Women's cancer

Breast cancer

Both women and men both have breasts.

In females the breasts are made up of milk glands.

The milk gland consists of lobules.

Lobules is where milk is made.

The milk then travels along tubes called ducts, that take milk to the nipples.

In men, the development of the lobules is suppressed at puberty by testosterone, the male sex hormone.

Both male and female breasts contain supportive fibrous tissue and fatty tissue.

Some breast tissue extends into the armpit (axilla).

The armpits contain a collection of lymph nodes (also called lymph glands), which are part of the lymphatic system.

The lymphatic system is part of the immune system and protects the body against disease and infection.

For more information on breast cancer visit the Cancer Council website.

Causes The exact cause of breast cancer is not known, but some factors increase the risk: getting older having several close relatives, like a mother, sister or daughter, diagnosed with breast cancer - these relatives can be from either the mother's or father's side of the family if you have had breast cancer before if you have had certain breast conditions such as atypical ductal hyperplasia, ductal carcinoma in situ or lobular carcinoma in situ.

Having some of these risk factors does not mean that you will develop breast cancer.

Most women with breast cancer have no known risk factors, aside from getting older.

In men, breast cancer usually occurs over the age of 60.

It is most common in men who have: several close members of their family (male or female) who have had breast cancer a relative diagnosed with breast cancer under the age of 40 several members of the family with cancer of the ovary or colon a rare genetic syndrome called Klinefelter's syndrome.

Men with this syndrome have three sex chromosomes (XXY) instead of the usual two (XY).

Inherited breast cancer gene A set of genes is inherited from each parent.

Sometimes there is a fault in one copy of a gene, which stops that gene working properly.

This fault is called a mutation.

A small number of breast cancers (about 5% or 1 in 20) may be caused by an inherited gene fault.

Two breast cancer genes have been found: BRCA1 and BRCA2.

Women in families with an inherited gene change could be at increased risk of ovarian cancer.

Men in these families may also be at increased risk of breast cancer and prostate cancer.

People with a strong family history of breast cancer can be tested to see if they have inherited a gene change.

Symptoms You may notice a change in your breast or your doctor may find an unusual breast change during a clinical breast examination.

Signs to look for include: a lump, lumpiness or thickening changes to the nipple - such as a change in shape, crusting, a sore or an ulcer, redness or a nipple that turns in (inverted) when it used to stick out changes to the skin of the breast - such as dimpling of the skin, unusual redness or other colour changes change in the shape or size of the breast - this might be either an increase or decrease in size unusual discharge from the nipple without squeezing swelling or discomfort in the armpit persistent, unusual pain - if this is not related to your normal monthly cycle, remains after a period and occurs in one breast only.

These changes don't necessarily mean you have breast cancer.

However, if you have any of these symptoms you should have them checked by your doctor without delay.

Some women have no symptoms and their breast cancer may be found on a screening mammogram.

Men's symptoms are similar to women's.

Diagnosis Several tests are usually used to find out if your breast change is due to breast cancer.

Physical examination Your doctor will feel your breasts and the lymph nodes under your arms, take a full medical history and ask about your family history.

Mammogram This is a low-dose x-ray of the breast.

It can find changes that are too small to be felt through physical examination.

Both breasts are checked.

Your breast is pressed between two x-ray plates, which spread the breast tissue out so clear pictures can be taken.

Many women find this procedure uncomfortable, but it's over in about 20 seconds.

Sometimes, a lump that can be felt is not seen on a mammogram and other tests will need to be done.

Ultrasound

Ultrasound uses soundwaves to make a picture of your breast.

A gel is spread on the breast, and a small device called a transducer is moved over the area.

It sends out soundwaves that echo when they meet something dense like an organ or tumour.

A computer creates a picture from these echoes.

This test is painless and takes 15 to 20 minutes.

Biopsy

Your doctor will suggest a biopsy if an abnormal or unusual area of tissue is found in your breast.

You may need one or more biopsies.

A biopsy means removing a small amount of breast tissue.

There are a few ways of doing this.

Fine needle aspiration

A thin needle is used to take some cells from the breast lump or abnormal area.

Sometimes an ultrasound is used to help guide the needle.

The test is a bit uncomfortable, similar to having blood taken for a blood test.

It is usually done in a specialist's rooms, a hospital outpatient department or at a radiology practice.

Core biopsy

A wider needle is used to remove a small piece of tissue, called a core, from the lump or abnormal area.

It is usually done under local anaesthetic.

A mammogram or ultrasound is used to help guide the needle.

A core biopsy may be uncomfortable and you may experience some pain.

Surgical biopsy

If the lump is too small to be biopsied using the method above, a surgical biopsy is needed.

To help the surgeon find the abnormal tissue, a needle and wire may be put into the breast under local anaesthetic before the biopsy.

The biopsy is then done in a separate operation using a general anaesthetic.

The lump and a small area of normal breast tissue around the lump are removed, along with the wire.

This operation is usually done as day surgery but may mean an overnight stay in hospital.

If the surgical biopsy removes all of the cancer, no further treatment is needed.

Some more tests may be done to see if the cancer has spread to other parts of the body.

This is called staging.

You may have one or more of these tests.

For more information on breast cancer diagnosis visit the Cancer Council website.

Treatment

Treatment for early breast cancer aims to remove the cancer and reduce the risk of the cancer spreading or coming back.

Your doctor will advise you on the best treatment for your cancer.

The choice of treatment will depend on your test results, where the cancer is and if it has spread, whether your cancer has oestrogen or progesterone receptor protein, your age and general health, and what you choose.

If you talk to other people with breast cancer, remember there are different types of breast cancer and the best treatment for one person may not be the best treatment for another.

Breast conserving surgery

Surgery to remove the breast cancer and some surrounding healthy tissue is called breast conserving surgery.

It is also called lumpectomy, complete local excision, partial mastectomy or wide local excision.

Breast conserving surgery is offered if the cancer is small compared to the size of the breast.

Mastectomy

Surgery to remove the whole breast is called mastectomy.

Usually the nipple is also removed.

The chest muscles are not removed.

Some or all of the lymph nodes in the armpit closest to your affected breast may also be removed.

This is called axillary surgery.

You may be offered a mastectomy if the cancer is large compared to the size of the breast or the cancer is in more than one area of the breast.

While your wound heals, you can wear a soft temporary breast form (prosthesis) inside your bra.

You may choose to fitted for a breast form or have your breast surgically reconstructed.

Breast reconstruction

During a breast reconstruction, the breast shape is recreated using either an implant or tissue from another part of your body.

Some surgeons do the reconstruction at the same time as the mastectomy (immediate reconstruction).

Others prefer to wait for several months or longer (deferred reconstruction).

Talk to your surgeon about what is best for you.

Removing lymph nodes Lymph nodes (glands) are found throughout the body, including the armpit.

They are small, bean-shaped collections of lymph cells that protect the body against disease and infection.

The lymph nodes are part of the lymphatic system.

The lymph nodes in the armpit (axilla) are often the first place breast cancer cells spread to outside the breast.

Radiotherapy

Radiotherapy uses x-rays to kill cancer cells or stop them from growing.

After breast-conserving surgery: radiotherapy is usually recommended to help destroy any cancer cells left in the breast and reduce the risk of the cancer coming back.

After mastectomy: radiotherapy to the chest is occasionally recommended.

After either type of breast surgery: radiotherapy to the lymph nodes in the armpit is occasionally recommended.

Chemotherapy

Chemotherapy uses drugs to kill or slow the growth of cancer cells.

Chemotherapy may be used: if the risk of the cancer returning is high, to try to prevent the breast cancer coming back or spreading to other parts of the body when cancer returns after surgery or radiotherapy, to gain control of the cancer and to relieve symptoms if the cancer does not respond to hormone therapy.

Chemotherapy is usually given through a vein (intravenously).

Usually you will be treated as a day patient but occasionally an overnight stay may be recommended.

You may have a number of Chemotherapy sessions, maybe up to 8, every 2-3 weeks over several months.

This gives your body time to recover before the next session.

How long you have Chemotherapy will depend on the type of breast cancer you have and what other treatments you are having.

For more information on breast cancer treatment visit the Cancer Council website.

Cervical cancer

The cervix is part of the female reproductive system the lower part of the uterus (womb) that connects to the vagina sometimes called the neck of the uterus the hollow organ shaped like an upside down pear found at the top of the vagina.

The cervix has many functions, including: producing some of the moistness that lubricates the vagina producing the mucus that helps sperm travel up to the Fallopian tube to fertilise an egg from the ovary holding the developing baby in the uterus during pregnancy.

During childbirth, the cervix widens to allow the baby to pass down into the birth canal (vagina).

The cervix is covered by two kinds of cells: Squamous - flat thin cells found in the outer layer of the cervix (ectocervix) Glandular - glandular cells are found in the cervical canal (endocervix) The point where these two cells meet is called the squamocolumnar junction.

For more information on cervical cancer visit Cancer Council website.

Causes The causes of cervical cancer are largely unknown.

However, some factors increase a woman's risk: Human Papillomavirus (HPV) infection (the name for a group of wart viruses) HPV is a common infection affecting the surface of any part of the body, including the skin, vagina and cervix.

More than 100 types of the virus have been identified but only some affect the genital area.

Around eight out of 10 women will become infected with the genital HPV at some time in their lives and, for most, it will clear up on its own.

Women only find out they have the HPV if it shows up on a Pap smear - it causes no symptoms.

Having HPV does not mean you will get cervical cancer.

Most women who have the HPV infection never get cervical cancer.

Only a few types of the HPV result in cervical cancer.

Smoking Produces chemicals that may damage the cells of the cervix and make cancer more likely to develop.

Cervical cancer and HPV vaccination From 2007, the Australian government provided free HPV vaccination to females 12-26 years.

The program ended in June 2009.

The selected vaccine prevents infection from four HPV types.

Most effective if young women are vaccinated before infected with the relevant HPV strains.

Ask your doctor about non-subsidised vaccines - some are available for women 26-45 years.

Vaccination doesn't protect against all HPV types that could cause cancer, so women should continue regular Pap testing.

Symptoms Early changes in the cells of the cervix (epithelial abnormalities) rarely cause symptoms, which is why doctors encourage women to have regular Pap tests.

If early cell changes develop into cervical cancer, the most common signs include: vaginal bleeding between periods bleeding after intercourse pain during intercourse unusual vaginal discharge vaginal bleeding after menopause excessive tiredness leg pain or swelling lower back pain.

All these symptoms are common to many conditions and may not mean you have cervical cancer.

However, if you have these symptoms you should have them checked by your doctor.

Diagnosis Pap test Most abnormal changes in cervical cells are detected with a Papanicolaou test (Pap test or Pap smear).

For a Pap test: the doctor uses a brush or small spatula to scrape some cells from the surface of the cervix (this may feel slightly uncomfortable, but usually only takes a few minutes). cells are examined for abnormalities.

A woman should have a Pap test once every two years, but some women have them more often.

About 5-7% of Pap tests produce abnormal results, which may include dysplasia.

Your doctor will talk to you if you have an abnormal result.

Colposcopy An examination that allows the doctor to see a magnified view of the cervix, vagina and vulva.

Can help identify where abnormal cells are.

Done using an instrument called a colposcope, which is like binoculars on a stand.

The colposcope doesn't enter the body - the doctor inserts an instrument called a speculum and views the magnified picture through the colposcope.

Beforehand, the vagina and cervix may be coated with a special solution to highlight abnormalities.

Takes 10-15 minutes.

Can be slightly uncomfortable.

Biopsy A small sample of tissue may be taken from an abnormal area on the cervix and sent to a laboratory for examination.

A colposcope will be used to see what area needs to be removed.

May be uncomfortable for a brief period.

Taken in the doctor's rooms or in a clinic.

Results are usually back within about a week.

Temporary side effects: Pain - similar to menstrual cramping.

Ask your doctor for pain-killers.

Light bleeding - bleeding or other vaginal discharge may be present, but will gradually disappear.

Infection - you should not have sexual intercourse or use tampons for a few days to reduce the risk of infection.

For more information on cervical cancer diagnosis visit Cancer Council website.

Treatment

Your doctor will advise you on the best treatment after considering your age, general health and whether the cancer has spread (the stage).

Surgery

Surgery is common for small tumours found only within the cervix.

The extent of the cancer in the cervix will determine the type of surgery needed.

Trachelectomy A type of surgery that may preserve fertility.

Radical trachelectomy - common for small cancers in young women.

Side effects are similar to those of a hysterectomy, however you will still have periods after surgery.

Cone biopsy If your tumour is very small, a cone biopsy may be the only treatment you need.

See Cone biopsy for more information.

Hysterectomy

The surgical removal of the uterus and cervix.

Two main types: Total hysterectomy - removal of uterus and cervix, with about five days in hospital.

Radical hysterectomy - removal of uterus and about two centimeters of upper vagina and tissues around the cervix.

May affect continence.

About a seven day hospital stay.

When you have either type of hysterectomy, you may also have: Bilateral salpingo oophorectomy - removal of ovaries and Fallopian tubes.

Pelvic lymphadenectomy - lymph nodes in pelvis are removed.

May cause leg swelling (lymphoedema).

Radiotherapy

radiotherapy uses x-rays to kill or injure cancer cells so they cannot multiply.

radiotherapy can be given in two ways: From outside the body (external).

A machine directs radiation at the cancer and surrounding tissue.

From inside the body (internal).

Radioactive material is put in thin tubes and implanted into your body on or near the cancer.

This is called brachytherapy.

Usually both external and internal radiotherapy is used to treat cervical cancer.

radiotherapy is usually given if you are not well enough for a major operation or if the tumour has spread into the tissues surrounding the cervix.

radiotherapy may be used after surgery or combined with Chemotherapy.

It can also treat the lymph nodes in the area of the cancer, in case the cancer has already spread.

External radiotherapy X-rays are aimed from a machine at the cervix and surrounding tissue (pelvic area).

You will lie on a table under the radiotherapy machine.

You'll be alone in the treatment room, but can talk through an intercom.

Common to have outpatient treatment from Monday to Friday for four to six weeks.

After the first visit to plan your treatment, which usually takes up to three hours, the actual treatment only takes a few minutes each time.

During the treatment you will regularly see the radiation oncologist and have weekly blood tests to make sure you are not becoming anaemic and to monitor your electrolytes.

Internal radiotherapy Also called brachytherapy.

You are given an anaesthetic and a radioactive implant is placed inside your body directly in and around the cancer (cervix and vagina area).

May have gauze packing and a stitch put in your vaginal lips to keep the implant in place.

A small tube (catheter) will be passed into the bladder to take away urine. Urologists.

Depending on where you receive your treatment, the implant may be left in for up to 72 hours.

The implant doesn't hurt while inserted but you may find it uncomfortable - pain relief can help.

During the time the implant is in, you won't be able to sit upright in bed.

You'll be in a room on your own but you will be able to talk to the hospital staff through an intercom.

Removing the implant can be uncomfortable, but once the implant is removed you will not be radioactive.

You will be able to go home after the implant has been removed and you have been monitored for any bleeding.

Ovarian cancer

The ovaries are part of the female reproductive system.

They are: small, almond-shaped organs, each about 3 cm long and 1 cm thick found in the lower part of the abdomen (pelvic cavity) covered with a layer of cells called the epithelium.

There is one ovary on each side of the womb (uterus).

In a woman of childbearing age, a mature egg (ovum) is released from one of the ovaries each month (ovulation).

This egg travels down the Fallopian tube to the uterus.

If the egg is not fertilised by sperm, it disintegrates.

The ovaries also contain cells that release the female hormones oestrogen and progesterone.

These cells are called sex-cord stromal cells.

As a woman gets older, the ovaries gradually produce less oestrogen and progesterone.

At the same time, the production of eggs also decreases and periods become irregular and eventually stop.

This is known as menopause and usually happens between the ages of 45 and 55.

After menopause, it is no longer possible to have a child by natural means.

For more information on Ovarian cancer visit the Cancer Council website.

Causes

The cause of ovarian cancer is unknown.

However, the following factors increase a woman's chance of developing ovarian cancer: Age: Most common in women over 50 and in women who have stopped menstruating (have been through menopause).

The risk increases with age.

Child-bearing history: Women who haven't had children, or were unable to have children, may be slightly more at risk.

Hormonal factors: Includes early puberty or late menopause and using oestrogen-only hormone replacement therapy (HRT).

Women who have taken the contraceptive pill for a number of years seem to have a lower risk.

There is also limited evidence suggesting that breastfeeding may protect against ovarian cancer.

There is no proven link between ovarian cancer and a high-fat diet, using talcum powder around the genital region, or the mumps virus.

Family history In about 5-10% of women diagnosed with ovarian cancer there may be an inherited faulty gene in their family.

This fault increases the risk of developing ovarian cancer.

There are two genetic conditions known to cause an increased risk of ovarian cancer: hereditary breast/ovarian cancer Lynch syndrome (hereditary non-polyposis colorectal cancer or HNPCC).

You may want to talk to your doctor or go to a family cancer clinic if you think you are at risk.

Symptoms Ovarian cancer is often a silent disease in the early stages, which means many women have no symptoms.

If symptoms do appear, they are usually vague and may include: swelling, pressure, discomfort or pain in the abdomen heartburn, nausea or bloating changes in toilet habits, such as constipation, diarrhoea and frequent urination due to pressure tiredness and appetite loss unexplained weight loss or weight gain changes in your menstrual pattern or postmenopausal bleeding pain during sex These symptoms are common to many illnesses, and most women with these symptoms will not have ovarian cancer.

Only tests can confirm the diagnosis.

Diagnosis Most ovarian cancer tumours are present for some time before they are discovered.

Sometimes ovarian cancer is found unexpectedly during an operation such as a hysterectomy.

Physical examination The doctor will check for a mass or lump by feeling your abdomen and doing a vaginal examination.

If there is a build-up of fluid in the abdomen, a fluid sample may be taken by a needle passed through the skin (paracentesis).

The fluid is checked under a microscope for cancer cells.

You may have a type of surgery called an exploratory laparotomy so the doctor can examine the tissue in your abdomen.

Blood tests Chemicals that are produced by cancer cells as proteins are found in the blood.

They are called tumour markers.

You will have a blood test to check the level of your tumour markers.

If your levels of the chemicals rise, you may have ovarian cancer.

However, you could have raised markers and not have ovarian cancer, as levels may be higher in women who have common gynaecological conditions, such as endometriosis or fibroids.

The most common tumour marker for ovarian cancer is called CA125.

Imaging and scans Your doctor may do a scan to see if you have cancer.

Abdominal ultrasound: A handheld device called a transducer is passed over your abdomen.

Echoes from soundwaves are turned into a picture by a computer.

Transvaginal ultrasound: A transducer is inserted into your vagina and echoes from soundwaves are turned into a picture by a computer.

This should not be painful.

CT scan: Uses x-ray beams to take pictures of the inside of your body.

You will be asked not to eat or drink before the scan, and you may have some liquid dye that makes your organs appear white on the scans.

You will lie on a table while the scanner, which is large and round like a doughnut, rotates around you.

MRI scan: Uses magnetism and radio waves to build up cross-section pictures of your body.

You will lie in a narrow metal cylinder.

X-rays: You may have chest or abdominal x-rays.

A bowel x-ray called a barium enema may also be done.

This means a white chalky liquid is put into your bowel through your anus and rectum and x-rays are taken.

For more information on Ovarian cancer diagnosis and prognosis visit the Cancer Council website.

Treatment

Treatment for ovarian cancer depends on what type of cancer you have, the stage, your general health and fitness, your doctors' recommendations and your wishes.

Epithelial ovarian cancer is commonly treated with surgery, Chemotherapy and/or radiotherapy.

Borderline tumours are usually treated with surgery.

Non-epithelial ovarian cancer is usually treated with surgery and/or Chemotherapy.

Surgery

Your doctor will discuss the most appropriate type of surgery with you.

Laparotomy The first treatment for ovarian cancer is usually an operation to look inside the abdomen.

This is called a laparotomy.

A cut is made in the lower abdomen from the bellybutton to the pubic bone.

Other types of surgery If there is obvious spread of cancer, you will need an operation to remove as much of the cancer as possible.

This is called surgical debulking.

You may also have one or more of the following procedures: total abdominal hysterectomy - removal of the uterus and cervix bilateral salpingo-oophorectomy - removal of both ovaries and both Fallopian tubes omentectomy - removal of the fatty protective tissue (omentum) covering the abdominal organs colectomy - removal of all or part of the bowel and rejoining of the two ends of the bowel or the creation of a new opening called a stoma (colostomy or ileostomy) lymphadenectomy - removal of the small, bean-shaped organs that help filter toxins from the blood stream (lymph nodes).

The surgeon will also take samples of the tumour and fluid in the abdomen and send them to a lab.

Chemotherapy

Chemotherapy is the treatment of cancer with anti-cancer (cytotoxic) drugs that kill or slow the growth of cancer cells.

Women with epithelial ovarian cancer that has spread outside the ovaries usually receive a combination of two Chemotherapy drugs: carboplatin and paclitaxel.

However, not everyone has both drugs, for example only one drug may be prescribed for frail or elderly women.

Chemotherapy is usually given through an intravenous drip.

Your first treatment may be given while you are recovering from surgery, or a few days after you leave hospital.

Around 6-8 treatments will be given every 3-4 weeks over about six months.

Blood tests will be taken to make sure your body's healthy cells have had time to recover.

The tests will also check the amounts of your tumour markers, such as CA125.

radiotherapy radiotherapy uses x-rays to kill or injure cancer cells they cannot multiply.

It is occasionally used to treat ovarian cancer, especially if the cancer is confined to the pelvic cavity.

You may have radiotherapy to the whole abdomen (called whole abdominal radiotherapy or WART), or to one particular area of your abdomen.

You will lie on an examination table and a machine above you will deliver the painless treatment.

You will have a number of treatment sessions.

Most women have treatment daily, Monday to Friday, for 3-4 weeks.

Your doctor will tell you how much treatment you need.

For more information on Ovarian cancer treatment visit the Cancer Council website.

Uterine cancer

The uterus part of the female reproductive system - main fuction is to nourish a developing foetus also called the womb about the size and shape of a hollow, upside-down pear mostly made up of smooth muscle tissue, called the myometrium.

The lining is called the endometrium. sits quite low in the abdomen and is held there lightly by muscle is joined to the vagina by the cervix, or neck of the uterus The role of the uterus When a woman ovulates, or produces eggs in their ovaries, an egg travels through their Fallopian tube into the uterus.

If the egg is fertilised by a sperm, it will implant itself into the lining of the uterus (endometrium) and grow into a baby.

If a woman is ovulating, the endometrium will grow thicker each month to prepare for pregnancy.

If the egg is not fertilised, the top layers of the endometrium are shed and flow out of the body through the vagina during menstruation (period).

Menopause occurs when a woman no longer releases the hormones that cause ovulation and menstruation.

A woman's monthly periods stop, and she is no longer able to become pregnant.

The uterus becomes smaller and the endometrium becomes thinner and inactive.

For more information on uterine cancer visit the Cancer Council website.

Causes In most cases, the exact cause of cancer of the uterus is unknown.

Some factors may increase a woman's risk: age - more common in women aged over 50 being menopausal - most common in postmenopausal women endometrial hyperplasia, a condition that occurs when the endometrium grows too thick never having children or infertility early menarche (first menstrual period) high blood pressure (hypertension) and diabetes obesity a family history of ovarian, endometrial, breast or bowel cancer previous pelvic radiation for cancer ovarian tumours or polycystic ovary syndrome taking oestrogen hormone replacement without progesterone taking the drug tamoxifen for the treatment of breast cancer.

If you are taking tamoxifen, you should discuss this risk with your doctor.

Uterine cancer is not caused by sexual activity and cannot be passed on this way.

Symptoms abnormal vaginal discharge or bleeding, particularly after menopause (can appear watery or bloody, and may be smelly) discomfort or pain in the abdomen difficult or painful urination pain during sex.

Diagnosis Physical examination Your doctor will feel your abdomen to check for swelling.

Your doctor may also look at your vagina and cervix using a medical tool to separate the walls of the vagina (speculum).

This is like having a Pap test.

Transvaginal ultrasound Scan uses soundwaves to create a picture of internal organs.

A small device called a transducer is put into your vagina.

A computer makes a picture your vagina, so the doctor can look at the size of the ovaries and uterus and the thickness of the endometrium.

You may also have a biopsy.

Hysteroscopy and biopsy a procedure that allows a doctor to see inside the uterus the cervix is stretched and opened, and a telescope-like device called a hysteroscope is inserted the doctor will remove some issue to examine (biopsy).

X-rays You may have a chest x-ray to check that your lungs and heart are healthy.

Sometimes special x-rays using dye or barium are taken to test how well your kidneys, bladder or bowel are working.

Your radiologist and urological surgeon will be able to provide you with more information on what tests are required. There is more information on radiology tests.

Computerised tomography (CT) scan: You will drink a liquid dye that makes your organs appear white on the scans.

You'll lie on a table while the scanner, which is large and round like a doughnut, moves around you.

Takes pictures of your body.

Usually takes about an hour, as an outpatient scan.

Painless.

Magnetic resonance imaging (MRI): A powerful magnet linked to a computer takes detailed pictures of areas inside the body.

You lie on a table that slides into a metal cylinder, which can be claustrophobic.

Usually takes about an hour, as an outpatient scan.

Painless.

Positron emission tomography (PET) scan: You will be injected with glucose solution containing a small amount of radioactive material.

Active cells like cancer cells take up this solution.

Your body is scanned for high levels of radioactive glucose.

Blood tests Blood tests can assess your general health.

For more information on uterine cancer visit the Cancer Council website.

Treatment

How treatment is decided Your doctor will consider several factor to determine the best treatment for your cancer: the results of your tests where the cancer is if it has spread your age general health what you want.

The main treatment for cancer of the uterus is surgery, because uterine cancer is often diagnosed before it has spread.

Many women do not need treatment other than surgery.

If the cancer has spread beyond the uterus, radiotherapy, hormone treatment or Chemotherapy may be used in addition to surgery.

Hysterectomy Surgery allows the doctors to find out the type of cancer you have and if it has spread.

Cancer of the uterus is usually treated by removing the uterus and cervix (total hysterectomy).

The Fallopian tubes and ovaries are also usually removed (bilateral salpingo oophorectomy).

Ovaries are removed during surgery because the cancer may have spread to the ovaries, or because ovaries produce oestrogen, which may help the cancer to grow.

The operation may be done as a laparoscopic ("keyhole") procedure - using only small cuts in the abdomen.

Tissue is removed through the vagina.

During the operation: A cut is usually made from the pubic area to the belly button.

Occasionally, it may be along the pubic line.

The surgeon removes tissue (fluid) for examination.

The surgeon checks all the organs in the abdomen, looking for signs of cancer spread (metastasis).

The organs are removed.

If the cancer is only on the surface or is in a very early stage, you may not need to have any more treatment.

Removing lymph nodes If the cancer has spread into the muscle wall of the uterus, this increases the risk of spread to the abdominal lymph nodes.

Removal of lymph nodes is called a lymphadenectomy.

The surgeon uses small clips to seal the lymph vessels.

If you have cancer in the lymph nodes, you may benefit from additional therapy.

radiotherapy radiotherapy uses x-rays to kill cancer cells or injure them so they cannot multiply.

The radiation can be targeted at cancer sites in your body.

radiotherapy may be giving if you are not well enough for a major operation, or as additional (adjuvant) therapy.

radiotherapy can be given in two ways: From inside the body (internal).

Radioactive material is put in thin tubes and inserted into your body on or near the cancer.

From outside the body (external).

A machine directs radiation at the cancer and surrounding tissue.

Side effects depend on the type of treatment you have.

Internal radiotherapy (brachytherapy) A type of radiotherapy where the radiation source is placed close to the cancer - an implant is inserted through the vagina or the tissues around the vagina using special applicators. the most common type of radiotherapy for cancer of the uterus commonly used after a hysterectomy can be done in two ways: Low-dose rate treatment: radiotherapy is given continuously, for up to 30 hours.

You will go to hospital to have a radioactive implant inserted, usually under general anaesthetic.

You will need to stay in a room on your own while the implant is in place, and may not be allowed to have any visitors during this time.

High-dose rate treatment: You may not need to stay in hospital for high-dose rate treatment, but will make 4-8 visits to the treatment centre as an outpatient.

The treatment time for each treatment can be as little as 5-10 minutes.

Your choice of treatment may be shaped by whether you are able to make several treatment visits.

External radiotherapy X-rays from a large machine are directed at the part of the body needing treatment (usually the lower abdominal area and pelvis, or other areas of the body, if cancer has spread).

You will probably have treatment from Monday to Friday for 4-6 weeks as an outpatient.

Treatment itself takes only a few minutes, but prep can take up to 1-3 hours.

It is painless when it is given.

Hormone treatment Some cancers of the uterus depend on hormones (such as oestrogen) for growth.

Hormone treatments that may be used include: Provera, which blocks the body's use of oestrogen, and is a form of the female hormone progesterone Tamoxifen, which is an anti-oestrogen drug.

Hormone treatment, which is taken orally, can work well for advanced or recurrent cancer of the uterus.

Chemotherapy

Chemotherapy uses drugs to kill or slow the growth of cancer cells.

The aim is to destroy cancer cells while causing the least possible damage to normal cells.

Chemotherapy may be used: for certain types of cancer, such as serous carcinoma when cancer returns after surgery or radiotherapy if the cancer does not respond to hormone treatment if cancer has spread beyond the uterus at the time of diagnosis, such that surgery is impossible.

Chemotherapy is usually given through a needle inserted into a vein (intravenously).

You may need to stay in hospital overnight or you may be treated as a day patient.

You may have a number of treatments, sometimes up to six, every 3-4 weeks over several months.

The length of treatment will depend on the disease and what other treatment is being used.

For more information on uterine cancer visit the Cancer Council website.

Vaginal cancer

The vagina is a muscular tube that extends from the opening of the womb (cervix) to the external part of a woman's sex organs (vulva).

It is the passageway through which menstrual blood flows, sexual intercourse occurs, and a baby is born.

For more information on vaginal cancer visit the Cancer Council website.

Causes DES A hormone drug called diethystilboestrol (DES) has been identified as a cause of a particular type of cancer of the vagina.

Between 1940 and 1970, DES was prescribed to pregnant women to try to prevent miscarriages.

The female children of women who took DES during pregnancy have a slightly increased risk of developing a type of cancer of the vagina called clear cell adenocarcinoma. (Only one in 1000 DES daughters develop vaginal cancer.

The incidence peaked in the 1970s and is now decreasing.) Although DES and some other female hormones (oestrogens) can be safely used to treat some other medical conditions, DES is no longer used during pregnancy.

HPV The human papilloma virus (HPV), which is the name for a group of wart viruses, is a risk factor for vaginal cancer.

HPV is a common infection affecting the skin surface of any part of the body, including the vagina and the cervix.

Other possible causes Cervical cancer: women who have had cervical cancer or pre-cervical cancer in the past are more likely to get vaginal cancer.

radiotherapy to the pelvic area: women who have had radiotherapy to the pelvic area also have a slightly higher risk, but this complication of radiotherapy is very rare, and women who have had this treatment still only have a tiny risk of developing vaginal cancer.

Symptoms The most common symptoms of vaginal cancer are: blood-stained vaginal discharge bleeding after sexual intercourse pain.

Problems with passing urine, such as blood in the urine, the need to pass urine frequently and the need to pass urine at night, can also occur.

Pain in the back passage may sometimes occur.

Diagnosis Usually you begin by seeing your GP, who will do a vaginal examination.

If there is a chance you have vaginal cancer, you should be referred to a gynaecological oncologist, who diagnoses and treats women with cancer of the reproductive organs.

Your doctor may also arrange for you to have a blood test and chest x-ray to check your general health.

The following tests are commonly used to diagnose vaginal cancer.

Internal vaginal examination At the hospital, the gynaecological oncologist will do a full pelvic examination. This will include examining the inside of your vagina to check for any lumps or swellings.

The doctor will also feel your groin and pelvic area to check for any swollen glands and may also check your back passage.

Pap smear You will have a Pap smear to check for early cell changes in the vagina or cervix.

Colposcopy If the cells taken in the smear test are abnormal, your doctor may ask you to have a colposcopy.

This is a closer examination of the vagina using a colposcope, which is a small low-powered microscope that allows the doctor or specialist nurse to see the vagina in more detail.

Biopsy A small sample of tissue will be taken from any abnormal areas, and examined under a microscope.

Further tests If the above tests show that you have a vaginal cancer, further tests may be necessary to find out whether any cancer cells have spread.

The results of these tests will help the specialist to decide on the best type of treatment for you.

For more information on vaginal cancer diagnosis visit the Cancer Council website Treatment The treatment for vaginal cancer depends on: age general health stage grade type of cancer.

radiotherapy radiotherapy is a commonly used treatment for many women with cancer of the vagina.

In some younger women, radiotherapy may be combined with Chemotherapy.

radiotherapy treats cancer by using x-rays, which destroy the cancer cells, while doing as little harm as possible to normal cells.

It is given in the radiotherapy department at the hospital.

The dose needed will depend on the exact type of cancer and whether it has spread into surrounding tissue, so you may find that you are having a different radiotherapy treatment from other women you meet at the hospital.

radiotherapy can be given in two ways: From outside the body (external).

A machine directs radiation at the cancer and surrounding tissue.

From inside the body (internal).

Radioactive material is put in thin tubes into your body on or near the cancer.

Most women have both external and internal radiotherapy.

External radiotherapy This involves beams of radiation being directed at the cancer from outside the body.

It is like having an x-ray.

You will be asked to visit the radiotherapy department for treatment every weekday for 4-6 weeks.

Each treatment takes several minutes and is painless.

Internal radiotherapy An applicator (similar to a tampon) containing a radioactive substance is inserted into your vagina.

The treatment may last several hours or a few days.

Sometimes, as well as the applicator, tiny radioactive needles may be placed into the area surrounding the vagina.

If these are needed, they are put in under general anaesthetic and are removed once the treatment ends.

Surgery

Sometimes the cancer needs to be removed in an operation.

The type of surgery you will have depends on the size and position of the cancer.

It may be possible to have an operation to remove the cancer together with some of the surrounding normal tissue.

Depending on the amount removed, the remaining vagina may be stretched so that you may still be able to have sexual intercourse.

Vaginectomy

Some women may need a larger operation that removes all of the vagina.

Sometimes it is possible to make a new vagina (vaginal reconstruction) using tissue from other parts of the body.

Radical hysterectomy It may also be necessary to remove the uterus (womb), cervix, ovaries and Fallopian tubes.

This is called a radical hysterectomy.

During this operation some of the lymph nodes in the pelvis may also be removed.

For more information on vaginal cancer treatment visit the Cancer Council website.

Vulvar cancer

The vulva is the external part of a woman's sex organs.

It consists of soft fatty tissue covered with pubic hair called the Mons Pubis (Mount of Venus), which is above the labia.

The labia have two outer larger lips (the labia majora), which surround two inner smaller and thinner lips (the labia minora).

At the top, where the labia minora join, is a highly sensitive organ called the clitoris.

When stimulated, the clitoris fills with blood and enlarges in size.

Stimulation of the clitoris can result in sexual excitement and orgasm, or climax.

Just below the clitoris is the opening through which women pass urine (the urethra) and below this is the vagina, a tubular passage through which menstrual blood flows, sexual intercourse occurs, and a baby is born.

The area of the skin between the vulva and anus is called the perineum.

All these structures are visible from outside the body.

Cancer of the vulva may involve any of the external female sex organs.

The most common areas for it to develop are the inner edges of the labia majora and the labia minora.

Less often, vulvar cancer may also involve the clitoris or the Bartholin's glands (small glands, one on each side of the vagina).

It can also affect the perineum.

For more information on vulva cancer visit the Cancer Council website.

Causes Precancerous conditions Although the cause of cancer of the vulva remains unknown, it has been linked to certain precancerous conditions.

A condition called VIN (vulvar intraepitheli al neoplasia) occurs in the skin of the vulva and can develop into vulvar cancer if left untreated.

The human papilloma virus (HPV), or wart virus, also appears to be associated with VIN. Almost one-third of vulvar cancers develop in women who have VIN. Women who have had multiple sex partners may be more exposed to a variety of HPV, but women who have had only one sex partner can develop VIN. In younger women, a precancerous lesion (area of tissue) is more likely to be associated with HPV, and this increases the risk of vulvar cancer.

This risk is increased in women who smoke.

Older women who get vulvar cancer usually don't have a link with HPV. Skin conditions Women who have certain non-cancerous skin conditions for a long time have an increased risk of developing vulvar cancer.

These conditions, called vulval lichen sclerosus and vulval lichen planus, affect the skin in the vulvar area.

The skin can become inflamed and itchy, and split and crack, causing pain.

The vulva may become distorted, and change in shape and size.

Almost two-thirds of vulvar cancers occur in women who also have lichen sclerosus, but only a small percentage (1-2%) of women with lichen sclerosus will go on to develop vulvar cancer.

Smoking Cigarette smoking increases the risk of developing both VIN and vulvar cancer.

This may be because smoking can make the immune system work less effectively.

Cancer of the vulva, like other cancers, is not infectious and cannot be passed on to other people.

An inherited faulty gene does not cause it and so other members of your family are not likely to be at risk of developing it. Symptoms The most common symptoms of cancer of the vulva are: itching, burning and soreness of the vulva a lump, swelling or wart-like growth thickened, raised, red, white or dark patches on the skin of the vulva bleeding or a blood-stained vaginal discharge burning pain when passing urine pain in the area of the vulva a sore or ulcerated area on the vulva a mole on the vulva that changes shape or colour.

Cancer of the vulva usually takes many years to develop but, as with other cancers, it is easier to treat and cure at an early stage.

Any of the above symptoms can be a sign of many conditions other than cancer, but always get your doctor to check them.

Diagnosis

Usually you begin by seeing your GP, who will examine you.

If there is a chance you have vulvar cancer, you should be referred to a gynaecological oncologist.

An oncologist is a doctor who specialises in the treatment of cancer.

A gynaecological oncologist diagnoses and treats women with cancer of the reproductive organs, such as cancer of the vulva.

Your doctor may also arrange for you to have a blood test and chest x-ray to check your general health.

At the clinic or hospital the gynaecological oncologist will take your medical history and do a full medical examination.

For more information on diagnosis of vulva cancer visit the Cancer Council website.

Treatment - Surgery

Surgery is the main treatment for cancer of the vulva.

It may be used either alone or in combination with radiotherapy and Chemotherapy.

Types of surgery Your doctor will talk to you about the most appropriate type of surgery, depending on the stage of your cancer.

All operations for cancer of the vulva will remove the area of the skin where the cancer is located.

The cancer will be removed using one of the following operations: Wide local excision takes out the cancer and a border (margin) of healthy cells, ideally at least 1cm, all around the cancer.

Radical local excision takes out the cancer and a larger area of normal tissue all around the cancer.

The groin lymph nodes may also be removed (known as lymph node dissection).

Partial vulvectomy removes part of the vulva.

Radical vulvectomy removes the entire vulva, including the clitoris, and usually the surrounding lymph nodes.

Pelvic exenteration is done if the cancer has spread beyond the vulva.

The surgeon removes the affected organs (such as the lower bowel, or the bladder and the cervix, uterus and vagina).

Any surgery aims to remove the cancer while preserving as much normal tissue as possible.

Usually only a small amount of unaffected skin is removed with the cancer, so it is often possible to stitch the remaining skin neatly together.

However, if it is necessary to remove a large area of skin, you may need a skin graft or skin flaps.

To do this, the surgeon may either take a thin piece of skin from another part of the body (usually the thigh or abdomen) and stitch it on to the operation site.

It may be possible to move (rotate) flaps of skin in the vulvar area to cover the wound.

Lymph glands The lymph glands in the groin are usually the first place to which vulvar cancer can spread.

Lymph glands are part of the lymphatic system, and are found mainly in the groins, neck and armpits.

If the cancer is deeper than 1mm, you will usually be advised to have the lymph glands removed from one or both groins.

This is done to check whether any cancer cells have spread from the vulva.

If your cancer is at the very earliest stage, you will not usually need surgery to your lymph glands.

Lymphoedema If the lymph glands in your groin have been removed, or if you have had radiotherapy to this part of your body, there is a risk of swelling of one or both legs.

The lymph glands normally help to remove lymph fluid from your legs.

Removing them can block the flow of lymph so that it collects in the tissues under your skin.

This can make your legs swell and is called lymphoedema.

The condition can develop in a few months or several years after treatment.

Lymphoedema can be treated with special massage techniques, bandaging and support stockings.

Many hospitals have a nurse or physiotherapist who specialises in this treatment.

Radiotherapy

radiotherapy uses x-rays to kill cancer cells or injure them so they cannot multiply.

It can be given externally, where a machine directs radiation at the cancer and surrounding tissue, or internally, where radioactive material is put in thin tubes into your body on or near the cancer.

radiotherapy may be given to the vulva and the lymph glands after surgery to make sure that any remaining cancer cells are destroyed, and to reduce the risk of the cancer coming back.

Whether you have radiotherapy or not will depend on the stage of your cancer, its size, whether it has spread to the lymph glands and, if so, how many are affected.

Sometimes radiotherapy is given before surgery to shrink the cancer and make it easier to remove.

If the cancer is known to have spread to the lymph glands, radiotherapy may be used instead of surgery to treat this area.

In advanced vulvar cancer (where the cancer has come back or spread), radiotherapy may be used to shrink a tumour and reduce symptoms to improve quality of life.

This is known as palliative radiotherapy.

External radiotherapy

External radiotherapy is normally given as a series of short daily treatments in the hospital radiotherapy department.

High-energy x-rays are directed from a machine at the area of the cancer.

The number of treatments will depend on the type and size of the cancer but the whole course of treatment for vulvar cancer will usually last a few weeks.

Each treatment takes 10-15 minutes.

External radiotherapy will not make you radioactive and it is safe for you to be with other people, including children, after your treatment.

Internal radiotherapy Internal radiotherapy, also called brachytherapy, involves putting a radioactive material directly into the cancer.

This type of therapy is given by inserting radioactive needles or wires into the cancer while you are under a general anaesthetic.

Over a few days, the needles or wires give a high dose of radiotherapy directly to the tumour from the inside.

You will need to be cared for in a single room in hospital for a few days until the doctor has removed the radioactive needles or wires from your body.

Although it will be safe for your family and close friends to visit you for short periods, children and pregnant women will not be allowed to visit, to avoid any chance of them being exposed to even tiny amounts of radiation.

The safety measures and visiting restrictions might make you feel very isolated, frightened and depressed at a time when you might want people around you.

The isolation only lasts while the radioactive wires are in place (usually for a few days).

Chemotherapy

Chemotherapy uses anti-cancer drugs (cytotoxic drugs) to kill or slow the growth of cancer cells.

Chemotherapy drugs are sometimes given as tablets or, more usually, by injection into a vein (intravenously).

It can often be given to you as an outpatient, but sometimes it will mean spending a few days in hospital.

Chemotherapy may be used at the same time as radiotherapy to improve the effectiveness of treatment.

For more information on treatment for vulva cancer visit Cancer Council website.

Prevention - reduce your risk

Cancer prevention can be up to you. 44,000 Australian women are diagnosed with cancer each year.

Don't become one of these statistics What is cancer? Cancer is a disease of the body's building blocks - or cells.

Cancer happens when genes become damaged and the cells begin to grow abnormally and out of control.

Abnormal cells may grow into a lump called a tumour, which may be benign (not cancerous) or malignant (cancerous).

Cancer isn't one single disease, but a range of diseases in which abnormal cells multiply and spread out of control, affecting a range of body organs.

Lowering your risk Get to know your body and what is normal for you.

If you notice any changes, see your doctor.

Quit smoking or better still, never start.

Smoking is a known carcinogenic that increases your risk of many cancers, particularly cancer of the cervix and vulva.

Being physically active and getting at least 30 minutes of moderate exercise most days has a range of health benefits and can lower your risk of cancer.

Eat a balanced diet with plenty of fruit and vegetables - aim for at least 2 serves of each every day.

Moderate amounts of red meat are good, but avoid processed meat if you can.

Keep your fat and salt intake low.

Limit or avoid drinking alcohol.

The recommendation for women is no more than one standard drink per day.

And try to have at least one or two alcohol-free days per week.

Protect yourself from the sun by: applying a 30+ broad-spectrum sunscreen whenever you plan to spend any time in the sun wearing clothing that covers sun-sensitive areas as well as your arms and legs wearing sunglasses and a hat that shades your face and neck staying in the shade when you can.

For more information on reducing your risk of breast & gynaecological cancers visit the Cancer Council website. If you would like to talk to a urological surgeon about bladder cancer there is a list of Australian urologists here - http://urologists.net.au

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