Many women face the possibility of having a reproductive disease/problems at some point in their lifetime. For some they’ve had issues their whole lives, for others problems develop suddenly with little or no warning. Some of the reproductive diseases that women can face are well known while others are not very well known and often get missed or misdiagnosed until it is either too late for treatment or the woman is physically and mentally/emotionally crippled by the pain.
This blog post series is inspired by my own recent experience of facing a potential diagnosis of either Endometriosis, which is what I was officially diagnosed with after a minor laparoscopic surgery and I already had a rudimentary knowledge of endometriosis as my mother has it as well, or Ovarian Cancer, which I knew pretty much nothing about let alone what the most common symptoms were until I faced the possibility of having it and began researching everything I could about ovarian cancer, so we are going to have a look at some of the most common reproductive diseases and problems that we as women can potentially face including endometriosis and ovarian cancer. I must stress right now that not everyone will develop one of these diseases/problems and this is not intended as a diagnostic or medical tool, this post is meant to provide awareness as it is always a good idea to know the signs and symptoms that can point to there being a problem so that you can find the best care provider possible for your particular circumstances.
The diseases we will be looking at in this blog post series are as follows:
- Ovarian Cancer
- Cervical Cancer
- Uterine Cancer
- Pelvic Inflammatory Disease (PID)
Cervical cancer develops from the tissues of the cervix. It is the third most commonly diagnosed reporductive cancer in Australian women and, with regular screening via pap smear, is one of the easiest reproductive cancers to diagnose.
So What Is Cervical Cancer?
Cervical cancer is a cancer that forms on the cervix in the area where the two different types of cells (the Squamous cells that are found on the outside of the cervix and the Glandular cells which are found inside the cervical canal) meet (called the squamocolumnar junction). Cervical cancer forms when there are changes in the cells, beginning in their DNA, which alter the way that the cell works and grows, causing abnormal growth and activity. According to cancer.org.au the most common type of cervical cancer is squamous cell carcinoma which accounts for approximately 80% of diagnosed cases, the other type of cervical cancer, Adenocarcinoma, is less common and much more difficult to diagnose as it develops higher up in the cervix/cervical canal.
Signs and Symptoms of Cervical Cancer
When the cells of the cervix first begin to change from their normal state there aren’t usually any symptoms at all and these changes are normally only picked up during a routine pap smear.
However, if these changes in the cervical cells to develop into cervical cancer, the following symptoms may become apparent:
- Vaginal bleeding in between normal periods/during the middle of your menstrual cycle when you wouldn’t normally bleed
- Your periods may become longer or heavier than is normal for you
- You may start bleeding after having sex
- You may experience pain during intercourse that you did not experience before
- You may notice unusual vaginal discharge that you did not experience before
- If you have already been through menopause you may notice abnormal vaginal bleeding
- You may experience excessive fatigue/tiredness
- You may notice leg pain or swelling that is abnormal for you
- You may begin to experience lower back pain which may worsen or stay the same
Diagnosis and Treatment of Cervical Cancer
Up until 2017 the only way to screen for cervical cancer was to have a pap smear, diagnosis was determined by studying the cervical cells and, if they appeared to be abnormal, having a biopsy, colposcopy and/or LLETZ proceedure to gain a large enough sample of the abnormal cells for testing that could be sent to pathology to determine if they were pre-cancerous or cancerous. Pap smears were recommended to be done from age 18 or every 2 years from first beginning sexual activity and have contributed greatly to a 50% reduction in cervical cancer deaths in Australia since 1991.
In Australia, as of December 1st 2017, the old pap smears that we know (and in many cases dread) will no longer be recommended and instead HPV testing screening will be recommended for all women every 5 years between the ages of 25 to 74 to test for the human papillomavirus (HPV) and to test cervical cells at the same time since several strains of HPV are known to contribute to the development of cervical cancer. The idea behind this is to improve early detection rates* for HPV related cervical cancers (many cervical cancers have a higher likelihood of being caused by one of several different strains of HPV which can contribute to the development of cervical cancer from the changes that it makes in the cervical cells during an active infection, however it should be noted that not all cervical cancers are caused by HPV infection and many people diagnosed with cervical cancer have not been exposed to any of the cancer causing strains of HPV at all, HPV just increases the chances of it developing at a later date. Having had the HPV vaccine also does not, unfortunately, preclude anyone from needing the HPV screening either as the vaccine only covers a few of the most common cancer-contributing strains and not all of them).
*As a side note, how this new HPV screening would be able to reduce cervical cancer deaths and provide earlier cervical cancer detection for the majority with a longer time frame between screenings is, to me, questionable since cervical cancer, and non-HPV related precancerous cells themselves, can in many cases develop quite quickly between the current screening times of 2 years between pap smears - 5 years is a long time to wait between screenings and, based on observations of our countries past history prior to 2-yearly pap smears and other countries (eg the USA for example) history with low numbers of regular pap smears being done, may end up resulting in an increase in later stage cervical cancer diagnoses as opposed to early stage and precancerous diagnoses, although how effective or ineffective it may end up being we will not likely know for another decade or so before we can make any accurate conclusions of effectiveness or ineffectiveness. I also wonder about the HPV screening for people who have not and, in the case of people who practice abstinence and monogamous couples who do not stray from each other and have previously been tested negative to HPV, would it not be a waste of resources screening people for something that they have not been exposed to and are unlikely to be exposed in future? These are questions for which I eagerly await unbiased evidence based answers and I will be going through any and all research that I can find about this new screening before I make my own personal conclusions.
If diagnosed with cervical cancer you will be given a stage (stages vary from 0 to IV, with 0 being abnormal cells on the surface layer and IV being that the cancer has spread to other organs), staging helps your doctor (in the case of cervical cancer it is usually an oncologist specialising in gynaecological cancers) determine the best options for treatment to suit your individual needs.
If the tumour/cancerous area of tissue is only small then a cone biopsy may be all that is needed to excise the cancerous cells.
For advanced disease confined to a small area a combination of radiotherapy and chemotherapy will likely be offered and, depending on how you respond, may be all that needed.
For metastatic disease (where it has spread elsewhere in the body creating new tumours/cancerous areas) treatment is a combination of chemotherapy, usually to try and reduce the size of the tumours/cancerous areas to give you more time with your loved one/s, and/or palliative care.
Surgery (excision) of the affected area may be a possible option for some people in combination with other treatments, it is best to speak with your doctor and ask lots of questions to help you understand what your treatment options are and what you can do, using the BRAIN acronym – benefits (what are they?), risks (what are they?), alternatives (are there any other options/alternatives to what is on offer?), intuition (what does your intuition/gut tell you?) & nothing (what would happen if you do nothing at all?) - can help you with making your decision about what you wish to do.
When do I seek Help?
Seek help when:
Please seek help from your medical care provider if you experience any combination of the above listed symptoms for more than 4 weeks or for more than 4 menstrual cycles in a row.
If your symptoms worsen and do not get better, if you start to lose or gain weight without trying and without doing anything different, if your pelvis and lower abdomen starts to enlarge without any discernible reason, if you start vomiting regularly without any discernible reason (eg you aren’t pregnant but are vomiting daily), if you start struggling to breathe on a daily basis without any discernible reason and/or anything else occurs that has you worried please see your medical care provider (and in the case of struggling to breathe, if its severe please go straight to your nearest emergency room or call an ambulance).