodes, the scar will also be in the armpit.  You may choose to have a breast reconstruction using implants or your own tissue, or to wear a breast prosthesis. 

• After a nipple-sparing mastectomy, the nipple and areola will be preserved, but the breast tissue will be removed. You may choose to have a breast reconstruction using implants or your own tissue. The nipple may lose some sensation or change in appearance. 

The treatment for breast cancer depends on the type and stage of the cancer, the presence of certain receptors on the cancer cells, your overall health, and your personal preferences. Some of the common treatments for breast cancer are: 

• Surgery: This involves removing the cancerous tissue from the breast and sometimes the nearby lymph nodes. Surgery can be breast-conserving (removing the cancer and some surrounding healthy tissue) or mastectomy (removing the entire breast tissue). Some women may also have breast reconstruction after surgery. 

• Chemotherapy: This uses drugs to kill or stop the growth of cancer cells. Chemotherapy may be given before or after surgery.  

• Radiation therapy: This uses high-energy rays to destroy cancer cells. Radiation therapy may be given after surgery to kill any remaining cancer.  

• Hormone therapy: This is used for hormone receptor-positive breast cancers, which grow in response to hormones such as oestrogen and progesterone. Hormone therapy blocks the action of these hormones or lowers their levels in the body. Hormone therapy may be given after surgery to prevent recurrence.  

• Targeted therapy: This is used for certain types of breast cancer with specific characteristics, such as HER2-positive breast cancer. Targeted therapy drugs target these specific features and block their growth or destroy them. Targeted therapy may be used in combination with chemotherapy, hormone therapy or on its own. 

The side effects of breast cancer treatment depend on the type and dose of treatment, the stage of the cancer, and your individual response. Some of the possible side effects are: 

• Hair loss: This can occur with chemotherapy or targeted therapy. Hair loss may affect the scalp, eyebrows, eyelashes and other parts of the body. Hair usually grows back after treatment ends, but it may be different in colour or texture. 

• Nausea and vomiting: This can occur with chemotherapy, radiation therapy or targeted therapy. Nausea and vomiting can usually be controlled with anti-nausea drugs, dietary changes and relaxation techniques. 

• Fatigue: This is a common side effect of chemotherapy, radiation therapy, hormone therapy and targeted therapy. Fatigue can last for months after treatment ends. Fatigue can be managed with rest, exercise, nutrition and emotional support. 

• Menopausal symptoms: These can occur with chemotherapy, hormone therapy or ovarian suppression. Menopausal symptoms include hot flashes, night sweats, vaginal dryness, mood swings and loss of libido. Menopausal symptoms can be treated with hormone replacement therapy (HRT) and non-hormonal drugs. 

• Lymphoedema: This is a swelling of the arm, hand or chest caused by a build-up of lymph fluid. Lymphoedema can occur after surgery or radiation therapy to the lymph nodes. Lymphoedema can be prevented with early detection and early intervention. Lymphoedema can be managed with specialised allied health professionals that are able to ensure compression garments, massage and exercises. 

• Cording: This is a tightness or pulling sensation in the arm or chest caused by inflammation or scarring of the lymph vessels. Cording can occur after surgery or radiation therapy to the lymph nodes and can be treated with stretching, massage or physical therapy. 

• Cognitive and memory changes: These include difficulties with concentration, memory or learning caused by changes in the brain and can occur with chemotherapy, hormone therapy or targeted therapy. Thinking and memory changes can be improved with cognitive exercises, memory aids, stress management, and adequate sleep. 

enetic testing for breast cancer is not recommended for everyone as most breast cancers are not caused by inherited gene mutations. Genetic testing may be considered for you if you have a personal or family history of breast cancer that suggests a higher risk of having a gene mutation, such as: 

• having breast cancer before the age of 45. 

• having breast cancer in both breasts or more than one type of cancer. 

• having ovarian cancer or male breast cancer at any age. 

• having two or more close relatives with breast or ovarian cancer, especially if diagnosed before the age of 50. 

• having Ashkenazi Jewish ancestry and a personal or family history of breast or ovarian cancer. 

No. A benign lump is not cancerous and cannot turn into cancer. However, it is important to make sure that the lump is benign in the first place as some breast cancers may be mistaken for benign lumps. If you notice any new or unusual lump in your breast, you should see your doctor as soon as possible for a clinical breast examination and further tests, such as a mammogram, ultrasound, or biopsy. These tests can confirm whether the lump is benign or malignant and help you decide on the best course of action. 

No. Most breast changes are not due to cancer, but to benign conditions, such as fibrocystic breast disease, mastitis, cysts, fibroadenomas or hormonal fluctuations. These conditions can cause lumps, swelling, pain, tenderness or nipple discharge in the breasts. However, some breast changes may be signs of breast cancer, such as: 

• a new lump or lumpiness, especially if it is only in one breast. 

• a change in the size or shape of your breast.