This transcript was extracted from the ‘Gynae cancers & symptoms to report‘ video.

So now we go on to our next speaker, to Patricia Rogers, who’s going to do a talk on “Gynae Cancers and symptoms to report”. There you go. Thanks Amy.

Hello everyone. Good morning. It’s lovely to have you all here as Shauna said and it’s great to have Shauna now as my new colleague. You probably hadn’t met Shauna before, so it’s amazing to have a sidekick and somebody working alongside me. So those who don’t know me, I’m Patricia Rogers, I am the Gynae Oncology Clinical Nurse Specialist, and you hopefully would have met me when you were diagnosed.

So I’m going to talk to you today about Gynae cancers and symptoms that you should be reporting to us. And we’ll talk a wee bit through, maybe we’ll touch on treatment as well and we’ll also touch on maybe late effects of treatment as well.

So, Gynae cancers, it’s a term used for all types of cancer that occur in the female reproductive organs and genitals, this includes cancer of the womb, fallopian tube, ovaries, cervix, vulva, and vagina. I’m going to start off with the most common Gynae cancer, which is womb cancer. So cancer of the womb may be called several different names, including uterine cancer or endometrial cancer, which is in the lining of the womb.

It’s the fourth most common cancer in the UK, and the most common of the gynae cancers, around 9700 diagnoses annually in the UK. And about average 260 women each year in Northern Ireland get diagnosed with a womb cancer. Endometrial cancer as you can see here in this wee diagram, it starts in a layer of the cells that form the lining of the uterus called the endometrium.

So I don’t know if you know all this but the top three risk factors for having a womb cancer; oestrogen, there are many types of womb cancer, but most happen with no clear reason. But we know that too much oestrogen, which is a type of hormone, can raise your risk of womb cancer. Oestrogen causes the cells in the womb to grow and divide, and cancer happens when there’s a mistake, when the cells are growing and dividing.

So anything that increases the amount of oestrogen you have obviously increases your risk of a womb cancer. Being overweight or obese is one of the biggest risks of womb cancer in the UK. But being overweight or obese is the biggest preventable risk factor of womb cancer and causes around a third of womb cancers.

Women who are obese or overweight have higher levels of oestrogen than those who are not because the fatty tissues produce more oestrogen and so the more body fat you have, the more oestrogen you produce. Age, womb cancers can affect anyone at any age. It is the most common after menopause and that means, post-menopause means you’ve not had a period for a full 12 months.

The risk of womb cancer increases with age. And the most this is the most common, more common with older people, with increasing rates of age 55 and over, and it usually peaks in around 75-79 age group. But we have younger ladies also present with womb cancers. So.

I’ve put up two diagrams here. The one on the left with the fancy lady in her white bathing suit and it’s usually symptoms that most people present with. We get a lot of ladies who present with womb cancer, and it’s usually they present with a bit of post-menopausal bleeding. The alert symptoms that you need to be looking out for and these alert symptoms, and I’ll talk about this later are also very much related to some of the treatments you might have.

So it’s very, very important to call myself or Shauna to make sure and talk it through if you have any of these alert symptoms; any new vaginal bleeding or discharge, any new bladder or bowel symptoms any new pelvic abdominal pain, unexplained persistent low back pain, weight loss or swelling in one or both legs and the key word in all of that is persistent symptoms new to you because a lot of them symptoms you can have after eating a bowl of pasta, you may get a bloated tummy or something like that you know. They’re very much related to other conditions as well but that’s why it’s important you ring us. Next one we’re going to talk about is, fallopian tube ovarian and peritoneum.

So your fallopian tube cancer can occur in one or both of the fallopian tubes. These are the tube-shaped structures that run between your uterus and ovaries. And the ovaries are the two small organs about the size of grapes which are connected to the womb and the fallopian tubes.

Primary peritoneal cancer, these are words you are going to, the ladies in the room who’ve had it have a diagnosis of fallopian tube/ovarian cancer there’s words like omentum, peritoneum, these are words that may have been, you may be familiar with that your consultant may have talked to you about when you got referred up to Belfast.

So primary peritoneal cancer is rare. And the peritoneum is a layer of thin tissue that lines inside of the tummy. And there’s two layers and the inner layer is the peritoneum covers the surface of all the organs like your liver, your bowel, your stomach.

There is a section in the inner layer that forms an extra flap of tissue that hangs down over the stomach in front of the bowel, and that’s called your omentum. Most ladies who have a diagnosis of fallopian tube or ovarian cancer would have, disease that’s maybe spread to the omentum. So you may have heard that word, being, that word may be familiar to you if you have that diagnosis.

In Northern Ireland, around 230 women are diagnosed with ovarian cancer each year, and over 46% are diagnosed at an early stage.

The top three risk factors for ovarian cancers are; age, those are over the age of 50 are higher risk. And most cases of ovarian cancer happen in those who have already gone through the menopause. About 80-100 cases of ovarian cancer are sporadic, that means that it’s not inherited. And your close relatives would be at most significant risk of developing the disease themselves.

About 20 in 100 cases of ovarian cancer are believed to be caused with an inherited genetic variant and it’s often BRCA1 or BRCA2 gene. And anybody with a diagnosis of ovarian or fallopian tube or peritoneal cancer. When they get referred to Belfast Trust, they would get automatically referred to genetics for further testing.

So alert symptoms. Again, ovarian cancer doesn’t always cause symptoms. Most people that present to us have come in with these symptoms that are fairly new to them. But unfortunately most ladies who come to us, when they start getting symptoms, these symptoms are caused by their cancer at a more advanced stage and that’s when you start to recognise the symptoms. Most of the symptoms are again, abdominal/pelvic pain, swelling or bloating, new bladder or bowel symptoms, any new vaginal bleeding or discharge, unexplained weight loss or shortness of breath. And the most important thing is that these are new. They’re not normal for you. They’re frequent and usually happen more than 12 times a month. So that’s persistent symptoms that don’t go away. And that’s when you need to be going to a GP, or that’s when most people usually present with.

Next up is cervical cancer. We’ve our job well cut out for us haven’t we, all these gynae cancers. When people say gynae oncology CNS they think it’s one cancer but we look after all these ladies with all these different types of cancers. Cervical cancer is a cancer that forms in the cervix and the cervix connects the vagina and the uterus.

There are two main types of cervical cancer. The most common is squamous cell, that’s the wee cells that are found on the outside of the cervix at the top of the vagina. The other type is adenocarcinoma. And this develops from a different type of cell that’s found in the cervical canal. Cervical cancer is the 14th most common in females in the UK and in Northern Ireland we get approximately 82 females a year. Almost all cervical cancers are caused by the sexually transmitted human – I can never say the word – HPV because of this, because of this, you’re all registered, hopefully with a GP in Northern Ireland who fall within the screening age range and are automatically invited for a screening test.

Women aged between 25 and 49 are invited every three years, and women aged between 50 and 64 are invited every five years. So cervical screening is not a test for cancer. It’s a test to help prevent cancer. That’s why it’s important for you to go when you’re invited. It checks a sample of cells from your cervix for high risk of the HPV and then if you’re a high risk, then you’re then tested for any abnormal cells. Is HPV is the most sexually active people come into contact with HPV during their lifetime and in most people the immune system can clear that within 6 to 12 months. But if this doesn’t happen, then and becomes more persistent than you are at high risk. Cervical cancer is more common in younger females, and most cervical cancer cases diagnosed in the UK are in females aged 30 to 34.

Smoking tobacco increases your risk of getting cervical cancer, and the reason for that is that it can prolong the infection and affect your immune system.

Most ladies present with, abnormal vaginal bleeding or discharge, new bladder or bowel symptoms, pelvic/abdominal pain, persistent low back pain, unexplained weight loss, swelling of one or both legs. And these alert symptoms are very much in keeping with people, patients who present to us with a more advanced stage of cervical cancer.

Majority of the time, these cervical cancers are picked up early but the key key key thing is that, ladies, if you attend for your screening, that hopefully that would be prevented. And hopefully I’m referring to the ladies who are sitting in the room who are at that age. So that’s good. Now, vulva cancer, also known as vulvar cancer or cancer of the vulva. This is a rare cancer that occurs in the genitals of the on the outside of the woman’s body.

This includes the labia minora and the labia majora. You might know these as your inner and outer lips. It can occur in the clitoris, the pubic mound and the the perineum, which is the skin between your vagina and your anus. Cancer of the vulva is one of the rare cancers, the most common type is squamous cell. It usually starts for wee pre-cancerous cells in the outer layer of the skins on the skin of the vulva.

It’s a rare cancer with only 1350 cases per year in the UK and approximately 36 in Northern Ireland. The risk factors again are HPV. That nasty HPV can infect the skin in different parts of the body, including the vulva. Smoking again weakens the immune system, making it less able to clear the virus and age, around 80% of vulva cancers are women over 60. But anyone with a vulva can be diagnosed with vulva cancer at any age. We’re seeing more and more women at the younger age.

You can also get benign conditions that can develop into a cancer and that’s why it’s important to present with any symptoms that you have. Conditions such as lichen sclerosus, a long term vulvar condition that causes itching and sometimes pain within the vulva area.

And the other one, there is vulva intraepithelial neoplasia (VIN), which may also develop it’s a skin condition of the vulva as well. That’s why it’s important to attend your GP if you have any symptoms that you’re worried about to get that assessed and get referred to the gynae team. For vulva cancers the alert symptoms are usually a vulva lump, itch, pain or ulcer, bleeding or discharge from the vulva, vagina or back passage, any unexplained weight loss, swelling in one or both legs, or a lump or swelling in the groin. And last but not least, the most rare gynae cancer is our vaginal cancer.

So the vagina is an internal muscular canal which connects the outside of the body with the vulva to the cervix. It’s the least common, more common in the ladies over 75, with 250 cases per year in the UK and around seven females in Northern Ireland, that’s the average number. This starts in squamous cells that line the vagina. And it starts also can be an adenocarcinoma, which is rare. And it’s usually starts in the wee glandular cells in the vagina. Risk factors, we don’t exactly know what causes vaginal cancer, but there are some factors that raise the risks.

Again age, 40% of cases are people aged over 75 and HPV again can cause B-cell changes, which sometimes turn into cancer. Over 3 in 4 cases of vaginal cancer are linked to HPV. The vaginal interepithelial neoplasia is also a benign condition but has potential to progress into a vaginal cancer.

Alert symptoms, usually bleeding quite similar to vulva only obviously you get bleeding or discharge from vagina, the back passage, bleeding after intercourse, unexplained weight loss, swelling in one or both legs or a lump or swelling in the groin.

I’m nearly there. Now I’m just going to highlight a few treatments that you would have been offered if you had had any of those diagnoses. Your treatment is tailored to you and there are a number of factors that guide you, guide us to what treatment is for you. The two things we look at when you get a cancer diagnosis, you look at your grade and your stage.

A grade is when we take a biopsy or you’ve had an operation and everything gets sent off to the clever people in the laboratory, and they look at it down a microscope, they say what type of cancer it is and how that how many cells there are and they grade that from a grade one, two and three, that guides your treatment.

Also, a stage is when if your treatment, if your cancer has spread beyond where it started and that’s what’s known as a stage that’s usually indicated either post-surgery or through doing scans and images. And that helps guide us, so lots of things guide us. You may have been offered surgery, usually considered as a primary treatment for womb, early stage cervical or vulva cancers.

Sometimes it’s not considered as the best option for the treatment. That may be due to a number of reasons. It might be that your body can’t cope with a big operation, or it may be that removing the cancer may cause too much damage to organs in your body. Chemotherapy, cytotoxic drugs. You may have chemotherapy as a first treatment if you don’t think it would be possible to remove the tumour, sometimes you get chemo first to shrink it down, then get offered surgery. Some patients just get chemo and respond really well to chemo. Radiotherapy, usually referred to as image guided radiotherapy. It uses high energy rays to destroy the wee cancer cells that’s usually associated more with womb, cervical, vulva or vagina. Brachytherapy, internal radiotherapy gives you radiation directly into the cervix, usually with cervical or womb cancers. Immunotherapies, a type of treatment that uses your own immune system to fight the disease or boosting to restore the ability to recognise and attack harmful cells. You may also have been offered Parp inhibitors. Anybody with an ovarian cancer/ fallopian tube may be on such treatments.

You would recognise it more as a maintenance treatment. These are inhibitors or targeted therapies that help prevent the cancer, reduce your risk of the cancer returning. You may also have been offered hormone treatment. We talked about oestrogen earlier and hormone treatments can help block oestrogen. Just to finish up what I mentioned earlier, although we gave you all these treatments there are also late effects of treatments.

And it is very important to try to be familiar with late effects and to know you can get a late effect of treatment anything up to ten years post your treatment and some ladies ring me and they are in a real panic thinking their cancer has recurred, and it’s actually a consequence of their treatment. So it’s really important for you to know that you can have late effects such as urinary or bowel problems,

Shauna even mentioned earlier fatigue can be a big impact, lymphoedema can cause and we’ll maybe touch on that later as well. And you, we get a lot of ladies who ring up with, vaginal bleeding or bleeding from the back passage, and that can all be a consequence of your radiotherapy. So it’s really important for you to recognise that and ring up and not automatically think you have a cancer recurrence.

And it’s important for us to know and get you, as Shauna talked about our 3 R’s earlier and we will get you referred and reassessed for that.

Sorry. So the most important thing, I suppose, is to know your key contacts. When you get a cancer diagnosis with us in the Northern Trust, majority of the time you get referred up to Belfast Trust for your treatment, and you meet a thousand nurses and a thousand people and it’s all very confusing when you get lots of names, it’s very very important that you know that we are your local contact, the person you probably met in the first instance.

And if you ever walk back into Antrim hospital for any such, for any reason, any admission it’s important you contact us so that we can help support you through that. So be mindful of your your key symptoms, what you’re looking out for, all your alert symptoms and obviously give us a call if you’re worried about anything. Thank you very much.