September is gynecological cancer awareness month

by Katy Maker, Nurse Midwife and Nurse Practitioner, Veterans Memorial Hospital & Clinics

Gynecologic cancers include cervical cancer, endometrial, uterine cancer, ovarian cancer, and vulvar cancers. Of these cancers, only cervical cancer is preventable in 90% of cases.  Screening for gynecologic cancers is important despite feelings of embarrassment.  With an awareness of how personal these exams are, I would strongly recommend establishing care with a healthcare provider that you feel comfortable with, who is respectful, and understands trauma-informed care and that you are sure will answer your questions and respect your concerns.

Cervical cancer is a very common type of cancer worldwide. The good news is that 90% of cervical cancers are highly preventable by vaccines and screening.  There is a very effective vaccine against human papilloma virus or HPV.  Immunization against this is now available and recommended for both males and females since there are other male cancers involved. The World Health Organization (WHO) has a goal of having 90% of females under the age of 15 vaccinated against HPV by 2030, and that screening be improved. WHO is aiming to achieve at least 70% or greater of women over 35 be screened with a high quality pap smear with HPV testing, and 90% of precancerous and cancerous results receive treatment. HPV immunization can begin between the ages of 9 and 12.

Pap smears should begin at the age of 21 at three-year intervals. Low-risk women over 30 and until 65 can be screened every five years with cytology and/or HPV testing. However, if you have history of precancerous or cancer treatment, these tests may be recommended at a closer interval.

Ovarian cancer is usually discovered when women suspect abdominal or pelvic symptoms or have a familial genetic tendency and are tested. Annual exams and symptom awareness is helpful for diagnoses. Symptoms would include new onset and continuing sensation of bloating in the abdomen, getting full quickly, pelvic or abdominal pain, changes in bowel habits that are becoming chronic such as diarrhea, constipation, or trouble passing stool, and urinary or pain. Some women will also have symptoms of unusual fatigue and back pain.

There is a mistaken belief that a hysterectomy prevents ovarian cancer. Most hysterectomies do not remove the ovaries.

The uterus may develop a type of cancer called a sarcoma, which is in the uterine muscle, or endometrial cancer, which involves the lining. Symptoms include unusual vaginal bleeding or unusual vaginal discharge after menopause, pelvic pain or pressure, or difficulty passing a bowel movement. Risk is greater with early onset of menses or late menopause, those with PCOS, those with family history of these types of cancer.

Finally, consideration should be given to vulvar cancer. Skin cancer from sun exposure is well understood and there is public awareness. However, people do not consider cancer in the vulva. Have the area examined if you notice changes in the skin including lesions or bleeding, or if you notice changes in the mucous membranes or having unusual bleeding or pain in the area. Having an annual exam, treating genital warts, and self-awareness can help decrease frequency of and diagnose this type of cancer.

As for any type of cancer, recommendations can be confusing. Below are recommendations that I endorse to reduce risk of and improve treatment for gynecologic cancers.
- HPV vaccination can prevent over 90% of cervical cancers, and regular Pap smears and HPV screening can catch this cancer at an early stage or in the precancer stage.
- Knowing your family history can guide genetic testing and help find women who are at higher risk for gynecologic cancers.
- Being proactive about new onset abdominal or pelvic symptoms (especially postmenopausal or unusual vaginal bleeding), or changes on the vulva area is important.
- Regular wellness exams are recommended, avoiding smoking, maintaining a healthy weight, and practicing safe sex are also very helpful.

For more information, feel free to contact Katy Maker at the Veterans Memorial Hospital Waukon Clinic at 563-568-5530 or the Postville Medical Clinic at 563-864-7221.