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Screening for gynaecological (women’s) cancers: Does it work and when should you seek specialist advice ?

Gynaecological cancers include cancers of the female reproductive tract, namely of the cervix, ovary, fallopian tube, uterus, vulva and the vagina.
Many factors cause gynaecological cancers. Screening and awareness of early signs and symptoms can result in the early detection of these cancers when treatment is more likely to be successful and a complete cure is a possibility. Diet, exercise and lifestyle choices play a significant role in the prevention of cancer. Additionally, knowledge of family history can increase the chance of prevention or early diagnosis by determining if someone may have a gene which makes them susceptible to cancer.
Over three-quarters of all new cases of cervical cancer are diagnosed between the ages of 25 and 64 years. It is the most common cancer in women below the age of 35 years. The primary recognised cause of cancer of the cervix is human papillomavirus infection (HPV). It is considered preventable as it has a recognizable precancerous condition and an accepted treatment modality for this precancerous stage. The NHS Cervical Screening Program is widely recognized to be one of the most successful cancer prevention programs in the world. Since its introduction, the number of cervical cancer cases has decreased by 7% year on year. The program aims to reduce the number of women who develop invasive cervical cancer (incidence) and the number of women who die from it (mortality). It does this by regularly screening all women at risk so that conditions which might otherwise develop into invasive cancer can be identified and treated earlier.
Ovarian cancer continues to be the most fatal of the female genital tract cancers. However, contrary to the commonly held perception, ovarian cancer is neither an asymptomatic disease nor a so-called ‘silent killer’. The initial presenting symptoms are often associated with other conditions, especially abdominal and gastrointestinal disorders until they become very obvious in advanced-stage disease. A strong family history of certain cancers may indicate the presence of hereditary gene mutations. Irregular periods or post menopausal bleeding, lower abdominal, backache and urinary frequency are symptoms which should prompt early investigation and referral to a specialist.
Womb cancer is the commonest gynaecological cancer in the developed world. The hallmark symptom of uterine cancer is post-menopausal bleeding (5%-10% of all symptomatic patients will have underlying cancer) with bleeding occurring at least one year after the last menstrual period in the presence of other evidence of ovarian failure. In pre-and peri-menopausal women, endometrial cancer presents with inter-menstrual bleeding often on a background of irregular, dysfunctional menstruation suggesting an-ovulation. Pain, vaginal discharge are rarer presentations of endometrial cancer and tend to be secondary to advanced malignancy. The baseline investigations in women with suspected endometrial cancer are a transvaginal ultrasound scan and an endometrial biopsy. In women who wish to preserve fertility and conserve their uterus, pre-cancerous changes can be attempted to be reversed by treating with intra-uterine progesterone system like the Mirena IUS and high dose progesterone.