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Cancer concerns

Some 21 women a day die of gynaecological cancers and yet, not enough is commonly known about the diseases.

Over 22,000 women are diagnosed with a gynaecological cancer each year in the UK. These cancers affect the womb, ovaries, cervix, vulva or vagina, according to the latest data released by The Eve Appeal

“This is 60 new diagnoses of a gynaecological cancer each day,” says Helen Hyndman, Ask Eve co-ordinator at the charity. “Despite these statistics, these cancers are often not talked about due to stigma and embarrassment. A recent survey run by The Eve Appeal (YouGov) showed that 30 per cent of people are not aware of any types of gynaecological cancer, and only two per cent of people think they can name all five types of gynaecological cancer.”

According to the Royal College of Nursing, it’s important that all healthcare professionals are aware of the common signs and symptoms associated with gynaecological cancers and respond appropriately to the red flags. Pharmacy customers should be encouraged to speak to their GP if they experience any unusual or ongoing symptoms, such as pain, bleeding or vaginal discharge. 

“Community pharmacies should use health promotions throughout the year to raise awareness about the importance of gynaecological screenings,” says Jacquie Lee, Numark information pharmacist. “Through keeping an eye on events in the calendar such as Gynaecological Cancer Awareness Month (September) and Cervical Screening Awareness Week (June), pharmacy teams can shed light on gynaecological screenings and demystify what they entail. Community pharmacies should also provide promotional materials, which can help educate customers about what to expect from a gynaecological screening.”

The Eve Appeal raises awareness about all five cancers. Information, support and advice is also available from Cancer Research UK, Macmillan Cancer Support and other gynaecological cancer charity websites.

Iron deficiency

Iron deficiency is a common problem among women. Low iron stores in the body can lead to reduced red blood cell production (iron deficiency anaemia); this can be diagnosed with a blood test. It’s estimated that in the UK around 23 per cent of pregnant women and 14 per cent of non-pregnant women are anaemic.

Risk factors include the extra demands of pregnancy, heavy periods, poor iron intake, family history, some medical conditions (such as coeliac disease, gastric ulcers and cancer) and taking certain medicines (e.g., nonsteroidal anti-inflammatory drugs, selective serotonin reuptake inhibitors or corticosteroids). 

Early signs of iron deficiency anaemia in otherwise healthy people include headaches, fatigue, mild breathlessness and restless leg syndrome. Other possible symptoms include dizziness, irritability, palpitations, a sore tongue, tinnitus and generalised itching. Iron deficiency symptoms without anaemia may include fatigue, lack of concentration, irritability, pale skin, dry and rough skin, dry and damaged hair, and hair loss.

Iron deficiency is treated by addressing underlying causes (such as heavy periods), eating iron-rich foods (such as fortified bread, dried fruits and dark green vegetables) and taking daily iron supplements for at least three months. Some people can’t tolerate iron tablets (which can cause constipation) and prefer to take gentler liquids or mouth sprays. If these fail to work, they may need iron injections. It’s important to store iron supplements away from young children as accidental poisoning can be fatal.

Womb (endometrial) cancer

Risk factors

Most people who get womb cancer tend to be aged between 40 and 74. Being overweight or obese causes around a third of womb cancers and is the biggest preventable risk factor. Women with more fat cells in their body tend to have higher levels of oestrogen, which triggers womb cells to divide and grow. The more oestrogen they have, the thicker their womb lining becomes and the more likely one of the cells will become cancerous. Anything else that increases the amount of oestrogen in the body can also increase the risk of womb cancer. Other risk factors include:

  • Oestrogen-only hormonal replacement therapy (HRT) 
  • Family history
  • Tamoxifen, taken for some types of breast cancer
  • Diabetes (which may be linked to being overweight)
  • Polycystic ovary syndrome
  • Starting periods at a young age
  • Late menopause.

The risk may be decreased by:

  • Having children
  • Taking the contraceptive pill
  • Physical activity.

Symptoms

The most common symptoms are bleeding between periods, after the menopause or after sex; unusually heavy periods; and coloured or watery vaginal discharge that may have an unpleasant odour.

Less common signs include blood in the urine, high platelet count and high blood sugar level. If women have gone through the menopause (they are 12 months after their last period) and experience post-menopausal bleeding, they should speak to their GP. 

Womb cancer is usually diagnosed with an ultrasound scan, followed by a biopsy. There’s no national screening programme, but if women are considered to be high risk due to their family history (called Lynch syndrome or HNPCC families) they may be offered a screening biopsy from the age of 35-40.

Ovarian cancer

Risk factors

The risk of developing ovarian cancer increases as people get older, with the highest risk in those aged 75-79. Between five to 15 out of 100 ovarian cancers are caused by faulty genes, such as BRCA1 and BRCA2.

Other risk factors include previous breast cancer, HRT, smoking, endometriosis, diabetes, being overweight or obese.

Protective factors include:

  • Combined contraceptive pill
  • Having children
  • Breastfeeding
  • Having a hysterectomy or tubes tied.

Symptoms

The symptoms of ovarian cancer may include: 

  • Persistent bloating 
  • Persistent pelvic/abdominal pain
  • Feeling full quickly
  • Constipation or diarrhoea
  • Loss of appetite
  • Change in bowel habits
  • Needing to urinate more regularly 
  • Abnormal vaginal bleeding
  • Unexplained weight loss and/or fatigue.

These symptoms can occur in other conditions, such as irritable bowel syndrome (IBS), but new, severe or ongoing symptoms, especially after the age of 50, should be checked out by a GP.

Most ovarian cancers can be diagnosed with a blood test (raised serum CA125). This is usually followed up with an ultrasound if symptoms are present, whether or not CA125 levels are raised. Definitive diagnosis requires a biopsy. There’s no reliable screening test for ovarian cancer.

Cervical cancer

Risk factors

The main cause of cervical cancer is a long-lasting infection with certain types of the human papilloma virus (HPV). HPV can be passed on through unprotected sex. In most people, the immune system clears HPV within a couple of years, but sometimes the virus persists.

Girls and boys aged 12 or 13, born after 1 September 2006, in the UK are routinely offered the HPV vaccine at school to protect against most types of the condition and reduce the risk of cervical and other cancers.

Other risk factors include:

  • HIV infection
  • Sexually transmitted infections (STIs)
  • Smoking tobacco
  • Taking the contraceptive pill for more than five years 
  • Having children
  • Family history.

Symptoms

Not everyone with cervical cancer has symptoms. The most common symptoms, when they do occur, are bleeding between periods or after sex, pain or discomfort during sex, unpleasant-smelling vaginal discharge and pelvic pain.

Diagnosis and screening

Screening is free on the NHS as part of the National Cervical Screening Programme. It checks for high-risk HPV and abnormal cervical cell changes. A nurse takes a sample of cells from the cervix using a small soft brush (smear test) and sends the sample to the laboratory.

Everyone with a cervix should be automatically invited for cervical screening if they are the ages between 25-65 and are registered as a female with a GP surgery (see box out on page 26). England, Scotland and Wales use HPV primary screening, which tests for HPV first. If high-risk HPV is found, the laboratory will check for cell changes. Currently, in Northern Ireland, the laboratory looks for changes in the cervical cells first and then tests for HPV should they find any changes. This is, however, expected to switch to HPV primary screening soon.

In England and Northern Ireland, eligible people receive an invitation to book a screening every three years if they are aged 25-49. After that, they will receive an invite every five years until the age of 64. In Wales and Scotland, an invite is sent every five years to those eligible aged 25-64.

Doctors use a colposcopy with biopsy after abnormal cervical screening tests or if someone has symptoms that could be caused by cervical cancer. Some women may have a cone biopsy as a treatment for abnormal cervical cells or to help diagnose cervical cancer.

Trans and non binary people

Anyone with a cervix is eligible for the National Cervical Screening Programme, including many trans men and non-binary people. If they are registered as female with their GP surgery, they will be invited for cervical screening via the national call and recall system, unless they choose to opt out of the programme. They won’t however be automatically invited for screening if they are registered as male.

Some eligible trans men and non-binary people have been turned away from cervical screening because externally they don’t look like they need it. There’s also an assumption that trans men and non-binary people have had gender confirmation surgery (which means they no longer have a cervix), but for a variety of reasons, many do not have this procedure and therefore remain eligible for the programme. 

It’s important not to make assumptions about gender and cervical screening eligibility, so that everyone feels safe and in control. 

For more information visit the Jo's Cervical Cancer Trust website.

Vulval cancer

Risk factors

Vulval cancer can affect all age groups but is more common in women aged 75 and older. HPV causes some vulval cancers, but is not the only potential cause. For example, other risk factors include some long term vulval skin conditions (lichen sclerosus and lichen planus), pre-cancerous cervical changes, previous cervical cancer, weakened immune system and systemic lupus erythematosus (SLE or lupus).

Symptoms

Symptoms

Early symptoms tend to be quite vague, but may include:

  • Vulval itching that doesn’t go away
  • Pain or soreness
  • Thickened, raised, red, white or dark patches of the skin of the vulva
  • A lump or open sore on the vulva.

Other symptoms may include:

  • Burning pain when passing urine
  • Discharge or bleeding, not related to periods
  • A lump or swelling in the groin
  • A mole on the vulva that changes shape or colour.

Some doctors recommend self-examination to be alert for any changes. The diagnosis includes a vaginal examination and pelvic examination, along with a biopsy.

Vaginal cancer

Risk factors

Vaginal cancer is more common in women aged 75 and over and is very rare in the under 40s. Risk factors include HPV infection, abnormal changes to vaginal cells and a weakened immune system.

Symptoms

There are no symptoms in the early stages, and up to 20 per cent of women diagnosed with vaginal cancer don’t have any symptoms at all. Doctors may pick up signs during routine cervical screening.

Symptoms may include:

  • Bleeding between periods or after the menopause
  • Bleeding after sex
  • Bad-smelling or blood-stained discharge
  • Pain during sex
  • A vaginal lump
  • Persistent vaginal itch.

The first tests are a pelvic examination and a colposcopy to see around the vulva and inside the vagina. This is usually followed by a biopsy.

Breast cancer

Breast cancer is the most common cancer in the UK, with one in seven women developing the disease during their lifetime. In addition, around 370 men are diagnosed with breast cancer in the UK each year. There are several different types, depending on where in the breast the cancer develops.

Breast cancer generally affects older women, but the risk can be affected by family history and lifestyle factors such as obesity, alcohol intake, smoking, the contraceptive pill and HRT. The NHS Breast Screening Programme is available to women aged between 50-70, as well as some trans and non-binary people. In some parts of England, the screening programme has been inviting women aged 47-73 as part of a trial.

Women should examine their own breasts and the surrounding area regularly for any changes. They should look and feel for:

  • A new lump or thickening in a breast or armpit
  • A change in size, shape or feel of a breast
  • Skin changes in the breast such as puckering, dimpling, a rash or redness
  • Fluid leaking from the nipple in a woman who isn’t pregnant or breastfeeding
  • Changes in the position of the nipple.

Breast pain isn’t usually a sign of breast cancer, but women should speak to their GP if they have any concerns.

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